International Journal of Environmental Research and Public Health

Research

10 pages, 1807 KiB

Open AccessArticle

Demographic and Urbanization Disparities of Liver Transplantation in Taiwan

by Pei-Hung Wen, Chin-Li Lu, Carol Strong, Yih-Jyh Lin, Yao-Li Chen, Chung-Yi Li and Chiang-Chin Tsai

Int. J. Environ. Res. Public Health 2018, 15(2), 177; https://doi.org/10.3390/ijerph15020177 - 23 Jan 2018

Cited by 12 | Viewed by 4701

Abstract

Limited access to or receipt of liver transplantation (LT) may jeopardize survival of patients with end-stage liver diseases. Taiwan launched its National Health Insurance (NHI) program in 1995, which essentially removes financial barriers to health care. This study aims to investigate where there [...] Read more.

Limited access to or receipt of liver transplantation (LT) may jeopardize survival of patients with end-stage liver diseases. Taiwan launched its National Health Insurance (NHI) program in 1995, which essentially removes financial barriers to health care. This study aims to investigate where there are still demographic and urbanization disparities of LT after 15 years of NHI program implementation. Data analyzed in this study were retrieved from Taiwan’s NHI inpatient claims. A total of 3020 people aged ≥18 years received LT between 2000 and 2013. We calculated crude and adjusted prevalence rate of LT according to secular year, age, sex, and urbanization. The multiple Poisson regression model was further employed to assess the independent effects of demographics and urbanization on prevalence of LT. The biennial number of people receiving LT substantially increased from 56 in 2000–2001 to 880 in 2012–2013, representing a prevalence rate of 1.63 and 18.58 per 10⁶, respectively. Such increasing secular trend was independent of sex. The prevalence was consistently higher in men than in women. The prevalence also increased with age in people <65 years, but dropped sharply in the elderly (≥65 years) people. We noted a significant disparity of LT in areas with different levels of urbanization. Compared to urban areas, satellite (prevalence rate ratio (PRR), 0.63, 95% confidence interval (CI), 0.57–0.69) and rural (PRR, 0.76, 95% CI, 0.69–0.83) areas were both associated with a significantly lower prevalence of LT. There are still significant demographic and urbanization disparities in LT after 15 years of NHI program implementation. Given the predominance of living donor liver transplantation in Taiwan, further studies should be conducted to investigate factors associated with having a potential living donor for LT. Full article

(This article belongs to the Section Health Economics)

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10 pages, 437 KiB

Open AccessArticle

The Association between Air Pollution and Outpatient and Inpatient Visits in Shenzhen, China

by Yachuan Liu, Shanen Chen, Jian Xu, Xiaojian Liu, Yongsheng Wu, Lin Zhou, Jinquan Cheng, Hanwu Ma, Jing Zheng, Denan Lin, Li Zhang and Lili Chen

Int. J. Environ. Res. Public Health 2018, 15(2), 178; https://doi.org/10.3390/ijerph15020178 - 23 Jan 2018

Cited by 18 | Viewed by 5419

Abstract

Nowadays, air pollution is a severe environmental problem in China. To investigate the effects of ambient air pollution on health, a time series analysis of daily outpatient and inpatient visits in 2015 were conducted in Shenzhen (China). Generalized additive model was employed to [...] Read more.

Nowadays, air pollution is a severe environmental problem in China. To investigate the effects of ambient air pollution on health, a time series analysis of daily outpatient and inpatient visits in 2015 were conducted in Shenzhen (China). Generalized additive model was employed to analyze associations between six air pollutants (namely SO₂, CO, NO₂, O₃, PM₁₀, and PM_2.5) and daily outpatient and inpatient visits after adjusting confounding meteorological factors, time and day of the week effects. Significant associations between air pollutants and two types of hospital visits were observed. The estimated increase in overall outpatient visits associated with each 10 µg/m³ increase in air pollutant concentration ranged from 0.48% (O₃ at lag 2) to 11.48% (SO₂ with 2-day moving average); for overall inpatient visits ranged from 0.73% (O₃ at lag 7) to 17.13% (SO₂ with 8-day moving average). Our results also suggested a heterogeneity of the health effects across different outcomes and in different populations. The findings in present study indicate that even in Shenzhen, a less polluted area in China, significant associations exist between air pollution and daily number of overall outpatient and inpatient visits. Full article

(This article belongs to the Special Issue Ambient Air Pollution and Health Vulnerability)

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16 pages, 1858 KiB

Open AccessFeature PaperArticle

System-Wide and Group-Specific Health Service Improvements: Cross-Sectional Survey of Outpatient Improvement Preferences and Associations with Demographic Characteristics

by Elizabeth A. Fradgley, Christine L. Paul, Jamie Bryant, Alison Zucca and Christopher Oldmeadow

Int. J. Environ. Res. Public Health 2018, 15(2), 179; https://doi.org/10.3390/ijerph15020179 - 23 Jan 2018

Cited by 2 | Viewed by 4566

Abstract

Efficient patient-centred quality improvement requires an understanding of the system-wide areas of dissatisfaction along with evidence to identify the programs which can be strategically targeted according to specific patient characteristics and preferences. This cross-sectional study reports the proportion of chronic disease outpatients selecting [...] Read more.

Efficient patient-centred quality improvement requires an understanding of the system-wide areas of dissatisfaction along with evidence to identify the programs which can be strategically targeted according to specific patient characteristics and preferences. This cross-sectional study reports the proportion of chronic disease outpatients selecting 23 patient-centred improvement initiatives. Using univariate tests and multivariable logistic regressions, this multi-site study also identifies initiatives differentially selected by outpatients according to clinical and demographic characteristics. A total of 475 outpatients participated (49% response). Commonly selected initiatives included: reducing wait-times (22.3%); convenient appointment scheduling (16.0%); and receiving up-to-date treatment information (16.0%). Within univariate tests, preferences for information and service accessibility initiatives were not significantly associated with specific subgroups. However, seven initiatives were preferred according to age, gender, diagnosis status, and chronic disease type within multivariate models. For example, neurology outpatients were more likely to select assistance to manage psychological symptoms when compared to oncology outpatients (OR: 2.89). Study findings suggest that system-wide programs to enhance information provision are strategic approaches to improve experiences across patient characteristics. Furthermore, a few initiatives can be targeted to specific groups and emphasized the importance of detailed scoping analyses and tailored implementation plans when designing patient-centred quality improvement programs. Full article

(This article belongs to the Special Issue Quality of Patient-Centered Care)

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26 pages, 4723 KiB

Open AccessArticle

Faecal Pathogen Flows and Their Public Health Risks in Urban Environments: A Proposed Approach to Inform Sanitation Planning

by Freya Mills, Juliet Willetts, Susan Petterson, Cynthia Mitchell and Guy Norman

Int. J. Environ. Res. Public Health 2018, 15(2), 181; https://doi.org/10.3390/ijerph15020181 - 23 Jan 2018

Cited by 37 | Viewed by 9796

Abstract

Public health benefits are often a key political driver of urban sanitation investment in developing countries, however, pathogen flows are rarely taken systematically into account in sanitation investment choices. While several tools and approaches on sanitation and health risks have recently been developed, [...] Read more.

Public health benefits are often a key political driver of urban sanitation investment in developing countries, however, pathogen flows are rarely taken systematically into account in sanitation investment choices. While several tools and approaches on sanitation and health risks have recently been developed, this research identified gaps in their ability to predict faecal pathogen flows, to relate exposure risks to the existing sanitation services, and to compare expected impacts of improvements. This paper outlines a conceptual approach that links faecal waste discharge patterns with potential pathogen exposure pathways to quantitatively compare urban sanitation improvement options. An illustrative application of the approach is presented, using a spreadsheet-based model to compare the relative effect on disability-adjusted life years of six sanitation improvement options for a hypothetical urban situation. The approach includes consideration of the persistence or removal of different pathogen classes in different environments; recognition of multiple interconnected sludge and effluent pathways, and of multiple potential sites for exposure; and use of quantitative microbial risk assessment to support prediction of relative health risks for each option. This research provides a step forward in applying current knowledge to better consider public health, alongside environmental and other objectives, in urban sanitation decision making. Further empirical research in specific locations is now required to refine the approach and address data gaps. Full article

(This article belongs to the Section Environmental Science and Engineering)

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10 pages, 1630 KiB

Open AccessArticle

Economic Conditions May Contribute to Increased Violence toward Children: A Nationwide Population-Based Analysis of Pediatric Injuries in Taiwanese Emergency Departments

by Yueh-Ping Liu, Ren-Jun Hsu, Mei-Hwan Wu, Chun-Chih Peng, Shu-Ting Chang, Wei-Te Lei, Tzu-Lin Yeh, Jui-Ming Liu and Chien-Yu Lin

Int. J. Environ. Res. Public Health 2018, 15(2), 182; https://doi.org/10.3390/ijerph15020182 - 23 Jan 2018

Cited by 2 | Viewed by 4657

Abstract

Childhood injuries are unfortunately common. Analysis procedures may assist professionals who work with children with developing preventive measures for protecting children’s wellness. This study explores the causes of pediatric injuries presenting to an emergency department in Taiwan. This nationwide, population-based study was conducted [...] Read more.

Childhood injuries are unfortunately common. Analysis procedures may assist professionals who work with children with developing preventive measures for protecting children’s wellness. This study explores the causes of pediatric injuries presenting to an emergency department in Taiwan. This nationwide, population-based study was conducted using data from the National Health Insurance Research Database of Taiwan (NHIRD). Patients aged <18 years were identified from approximately one million individuals listed in the NHIRD. We followed up with these patients for nine years and analyzed the causes of injuries requiring presentation to an emergency department. Variables of interest were age, sex, injury mechanisms, and temporal trends. A total of 274,028 children were identified in our study. Between 2001 and 2009, the leading causes of pediatric injuries treated in emergency departments were motor vehicle injuries, falls, and homicide. The overall incidence of injuries declined over the course of the study because of reductions in motor vehicle accidents and falls. The incidence of homicide increased during the study period, particularly between 2007 and 2009. A moderately inverse correlation between homicide rate and economic growth was observed (correlation coefficient: −0.613, p = 0.041). There was a general decline in pediatric injuries between 2001 and 2009. Public policy changes, including motorcycle helmet laws and increases in alcohol taxes, may have contributed to this decline. Unfortunately, the incidence of homicide increased over the course of the study. Ongoing financial crises may have contributed to this increase. Multidisciplinary efforts are required to reduce homicide and reinforce the importance of measures that protect children against violence. Full article

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22 pages, 6563 KiB

Open AccessFeature PaperArticle

Vertical Geochemical Variations and Speciation Studies of As, Fe, Mn, Zn, and Cu in the Sediments of the Central Gangetic Basin: Sequential Extraction and Statistical Approach

by Manoj Kumar and AL. Ramanathan

Int. J. Environ. Res. Public Health 2018, 15(2), 183; https://doi.org/10.3390/ijerph15020183 - 23 Jan 2018

Cited by 7 | Viewed by 4492

Abstract

A geochemical and speciation study of As, Fe, Mn, Zn, and Cu was performed using sequential extraction and statistical approaches in the core sediments taken at two locations—Rigni Chhapra and Chaube Chhapra—of the central Gangetic basin (India). A gradual increase in the grain [...] Read more.

A geochemical and speciation study of As, Fe, Mn, Zn, and Cu was performed using sequential extraction and statistical approaches in the core sediments taken at two locations—Rigni Chhapra and Chaube Chhapra—of the central Gangetic basin (India). A gradual increase in the grain size (varying from clay to coarse sands) was observed in both the core profiles up to 30.5 m depth. The concentrations of analyzed elements ranged as follows: 6.9–14.2 mg/kg for As, 13,849–31,088 mg/kg for Fe, 267–711 mg/kg for Mn, 45–164 mg/kg for Cu for Rigni Chhapra while for Chaube Chhapra the range was 7.5–13.2 mg/kg for As, 10,936–37,052 mg/kg for Fe, 267–1052 mg/kg for Mn, 60–198 mg/kg for Zn and 60–108 mg/kg for Cu. Significant amounts (53–95%) of all the fractionated elemental concentrations were bound within the crystal structure of the minerals as a residual fraction. The reducible fraction was the second most dominant fraction for As (7% and 8%), Fe (3%), Mn (20% and 26%), and Cu (7% and 6%) respectively for both the cores. It may be released when aquifers subjected to changing redox conditions. The acid soluble fraction was of most interest because it could quickly mobilize into the water system which formed the third most dominating among all three fractions. Four color code of sediments showed an association with total As concentration and did not show a relation with any fraction of all elements analyzed. The core sediment was observed enriched with As and other elements (Cu, Fe, Mn, and Zn). However, it fell under uncontaminated to moderately contaminate which might exhibit a low risk in prevailing natural conditions. X-ray diffraction analyses indicated the availability of siderite and magnetite minerals in the core sediments in a section of dark grey with micaceous medium sand with organic matter (black). Full article

(This article belongs to the Special Issue Arsenic Contamination, Bioavailability and Public Health)

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17 pages, 757 KiB

Open AccessFeature PaperArticle

Exploring Facilitators and Barriers to Initiation and Completion of the Human Papillomavirus (HPV) Vaccine Series among Parents of Girls in a Safety Net System

by Sean T. O’Leary, Steven Lockhart, Juliana Barnard, Anna Furniss, Miriam Dickinson, Amanda F. Dempsey, Shannon Stokley, Steven Federico, Michael Bronsert and Allison Kempe

Int. J. Environ. Res. Public Health 2018, 15(2), 185; https://doi.org/10.3390/ijerph15020185 - 23 Jan 2018

Cited by 18 | Viewed by 6299

Abstract

Objective: To assess, among parents of predominantly minority, low-income adolescent girls who had either not initiated (NI) or not completed (NC) the HPV vaccine series, attitudes and other factors important in promoting the series, and whether attitudes differed by language preference. Design/Methods: From [...] Read more.

Objective: To assess, among parents of predominantly minority, low-income adolescent girls who had either not initiated (NI) or not completed (NC) the HPV vaccine series, attitudes and other factors important in promoting the series, and whether attitudes differed by language preference. Design/Methods: From August 2013–October 2013, we conducted a mail survey among parents of girls aged 12–15 years randomly selected from administrative data in a Denver safety net system; 400 parents from each group (NI and NC) were targeted. Surveys were in English or Spanish. Results: The response rate was 37% (244/660; 140 moved or gone elsewhere; 66% English-speaking, 34% Spanish-speaking). Safety attitudes of NIs and NCs differed, with 40% NIs vs. 14% NCs reporting they thought HPV vaccine was unsafe (p < 0.0001) and 43% NIs vs. 21% NCs that it may cause long-term health problems (p < 0.001). Among NCs, 42% reported they did not know their daughter needed more shots (English-speaking, 20%, Spanish-speaking 52%) and 39% reported that “I wasn’t worried about the safety of the HPV vaccine before, but now I am” (English-speaking, 23%, Spanish-speaking, 50%). Items rated as very important among NIs in the decision regarding vaccination included: more information about safety (74%), more information saying it prevents cancer (70%), and if they knew HPV was spread mainly by sexual contact (61%). Conclusions: Safety concerns, being unaware of the need for multiple doses, and low perceived risk of infection remain significant barriers to HPV vaccination for at-risk adolescents. Some parents’ safety concerns do not appear until initial vaccination. Full article

(This article belongs to the Special Issue Interventions and Approaches to Optimize Immunization Coverage Across the Lifespan)

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16 pages, 6593 KiB

Open AccessArticle

Study on Urban Heat Island Intensity Level Identification Based on an Improved Restricted Boltzmann Machine

by Yang Zhang, Ping Jiang, Hongyan Zhang and Peng Cheng

Int. J. Environ. Res. Public Health 2018, 15(2), 186; https://doi.org/10.3390/ijerph15020186 - 23 Jan 2018

Cited by 13 | Viewed by 4887

Abstract

Thermal infrared remote sensing has become one of the main technology methods used for urban heat island research. When applying urban land surface temperature inversion of the thermal infrared band, problems with intensity level division arise because the method is subjective. However, this [...] Read more.

Thermal infrared remote sensing has become one of the main technology methods used for urban heat island research. When applying urban land surface temperature inversion of the thermal infrared band, problems with intensity level division arise because the method is subjective. However, this method is one of the few that performs heat island intensity level identification. This paper will build an intensity level identifier for an urban heat island, by using weak supervision and thought-based learning in an improved, restricted Boltzmann machine (RBM) model. The identifier automatically initializes the annotation and optimizes the model parameters sequentially until the target identifier is completed. The algorithm needs very little information about the weak labeling of the target training sample and generates an urban heat island intensity spatial distribution map. This study can provide reliable decision-making support for urban ecological planning and effective protection of urban ecological security. The experimental results showed the following: (1) The heat island effect in Wuhan is existent and intense. Heat island areas are widely distributed. The largest heat island area is in Wuhan, followed by the sub-green island. The total area encompassed by heat island and strong island levels accounts for 54.16% of the land in Wuhan. (2) Partially based on improved RBM identification, this method meets the research demands of determining the spatial distribution characteristics of the internal heat island effect; its identification accuracy is superior to that of comparable methods. Full article

(This article belongs to the Section Environmental Science and Engineering)

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15 pages, 4045 KiB

Open AccessArticle

Present and Future of Dengue Fever in Nepal: Mapping Climatic Suitability by Ecological Niche Model

by Bipin Kumar Acharya, Chunxiang Cao, Min Xu, Laxman Khanal, Shahid Naeem and Shreejana Pandit

Int. J. Environ. Res. Public Health 2018, 15(2), 187; https://doi.org/10.3390/ijerph15020187 - 23 Jan 2018

Cited by 61 | Viewed by 10574

Abstract

Both the number of cases of dengue fever and the areas of outbreaks within Nepal have increased significantly in recent years. Further expansion and range shift is expected in the future due to global climate change and other associated factors. However, due to [...] Read more.

Both the number of cases of dengue fever and the areas of outbreaks within Nepal have increased significantly in recent years. Further expansion and range shift is expected in the future due to global climate change and other associated factors. However, due to limited spatially-explicit research in Nepal, there is poor understanding about the present spatial distribution patterns of dengue risk areas and the potential range shift due to future climate change. In this context, it is crucial to assess and map dengue fever risk areas in Nepal. Here, we used reported dengue cases and a set of bioclimatic variables on the MaxEnt ecological niche modeling approach to model the climatic niche and map present and future (2050s and 2070s) climatically suitable areas under different representative concentration pathways (RCP2.6, RCP6.0 and RCP8.5). Simulation-based estimates suggest that climatically suitable areas for dengue fever are presently distributed throughout the lowland Tarai from east to west and in river valleys at lower elevations. Under the different climate change scenarios, these areas will be slightly shifted towards higher elevation with varied magnitude and spatial patterns. Population exposed to climatically suitable areas of dengue fever in Nepal is anticipated to further increase in both 2050s and 2070s on all the assumed emission scenarios. These findings could be instrumental to plan and execute the strategic interventions for controlling dengue fever in Nepal. Full article

(This article belongs to the Special Issue Health Impacts of Warming of 1.5 °C and 2 °C)

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9 pages, 456 KiB

Open AccessFeature PaperArticle

Parental Attitudes, Behaviors, and Barriers to School Readiness among Parents of Low-Income Latino Children

by Jaime Peterson, Janine Bruce, Neel Patel and Lisa J. Chamberlain

Int. J. Environ. Res. Public Health 2018, 15(2), 188; https://doi.org/10.3390/ijerph15020188 - 24 Jan 2018

Cited by 33 | Viewed by 9470

Abstract

We sought to explore parental attitudes, behaviors, and barriers regarding school readiness in a county clinic serving low income, Latino children. Between December 2013–September 2014, we conducted a cross sectional survey of parents during 3–6 years well-child appointments about school readiness (SR) across: [...] Read more.

We sought to explore parental attitudes, behaviors, and barriers regarding school readiness in a county clinic serving low income, Latino children. Between December 2013–September 2014, we conducted a cross sectional survey of parents during 3–6 years well-child appointments about school readiness (SR) across: (1) attitudes/behaviors; (2) barriers; and (3) awareness; and (4) use of local resources. Most parents (n = 210, response rate 95.6%) find it very important/important for their child to know specific skills prior to school: take turns and share (98.5%), use a pencil and count (97.6%), know letters (99.1%), colors (97.1%), and shapes (96.1%). Over 80% of parents find education important and engage in positive SR behaviors: singing, practicing letters, or reading. Major barriers to SR were lack of knowledge for kindergarten readiness, language barriers, access to books at home, constraints on nightly reading, difficulty completing school forms, and limited free time with child. Awareness of local resources such as preschool programs was higher than actual utilization. These low-income, Latino parents value SR but lack knowledge to prepare their child for school and underutilize community resources such as free preschool programs. Pediatricians are uniquely positioned to address these needs, but more evidence-based interventions are needed. Full article

(This article belongs to the Special Issue The Health Needs of Vulnerable Children: Challenges and Solutions)

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11 pages, 1734 KiB

Open AccessArticle

A Cross-Sectional Study of Viral Hepatitis Perception among Residents from Southeast and North Regions of Brazil

by Helena Medina Cruz, Vanessa Salete De Paula and Livia Melo Villar

Int. J. Environ. Res. Public Health 2018, 15(2), 189; https://doi.org/10.3390/ijerph15020189 - 24 Jan 2018

Cited by 9 | Viewed by 6176

Abstract

Few data are available regarding viral hepatitis perception among the general global population. The present study aims to estimate the perception of viral hepatitis in a cohort of individuals living in two geographical regions of Brazil: North (Manaus city (MA)) and Southeast (Rio [...] Read more.

Few data are available regarding viral hepatitis perception among the general global population. The present study aims to estimate the perception of viral hepatitis in a cohort of individuals living in two geographical regions of Brazil: North (Manaus city (MA)) and Southeast (Rio de Janeiro city (RJ)). A cross-sectional, descriptive study was carried out among 287 subjects recruited in MA (134) and RJ (153). All individuals answered a questionnaire assessing socio-demographic characteristics and viral hepatitis awareness. Participants’ responses were scored and divided using interquartile values. Associations between socio-demographic characteristics and knowledge were also evaluated. Interquartile analysis scored 0–21 correct answers as “Very Weak”; 22–27 as “Weak”; 28–31 as “Intermediate”; and 32–47 as “Desirable”. Mean ± standard deviations (SD) of correct responses were weak in both MA (24.1 ± 7.0) and RJ (26.3 ± 7.3). Bivariate analysis showed an association between viral hepatitis awareness and both education level (p < 0.001) and family income (p < 0.01). Desirable scores were more common in female participants (61%), those aged between 21–30 years (40%), those with a secondary education (51.7%), those who received high income (31.6%), and those from RJ (70.0%). Health education campaigns in these cities are recommended to increase knowledge and reduce the transmission of these viruses. Full article

(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)

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17 pages, 711 KiB

Open AccessFeature PaperArticle

What Works? Toward a New Classification System for Mental Health Supported Accommodation Services: The Simple Taxonomy for Supported Accommodation (STAX-SA)

by Peter McPherson, Joanna Krotofil and Helen Killaspy

Int. J. Environ. Res. Public Health 2018, 15(2), 190; https://doi.org/10.3390/ijerph15020190 - 24 Jan 2018

Cited by 69 | Viewed by 8871

Abstract

Inconsistent terminology and variation in service models have made synthesis of the supported accommodation literature challenging. To overcome this, we developed a brief, categorical taxonomy that aimed to capture the defining features of different supported accommodation models: the simple taxonomy for supported accommodation [...] Read more.

Inconsistent terminology and variation in service models have made synthesis of the supported accommodation literature challenging. To overcome this, we developed a brief, categorical taxonomy that aimed to capture the defining features of different supported accommodation models: the simple taxonomy for supported accommodation (STAX-SA). Data from a previous review of existing classification systems were used to develop the taxonomy structure. After initial testing and amendments, the STAX-SA and an existing taxonomy were applied to 132 supported accommodation service descriptions drawn from two systematic reviews and their performance compared. To assess external validity, the STAX-SA was distributed to a sample of supported accommodation managers in England and they were asked to use it to classify their services. The final version of the STAX-SA comprised of five supported accommodation ‘types’, based on four domains; Staffing location; Level of support; Emphasis on move-on; and Physical setting. The STAX-SA accurately categorized 71.1% (n = 94) of service descriptions, outperforming the comparison tool, and was not affected by publication date or research design. The STAX-SA effectively discriminated between ‘real world’ service models in England and 53.2% (n = 17) of service managers indicated that the taxonomy was ‘Very effective’ or ‘Extremely effective’ in capturing key characteristics of their service. The STAX-SA is an effective tool for classifying supported accommodation models and represents a promising approach to synthesizing the extant effectiveness literature. The authors recommend the development of reporting guidelines for future supported accommodation publications to facilitate comparison between models. Full article

(This article belongs to the Special Issue Mental Health and Social Care and Social Interventions)

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17 pages, 770 KiB

Open AccessFeature PaperArticle

Allostatic Load and Effort-Reward Imbalance: Associations over the Working-Career

by José Ignacio Cuitún Coronado, Tarani Chandola and Andrew Steptoe

Int. J. Environ. Res. Public Health 2018, 15(2), 191; https://doi.org/10.3390/ijerph15020191 - 24 Jan 2018

Cited by 25 | Viewed by 7064

Abstract

Although associations between work stressors and stress-related biomarkers have been reported in cross-sectional studies, the use of single time measurements of work stressors could be one of the reasons for inconsistent associations. This study examines whether repeated reports of work stress towards the [...] Read more.

Although associations between work stressors and stress-related biomarkers have been reported in cross-sectional studies, the use of single time measurements of work stressors could be one of the reasons for inconsistent associations. This study examines whether repeated reports of work stress towards the end of the working career predicts allostatic load, a measure of chronic stress related physiological processes. Data from waves 2 to 6 of the English Longitudinal Study of Ageing (ELSA) were analysed, with a main analytical sample of 2663 older adults (aged 50+) who had at least one measurement of effort-reward imbalance between waves 2–6 and a measurement of allostatic load at wave 6. Cumulative work stress over waves 2–6 were measured by the effort-reward imbalance model. ELSA respondents who had reported two or more occasions of imbalance had a higher (0.3) estimate of the allostatic load index than those who did not report any imbalance, controlling for a range of health and socio-demographic factors, as well as allostatic load at baseline. More recent reports of imbalance were significantly associated with a higher allostatic load index, whereas reports of imbalance from earlier waves of ELSA were not. The accumulation of work related stressors could have adverse effects on chronic stress biological processes. Full article

(This article belongs to the Special Issue Work Stress and the Development of Chronic Diseases)

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11 pages, 309 KiB

Open AccessArticle

Oral Contact Events and Caregiver Hand Hygiene: Implications for Fecal-Oral Exposure to Enteric Pathogens among Infants 3–9 Months Living in Informal, Peri-Urban Communities in Kisumu, Kenya

by Emily Davis, Oliver Cumming, Rose Evalyne Aseyo, Damaris Nelima Muganda, Kelly K. Baker, Jane Mumma and Robert Dreibelbis

Int. J. Environ. Res. Public Health 2018, 15(2), 192; https://doi.org/10.3390/ijerph15020192 - 24 Jan 2018

Cited by 21 | Viewed by 5691

Abstract

Childhood diarrhea is one of the leading causes of morbidity and mortality in children under five in low and middle-income countries, second only to respiratory illness. The mouthing behavior that is common in children exposes them to fecal-orally transmitted pathogens that can result [...] Read more.

