The Impact of COVID-19 on the Mental-Emotional Wellbeing of Primary Healthcare Professionals: A Descriptive Correlational Study

The present study aimed to examine work environment related factors and frontline primary healthcare profes-sionals’mental-emotional wellbeing during the COVID-19 pandemic in school communities of Hong Kong.A total of 61(20%)school health nurses(frontline primary healthcare professionals)participated in a cross-sec-tional online survey from March to June 2020.Outcomes of mental-emotional health were measured using the Mental Health Continuum-Short Form(14-item scale with three subscales related to emotional,social and psychological wellbeing);the Perceived Stress Scale(10-item scale with two subscales related to perceived help-lessness and lack of self-efficacy);and the Coping Orientation to Problems Experienced Inventory(Brief COPE),a 28-item inventory with two subscales related to adaptive and maladaptive strategies.Almost half(42.6%)of par-ticipants experienced mental health problems.Those employed in government subsidized schools had signifi-cantly lower scores in mental health wellbeing than those who worked in private schools.Factors relating to increased mental health problems included lack of emotional support,inadequate training relating to infection prevention and control measures,disengagement and self-blame.A variety of factors influencing school health nurses’social,emotional and psychological wellbeing in their work environment during the COVID-19 pandemic were also reported.The mental-emotional wellbeing of school nurses may relate to their subjective feeling of lone-liness as participants were the sole frontline primary healthcare professional working in the school community during the COVID-19 pandemic.Studyfindings provide relevant evidence for management teams to build a cul-ture of psychological and social support into workplace policies and procedures.Continuous staff development and adequate social support are important to promote the mental-emotional wellbeing of primary healthcare pro-fessionals in school communities as they play a significant role in safeguarding resources during pandemics.

Factors influencing spiritual wellbeing among pancreatic ductal adenocarcinoma patients receiving chemotherapy

BACKGROUND Spiritual wellbeing emphasizes optimistic and positive attitudes while selfregulating negative emotions when coping with stress.However,there have only been a few small studies of spiritual wellbeing of pancreatic ductal adenocarcinoma(PDAC)patients undergoing chemotherapy.The core factors influencing spiritual wellbeing in this clinical population are still unclear.AIM To identify factors influencing spiritual wellbeing among patients with PDAC receiving chemotherapy.METHODS A total of 143 PDAC patients receiving chemotherapy were enrolled from January to December 2022.Patients completed general information questionnaires including:Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12 Item Scale(FACIT-Sp-12),European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30(EORTC QLQ-C30)and Zung’s Self-rating Anxiety Scale(SAS).Independent sample t-test,one-way analysis of variance,Pearson’s correlation analysis,and multiple linear regression analysis were adopted for statistical analyses.P<0.05(two-tailed)was considered statistically significant for all tests.RESULTS Total spiritual wellbeing(FACIT-Sp-12)score was 32.16±10.06 points,while dimension sub-scores were 10.85±3.76 for faith,10.55±3.42 for meaning,and 10.76±4.00 for peace.Total spiritual wellbeing score was negatively correlated with SAS score for anxiety and with the symptom domain of EORTC QLC-C30.Conversely,spiritual wellbeing score was positively correlated with global health status and EORTC QLQ-C30 role functioning domain score.Multivariate regression analysis identified educational level,health insurance category,symptom domain,functional role domain,and global health status as significant independent factors influencing spiritual wellbeing among PDAC patients undergoing chemotherapy(R2=0.502,P<0.05).CONCLUSION Individualized spiritual support is needed for PDAC patients.Health,daily functioning,emotional,cognitive,and social function status should be taken into account to promote implementation of spirituality in nursing practice.

China's low-carbon competitiveness and its effect decomposition from the perspective of wellbeing performance of ecological input

From the perspective of wellbeing performance of ecological input,this paper constructs a low-carbon competitiveness evaluation model with wellbeing performance of carbon emissions as the measurement standard,and uses the LMDI factor decomposition method to decompose the total effect of low-carbon competitiveness changes into technology effect and service effect.And then it conducts positive analysis and comparison of the low-carbon competitiveness and its effect contribution of G20 countries from1990 to 2018.The results are as follows:Firstly,in 2018,the UK,France,Argentina,Brazil,and Germany had higher low-carbon competitiveness.From 1990 to 2018,the low-carbon competitiveness of the UK,Turkey,Germany,Italy,and Brazil increase rapidly.Secondly,from 1990 to 2018,the total effect of low-carbon competitiveness of G20 member states was all positive,that is to say,the overall wellbeing performance of carbon emissions increased,technology effect and service effect are positive in 17 countries and negative in 2 countries respectively.Thirdly,China's low-carbon competitiveness is low,lacking static and dynamic advantages,although the technology effect is the highest,but the service effect is the lowest,resulting in a low total effect,which indicates that the wellbeing performance of economic growth is the main bottleneck of China's low-carbon development.Finally,the policy recommendations for China's future low-carbon transition and sustainable development are put forward.

