Search results for: health seeking

Authors: Rebecca-Lee Kuhnert, Ron Rapee

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Up to 15% of Australian youth will experience an emotional disorder, yet relatively few get the help they need. Schools provide an ideal environment through which we can identify young people who are struggling and provide them with appropriate help. Universal mental health screening is a method by which all young people in school can be quickly assessed for emotional disorders, after which identified youth can be linked to appropriate health services. Despite the obvious logic of this process, universal mental health screening has received little scientific evaluation and even less application in Australian schools. This study will develop methods for Australian education systems to help identify young people (aged 9-17 years old) who are struggling with existing and emerging emotional disorders. Prior to testing, a series of focus groups will be run to get feedback and input from young people, parents, teachers, and mental health professionals. They will be asked about their thoughts on school-based screening methods and and how to best help students at risk of emotional distress. Schools (n=91) across New South Wales, Australia will be randomised to do either immediate screening (in May 2021) or delayed screening (in February 2022). Students in immediate screening schools will complete a long online mental health screener consisting of standard emotional health questionnaires. Ultimately, this large set of items will be reduced to a small number of items to form the final brief screener. Students who score in the “at-risk” range on any measure of emotional health problems will be identified to schools and offered pathways to relevant help according to the most accepted and approved processes identified by the focus groups. Nine months later, the same process will occur among delayed screening schools. At this same time, students in the immediate screening schools will complete screening for a second time. This will allow a direct comparison of the emotional health and help-seeking between youth whose schools had engaged in the screening and pathways to care process (immediate) and those whose schools had not engaged in the process (delayed). It is hypothesised that there will be a significant increase in students who receive help from mental health support services after screening, compared with baseline. It is also predicted that all students will show significantly less emotional distress after screening and access to pathways of care. This study will be an important contribution to Australian youth mental health prevention and early intervention by determining whether school screening leads to a greater number of young people with emotional disorders getting the help that they need and improving their mental health outcomes.

Keywords: children and young people, early intervention, mental health, mental health screening, prevention, school-based mental health

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Authors: Zahra Karimian, Effat Merghati Khoei, Raziyeh Maasoumi

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Background: Women's sexual well-being is center of focus in the field of sexology. Study of sexual behavior and investigating its predictors is important in women's health promotion. Objectives: This study aimed to explore the components of sexual behaviors and their possible associations with the women's demographic. Methods: A National Sexual Behavior Assessment Questionnaire was administered to 500 women ages 15 to 45 who referred to the public health centers seeking for health care services. The associations with demographic were examined. Results: From all participant, 31.8% of women obtain high score in the sexual capacity 21.2% in sexual motivation and 0.2% in sexual function. In sexual script component, 86.2% of women were holding traditional beliefs toward sexual behaviors; the majority (91.5%) of women believed in mutual and relational sexuality, 83.4% believed in androcentricity (male-dominated sexuality). Pearson correlation test showed significant positive correlations between sexual capacity, motivation, function and sexual script (p < 0.05). Regression model showed that sexual capacity is associated with women's education, age of her spouse. Sexual function and sexual motivation were significantly associated with the age of subjects' spouses. Conclusion: In this study, lower score was found in sexual performance while women were scored higher in the sexual capacity and motivation. We argue that these lower score in sexual performance more likely is due to the level of participants' religiosity and formation of their sexuality through an androcentric culture. Women's level of education and the spouse age appear to be predicting factors in the scores the subjects gained. We suggest that gender-specific and culturally sensitive sexuality education should be focus of women's health programs in Iran.

Keywords: sexual behaviors, women, health, Iran

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Authors: Vibha Kriti

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Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder generally found in reproductive women. It is associated with significant reproductive, metabolic, cosmetic, and psychological consequences. Objective: There is a high prevalence of PCOS found among reproductive-age women, therefore, the major objective of the present study is to identify the illness perception of PCOS women and to explore the relationship between illness perception and health-related quality of life (HRQoL). Material and Method: A cross-sectional study was conducted in a university tertiary-care center, Sir Sunder Lal Hospital, Banaras Hindu University (B.H.U). Tools used for data collection were self-structured, which included socio-demographic status, illness perception questionnaire (revised version), and short-form 36 for assessing illness perception and health-related quality of life, respectively. Statistical analysis was done by SPSS version ‘24’. Results: The results of correlation analyses indicated that there is a strong relationship between strong illness perception and HRQoL. Stepwise regression indicated that illness identity, long illness duration, and severe consequences were associated with the worse outcome on emotional functioning and on social functioning. A high score on the controllability of the disease and seeking social support was significantly related to better functioning. Conclusion: Illness perception is an important factor in self-care behaviors in PCOS females and has a strong association with health-related quality of life and has a profound effect on it.

Keywords: polycystic ovary syndrome, illness perception, quality of life, young females, mental health

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Authors: Qin Wei

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There has been an increased number of immigrants arriving in Canada and a concurrent rise in the number of immigrant youth suffering from drug abuse. Immigrant youths’ drug abuse has become a significant social and public health concern for researchers. This literature review explores the nature of immigrant youths’ drug abuse by examining the factors influencing the onset of substance misuse, the barriers that discourage youth to seek out treatment, and how to resolve addictions amidst immigrant youth. Findings from the literature demonstrate that diminished parental supervision, acculturation challenges, peer conformity, discrimination, and ethnic marginalization are all significant factors influencing youth to use drugs as an outlet for their pain, while culturally competent care and fear of family and culture-based addiction stigma act as barriers discouraging youth from seeking out addiction support. To resolve addiction challenges amidst immigrant youth, future research should focus on promoting and implementing culturally sensitive practices and psychoeducational initiatives into immigrant communities and within public health policies.