Childhood diarrhea is one of the leading causes of morbidity and mortality in children under five in low and middle-income countries, second only to respiratory illness. The mouthing behavior that is common in children exposes them to fecal-orally transmitted pathogens that can result in diarrhea; however, there is a need for further evidence on specific exposure routes. This study describes the frequency and diversity of two important routes of enteric pathogen exposure among infants 3–9 months of age: infant oral contact behavior and caregiver handwashing behavior. Data were collected through structured observations of 25 index infants for the oral contact data and 25 households for the caregiver handwashing data in a peri-urban setting in Kisumu (Obunga), Kenya. Breast was the most common type of oral contact event with an average of 3.00 per observation period and 0.5 events per hour. This was followed by a range of physical objects with an average of 2.49 per observation and 0.4 events per hour. The “infant’s own hands” was the third most common oral contact, with an average of 2.16 events per hour, and 0.4 oral contact events per hour. Food and liquids were the 4th and 5th most common oral contact events with an average of 1.64 food contacts and 0.52 liquid oral contact events per observation period. Feeding events, including breastfeeding, were the most commonly observed key juncture—71% of total junctures observed were caregivers feeding children. This was followed by child cleaning (23%), caregiver toilet uses at (4%), and lastly food preparation at 2%. HWWS was observed only once before a feeding event (1%), twice after cleaning a child (9%), and twice after caregiver toilet use (40%). The combined implication of data from observing oral contact behavior in children and hand hygiene of caregivers suggests that caregiver hand hygiene prior to feeding events and after cleaning a child are priority interventions. Full article

(This article belongs to the Section Environmental Health)

16 pages, 297 KiB

Open AccessArticle

“Girls Have More Challenges; They Need to Be Locked Up”: A Qualitative Study of Gender Norms and the Sexuality of Young Adolescents in Uganda

by Anna B. Ninsiima, Els Leye, Kristien Michielsen, Elizabeth Kemigisha, Viola N. Nyakato and Gily Coene

Int. J. Environ. Res. Public Health 2018, 15(2), 193; https://doi.org/10.3390/ijerph15020193 - 24 Jan 2018

Cited by 80 | Viewed by 10341

Abstract

Unequal power and gender norms expose adolescent girls to higher risks of HIV, early marriages, pregnancies and coerced sex. In Uganda, almost half of the girls below the age of 18 are already married or pregnant, which poses a danger to the lives [...] Read more.

Unequal power and gender norms expose adolescent girls to higher risks of HIV, early marriages, pregnancies and coerced sex. In Uganda, almost half of the girls below the age of 18 are already married or pregnant, which poses a danger to the lives of young girls. This study explores the social construction of gender norms from early childhood, and how it influences adolescents’ agency. Contrary to the mainstream theory of agency, which focuses on the ability to make informed choices, adolescents’ agency appears constrained by context-specific obstacles. This study adopted qualitative research approaches involving 132 participants. Of these, 44 were in-depth interviews and 11 were focus group discussions, parcelled out into separate groups of adolescents (12–14 years), teachers, and parents (n = 88), in Western Uganda. Data were analysed manually using open and axial codes, and conclusions were inductive. Results show that gender norms are established early in life, and have a very substantial impact on the agency of young adolescents. There were stereotypical gender norms depicting boys as sexually active and girls as restrained; girls’ movements were restricted; their sexual agency constrained; and prevention of pregnancy was perceived as a girl’s responsibility. Programs targeting behavioural change need to begin early in the lives of young children. They should target teachers and parents about the values of gender equality and strengthen the legal system to create an enabling environment to address the health and wellbeing of adolescents. Full article

(This article belongs to the Special Issue Teenage Reproductive Health: Pregnancy, Contraception, Unsafe Abortion, Fertility)

23 pages, 2758 KiB

Open AccessArticle

Multiple Attribute Group Decision-Making Methods Based on Trapezoidal Fuzzy Two-Dimensional Linguistic Partitioned Bonferroni Mean Aggregation Operators

by Kedong Yin, Benshuo Yang and Xuemei Li

Int. J. Environ. Res. Public Health 2018, 15(2), 194; https://doi.org/10.3390/ijerph15020194 - 24 Jan 2018

Cited by 17 | Viewed by 4538

Abstract

In this paper, we investigate multiple attribute group decision making (MAGDM) problems where decision makers represent their evaluation of alternatives by trapezoidal fuzzy two-dimensional uncertain linguistic variable. To begin with, we introduce the definition, properties, expectation, operational laws of trapezoidal fuzzy two-dimensional linguistic [...] Read more.

In this paper, we investigate multiple attribute group decision making (MAGDM) problems where decision makers represent their evaluation of alternatives by trapezoidal fuzzy two-dimensional uncertain linguistic variable. To begin with, we introduce the definition, properties, expectation, operational laws of trapezoidal fuzzy two-dimensional linguistic information. Then, to improve the accuracy of decision making in some case where there are a sort of interrelationship among the attributes, we analyze partition Bonferroni mean (PBM) operator in trapezoidal fuzzy two-dimensional variable environment and develop two operators: trapezoidal fuzzy two-dimensional linguistic partitioned Bonferroni mean (TF2DLPBM) aggregation operator and trapezoidal fuzzy two-dimensional linguistic weighted partitioned Bonferroni mean (TF2DLWPBM) aggregation operator. Furthermore, we develop a novel method to solve MAGDM problems based on TF2DLWPBM aggregation operator. Finally, a practical example is presented to illustrate the effectiveness of this method and analyses the impact of different parameters on the results of decision-making. Full article

(This article belongs to the Special Issue Decision Models in Green Growth and Sustainable Development)

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19 pages, 2578 KiB

Open AccessArticle

Optimum Water Quality Monitoring Network Design for Bidirectional River Systems

by Xiaohui Zhu, Yong Yue, Prudence W. H. Wong, Yixin Zhang and Jianhong Tan

Int. J. Environ. Res. Public Health 2018, 15(2), 195; https://doi.org/10.3390/ijerph15020195 - 24 Jan 2018

Cited by 5 | Viewed by 4764

Abstract

Affected by regular tides, bidirectional water flows play a crucial role in surface river systems. Using optimization theory to design a water quality monitoring network can reduce the redundant monitoring nodes as well as save the costs for building and running a monitoring [...] Read more.

Affected by regular tides, bidirectional water flows play a crucial role in surface river systems. Using optimization theory to design a water quality monitoring network can reduce the redundant monitoring nodes as well as save the costs for building and running a monitoring network. A novel algorithm is proposed to design an optimum water quality monitoring network for tidal rivers with bidirectional water flows. Two optimization objectives of minimum pollution detection time and maximum pollution detection probability are used in our optimization algorithm. We modify the Multi-Objective Particle Swarm Optimization (MOPSO) algorithm and develop new fitness functions to calculate pollution detection time and pollution detection probability in a discrete manner. In addition, the Storm Water Management Model (SWMM) is used to simulate hydraulic characteristics and pollution events based on a hypothetical river system studied in the literature. Experimental results show that our algorithm can obtain a better Pareto frontier. The influence of bidirectional water flows to the network design is also identified, which has not been studied in the literature. Besides that, we also find that the probability of bidirectional water flows has no effect on the optimum monitoring network design but slightly changes the mean pollution detection time. Full article

(This article belongs to the Special Issue Innovative Methods for Monitoring and Assessment of Contaminants in Aquatic Ecosystems)

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8 pages, 1004 KiB

Open AccessArticle

Examining the Impact of Maternal Individual Features on Children’s Behavioral Problems in Adoptive Families: The Role of Maternal Temperament and Neurobiological Markers

by Yagmur Ozturk, Virginia Barone and Lavinia Barone

Int. J. Environ. Res. Public Health 2018, 15(2), 196; https://doi.org/10.3390/ijerph15020196 - 24 Jan 2018

Cited by 5 | Viewed by 4536

Abstract

The first year after adoption constitutes a sensitive period for both strengthening the new emotional bond in the family and checking its appropriate development by adoption services. A key variable for children’s catch-up are adoptive parents’ socioemotional and individual features. The aim of [...] Read more.

The first year after adoption constitutes a sensitive period for both strengthening the new emotional bond in the family and checking its appropriate development by adoption services. A key variable for children’s catch-up are adoptive parents’ socioemotional and individual features. The aim of this study is to investigate links between adoptive mothers’ individual features and behavioral problems in their children in the first year after adoption placement, by testing the moderating role of both age at adoption and maternal genetic polymorphisms. Seventy-eight adoptive mothers completed temperament and genetic measures. Mothers showed a specific pattern of interaction between basic temperament traits and genetic markers in their assessment of children’s behavioral problems; dopamine D4 receptor gene and children’s age at adoption are two moderators in the association in which mothers’ temperament was affecting the evaluation of their children’s behavioral problems. Findings highlight a still undervalued area of parenting resources in the process of post-institutionalized children’s catch-up after adoption placement, by showing how individual features count in the commonly measured variable of children’s behavioral and emotional problems. This could help in orienting identification and choice of key variables for family assessment after adoption placement, thus contributing in fostering children’s healthy development. Full article

(This article belongs to the Special Issue Maternal and Child Health 2018)

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15 pages, 1060 KiB

Open AccessArticle

Managing Exposure to Benzene and Total Petroleum Hydrocarbons at Two Oil Refineries 1977–2014

by Tapani Tuomi, Henna Veijalainen and Tiina Santonen

Int. J. Environ. Res. Public Health 2018, 15(2), 197; https://doi.org/10.3390/ijerph15020197 - 24 Jan 2018

Cited by 13 | Viewed by 5414

Abstract

Air concentrations of and inhalation exposure to total petroleum hydrocarbons (TPH) and benzene was monitored separately at two oil refineries from 1977 to 2014. Prevention policies and control measures that may explain changes were surveyed. The aim was to evaluate how the application [...] Read more.

Air concentrations of and inhalation exposure to total petroleum hydrocarbons (TPH) and benzene was monitored separately at two oil refineries from 1977 to 2014. Prevention policies and control measures that may explain changes were surveyed. The aim was to evaluate how the application of of Occupational Health and Safety Assessment Series OHSAS 18001.04 principles as well as Environmental protection Agency EPA and European Oil Company Organisation for Environment, Health and Safety CONCAWE practices have influenced air concentrations. Benzene air concentrations declined in 11 of 17 units, six of which were associated with declining exposures. Benzene air concentrations declined across all units on average by 46%. This amounts to an average yearly decline of 1.7%. TPH air concentrations declined in 10 of 17 units, seven of which were associated with declining exposures. The average decline in TPH air concentrations was 49%, corresponding to 1.3% per year. As a result, average working day exposure in 10 of 17 units have declined significantly and today, benzene and TPH exposure in most units are well below 10% of the current Occupational Exposure Limit (OEL_8h:s). A decline in air concentrations have coincided with consistent implementation of control measures. Such measures include on-line monitoring of leaks; benzene recovery; floating container roofs; improved valves and seals; hermetic pumps; recovery of loading gases and instalment of torches in terminals; cutback in coke combustion; a new production line spanning directly from the dock to aromatics production; and recovery of loading gases in the doc. Other tools in exposure management include personal leak monitors, on-line measurements, monitoring campaigns, risk assessment, and availability and user training of protective equipment. However, improvements are still needed. Hydrocarbon or benzene air concentrations have not declined in 8 of 17 units, in some of which concentrations exceed 10% of the relevant OEL_8h value. In addition, for benzene even 10% of the current OEL, 0.1 ppm, might still possess a risk. With this in mind, methods to estimate exposure at the refineries need to be improved to enable measuring benzene concentrations <0.1 ppm. Shut downs of the refinery have been associated with peaks in exposure concentrations. Consequently, effort should be placed on safe working methods pertaining to shutdowns. Also, the connection and detachment of hoses continues to be problematic from the point of view of controlling exposure. Full article

(This article belongs to the Special Issue Environmental and Occupational Exposure to Benzene and Oxidative Damage)

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12 pages, 1250 KiB

Open AccessArticle

The Asbestos Ban in Korea from a Grassroots Perspective: Why Did It Occur?

by Yu-Ryong Yoon, Kyeong Min Kwak, Yeyong Choi, Kanwoo Youn, Jinwook Bahk, Dong-Mug Kang and Domyung Paek

Int. J. Environ. Res. Public Health 2018, 15(2), 198; https://doi.org/10.3390/ijerph15020198 - 25 Jan 2018

Cited by 11 | Viewed by 5360

Abstract

In 2009, asbestos was finally banned in Korea, about 70 years after the first opening of asbestos mines under Japanese control. After having presented the history of asbestos industry, together with its regulations and health effects over time, we constructed narrative analyses of [...] Read more.

In 2009, asbestos was finally banned in Korea, about 70 years after the first opening of asbestos mines under Japanese control. After having presented the history of asbestos industry, together with its regulations and health effects over time, we constructed narrative analyses of how the asbestos issue under the prevailing risk system was managed by whom and for what purpose, to provide context for the change. We could identify five different phases: laissez-faire, politico-technical, economic–managerial, health-oriented cultural, and human rights-based post-cultural risk systems. The changes leading to the asbestos ban evolved over different phases, and each phase change was necessary to reach the final ban, in that, without resolving the previous issues by examining different categories of potential alternatives, either the final ban was not possible or, even if instituted, could not be sustained. An asbestos ban could be introduced when all the alternatives to these issues, including legitimate political windows, economic rationalizations, health risk protections, and human rights sensitivities, were available. We think the alternatives that we had were not in perfect shape, but in more or less loosely connected forms, and hence we had to know how to build solidarities between different stakeholders to compensate for the imperfections. Full article

(This article belongs to the Special Issue Global Panorama of National Experiences in Public Health Actions to Ban Asbestos)

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12 pages, 294 KiB

Open AccessArticle

Analysis and Assessment of Exposure to Selected Phthalates Found in Children’s Toys in Christchurch, New Zealand

by Matthew James Ashworth, Andrew Chappell, Ellen Ashmore and Jefferson Fowles

Int. J. Environ. Res. Public Health 2018, 15(2), 200; https://doi.org/10.3390/ijerph15020200 - 25 Jan 2018

Cited by 39 | Viewed by 5529

Abstract

Internationally several phthalates are subject to regulatory control regarding maximum allowable concentrations in children’s toys. Such regulation is not in place in New Zealand. Phthalates have been associated with developmental toxicity and endocrine disruption. We determined the concentration of seven phthalates in children’s [...] Read more.

Internationally several phthalates are subject to regulatory control regarding maximum allowable concentrations in children’s toys. Such regulation is not in place in New Zealand. Phthalates have been associated with developmental toxicity and endocrine disruption. We determined the concentration of seven phthalates in children’s toys purchased in Christchurch, New Zealand. These results provided data for an exposure assessment deriving Hazard Indices (HI) for oral and dermal exposure routes in children, based on the concentration of mixtures of phthalates shown by the EU to produce either reproductive/developmental or hepatotoxic effects. Of the 49 toys analyzed, 65% contained at least one phthalate at a concentration of >0.1% by mass; and 35% contained multiple-phthalates at individual concentrations of >0.1%. A HI of 3.4 was derived for the combined exposures to the four phthalates associated with reproductive and developmental effects. A HI of 0.3 was derived for the group of phthalates associated with hepatotoxic effects. Five phthalates were detected at levels exceeding the EU regulatory limit of 0.1% by mass. Risk assessment calculations indicate that, using realistic exposure scenarios, the worst-case combined exposure to phthalates associated with developmental toxicity exceeded a HI of 1 so may cause adverse developmental effects. Full article

10 pages, 282 KiB

Open AccessArticle

Urinary Metabolite Levels of Flame Retardants in Electronic Cigarette Users: A Study Using the Data from NHANES 2013–2014

by Binnian Wei, Maciej L. Goniewicz, Richard J. O’Connor, Mark J. Travers and Andrew J. Hyland

Int. J. Environ. Res. Public Health 2018, 15(2), 201; https://doi.org/10.3390/ijerph15020201 - 25 Jan 2018

Cited by 16 | Viewed by 5359

Abstract

Evaluating the safety of e-cigarettes and making informed judgement about developing potential standards require sufficient scientific evidence. Since e-cigarettes are highly engineered products containing plastic, glass and metal parts, and e-liquids are largely different matrices, many toxic compounds which are not typical hazards [...] Read more.

Evaluating the safety of e-cigarettes and making informed judgement about developing potential standards require sufficient scientific evidence. Since e-cigarettes are highly engineered products containing plastic, glass and metal parts, and e-liquids are largely different matrices, many toxic compounds which are not typical hazards for the users of combustible tobacco products (e.g., cigarettes), could exist in e-liquids, and consequently, posing potential health risk to e-cigarette users. We combined the measurements of urinary metabolites of organophosphate flame retardants (OPFRs) with questionnaire data collected in the National Health and Nutrition Examination Surveys (NHANES) from 2013 to 2014, and we compared adjusted geometric means (GM) for each biomarker in e-cigarette users with levels in non-users and users of various tobacco products using multiple regression analyses to adjust for potential confounders. We found diphenyl phosphate (DPhP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP), bis(2-chloroethyl) phosphate (BCEP), and dibutyl phosphate (DBUP) were detected in all e-cigarette users. The adjusted GM of BCEP, the metabolite of tris(2-chloroethyl) phosphate (TCEP), was 81% higher than nonusers (p = 0.0124) and significantly higher than those for both cigarette and cigar users (p < 0.05). The findings in this pilot study suggest that certain OPFRs may present in e-cigarettes as contaminants, and consequently, resulting in higher exposure levels in e-cigarette users compared to nonusers. As we only identified 14 e-cigarette users in the survey, the findings in this study need to be confirmed in future study at a larger scale. A better examination of the types and levels of FRs and their potential contamination sources in e-cigarettes is also needed. Full article

12 pages, 3172 KiB

Open AccessArticle

Trace Elements in Soils and Selected Agricultural Plants in the Tongling Mining Area of China

by Ziwei Ding, Yang Li, Qingye Sun and Haojie Zhang

Int. J. Environ. Res. Public Health 2018, 15(2), 202; https://doi.org/10.3390/ijerph15020202 - 25 Jan 2018

Cited by 61 | Viewed by 5221

Abstract

The quality and safety of agricultural products from metal mining areas are of wide concern. In order to investigate the contents and health risks of trace elements in fruit vegetables planted in metal mining areas, 440 samples of fruit vegetables from 117 vegetable [...] Read more.

The quality and safety of agricultural products from metal mining areas are of wide concern. In order to investigate the contents and health risks of trace elements in fruit vegetables planted in metal mining areas, 440 samples of fruit vegetables from 117 vegetable plots were collected from Tongling mining area. Trace element contents in fruit vegetables and soil were measured. The results indicated that the total concentration of trace elements in some of the soil samples exceeded the Grade II national standard in China. Transfer factor (TF) of Cd was the highest (8.360), followed by Zn, Cu, As, and Pb. Estimated daily intake (EDI) of the trace elements, except Cd, were generally below the maximum tolerable daily intake (MTDI). The target hazard quotient (THQ) of Zn for children was more than 1 in some vegetables, suggesting potential health hazards for child population. Total target hazard quotient (TTHQ) of Cu and Zn were also more than 1 through consumption of all vegetables, indicating significant health risks. For both adults and children, hazard index (HI) was more than 1 for the consumption of vegetables. The findings reveal the health risks associated with the consumption of trace elements through the intake of selected vegetables in the population of Tongling. Full article

(This article belongs to the Collection Environmental Risk Assessment)

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17 pages, 2732 KiB

Open AccessArticle

Assessment of Tomato (Solanum lycopersicum L.) Producers’ Exposure Level to Pesticides, in Kouka and Toussiana (Burkina Faso)

by Diakalia Son, Fabrice K. B. Zerbo, Schémaeza Bonzi, Bruno Schiffers, Irénée Somda, Bruno Schiffers and Anne Legreve

Int. J. Environ. Res. Public Health 2018, 15(2), 204; https://doi.org/10.3390/ijerph15020204 - 25 Jan 2018

Cited by 22 | Viewed by 6411

Abstract

To assess producers’ exposure level to pesticides in vegetable production in Burkina Faso, a study was carried out in 2016 and 2017 among 30 tomato producers in the municipalities of Kouka and Toussiana. Eighteen (18) commercial formulations were identified, with more than 50% [...] Read more.

To assess producers’ exposure level to pesticides in vegetable production in Burkina Faso, a study was carried out in 2016 and 2017 among 30 tomato producers in the municipalities of Kouka and Toussiana. Eighteen (18) commercial formulations were identified, with more than 50% of pesticides destined for cotton production. Eleven active substances have been identified and the most frequently used are λ-cyhalothrin (35%), acetamiprid (22%) and profenofos (13%). The most commonly used chemical families are pyrethroids (28%) and organophosphates (18%). The study revealed a low level of training for producers, a high use of pesticides according to the Frequency Treatment Indicator, and a very low level of protection used by producers. The Health Risk Index shows that active substances such as methomyl, λ-cyhalothrin and profenofos present very high risk to operators’ health. Based on the UK-POEM model, the predictive exposure levels obtained varied from 0.0105 mg/kg body weight/day to 1.7855 mg/kg body weight/day, which is several times higher than the Acceptable Operator Exposure Level. However, the study also shows that exposure can be greatly reduced if the required Personal Protective Equipment is worn. Producers’ awareness and training on integrated pest management are necessary to reduce the risks linked to the pesticides use in Burkina Faso. Full article

(This article belongs to the Special Issue The Impact of Agricultural Pesticides on Human Health and the Environment)

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14 pages, 1447 KiB

Open AccessArticle

Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up

by Andrea D. Rozema, Marieke Hiemstra, Jolanda J. P. Mathijssen, Maria W. J. Jansen and Hans J. A. M. Van Oers

Int. J. Environ. Res. Public Health 2018, 15(2), 205; https://doi.org/10.3390/ijerph15020205 - 25 Jan 2018

Cited by 21 | Viewed by 7169

Abstract

The effectiveness of outdoor smoking bans on smoking behavior among adolescents remains inconclusive. This study evaluates the long-term impact of outdoor school ground smoking bans among adolescents at secondary schools on the use of conventional cigarettes, e-cigarettes (with/without nicotine) and water pipes. Outdoor [...] Read more.

The effectiveness of outdoor smoking bans on smoking behavior among adolescents remains inconclusive. This study evaluates the long-term impact of outdoor school ground smoking bans among adolescents at secondary schools on the use of conventional cigarettes, e-cigarettes (with/without nicotine) and water pipes. Outdoor smoking bans at 19 Dutch secondary schools were evaluated using a quasi-experimental design. Data on 7733 adolescents were obtained at baseline, and at 6 and 18-month follow-up. The impact of outdoor smoking bans on ‘ever use of conventional cigarettes’, ‘smoking onset’, ‘ever use of e-cigarette with nicotine’, ‘e-cigarette without nicotine’, and ‘water pipe’ was measured. Multilevel logistic regression analysis was used. At schools with a ban, implementation fidelity was checked. At schools where a ban was implemented, at 18-month follow-up more adolescents had started smoking compared to the control condition. No effect of implementation of the ban was found for smoking prevalence, e-cigarettes with/without nicotine, and water pipe use. Implementation fidelity was sufficient. No long-term effects were found of an outdoor smoking ban, except for smoking onset. The ban might cause a reversal effect when schools encounter difficulties with its enforcement or when adolescents still see others smoking. Additional research is required with a longer follow-up than 18 months. Full article

(This article belongs to the Special Issue Development and Evaluation of New Tobacco Control Interventions)

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17 pages, 7294 KiB

Open AccessArticle

Spatial Distribution, Chemical Fraction and Fuzzy Comprehensive Risk Assessment of Heavy Metals in Surface Sediments from the Honghu Lake, China

by Fei Li, Minsi Xiao, Jingdong Zhang, Chaoyang Liu, Zhenzhen Qiu and Ying Cai

Int. J. Environ. Res. Public Health 2018, 15(2), 207; https://doi.org/10.3390/ijerph15020207 - 26 Jan 2018

Cited by 27 | Viewed by 5084

Abstract

Spatial concentrations and chemical fractions of heavy metals (Cr, Cu, Pb, Zn and Cd) in 16 sampling sites from the Honghu Lake were investigated using an atomic absorption spectrophotometer and optimized BCR (the European Community Bureau of Reference) three-stage extraction procedure. Compared with [...] Read more.

Spatial concentrations and chemical fractions of heavy metals (Cr, Cu, Pb, Zn and Cd) in 16 sampling sites from the Honghu Lake were investigated using an atomic absorption spectrophotometer and optimized BCR (the European Community Bureau of Reference) three-stage extraction procedure. Compared with the corresponding probable effect levels (PELs), adverse biological effects of the studied five sediment metals decreased in the sequence of Cr > Cu > Zn > Pb > Cd. Geo-accumulation index (I_geo) values for Cr, Cu, Pb and Zn in each sampling site were at un-contamination level, while the values for Cd varied from un-contamination level to moderate contamination level. Spatially, the enrichment degree of Cd in lower part of the South Lake, the west part of the North Lake and the outlet were higher than the other parts of Honghu Lake. For metal chemical fractions, the proportions of the acid-extractable fraction of five metal contents were in the descending order: Cd, Cu, Zn, Pb and Cr. Cd had the highest bioaccessibility. Being the above indexes focused always on heavy metals’ total content or chemical fraction in deterministic assessment system, which may confuse decision makers, the fuzzy comprehensive risk assessment method was established based on PEI (Potential ecological risk index), RAC (Risk assessment code) and fuzzy theory. Average comprehensive risks of heavy metals in sediments revealed the following orders: Cd (considerable risk) > Cu (moderate risk) > Zn (low risk) > Pb > Cr. Thus, Cd and Cu were determined as the pollutants of most concern. The central part of South Honghu Lake (S4, S5, S6, S9, S12 and S14), east part of the North Honghu Lake (S1) and outlet of outlet of the Honghu Lake (S10) were recommended as the priority control areas. Specifically, it is necessary to pay more attention to S1, S4, S5, S6, S9 and S16 when decision making for their calculated membership values (probabilities) of adjacent risk levels quite close. Full article

(This article belongs to the Special Issue Human Health, Environmental Informatics and Risk: Managing Hazards in the Information Era)

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17 pages, 1133 KiB

Open AccessArticle

Annoyance Judgment and Measurements of Environmental Noise: A Focus on Italian Secondary Schools

by Fabrizio Minichilli, Francesca Gorini, Elena Ascari, Fabrizio Bianchi, Alessio Coi, Luca Fredianelli, Gaetano Licitra, Federica Manzoli, Lorena Mezzasalma and Liliana Cori

Int. J. Environ. Res. Public Health 2018, 15(2), 208; https://doi.org/10.3390/ijerph15020208 - 26 Jan 2018

Cited by 142 | Viewed by 9985

Abstract

The effects of noise on students’ health, well-being, and learning are of growing concern among both the general public and policy-makers in Europe. Several studies have highlighted the consequences of noise on children’s learning and performance at school. This study investigates the relationship [...] Read more.

The effects of noise on students’ health, well-being, and learning are of growing concern among both the general public and policy-makers in Europe. Several studies have highlighted the consequences of noise on children’s learning and performance at school. This study investigates the relationship between noise judgment in school goers aged 11–18 and noise measurements aimed at evaluating their exposure at school. For this purpose, a questionnaire was administered to 521 individuals in 28 classrooms in eight schools of four cities in Italy, with different environmental characteristics. Using a Likert-type scale, a selected set of responses related to noise generated an Annoyance Index (AI) score for each student and a classroom median score (MAI). From the noise data acquired, a global noise score (GNS) was assigned to each classroom. A higher AI was found in industrialized areas and among younger students. No significant differences in noise judgment were found by gender. A significant inverse correlation was described between MAI and GNS, thus the better the acoustic quality of the classrooms, the less the perceived noise and annoyance. The results show that noise perception and consequent disturbance are highly correlated with classroom acoustics, and confirm that annoyance represents the most widespread subjective response to noise. Full article

(This article belongs to the Special Issue Noise-Related Annoyance)

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10 pages, 312 KiB

Open AccessArticle

Self-Harm among Young People Detained in the Youth Justice System in Sri Lanka

by Lushan V. Hettiarachchi, Stuart A. Kinner, Holly Tibble and Rohan Borschmann

Int. J. Environ. Res. Public Health 2018, 15(2), 209; https://doi.org/10.3390/ijerph15020209 - 26 Jan 2018

Cited by 16 | Viewed by 6124

Abstract

Self-harm is prevalent in incarcerated adults, yet comparatively few studies of self-harm in detained youth (and even fewer in low- and middle-income countries) have been published. We examined the prevalence and correlates of self-harm in a sample of 181 young people (mean age [...] Read more.