From insulin detemir to glargine: Effect on glycemic control and psychological wellbeing in patients with diabetes mellitus type 2 in daily practice

The success of a specific treatment is traditionally judged according to parameters such as HbA1c. However, other, patient-reported outcomes (PRO) of (insulin) therapy, become increasingly more important. The introduction of (basal) insulin-analogues could possibly improve PRO, particularly “quality of life”. Direct comparative studies between once daily insulin glargine and once to twice or twice daily insulin detemir have previously shown differences in insulin dosage, dosing frequency and weight gain. Whether this leads to a difference in quality of life in patients who are transferred from insulin detemir to insulin glargine remains to be determined. To establish the effect of insulin glargine on quality of life and patient satisfaction in patients with DM2 who are in poor metabolic control with a (human) basal insulin, a large prospective, observational study in Dutch daily practice was performed. The results of the patient population switched from NPH-insulin to insulin glargine have been published previously. In this article the results of the group of patients treated with insulin detemir before the observation period are described. The results of this observational study show that changing basal insulin therapy to insulin glargine in patients with DM2 who are in poor glycemic control with insulin detemir leads to a clinically significant improvement of glycemic control as well as emotional wellbeing, despite a small increase in weight. Whether other factors such as decreased dosing frequency play a role remains to be determined by future studies.

Effects of Academic Stress and Perceived Social Support on the Psychological Wellbeing of Adolescents in Ghana

The purpose of this study was to examine how academic stress and perceived social support influence the psychological wellbeing of Senior High School students in Ghana. Two hundred and twenty six male and female students participated. The general health questionnaire, student life-stress inventory and perceived social support from family and friends scales were used to assess psychological wellbeing, academic stress and perceived social support respectively. The results indicated that perceived social support buffered the effects of academic stress on psychological wellbeing. Girls reported higher scores on perceived social support but reported more depression. Boys reported higher academic stress and better psychological wellbeing, and these have been attributed partly to the socialisation role of gender. These results have policy implications in respect of the creation of a cordial school environment as well as encouraging a healthy interpersonal relationship between adolescents and their family and friends with the aim of reducing academic stress appraisal which is inimical to the psychological wellbeing of adolescents.

Parenting preschoolers with autism: Socioeconomic influences on wellbeing and sense of competence

BACKGROUND Previous research suggests that parents raising a child with autism experience higher levels of psychological distress than parents of typically developing children and parents of children with other developmental disorders. Little is known, however, about the intersection between the effects of socioeconomic status(SES) on the wellbeing and sense of parental competency of parents of preschoolers with autism and how it relates to child symptom severity.AIM To examine the relationship between their child's symptom severity, SES, as measured by neighbourhood advantage and occupational status, on the psychological wellbeing and perceived parenting competence among parents of preschoolers with autism.METHODS Parents of 117 preschool-aged children with a diagnosis of autism spectrum disorder(ASD), 107 mothers and 54 fathers, completed questionnaires about their child's symptoms of ASD and functioning, their own perceptions of their wellbeing and parental competence on entry to an early intervention program in Sydney, Australia. Parents also provided demographic information pertaining to their occupation, level of education attained and address(postcode). All children were also assessed for their severity of symptoms using the Autism Diagnostic Observation Schedule. The Australian Socioeconomic Index of occupationalstatus as a measure of familial SES and the Index of Relative Socio-economic Advantage and Disadvantage as a measure of neighbourhood advantage were used to examine the impact of SES on parental sense of competence and wellbeing.RESULTS Compared to normative populations, both mothers and fathers in our sample reported significantly higher levels of parenting sense of efficacy but lower levels of interest in the parenting role. Mothers also displayed higher levels of satisfaction. Both mothers and fathers displayed higher levels of depression than normative populations with mothers also reporting greater levels of stress and anxiety. Child symptom severity was associated with maternal parenting competency with these relationships amplified among mothers with higher familial SES and who lived in areas of greater neighbourhood advantage.Increased adaptive functioning was associated with better maternal wellbeing,particularly among mothers who lived in areas of greater neighbourhood advantage. Contrastingly, paternal parenting competence was generally not influenced by child adaptive functioning or symptom severity, although for those in higher familial SES brackets, children's symptom severity and maladaptive symptoms were negatively related to paternal sense of parenting efficacy. There was a trend towards moderate relationships between lower familial SES and greater depression, stress and anxiety among fathers, but no relationship with their child's ASD symptom severity or functioning.CONCLUSION SES differentially impacts wellbeing and sense of parenting competence and its relationship to the impact of child symptoms for mothers and fathers of preschoolers with autism.