Keywords: approaches, barriers, drug abuse, Canada, immigrant youth, reasons

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Authors: Neusa Fernanda Torres, Buyisile Chibi, Lyn E. Middleton, Vernon P. Solomon, Tivani P. Mashamba-Thompson

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Background: Self-medication with antibiotics (SMA) is a global concern, with a higher incidence in low and middle-income countries (LMICs). Despite intense world-wide efforts to control and promote the rational use of antibiotics, continuing practices of SMA systematically exposes individuals and communities to the risk of antibiotic resistance and other undesirable antibiotic side effects. Moreover, it increases the health systems costs of acquiring more powerful antibiotics to treat the resistant infection. This review thus maps evidence on the factors influencing self-medication with antibiotics in these settings. Methods: The search strategy for this review involved electronic databases including PubMed, Web of Knowledge, Science Direct, EBSCOhost (PubMed, CINAHL with Full Text, Health Source - Consumer Edition, MEDLINE), Google Scholar, BioMed Central and World Health Organization library, using the search terms:’ Self-Medication’, ‘antibiotics’, ‘factors’ and ‘reasons’. Our search included studies published from 2007 to 2017. Thematic analysis was performed to identify the patterns of evidence on SMA in LMICs. The mixed method quality appraisal tool (MMAT) version 2011 was employed to assess the quality of the included primary studies. Results: Fifteen studies met the inclusion criteria. Studies included population from the rural (46,4%), urban (33,6%) and combined (20%) settings, of the following LMICs: Guatemala (2 studies), India (2), Indonesia (2), Kenya (1), Laos (1), Nepal (1), Nigeria (2), Pakistan (2), Sri Lanka (1), and Yemen (1). The total sample size of all 15 included studies was 7676 participants. The findings of the review show a high prevalence of SMA ranging from 8,1% to 93%. Accessibility, affordability, conditions of health facilities (long waiting, quality of services and workers) as long well as poor health-seeking behavior and lack of information are factors that influence SMA in LMICs. Antibiotics such as amoxicillin, metronidazole, amoxicillin/clavulanic, ampicillin, ciprofloxacin, azithromycin, penicillin, and tetracycline, were the most frequently used for SMA. The major sources of antibiotics included pharmacies, drug stores, leftover drugs, family/friends and old prescription. Sore throat, common cold, cough with mucus, headache, toothache, flu-like symptoms, pain relief, fever, running nose, toothache, upper respiratory tract infections, urinary symptoms, urinary tract infection were the common disease symptoms managed with SMA. Conclusion: Although the information on factors influencing SMA in LMICs is unevenly distributed, the available information revealed the existence of research evidence on antibiotic self-medication in some countries of LMICs. SMA practices are influenced by social-cultural determinants of health and frequently associated with poor dispensing and prescribing practices, deficient health-seeking behavior and consequently with inappropriate drug use. Therefore, there is still a need to conduct further studies (qualitative, quantitative and randomized control trial) on factors and reasons for SMA to correctly address the public health problem in LMICs.

Keywords: antibiotics, factors, reasons, self-medication, low and middle-income countries (LMICs)

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Authors: Tracy Smith-Carrier

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In 1995, the World Health Organization declared that poverty was the biggest killer and the greatest cause of suffering in the world. Income is certainly a key social determinant of health, the lack of which causes innumerable health and mental health conditions. In seeking to provide relief from financial hardship for residents within their populace, states in the Global North have largely turned to the non-profit and charitable sector. The stigma and shame of accessing charity is a significant barrier for many, but what is more problematic is that the embrace of the charitable model has let governments off the hook from responding to their international human rights obligations. Although states are signatories to various human rights treaties and conventions internationally, many of these laws have not been implemented domestically. This presentation explores the limits of the charitable model in addressing poverty in countries of the Global North. Unlike in the ages passed, when poverty was thought to be an individual problem, we now know that poverty is largely systemic in nature. In this presentation, we will identify the structural determinants of poverty, outline why people are reticent to access charitable programs and services and how income security is reproduced through the charitable model, and discuss evidence-informed solutions, such as a basic income guarantee, to move beyond the charitable model in favour of a rights-based justice model. To move beyond charity, we must demand that governments recognize our fundamental human rights and address poverty and hunger using a justice model based on substantive human rights.

Keywords: basic income, charity, poverty, income security, hunger, food security, social justice, human rights

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Authors: Njoroge Margaret W., Johnson Deborah

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Gender-specific risk factors for common mental disorders that disproportionately affect women include but are not limited to gender-based violence, socioeconomic disadvantage, sociocultural factors and unrelenting responsibility for the care of others. The overall objective of this study was to assess mental health conditions and their risk factors among women in Garissa County, Kenya. The study adopted both quantitative and qualitative research designs. The study participants were 100 adult women and 20 key informants from different sectors in the region. Data was collected using DSM-5 (PCL-5) and Kessler Psychological Distress, interviews schedule and focus group discussions. Analysis of quantitative data was done using univariate analysis, while qualitative data was analyzed using thematic analysis. The results revealed that about 60% of women presented with moderate to severe psychological distress (PD), while 53% presented with PTSD. Additionally, women who have undergone female genital mutilation had higher PTSD and PD scores. They also presented with low self-esteem, depressive symptoms, sex anxiety, avoidance of reminders and intrusive memories of the event, especially those who developed fistula. The risk factors for poor mental health outcomes include lack of awareness/knowledge of mental health, retrogressive cultural practices (child marriage and female genital mutilation), as well as beliefs about the causes of mental disorders. The study also established that people with mental illness are neglected, abused and stigmatized. Preferred treatment approaches include prayers and the use of witch doctors and traditional healers. The study recommends gendered and culturally responsive interventions geared towards increasing community awareness and knowledge on mental health, reducing stigma and improving mental-health-seeking behaviors for women and girls in the region. Supported by the Ministry of Health, the approach should be spearheaded by trained community lay counselors.

Keywords: women, mental health conditions, cultural beliefs/practices, stigma, poverty, psychological distress, PTSD

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Authors: Rafael Felipe Guatura da Silva, José Luis Gomes da Silva, Luiz Antonio, Ferreira Perrone de Brito

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Noise can cause serious damage to human health, such as hearing loss, stress, irritability, fatigue, and others. Aviation is a place where your entire process should be work out with the utmost attention and commitment of human resources, thus the need to study the effects of noise in this sector, as aeronautical noise levels are high. This study aimed to evaluate the impact of noise pollution on the performance of professionals regarding the fatigue generated by aeronautical noise and time to noise exposure. The methodology used consists of measurements of sound pressure levels at 42 points of the aerodrome. The selected points are located inside the hangars and outside the airfield hangars. All points chosen are close to the professionals' work areas, seeking to identify the sound pressure levels to which they submitted. The other part of the research used the principle on the application of a self-report questionnaire to a sample of 207 people working inside the aerodrome. The 207 professionals surveyed consist of aircraft mechanics, pilots, maintenance managers, and administrative professionals. The questionnaire was intended to evaluate the knowledge that professionals have about health risks caused by sound exposure as well as to identify diseases that professionals have, and that may be associated with exposure to high levels of sound pressure. Preliminary results identify points with sound pressure levels of up to 91.7 dB, thus highlighting the need for the use of personal protective equipment that reduces noise exposure. It was also identified a large number of professionals who are bothered by the sound exposure and approximately 25% of professionals interviewed reported having a hearing disorder.