Self-harm is prevalent in incarcerated adults, yet comparatively few studies of self-harm in detained youth (and even fewer in low- and middle-income countries) have been published. We examined the prevalence and correlates of self-harm in a sample of 181 young people (mean age 15.0 years, SD = 2.3) detained in the youth justice system in Sri Lanka. Structured face-to-face questionnaires assessed demographic characteristics, family and social background, substance use, self-harm history (including frequency, method, and intention), bullying victimization, physical and sexual abuse (victimization and perpetration), and exposure to self-harm/suicide by others. Seventy-seven participants (43%) reported a lifetime history of self-harm, 19 of whom (25%) who reported doing so with suicidal intent. Fifty participants (65% of those with a history of self-harm) reported engaging in self-harm impulsively, with no prior planning. A history of self-harm was associated with being female, prior sexual abuse victimization, prior exposure to self-harm by friends, and a lifetime history of self-harm ideation. High rates of substance use, bullying victimization, parental incarceration, and exposure to suicide were reported across the sample. Young people detained in the youth justice system in Sri Lanka are a vulnerable group with high rates of self-harm, substance use, and psychosocial risk factors. Strategies for identifying and preventing self-harm, and targeted psychological interventions designed specifically to address impulsivity, may contribute to more positive outcomes in this marginalised population. Full article

(This article belongs to the Special Issue Advances in Suicide Research)

16 pages, 491 KiB

Open AccessArticle

Depression in Intimate Partner Violence Victims in Slovenia: A Crippling Pattern of Factors Identified in Family Practice Attendees

by Nena Kopčavar Guček and Polona Selič

Int. J. Environ. Res. Public Health 2018, 15(2), 210; https://doi.org/10.3390/ijerph15020210 - 26 Jan 2018

Cited by 13 | Viewed by 4538

Abstract

This multi-centre cross-sectional study explored associations between prevalence of depression and exposure to intimate partner violence (IPV) at any time in patients’ adult life in 471 participants of a previous IPV study. In 2016, 174 interviews were performed, using the Short Form Domestic [...] Read more.

This multi-centre cross-sectional study explored associations between prevalence of depression and exposure to intimate partner violence (IPV) at any time in patients’ adult life in 471 participants of a previous IPV study. In 2016, 174 interviews were performed, using the Short Form Domestic Violence Exposure Questionnaire, the Zung Scale and questions about behavioural patterns of exposure to IPV. Family doctors reviewed patients’ medical charts for period from 2012 to 2016, using the Domestic Violence Exposure Medical Chart Check List, for conditions which persisted for at least three years. Depression was found to be associated with any exposure to IPV in adult life and was more likely to affect women. In multivariable logistic regression modelling, factors associated with self-rated depression were identified (p < 0.05). Exposure to emotional and physical violence was identified as a risk factor in the first model, explaining 23% of the variance. The second model explained 66% of the variance; past divorce, dysfunctional family relationships and a history of incapacity to work increased the likelihood of depression in patients. Family doctors should consider IPV exposure when detecting depression, since lifetime IPV exposure was found to be 40.4% and 36.9% of depressed revealed it. Full article

(This article belongs to the Special Issue Frontiers in Mental Health and the Environment)

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17 pages, 1302 KiB

Open AccessArticle

Long-Term Weight Loss Effects of a Behavioral Weight Management Program: Does the Community Food Environment Matter?

by Shannon N. Zenk, Elizabeth Tarlov, Coady Wing, Stephen A. Matthews, Hao Tong, Kelly K. Jones and Lisa M. Powell

Int. J. Environ. Res. Public Health 2018, 15(2), 211; https://doi.org/10.3390/ijerph15020211 - 26 Jan 2018

Cited by 12 | Viewed by 6170

Abstract

This study examined whether community food environments altered the longer-term effects of a nationwide behavioral weight management program on body mass index (BMI). The sample was comprised of 98,871 male weight management program participants and 15,385 female participants, as well as 461,302 and [...] Read more.

This study examined whether community food environments altered the longer-term effects of a nationwide behavioral weight management program on body mass index (BMI). The sample was comprised of 98,871 male weight management program participants and 15,385 female participants, as well as 461,302 and 37,192 inverse propensity-score weighted matched male and female controls. We measured the community food environment by counting the number of supermarkets, convenience stores, and fast food restaurants within a 1-mile radius around each person’s home address. We used difference-in-difference regression models with person and calendar time fixed effects to estimate MOVE! effects over time in sub-populations defined by community food environment attributes. Among men, after an initial decrease in BMI at 6 months, the effect of the program decreased over time, with BMI increasing incrementally at 12 months (0.098 kg/m², p < 0.001), 18 months (0.069 kg/m², p < 0.001), and 24 months (0.067 kg/m², p < 0.001). Among women, the initial effects of the program decreased over time as well. Women had an incremental BMI change of 0.099 kg/m² at 12 months (p < 0.05) with non-significant incremental changes at 18 months and 24 months. We found little evidence that these longer-term effects of the weight management program differed depending on the community food environment. Physiological adaptations may overwhelm environmental influences on adherence to behavioral regimens in affecting longer-term weight loss outcomes. Full article

(This article belongs to the Special Issue Food Environment, Diet, and Health)

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16 pages, 628 KiB

Open AccessArticle

The Effect of Childhood Health Status on Adult Health in China

by Qing Wang, Huyang Zhang, John A. Rizzo and Hai Fang

Int. J. Environ. Res. Public Health 2018, 15(2), 212; https://doi.org/10.3390/ijerph15020212 - 26 Jan 2018

Cited by 18 | Viewed by 4548

Abstract

Childhood health in China was poor in the 1950s and 1960s because of limited nutrition. In the last three decades, China has distinguished itself through its tremendous economic growth and improvements in health and nutrition. However, prior to such growth, access to good [...] Read more.

Childhood health in China was poor in the 1950s and 1960s because of limited nutrition. In the last three decades, China has distinguished itself through its tremendous economic growth and improvements in health and nutrition. However, prior to such growth, access to good nutrition was more variable, with potentially important implications, not only for childhood health, but also for adult health, because of its long-term effects lasting into adulthood. To shed light on these issues, this study examined the long-run association between childhood health and adult health outcomes among a middle-aged Chinese population and addresses the endogeneity of childhood health. A nationwide database from the 2011 China Health and Retirement Longitudinal Study (CHARLS) was employed. Three adult health outcomes variables were used: self-reported health status, cognition, and physical function. The local variation in grain production in the subjects’ fetal period and the first 24 months following birth was employed as an instrument for childhood health in order to correct for its endogeneity. Childhood health recalled by the respondents was positively and significantly associated with their adult health outcomes in terms of self-reported health status, cognition, and physical function in single-equation estimates that did not correct for the endogeneity of childhood health. A good childhood health status increased the probabilities of good adult health, good adult cognitive function, and good adult physical function by 16% (95% CI: 13–18%), 13% (95% CI: 10–15%), and 14% (95% CI: 12–17%), respectively. After correcting for endogeneity, the estimated effects of good childhood health were consistent but stronger. We also studied the male and female populations separately, finding that the positive effects of childhood health on adult health were larger for males. In China, childhood health significantly affects adult health. This suggests that early interventions to promote childhood health will have long-term benefits in China and that health-care policies should consider their long-term impacts over the life cycle in addition to their effects on specific age groups. Full article

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11 pages, 2371 KiB

Open AccessArticle

Physiological Effects of Visual Stimulation with Forest Imagery

by Chorong Song, Harumi Ikei and Yoshifumi Miyazaki

Int. J. Environ. Res. Public Health 2018, 15(2), 213; https://doi.org/10.3390/ijerph15020213 - 26 Jan 2018

Cited by 88 | Viewed by 10814

Abstract

This study was aimed to clarify the physiological effects of visual stimulation using forest imagery on activity of the brain and autonomic nervous system. Seventeen female university students (mean age, 21.1 ± 1.0 years) participated in the study. As an indicator of brain [...] Read more.

This study was aimed to clarify the physiological effects of visual stimulation using forest imagery on activity of the brain and autonomic nervous system. Seventeen female university students (mean age, 21.1 ± 1.0 years) participated in the study. As an indicator of brain activity, oxyhemoglobin (oxy-Hb) concentrations were measured in the left and right prefrontal cortex using near-infrared time-resolved spectroscopy. Heart rate variability (HRV) was used as an indicator of autonomic nervous activity. The high-frequency (HF) component of HRV, which reflected parasympathetic nervous activity, and the ratio of low-frequency (LF) and high-frequency components (LF/HF), which reflected sympathetic nervous activity, were measured. Forest and city (control) images were used as visual stimuli using a large plasma display window. After sitting at rest viewing a gray background for 60 s, participants viewed two images for 90 s. During rest and visual stimulation, HRV and oxy-Hb concentration in the prefrontal cortex were continuously measured. Immediately thereafter, subjective evaluation of feelings was performed using a modified semantic differential (SD) method. The results showed that visual stimulation with forest imagery induced (1) a significant decrease in oxy-Hb concentrations in the right prefrontal cortex and (2) a significant increase in perceptions of feeling “comfortable,” “relaxed,” and “natural.” Full article

(This article belongs to the Special Issue Evidence-Based Nature Therapy: Advances in Physiological Evaluation)

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12 pages, 315 KiB

Open AccessArticle

Sex-Specific Associations in Nutrition and Activity-Related Risk Factors for Chronic Disease: Australian Evidence from Childhood to Emerging Adulthood

by Erin Hoare, Sarah R. Dash, Garry L. Jennings and Bronwyn A. Kingwell

Int. J. Environ. Res. Public Health 2018, 15(2), 214; https://doi.org/10.3390/ijerph15020214 - 26 Jan 2018

Cited by 8 | Viewed by 5305

Abstract

Global assessments of burden of disease suggests there are sex differences in risk factors for chronic disease, including overweight/obesity, dietary patterns and habitual physical activity. Given that prevention efforts aim to target such factors to reduce disease risk, the age at which sex [...] Read more.

Global assessments of burden of disease suggests there are sex differences in risk factors for chronic disease, including overweight/obesity, dietary patterns and habitual physical activity. Given that prevention efforts aim to target such factors to reduce disease risk, the age at which sex differences may occur is of particular interest. Early life to young adulthood is the optimal time for intervention, with lifestyle habits typically forming during this period. This study aimed to identify the sex differences in risk factors for chronic disease during childhood (5–9 years), adolescence (10–17 years) and emerging adulthood (18–25 years) in a large population-representative Australian sample. Among children in this study (n = 739), no sex-related differences were observed. Among adolescents (n = 1304), females were more likely than males to meet daily fruit and vegetable recommendations (12.9% vs. 7.5%; OR = 1.84, 95% CI = 1.16, 2.93, p < 0.05). Among emerging adults (n = 909), females were less likely to be overweight/obese (30.1% vs. 39.8%; OR = 0.65, 95% CI = 0.44, 0.95, p < 0.05) and more likely to meet physical activity recommendations (52.1% vs. 42.3%; OR = 1.44, 95% CI = 1.01, 2.06, p < 0.05). These findings suggest that sex differences for risk factors of chronic disease occur during adolescence and emerging adulthood, although the differences are not consistent across age periods. From adolescence onwards, it appears that females exhibit lower risk factors than males and a life span approach to risk factor monitoring is warranted. Full article

(This article belongs to the Special Issue Eating and Exercise in Children and Adolescents)

7 pages, 603 KiB

Open AccessArticle

Study of Stroke Incidence in the Aseer Region, Southwestern Saudi Arabia

by Adel A. Alhazzani, Ahmed A. Mahfouz, Ahmed Y. Abolyazid, Nabil J. Awadalla, Razia Aftab, Aesha Faraheen and Shamsun Nahar Khalil

Int. J. Environ. Res. Public Health 2018, 15(2), 215; https://doi.org/10.3390/ijerph15020215 - 26 Jan 2018

Cited by 26 | Viewed by 5883

Abstract

Recent data regarding first-stroke incidence in Saudi Arabia in general and in the Aseer region in particular are scarce and even lacking. The aim of this work was to study the first-time stroke incidence in the Aseer region, southwestern Saudi Arabia. All first-stroke [...] Read more.

Recent data regarding first-stroke incidence in Saudi Arabia in general and in the Aseer region in particular are scarce and even lacking. The aim of this work was to study the first-time stroke incidence in the Aseer region, southwestern Saudi Arabia. All first-stroke patients admitted to all hospitals in the Aseer region over a one-year period (January through December 2016) were included. Stroke patients outside the Aseer region were excluded from the study. The incidence per 100,000 patients and the concomitant 95% CI (Confidence Intervals) were computed. The present study included 1249 first-time stroke patients and calculated an overall minimal incidence rate of hospitalized first-time stroke of 57.64 per 100,000 persons per year (95% CI: 57.57–57.70). A steady increase was noticed depending on the patients' age, reaching a figure of 851.81 (95% CI: 849.2–854.5) for those patients aged 70 years and more. Overall, the incidence rate for females (48.14; 95% CI: 48.04–48.24) was lower compared to males (65.52; 95% CI: 65.1–66.0). Taking into consideration the expected rise of the elderly because of the prominent medical services provided by the Saudi government, leading to a subsequent change in the horizontal and vertical age distribution structure of the population, an increase in the number of stroke patients is expected. It is suggested to establish a nationwide stroke surveillance system in the Kingdom, with the objective to report, analyze, and maintain an updated overview of the stroke status in Saudi Arabia. Full article

(This article belongs to the Section Global Health)

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14 pages, 609 KiB

Open AccessArticle

Intention for Car Use Reduction: Applying a Stage-Based Model

by Lars E. Olsson, Jana Huck and Margareta Friman

Int. J. Environ. Res. Public Health 2018, 15(2), 216; https://doi.org/10.3390/ijerph15020216 - 26 Jan 2018

Cited by 44 | Viewed by 6743

Abstract

This study investigates which variables drive intention to reduce car use by modelling a stage of change construct with mechanisms in the Theory of Planned Behavior (TPB) and Norm Activation Model (NAM). Web questionnaires (n = 794) were collected via 11 workplaces. [...] Read more.

This study investigates which variables drive intention to reduce car use by modelling a stage of change construct with mechanisms in the Theory of Planned Behavior (TPB) and Norm Activation Model (NAM). Web questionnaires (n = 794) were collected via 11 workplaces. The socio-demographics, work commute, stage of change, attitudes to sustainable travel modes, social norms, perceived behavioral control, and personal norm were assessed. An initial descriptive analysis revealed that 19% of the employees saw no reason to reduce their car use; 35% would like to reduce their car use but felt it was impossible; 12% were thinking about reducing their car use but were unsure of how or when to do this; 12% had an aim to reduce current car use, and knew which journeys to replace and which modes to use; and 23% try to use modes other than a car for most journeys, and will maintain or reduce their already low car use in the coming months. A series of Ordered Logit Models showed that socio-demographic variables did not explain the stage of change. Instead, personal norms, instrumental and affective attitudes, and perceived behavioral control toward sustainable travel modes were all significant and explained 43% of the variance in stage of change. Furthermore, it was found that the significant relationships were not linear in nature. The analysis also showed an indirect effect of social norms on the stage of change through personal norms. Implications are discussed regarding the design of interventions aimed at influencing a sustainable work commute. Full article

(This article belongs to the Special Issue Sustainable Transportation and Health)

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12 pages, 304 KiB

Open AccessArticle

Current Age, Age at First Sex, Age at First Homelessness, and HIV Risk Perceptions Predict Sexual Risk Behaviors among Sexually Active Homeless Adults

by Diane Santa Maria, Daphne C. Hernandez, Katherine R. Arlinghaus, Kathryn R. Gallardo, Sarah B. Maness, Darla E. Kendzor, Lorraine R. Reitzel and Michael S. Businelle

Int. J. Environ. Res. Public Health 2018, 15(2), 218; https://doi.org/10.3390/ijerph15020218 - 26 Jan 2018

Cited by 12 | Viewed by 14486

Abstract

While HIV disproportionately impacts homeless individuals, little is known about the prevalence of HIV risk behaviors in the southwest and how age factors and HIV risk perceptions influence sexual risk behaviors. We conducted a secondary data analysis (n = 460) on sexually [...] Read more.

While HIV disproportionately impacts homeless individuals, little is known about the prevalence of HIV risk behaviors in the southwest and how age factors and HIV risk perceptions influence sexual risk behaviors. We conducted a secondary data analysis (n = 460) on sexually active homeless adults from a cross-sectional study of participants (n = 610) recruited from homeless service locations, such as shelters and drop-in centers, in an understudied region of the southwest. Covariate-adjusted logistic regressions were used to assess the impact of age at homelessness onset, current age, age at first sex, and HIV risk perceptions on having condomless sex, new sexual partner(s), and multiple sexual partners (≥4 sexual partners) in the past 12 months. Individuals who first experienced homelessness by age 24 were significantly more likely to report condomless sex and multiple sexual partners in the past year than those who had a later onset of their first episode of homelessness. Individuals who were currently 24 years or younger were more likely to have had condomless sex, new sexual partners, and multiple sexual partners in the past 12 months than those who were 25 years or older. Those who had low perceived HIV risk had lower odds of all three sexual risk behaviors. Social service and healthcare providers should consider a younger age at homelessness onset when targeting HIV prevention services to youth experiencing homelessness. Full article

(This article belongs to the Special Issue Health and Health Care for Homeless People in Various Contexts)

16 pages, 323 KiB

Open AccessArticle

Quality of Life (QoL) Survey in Hong Kong: Understanding the Importance of Housing Environment and Needs of Residents from Different Housing Sectors

by Zhonghua Gou, Xiaohuan Xie, Yi Lu and Maryam Khoshbakht

Int. J. Environ. Res. Public Health 2018, 15(2), 219; https://doi.org/10.3390/ijerph15020219 - 27 Jan 2018

Cited by 59 | Viewed by 9464

Abstract

This study presents a Quality of Life (QoL) survey to understand the influence of the housing environment and needs of residents from different housing sectors. The research focuses on Hong Kong where living conditions have become the main affect for people’s QoL. Through [...] Read more.

This study presents a Quality of Life (QoL) survey to understand the influence of the housing environment and needs of residents from different housing sectors. The research focuses on Hong Kong where living conditions have become the main affect for people’s QoL. Through a household survey using a standard instrument “Word Health Organisation (WHO) Quality of Life-BREF”, the article found that among the four WHO QoL domains (Physical Health, Psychological Health, Social Relations And Environment), Environment, particularly its constitute aspect housing environment was the most influential factor for overall quality of life for the public rental housing sector where low-income people live. This research also found that different groups of people have differing needs of their housing environments: the low-income group needs better location and privacy while the medium and high-income groups need better architectural quality. Based on differentiating their needs and wants, this research argues for prioritizing the low-income group’s needs for effectively improving their QoL. Full article

14 pages, 457 KiB

Open AccessArticle

Environmental Regulation, Foreign Direct Investment and Green Technological Progress—Evidence from Chinese Manufacturing Industries

by Jiangfeng Hu, Zhao Wang, Yuehan Lian and Qinghua Huang

Int. J. Environ. Res. Public Health 2018, 15(2), 221; https://doi.org/10.3390/ijerph15020221 - 29 Jan 2018

Cited by 85 | Viewed by 7533

Abstract

This study examines the spillover effects of foreign direct investment (FDI) on green technology progress rate (as measured by the green total factor productivity). The analysis utilizes two measures of FDI, labor-based FDI and capital-based FDI, and separately investigates four sets of industry [...] Read more.

This study examines the spillover effects of foreign direct investment (FDI) on green technology progress rate (as measured by the green total factor productivity). The analysis utilizes two measures of FDI, labor-based FDI and capital-based FDI, and separately investigates four sets of industry classifications—high/low discharge regulation and high/low emission standard regulation. The results indicate that in the low discharge regulation and low emission standard regulation industry, labor-based FDI has a significant negative spillover effect, and capital-based FDI has a significant positive spillover effect. However, in the high-intensity environmental regulation industry, the negative influence of labor-based FDI is completely restrained, and capital-based FDI continues to play a significant positive green technological spillover effects. These findings have clear policy implications: the government should be gradually reducing the labor-based FDI inflow or increasing stringency of environmental regulation in order to reduce or eliminate the negative spillover effect of the labor-based FDI. Full article

(This article belongs to the Special Issue Decision Models in Green Growth and Sustainable Development)

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14 pages, 295 KiB

Open AccessArticle

An Online Survey of New Zealand Vapers

by Penelope Truman, Marewa Glover and Trish Fraser

Int. J. Environ. Res. Public Health 2018, 15(2), 222; https://doi.org/10.3390/ijerph15020222 - 29 Jan 2018

Cited by 13 | Viewed by 8533

Abstract

Using electronic cigarettes (vaping) is controversial, but is increasingly widespread. This paper reports the results of an electronic survey of vapers in New Zealand, a country where the sale and supply of e-liquids containing nicotine is illegal, although vapers can legally access e-liquids [...] Read more.

Using electronic cigarettes (vaping) is controversial, but is increasingly widespread. This paper reports the results of an electronic survey of vapers in New Zealand, a country where the sale and supply of e-liquids containing nicotine is illegal, although vapers can legally access e-liquids from overseas. An on-line survey was conducted, using vaper and smoking cessation networks for recruitment, with follow up surveys conducted 1 and 2 months after the initial survey. 218 participants were recruited. Almost all had been smokers, but three quarters no longer smoked, with the remainder having significantly reduced their tobacco use. Three participants were non-smokers before starting to vape, but none had gone on to become smokers. The overriding motivation to begin and continue vaping was to stop or to reduce smoking. The results were consistent with a progression from initially both vaping and smoking using less effective electronic cigarette types, then moving to more powerful devices, experimentation with flavors and nicotine strengths—all resulting in reducing or stopping tobacco use. Lack of access to nicotine and lack of support for their chosen cessation method were the main problems reported. Vaping had resulted in effective smoking cessation for the majority of participants. Full article

(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)

12 pages, 308 KiB

Open AccessArticle

Factors Associated with Cigarette Smoking and Motivation to Quit among Street Food Sellers in Vietnam

by Xuan Thanh Thi Le, Lien Thi To, Huong Thi Le, Hanh Duc Hoang, Khanh Nam Do, Cuong Tat Nguyen, Bach Xuan Tran, Huyen Phuc Do, Luong Thanh Nguyen, Carl A. Latkin, Melvyn W. B. Zhang and Roger C. M. Ho

Int. J. Environ. Res. Public Health 2018, 15(2), 223; https://doi.org/10.3390/ijerph15020223 - 29 Jan 2018

Cited by 1 | Viewed by 5196

Abstract

Since 2013, smoke-free signs in public places, including in restaurants and food stores, have been introduced in Vietnam, aiming to prevent passive smoking. Although extensive research has been carried out on second-hand smoking among clients in public places (e.g., hospitals, restaurants) in Vietnam, [...] Read more.

Since 2013, smoke-free signs in public places, including in restaurants and food stores, have been introduced in Vietnam, aiming to prevent passive smoking. Although extensive research has been carried out on second-hand smoking among clients in public places (e.g., hospitals, restaurants) in Vietnam, no single study exists which captures the current practice of smoking among street food outlets. This study aims to estimate the prevalence of smoking and identify factors associated with smoking status and cessation motivation amongst food sellers in Vietnam. A cross-sectional study involving 1733 food providers at outlets was conducted in 29 districts in Hanoi capital, Vietnam, in 2015. The prevalence of smoking amongst food sellers was determined to be 8.5% (25% for men and 0.8% for women). The enforcement of the smoke-free policy remains modest, since only 7.9% observed outlets complied with the law, providing a room designated for smokers. Although approximately 80% of the participants were aware of the indoor smoke-free regulations in public places, such as restaurants and food stores, 40.2% of smokers reported no intention of quitting smoking. A percentage of 37.6% of current smokers reported that despite having intentions to quit, they did not receive any form of support for smoking cessation. Being male and having hazardous drinking habits and a poor quality of life were all factors that were significantly associated with smoking status. Additionally, having awareness of smoking’s adverse effects and being frequently supervised by the authority were associated with a greater motivation to quit. This study highlights the importance of an accompanying education and smoking cessation program in addition to the frequent inspection and reinforcement of smoke-free policy in food stores. This research extends on our knowledge of smoking prevalence and its factors related to smoking events and motivation to quit among street food outlets. Overall, this study strengthens the idea that more government efforts towards preventing passive smoking and smoking cessation education are necessary in restaurants and other street food outlets. Full article

17 pages, 1493 KiB

Open AccessArticle

Are Perceived and Objective Distances to Fresh Food and Physical Activity Resources Associated with Cardiometabolic Risk?

by Katherine L. Baldock, Catherine Paquet, Natasha J. Howard, Neil T. Coffee, Anne W. Taylor and Mark Daniel

Int. J. Environ. Res. Public Health 2018, 15(2), 224; https://doi.org/10.3390/ijerph15020224 - 29 Jan 2018

Cited by 23 | Viewed by 5000

Abstract

Perceived and objective measures of neighbourhood features have shown limited correspondence. Few studies have examined whether discordance between objective measures and individual perceptions of neighbourhood environments relates to individual health. Individuals with mismatched perceptions may benefit from initiatives to improve understandings of resource [...] Read more.

Perceived and objective measures of neighbourhood features have shown limited correspondence. Few studies have examined whether discordance between objective measures and individual perceptions of neighbourhood environments relates to individual health. Individuals with mismatched perceptions may benefit from initiatives to improve understandings of resource availability. This study utilised data from n = 1491 adult participants in a biomedical cohort to evaluate cross-sectional associations between measures of access (perceived, objective, and perceived-objective mismatch) to fruit and vegetable retailers (FVR) and public open space (POS), and clinically-measured metabolic syndrome and its component risk factors: central obesity, dyslipidaemia, hypertension and pre-diabetes/diabetes. Access measures included perceived distances from home to the nearest FVR and POS, corresponding objectively-assessed road network distances, and the discordance between perceived and objective distances (overestimated (i.e., mismatched) distances versus matched perceived-objective distances). Individual and neighbourhood measures were spatially joined using a geographic information system. Associations were evaluated using multilevel logistic regression, accounting for individual and area-level covariates. Hypertension was positively associated with perceived distances to FVR (odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.02, 1.28) and POS (OR = 1.19, 95% CI = 1.05, 1.34), after accounting for covariates and objective distances. Hypertension was positively associated with overestimating distances to FVR (OR = 1.36, 95% CI = 1.02, 1.80). Overestimating distances to POS was positively associated with both hypertension (OR = 1.42, 95% CI = 1.11, 1.83) and dyslipidaemia (OR = 1.25, 95% CI = 1.00, 1.57). Results provide new evidence for specific associations between perceived and overestimated distances from home to nearby resources and cardiometabolic risk factors. Full article

(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)

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14 pages, 2124 KiB

Open AccessArticle

Exploring the Impacts of Housing Condition on Migrants’ Mental Health in Nanxiang, Shanghai: A Structural Equation Modelling Approach

by Yang Xiao, Siyu Miao, Chinmoy Sarkar, Huizhi Geng and Yi Lu

Int. J. Environ. Res. Public Health 2018, 15(2), 225; https://doi.org/10.3390/ijerph15020225 - 29 Jan 2018

Cited by 46 | Viewed by 8976

Abstract

Although rapid urbanization and associated rural-to-urban migration has brought in enormous economic benefits in Chinese cities, one of the negative externalities include adverse effects upon the migrant workers’ mental health. The links between housing conditions and mental health are well-established in healthy city [...] Read more.

Although rapid urbanization and associated rural-to-urban migration has brought in enormous economic benefits in Chinese cities, one of the negative externalities include adverse effects upon the migrant workers’ mental health. The links between housing conditions and mental health are well-established in healthy city and community planning scholarship. Nonetheless, there has thusfar been no Chinese study deciphering the links between housing conditions and mental health accounting for macro-level community environments, and no study has previously examined the nature of the relationships in locals and migrants. To overcome this research gap, we hypothesized that housing conditions may have a direct and indirect effects upon mental which may be mediated by neighbourhood satisfaction. We tested this hypothesis with the help of a household survey of 368 adult participants in Nanxiang Town, Shanghai, employing a structural equation modeling approach. Our results point to the differential pathways via which housing conditions effect mental health in locals and migrants. For locals, housing conditions have direct effects on mental health, while as for migrants, housing conditions have indirect effects on mental health, mediated via neighborhood satisfaction. Our findings have significant policy implications on building an inclusive and harmonious society. Upstream-level community interventions in the form of sustainable planning and designing of migrant neighborhoods can promote sense of community, social capital and support, thereby improving mental health and overall mental capital of Chinese cities. Full article

(This article belongs to the Special Issue Frontiers in Mental Health and the Environment)

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9 pages, 294 KiB

Open AccessArticle

Association between Drug Usage and Constipation in the Elderly Population of Greater Western Sydney Australia

by Alexandra Fragakis, Jerry Zhou, Haider Mannan and Vincent Ho

Int. J. Environ. Res. Public Health 2018, 15(2), 226; https://doi.org/10.3390/ijerph15020226 - 29 Jan 2018

Cited by 15 | Viewed by 6145

Abstract

The low socioeconomic region of Greater Western Sydney (GWS) has higher than average rates of gastrointestinal symptoms. The relationship between prescription drug usage and constipation has not been explored. The aim of this study was to investigate the impact of drug use on [...] Read more.