Understanding the Interrelationship Between Global Terrorist Attacks and the Citizen＇s Wellbeing.＂ The Complexity of Terrorism

Terrorism is a global phenomenon that over the last 44 years more than 140,000 terrorist events have been carried out. In the period from 1970-2001, the five countries with the largest number of terrorist attacks were Colombia, Peru, El Salvador, United Kingdom, and India. On the other hand, in the post-2001 context, the five countries with the largest number of terrorist attacks were Iraq, Pakistan, Afghanistan, India, and Thailand. One method for measuring in an aggregate way, how many people have suffered under terrorist attacks at national level is to analyze the correlation between some national wellbeing indicators and the number of terrorist attacks. The aim of this study is to analyze empirically the correlation between the global terrorist attacks and the countries wellbeing indicators. Five indicators show a strong relationship with the number of terrorist attacks in the case of the four most attacked countries in the post-2001 context. The authors consider that their findings can support the design of new strategies for preventing terrorist activities taking into account certain socio-economic and political drivers. The authors conclude that as such drivers are socio-complex, so it is necessary to adopt the complex adaptive system （CAS） approach to provide a new way of thinking about terrorism.

Young People’s Conceptualization of Their Wellbeing: Culturally Situated Understandings in the Context of Kazakhstan

Little is known about the wellbeing of young people living in post-Soviet nation contexts such as Kazakhstan. The qualitative data reported represents the views of 309 Kazakhstani young people on their conceptualizations of wellbeing that fell broadly into three major thematic categories: external factors from one’s surroundings;relationships with others;and internal aspects of the self. The direct consequence of inadequate physical environment on health and the environment’s impact on psychological wellbeing through leisure, lifestyle, education, and employment opportunities were emphasized. Affirmative connections with others were associated with increased levels of emotional wellbeing. The importance of making independent choices as well as being actively involved in leisure, volunteering and extracurricular school activities for achieving optimal levels of wellbeing was highlighted.

Positive Massage for Couples’ Wellbeing and Relationships: The Bridge between Positive Psychology and Massage

Although positive psychology interventions are generally aimed at individuals, when considering couples, a dyadic approach may be more effective. In terms of a couples’ wellbeing, their relationship is one of the most important factors. As such, interventions targeted for both members’ wellbeing via their relationship are likely to be of value. Currently, there exist limited dyadic positive activity interventions available in positive psychology, and notably, tactile intervention is lacking. Massage is the evidence based tactile health modality that has long history as a therapeutic intervention, as well as being one of the most natural human health-oriented behaviours. The current commentary argues for the link between positive psychology and massage, and that “Positive Massage” can be a bridge between the hitherto distinct entities of positive psychology and massage. Furthermore, based on the conceptual theoretical model of the link between Positive Massage and wellbeing, we propose that Positive Massage can be an effective positive intervention impacting on couples’ wellbeing and enhancing their relationships.