Keywords: aeronautical noise, fatigue, noise and health, noise management

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Authors: Henry Venter, Murali Thyloth, Alceu Casseb

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Historically, mental and substance use disorders were not a global health priority. Since the 1993 World Development Report, the importance of the contribution of mental health and substance abuse on the relative global burden associated with disease morbidity has been recognized with 300 million people worldwide suffering from depression alone. This led to an international effort to improve the mental health of populations around the world. Despite these efforts some countries remain at the top of the list of countries with the highest rate of mental illness. Important research questions were asked: Would there be commonalities regarding mental health between these countries; would there be common factors leading to the high prevalence of mental illness; and how prepared are these countries with mental health delivery? Findings from this research can aid organizations and institutions preparing mental health service providers to focus training and preparation to address specific needs revealed by the study. Methods: Researchers decided to compare three distinctly different countries at the top of the list of countries with the highest rate of mental illness, the USA, India and Brazil, situated on three different continents with different economies and lifestyles. Data were collected using archival research methodology, reviewing records and findings of international and national health and mental health studies to subtract and compare data and findings. Results: The findings indicated that India is the most depressed country in the world, followed by the USA (and China) with Brazil in Latin America with the greatest number of depressed individuals. By 2020 roughly 20% of India, acountry of over one billion citizens, will suffer from some form of mental illnees, yet there are less than 4,000 experts available. In the USA 164.8 million people were substance abusers and an estimate of 47.6 million adults, 18 or older, had any mental illness in 2018. That means that about one in five adults in the USA experiences some form of mental illness each year, but only 41% of those affected received mental health care or services in the past year. Brazil has the greatest number of depressed individuals, in Latin America. Adults living in Sao Paulo megacity has prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world with more than one million adults with serious impairment levels. Discussion: The results show that, despite the vast socioeconomic differences between the three countries, there are correlations regarding mental health prevalence and difficulty to provide adequate services including a lack of awareness of how serious mental illness is, stigma for seeking mental illness, with comorbidity a common phenomenon, and a lack of partnership between different levels of service providers, which weakens mental health service delivery. The findings also indicate that mental health training institutions have a monumental task to prepare personnel to address the future mental health needs in each of the countries compared, which will constitute the next phase of the research.

Keywords: mental health epidemiology, mental health disorder, mental health prevalence, mental health treatment

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Authors: Philippe Gugler

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Goal of the study: The concept of competitiveness has been addressed by economic theorists and policymakers for several hundreds of years, with both groups trying to understand the drivers of economic prosperity and social welfare. The goal of this contribution is to address the major useful theoretical contributions that permit to identify the main drivers of a territory’s competitiveness. We first present the major contributions found in the classical and neo-classical theories. Then, we concentrate on two majors schools providing significant thoughts on the competitiveness of locations: the Economic Geography (EG) School and the International Business (IB) School. Methodology: The study is based on a literature review of the classical and neo-classical theories, on the economic geography theories and on the international business theories. This literature review establishes links between these theoretical mainstreams. This work is based on the academic framework establishing a meaningful literature review aimed to respond to our research question and to develop further research in this field. Results: The classical and neo-classical pioneering theories provide initial insights that territories are different and that these differences explain the discrepancies in their levels of prosperity and standards of living. These theories emphasized different factors impacting the level and the growth of productivity in a given area and therefore the degree of their competitiveness. However, these theories are not sufficient to more precisely identify the drivers and enablers of location competitiveness and to explain, in particular, the factors that drive the creation of economic activities, the expansion of economic activities, the creation of new firms and the attraction of foreign firms. Prosperity is due to economic activities created by firms. Therefore, we need more theoretical insights to scrutinize the competitive advantages of territories or, in other words, their ability to offer the best conditions that enable economic agents to achieve higher rates of productivity in open markets. Two major theories provide, to a large extent, the needed insights: the economic geography theory and the international business theory. The economic geography studies scrutinized in this study from Marshall to Porter, aim to explain the drivers of the concentration of specific industries and activities in specific locations. These activity agglomerations may be due to the creation of new enterprises, the expansion of existing firms, and the attraction of firms located elsewhere. Regarding this last possibility, the international business (IB) theories focus on the comparative advantages of locations as far as multinational enterprises (MNEs) strategies are concerned. According to international business theory, the comparative advantages of a location serves firms not only by exploiting their ownership advantages (mostly as far as market seeking, resource seeking and efficiency seeking investments are concerned) but also by augmenting and/or creating new ownership advantages (strategic asset seeking investments). The impact of a location on the competitiveness of firms is considered from both sides: the MNE’s home country and the MNE’s host country.

Keywords: competitiveness, economic geography, international business, attractiveness of businesses

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Authors: M. Illias Kanchan

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The death of a woman during pregnancy and childbirth is not only a health issue, but also a matter of social injustice. This study makes an attempt to explore the association between maternal death and associated factors in West Bengal using the approaches of facility-based and community-based maternal death review. Bivariate and binary logistic regression analysis have been performed to understand the causes and circumstances of maternal deaths in West Bengal. Delay in seeking care was the major contributor in maternal deaths, near about one-third women died due to this factor. The most common cause of maternal death is found to be hypertensive disorders of pregnancy or eclampsia. We believe that these deaths can be averted by reducing hypertensive disorders of pregnancy or eclampsia.

Keywords: maternal death, facility-based, community-based, review, west Bengal, eclampsia

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Authors: Nargiza Nuralieva

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This meta-analysis investigates the effectiveness of mental health interventions tailored for international students in China, with a specific focus on Uzbek students and Silk Road scholarship recipients. The comprehensive literature review synthesizes existing studies, papers, and reports, evaluating the outcomes, limitations, and cultural considerations of these programs. Data selection targets mental health programs for international students, honing in on a subset analysis related to Uzbek students and Silk Road scholarship recipients. The analysis encompasses diverse outcome measures, such as reported stress levels, utilization rates of mental health services, academic performance, and more. Results reveal a consistent and statistically significant reduction in reported stress levels, emphasizing the positive impact of these interventions. Utilization rates of mental health services witness a significant increase, highlighting the accessibility and effectiveness of support. Retention rates show marked improvement, though academic performance yields mixed findings, prompting nuanced exploration. Psychological well-being, quality of life, and overall well-being exhibit substantial enhancements, aligning with the overarching goal of holistic student development. Positive outcomes are observed in increased help-seeking behavior, positive correlations with social support, and significant reductions in anxiety levels. Cultural adaptation and satisfaction with interventions both indicate positive outcomes, underscoring the effectiveness of culturally sensitive mental health support. The findings emphasize the importance of tailored mental health interventions for international students, providing novel insights into the specific needs of Uzbek students and Silk Road scholarship recipients. This research contributes to a nuanced understanding of the multifaceted impact of mental health programs on diverse student populations, offering valuable implications for the design and refinement of future interventions. As educational institutions continue to globalize, addressing the mental health needs of international students remains pivotal for fostering inclusive and supportive learning environments.