The low socioeconomic region of Greater Western Sydney (GWS) has higher than average rates of gastrointestinal symptoms. The relationship between prescription drug usage and constipation has not been explored. The aim of this study was to investigate the impact of drug use on constipation in the elderly population of GWS (NSW, Australia). A random selection of elderly residents completed a postal questionnaire for constipation and drug use (response 30.7%). Bivariate associations between constipation and number of drug use and number of drug use with constipation adverse effect were compared. For multivariate analysis multiple logistic regression was performed for constipation with the number of drugs, use of drugs with known constipation side effects, and each drug class (Anatomical Therapeutic Chemical Classification System (ATC) level 4) as independent variables. The prevalence of constipation was 33.9%. There was a dose–response relationship between constipation and the number of drugs used (odds ratio 1.24, p < 0.001) and the usage of drugs with known constipation adverse effects (odds ratio 2.21, p = 0.009). These findings suggest that constipation is associated with the number of drugs used, particularly those with constipation adverse-effects, in the elderly of GWS. Full article

(This article belongs to the Section Global Health)

10 pages, 1268 KiB

Open AccessArticle

Do Working Conditions of Patients in Psychotherapeutic Consultation in the Workplace Differ from Those in Outpatient Care? Results from an Observational Study

by Amira Barrech, Reinhold Kilian, Edit Rottler, Lucia Jerg-Bretzke, Michael Hölzer, Monika Annemarie Rieger, Marc Nicolas Jarczok, Harald Gündel and Eva Rothermund

Int. J. Environ. Res. Public Health 2018, 15(2), 227; https://doi.org/10.3390/ijerph15020227 - 30 Jan 2018

Cited by 5 | Viewed by 4552

Abstract

In previous studies, it was found that patients treated at a psychosomatic outpatient clinic (PSOC) for common mental disorders showed more severe symptoms than those who used a psychotherapeutic consultation service at the workplace (PSIW). This study examines whether the higher symptom severity [...] Read more.

In previous studies, it was found that patients treated at a psychosomatic outpatient clinic (PSOC) for common mental disorders showed more severe symptoms than those who used a psychotherapeutic consultation service at the workplace (PSIW). This study examines whether the higher symptom severity of the PSOC patients in comparison to their PSIW counterparts is also related to higher levels of occupational stress as measured by the demand-control-support model (DCS). N = 253 participants (PSIW n = 100; PSOC n = 153) provided self-reported data on demands, decision latitude, social support, and health before consultation. The association between mental health care setting, symptom level and demands, decision latitude, and social support was assessed by means of a path model. Results of the path model indicated that the higher level of depression in PSOC patients was related to higher levels of demands and lower levels of social support. Demands and social support were found to be indirectly associated with treatment setting. No interaction effect between demands, decision latitude, social support, and depression was found. Results of this study reveal that the working conditions influenced the pathway to care process via symptom severity. Full article

(This article belongs to the Special Issue Work Stress and the Development of Chronic Diseases)

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13 pages, 513 KiB

Open AccessArticle

The Effect of the eHealth Intervention ‘MyPlan 1.0’ on Physical Activity in Adults Who Visit General Practice: A Quasi-Experimental Trial

by Laurent Degroote, Jolien Plaete, Ilse De Bourdeaudhuij, Maïté Verloigne, Vicky Van Stappen, An De Meester, Louise Poppe, Celien Van der Mispel and Geert Crombez

Int. J. Environ. Res. Public Health 2018, 15(2), 228; https://doi.org/10.3390/ijerph15020228 - 30 Jan 2018

Cited by 17 | Viewed by 4943

Abstract

Physical inactivity is one of the major risk factors for poor health in the world. Therefore, effective interventions that promote physical activity are needed. Hence, we developed an eHealth intervention for adults, i.e., ‘MyPlan 1.0’, which includes self-regulation techniques for behaviour change. This [...] Read more.

Physical inactivity is one of the major risk factors for poor health in the world. Therefore, effective interventions that promote physical activity are needed. Hence, we developed an eHealth intervention for adults, i.e., ‘MyPlan 1.0’, which includes self-regulation techniques for behaviour change. This study examined the effect of ‘MyPlan 1.0’ on physical activity (PA) levels in general practice. 615 adults (≥18 years) were recruited in 19 Flemish general practices, for the intervention group (n = 328) or for the wait-list control group (n = 183). Participants in the intervention group received the web-based intervention ‘MyPlan 1.0’ and were prompted to discuss their personal advice/action plan with their general practitioner. Participants in the wait-list control group only received general advice from the website. Self-reported physical activity was assessed with the International Physical Activity Questionnaire (IPAQ) at baseline and after one month. A three-level (general practice, adults, time) regression analysis was conducted in MLwiN. Significant intervention effects were found for total PA and moderate to vigorous PA with an increase for the intervention group compared to a decrease in the control condition. However, there was a high dropout rate in the intervention group (76%) and the wait-list control group (57%). Our self-regulation intervention was effective in increasing physical activity levels in adults. Future studies should consider strategies to prevent the large dropout from participants. Full article

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12 pages, 270 KiB

Open AccessArticle

Factors Associated with Pregnancy among Married Adolescents in Nepal: Secondary Analysis of the National Demographic and Health Surveys from 2001 to 2011

by Rina Pradhan, Karen Wynter and Jane Fisher

Int. J. Environ. Res. Public Health 2018, 15(2), 229; https://doi.org/10.3390/ijerph15020229 - 30 Jan 2018

Cited by 14 | Viewed by 5732

Abstract

Pregnancy-related morbidity and mortality are much more prevalent among adolescents than adults, particularly in low-income settings. Little is known about risk factors for pregnancy among adolescents in Nepal, but setting-specific evidence is needed to inform interventions. This study aimed to describe the prevalence, [...] Read more.

Pregnancy-related morbidity and mortality are much more prevalent among adolescents than adults, particularly in low-income settings. Little is known about risk factors for pregnancy among adolescents in Nepal, but setting-specific evidence is needed to inform interventions. This study aimed to describe the prevalence, and identify factors associated with pregnancy among adolescents in Nepal between 2001 and 2011. Secondary analyses of Nepal Demographic Health Surveys (NDHS) data from 2001, 2006, and 2011 were completed. The outcome was any pregnancy or birth among married adolescents; prevalence was calculated for each survey year. Although the rate of marriage among adolescent women in Nepal decreased significantly from 2001 to 2011, prevalence of pregnancy and birth among married adolescent women in Nepal remains high (average 56%) in Nepal, and increased significantly between 2001 and 2011. Regression analyses of this outcome indicate higher risk was associated with living in the least resourced region, early sexual debut, and older husband. Despite national efforts to reduce pregnancies among married adolescent women in Nepal, prevalence remains high. Integrated, cross-sectoral prevention efforts are required. Poverty reduction and infrastructure improvements may lead to lower rates of adolescent pregnancy. Full article

(This article belongs to the Special Issue Teenage Reproductive Health: Pregnancy, Contraception, Unsafe Abortion, Fertility)

23 pages, 5325 KiB

Open AccessArticle

Ventilation Positive Pressure Intervention Effect on Indoor Air Quality in a School Building with Moisture Problems

by Camilla Vornanen-Winqvist, Kati Järvi, Sander Toomla, Kaiser Ahmed, Maria A. Andersson, Raimo Mikkola, Tamás Marik, László Kredics, Heidi Salonen and Jarek Kurnitski

Int. J. Environ. Res. Public Health 2018, 15(2), 230; https://doi.org/10.3390/ijerph15020230 - 30 Jan 2018

Cited by 30 | Viewed by 6483

Abstract

This case study investigates the effects of ventilation intervention on measured and perceived indoor air quality (IAQ) in a repaired school where occupants reported IAQ problems. Occupants’ symptoms were suspected to be related to the impurities leaked indoors through the building envelope. The [...] Read more.

This case study investigates the effects of ventilation intervention on measured and perceived indoor air quality (IAQ) in a repaired school where occupants reported IAQ problems. Occupants’ symptoms were suspected to be related to the impurities leaked indoors through the building envelope. The study’s aim was to determine whether a positive pressure of 5–7 Pa prevents the infiltration of harmful chemical and microbiological agents from structures, thus decreasing symptoms and discomfort. Ventilation intervention was conducted in a building section comprising 12 classrooms and was completed with IAQ measurements and occupants’ questionnaires. After intervention, the concentration of total volatile organic compounds (TVOC) and fine particulate matter (PM_2.5) decreased, and occupants’ negative perceptions became more moderate compared to those for other parts of the building. The indoor mycobiota differed in species composition from the outdoor mycobiota, and changed remarkably with the intervention, indicating that some species may have emanated from an indoor source before the intervention. Full article

(This article belongs to the Special Issue Air Quality and Health)

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11 pages, 291 KiB

Open AccessArticle

Association between Social Activities and Cognitive Function among the Elderly in China: A Cross-Sectional Study

by Chang Fu, Zhen Li and Zongfu Mao

Int. J. Environ. Res. Public Health 2018, 15(2), 231; https://doi.org/10.3390/ijerph15020231 - 30 Jan 2018

Cited by 136 | Viewed by 15453

Abstract

Participation in social activities is one of important factors for older adults’ health. The present study aims to examine the cross-sectional association between social activities and cognitive function among Chinese elderly. A total of 8966 individuals aged 60 and older from the 2015 [...] Read more.

Participation in social activities is one of important factors for older adults’ health. The present study aims to examine the cross-sectional association between social activities and cognitive function among Chinese elderly. A total of 8966 individuals aged 60 and older from the 2015 China Health and Retirement Longitudinal Study were obtained for this study. Telephone interviews of cognitive status, episodic memory, and visuospatial abilities were assessed by questionnaire. We used the sum of all three of the above measures to represent the respondent’s cognitive status as a whole. Types and frequencies of participation in social groups were used to measure social activities. Multiple linear regression analysis was used to explore the relationship between social activities and cognitive function. After adjustment for demographics, smoking, drinking, depression, hypertension, diabetes, basic activities of daily living, instrumental activities of daily living, and self-rated health, multiple linear regression analysis revealed that interaction with friends, participating in hobby groups, and sports groups were associated with better cognitive function among both men and women (p < 0.05); doing volunteer work was associated with better cognitive function among women but not among men (p < 0.05). These findings suggest that there is a cross-sectional association between participation in social activities and cognitive function among Chinese elderly. Longitudinal studies are needed to examine the effects of social activities on cognitive function. Full article

(This article belongs to the Collection Aging and Public Health)

13 pages, 1008 KiB

Open AccessArticle

Determining Exposure Factors of Anti-Fogging, Dye, Disinfectant, Repellent, and Preservative Products in Korea

by Daeyeop Lee, Joo-Hyon Kim, Taksoo Kim, Hyojung Yoon, Areum Jo, Byeongwoo Lee, Hyunwoo Lim, Pilje Kim and Jungkwan Seo

Int. J. Environ. Res. Public Health 2018, 15(2), 232; https://doi.org/10.3390/ijerph15020232 - 30 Jan 2018

Cited by 3 | Viewed by 4983

Abstract

Reliable exposure factors are essential to determine health risks posed by chemicals in consumer products. We analyzed five risk-concerned product categories (anti-fogging, dye, disinfectant, repellent, and preservative products) for 13 products (three car anti-fogging products, a lens anti-fogging product, two car dye products, [...] Read more.

Reliable exposure factors are essential to determine health risks posed by chemicals in consumer products. We analyzed five risk-concerned product categories (anti-fogging, dye, disinfectant, repellent, and preservative products) for 13 products (three car anti-fogging products, a lens anti-fogging product, two car dye products, two drain disinfectants, an air conditioner disinfectant, a chlorine-based disinfectant, a fabric repellent, an insect repellent for food, and a wood preservative) considered to be of high risk in order to determine exposure factors via web surveys and estimation of amount of product. Among the 3000 participants (1482 (49%) men) aged ≥19 years, drain disinfectants were used most frequently (38.2%); the rate of usage of the other products ranged between 1.1–24.0%. The usage rates for the consumer products differed by sex, age, income, and education. Some consumer products such as car and lens anti-fogging products, chlorine-based disinfectants, fabric repellents, and drain disinfectants were regularly used more than once a month, while car dye products, air conditioner disinfectants, insect repellents for food, and wood preservatives were not regularly used owing to the specific product purposes and seasonal needs. Our results could be used for managing or controlling chemical substances in consumer products and conducting accurate exposure assessments. Full article

(This article belongs to the Collection Environmental Risk Assessment)

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31 pages, 744 KiB

Open AccessArticle

Patient Satisfaction with Pre-Hospital Emergency Services. A Qualitative Study Comparing Professionals’ and Patients’ Views

by Fernando García-Alfranca, Anna Puig, Carles Galup, Hortensia Aguado, Ismael Cerdá, Mercedes Guilabert, Virtudes Pérez-Jover, Irene Carrillo and José Joaquín Mira

Int. J. Environ. Res. Public Health 2018, 15(2), 233; https://doi.org/10.3390/ijerph15020233 - 30 Jan 2018

Cited by 25 | Viewed by 9376

Abstract

Objective: To describe patient satisfaction with pre-hospital emergency knowledge and determine if patients and professionals share a common vision on the satisfaction predictors. Methods: A qualitative study was conducted in two phases. First, a systematic review following the PRISMA protocol was carried [...] Read more.

Objective: To describe patient satisfaction with pre-hospital emergency knowledge and determine if patients and professionals share a common vision on the satisfaction predictors. Methods: A qualitative study was conducted in two phases. First, a systematic review following the PRISMA protocol was carried out searching publications between January 2000 and July 2016 in Medline, Scopus, and Cochrane. Second, three focus groups involving professionals (advisers and healthcare providers) and a total of 79 semi-structured interviews involving patients were conducted to obtain information about what dimensions of care were a priority for patients. Results: Thirty-three relevant studies were identified, with a majority conducted in Europe using questionnaires. They pointed out a very high level of satisfaction of callers and patients. Delay with the assistance and the ability for resolution of the case are the elements that overlap in fostering satisfaction. The published studies reviewed with satisfaction neither the overall care process nor related the measurement of the real time in responding to an emergency. The patients and professionals concurred in their assessments about the most relevant elements for patient satisfaction, although safety was not a predictive factor for patients. Response capacity and perceived capacity for resolving the situation were crucial factors for satisfaction. Conclusions: Published studies have assessed similar dimensions of satisfaction and have shown high patient satisfaction. Expanded services resolving a wide number of issues that can concern citizens are also positively assessed. Delays and resolution capacity are crucial for satisfaction. Furthermore, despite the fact that few explanations may be given due to a lack of face-to-face attention, finding the patient’s location, taking into account the caller’s emotional needs, and maintaining phone contact until the emergency services arrive are high predictors of satisfaction. Full article

(This article belongs to the Special Issue Healthcare Quality and Patient Satisfaction)

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19 pages, 1272 KiB

Open AccessArticle

Effectiveness of a Lifestyle Intervention on Social Support, Self-Efficacy, and Physical Activity among Older Adults: Evaluation of Texercise Select

by Marcia G. Ory, Shinduk Lee, Gang Han, Samuel D. Towne, Cindy Quinn, Taylor Neher, Alan Stevens and Matthew Lee Smith

Int. J. Environ. Res. Public Health 2018, 15(2), 234; https://doi.org/10.3390/ijerph15020234 - 30 Jan 2018

Cited by 34 | Viewed by 9202

Abstract

Despite the well-recognized benefits of physical activity across the life course, older adults are more inactive than other age groups. The current study examines the effects of Texercise Select participation on self-reported sedentary, light, moderate, and vigorous physical activity. Secondarily, this study examined [...] Read more.

Despite the well-recognized benefits of physical activity across the life course, older adults are more inactive than other age groups. The current study examines the effects of Texercise Select participation on self-reported sedentary, light, moderate, and vigorous physical activity. Secondarily, this study examined intervention effects on two potential facilitators of physical activity: (1) self-efficacy for being more physically active and (2) social support received for physical activity. This study used a non-equivalent group design with self-reported surveys administered at baseline, three-month (immediate post for cases) and six-month follow-ups for the intervention (n = 163) and a comparison group (n = 267). Multivariable mixed model analyses were conducted controlling for age, sex, race, ethnicity, education, comorbid conditions, and site. Among the intervention group, the program had significant immediate effects on most primary outcomes (p < 0.05) at three months. Furthermore, significant improvements were observed for all physical activity intensity levels at six months (p < 0.05). The reduction in sedentary behavior and increases in all physical activity intensity levels were significantly greater from baseline to three-month and baseline to six-month follow-ups among intervention group participants relative to those in the comparison group. This study confirms the effectiveness of Texercise Select to reduce sedentary behavior and improve physicality, supporting the intervention’s robustness as a scalable and sustainable evidence-based program. It also counters negative stereotypes that older adults are not interested in attending multi-modal lifestyle intervention programs nor able to make health behavior changes that can improve health and overall functioning. Full article

(This article belongs to the Collection Aging and Public Health)

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13 pages, 599 KiB

Open AccessArticle

Patterns of Signs That Telephone Crisis Support Workers Associate with Suicide Risk in Telephone Crisis Line Callers

by Tara Hunt, Coralie Wilson, Peter Caputi, Ian Wilson and Alan Woodward

Int. J. Environ. Res. Public Health 2018, 15(2), 235; https://doi.org/10.3390/ijerph15020235 - 30 Jan 2018

Cited by 8 | Viewed by 6044

Abstract

Signs of suicide are commonly used in suicide intervention training to assist the identification of those at imminent risk for suicide. Signs of suicide may be particularly important to telephone crisis-line workers (TCWs), who have little background information to identify the presence of [...] Read more.

Signs of suicide are commonly used in suicide intervention training to assist the identification of those at imminent risk for suicide. Signs of suicide may be particularly important to telephone crisis-line workers (TCWs), who have little background information to identify the presence of suicidality if the caller is unable or unwilling to express suicidal intent. Although signs of suicide are argued to be only meaningful as a pattern, there is a paucity of research that has examined whether TCWs use patterns of signs to decide whether a caller might be suicidal, and whether these are influenced by caller characteristics such as gender. The current study explored both possibilities. Data were collected using an online self-report survey in a Australian sample of 137 TCWs. Exploratory factor analysis uncovered three patterns of suicide signs that TCWs may use to identify if a caller might be at risk for suicide (mood, hopelessness, and anger), which were qualitatively different for male and female callers. These findings suggest that TCWs may recognise specific patterns of signs to identify suicide risk, which appear to be influenced to some extent by the callers’ inferred gender. Implications for the training of telephone crisis workers and others including mental-health and medical professionals, as well as and future research in suicide prevention are discussed. Full article

(This article belongs to the Special Issue Advances in Suicide Research)

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18 pages, 1869 KiB

Open AccessArticle

The External Performance Appraisal of China Energy Regulation: An Empirical Study Using a TOPSIS Method Based on Entropy Weight and Mahalanobis Distance

by Zheng-Xin Wang, Dan-Dan Li and Hong-Hao Zheng

Int. J. Environ. Res. Public Health 2018, 15(2), 236; https://doi.org/10.3390/ijerph15020236 - 30 Jan 2018

Cited by 33 | Viewed by 5487

Abstract

In China’s industrialization process, the effective regulation of energy and environment can promote the positive externality of energy consumption while reducing negative externality, which is an important means for realizing the sustainable development of an economic society. The study puts forward an improved [...] Read more.

In China’s industrialization process, the effective regulation of energy and environment can promote the positive externality of energy consumption while reducing negative externality, which is an important means for realizing the sustainable development of an economic society. The study puts forward an improved technique for order preference by similarity to an ideal solution based on entropy weight and Mahalanobis distance (briefly referred as E-M-TOPSIS). The performance of the approach was verified to be satisfactory. By separately using traditional and improved TOPSIS methods, the study carried out the empirical appraisals on the external performance of China’s energy regulation during 1999~2015. The results show that the correlation between the performance indexes causes the significant difference between the appraisal results of E-M-TOPSIS and traditional TOPSIS. The E-M-TOPSIS takes the correlation between indexes into account and generally softens the closeness degree compared with traditional TOPSIS. Moreover, it makes the relative closeness degree fluctuate within a small-amplitude. The results conform to the practical condition of China’s energy regulation and therefore the E-M-TOPSIS is favorably applicable for the external performance appraisal of energy regulation. Additionally, the external economic performance and social responsibility performance (including environmental and energy safety performances) based on the E-M-TOPSIS exhibit significantly different fluctuation trends. The external economic performance dramatically fluctuates with a larger fluctuation amplitude, while the social responsibility performance exhibits a relatively stable interval fluctuation. This indicates that compared to the social responsibility performance, the fluctuation of external economic performance is more sensitive to energy regulation. Full article

(This article belongs to the Special Issue Decision Models in Green Growth and Sustainable Development)

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15 pages, 528 KiB

Open AccessArticle

Use of an Integrated Research-Practice Partnership to Improve Outcomes of a Community-Based Strength-Training Program for Older Adults: Reach and Effect of Lifelong Improvements through Fitness Together (LIFT)

by Meghan L. Wilson, Thomas E. Strayer III, Rebecca Davis and Samantha M. Harden

Int. J. Environ. Res. Public Health 2018, 15(2), 237; https://doi.org/10.3390/ijerph15020237 - 31 Jan 2018

Cited by 17 | Viewed by 6135

Abstract

Only 17% of older adults meet the recommendations for two days of full body strength training that is associated with improved functional fitness; reduced risk of falls; and reduced morbidity and mortality rates. Community-based interventions are recommended as they provide supportive infrastructure to [...] Read more.

Only 17% of older adults meet the recommendations for two days of full body strength training that is associated with improved functional fitness; reduced risk of falls; and reduced morbidity and mortality rates. Community-based interventions are recommended as they provide supportive infrastructure to reach older adults and impact strength training behaviors. Scalability and sustainability of these interventions is directly linked with setting-level buy-in. Adapting an intervention through an integrated research–practice partnership may improve individual and setting-level outcomes. The purpose of this study was to evaluate the initial reach and effect of a locally adapted, health educator-led strength-training intervention; Lifelong Improvements through Fitness Together (LIFT). LIFT was compared to an evidence-based exercise program, Stay Strong; Stay Healthy (SSSH). Intervention dose and mode were the same for LIFT and SSSH, but LIFT included behavioral change strategies. Older adult functional fitness was assessed before and after the 8-week strength training intervention. Health educators who delivered LIFT and SSSH were able to reach 80 and 33 participants, respectively. Participants in LIFT were able to significantly improve in all functional fitness measures whereas SSSH participants were only able to significantly improve in 5 of the 7 functional fitness measures. In conclusion, this study provides preliminary evidence that the locally adapted program reached more individuals and had improvements in functional fitness. Full article

(This article belongs to the Collection Aging and Public Health)

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10 pages, 2102 KiB

Open AccessArticle

Microwave-Hydrothermal Treated Grape Peel as an Efficient Biosorbent for Methylene Blue Removal

by Lin Ma, Chunhai Jiang, Zhenyu Lin and Zhimin Zou

Int. J. Environ. Res. Public Health 2018, 15(2), 239; https://doi.org/10.3390/ijerph15020239 - 31 Jan 2018

Cited by 26 | Viewed by 4837

Abstract

Biosorption using agricultural wastes has been proven as a low cost and efficient way for wastewater treatment. Herein, grape peel treated by microwave- and conventional-hydrothermal processes was used as low cost biosorbent to remove methylene blue (MB) from aqueous solutions. The adsorption parameters [...] Read more.

Biosorption using agricultural wastes has been proven as a low cost and efficient way for wastewater treatment. Herein, grape peel treated by microwave- and conventional-hydrothermal processes was used as low cost biosorbent to remove methylene blue (MB) from aqueous solutions. The adsorption parameters including the initial pH value, dosage of biosorbents, contact time, and initial MB concentration were investigated to find the optimum adsorption conditions. The biosorbent obtained by microwave-hydrothermal treatment only for 3 min at 180 °C (microwave-hydrothermal treated grape peel, MGP) showed faster kinetics and higher adsorption capability than that produced by a conventional-hydrothermal process (hydrothermal treated grape peel, HGP) with a duration time of 16 h. The maximum adsorption capability of MGP under the optimum conditions (pH = 11, a dosage of 2.50 g/L) as determined with the Langmuir model reached 215.7 mg/g, which was among the best values achieved so far on biosorbents. These results demonstrated that the grape peel treated by a quick microwave-hydrothermal process can be a very promising low cost and efficient biosorbent for organic dye removal from aqueous solutions. Full article

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13 pages, 291 KiB

Open AccessArticle

The Influence of Supportive and Ethical Work Environments on Work-Related Accidents, Injuries, and Serious Psychological Distress among Hospital Nurses

by Maki Tei-Tominaga and Miharu Nakanishi

Int. J. Environ. Res. Public Health 2018, 15(2), 240; https://doi.org/10.3390/ijerph15020240 - 31 Jan 2018

Cited by 28 | Viewed by 7404

Abstract

The healthcare industry in Japan has experienced many cases of work-related injuries, accidents, and workers’ compensation claims because of mental illness. This study examined the influence of supportive and ethical work environments on work-related accidents, injuries, and serious psychological distress among hospital nurses. [...] Read more.

The healthcare industry in Japan has experienced many cases of work-related injuries, accidents, and workers’ compensation claims because of mental illness. This study examined the influence of supportive and ethical work environments on work-related accidents, injuries, and serious psychological distress among hospital nurses. Self-reported questionnaires were distributed to nurses (n = 1114) from 11 hospitals. Valid responses (n = 822, 93% women, mean age = 38.49 ± 10.09 years) were used for analyses. The questionnaire included items addressing basic attributes, work and organizational characteristics, social capital and ethical climate at the workplace, psychological distress, and experience of work-related accidents or injuries in the last half year. The final model of a multivariate logistic regression analysis revealed that those who work less than 4 h of overtime per week (OR = 0.313), those who work on days off more than once per month (OR = 0.424), and an exclusive workplace climate (OR = 1.314) were significantly associated with work-related accidents or injuries. Additionally, an exclusive workplace climate (OR = 1.696) elevated the risk of serious psychological distress. To prevent work-related compensation cases, which are caused by these variables, strengthening hospitals’ occupational health and safety is necessary. Full article

(This article belongs to the Special Issue Healthcare Quality and Patient Satisfaction)

11 pages, 337 KiB

Open AccessFeature PaperArticle

Prevalence of Mental Disorders and Addictions among Homeless People in the Greater Paris Area, France

by Anne Laporte, Stéphanie Vandentorren, Marc-Antoine Détrez, Caroline Douay, Yann Le Strat, Erwan Le Méner, Pierre Chauvin and The Samenta Research Group

Int. J. Environ. Res. Public Health 2018, 15(2), 241; https://doi.org/10.3390/ijerph15020241 - 31 Jan 2018

Cited by 33 | Viewed by 8152

Abstract

The Samenta study was conducted in 2009 in the Greater Paris area to estimate the prevalence of psychiatric disorders in homeless people. A cross-sectional survey was performed with a three-stage random sample of homeless people (n = 859), including users of day [...] Read more.

The Samenta study was conducted in 2009 in the Greater Paris area to estimate the prevalence of psychiatric disorders in homeless people. A cross-sectional survey was performed with a three-stage random sample of homeless people (n = 859), including users of day services, emergency shelters, hot meal distribution, long-term rehabilitation centres, and social hotels. Information was collected by a lay interviewer, using the Mini International Neuropsychiatric Interview, and completed by a psychologist through an open clinical interview. In the end, a psychiatrist assessed the psychiatric diagnosis according to the International Statistical Classification of Diseases and Related Health Problems (ICD, 10th revision). One third of homeless people in the Paris area had at least one severe psychiatric disorder (SPD): psychotic disorders (13%), anxiety disorders (12%), or severe mood disorders (7%). One in five was alcohol-dependent and 18% were drug users. Homeless women had significantly higher prevalence of anxiety disorders and depression compared to men, who were more likely to suffer from psychotic disorders. Homeless people of French origin were at higher risk of SPD, as well as people who experienced various adverse life events before the age of 18 (running away, sexual violence, parental disputes, and/or addictions) and those who experienced homelessness for the first time before the age of 26. The prevalence rates of the main psychiatric disorders within the homeless population of our study are consistent with those reported in other Western cities. Our results advocate for an improvement in the detection, housing, and care of psychiatric homeless people. Full article

(This article belongs to the Special Issue Health and Health Care for Homeless People in Various Contexts)

10 pages, 633 KiB

Open AccessArticle

Adverse Selection in Community Based Health Insurance among Informal Workers in Bangladesh: An EQ-5D Assessment

by Sayem Ahmed, Abdur Razzaque Sarker, Marufa Sultana, Sanchita Chakrovorty, Md. Zahid Hasan, Andrew J. Mirelman and Jahangir A. M. Khan

Int. J. Environ. Res. Public Health 2018, 15(2), 242; https://doi.org/10.3390/ijerph15020242 - 31 Jan 2018

Cited by 7 | Viewed by 5958

Abstract

Community-based Health Insurance (CBHI) schemes are recommended for providing financial risk protection to low-income informal workers in Bangladesh. We assessed the problem of adverse selection in a pilot CBHI scheme in this context. In total, 1292 (646 insured and 646 uninsured) respondents were [...] Read more.