Mental Wellbeing Monitoring in a Sample of Emergency Medical Service Personnel

Background: There have been concerns regarding the mental wellbeing of emergency medical service staff, particularly when faced with multiple trauma exposures. This study aimed to describe a cross-sectional view of the mental wellbeing status of emergency medical service workers, as well as to comment on the usefulness of an electronic survey tool to reach staff that is distributed across large geographical areas. Methods: The data presented here are drawn from an anonymous, voluntary, electronic survey, made available via the internet, to emergency medical service workers in the Western Cape province of South Africa. This paper reports on four domain expressions of mental wellbeing, namely disordered mood, problematic substance use, post-traumatic stress disorder, and domestic discord. Results: Elevated rates were reported by this sample, across all four distress domains, i.e. mood disorder = 12.3%;problematic substance use = 14.9%;post-traumatic stress disorder = 11.9%;and domestic discord = 11.9%. These rates were generally similar to data from comparable emergency worker groups, and much higher than local population estimates. Conclusions: The data support earlier findings that emergency medical work is associated with increased risk for symptoms of psychological distress, which present a strong case for regular organizational monitoring of employees’ mental wellbeing. In this regard, a brief, internet delivered, survey-type tool showed promise for screening employees, in order to guide further streaming of distressed individuals towards appropriate support services. Further work is required to develop clear mechanisms for referral and intervention in order to optimize a confidential and supportive monitoring program.

The Influence of Confucius＇ Moral Standards on Wellbeing of Academics in Higher Education in China in the Context of the Chinese Dream

The Chinese Dream, adopted by General Secretary Xi Jinping, was used and spread in China. It is about Chinese prosperity, collective effort, socialism and national glory. It is also about the welfare, wellbeing, and quality of life of every Chinese. Academics in higher education in China are facing changes both across the globe and in China, they must take the challenges. This paper does research on wellbeing of the academics from the aspects of the definition of wellbeing, the situation both in the world and in China, the Chinese concept of happiness, the possible influence of Confucius moral standards on wellbeing of Chinese. This paper may help school leaders implement policies that foster effective work environment in the new era in China.

Health, Wellbeing and Self-Esteem: Web-Based Support in Children with Urogenital or Bowel Malformation

Children with urogenital malformation or bowel disturbances are a vulnerable group and are at risk of experiencing ill health. At school they have to face and cope with situations they are unused to and often feel excluded. There is a lack of studies investigating prevention of ill health in this group of children. Objective: The aim of the study was to investigate the health/well-being and self-esteem, before and after a one-year intervention comprising person-centred, web-based learning support, in preschool children born with malformations in the urethra, bladder, genitals and/or bowel. Study design: Nine boys and one girl participated, aged 3 - 7 years (study group) with diagnoses of epispadia, bladder exstrophy, urethra valves and Hirschprung’s disease. Two questionnaires were used, developed to measure index of health/wellbeing and self-esteem in younger children. In the study group, the interviews were repeated after one year. The group was compared with a control group of 20 healthy, age-matched children. Results: Before the intervention, there were no differences in wellbeing (Children condition index) between the study group and the control group. One year after the start of the web-based preschool, wellbeing in the study group had slightly improved, but not significantly compared to before the intervention. No significant difference was found compared to the control group. When measured self-esteem (I think I am) before the intervention, the study group had significantly better self-esteem compared to the control group. One year later, there was a slight improvement in self-esteem, but two children scored worse in the domain Psychological wellbeing. In comparison with the group of healthy children, the self-esteem in the study group was better for total sum (p = 0.0002). Discussion: Wellbeing and self-esteem seem to be good in children aged 3 - 7 years with uro-genital and bowel malformations, according to the findings of this study. This is better than reports concerning older children. Despite high initial values compared to healthy children, continued, but not significant, improvement in wellbeing and self-esteem was shown one year after intervention. Conclusions: The results of the intervention aimed at promoting health, wellbeing and self-esteem are promising but a longer-term follow-up in a larger group of children is needed.

A cross-sectional study of the relationships between ethnicity and occupational classes with mental wellbeing in the UK

Various aspects of a job (e.g. contract clauses, promotion, wages, job security and workplacehierarchy) are becoming increasingly complex and have some effect on an employee’s wellbeing. Simultaneously,research about an increase in mental health issues due to workplace obstacles for ethnic minorities is amassing butthere is a lack of policymaking to tackle this via accessible mental health support at the workplace. My study aimsto assess the effect of occupational class and ethnicity on wellbeing in the UK working population. Methods: Thestudy assessed 3,374 adult employees who participated in the Health Survey for England from 2014–2016 and werecategorised in 1/3 National Statistics Socio-economic Classification groups. The Warwick-Edinburgh MentalWellbeing Scale was used as a measure of mental wellbeing. I explored the relationship between occupational classand wellbeing score using linear regression, accounting for demographic and socioeconomic covariates: age, sex,income and education. My sample’s ethnicity breakdown was White: 3,051;Black: 83;Asian: 180;Mixed: 39;Other:21 adults. Results: Of the sample, 46.8% of adults belonged to managerial and professional occupations and 90.4%were of White ethnicity. Managerial and professional occupations had a higher mean wellbeing score (48.54;P <0.001) than routine and manual occupations (47.69;P < 0.05). Multiple ethnic background showed the highest meanwellbeing score (52.82;P < 0.05), compared to White adults with the lowest wellbeing score (48.57;P << 0.001).Unlike occupational class which had a small effect size (partial eta-squared = 0.02), when holding education, income,age and sex constant, ethnicity had a statistically significant association with wellbeing. Conclusion: White ethnicityand routine and manual occupations are high-risk groups for poor mental wellbeing. The impact of ethnicity andoccupational class on wellbeing scores remained after accounting for socioeconomic and demographic factors.