Keywords: international students, mental health interventions, cross-cultural support, silk road scholarship, meta-analysis

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Authors: Farzad Jalilian, Mehdi Mirzaei Alavijeh

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Background: E-interventions as a universal approach to prevent a high-risk behavior, such as alcohol drinking. This study was conducted to evaluate web-based alcohol drinking preventative intervention efficiency among medical university students in Iran. Methods: Overall, 150 freshman and sophomore male student’s college students participated in this study as intervention and control group. This was a longitudinal randomized pre- and post-test series control group design panel study to implement a behavior modification based intervention to alcohol drinking prevention among college students. Cross-tabulation, t-test, repeated measures, and GEE by using SPSS statistical package, version 21 was used for the statistical analysis. The participants were followed up for 6 months with data collection scheduled at baseline, 3 and 6 months. The primary outcomes are attitude, self-control, and sensation seeking. Furthermore, the secondary outcome is comparing alcohol drinking among the study groups. Results: It was found significant reduce in average response for an attitude towards alcohol drinking and sensation seeking among intervention group (P < 0.05). But after intervention not significant difference between intervention and control group of improve self-control and reduce alcohol drinking (P > 0.05). Conclusion: Our intervention has been accompanied with reducing alcohol use rate. These findings indicate that e-intervention may be effectiveness approach to address the alcohol prevention among college students.

Keywords: e-interventions, alcohol drinking, students, Iran

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Authors: Panrapee Suttiwan, Rewadee Watakakosol Arunya Tuicomepee, Sakkaphat T. Ngamake

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Alcohol consumption ranks among the top six of health-risk behaviors that lead to disability and death among Thai teenagers. Underage drinkers have higher health risks than their non-drinking peers do. This study, therefore, aimed to explore salient beliefs of Thai teenagers with alcohol reduction and cessation based on the Theory of Planned Behaviour theoretical framework. Participants were 225 high-school and vocational school students, most of whom (60.9%) consumed alcohol almost daily (5-6 times / week), and one-third of whom (33.8%) reported habitual moderate drink. The average age was 16.5 (SD = 0.9), and the average age of the first use of alcohol was 13.7 (SD = 2.2). Instrument was an open-ended questionnaire that elicited beliefs about having alcohol reduction / cessation in the past 12 months. Findings revealed salient benefit beliefs of alcohol reduction / cessation among the teens such as improved physical and mental health, accident and violence avoidance, less sexual risks, money and time saving, better academic performance, and improved relationships. In contrast, the teens identified several disadvantage beliefs such as deteriorating health, social awkwardness, lack of little fun, excitement, and experience, physical uneasiness, stress, and lack of self-confidence. Salient normative groups for alcohol reduction / cessation included parents, elder relatives, siblings, close friends, teachers, boy / girlfriends, and seniors / juniors at school. Situations influencing alcohol reduction / cessation included quarrels with boy / girlfriends, family conflicts, peer pressure, partying and socializing, festive holidays and anniversary celebration, and visiting entertainment places, etc. This study provides empirical evidence that help to identify normative attitudes towards alcohol reduction / cessation and may thus be an important knowledge for public health campaigns seeking to reduce alcohol consumption in this population.

Keywords: alcohol consumption reduction, cessation, salient belief, Thai teenagers

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Authors: Huang Wei-Chi, Li Wei, Yu Tien-Chieh

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Medication adherence is crucial for treatment success. Adherence problem is common in patients with polypharmacy, especially in the geriatric population who are vulnerable to multiple chronic conditions but averagely less knowledgeable about diseases and medications. In order to help patients take medications appropriately and enhance the understanding of diseases or medications, a Line official account named e-Pharmacist was designed. The line is a popular freeware app with the highest penetration rate (95.7%) in Taiwan. The interface of e-Pharmacist is user-friendly for easy-to-read and convenient operating. Differ from other medication adherence apps, users just added e-Pharmacist as a LINE friend without installing any more apps and the drug lists were automatically downloaded from the personal electronic medical records with security permission. Over and above medication reminder, several additional capabilities were set up and engaged in the platform of e-Pharmacist including prescription refill reservation, laboratory examination consultation, medical appointment registration, and “Daily Health Log” where patients can record and track data of blood pressure/blood sugar and daily meals for self-health management as well as can share the important information to clinical professionals when seeking medical help. Additionally, a Line chatbot was utilized to provide tailored medicine information for the individual user. From July 2020 to March 2022, around 3000 patients added e-pharmacist as Line friends. Every day more than 1500 patients receive messages from e-pharmacist to notify them to take medicine. Thanks to the e-pharmacist alert system and Chatbot, the low-compliance patients (defined by Program on Adherence to Medication, PAM) significantly dropped from 36% to 6%, whereas the high-compliance patients dramatically increased from 13% to 77%. The user satisfaction is 98%. In brief, an e-pharmacist is not only a medication reminder but also a tailored personal assistant with value-added service for health management.

Keywords: e-pharmacist, self-health management, medication reminder, value-added service

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Authors: Zeynep Karacor, Rahime Hulya Ozturk

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In recent years, the rise of population density and the problem of aging population took attention to the health expenditures. In Turkey, some regulations and infrastructure changes in health sector have occurred. These changes are called Health Transformation Program. The productivity of health services, patient satisfaction, quality of services are tried to be improved with this program. Some radical changes are applied in Turkish economy in this context. The aim of this paper is to present the effects of Health Transformation Program on health expenditures. In the first part of the paper, some information’s about health system and applications in Turkey are discussed. In the second part, the aims of Health Transformation Program are explained. And in the third part the effects of Health Transformation Program on health expenditures are examined.