Community-based Health Insurance (CBHI) schemes are recommended for providing financial risk protection to low-income informal workers in Bangladesh. We assessed the problem of adverse selection in a pilot CBHI scheme in this context. In total, 1292 (646 insured and 646 uninsured) respondents were surveyed using the Bengali version of the EuroQuol-5 dimensions (EQ-5D) questionnaire for assessing their health status. The EQ-5D scores were estimated using available regional tariffs. Multiple logistic regression was applied for predicting the association between health status and CBHI scheme enrolment. A higher number of insured reported problems in mobility (7.3%; p = 0.002); self-care (7.1%; p = 0.000) and pain and discomfort (7.7%; p = 0.005) than uninsured. The average EQ-5D score was significantly lower among the insured (0.704) compared to the uninsured (0.749). The regression analysis showed that those who had a problem in mobility (m 1.25–2.17); self-care (OR = 2.29; 95% CI: 1.62–3.25) and pain and discomfort (OR = 1.43; 95% CI: 1.13–1.81) were more likely to join the scheme. Individuals with higher EQ-5D scores (OR = 0.46; 95% CI: 0.31–0.69) were less likely to enroll in the scheme. Given that adverse selection was evident in the pilot CBHI scheme, there should be consideration of this problem when planning scale-up of these kind of schemes. Full article

(This article belongs to the Special Issue Insurance and Health)

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23 pages, 10860 KiB

Open AccessArticle

Landslide Susceptibility Assessment Using Spatial Multi-Criteria Evaluation Model in Rwanda

by Jean Baptiste Nsengiyumva, Geping Luo, Lamek Nahayo, Xiaotao Huang and Peng Cai

Int. J. Environ. Res. Public Health 2018, 15(2), 243; https://doi.org/10.3390/ijerph15020243 - 31 Jan 2018

Cited by 94 | Viewed by 13174

Abstract

Landslides susceptibility assessment has to be conducted to identify prone areas and guide risk management. Landslides in Rwanda are very deadly disasters. The current research aimed to conduct landslide susceptibility assessment by applying Spatial Multi-Criteria Evaluation Model with eight layers of causal factors [...] Read more.

Landslides susceptibility assessment has to be conducted to identify prone areas and guide risk management. Landslides in Rwanda are very deadly disasters. The current research aimed to conduct landslide susceptibility assessment by applying Spatial Multi-Criteria Evaluation Model with eight layers of causal factors including: slope, distance to roads, lithology, precipitation, soil texture, soil depth, altitude and land cover. In total, 980 past landslide locations were mapped. The relationship between landslide factors and inventory map was calculated using the Spatial Multi-Criteria Evaluation. The results revealed that susceptibility is spatially distributed countrywide with 42.3% of the region classified from moderate to very high susceptibility, and this is inhabited by 49.3% of the total population. In addition, Provinces with high to very high susceptibility are West, North and South (40.4%, 22.8% and 21.5%, respectively). Subsequently, the Eastern Province becomes the peak under low susceptibility category (87.8%) with no very high susceptibility (0%). Based on these findings, the employed model produced accurate and reliable outcome in terms of susceptibility, since 49.5% of past landslides fell within the very high susceptibility category, which confirms the model’s performance. The outcomes of this study will be useful for future initiatives related to landslide risk reduction and management. Full article

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13 pages, 606 KiB

Open AccessArticle

The Role of Motivation to Reduce Obesity among Elderly People: Response to Priming Temptation in Obese Individuals

by Małgorzata Obara-Gołębiowska, Hanna Brycz, Małgorzata Lipowska and Mariusz Lipowski

Int. J. Environ. Res. Public Health 2018, 15(2), 244; https://doi.org/10.3390/ijerph15020244 - 1 Feb 2018

Cited by 6 | Viewed by 6469

Abstract

The risk of obesity-related disorders is increased among the elderly, so changing eating habits can be an important element of prevention. The main aim of this article is to consider whether looking at pictures that present either fattening food or healthy food may [...] Read more.

The risk of obesity-related disorders is increased among the elderly, so changing eating habits can be an important element of prevention. The main aim of this article is to consider whether looking at pictures that present either fattening food or healthy food may motivate elderly people to change their nutrition habits. Might priming different kinds of food influence the attractiveness of the food for people in late adulthood undergoing obesity therapy? Based on priming theories, we analysed the effects of the conscious processing of stimuli associated with dietary habits in individuals aged with BMI ≥ 30 kg/m². Our experiments confirmed the influence of a higher-priority goal of “slimming” on the perception and internalization of nutrition-related stimuli. In response to such stimuli, individuals who are actively involved in weight reduction and health-oriented programs use strategies for resisting temptation and to effectively “slim”. We present our findings in the context of their theoretical background and practical application. Full article

(This article belongs to the Collection Aging and Public Health)

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11 pages, 285 KiB

Open AccessArticle

Empowering Retailers to Refuse to Sell Tobacco Products to Minors

by Min-Li Chen, Li-Na Chou and Ya-Cheng Zheng

Int. J. Environ. Res. Public Health 2018, 15(2), 245; https://doi.org/10.3390/ijerph15020245 - 1 Feb 2018

Cited by 7 | Viewed by 3941

Abstract

Tobacco smoking and exposure to secondhand smoke are major environmental risk factors that negatively influence health. It is recommended that tobacco product manufacturers and retailers receive empowerment counseling programs to achieve adolescent health targets. The present study conducted an empowerment counseling session to [...] Read more.

Tobacco smoking and exposure to secondhand smoke are major environmental risk factors that negatively influence health. It is recommended that tobacco product manufacturers and retailers receive empowerment counseling programs to achieve adolescent health targets. The present study conducted an empowerment counseling session to counsel tobacco product retailers in refusing to sell tobacco products to minors. The three stages of this study were conducted from March 2015 to February 2017. The results revealed that 74% of retailers were selling tobacco products to minors at baseline, 40% at stage two and 15% at stage three. These represent significant reductions in selling tobacco products to minors (all stage differences p < 0.001). However, experimental design studies could be used to examine the empowerment counseling program for preventing tobacco sales to minors in the future. Moreover, health care providers should collaborate with tobacco product retailers to design unique empowerment counseling sessions for specific regions to improve retailers’ capabilities for self-management in terms of tobacco hazard prevention. Full article

18 pages, 3912 KiB

Open AccessArticle

Spatio-Temporal Dynamic Analysis of Sustainable Development in China Based on the Footprint Family

by Jing Zhao, Caihong Ma, Xiangui Zhao and Xiaoyu Wang

Int. J. Environ. Res. Public Health 2018, 15(2), 246; https://doi.org/10.3390/ijerph15020246 - 1 Feb 2018

Cited by 20 | Viewed by 7632

Abstract

The existing index systems on sustainable evaluation are mostly based on a multi index comprehensive evaluation method. The main disadvantage of this approach is that the selection and assignment of evaluation indexes are greatly influenced by subjective factors, which can result in poor [...] Read more.

The existing index systems on sustainable evaluation are mostly based on a multi index comprehensive evaluation method. The main disadvantage of this approach is that the selection and assignment of evaluation indexes are greatly influenced by subjective factors, which can result in poor comparability of results. By contrast, the Footprint Family (including ecological footprint, carbon footprint, and water footprint) is not affected by subjective factors. The Footprint Family also covers the basic tenets of sustainable development. This paper proposes use of a sustainable development evaluation index system based on the principle of the Footprint Family, and including the ecological pressure index (EPI), the ecological occupancy index (EOI), the ecological economic coordination index (EECI), the GHG (Greenhouse Gas) emission index (CEI), the water resources stress index (WSI), and the sustainable development index (SDI). Furthermore, a standard for grading the evaluated results based on global benchmarks is formulated. The results of an empirical study in China were the following. The development situation deteriorated from 1990 to 2015. The results showed that the SDI decreased from a medium level (grade 5) to a lower-medium level (grade 4). The results of this empirical study also showed that the method of evaluation can avoid the influence of subjective factors and can be used in the evaluation of sustainable development for various temporal and spatial conditions. Full article

(This article belongs to the Special Issue Proceedings of 2nd International Symposium on Environment Science and Health)

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16 pages, 308 KiB

Open AccessArticle

Assessing Heat Stress and Health among Construction Workers in a Changing Climate: A Review

by Payel Acharya, Bethany Boggess and Kai Zhang

Int. J. Environ. Res. Public Health 2018, 15(2), 247; https://doi.org/10.3390/ijerph15020247 - 1 Feb 2018

Cited by 137 | Viewed by 17825

Abstract

Construction workers are at an elevated risk of heat stress, due to the strenuous nature of the work, high temperature work condition, and a changing climate. An increasing number of workers are at risk, as the industry’s growth has been fueled by high [...] Read more.

Construction workers are at an elevated risk of heat stress, due to the strenuous nature of the work, high temperature work condition, and a changing climate. An increasing number of workers are at risk, as the industry’s growth has been fueled by high demand and vast numbers of immigrant workers entering into the U.S., the Middle East and Asia to meet the demand. The risk of heat-related illnesses is increased by the fact that little to no regulations are present and/or enforced to protect these workers. This review recognizes the issues by summarizing epidemiological studies both in the U.S. and internationally. These studies have assessed the severity with which construction workers are affected by heat stress, risk factors and co-morbidities associated with heat-related illnesses in the construction industry, vulnerable populations, and efforts in implementing preventive measures. Full article

(This article belongs to the Section Occupational Safety and Health)

13 pages, 3152 KiB

Open AccessArticle

Women’s Ideas about the Health Effects of Household Air Pollution, Developed through Focus Group Discussions and Artwork in Southern Nepal

by Delan Devakumar, Zeshan Qureshi, Jenevieve Mannell, Manju Baruwal, Neha Sharma, Eva Rehfuess, Naomi M. Saville, Dharma S. Manandhar and David Osrin

Int. J. Environ. Res. Public Health 2018, 15(2), 248; https://doi.org/10.3390/ijerph15020248 - 1 Feb 2018

Cited by 20 | Viewed by 7003

Abstract

Household air pollution is a major cause of ill health, but few solutions have been effective to date. While many quantitative studies have been conducted, few have explored the lived experiences and perceptions of women who do the cooking, and as a result [...] Read more.

Household air pollution is a major cause of ill health, but few solutions have been effective to date. While many quantitative studies have been conducted, few have explored the lived experiences and perceptions of women who do the cooking, and as a result are those most exposed to household air pollution. In this study, we worked with groups of home cooks, and sought to use art as a means of engaging them in discussions of how household air pollution from cooking affects their lives. In the Terai district of southern Nepal, we held four focus groups that included 26 local women from urban and peri-urban areas, as well as six local artists. The women then met approximately weekly over four months, and produced images related to air pollution. Transcripts from the focus groups were reviewed independently by two authors, who initially categorised data deductively to pre-defined nodes, and subsequently inductively reviewed emergent themes. Women identified a number of health effects from air pollution. The main physical effects related to the eye and the respiratory system, and women and young children were seen as most vulnerable. The psychosocial effects of air pollution included reduced food intake by women and lethargy. Suggested solutions included modifications to the cooking process, changing the location of stoves, and increasing ventilation. The main barriers were financial. The lived experiences of women in southern Nepal around the problem of air pollution offers a more nuanced and context-specific understanding of the perceptions and challenges of addressing air pollution, which can be used to inform future interventions. Full article

(This article belongs to the Section Global Health)

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14 pages, 326 KiB

Open AccessArticle

Risk Factors for Obesity and Overfat among Primary School Children in Mashonaland West Province, Zimbabwe

by George Kambondo and Benn Sartorius

Int. J. Environ. Res. Public Health 2018, 15(2), 249; https://doi.org/10.3390/ijerph15020249 - 2 Feb 2018

Cited by 12 | Viewed by 5013

Abstract

Associated childhood obesity risk factors are not well established in developing countries such as Zimbabwe and this information is essential for tailored intervention development. This study aimed to identify prominent risk factors for overweight/obese and overfat/obese among primary school children of Mashonaland West [...] Read more.

Associated childhood obesity risk factors are not well established in developing countries such as Zimbabwe and this information is essential for tailored intervention development. This study aimed to identify prominent risk factors for overweight/obese and overfat/obese among primary school children of Mashonaland West Province in Zimbabwe. A school-based cross-sectional study was conducted using multi-stage random cluster sampling approach (30 × 30). Bivariate and multivariable logistic regression was employed and identified the risk factors for overweight/obese and overfat/obese. A total of 974 participants were enrolled in the study. Prominent significant risk factors of overweight/obese after multivariable adjustment were higher socio-economic households; parental diabetes status; and living in Makonde, Zvimba, Sanyati or Mhondoro-Ngezi district as opposed to Hurungwe district. Risk factors for overfat/obese that remained statically significant were children in urban areas (aOR = 3.19, 95% CI: 2.18−4.66, p = 0.000), being one child in a household, and parents who have diabetes mellitus. Living in Makonde, Sanyati, and Zvimba district remained associated with overfat/obese compared to Hurungwe district. This study has identified prominent proximal determinants of overweight/obese and overfat/obese among primary school children in Zimbabwe, to better assist policy guidance. Aggressive education on good nutrition activities should be tailored and targeted to most affected urban areas within high-risk districts. Full article

15 pages, 12246 KiB

Open AccessArticle

Using Twitter to Better Understand the Spatiotemporal Patterns of Public Sentiment: A Case Study in Massachusetts, USA

by Xiaodong Cao, Piers MacNaughton, Zhengyi Deng, Jie Yin, Xi Zhang and Joseph G. Allen

Int. J. Environ. Res. Public Health 2018, 15(2), 250; https://doi.org/10.3390/ijerph15020250 - 2 Feb 2018

Cited by 46 | Viewed by 9324

Abstract

Twitter provides a rich database of spatiotemporal information about users who broadcast their real-time opinions, sentiment, and activities. In this paper, we sought to investigate the holistic influence of land use and time period on public sentiment. A total of 880,937 tweets posted [...] Read more.

Twitter provides a rich database of spatiotemporal information about users who broadcast their real-time opinions, sentiment, and activities. In this paper, we sought to investigate the holistic influence of land use and time period on public sentiment. A total of 880,937 tweets posted by 26,060 active users were collected across Massachusetts (MA), USA, through 31 November 2012 to 3 June 2013. The IBM Watson Alchemy API (application program interface) was employed to quantify the sentiment scores conveyed by tweets on a large scale. Then we statistically analyzed the sentiment scores across different spaces and times. A multivariate linear mixed-effects model was used to quantify the fixed effects of land use and the time period on the variations in sentiment scores, considering the clustering effect of users. The results exposed clear spatiotemporal patterns of users’ sentiment. Higher sentiment scores were mainly observed in the commercial and public areas, during the noon/evening and on weekends. Our findings suggest that social media outputs can be used to better understand the spatial and temporal patterns of public happiness and well-being in cities and regions. Full article

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9 pages, 333 KiB

Open AccessArticle

A Community-Based Study to Estimate the Seroprevalence of Trichinellosis and Echinococcosis in the Roma and Non-Roma Population of Slovakia

by Daniela Antolová, Monika Halánová, Martin Janičko, Peter Jarčuška, Katarína Reiterová, Júlia Jarošová, Andrea Madarasová Gecková, Daniel Pella, Sylvia Dražilová and HepaMeta Team

Int. J. Environ. Res. Public Health 2018, 15(2), 251; https://doi.org/10.3390/ijerph15020251 - 2 Feb 2018

Cited by 7 | Viewed by 4091

Abstract

Trichinellosis and cystic and alveolar echinococcosis are serious parasitic diseases transmissible between animals and humans. Moreover, alveolar echinococcosis is considered one of the most dangerous of human helminthoses. Roma communities are particularly numerous in Central and Eastern Europe. They are often concentrated in [...] Read more.

Trichinellosis and cystic and alveolar echinococcosis are serious parasitic diseases transmissible between animals and humans. Moreover, alveolar echinococcosis is considered one of the most dangerous of human helminthoses. Roma communities are particularly numerous in Central and Eastern Europe. They are often concentrated in economically undeveloped regions and live in segregated localities with unsatisfactory housing and sanitary conditions. The study aimed to find out the seroprevalence of Trichinella and Echinococcus infections in the Roma population of segregated settlements and to compare it with the seropositivity of the non-Roma population of eastern Slovakia. Out of 823 samples, three sera showed seropositivity to Trichinella in the ELISA (Enzyme-linked immunosorbent assay) test. Subsequent Western blot reaction (WB) confirmed seropositivity in two Roma women. ELISA seropositivity to E. multilocularis was recorded in six persons (0.73%), and five (0.61%) respondents were seropositive to E. granulosus, but WB confirmed the presence of antibodies to Echinococcus spp. in one Roma participant. Positive persons suffered from unspecific clinical symptoms; Trichinella-positive persons reported headache, cough, fatigue, and muscle pain. The Echinococcus-positive participant suffered from headache and back pain. The study showed that the worse living conditions of the Roma community did not significantly influence the occurrence of Trichinella and Echinococcus infections in this minority. Full article

(This article belongs to the Special Issue Roma Health)

22 pages, 2598 KiB

Open AccessArticle

Residents’ Self-Reported Health Effects and Annoyance in Relation to Air Pollution Exposure in an Industrial Area in Eastern-Estonia

by Hans Orru, Jane Idavain, Mihkel Pindus, Kati Orru, Kaisa Kesanurm, Aavo Lang and Jelena Tomasova

Int. J. Environ. Res. Public Health 2018, 15(2), 252; https://doi.org/10.3390/ijerph15020252 - 2 Feb 2018

Cited by 35 | Viewed by 6190

Abstract

Eastern Estonia has large oil shale mines and industrial facilities mainly focused on electricity generation from oil shale and shale oil extraction, which produce high air pollution emissions. The “Study of the health impact of the oil shale sector—SOHOS” was aimed at identifying [...] Read more.

Eastern Estonia has large oil shale mines and industrial facilities mainly focused on electricity generation from oil shale and shale oil extraction, which produce high air pollution emissions. The “Study of the health impact of the oil shale sector—SOHOS” was aimed at identifying the impacts on residents’ health and annoyance due to the industrial processing. First, a population-wide survey about health effects and annoyance was carried out. Second, the total and oil shale sectors’ emitted concentrations of benzene, phenol, and PM_2.5 were modelled. Third, the differences between groups were tested and relationships between health effects and environmental pollution studied using multiple regression analysis. Compared to the control groups from non-industrial areas in Tartu or Lääne-Viru, residents of Ida-Viru more frequently (p < 0.05) reported wheezing, chest tightness, shortness of breath, asthma attacks, a long-term cough, hypertension, heart diseases, myocardial infarction, stroke, and diabetes. All health effects except asthma were reported more frequently among non-Estonians. People living in regions with higher levels of PM_2.5, had significantly higher odds (p < 0.05) of experiencing chest tightness (OR = 1.13, 95% CI 1.02–1.26), shortness of breath (1.16, 1.03–1.31) or an asthma attack (1.22, 1.04–1.42) during the previous year. People living in regions with higher levels of benzene had higher odds of experiencing myocardial infarction (1.98, 1.11–3.53) and with higher levels of phenol chest tightness (1.44, 1.03–2.00), long-term cough (1.48, 1.06–2.07) and myocardial infarction (2.17, 1.23–3.83). The prevalence of adverse health effects was also higher among those who had been working in the oil shale sector. Next to direct health effects, up to a quarter of the residents of Ida-Viru County were highly annoyed about air pollution. Perceived health risk from air pollution increased the odds of being annoyed. Annoyed people in Ida-Viru had significantly higher odds of experiencing respiratory symptoms during the last 12 months, e.g., wheezing (2.30, 1.31–4.04), chest tightness (2.88, 1.91–4.33 or attack of coughing (1.99, 1.34–2.95). Full article

(This article belongs to the Special Issue Air Quality and Health)

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12 pages, 310 KiB

Open AccessArticle

Long-Term Effectiveness of Stress Management at Work: Effects of the Changes in Perceived Stress Reactivity on Mental Health and Sleep Problems Seven Years Later

by Raphael M. Herr, Amira Barrech, Natalie Riedel, Harald Gündel, Peter Angerer and Jian Li

Int. J. Environ. Res. Public Health 2018, 15(2), 255; https://doi.org/10.3390/ijerph15020255 - 3 Feb 2018

Cited by 58 | Viewed by 15589

Abstract

The reduction of stress reactivity resulting from stress management interventions prevents disorders and improves mental health, however, its long-term sustainability has been little examined. The objective of this study was, therefore, to determine the effectiveness of a stress management intervention, designed to improve [...] Read more.

The reduction of stress reactivity resulting from stress management interventions prevents disorders and improves mental health, however, its long-term sustainability has been little examined. The objective of this study was, therefore, to determine the effectiveness of a stress management intervention, designed to improve stress reactivity, for mental health and sleep problems seven years later, using longitudinal data from 101 male industrial workers. Linear regressions estimated the adjusted effects of the changes in stress reactivity in general as well as in its six subdimensions (work overload, social conflict, social stress, failure at work, and anticipatory and prolonged reactivity) on depression, anxiety, and sleep problems seven years later. The improvement of the prolonged reactivity had positive effects on depression, anxiety, and sleep problems (unstandardized regression coefficients [Bs] ≥ 0.35, all p-values ≤ 0.01). Depression and sleep problems were further improved by a reduction of the reactivity to social conflicts (Bs ≥ 0.29, p-values < 0.05), and an improvement in the overall reactivity score positively influenced sleep problems (B = 0.07, p = 0.017). In conclusion, the improvement of stress reactivity resulting from a work stress intervention was effective and generally long-lasting in preventing mental health and sleep problems. The reduction of the prolonged reactivity seems of particular importance and efficient in inhibiting negative stress manifestations. Full article

(This article belongs to the Special Issue Workplace Health Promotion 2018)

13 pages, 300 KiB

Open AccessArticle

Relative Contributions of Different Lifestyle Factors to Health-Related Quality of Life in the Elderly

by Xiaona Zhang, Ruyi Xia, Shu Wang, Wei Xue, Jian Yang, Shuliu Sun and Guihua Zhuang

Int. J. Environ. Res. Public Health 2018, 15(2), 256; https://doi.org/10.3390/ijerph15020256 - 3 Feb 2018

Cited by 21 | Viewed by 4975

Abstract

Much of the previous literature has studied the relationship between individual lifestyle factors and the health-related quality of life (HRQOL). However, only a few studies combined them to explore their relative importance to the HRQOL in the elderly. This study assesses the HRQOL [...] Read more.

Much of the previous literature has studied the relationship between individual lifestyle factors and the health-related quality of life (HRQOL). However, only a few studies combined them to explore their relative importance to the HRQOL in the elderly. This study assesses the HRQOL of the urban, rural, and institutionalized Chinese elderly and explores the relative contributions of different lifestyle factors to their HRQOL. The SF-36v2 Health Survey, the WHOQOL-OLD module, and the socio-demographic and lifestyle questionnaire were utilized in this study. Hierarchical regression was performed in order to analyze the results. The physical and mental component scores of the SF-36v2 survey were 47.05 ± 9.95 and 54.92 ± 9.92, respectively. The total score for the WHOQOL-OLD module was 73.01 ± 11.99, with institutionalized persons reporting lower scores. For the physical component of the elderly participants’ HRQOL, the R² value changed the most (0.116) when exercise-and-labor-related factors were added in. For the mental component, sleep-related (0.054), and leisure-time-activity-related factors (0.053) caused the largest change of the R² value. For the elderly-specific HRQOL, measured by the WHOQOL-OLD module, the leisure-time-activity-related factors caused the largest change in the R² value (0.119), followed by exercise-and-labor-related factors (0.078). Heterogeneity was present among the three subgroups. In sum, compared with their community-dwelling counterparts, the HRQOL of institutionalized older people was relatively poor and different lifestyle factors contributed to the HRQOL differently. Full article

17 pages, 522 KiB

Open AccessArticle

Predicting Effects of the Self and Contextual Factors on Violence: A Comparison between School Students and Youth Offenders in Macau

by T. Wing Lo and Christopher H. K. Cheng

Int. J. Environ. Res. Public Health 2018, 15(2), 258; https://doi.org/10.3390/ijerph15020258 - 3 Feb 2018

Cited by 11 | Viewed by 5798

Abstract

This study was designed to explore the self and contextual factors for violence in two samples of school students and youth offenders in Macau. There were 3085 participants who were between 12 and 20 years old; 48.3% of them were male and 51.7% [...] Read more.

This study was designed to explore the self and contextual factors for violence in two samples of school students and youth offenders in Macau. There were 3085 participants who were between 12 and 20 years old; 48.3% of them were male and 51.7% female. Findings revealed that youth offenders exhibited more violence than school students. For the self factors, while lower self-esteem and higher self-efficacy of school students were associated with more violent behavior, these two variables had no significant effects for youth offenders. For the contextual factors, family conflict was the strongest predictor of violence, and school commitment/attachment was the weakest predictor for both samples. For youth offenders, family conflict had the largest direct effect, followed by susceptibility to negative peer influence and influence of the Triad gangs, while school commitment/attachment had a significant though mild direct effect. For school students, family conflict mediated the effect of self-esteem and self-efficacy on violence. While Triad gangs’ influence was the second strongest predictor of violence, being exposed to Triad gangs’ influence also mediated the effect of self-esteem and self-efficacy on violence. It is recommended that youth outreach services with a focus on family support and gang detachment for at-risk youth be strengthened. Full article

(This article belongs to the Special Issue Youth Violence as a Public Health Issue)

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23 pages, 1184 KiB

Open AccessArticle

Interactive Cumulative Burden Assessment: Engaging Stakeholders in an Adaptive, Participatory and Transdisciplinary Approach

by Rehana Shrestha, Johannes Flacke, Javier Martinez and Martin Van Maarseveen

Int. J. Environ. Res. Public Health 2018, 15(2), 260; https://doi.org/10.3390/ijerph15020260 - 3 Feb 2018

Cited by 18 | Viewed by 5414

Abstract

Cumulative burden assessment (CuBA) has the potential to inform planning and decision-making on health disparities related to multiple environmental burdens. However, scholars have raised concerns about the social complexity to be dealt with while conducting CuBA, suggesting that it should be addressed in [...] Read more.

Cumulative burden assessment (CuBA) has the potential to inform planning and decision-making on health disparities related to multiple environmental burdens. However, scholars have raised concerns about the social complexity to be dealt with while conducting CuBA, suggesting that it should be addressed in an adaptive, participatory and transdisciplinary (APT) approach. APT calls for deliberation among stakeholders by engaging them in a process of social learning and knowledge co-production. We propose an interactive stakeholder-based approach that facilitates a science-based stakeholder dialogue as an interface for combining different knowledge domains and engendering social learning in CuBA processes. Our approach allows participants to interact with each other using a flexible and auditable CuBA model implemented within a shared workspace. In two workshops we explored the usefulness and practicality of the approach. Results show that stakeholders were enabled to deliberate on cumulative burdens collaboratively, to learn about the technical uncertainties and social challenges associated with CuBA, and to co-produce knowledge in a realm of both technical and societal challenges. The paper identifies potential benefits relevant for responding to social complexity in the CuBA and further recommends exploration of how our approach can enable or constraint social learning and knowledge co-production in CuBA processes under various institutional, social and political contexts. Full article

(This article belongs to the Special Issue Environmental Health Indicators for Policy Support)

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12 pages, 334 KiB

Open AccessFeature PaperArticle

Adverse Pregnancy Outcomes among Adolescents in Northwest Russia: A Population Registry-Based Study

by Anna A. Usynina, Vitaly Postoev, Jon Øyvind Odland and Andrej M. Grjibovski

Int. J. Environ. Res. Public Health 2018, 15(2), 261; https://doi.org/10.3390/ijerph15020261 - 3 Feb 2018

Cited by 20 | Viewed by 5636

Abstract

This study aimed to assess whether adolescents have an increased risk of adverse pregnancy outcomes (APO) compared to adult women. We used data on 43,327 births from the population-based Arkhangelsk County Birth Registry, Northwest Russia, for 2012–2014. The perinatal outcomes included stillbirth, preterm [...] Read more.