Exploring Individual Lifetime Wellbeing： An Optimal Year of Birth

This paper aims to explore the concept of wellbeing from an individual＇s perspective. Current indicators of wellbeing [including economic indicators such as Gross Domestic Product （GDP）] are static indicators--they take into account issues as they are in a given period of time such as the current year. However, these indicators fail to measure the sense of wellbeing felt by an individual over a lifetime, and therefore could miss important issues of relevance when developing policy and other interventions to improve wellbeing. Various wellbeing indicators for the OK over the period of 1945-2013 are explored. These indicators are used to develop a ＂lifetime wellbeing＂ measure. The indicators are grouped and predictions of indicators into the future are made. The data show that some indicators have peaked and are now in decline. Therefore, under a certain choice of indicators and weightings, it is possible to maximise wellbeing over a person＇s lifetime meaning, there may have been an optimum year in which to be born.

Impact of Educational Programs about Methods of Assessment of Fetal Wellbeing during Pregnancy among Staff Nurses

Objective: Aims of the study are to study the impact of increased knowledge and awareness among staff nurses towards assessment of methods of fetal wellbeing to early identification of pregnancy outcomes and the frequency of interventions during delivery. Design: A quasi-experimental design was used in carrying out the study to impact knowledge and awareness assessment of methods of fetal wellbeing among staff nurses. The study was conducted at obstetric & gynecological department working at setting in Jarsh Governorate Hospitals & Prince Hussein Bin Abdullah Hospitals. Methods: The study sample consisted of all staff nurses working at obstetric & gynecological department in Jarsh Governorate Hospital & Prince Hussein Bin Abdullah Hospitals who have agreed to participate in the study. The current study has included 150 staff types of sample convenient sample. Results: The main findings of this study showed that there is a highly statistical significance differences between pre-test and post-test in all answers regarding knowledge about methods of fetal wellbeing assessment. Conclusion: Nurses have a major role to prevent the complication for the fetus and mother during pregnancy. Nurses coming in contact with the antenatal mothers should take initiative to provide necessary information to the women and the relatives on different methods used for the assessment of fetal wellbeing, so as to improve the quality of life among the pregnant women. For that they should adequate knowledge about all the aspects of fetal wellbeing, so that they can prevent the complication.

Health behaviours and wellbeing of health workers amidst the COVID-19 pandemic

The coronavirus disease 2019(COVID-19)pandemic has led to heightened levels of anxiety and stress levels towards the health threats posed by the SARS-CoV-2 virus.At least 10%of those infected were health workers.In addition,a large proportion of infected cases and deaths were possibly due to SARS-CoV-2 infections acquired in hospitals or long-term care facilities.Health workers,especially those working on the frontline play a crucial role in controlling and preventing the COVID-19 pandemic.Previous studies reported that health workers were exposed to severe emotional stress(i.e.,burnout,depression and anxiety symptoms)during the outbreaks of infectious diseases including severe acute respiratory syndrome(SARS),Ebola and Middle East respiratory syndrome(MERS).It is therefore important to be aware that prolonged exposure to moderate-to severe stress can have negative health consequences and reduce the work performance of health workers.Therefore,some immediate measures should be taken by the health care institutions and relevant health authorities to ensure that Chinese health workers are better supported in caring for large number of COVID-19 patients.Future studies should examine the health status and work efficiency of health workers working in high stress environment amidst the COVID-19 pandemic or other disasters.