Keywords: health transformation program, Turkey, health services, health expenditures

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Authors: Priyoth Kittiteerasack, Alana Steffen, Alicia K. Matthews

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Depression is a leading cause of the worldwide burden of disability and disease burden. Notably, lesbian, gay, bisexual, and transgender (LGBT) populations are more likely to be a high-risk group for depression compared to their heterosexual and cisgender counterparts. To date, little is known about the rates and predictors of depression among Thai LGBT populations. As such, the purpose of this study was to: 1) measure the prevalence of depression among a diverse sample of Thai LGBT adults and 2) determine the influence of minority stress variables (discrimination, victimization, internalized homophobia, and identity concealment), general stress (stress and loneliness), and coping strategies (problem-focused, avoidance, and seeking social support) on depression outcomes. This study was guided by the Minority Stress Model (MSM). The MSM posits that elevated rates of mental health problems among LGBT populations stem from increased exposures to social stigma due to their membership in a stigmatized minority group. Social stigma, including discrimination and violence, represents unique sources of stress for LGBT individuals and have a direct impact on mental health. This study was conducted as part of a larger descriptive study of mental health among Thai LGBT adults. Standardized measures consistent with the MSM were selected and translated into the Thai language by a panel of LGBT experts using the forward and backward translation technique. The psychometric properties of translated instruments were tested and acceptable (Cronbach’s alpha > .8 and Content Validity Index = 1). Study participants were recruited using convenience and snowball sampling methods. Self-administered survey data were collected via an online survey and via in-person data collection conducted at a leading Thai LGBT organization. Descriptive statistics and multivariate analyses using multiple linear regression models were conducted to analyze study data. The mean age of participants (n = 411) was 29.5 years (S.D. = 7.4). Participants were primarily male (90.5%), homosexual (79.3%), and cisgender (76.6%). The mean score for depression of study participant was 9.46 (SD = 8.43). Forty-three percent of LGBT participants reported clinically significant levels of depression as measured by the Beck Depression Inventory. In multivariate models, the combined influence of demographic, stress, coping, and minority stressors explained 47.2% of the variance in depression scores (F(16,367) = 20.48, p < .001). Minority stressors independently associated with depression included discrimination (β = .43, p < .01) victimization (β = 1.53, p < .05), and identity concealment (β = -.54, p < .05). In addition, stress (β = .81, p < .001), history of a chronic disease (β = 1.20, p < .05), and coping strategies (problem-focused coping β = -1.88, p < .01, seeking social support β = -1.12, p < .05, and avoidance coping β = 2.85, p < .001) predicted depression scores. The study outcomes emphasized that minority stressors uniquely contributed to depression levels among Thai LGBT participants over and above typical non-minority stressors. Study findings have important implications for nursing practice and the development of intervention research.

Keywords: depression, LGBT, minority stress, sexual and gender minority, Thailand

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Authors: Md. S. Sabuz

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Bangladesh, a South Asian developing country, has achieved a remarkable breakthrough in health indicators during the last four decades despite immense income inequality. This phenomenon results in the mystical exclusion of marginalized people from obtaining health care facilities. However, the persistence of exclusion of the disadvantaged remains troubling. Exclusion occurs from occupational inferiority, pay and wage differences, educational backwardness, gender disparity to urban-rural complexity and eliminate the unprivileged from seeking and availing the health services. Evidence from Bangladesh shows that many sick people prefer to die at home without securing medical services because in previous times they were not treated well, not because the medical facilities were inadequate or antediluvian but the socio-economic class allows them to receive obdurate treatment. Furthermore, government and policymakers have given enormous emphasis on infrastructural development and achieving health indicators instead of ensuring quality services and inclusiveness of people from all spheres. Therefore, it is high time to address the issues concerning this and highlight the impact of economic status on health status in a sociological perspective. The objective of this study is to consider ways of assessing and exploring the impact of economic status for instance: occupational status, pay and wage variable, on health status in the context of Bangladesh. The hypotheses are that there are a significant number of factors affecting economic status which are impactful for health status eventually, but acute income inequality is a prominent factor. Illiteracy, gender disparity, remoteness, incredibility on services, superior costs, superstition etc. are the dominant indicators behind the economic factors influencing the health status. The chosen methodologies are a qualitative and quantitative approaches to accomplish the research objectives. Secondary sources of data will be used to conduct the study. Surveys will be conducted on the people who have ever been through the health care facilities and people from the different socio-economic and cultural backgrounds. Focus group discussions will be conducted to acquire the data from different cultural and regional citizens. The findings show that 48% of people who are from disadvantaged communities have been deprived of proper health care facilities. The general reasons behind this are the higher cost of medicines and other equipment. A significant number of people are unaware of the appropriate facilities. It was found that the socio-economic variables are the main influential factors that work as the driving force for both economic dimension and health status. Above all regional variables and gender, dimensions have an enormous effect on determining the health status of an individual or community. Amidst many positive achievements for example decrease in the child mortality rate, an increase in the immunization programs of the child etc., the inclusiveness of all classes of people in health care facilities has been overshadowed in Bangladesh. However, this phenomenon along with the socio-economic and cultural phenomena significantly demolishes the quality and inclusiveness of the health status of people.

Keywords: cultural context of health, economic status, gender and health, rural health care

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Authors: Ahmed Deen

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The introduction of the mobile devices which were equipped with internet access and a camera, as well as the messaging services, has become a major inspiration for the use of the mobile devices in the growth in the reporting of news. Mobile journalism (MOJO) was a creation of modern technology, especially the use of mobile technology for video journalism purposes. MOJO, thus, is the process by which information is collected and disseminated to society, through the use of mobile technology, and even the use of the tablets. This paper seeks to better understand the ethics of Saudi mobile journalists towards news coverage. Also, this study aims to explore the relationship between minimizing harms and truth-seeking efforts among Saudi mobile journalists. Three main ethics were targeted in this study, which are seek truth and report it, minimize harm, and being accountable. Diffusion of innovation theory applied to reach this study’s goals. The non- probability sampling approach, ‘Snowball Sampling’ was used to target 124 survey participants, an online survey via SurveyMonkey that was distributed through social media platforms as a web link. The code of ethics of the Society of Professional Journalists has applied as a scale in this study. This study found that the relationship between minimizing harm and truth-seeking efforts is significantly moderate among Saudi mobile journalists. Also, it is found that the level journalistic experiences and using smartphones to cover news are weakly and negatively related to the perceptions of mobile journalism among Saudi journalists, while Saudi journalists who use their smartphone to cover the news between 1-3 years, were the majority of participants (55 participants by 51.4%).