This study aimed to assess whether adolescents have an increased risk of adverse pregnancy outcomes (APO) compared to adult women. We used data on 43,327 births from the population-based Arkhangelsk County Birth Registry, Northwest Russia, for 2012–2014. The perinatal outcomes included stillbirth, preterm birth (<37 and <32 weeks), low and very low birthweight, 5 min Apgar score <7 and <4, perinatal infections, and the need for neonatal transfer to a higher-level hospital. Multivariable logistic regression was applied to assess the associations between age and APO. Altogether, 4.7% of deliveries occurred in adolescents. Both folic acid intake and multivitamin intake during pregnancy were more prevalent in adults. Adolescents were more likely to be underweight, to smoke, and to have infections of the kidney and the genital tract compared to adult women. Compared to adults, adolescents were at lower risk of low birthweight, a 5 min Apgar score <7, and need for neonatal transfer. Adolescents had no increased risk of other APO studied in the adjusted analysis, suggesting that a constellation of other factors, but not young age per se, is associated with APO in the study setting. Full article

(This article belongs to the Special Issue Teenage Reproductive Health: Pregnancy, Contraception, Unsafe Abortion, Fertility)

9 pages, 298 KiB

Open AccessArticle

Stepping It Up: Walking Behaviors in Children Transitioning from 5th to 7th Grade

by Sharon E. Taverno Ross, Morgan N. Clennin, Marsha Dowda, Natalie Colabianchi and Russell R. Pate

Int. J. Environ. Res. Public Health 2018, 15(2), 262; https://doi.org/10.3390/ijerph15020262 - 3 Feb 2018

Cited by 12 | Viewed by 4182

Abstract

The purpose of this study was to (1) describe children’s walking behaviors in 5th to 7th grade and change over time and (2) examine associations between walking behaviors and Walk Score^®. Participants consisted of n = 586 students from the Transitions [...] Read more.

The purpose of this study was to (1) describe children’s walking behaviors in 5th to 7th grade and change over time and (2) examine associations between walking behaviors and Walk Score^®. Participants consisted of n = 586 students from the Transitions and Activity Changes in Kids (TRACK) Study. Children reported any walking behavior (e.g., exercise and transportation) over the past five days. Walk Score was calculated based on children’s home address. Descriptive statistics summarized walking behaviors by gender and time, and repeated measure mixed models examined the relationship between walking behaviors and Walk Score. Approximately 46.8% and 19.2% of 5th grade children reported walking for exercise and transportation, respectively, and these percentages declined through 7th grade. Girls reported higher levels of total walking behavior and walking for exercise than boys (p < 0.001). Girls with a higher Walk Score had 63% higher odds of reporting walking for transportation than girls with a lower Walk Score (OR = 1.63, 95% CI = 1.02, 2.62). Walking behaviors among children were infrequent with significant declines over time, and of the nine associations examined with Walk Score, only one was significant. Efforts should prioritize frequent walking behavior and community design to increase children’s physical activity. Full article

(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)

11 pages, 284 KiB

Open AccessArticle

Fat Mass Index and Body Mass Index Affect Peak Metabolic Equivalent Negatively during Exercise Test among Children and Adolescents in Taiwan

by Shenghui Tuan, Hungtzu Su, Yijen Chen, Minhui Li, Yunjen Tsai, Chunhan Yang and Kolong Lin

Int. J. Environ. Res. Public Health 2018, 15(2), 263; https://doi.org/10.3390/ijerph15020263 - 4 Feb 2018

Cited by 16 | Viewed by 5456

Abstract

Peak metabolic equivalent (MET) is the most reliable indicator of cardiorespiratory fitness (CRF). The aim of this study was to examine the association between CRF indicated by peak MET and body mass index (BMI) or fat mass index (FMI) in Taiwanese children and [...] Read more.

Peak metabolic equivalent (MET) is the most reliable indicator of cardiorespiratory fitness (CRF). The aim of this study was to examine the association between CRF indicated by peak MET and body mass index (BMI) or fat mass index (FMI) in Taiwanese children and adolescents (C-A). Data of 638 C-A aged 10–18 that received symptom-limited treadmill exercise testing was analyzed. Anthropometry-body composition was measured by vector bioelectrical impedance analysis. BMI was defined as body weight (kg)/body height (m)² and FMI was defined as fat mass (kg)/body height (m)². BMI was grouped by Taiwanese obesity cut-off points. FMI Class-I was categorized by percentage of body fat. FMI Class-II used the reference values from Korean C-A. Excess adiposity was defined as (1) “overweight” and “obesity” by BMI, (2) greater than the sex- and age-specific 75th percentile of whole subjects by FMI Class-I, and (3) greater than 95th percentiles of reference value by FMI Class-II. Boys had significantly higher fat mass and FMI, and had more excess adiposity than girls (all p < 0.05). Both boys and girls with excess adiposity (by any definition) had lower MET at anaerobic threshold (AT MET) and peak MET (all p < 0.001). BMI and FMI were significantly negatively associated with both AT MET and peak MET significantly (all p < 0.001). FMI (95% CI: −0.411~−0.548) correlated with peak MET more than BMI (95% CI: −0.134~ −0.372) did. Excess adiposity affected CRF negatively. It is concluded that weight management should start early in childhood. Full article

(This article belongs to the Special Issue Obesity Prevention in Children and Adolescents)

13 pages, 1411 KiB

Open AccessArticle

The Effect of a Leisure Time Physical Activity Intervention Delivered via a Workplace: 15-Month Follow-Up Study

by Marit Skogstad, Lars-Kristian Lunde, Bente Ulvestad, Hans Christian D. Aass, Thomas Clemm, Asgeir Mamen and Øivind Skare

Int. J. Environ. Res. Public Health 2018, 15(2), 264; https://doi.org/10.3390/ijerph15020264 - 4 Feb 2018

Cited by 7 | Viewed by 6501

Abstract

In line with recommendations from both the World Health Organization and the European Union some employers encourage workplace health promotion through physical activity (PA) facilities and leisure time PA-initiatives. The current study describes a 15-month follow-up after an 8-week workplace delivered PA-initiative, investigates [...] Read more.

In line with recommendations from both the World Health Organization and the European Union some employers encourage workplace health promotion through physical activity (PA) facilities and leisure time PA-initiatives. The current study describes a 15-month follow-up after an 8-week workplace delivered PA-initiative, investigates if improvements in cardiovascular risk status are sustainable, and elucidates differences according to educational level. One hundred and twenty one employees (43 women) were examined before and after the 8-week PA-initiative and 94 at the 15-month follow-up. PA-levels, blood pressure, resting heart rate, lipids, glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), and selected markers of inflammation were registered at baseline, immediately after the 8-week PA-initiative, and 15 months after baseline. At the end of follow-up (15-month), PA-levels—increased during the 8-week intervention—had returned to baseline values. None of the five improvements in cardiovascular markers (total cholesterol, low density lipoprotein (LDL), P-selectin, CD40Ligand (CD40L) and Monocyte chemoattractant protein-1 (MCP-1)) seen at the 8-week follow-up were sustained. At the 15-month follow-up as compared to baseline HbA1c, CRP (log) and interleukin-6 (IL-6) were reduced by 0.06 mmol/L (95% CI −0.11,−0.01), 0.25 mg/L (95% CI −0.46,−0.04) and 0.39 pg/mL (95% CI −0.75, −0.04), respectively. At baseline, there were differences in cardiovascular risk factors comparing men with low versus high levels of education. No differences in changes in outcomes between these groups of men were found during follow-up. In this study highly educated men generally have lower levels of cardiovascular risk factors, but the effect of PA on such markers in this group do not differ from the effects seen in less educated men. Full article

(This article belongs to the Special Issue Occupational Sedentary Behaviour)

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14 pages, 310 KiB

Open AccessFeature PaperArticle

Prevalence of and Factors Associated with Work-Related Musculoskeletal Symptoms in Nursing Assistants Working in Nursing Homes

by Kin Cheung, Grace Szeto, Godfrey Kin Bun Lai and Shirley S. Y. Ching

Int. J. Environ. Res. Public Health 2018, 15(2), 265; https://doi.org/10.3390/ijerph15020265 - 4 Feb 2018

Cited by 36 | Viewed by 8046

Abstract

The prevalence of work-related musculoskeletal symptoms (WRMSs) in different body parts for nursing assistants (NAs) working in nursing homes is currently unknown. The aim of this study was to determine the extent of WRMSs in nursing assistants and the factors associated with them. [...] Read more.

The prevalence of work-related musculoskeletal symptoms (WRMSs) in different body parts for nursing assistants (NAs) working in nursing homes is currently unknown. The aim of this study was to determine the extent of WRMSs in nursing assistants and the factors associated with them. Four hundred and forty NAs from 52 nursing homes, recruited by convenience sampling, participated in this cross-sectional study in 2014–2015. A valid and reliable study questionnaire was used to collect data. The results of our study found that 88.4% of NAs reported at least one body part with WRMSs. These NAs reported more symptoms in the shoulders than lower back. Adverse workstyle (OR = 1.04, 95% CI = 1.01–1.08) was the only factor associated with WRMSs after adjustment for potential confounders using multivariable logistic regression. This adverse workstyle could be developed because of physical and psychological work demands. Efforts should be directed at integrating “workstyle intervention” into lifestyle physical activity training to this group of healthcare workers. Full article

(This article belongs to the Special Issue Musculoskeletal Disorders)

15 pages, 327 KiB

Open AccessArticle

Do Authoritarian Governments Respond to Public Opinion on the Environment? Evidence from China

by Xiao Tang, Weiwei Chen and Tian Wu

Int. J. Environ. Res. Public Health 2018, 15(2), 266; https://doi.org/10.3390/ijerph15020266 - 4 Feb 2018

Cited by 36 | Viewed by 6171

Abstract

Given its serious impacts on the public’s health, air pollution in China is a matter of strong public concern, particularly in reference to malodorous waste gas. Petition letters related to atmospheric pollution accounted for about 40% of the total petition cases. However, scholarly [...] Read more.

Given its serious impacts on the public’s health, air pollution in China is a matter of strong public concern, particularly in reference to malodorous waste gas. Petition letters related to atmospheric pollution accounted for about 40% of the total petition cases. However, scholarly views differ on whether the Chinese government responds to public opinion on the environment and seeks to improve its environmental governance behavior. For this study, data from national surveys on the public’s environmental satisfaction administered during the period 2011–2015 were analyzed to determine whether the public’s dissatisfaction with the state of the environment in a given year resulted in increased investments by provincial governments in pollution governance during the following year. The study’s findings revealed that governmental behavior in response to public opinion on the environment was selective within the field of environmental governance, with provincial governments being inclined to invest more in waste gas pollution control than in water pollution control. Furthermore, results from this study show that the Chinese government tends to put more efforts into the environmental field where it could more easily achieve short-term benefits. Full article

(This article belongs to the Special Issue Green Environment, Green Operations and Sustainability)

14 pages, 1145 KiB

Open AccessArticle

Conceptualizing and Managing Medical Emergencies Where No Formal Paramedical System Exists: Perspectives from a Remote Indigenous Community in Canada

by Jeffrey Curran, Stephen D. Ritchie, Jackson Beardy, David VanderBurgh, Karen Born, John Lewko and Aaron M. Orkin

Int. J. Environ. Res. Public Health 2018, 15(2), 267; https://doi.org/10.3390/ijerph15020267 - 4 Feb 2018

Cited by 6 | Viewed by 6957

Abstract

(1) Background: Remote communities in Canada lack an equitable emergency medical response capacity compared to other communities. Community-based emergency care (CBEC) training for laypeople is a model that has the potential to enhance the medical emergency response capacity in isolated and resource-limited contexts. [...] Read more.

(1) Background: Remote communities in Canada lack an equitable emergency medical response capacity compared to other communities. Community-based emergency care (CBEC) training for laypeople is a model that has the potential to enhance the medical emergency response capacity in isolated and resource-limited contexts. The purpose of this study was to understand the characteristics of medical emergencies and to conceptualize and present a framework for what a medical emergency is for one remote Indigenous community in northwestern Ontario, in order to inform the development of CBEC training. (2) Methods: This study adhered to the principles of community-based participatory research and realist evaluation; it was an integrated component of the formative evaluation of the second Sachigo Lake Wilderness Emergency Response Education Initiative (SLWEREI) training course in 2012. Twelve members of Sachigo Lake First Nation participated in the training course, along with local nursing staff, police officers, community Elders, and course instructors (n = 24 total), who participated in interviews, focus groups, and a collaborative discussion of local health issues in the development of the SLWEREI. (3) Results: The qualitative results are organized into sections that describe the types of local health emergencies and the informal response system of community members in addressing these emergencies. Prominent themes of health adversity that emerged were an inability to manage chronic conditions and fears of exacerbations, the lack of capacity for addressing mental illness, and the high prevalence of injury for community members. (4) Discussion: A three-point framework of what constitutes local perceptions of an emergency emerged from the findings in this study: (1) a sense of isolation; (2) a condition with a potentially adverse outcome; and (3) a need for help. Full article

(This article belongs to the Special Issue Indigenous Health and Wellbeing)

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14 pages, 471 KiB

Open AccessArticle

Will Green CSR Enhance Innovation? A Perspective of Public Visibility and Firm Transparency

by Weiwei Wu, Yexin Liu, Tachia Chin and Wenzhong Zhu

Int. J. Environ. Res. Public Health 2018, 15(2), 268; https://doi.org/10.3390/ijerph15020268 - 4 Feb 2018

Cited by 83 | Viewed by 9674

Abstract

In response to the asking and requiring of stakeholders to be more environmentally responsible, firms must commit to green corporate social responsibility (CSR). Firms being green and responsible always can acquire intangible resources that are important for firm innovation. Given the scarcity of [...] Read more.

In response to the asking and requiring of stakeholders to be more environmentally responsible, firms must commit to green corporate social responsibility (CSR). Firms being green and responsible always can acquire intangible resources that are important for firm innovation. Given the scarcity of existing research addressing relevant issues in depth, this paper expands our understanding of green CSR by revealing its antecedent effects on firm innovation performance. We also include public visibility and firm transparency as contingency factors to explore the relationship between green CSR and firm innovation performance. Using data collected from publicly listed firms in China, we find that greater innovation performance is associated with an increase in firm green CSR, and the positive relationship between green CSR and innovation performance is moderated by public visibility and firm transparency. Based on the results, theoretical contributions and practical implications are outlined. Full article

(This article belongs to the Special Issue Green Environment, Green Operations and Sustainability)

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12 pages, 2292 KiB

Open AccessArticle

Removal of Pharmaceutical and Personal Care Products (PPCPs) from Municipal Waste Water with Integrated Membrane Systems, MBR-RO/NF

by Yonggang Wang, Xu Wang, Mingwei Li, Jing Dong, Changhong Sun and Guanyi Chen

Int. J. Environ. Res. Public Health 2018, 15(2), 269; https://doi.org/10.3390/ijerph15020269 - 5 Feb 2018

Cited by 121 | Viewed by 8247

Abstract

This study focuses on the application of combining membrane bioreactor (MBR) treatment with reverse osmosis (RO) or nanofiltration (NF) membrane treatment for removal of pharmaceuticals and personal care products (PPCPs) in municipal wastewater. Twenty-seven PPCPs were measured in real influent with lowest average [...] Read more.

This study focuses on the application of combining membrane bioreactor (MBR) treatment with reverse osmosis (RO) or nanofiltration (NF) membrane treatment for removal of pharmaceuticals and personal care products (PPCPs) in municipal wastewater. Twenty-seven PPCPs were measured in real influent with lowest average concentration being trimethoprim (7.12 ng/L) and the highest being caffeine (18.4 ng/L). The results suggest that the MBR system effectively removes the PPCPs with an efficiency of between 41.08% and 95.41%, and that the integrated membrane systems, MBR-RO/NF, can achieve even higher removal rates of above 95% for most of them. The results also suggest that, due to the differences in removal mechanisms of NF/RO membrane, differences of removal rates exist. In this study, the combination of MBR-NF resulted in the removal of 13 compounds to below detection limits and MBR-RO achieved even better results with removal of 20 compounds to below detection limits. Full article

(This article belongs to the Section Environmental Science and Engineering)

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12 pages, 2634 KiB

Open AccessArticle

Epidemiological Characteristics and Spatial-Temporal Distribution of Hand, Foot, and Mouth Disease in Chongqing, China, 2009–2016

by Li Qi, Wenge Tang, Han Zhao, Hua Ling, Kun Su, Hua Zhao, Qin Li and Tao Shen

Int. J. Environ. Res. Public Health 2018, 15(2), 270; https://doi.org/10.3390/ijerph15020270 - 5 Feb 2018

Cited by 31 | Viewed by 7368

Abstract

(1) Objective: Even with licensed vaccine for enterovirus 71 (EV71) put into market in 2016 in China, hand, foot, and mouth disease (HFMD) is still a threat for children’s health in Chongqing. We described the epidemiological characteristics and spatial–temporal patterns of HFMD [...] Read more.

(1) Objective: Even with licensed vaccine for enterovirus 71 (EV71) put into market in 2016 in China, hand, foot, and mouth disease (HFMD) is still a threat for children’s health in Chongqing. We described the epidemiological characteristics and spatial–temporal patterns of HFMD in Chongqing from 2009 to 2016, in order to provide information and evidence for guiding public health response and intervention. (2) Methods: We retrieved the HFMD surveillance data from January 2009 to December 2016 from “National Disease Reporting Information System”, and then analyzed demographic and geographical information integrally. Descriptive analysis was conducted to evaluate the epidemic features of HFMD in Chongqing. The spatial–temporal methods were performed to explore the clusters at district/county level. (3) Results: A total of 276,207 HFMD cases were reported during the study period (total population incidence: 114.8 per 100,000 per year), including 641 severe cases (129 deaths). The annual incidence of HFMD sharply increased in even-numbered years, but remained stable or decreased in odd-numbered years. A semiannual seasonality was observed during April to July, and October to December in each year. The male-to-female ratios of the mild and severe cases were 1.4:1 and 1.5:1, with the median age of 2.3 years and 1.9 years, respectively. More than 90% of the cases were children equal to and less than 5 years old. High-incidence clustered regions included the main urban districts and northeast regions according to incidence rates comparison or space–time cluster analysis. A total of 19,482 specimen were collected from the reported cases and 13,277 (68.2%) were positive for enterovirus. EV71 was the major causative agent for severe cases, while other enteroviruses were the predominant serotype for mild cases. (4) Conclusions: The characteristics of HFMD in Chongqing exhibited a phenomenon of increasing incidence in two-year cycles and semiannual seasonality in time distribution. Children ≤5 years old, especially boys, were more affected by HFMD. EV71 was the major causative agent for severe cases. We suggest initiating mass EV71 vaccination campaigns among children aged 6 months to 5 years in Chongqing, especially in the main urban districts and northern regions, in order to reduce case fatality, and take integrated measurements for controlling and preventing HFMD attributed to other enteroviruses. Full article

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14 pages, 2252 KiB

Open AccessArticle

Empirical Study on the Sustainability of China’s Grain Quality Improvement: The Role of Transportation, Labor, and Agricultural Machinery

by Ming Zhang, Fang Duan and Zisen Mao

Int. J. Environ. Res. Public Health 2018, 15(2), 271; https://doi.org/10.3390/ijerph15020271 - 5 Feb 2018

Cited by 13 | Viewed by 5496

Abstract

As a major part of farming sustainability, the issues of grain production and its quality improvement have been important in many countries. This paper aims to address these issues in China. Based on the data from the main production provinces and by applying [...] Read more.

As a major part of farming sustainability, the issues of grain production and its quality improvement have been important in many countries. This paper aims to address these issues in China. Based on the data from the main production provinces and by applying the stochastic frontier analysis methodology, we find that the improvement of transportation and the use of agricultural machinery have become the main driving forces for grain quality improvement in China. After further studying different provinces’ potentials of grain quality improvement, we show that grain quality has increased steadily. Therefore, we can conclude China’s grain quality improvement is indeed sustainable. Furthermore, different grains like rice, wheat, and corn share similar characteristics in terms of quality improvement, but the improvement rate for rice is relatively low, while those of corn and wheat are relatively high. Moreover, the overall change of efficiency gain of grain quality improvement is not significant for different provinces. The efficiency gains of the quality improvements for rice and wheat even decrease slightly. In addition, we find that only expanding grain quality improvement potential can simultaneously achieve the dual objectives of improving grain quality and increasing yield. Full article

(This article belongs to the Special Issue Decision Models in Green Growth and Sustainable Development)

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11 pages, 494 KiB

Open AccessFeature PaperArticle

Primary Care Comprehensiveness Can Reduce Emergency Department Visits and Hospitalization in People with Hypertension in South Korea

by Nak-Jin Sung, Yong-Jun Choi and Jae-Ho Lee

Int. J. Environ. Res. Public Health 2018, 15(2), 272; https://doi.org/10.3390/ijerph15020272 - 5 Feb 2018

Cited by 25 | Viewed by 5472

Abstract

Hypertension has been the leading risk factor contributing to cardiovascular morbidity and mortality, which needs comprehensive measures to manage and can be controlled effectively in primary care. In the health care context of South Korea, where specialists can see patients directly at their [...] Read more.

Hypertension has been the leading risk factor contributing to cardiovascular morbidity and mortality, which needs comprehensive measures to manage and can be controlled effectively in primary care. In the health care context of South Korea, where specialists can see patients directly at their own community clinics and there has been no consensus on the definition of primary care, the authors used the nationally representative 2013 Korea Health Panel data, categorized adults (≥18 years) with hypertension by types of usual source of care (USC), and analyzed the association of having a comprehensive community clinic (i.e., primary care) physician as a USC with experience of emergency department (ED) visits and hospitalization within a year. After adjusting for cofounding variables including Charlson comorbidity index scores, those having a primary care physician as a USC remained associated with a decrease in an experience of ED visits (OR: 0.61, 95% CI: 0.40–0.93) and hospitalization (OR: 0.69, 95% CI: 0.49–0.96), compared to those not having a usual physician. Health policies that promote having a primary care physician as a USC could decrease unnecessary experience of ED visits and hospitalization by adults with hypertension. This can partly reduce ED overcrowding and avoidable hospitalization in Korea. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

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14 pages, 5478 KiB

Open AccessArticle

Evaluating the Hydrologic Performance of Low Impact Development Scenarios in a Micro Urban Catchment

by Chunlin Li, Miao Liu, Yuanman Hu, Rongqing Han, Tuo Shi, Xiuqi Qu and Yilin Wu

Int. J. Environ. Res. Public Health 2018, 15(2), 273; https://doi.org/10.3390/ijerph15020273 - 5 Feb 2018

Cited by 28 | Viewed by 5043

Abstract

As urbanization progresses, increasingly impervious surfaces have changed the hydrological processes in cities and resulted in a major challenge for urban stormwater control. This study uses the urban stormwater model to evaluate the performance and costs of low impact development (LID) scenarios in [...] Read more.

As urbanization progresses, increasingly impervious surfaces have changed the hydrological processes in cities and resulted in a major challenge for urban stormwater control. This study uses the urban stormwater model to evaluate the performance and costs of low impact development (LID) scenarios in a micro urban catchment. Rainfall-runoff data of three rainfall events were used for model calibration and validation. The pre-developed (PreDev) scenario, post-developed (PostDev) scenario, and three LID scenarios were used to evaluate the hydrologic performance of LID measures. Using reduction in annual runoff as the goal, the best solutions for each LID scenario were selected using cost-effectiveness curves. The simulation results indicated that the three designed LID scenarios could effectively reduce annual runoff volumes and pollutant loads compared with the PostDev scenario. The most effective scenario (MaxPerf) reduced annual runoff by 53.4%, followed by the sponge city (SpoPerf, 51.5%) and economy scenarios (EcoPerf, 43.1%). The runoff control efficiency of the MaxPerf and SpoPerf scenarios increased by 23.9% and 19.5%, respectively, when compared with the EcoPerf scenario; however, the costs increased by 104% and 83.6%. The reduction rates of four pollutants (TSS, TN, TP, and COD) under the MaxPerf scenario were 59.8–61.1%, followed by SpoPerf (53.9–58.3%) and EcoPerf (42.3–45.4%), and the costs of the three scenarios were 3.74, 3.47 and 1.83 million yuan, respectively. These results can provide guidance to urban stormwater managers in future urban planning to improve urban water security. Full article

(This article belongs to the Special Issue Stormwater Management in Urban Areas)

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13 pages, 299 KiB

Open AccessArticle

Prevalence and Correlates of Cyberbullying Perpetration. Findings from a German Representative Student Survey

by Marie Christine Bergmann and Dirk Baier

Int. J. Environ. Res. Public Health 2018, 15(2), 274; https://doi.org/10.3390/ijerph15020274 - 6 Feb 2018

Cited by 34 | Viewed by 7450

Abstract

Based on a survey of 9512 ninth-grade students conducted in Lower Saxony in 2013, this paper examines the prevalence of cyberbullying perpetration and the correlates of this behavior. Binary logistic multilevel regression was used in order to analyze correlates of sexual and psychological [...] Read more.

Based on a survey of 9512 ninth-grade students conducted in Lower Saxony in 2013, this paper examines the prevalence of cyberbullying perpetration and the correlates of this behavior. Binary logistic multilevel regression was used in order to analyze correlates of sexual and psychological cyberbully perpetration. In the preceding semester, 2.4% of the adolescents were perpetrators of psychological cyberbullying and 0.4% bullied someone online sexually. Low levels of empathy, frequent consumption of violent media, and being victims of aggressive online behaviors are correlated with the risk that a child will become a bully. Female adolescents are less likely than boys to engage in sexual cyberbullying perpetration, but they are more likely to engage in psychological cyberbullying perpetration. Only a small share of adolescents engage in sexual and psychological cyberbullying perpetration. Both behaviors differ in their correlates, however being a victim of aggressive online behaviors increase the risk for perpetration of both behaviors, respectively. Full article

24 pages, 771 KiB

Open AccessArticle

Does Walkability Contribute to Geographic Variation in Psychosocial Distress? A Spatial Analysis of 91,142 Members of the 45 and Up Study in Sydney, Australia

by Darren J. Mayne, Geoffrey G. Morgan, Bin B. Jalaludin and Adrian E. Bauman

Int. J. Environ. Res. Public Health 2018, 15(2), 275; https://doi.org/10.3390/ijerph15020275 - 6 Feb 2018

Cited by 12 | Viewed by 6856

Abstract

Walkability describes the capacity of the built environment to promote walking, and has been proposed as a potential focus for community-level mental health planning. We evaluated this possibility by examining the contribution of area-level walkability to variation in psychosocial distress in a population [...] Read more.

Walkability describes the capacity of the built environment to promote walking, and has been proposed as a potential focus for community-level mental health planning. We evaluated this possibility by examining the contribution of area-level walkability to variation in psychosocial distress in a population cohort at spatial scales comparable to those used for regional planning in Sydney, Australia. Data on psychosocial distress were analysed for 91,142 respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. We fit conditional auto regression models at the postal area level to obtain smoothed “disease maps” for psychosocial distress, and assess its association with area-level walkability after adjusting for individual- and area-level factors. Prevalence of psychosocial distress was 7.8%; similar for low (7.9%), low-medium (7.9%), medium-high (8.0%), and high (7.4%) walkability areas; and decreased with reducing postal area socioeconomic disadvantage: 12.2% (most), 9.3%, 7.5%, 5.9%, and 4.7% (least). Unadjusted disease maps indicated strong geographic clustering of psychosocial distress with 99.0% of excess prevalence due to unobserved and spatially structured factors, which was reduced to 55.3% in fully adjusted maps. Spatial and unstructured variance decreased by 97.3% and 39.8% after adjusting for individual-level factors, and another 2.3% and 4.2% with the inclusions of area-level factors. Excess prevalence of psychosocial distress in postal areas was attenuated in adjusted models but remained spatially structured. Postal area prevalence of high psychosocial distress is geographically clustered in Sydney, but is unrelated to postal area walkability. Area-level socioeconomic disadvantage makes a small contribution to this spatial structure; however, community-level mental health planning will likely deliver greatest benefits by focusing on individual-level contributors to disease burden and inequality associated with psychosocial distress. Full article

(This article belongs to the Special Issue Frontiers in Mental Health and the Environment)

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12 pages, 950 KiB

Open AccessArticle

Identification of Pancreatic Injury in Patients with Elevated Amylase or Lipase Level Using a Decision Tree Classifier: A Cross-Sectional Retrospective Analysis in a Level I Trauma Center

by Cheng-Shyuan Rau, Shao-Chun Wu, Peng-Chen Chien, Pao-Jen Kuo, Yi-Chun Chen, Hsiao-Yun Hsieh, Ching-Hua Hsieh and Hang-Tsung Liu

Int. J. Environ. Res. Public Health 2018, 15(2), 277; https://doi.org/10.3390/ijerph15020277 - 6 Feb 2018

Cited by 19 | Viewed by 8249

Abstract

Background: In trauma patients, pancreatic injury is rare; however, if undiagnosed, it is associated with high morbidity and mortality rates. Few predictive models are available for the identification of pancreatic injury in trauma patients with elevated serum pancreatic enzymes. In this study, we [...] Read more.