Impact of Levels of Education on Perceived Academic Stress and Mental Wellbeing: An Investigation into Online Mode of Learning during Pandemic

A sudden outbreak of the current pandemic COVID-19 has switches the learning to online mode which leads to an increase in perceived academic stress and a serious threat to the mental well-being of the students across the globe.The aim of the current study was therefore,to examine the impact of online learning on perceived academic stress and mental well being of the students with moderating effects of levels of education,during the current pandemic.Measures of the constructs were obtained by the online Google form which consists of the Perceptions of Academic Stress Scale(PASS)by Dalia Bedewy and Adel Gabriel(2015)and War­wick-Edinburg Mental Well-being Scale(2008),from a sample of 150 undergraduate students aged 19-25 years studying in different colleges of Bengaluru,India.Mental well-being constituted the criterion variable whilst academic stress and levels of education were treated as predictor variables.Two-way ANOVA were employed.Results show that academic stress is a significant negative predictor of mental wellbeing(r=-.083;p<0.05),there is a significant difference in the perceived academic stress(df=2;F=2.72;p<0.05)which increase in hierarchy(Third year&first year MD=-3.7;Third year&second year MD=-3.2)and mental well being(df=2,F=5.314 p<0.05)which decreases in hierarchy(Third year&first year MD=-5.8;Third year&second year MD=-5.860)of the students at different educational levels and a combination perceived aca­demic stress and educational levels predicts variance in mental well being of the students(R2=0.052;p>0.05).It was concluded that combined aca­demic stress and educational levels have an impact on mental wellbeing of students in online mode of learning during the current pandemic,but this impact is low(only 5.2%).

China's Greatest Contribution to the World Lies in Safeguarding Democracy and Wellbeing for One-Fifth of Humanity

China has a population that is one-fifth of humanity. Most of its people live in rural areas. This country has been built and developed on the ruins of semi-colonialism and semi-feudalism and on a foundation of ＂poverty and blankness.＂ The founding of New China created the political condition for the advancement of people＇s democracy. Since the adoption of reform and open policies, or gaige kaifang, China has gradually found an effective way, suited for Chinese conditions,

Le Corbusier’s Four Compositions’Promotion of Wellbeing and Meaning

The architect Le Corbusier’s“Four Compositions”outlined in his Oeuvre Complete provides a flexible platform that allows for a range of design options to promote wellbeing.Like a biological stem cell,his compositions can advance multiple wellbeing elements found in the emerging field of Positive Psychology where positive emotions,engagement,relationships,and meaning play a critical role.Using the visual analysis method,this paper examines his compositions for their relevance in today’s more complex demands for wellbeing.Three of four of Le Corbusier’s preferred compositions provide a flexible system to foster healthy outdoor and near-outdoor spaces that can generate:(1)greater levels of thermal and visual comfort,(2)higher qualities of daylight and fresh air,(3)more opportunities to engage with stress-reducing nature,(4)more opportunities for social engagements and,(5)more opportunities for the building to express a virtuous meaning.For these reasons,this may explain why three of his preferred compositions keep expressing themselves in today’s designs.The author will examine a selection of Corbus’s late architecture in the 1950’s and 1960’s and more recent buildings that utilized Corbu’s“Four Compositions”to promote overall wellbeing for which virtuous meaning plays a critical part.

Spatio-temporal analysis of human wellbeing and its coupling relationship with ecosystem services in Shandong province, China

Rapid economic and social change promotes to improve human wellbeing(HW),but poses threats to ecosystems and the environment.Studying the coupling relationship between HW and ecosystem services(ES)is crucial for informing high-quality development.Firstly,we built a comprehensive index system for HW assessment,and evaluated HW for 17 prefecture-level cities in Shandong province,China,from 2000 to 2018.Then,we quantified ES based on land use data.Finally,we assessed the coupling coordination degree and analyzed the relationships between HW and each type of ES value.The results were as follows:(1)HW values increased overall in Shandong,with the highest value in Jinan(0.8034)and the lowest value in Heze(0.4965)in 2018.(2)The total ES values for the 17 cities increased slightly.The ranking of 17 cities according to the ES value per unit area was different from the ranking according to the total ES value.(3)All 17 cities in Shandong were in the coordinated development phase after 2015,with increasing coupling coordination degrees.There were clear positive relationships between HW and ES.General and specific policy recommendations were proposed,providing scientific evidence and a reference for Shandong’s urban management and policy formulation.