Keywords: mobile journalism, Saudi journalism, smartphone, Saudi Arabia

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Authors: Florence Awde

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In 2023, it was expected 350 parents in Arizona would have a child receive a cancer diagnosis (Welcome Arizona Cancer Foundation For Children, n.d.). The news of a child’s diagnosis with cancer can be overwhelming and confusing, especially for those lucky enough to lack a personal tie to the disease that takes approximately 1800 children’s lives each year in the United States (Deegan et al., n.d.). A parent’s beliefs, attitudes, and understandings surrounding cancer are vital for medical staff to provide adequate and culturally competent care for each patient, especially across cultural and ethnic lines in regions housing multicultural populations. Arizona's cultural/linguistic mosaic houses many White and Latino populations and English and Spanish speakers. Variations in insurance coverage, from those insured through public insurance programs (e.g., Medicaid) or private insurance plans (e.g., employee-sponsored insurance) versus those uninsured, also factor into health-seeking attitudes and behaviors. To further understand parental attitudes, understandings, and beliefs towards childhood cancer, 22 parents (11 of Latino ethnicity, 11 of White ethnicity) were interviewed on these facets of childhood cancer, despite 21 of the 22 never having a child receive a cancer diagnosis. The exploration of these perceptions across ethnic lines revealed a higher report of fear-orientated beliefs amongst Latino parents--hypothesized to be rooted in the starkly contrasting lack of belief in the possibility of recovering for children with cancer, compared to their white counterparts who displayed more optimism in the recovery process. Further, this study’s results lay the foundation for future scholarship to explore avenues of information dispersal to Latino parents that correct misconceptions of health outcomes and enable earlier intervention to be possible, ultimately correlating to better health and treatment outcomes by increasing parental health literacy rates for childhood cancer in the Phoenix Metropolitan.

Keywords: Childhood Cancer, Parental Beliefs, Parental Attitudes, Parental Understandings, Phoenix Metropolitan, Culturally Competent Care, Health Disparities, Health Inequities

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Authors: Adriano Mortada

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Human history is rife with conflict, and the question of refugee status determination and their rehabilitation has been up for debate since. Refugee Status Determination is the administrative or legal process by which UNHCR or governments determine whether a person seeking international protection or asylum can be identified as a refugee under international, regional, or national law. Refugee Status Determination is considered to be a vital process in aiding refugees’ realization of their rights under international law. One of the major reasons why the refugee status determination is considered an “issue”, and is one that is much debated upon annually, is the fact that the national bureaucratic systems are rigid and unbending. This is particularly concerning in the 21st century despite human advancement in policy and diplomacy, working in tandem with the United Nations and their charters and resolutions on human rights and dignity. The paper seeks to criticize the European member states' response to the refugee crisis and their inflexible and prejudiced bureaucratic systems when it comes to refugee status determination. The paper looks at multiple case studies as primary evidence and the alternate case studies where the system helped refugees, like those in Jordan, Pakistan, Turkey, and Lebanon. The main concern of the paper is to highlight the bias in the selected European systems, which do not stem from the Human Rights Charter but rather on the basis of geographical backgrounds, cultural and religious affiliations of those seeking refugee status or asylum in their respective countries. The paper hopes to not only create awareness about this issue but also provide a research background to advocacy programs to bring a change in the systems.

Keywords: refugee status determination, human rights, bureaucracy, United Nations, European Union

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Authors: Lucksini Raveendran

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Introduction: This mixed-methods study focuses on the experiences of ethnocultural youth and families in Canada, identifying key barriers and opportunities to inform service programming and policies that can better meet their mental health needs during the COVID-19 pandemic and beyond. Methods: Mental Health Commission of Canada's Headstrong initiative administered the youth survey (April – June 2020) and family survey (June – August 2020) with a total sample size of 137 and 481 respondents, respectively. Thematic analysis was conducted to identify key challenges faced, coping strategies used, and help-seeking behaviours. A similar approach was also applied to the family survey data, but instead, a representative sample was collated to analyze geographically variable and ethnically diverse subgroups. Results and analysis: Multiple challenges have impacted families, including increased feelings of loneliness and distress from border travel restrictions, especially among those navigating pregnancy alone or managing children with developmental needs, which is often understudied. Also, marginalized groups were disproportionately affected by inequitable access to communication technologies, further deepening the digital divide. Some reported living in congregated homes with regular conflicts, thus leading to increased anxiety and exposure to violence. For many families, urbanicity and ethnicity played a key role in how families reported coping with feelings of uncertainty while managing work commitments, navigating community resources, fulfilling care responsibilities, and homeschooling children of all ages. Despite these challenges, there was evidence of post-traumatic growth and building community resiliency. Conclusions and implications for policy, practice, or additional research: There is a need to foster opportunities to promote and sustain mental health, wellness, and resilience for families through social connections. Also, intersectionality must be embedded in the collection, analysis, and application of data to improve equitable access to evidence-based and recovery-oriented mental health supports among diverse families in Canada. Lastly, address future research on the long-term COVID-19 impacts of travel border restrictions on family wellness.

Keywords: mental health, youth mental health, family wellness, health equity

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Authors: Valentina Colonnello, Paolo Maria Russo

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Decades of cross-species affective neuroscience research by Panksepp and others have identified basic evolutionarily preserved subcortical emotional systems that humans share with mammals and many vertebrates. These primary emotional systems encode unconditional affective responses and contribute to the development of personality traits throughout ontogenesis and interactions with the environment. The Affective Neuroscience Personality Scale (ANPS) measures individual differences in affective personality traits associated with the basic emotional systems of CARE, PLAY, SEEKING, SADNESS, FEAR, and ANGER, along with Spirituality, which is a more cognitively and socially refined expression of affectivity. Though the ANPS’s power to predict human psychological distress has been documented, to the best of our knowledge, its predictive power for psychological wellbeing has not been explored. This study therefore investigates the relationship between affective neuroscience traits and psychological wellbeing facets. Because the emotional systems are thought to influence cognitively-mediated mental processes about the self and the world, understanding the relationship between affective traits and psychological wellbeing is particularly relevant to understanding the affective dimensions of health. In a cross-sectional study, healthy participants (n = 402) completed the ANPS and the Psychological Wellbeing scale. Multiple regressions revealed that each facet of wellbeing was explained by two to four affective traits, and each trait was significantly related to at least one aspect of wellbeing. Specifically, SEEKING predicted all the wellbeing facets, except for positive relations; CARE predicted personal growth, positive relations, purpose in life, and self-acceptance; PLAY and, inversely, ANGER predicted positive relations; SADNESS inversely predicted autonomy, while FEAR inversely predicted purpose in life. SADNESS and FEAR inversely predicted environmental mastery and self-acceptance. Finally, Spirituality predicted personal growth, positive relations, and self-acceptance. These findings are the first to show the relationship between affective neuroscience personality traits and psychological wellbeing. They also call attention to the distinctive role of FEAR and PANIC traits in psychological wellbeing facets, thereby complementing or even overcoming the traditional personality approach to neuroticism as a global trait.