Background: In trauma patients, pancreatic injury is rare; however, if undiagnosed, it is associated with high morbidity and mortality rates. Few predictive models are available for the identification of pancreatic injury in trauma patients with elevated serum pancreatic enzymes. In this study, we aimed to construct a model for predicting pancreatic injury using a decision tree (DT) algorithm, along with data obtained from a population-based trauma registry in a Level I trauma center. Methods: A total of 991 patients with elevated serum levels of amylase (>137 U/L) or lipase (>51 U/L), including 46 patients with pancreatic injury and 865 without pancreatic injury between January 2009 and December 2016, were allocated in a ratio of 7:3 to training (n = 642) or test (n = 269) sets. Using the data on patient and injury characteristics as well as laboratory data, the DT algorithm with Classification and Regression Tree (CART) analysis was performed based on the Gini impurity index, using the rpart function in the rpart package in R. Results: Among the trauma patients with elevated amylase or lipase levels, three groups of patients were identified as having a high risk of pancreatic injury, using the DT model. These included (1) 69% of the patients with lipase level ≥306 U/L; (2) 79% of the patients with lipase level between 154 U/L and 305 U/L and shock index (SI) ≥ 0.72; and (3) 80% of the patients with lipase level <154 U/L with abdomen injury, glucose level <158 mg/dL, amylase level <90 U/L, and neutrophil percentage ≥76%; they had all sustained pancreatic injury. With all variables in the model, the DT achieved an accuracy of 97.9% (sensitivity of 91.4% and specificity of 98.3%) for the training set. In the test set, the DT achieved an accuracy of 93.3%, sensitivity of 72.7%, and specificity of 94.2%. Conclusions: We established a DT model using lipase, SI, and additional conditions (injury to the abdomen, glucose level <158 mg/dL, amylase level <90 U/L, and neutrophils ≥76%) as important nodes to predict three groups of patients with a high risk of pancreatic injury. The proposed decision-making algorithm may help in identifying pancreatic injury among trauma patients with elevated serum amylase or lipase levels. Full article

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13 pages, 1038 KiB

Open AccessArticle

Prevention of Common Mental Disorders in Employees. Perspectives on Collaboration from Three Health Care Professions

by Eva Rothermund, Martina Michaelis, Marc N. Jarczok, Elisabeth M. Balint, Rahna Lange, Stephan Zipfel, Harald Gündel, Monika A. Rieger and Florian Junne

Int. J. Environ. Res. Public Health 2018, 15(2), 278; https://doi.org/10.3390/ijerph15020278 - 6 Feb 2018

Cited by 22 | Viewed by 6491

Abstract

Collaboration among occupational health physicians, primary care physicians and psychotherapists in the prevention and treatment of common mental disorders in employees has been scarcely researched. To identify potential for improvement, these professions were surveyed in Baden-Württemberg (Germany). Four hundred and fifty occupational health [...] Read more.

Collaboration among occupational health physicians, primary care physicians and psychotherapists in the prevention and treatment of common mental disorders in employees has been scarcely researched. To identify potential for improvement, these professions were surveyed in Baden-Württemberg (Germany). Four hundred and fifty occupational health physicians, 1000 primary care physicians and 700 resident medical and psychological psychotherapists received a standardized questionnaire about their experiences, attitudes and wishes regarding activities for primary, secondary and tertiary prevention of common mental disorders in employees. The response rate of the questionnaire was 30% (n = 133) among occupational health physicians, 14% (n = 136) among primary care physicians and 27% (n = 186) among psychotherapists. Forty percent of primary care physicians and 33% of psychotherapists had never had contact with an occupational health physician. Psychotherapists indicated more frequent contact with primary care physicians than vice versa (73% and 49%, respectively). Better cooperation and profession-specific training on mental disorders and better knowledge about work-related stress were endorsed. For potentially involved stakeholders, the importance of interdisciplinary collaboration for better prevention and care of employees with common mental disorders is very high. Nevertheless, there is only little collaboration in practice. To establish quality-assured cooperation structures in practice, participants need applicable frameworks on an organizational and legal level. Full article

(This article belongs to the Section Occupational Safety and Health)

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19 pages, 5008 KiB

Open AccessArticle

Seasonal and Spatial Variability of Anthropogenic and Natural Factors Influencing Groundwater Quality Based on Source Apportionment

by Xueru Guo, Rui Zuo, Li Meng, Jinsheng Wang, Yanguo Teng, Xin Liu and Minhua Chen

Int. J. Environ. Res. Public Health 2018, 15(2), 279; https://doi.org/10.3390/ijerph15020279 - 6 Feb 2018

Cited by 48 | Viewed by 5903

Abstract

Globally, groundwater resources are being deteriorated by rapid social development. Thus, there is an urgent need to assess the combined impacts of natural and enhanced anthropogenic sources on groundwater chemistry. The aim of this study was to identify seasonal characteristics and spatial variations [...] Read more.

Globally, groundwater resources are being deteriorated by rapid social development. Thus, there is an urgent need to assess the combined impacts of natural and enhanced anthropogenic sources on groundwater chemistry. The aim of this study was to identify seasonal characteristics and spatial variations in anthropogenic and natural effects, to improve the understanding of major hydrogeochemical processes based on source apportionment. 34 groundwater points located in a riverside groundwater resource area in northeast China were sampled during the wet and dry seasons in 2015. Using principal component analysis and factor analysis, 4 principal components (PCs) were extracted from 16 groundwater parameters. Three of the PCs were water-rock interaction (PC₁), geogenic Fe and Mn (PC₂), and agricultural pollution (PC₃). A remarkable difference (PC₄) was organic pollution originating from negative anthropogenic effects during the wet season, and geogenic F enrichment during the dry season. Groundwater exploitation resulted in dramatic depression cone with higher hydraulic gradient around the water source area. It not only intensified dissolution of calcite, dolomite, gypsum, Fe, Mn and fluorine minerals, but also induced more surface water recharge for the water source area. The spatial distribution of the PCs also suggested the center of the study area was extremely vulnerable to contamination by Fe, Mn, COD, and F⁻. Full article

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15 pages, 1206 KiB

Open AccessArticle

Microplastics Reduce Short-Term Effects of Environmental Contaminants. Part I: Effects of Bisphenol A on Freshwater Zooplankton Are Lower in Presence of Polyamide Particles

by Saskia Rehse, Werner Kloas and Christiane Zarfl

Int. J. Environ. Res. Public Health 2018, 15(2), 280; https://doi.org/10.3390/ijerph15020280 - 6 Feb 2018

Cited by 117 | Viewed by 10666

Abstract

Microplastics can have direct physical effects on organisms in freshwater systems, and are considered as vectors for absorbed environmental pollutants. It is still under discussion if microplastics are relevant pollutant vectors for uptake into aquatic organisms in comparison to further uptake pathways, e.g., [...] Read more.

Microplastics can have direct physical effects on organisms in freshwater systems, and are considered as vectors for absorbed environmental pollutants. It is still under discussion if microplastics are relevant pollutant vectors for uptake into aquatic organisms in comparison to further uptake pathways, e.g., via water or sediment particles. We analyzed how the presence of microplastics (polyamide particles, PA) modifies acute effects of the environmental pollutant bisphenol A (BPA) on freshwater zooplankton (Daphnia magna). Daphnids were exposed to PA particles and BPA alone, before combining them in the next step with one concentration of PA and varying concentrations of BPA. The PA particles themselves did not induce negative effects, while the effects of BPA alone followed a typical dose-dependent manner. Sorption of BPA to PA particles prior to exposure led to a reduction of BPA in the aqueous phase. The combination of BPA and PA led to decreased immobilization, although PA particles loaded with BPA were ingested by the daphnids. Calculations based on physiochemistry and equilibrium assumptions indicated lower BPA body burden of daphnids in the presence of PA particles. These results confirm model-based studies, and show that investigated microplastic concentrations are negligible for the overall pollutant uptake of daphnids with water as additional uptake pathway. Full article

(This article belongs to the Special Issue Microplastics: Hazards to Environmental and Human Health)

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13 pages, 1605 KiB

Open AccessArticle

Stakeholders Opinions on Multi-Use Deep Water Offshore Platform in Hsiao-Liu-Chiu, Taiwan

by Ya-Tsune Sie, Pierre-Alexandre Château, Yang-Chi Chang and Shiau-Yun Lu

Int. J. Environ. Res. Public Health 2018, 15(2), 281; https://doi.org/10.3390/ijerph15020281 - 6 Feb 2018

Cited by 7 | Viewed by 6330

Abstract

This paper describes a group model building activity designed to elicit the potential effects a projected multi-use deep water offshore platform may have on its local environment, including ecological and socio-economic issues. As such a platform is proposed for construction around the island [...] Read more.

This paper describes a group model building activity designed to elicit the potential effects a projected multi-use deep water offshore platform may have on its local environment, including ecological and socio-economic issues. As such a platform is proposed for construction around the island of Hsiao-Liu-Chiu, Taiwan, we organized several meetings with the local stakeholders and structured the debates using group modeling methods to promote consensus. During the process, the participants iteratively built and revised a causal-loop diagram that summarizes their opinions. Overall, local stakeholders concluded that a multi-use deep water offshore marine platform might have beneficial effects for Hsiao-Liu-Chiu because more tourists and fish could be attracted by the structure, but they also raised some potential problems regarding the law in Taiwan and the design of the offshore platform, especially its resistance to extreme weather. We report the method used and the main results and insights gained during the process. Full article

(This article belongs to the Special Issue Decision Models in Green Growth and Sustainable Development)

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21 pages, 5101 KiB

Open AccessFeature PaperArticle

Testing Cessation Messages for Cigarette Package Inserts: Findings from a Best/Worst Discrete Choice Experiment

by James F. Thrasher, Farahnaz Islam, Rachel E. Davis, Lucy Popova, Victoria Lambert, Yoo Jin Cho, Ramzi G. Salloum, Jordan Louviere and David Hammond

Int. J. Environ. Res. Public Health 2018, 15(2), 282; https://doi.org/10.3390/ijerph15020282 - 6 Feb 2018

Cited by 20 | Viewed by 6447

Abstract

This study assessed smokers’ responses to different smoking cessation topics and imagery for cigarette package inserts. Adult smokers from Canada (n = 1000) participated in three discrete choice experiments (DCEs): DCE 1 assessed five cessation benefit topics and five imagery types; DCE [...] Read more.

This study assessed smokers’ responses to different smoking cessation topics and imagery for cigarette package inserts. Adult smokers from Canada (n = 1000) participated in three discrete choice experiments (DCEs): DCE 1 assessed five cessation benefit topics and five imagery types; DCE 2 assessed five messages with tips to improve cessation success and five imagery types; DCE 3 assessed four reproductive health benefits of cessation topics and four imagery types. In each DCE, participants evaluated four or five sets of four inserts, selecting the most and least motivating (DCEs 1 & 3) or helpful (DCE 2) for quitting. Linear mixed models regressed choices on insert and smoker characteristics. For DCE 1, the most motivating messages involved novel disease topics and imagery of younger women. For DCE 2, topics of social support, stress reduction and nicotine replacement therapy were selected as most helpful, with no differences by imagery type. For DCE 3, imagery influenced choices more than topic, with imagery of a family or a mom and baby selected as most motivating. Statistically significant interactions for all three experiments indicated that the influence of imagery type on choices depended on the message topic. Messages to promote smoking cessation through cigarette pack inserts should consider specific combinations of message topic and imagery. Full article

(This article belongs to the Special Issue Development and Evaluation of New Tobacco Control Interventions)

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10 pages, 429 KiB

Open AccessArticle

Depressive Symptoms of Chinese Children: Prevalence and Correlated Factors among Subgroups

by Mi Zhou, Guangsheng Zhang, Scott Rozelle, Kaleigh Kenny and Hao Xue

Int. J. Environ. Res. Public Health 2018, 15(2), 283; https://doi.org/10.3390/ijerph15020283 - 7 Feb 2018

Cited by 65 | Viewed by 6667

Abstract

Economic growth and socioeconomic changes have transformed nearly every aspect of childhood in China, and many are worried by the increasing prevalence of mental health issues among children, particularly depression. To provide insight into the distribution of depressive symptoms among children in China [...] Read more.

Economic growth and socioeconomic changes have transformed nearly every aspect of childhood in China, and many are worried by the increasing prevalence of mental health issues among children, particularly depression. To provide insight into the distribution of depressive symptoms among children in China and identify vulnerable groups, we use data from the 2012 China Family Panel Survey (CFPS), a survey that collected data from a large, nationally representative sample of the Chinese population. Using the CFPS data, we construct a sample of 2679 children aged 10–15 years old from 25 provinces in China. According to our results, the incidence of depression varies by geographic area. Specifically, we find that rates of depressive symptoms are significantly lower in urban areas (14% of sample children) than in rural areas (23% of sample children). Our results also show that children from ethnic minorities, from poorer families, and whose parents are depressed are more likely to be depressed than other children. In contrast, we find that depressive symptoms do not vary by gender. Full article

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10 pages, 1676 KiB

Open AccessArticle

Degradation Investigation of Selected Taste and Odor Compounds by a UV/Chlorine Advanced Oxidation Process

by Jingyun Fang, Jiajian Liu, Chii Shang and Chihhao Fan

Int. J. Environ. Res. Public Health 2018, 15(2), 284; https://doi.org/10.3390/ijerph15020284 - 7 Feb 2018

Cited by 29 | Viewed by 5841

Abstract

Taste- and odor-causing (T&O) compounds are a major concern in drinking water treatment plants due to their negative impacts on the safety and palatability of water supply. This study explored the degradation kinetics and radical chemistry of four often-detected T&O compounds, geosmin (GSM), [...] Read more.

Taste- and odor-causing (T&O) compounds are a major concern in drinking water treatment plants due to their negative impacts on the safety and palatability of water supply. This study explored the degradation kinetics and radical chemistry of four often-detected T&O compounds, geosmin (GSM), 2-methylisoborneol (MIB), benzothiazole (BT), and 2-isobutyl-3-methoxypyrazine (IBMP), in the ultraviolet/chlorine (UV/chlorine) advanced oxidation process. All experiments were carried out in a 700 mL photoreactor and the process effectively degraded the investigated T&O compounds in a slightly acidic environment. The degradation of T&O decreased with increasing pH but slightly with decreasing chlorine dosage. When the pH increased from 6 to 8, the pseudo-first-order rate constants of GSM, MIB, BT, and IBMP dropped from 2.84 × 10⁻³, 2.29 × 10⁻³, 3.64 × 10⁻³, and 2.76 × 10⁻³ s⁻¹ to 3.77 × 10⁻⁴, 2.64 × 10⁻⁴, 6.48 × 10⁻⁴, and 6.40 × 10⁻⁴ s⁻¹, respectively. Increasing the chlorine dosage slightly accelerated the degradation of the investigated T&O compounds, but excessive hypochlorous acid and hypochlorite scavenged the HO• radicals and reactive chlorine species (RCS). Generally, HO• primarily contributed to the degradation of all of the investigated T&O compounds as compared to RCS. The degradation by RCS was found to be structurally selective. RCS could not degrade GSM, but contributed to the degradation of MIB, BT, and IBMP. The results confirmed that the proposed oxidation process effectively degraded typical T&O compounds in aqueous phase. Full article

(This article belongs to the Special Issue Emerging Contaminants VS. Legacy Pollutants: Their Impacts on the Environmental Integrity and Public Health)

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6 pages, 310 KiB

Open AccessArticle

Clinical Aspects of Foot Health in Individuals with Alzheimer’s Disease

by Daniel López-López, Marta Grela-Fariña, Marta Elena Losa-Iglesias, César Calvo-Lobo, David Rodríguez-Sanz, Patricia Palomo-López and Ricardo Becerro-de-Bengoa-Vallejo

Int. J. Environ. Res. Public Health 2018, 15(2), 286; https://doi.org/10.3390/ijerph15020286 - 7 Feb 2018

Cited by 8 | Viewed by 4935

Abstract

Alzheimer’s disease (AD) shows a marked presence of physiologic changes and the start or aggravation of underlying diseases such as physical frailty in diverse anatomical regions. It is believed to have a particularly harmful effect on the health of the foot. We examined [...] Read more.

Alzheimer’s disease (AD) shows a marked presence of physiologic changes and the start or aggravation of underlying diseases such as physical frailty in diverse anatomical regions. It is believed to have a particularly harmful effect on the health of the foot. We examined the foot health status in older persons with AD, with a specific focus on the extent to which people with AD may be using inadequate footwear in old age. Seventy-three community-dwelling people with probable, mild to moderate AD aged 65–95 years were recruited from a center of excellence for AD. A single trained physician evaluated health status and foot conditions. Current shoe and foot length and width measurements were taken using a calibrated Brannock device. The results indicate that sixty-five participants (89.04%) suffered from feet problems. Also, only twenty-two subjects (30.14%) used the correct shoes in width and size related with the morphology of their feet. Fifty-one participants (69.86%) were using incorrect shoes in length or width. The present study revealed that peoples with AD had a high presence of foot health problems. Also, the use of inappropriate shoes revealed measurable differences of association between shoe size and the morphology of the foot. Full article

16 pages, 2450 KiB

Open AccessArticle

Microplastics Reduce Short-Term Effects of Environmental Contaminants. Part II: Polyethylene Particles Decrease the Effect of Polycyclic Aromatic Hydrocarbons on Microorganisms

by Julia Kleinteich, Sven Seidensticker, Nikolaj Marggrander and Christiane Zarfl

Int. J. Environ. Res. Public Health 2018, 15(2), 287; https://doi.org/10.3390/ijerph15020287 - 7 Feb 2018

Cited by 105 | Viewed by 11438

Abstract

Microplastic particles in terrestrial and aquatic ecosystems are currently discussed as an emerging persistent organic pollutant and as acting as a vector for hydrophobic chemicals. Microplastic particles may ultimately deposit and accumulate in soil as well as marine and freshwater sediments where they [...] Read more.

Microplastic particles in terrestrial and aquatic ecosystems are currently discussed as an emerging persistent organic pollutant and as acting as a vector for hydrophobic chemicals. Microplastic particles may ultimately deposit and accumulate in soil as well as marine and freshwater sediments where they can be harmful to organisms. In this study, we tested the sensitivity of natural freshwater sediment bacterial communities (by genetic fingerprint) to exposure to microplastics (polyethylene, 2 and 20 mg/g sediment) and microplastics loaded with polycyclic aromatic hydrocarbons (PAHs, phenanthrene and anthracene), using a laboratory-based approach. After two weeks of incubation, the bacterial community composition from an unpolluted river section was altered by high concentrations of microplastics, whereas the community downstream of a wastewater treatment plant remained unchanged. Low microplastic concentrations loaded with phenanthrene or anthracene induced a less pronounced response in the sediment communities compared to the same total amount of phenanthrene or anthracene alone. In addition, biodegradation of the PAHs was reduced. This study shows, that microplastic can affect bacterial community composition in unpolluted freshwater sediments. Moreover, the results indicate that microplastics can serve as a vehicle for hydrophobic pollutants but bioavailability of the latter is reduced by the sorption to microplastics. Full article

(This article belongs to the Special Issue Microplastics: Hazards to Environmental and Human Health)

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20 pages, 3256 KiB

Open AccessArticle

Smokers’ Views on Personal Carbon Monoxide Monitors, Associated Apps, and Their Use: An Interview and Think-Aloud Study

by Aleksandra Herbeć, Olga Perski, Lion Shahab and Robert West

Int. J. Environ. Res. Public Health 2018, 15(2), 288; https://doi.org/10.3390/ijerph15020288 - 7 Feb 2018

Cited by 17 | Viewed by 6737

Abstract

Smartphone-based personal carbon monoxide (CO) monitors and associated apps, or “CO Smartphone Systems” (CSSs) for short, could enable smokers to independently monitor their smoking and quitting. This study explored views and preferences regarding CSSs and their use among 16 adult, UK-based smokers. First, [...] Read more.

Smartphone-based personal carbon monoxide (CO) monitors and associated apps, or “CO Smartphone Systems” (CSSs) for short, could enable smokers to independently monitor their smoking and quitting. This study explored views and preferences regarding CSSs and their use among 16 adult, UK-based smokers. First, semi-structured interviews explored participants’ expectations of CSSs. Secondly, a think-aloud study identified participants’ reactions to a personal CO monitor and to existing or prototype apps. Framework Analysis identified five themes: (1) General views, needs, and motivation to use CSSs; (2) Views on the personal CO monitor; (3) Practicalities of CSS use; (4) Desired features in associated apps; and (5) Factors affecting preferences for CSSs and their use. Participants had high expectations of CSSs and their potential to increase motivation. Priority app features included: easy CO testing journeys, relevant and motivating feedback, and recording of contextual data. Appearance and usability of the personal CO monitor, and accuracy and relevance of CO testing were considered important for engagement. Participants differed in their motivation to use and preferences for CSSs features and use, which might have non-trivial impact on evaluation efforts. Personal CO monitors and associated apps may be attractive tools for smokers, but making CSSs easy to use and evaluating these among different groups of smokers may be challenging. Full article

(This article belongs to the Special Issue Development and Evaluation of New Tobacco Control Interventions)

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11 pages, 622 KiB

Open AccessFeature PaperArticle

Incidence Rates of and Mortality after Hip Fracture among German Nursing Home Residents

by Hannes Jacobs, Hajo Zeeb and Falk Hoffmann

Int. J. Environ. Res. Public Health 2018, 15(2), 289; https://doi.org/10.3390/ijerph15020289 - 7 Feb 2018

Cited by 17 | Viewed by 5473

Abstract

Little is known about hip fracture rates and post-fracture mortality among nursing home residents. This retrospective cohort study examined incidence rates (IR) of and mortality after hip fracture in this population focusing on sex differences. A cohort of >127,000 residents ≥65 years, newly [...] Read more.

Little is known about hip fracture rates and post-fracture mortality among nursing home residents. This retrospective cohort study examined incidence rates (IR) of and mortality after hip fracture in this population focusing on sex differences. A cohort of >127,000 residents ≥65 years, newly admitted to German nursing homes between 2010 and 2014 were used to calculate age-, sex-, care-need- and time after admission-specific IR. To determine mortality, the Kaplan-Meier-method was applied. Using Cox regression, we studied mortality and estimated time-dependent hazard ratios (HRs). For this purpose, to each person with a hip fracture, one resident without a hip fracture was matched by sex, age and care-need using risk-set sampling. 75% were women (mean age: 84.0 years). During 168,588 person-years (PY), 8537 residents with at least one hip fracture were observed. The IR for women and men were 52.9 and 42.5/1000 PY. For both sexes, IR increased with rising age and decreased with increasing care-level. IR were highest in the first months after admission and subsequently declined afterwards. The impact of hip fractures on mortality was time-dependent. Mortality of residents with hip fracture was highest in the first two months after fracture compared to those without (HR): 2.82; 95% CI 2.57–3.11) and after six months, no differences were found (HR: 1.10; 95% CI 0.98–1.22) Further research should always include analyses stratified by sex, age and time period after admission. Full article

(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)

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13 pages, 586 KiB

Open AccessArticle

Characteristics of Stress and Suicidal Ideation in the Disclosure of Sexual Orientation among Young French LGB Adults

by Elodie Charbonnier, Florence Dumas, Adam Chesterman and Pierluigi Graziani

Int. J. Environ. Res. Public Health 2018, 15(2), 290; https://doi.org/10.3390/ijerph15020290 - 7 Feb 2018

Cited by 4 | Viewed by 7731

Abstract

Background: Lesbians, gays, and bisexual people (LGB) present high levels of suicidal ideation. The disclosure of sexual orientation is a stressful experience which presents a high suicide risk. Research has not paid sufficient attention to stress during this disclosure in order to understand [...] Read more.

Background: Lesbians, gays, and bisexual people (LGB) present high levels of suicidal ideation. The disclosure of sexual orientation is a stressful experience which presents a high suicide risk. Research has not paid sufficient attention to stress during this disclosure in order to understand suicide among LGB people. The aims of this study were to investigate: (1) the characteristics of stress during this revelation, more precisely cognitive appraisal, emotions, and coping; and (2) associations between these characteristics and suicidal ideation. Method: A total of 200 LGB young adults answered the “Stressful situation assessment questionnaire”, focusing on the most stressful disclosure of sexual orientation they have ever experienced. Results: Avoidance coping is a good predictor of suicidal ideation, and mediates the association between primary appraisal (risk “Harm myself and others”) and suicidal ideation. Conclusions: Our study illustrates the need to better understand stress during the disclosure of sexual orientation to prevent and care for suicide risk among LGB young adults. Full article

(This article belongs to the Special Issue Advances in Suicide Research)

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14 pages, 850 KiB

Open AccessArticle

Daily Patterns of Preschoolers’ Objectively Measured Step Counts in Six European Countries: Cross-Sectional Results from the ToyBox-Study

by Vicky Van Stappen, Delfien Van Dyck, Julie Latomme, Ilse De Bourdeaudhuij, Luis Moreno, Piotr Socha, Violeta Iotova, Berthold Koletzko, Yannis Manios, Odysseas Androutsos, Greet Cardon and Marieke De Craemer

Int. J. Environ. Res. Public Health 2018, 15(2), 291; https://doi.org/10.3390/ijerph15020291 - 7 Feb 2018

Cited by 7 | Viewed by 4926

Abstract

This study is part of the ToyBox-study, which is conducted in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain), aiming to develop a cost-effective kindergarten-based, family-involved intervention to prevent overweight and obesity in four- to six-year-old preschool children. In the current [...] Read more.

This study is part of the ToyBox-study, which is conducted in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain), aiming to develop a cost-effective kindergarten-based, family-involved intervention to prevent overweight and obesity in four- to six-year-old preschool children. In the current study, we aimed to examine and compare preschoolers’ step count patterns, across the six European countries. A sample of 3578 preschoolers (mean age: 4.8 ± 0.4) was included. Multilevel analyses were performed to take clustering of measurements into account. Based on the average hourly steps, step count patterns for the six European countries were created for weekdays and weekend days. The step count patterns during weekdays were related to the daily kindergarten schedules. Step count patterns during weekdays showed several significant peaks and troughs (p < 0.01) and clearly reflected the kindergartens’ daily schedules, except for Germany. For example, low numbers of steps were observed during afternoon naptimes and high numbers of steps during recess. In Germany, step count patterns did not show clear peaks and troughs, which can be explained by a less structured kindergarten schedule. On weekend days, differences in step count patterns were observed in the absolute number of steps in the afternoon trough and the period in which the evening peak occurred. Differences in step count patterns across the countries can be explained by differences in (school) policy, lifestyle habits, and culture. Therefore, it might be important to respond to these step count patterns and more specifically to tackle the inactive periods during interventions to promote physical activity in preschoolers. Full article

(This article belongs to the Special Issue Eating and Exercise in Children and Adolescents)

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10 pages, 434 KiB

Open AccessArticle

Influential Effects of Intrinsic-Extrinsic Incentive Factors on Management Performance in New Energy Enterprises

by Ping Wang, Zhengnan Lu and Jihong Sun

Int. J. Environ. Res. Public Health 2018, 15(2), 292; https://doi.org/10.3390/ijerph15020292 - 8 Feb 2018

Cited by 13 | Viewed by 6208

Abstract

Background: New energy has become a key trend for global energy industry development. Talent plays a very critical role in the enhancement of new energy enterprise competitiveness. As a key component of talent, managers have been attracting more and more attention. The [...] Read more.