Keywords: affective neuroscience, individual differences, personality, wellbeing

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Authors: Gyan Kashyap, Shri Kant Singh

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Improved mental health can be articulated as a good physical health and quality of life. Mental health plays an important role in survival of any one’s life. In today’s time people living with stress in life due to their personal matters, health problems, unemployment, work environment, living environment, substance use, life style and many more important reasons. Many studies confirmed that the significant proportion of mental health people increasing in India. This study is focused on mental well-being of male leather tannery workers in Kanpur city, India. Environment at work place as well as living environment plays an important health risk factors among leather tannery workers. Leather tannery workers are more susceptible to many chemicals and physical hazards, just because they are liable to be affected by their exposure to lots of hazardous materials and processes during tanning work in very hazardous work environment. The aim of this study to determine the level of mental health disorder and quality of life among male leather tannery and non-tannery workers in Kanpur city, India. This study utilized the primary data from the cross- sectional household study which was conducted from January to June, 2015 on tannery and non-tannery workers as a part of PhD program from the Jajmau area of Kanpur city, India. The sample of 286 tannery and 295 non-tannery workers has been collected from the study area. We have collected information from the workers of age group 15-70 those who were working at the time of survey for at least one year. This study utilized the general health questionnaire (GHQ-12) and work related stress scale to test the mental wellbeing of male tannery and non-tannery workers. By using GHQ-12 and work related stress scale, Polychoric factor analysis method has been used for best threshold and scoring. Some of important question like ‘How would you rate your overall quality of life’ on Likert scale to measure the quality of life, their earnings, education, family size, living condition, household assets, media exposure, health expenditure, treatment seeking behavior and food habits etc. Results from the study revealed that around one third of tannery workers had severe mental health problems then non-tannery workers. Mental health problem shown the statistically significant association with wealth quintile, 56 percent tannery workers had severe mental health problem those belong to medium wealth quintile. And 42 percent tannery workers had moderate mental health problem among those from the low wealth quintile. Work related stress scale found the statistically significant results for tannery workers. Large proportion of tannery and non-tannery workers reported they are unable to meet their basic needs from their earnings and living in worst condition. Important result from the study, tannery workers who were involved in beam house work in tannery (58%) had severe mental health problem. This study found the statistically significant association with tannery work and mental health problem among tannery workers.

Keywords: GHQ-12, mental well-being, factor analysis, quality of life, tannery workers

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Authors: Siphesihle Hlongwane

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Background: Globally, alcohol consumption, smoking, and the use of illicit drugs kill more than 11.8 million people each year. In sub-Saharan Africa, substance abuse is responsible for more than 6.4% of all deaths recorded and about 4.7% of all Disability Adjusted Life Years (DALYs), with numbers still expected to grow if no drastic measures are taken to curb and address drug use. In a setting where substance use is rife, understanding contextual factors that influence an individual’s perceived eligibility to seek rehabilitation is paramount. Using the candidacy framework, we unpack how situational factors influence an individual’s perceived eligibility for healthcare uptake in adolescents and youth with substance use disorder (SUD). Methods: The candidacy framework is concerned with how people consider their eligibility for accessing a health service. The study collected and analyzed primary qualitative data to answer the research question. Data were collected between January and July 2022 on participants aged between 18 and 35 for drug users and 18 to 60 for family members. Participants include 20 previous and current drug users and 20 family members that experience the effects of addiction. A pre-drafted semi-structured interview guide was administered to a conveniently sampled population supplemented with a referral sampling method. Data were thematically analyzed using the NVivo 12pro software to manage the data. Findings: Our findings show that people with substance use disorders are aware of their drug use habits and acknowledge their candidacy for health services. Candidacy for health services is also acknowledged by those around them, such as family members and peers, and as such, information on the navigation of health services for drug users is shared by those who have attended health services, those affected by drug use, and this includes health service research by family members to identify accessible health services. While participants reported willingness to quit drug use if assistance is provided, the permeability of health care services is hindered by both individual determinations to quit drug use from long-time use and the availability of health services for drug users, such as rehabilitation centers. Our findings also show that drug users are conscious and can articulate their ailments; however, the hunt for the next dose of drugs and long waiting cues for health service acquisition overshadows their claim to health services. Participants reported a mixture of treatments prescribed, with some more gruesome than others prescribed, thus serving as both a facilitator and barrier for health service uptake. Despite some unorthodox forms of treatments prescribed in health care, the majority of those who enter treatment complete the process of treatment, although some are met with setbacks and sometimes relapse after treatment has finished. Conclusion: Drug users are able to ascertain their candidacy for health services; however, individual and environmental characteristics relating to drug use hinder the use of health services. Drug use interventions need to entice health service uptake as a way to improve candidacy for health use.

Keywords: substance use disorder, rehabilitation, drug use, relapse, South Africa, candidacy framework

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Authors: Arzu K. Harmanci Seren, Burcu Alacam, Serap Altuntas, Ulku Baykal

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Organizational justice has been evaluated as a concept related to rules developed with regards to distributing gains and making decisions of distribution such as duty, goods, service, reward, punishment, fee, organizational position, opportunity or role among those working in that organization, and to social norms on which these rules are based. Studies of organizational justice are crucial for analyzing the organizational life. It is considered that organization justice will be positively influential upon organizational behaviours such as employees’ level of work satisfaction, their performance, and behaviours of organization citizenship, management by values perception, tendency towards cooperation, and towards quitting their jobs. However, when the literature related to health and nurse management is examined, authors could not reach enough findings related to the influence of nurses’ perception of organizational justice upon the perception of management and the intention of quitting in accordance with the values. For that reason, this study has been carried out with the purpose of determining the influence of nurses’ perception of organizational justice upon the perception of management and the intention of quitting in accordance with the values. The study has been carried out with 176 nurses working in a university hospital in Istanbul and a private hospital who accepted to take part in the study, and it is definitive and relation-seeking. Before the data has been collected, ethics committee approval and institutional permissions have been taken, Organizational Justice Scale, Management by Values, Intention to Leave Scale with a questionnaire including 8 questions that aims at defining the personal and professional characteristics of the nurses have been used as a means of data collection. The data collected between 1 May and 20 June 2016 have been evaluated by the researchers in a computer via definitive, relation-seeking and psychometric statistic. As a result of the study, it has been determined that most of the nurses are working in a university hospital (70.5%), that they are 30 and over (49.4%), women (91.5%), single (52.8%) and have a Bachelor’s Degree (48.3%), working in a surgery unit (17.6), have 5 year or less institutional experience (44.9%), 11 year or more professional experience. Cronbach alpha values of the scales used in this study are .94, .95 and .56. Nurses’ average scores of Organizational Justice Scale is M= 3.35±.96, Management by Values Scale is M=3.30±.74, Intention to Leave Scale is M=8.36±3.14. As a result of the analysis carried out in order to determine the influence of nurses’ perception of organizational justice upon the perception of management and the intention of quitting in accordance with the values, it has been pointed out that the Perception of Organizational Justice influenced the perception of Management by Values positively, Intention to Leave negatively.

Keywords: intention to leave, management by values, nursing, organizational justice

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Authors: Tania Camarillo Contreras, Yana Kuchirko

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Women’s sexuality, despite it being a core part of human functioning, has historically been stigmatized, silenced, and regulated and silenced across many cultures. The regulation of women’s bodies and desires has often been accomplished via gender ideologies and norms that ascribe power to men over women. Within Latino communities, gender ideologies like marianismo provide scripts by which women are expected to adhere submissiveness, purity, and putting others’ needs before their own. Prior work on sexuality-related topics among Latinas has almost exclusively examined the roles of risky behavior, partner violence, and gender roles on psychological and health outcomes. it know little about positive aspects of Latinas’ sexuality, such as their perspectives on sexual excitation and inhibition. Moreover, we know little about Latina’s sexuality in relation to marianismo. In this study, it ask the following questions (1) What are Latina’s perspectives on sexual excitation/inhibition? Do they vary by demographic variables (e.g., education, religiosity); (2) Does endorsement of marianismo among Latina women predict their perspectives on sexual excitation/sexual inhibition? and (3) Does endorsement of double standard (mediator variable) mediate the relation between marianismo (Independent) and sexual excitation/sexual inhibition? The results of this study shed light on effects of culturally specific gender ideologies like marianismo on women’s sexualities and have implications for culturally informed and gender-affirming policies seeking to better support Latinas’ sexual health.

Keywords: cultural beliefs, latinas, marianismo, sexuality, sexual inhibition

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Authors: Julie Mariam Abraham, G. J. Melendez-Torres

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Background. Maternal mortality is disproportionately higher in low- and middle- income countries (LMICs) compared to other parts of the world. At the current pace of progress, the Sustainable Development Goals for maternal mortality rate will not be achieved by 2030. A variety of factors influence the increased risk of maternal complications in LMICs. These are exacerbated by socio-economic and political factors, including poverty, illiteracy, and gender inequality. This paper aims to use realist synthesis to identify the contexts, mechanisms, and outcomes (CMOs) of maternal health interventions conducted in LMICs to inform evidence-based practice for future maternal health interventions. Methods. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in LMICs published in the last five years. We used open and axial coding of CMOs to develop an explanatory framework for intervention effectiveness. Results. After eligibility screening and full-text analysis, 44 papers were included. The intervention strategies and measured outcomes varied within reviews. Healthcare system level contextual factors were the most frequently reported, and infrastructural capacity was the most reported context. The most prevalent mechanism was increased knowledge and awareness. Discussion. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences, and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilisation and involvement to enable tailored interventions with optimal contextual fit.

Keywords: maternal mortality, service delivery and organisation, realist synthesis, sustainable development goals, overview of reviews

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Authors: Viknesh Kasthuri, Victoria Angenent-Mari, Jade Wexler

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The COVID-19 pandemic dramatically altered the landscape of asylum medicine. Brown Human Rights Asylum Clinic (BHRAC) is a medical-student-run asylum clinic that provides pro-bono medical evaluations and forensic affidavits for individuals seeking asylum in New England. After the outbreak of COVID-19 in March 2020, BHRAC experienced numerous changes both in the number of clients requesting services as well as in the resource needs of these clients. Uniquely, BHRAC assesses the needs of clients during their affidavit interview and seeks to address these needs by connecting clients to local community organizations and resources. Data regarding the specific needs of clients range from 2019-present day. Analysis of internal BHRAC’s internal data suggested a small increase in requests for assistance with light and gas (from 5% of total resource requests pre-COVID to 11%), as well as a decrease in requests for mental health services (from 20% of resources pre-COVID to 13% post-COVID). Furthermore, BHRAC witnessed a decline in clinic volume during the second half of 2020. In short, our data suggest that the pandemic affected asylum seekers' access to medico-legal services and the resources they need. Future research with larger sample sizes and in other geographic locations is required to determine the holistic impact of the COVID-19 pandemic on asylum seekers.

Keywords: asylum clinic, asylum medicine, COVID, social determinants of health

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Authors: Beatriz dos Anjos Furtado, Marina Barreiros Lamim, Camila Avozani Zago, Julianne Alvim Milward-de-Azevedo, Luís Cláudio Meirelles de Medeiros

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The intense process of economic acceleration, expansion of industrial activities and capitalism, combined with population growth, while promoting the development, bring environmental consequences and dynamics of locations. It can be seen that society is seeking to break with old paradigms of capitalist society, seeking to reconcile growth with sustainable development, with a change of mentality of the stakeholders of the production process (shareholders, employees, suppliers, customers, governments, and neighbors, groups citizens and the public in general). In this context, this research aims to map the stakeholders interested in environmental management in industries located in the city of Três Rios/RJ. The city of Três Rios is located in South-Central region of the state of Rio de Janeiro - Brazil. Methodological resources used refer to descriptive and field research, whose nature is qualitative and quantitative. It is also of multicases studies in the study area, and the data collection occurred by means of semi-structured questionnaires and interviews with employees related to the environmental area of the industries located in Três Rios and registered at the Federation of Industries the State of Rio de Janeiro - FIRJAN in the version of 2013 and active in federal revenue. Through this research it observed, among other things, the stakeholders involved in the environmental management process of “Três Rios” industry respondents, and those responding to the demands of environmental management.

Keywords: stakeholders, environmental management, industry, state, customer

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