Background: New energy has become a key trend for global energy industry development. Talent plays a very critical role in the enhancement of new energy enterprise competitiveness. As a key component of talent, managers have been attracting more and more attention. The increase in job performance relies on, to a certain extent, incentive mechanism. Based on the Two-factor Theory, differences in influences and effects of different incentives on management performance have been checked in this paper from an empirical perspective. Methods: This paper selects the middle and low level managers in new energy enterprises as research samples and classifies the managers’ performance into task performance, contextual performance and innovation performance. It uses manager performance questionnaires and intrinsic-extrinsic incentive factor questionnaires to investigate and study the effects and then uses Amos software to analyze the inner link between the intrinsic-extrinsic incentives and job performance. Results: Extrinsic incentives affect task performance and innovation performance positively. Intrinsic incentives impose active significant effects on task performance, contextual performance, and innovation performance. The intrinsic incentive plays a more important role than the extrinsic incentive. Conclusions: Both the intrinsic-extrinsic incentives affect manager performance positively and the intrinsic incentive plays a more important role than the extrinsic incentive. Several suggestions to management should be given based on these results. Full article

(This article belongs to the Special Issue Decision Models in Green Growth and Sustainable Development)

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12 pages, 1441 KiB

Open AccessArticle

Environmental Intolerance, Symptoms and Disability Among Fertile-Aged Women

by Aki Vuokko, Kirsi Karvala, Jussi Lampi, Leea Keski-Nisula, Markku Pasanen, Raimo Voutilainen, Juha Pekkanen and Markku Sainio

Int. J. Environ. Res. Public Health 2018, 15(2), 293; https://doi.org/10.3390/ijerph15020293 - 8 Feb 2018

Cited by 16 | Viewed by 4633

Abstract

The purpose was to study the prevalence of environmental intolerance (EI) and its different manifestations, including behavioral changes and disability. Fertile-aged women (n = 680) of the Kuopio Birth Cohort Study were asked about annoyance to 12 environmental factors, symptoms and behavioral [...] Read more.

The purpose was to study the prevalence of environmental intolerance (EI) and its different manifestations, including behavioral changes and disability. Fertile-aged women (n = 680) of the Kuopio Birth Cohort Study were asked about annoyance to 12 environmental factors, symptoms and behavioral changes. We asked how much the intolerance had disrupted their work, household responsibilities or social life. We chose intolerance attributed to chemicals, indoor molds, and electromagnetic fields to represent typical intolerance entities. Of the respondents, 46% reported annoyance to chemicals, molds, or electromagnetic fields. Thirty-three percent reported symptoms relating to at least one of these three EIs, 18% reported symptoms that included central nervous system symptoms, and 15% reported behavioral changes. Indicating disability, 8.4% reported their experience relating to any of the three EIs as at least “somewhat difficult”, 2.2% “very difficult” or “extremely difficult”, and 0.9% “extremely difficult”. Of the latter 2.2%, all attributed their intolerance to indoor molds, and two thirds also to chemicals. As the number of difficulties increased, the number of organ systems, behavioral changes and overlaps of the three EIs also grew. EI is a heterogeneous phenomenon and its prevalence depends on its definition. The manifestations of EI form a continuum, ranging from annoyance to severe disability. Full article

(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)

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17 pages, 334 KiB

Open AccessArticle

Disease and Economic Burden of Hospitalizations Attributable to Diabetes Mellitus and Its Complications: A Nationwide Study in Brazil

by Michelle Quarti Machado Rosa, Roger Dos Santos Rosa, Marcelo G. Correia, Denizar V. Araujo, Luciana R. Bahia and Cristiana M. Toscano

Int. J. Environ. Res. Public Health 2018, 15(2), 294; https://doi.org/10.3390/ijerph15020294 - 8 Feb 2018

Cited by 33 | Viewed by 7638

Abstract

Diabetes is associated with a significant burden globally. The costs of diabetes-related hospitalizations are unknown in most developing countries. The aim of this study was to estimate the total number and economic burden of hospitalizations attributable to diabetes mellitus (DM) and its complications [...] Read more.

Diabetes is associated with a significant burden globally. The costs of diabetes-related hospitalizations are unknown in most developing countries. The aim of this study was to estimate the total number and economic burden of hospitalizations attributable to diabetes mellitus (DM) and its complications in adults from the perspective of the Brazilian Public Health System in 2014. Data sources included the National Health Survey (NHS) and National database of Hospitalizations (SIH). We considered diabetes, its microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications (coronary heart disease, cerebrovascular disease, and peripheral arterial disease), respiratory and urinary tract infections, as well as selected cancers. Assuming that DM patients are hospitalized for these conditions more frequently that non-DM individuals, we estimated the etiological fraction of each condition related to DM, using the attributable risk methodology. We present number, average cost per case, and overall costs of hospitalizations attributable to DM in Brazil in 2014, stratified by condition, state of the country, gender and age group. In 2014, a total of 313,273 hospitalizations due to diabetes in adults were reported in Brazil (4.6% of total adult hospitalization), totaling (international dollar) Int$264.9 million. The average cost of an adult hospitalization due to diabetes was Int$845, 19% higher than hospitalization without DM. Hospitalizations due to cardiovascular diseases related to diabetes accounted for the higher proportion of costs (47.9%), followed by microvascular complications (25.4%) and DM per se (18.1%). Understanding the costs of diabetes and its major complications is crucial to raise awareness and to support the decision-making process on policy implementation, also allowing the assessment of prevention and control strategies. Full article

(This article belongs to the Special Issue Economic Causes and Impacts of Diabetes and Diabetes-Related Conditions)

11 pages, 320 KiB

Open AccessArticle

The Impact of Sustainable Development Technology on a Small Economy—The Case of Energy-Saving Technology

by Xiding Chen, Qinghua Huang, Weilun Huang and Xue Li

Int. J. Environ. Res. Public Health 2018, 15(2), 295; https://doi.org/10.3390/ijerph15020295 - 8 Feb 2018

Cited by 5 | Viewed by 4302

Abstract

We investigated the impact of a sustainable development technology on the macroeconomic variables in a small economy utilizing a case study with a stochastically improving energy saving technology and a stochastically increasing energy price. The results show the technological displacement effects of energy [...] Read more.

We investigated the impact of a sustainable development technology on the macroeconomic variables in a small economy utilizing a case study with a stochastically improving energy saving technology and a stochastically increasing energy price. The results show the technological displacement effects of energy saving technology are stronger, but there are more ambiguous instantaneous returns to physical capital. However, the energy saving technology’s displacement effects might not affect the conditions under which the Harberger-Laursen-Metzler (HLM) effect holds. The effects of rising energy prices on bonds are stronger, and there are more ambiguous instantaneous returns, but the conditions under which the HLM effect holds are different. Full article

(This article belongs to the Special Issue Decision Models in Green Growth and Sustainable Development)

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23 pages, 1809 KiB

Open AccessArticle

The Roles of Three Types of Knowledge and Perceived Uncertainty in Explaining Risk Perception, Acceptability, and Self-Protective Response—A Case Study on Endocrine Disrupting Surfactants

by Hien Ho and Tsunemi Watanabe

Int. J. Environ. Res. Public Health 2018, 15(2), 296; https://doi.org/10.3390/ijerph15020296 - 8 Feb 2018

Cited by 16 | Viewed by 6949

Abstract

The ubiquitous surfactants nonylphenol (NP) and its ethoxylates (NPEOs), which are known as endocrine disrupters, have appeared in the lists of restricted chemical substances, monitoring programs, and environmental quality standards of many countries due to their adverse effects. Recent studies have reported alarming [...] Read more.

The ubiquitous surfactants nonylphenol (NP) and its ethoxylates (NPEOs), which are known as endocrine disrupters, have appeared in the lists of restricted chemical substances, monitoring programs, and environmental quality standards of many countries due to their adverse effects. Recent studies have reported alarming levels of NP, as the final metabolite of NPEOs, in Vietnamese urban waters, whilst response to this issue is negligible. With the aim of addressing how the public perceives and expects to avoid the risk of endocrine disrupting surfactants (EDSs), the study tested the hypothesized roles of specific knowledge, general knowledge, and perceived uncertainty using structural equation modelling. The findings revealed that different types of knowledge played certain roles in explaining risk perception, risk acceptability, and self-protective response, which are distinguished by experience amongst the public. Evidence of the mediating role that perceived uncertainty may play in the decrease of risk perception and the increase of risk unacceptance has been provided. The insights gained from the study may help answer why the public are in favor of taking non-diet-related self-protective measures rather than changing their dietary habits, which illustrates a comparison with the basis of health belief model. The needs for building cognitive capacity amongst the public, particularly pregnant women and young mothers, and risk communication concerning endocrine disrupting contamination linked to reproductive health are highlighted. Full article

(This article belongs to the Collection Health Behavior and Public Health)

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14 pages, 496 KiB

Open AccessArticle

A Qualitative Exploration of the Role of Vape Shop Environments in Supporting Smoking Abstinence

by Emma Ward, Sharon Cox, Lynne Dawkins, Sarah Jakes, Richard Holland and Caitlin Notley

Int. J. Environ. Res. Public Health 2018, 15(2), 297; https://doi.org/10.3390/ijerph15020297 - 9 Feb 2018

Cited by 33 | Viewed by 24184

Abstract

E-cigarettes are the most popular method of quitting smoking in England and most are purchased in specialist vape shops. This qualitative study explores how the vape shop environment is experienced by quitters to support smoking abstinence. Semi-structured qualitative interviews were conducted to elicit [...] Read more.

E-cigarettes are the most popular method of quitting smoking in England and most are purchased in specialist vape shops. This qualitative study explores how the vape shop environment is experienced by quitters to support smoking abstinence. Semi-structured qualitative interviews were conducted to elicit experiences of e-cigarette use, including experiences of vape shops, in 40 people who had used e-cigarettes in a quit attempt. Observations of six shops in a range of locations were also undertaken. Interview and observation data were analysed using inductive thematic analysis and triangulated. At an individual level, smoking abstinence was supported through shop assistants’ attempts to understand customers’ smoking preferences in order to: (i) tailor advice about the most appropriate product; and (ii) offer an ongoing point of contact for practical help. At an interpersonal level, shops offered opportunity to socialise and reinforce a vaping identity, although the environment was perceived as intimidating for some (e.g., new and female users). At a structural level, shops ensured easy access to products perceived to be good value by customers and had adapted to legislative changes. Vape shops can provide effective behavioural support to quitters to maintain smoking abstinence. Health professionals could capitalise on this through partnership working with shops, to ensure best outcomes for clients wanting to use e-cigarettes to quit smoking. Full article

(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)

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10 pages, 294 KiB

Open AccessArticle

Suicidal Ideation among Youth Living in the Slums of Kampala, Uganda

by Rachel Culbreth, Monica H. Swahn, David Ndetei, Lynnette Ametewee and Rogers Kasirye

Int. J. Environ. Res. Public Health 2018, 15(2), 298; https://doi.org/10.3390/ijerph15020298 - 9 Feb 2018

Cited by 32 | Viewed by 5894

Abstract

The purpose of this study is to examine the factors associated with suicidal ideation among youth living in the slums of Kampala, Uganda. Analyses are based on cross-sectional survey data, collected in 2014, of a convenience sample (n = 1134) of urban [...] Read more.

The purpose of this study is to examine the factors associated with suicidal ideation among youth living in the slums of Kampala, Uganda. Analyses are based on cross-sectional survey data, collected in 2014, of a convenience sample (n = 1134) of urban service-seeking youth participating in a Uganda Youth Development Link drop-in center. Logistic regression analyses were computed to determine the psychosocial factors associated with suicidal ideation. Among youth participants, 23.54% (n = 266) reported suicidal ideation in the past year. In the multivariable analysis, suicidal ideation was associated with being female (OR: 1.61; 95% CI: 1.15, 2.25), reporting one (OR: 1.51; 95% CI: 1.05, 2.18) or two deceased parents (OR: 1.55; 95% CI: 1.03, 2.35), ever living on the streets (OR: 2.65; 95% CI: 1.86, 3.79), problem drinking (OR: 1.83; 95% CI: 1.19, 2.80), sexually transmitted infection (OR: 1.59; 95% CI: 1.14, 2.21), ever being raped (OR: 1.49; 95% CI: 1.01, 2.20), and experiencing physical child abuse (OR: 2.40; 95% CI: 1.75, 3.27). Our findings underscore many unmet needs in this vulnerable population. However, strategies that specifically seek to address problem drinking—a modifiable risk factor for suicidal ideation—may be particularly warranted in this low-resource setting. Full article

(This article belongs to the Special Issue Advances in Suicide Research)

19 pages, 547 KiB

Open AccessArticle

Urinary Arsenic in Human Samples from Areas Characterized by Natural or Anthropogenic Pollution in Italy

by Fabrizio Minichilli, Fabrizio Bianchi, Anna Maria Ronchi, Francesca Gorini and Elisa Bustaffa

Int. J. Environ. Res. Public Health 2018, 15(2), 299; https://doi.org/10.3390/ijerph15020299 - 9 Feb 2018

Cited by 12 | Viewed by 5774

Abstract

Arsenic is ubiquitous and has a potentially adverse impact on human health. We compared the distribution of concentrations of urinary inorganic arsenic plus methylated forms (uc(iAs+MMA+DMA)) in four Italian areas with other international studies, and we assessed the relationship between uc(iAs+MMA+DMA) and various [...] Read more.

Arsenic is ubiquitous and has a potentially adverse impact on human health. We compared the distribution of concentrations of urinary inorganic arsenic plus methylated forms (uc(iAs+MMA+DMA)) in four Italian areas with other international studies, and we assessed the relationship between uc(iAs+MMA+DMA) and various exposure factors. We conducted a human biomonitoring study on 271 subjects (132 men) aged 20–44, randomly sampled and stratified by area, gender, and age. Data on environmental and occupational exposure and dietary habits were collected through a questionnaire. Arsenic was speciated using chromatographic separation and inductively coupled mass spectrometry. Associations between uc(iAs+MMA+DMA) and exposure factors were evaluated using the geometric mean ratio (GMR) with a 90% confidence interval by stepwise multiple regression analysis. The 95th percentile value of uc(iAs+MMA+DMA) for the whole sample (86.28 µg/L) was higher than other national studies worldwide. A statistical significant correlation was found between uc(iAs+MMA+DMA) and occupational exposure (GMR: 2.68 [1.79–4.00]), GSTT gene (GMR: 0.68 [0.52–0.80]), consumption of tap water (GMR: 1.35 [1.02–1.77]), seafood (GMR: 1.44 [1.11–1.88]), whole milk (GMR: 1.34 [1.04–1.73]), and fruit/vegetables (GMR: 1.37 [1.03–1.82]). This study demonstrated the utility of uc(iAs+MMA+DMA) as a biomarker to assess environmental exposure. In a public health context, this information could be used to support remedial action, to prevent individuals from being further exposed to environmental arsenic sources. Full article

(This article belongs to the Special Issue Arsenic Contamination, Bioavailability and Public Health)

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19 pages, 1985 KiB

Open AccessFeature PaperArticle

An Experimental Exploration of the Effects of Exposure to Images of Nature on Rumination

by Sarah Elizabeth Golding, Birgitta Gatersleben and Mark Cropley

Int. J. Environ. Res. Public Health 2018, 15(2), 300; https://doi.org/10.3390/ijerph15020300 - 9 Feb 2018

Cited by 24 | Viewed by 7694

Abstract

Exposure to natural environments has been shown to have beneficial effects on mood. Rumination is a thinking style associated with negative mood, and sometimes depression, and is characterized by repetitive, intrusive thoughts, often with a negative emotional element. This study investigated whether exposure [...] Read more.

Exposure to natural environments has been shown to have beneficial effects on mood. Rumination is a thinking style associated with negative mood, and sometimes depression, and is characterized by repetitive, intrusive thoughts, often with a negative emotional element. This study investigated whether exposure to nature, operationalized using photographs presented as a slideshow, could aid reduction in levels of state rumination. An experimental, within-between (Time x Condition) participant design was used; participants (n = 58) undertook a presentation task designed to induce rumination and influence mood. Participants were then randomly allocated to either: watch a slideshow of a natural environment, watch a slideshow of an urban environment, or wait patiently with no distractions. Data were collected at baseline, after the presentation, and after the slideshow. Environmental exposure had no effect on levels of rumination or negative mood, but did have a significant effect on levels of positive mood, ‘being away’, and ‘fascination’. Positive mood declined in those who saw the urban slideshow, but remained the same in those who saw the nature slideshow, whilst levels of being away and fascination were highest in those who saw the nature slideshow. This study extends previous restorative environment research by exploring the effects of nature on rumination. Full article

(This article belongs to the Special Issue Stress and Health)

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16 pages, 338 KiB

Open AccessArticle

Perceived Environmental Factors Associated with Obesity in Libyan Men and Women

by Hamdi Lemamsha, Chris Papadopoulos and Gurch Randhawa

Int. J. Environ. Res. Public Health 2018, 15(2), 301; https://doi.org/10.3390/ijerph15020301 - 9 Feb 2018

Cited by 8 | Viewed by 4723

Abstract

Background: There is a lack of research pertaining to the links between built environment attributes and obesity in adults in the Eastern Mediterranean Region. In the Libyan context, no previous studies have been conducted to investigate this relationship. Therefore, the aim of [...] Read more.

Background: There is a lack of research pertaining to the links between built environment attributes and obesity in adults in the Eastern Mediterranean Region. In the Libyan context, no previous studies have been conducted to investigate this relationship. Therefore, the aim of this study was to examine associations between perceived neighbourhood built environmental attributes and obesity among Libyan men and women. The prevalence of overweight and obesity was also assessed. Methods: A cross-sectional study design was used for the population-based survey in Benghazi, Libya. A multi-stage cluster sampling technique was used to select Libyan adults from the Benghazi electoral register. The Physical Activity Neighbourhood Environment Scale (PANES) was used to measure participants’ perception of neighbourhood environmental factors. Using the Tanita BC-601 Segmental Body Composition Monitor and a portable stadiometer, anthropometric measurements were taken at a mutually agreeable place by qualified nurses. Results: Four hundred and one Libyan adults were recruited (78% response rate). Participants were aged 20–65 years, 63% were female, and all had lived in Benghazi for over 10 years. The prevalence of obesity and overweight was 42.4% and 32.9% respectively. A significant association was found between BMI and 6 neighbourhood environment attributes, specifically: street connectivity, unsafe environment and committing crimes at night, and neighbourhood aesthetics. For men only, these were: access to public transport, access to recreational facilities, and unsafe environment and committing crimes during the day. The attribute ‘residential density zones’ was only significant for women. Conclusions: The study suggests that Libyan people are at risk of living in neighbourhoods with unsupportive environmental features of physical activity, which are likely to promote obesity of both genders. The findings of this study could inform Libyan health policies about interventions in the obesogenic environments that might slow the obesity epidemic and contain the public health crisis. This study suggests that further research is needed, within the Libyan context, to explore the impact of the neighbourhood environment attributes on contributing to increased obesity. Full article

12 pages, 561 KiB

Open AccessArticle

“I Was Relieved to Know That My Baby Was Safe”: Women’s Attitudes and Perceptions on Using a New Electronic Fetal Heart Rate Monitor during Labor in Tanzania

by Sara Rivenes Lafontan, Johanne Sundby, Hege L. Ersdal, Muzdalifat Abeid, Hussein L. Kidanto and Columba K. Mbekenga

Int. J. Environ. Res. Public Health 2018, 15(2), 302; https://doi.org/10.3390/ijerph15020302 - 9 Feb 2018

Cited by 24 | Viewed by 6910

Abstract

To increase labor monitoring and prevent neonatal morbidity and mortality, a new wireless, strap-on electronic fetal heart rate monitor called Moyo was introduced in Tanzania in 2016. As part of the ongoing evaluation of the introduction of the monitor, the aim of this [...] Read more.

To increase labor monitoring and prevent neonatal morbidity and mortality, a new wireless, strap-on electronic fetal heart rate monitor called Moyo was introduced in Tanzania in 2016. As part of the ongoing evaluation of the introduction of the monitor, the aim of this study was to explore the attitudes and perceptions of women who had worn the monitor continuously during their most recent delivery and perceptions about how it affected care. This knowledge is important to identify barriers towards adaptation in order to introduce new technology more effectively. We carried out 20 semi-structured individual interviews post-labor at two hospitals in Tanzania. A thematic content analysis was used to analyze the data. Our results indicated that the use of the monitor positively affected the women’s birth experience. It provided much-needed reassurance about the wellbeing of the child. The women considered that wearing Moyo improved care due to an increase in communication and attention from birth attendants. However, the women did not fully understand the purpose and function of the device and overestimated its capabilities. This highlights the need to improve how and when information is conveyed to women in labor. Full article

(This article belongs to the Special Issue Teenage Reproductive Health: Pregnancy, Contraception, Unsafe Abortion, Fertility)

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11 pages, 679 KiB

Open AccessArticle

Walking Outdoors during Seminars Improved Perceived Seminar Quality and Sense of Well-Being among Participants

by Olle Bälter, Björn Hedin, Helena Tobiasson and Susanna Toivanen

Int. J. Environ. Res. Public Health 2018, 15(2), 303; https://doi.org/10.3390/ijerph15020303 - 9 Feb 2018

Cited by 16 | Viewed by 6079

Abstract

Low levels of physical activity and sedentary behaviour are a growing health problem globally. Physical inactivity is associated with increased risk of numerous ailments, cardiovascular disease and mortality. Our primary aim was to perform a feasibility study on how to incorporate physical activity [...] Read more.

Low levels of physical activity and sedentary behaviour are a growing health problem globally. Physical inactivity is associated with increased risk of numerous ailments, cardiovascular disease and mortality. Our primary aim was to perform a feasibility study on how to incorporate physical activity among students and teachers in regular teaching activities. The second aim was to investigate how students and teachers perceived the differences between outdoor walking seminars and regular indoor seminars. By transforming an on-campus course into a blended course, we were able to conduct seminars outdoors in nearby nature while walking. These walking seminars were evaluated among 131 students and nine teachers leading the walking seminars. The responses to the student survey and teacher interviews indicate that discussions, sense of well-being and the general quality of the seminar improved, regardless of how physically active participants were the rest of the time. The study shows one way to increase physical activity with small means; in our case, a reorganization of how we prepared for the seminars which allowed for walking discussions. Full article

(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)

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24 pages, 4970 KiB

Open AccessArticle

Solid Particle Number Emission Factors of Euro VI Heavy-Duty Vehicles on the Road and in the Laboratory

by Barouch Giechaskiel

Int. J. Environ. Res. Public Health 2018, 15(2), 304; https://doi.org/10.3390/ijerph15020304 - 9 Feb 2018

Cited by 71 | Viewed by 9610

Abstract

Particulate matter (PM), and in particular ultrafine particles, have a negative impact on human health. The contribution of vehicle PM emissions to air pollution is typically quantified with emission inventories, which need vehicle emission factors as input. Heavy-duty vehicles, although they represent a [...] Read more.

Particulate matter (PM), and in particular ultrafine particles, have a negative impact on human health. The contribution of vehicle PM emissions to air pollution is typically quantified with emission inventories, which need vehicle emission factors as input. Heavy-duty vehicles, although they represent a small percentage of the vehicle population in nearly every major country, contribute the majority of the on-road PM emissions. However, the published data of modern heavy-duty vehicle emissions are scarce, and for the newest Euro VI technologies, almost non-existent. The main objective of this paper is to present Solid Particle Number (SPN) emission factors from Euro VI heavy-duty vehicles using diesel, Compressed Natural Gas (CNG), or Liquefied Natural Gas (LNG). Urban, rural and motorway (highway) emissions were determined on the road at various European cities using SPN Portable Emission Measurement Systems (PEMS). Additional tests on a heavy-duty chassis dynamometer showed that the solid sub-23 nm fraction, which is not covered at the moment in the European regulation, is high, especially for CNG engines. The significant contribution of regeneration events and the effect of ambient temperature and engine cold-start on particle emissions were also discussed. Full article

(This article belongs to the Special Issue Air Quality and Health)

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17 pages, 2423 KiB

Open AccessArticle

A Longitudinal Study of Predictors for Adolescent Electronic Cigarette Experimentation and Comparison with Conventional Smoking

by Jaana M. Kinnunen, Hanna Ollila, Jaana Minkkinen, Pirjo L. Lindfors and Arja H. Rimpelä

Int. J. Environ. Res. Public Health 2018, 15(2), 305; https://doi.org/10.3390/ijerph15020305 - 9 Feb 2018

Cited by 35 | Viewed by 6042

Abstract

Little is known of the predictors of electronic cigarette (e-cigarette) use among adolescents, even though the use is increasing. We studied here the predictors for e-cigarette experimentation (tried and tried more than twice) and compared them with predictors for conventional smoking. A baseline [...] Read more.

Little is known of the predictors of electronic cigarette (e-cigarette) use among adolescents, even though the use is increasing. We studied here the predictors for e-cigarette experimentation (tried and tried more than twice) and compared them with predictors for conventional smoking. A baseline school survey was conducted in the Helsinki metropolitan area, Finland, in 2011 for seventh graders (12 to 13-year-olds). Response rate was 73%. The same students were followed up in 2014 (9th grade, 15 to 16-year-olds), N = 5742. Generalized linear mixed models controlling for school clustering were used. In the follow-up, 43.3% of boys and 25.6% of girls had tried e-cigarettes and 21.9% and 8.1% correspondingly more than twice. The strongest predictors for both genders were conventional smoking, drunkenness and energy drink use. Furthermore, poor academic achievement predicted e-cigarette experimentation for both genders, and for boys, participation in team sports was a predictor. The predictors for experimenting and for experimenting more than twice were very similar, except for boys’ participation in team sports. They were also similar compared to the predictors of conventional smoking but the associations were weaker. To conclude, smoking and other addictive behaviors predict adolescents’ experimentation with e-cigarettes. Family’s socioeconomic background had little significance. Full article

(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)

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27 pages, 3962 KiB

Open AccessArticle

Taking Action on Air Pollution Control in the Beijing-Tianjin-Hebei (BTH) Region: Progress, Challenges and Opportunities

by Li Wang, Fengying Zhang, Eva Pilot, Jie Yu, Chengjing Nie, Jennifer Holdaway, Linsheng Yang, Yonghua Li, Wuyi Wang, Sotiris Vardoulakis and Thomas Krafft

Int. J. Environ. Res. Public Health 2018, 15(2), 306; https://doi.org/10.3390/ijerph15020306 - 9 Feb 2018

Cited by 115 | Viewed by 12819

Abstract

Due to rapid urbanization, industrialization and motorization, a large number of Chinese cities are affected by heavy air pollution. In order to explore progress, remaining challenges, and sustainability of air pollution control in the Beijing-Tianjin-Hebei (BTH) region after 2013, a mixed method analysis [...] Read more.

Due to rapid urbanization, industrialization and motorization, a large number of Chinese cities are affected by heavy air pollution. In order to explore progress, remaining challenges, and sustainability of air pollution control in the Beijing-Tianjin-Hebei (BTH) region after 2013, a mixed method analysis was undertaken. The quantitative analysis comprised an overview of air quality management in the BTH region. Semi-structured expert interviews were conducted with 12 stakeholders from various levels of government and research institutions who played substantial roles either in decision-making or in research and advising on air pollution control in the BTH region. The results indicated that with the stringent air pollution control policies, the air quality in BTH meets the targets of the Air Pollution Prevention and Control Action Plan. However, improvements vary across the region and for different pollutants. Although implementation has been decisive and was at least in parts effectively enforced, significant challenges remained with regard to industrial and traffic emission control, and national air quality limits continued to be significantly exceeded and competing development interests remained mainly unsolved. There were also concerns about the sustainability of the current air pollution control measures especially for industries due to the top-down enforcement, and the associated large burden of social cost including unemployment and social inequity resulting industrial restructuring. Better mechanisms for ensuring cross-sectoral coordination and for improved central-local government communication were suggested. Further suggestions were provided to improve the conceptual design and effective implementation of respective air pollution control strategies in BTH. Our study highlights some of the major hurdles that need to be addressed to succeed with a comprehensive air pollution control management for the Chinese mega-urban agglomerations. Full article

(This article belongs to the Section Environmental Health)

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12 pages, 1851 KiB

Open AccessArticle

Acute Effects of Ambient PM_2.5 on All-Cause and Cause-Specific Emergency Ambulance Dispatches in Japan

by Vera Ling Hui Phung, Kayo Ueda, Shunji Kasaoka, Xerxes Seposo, Saira Tasmin, Shinichi Yonemochi, Arthit Phosri, Akiko Honda, Hirohisa Takano, Takehiro Michikawa and Hiroshi Nitta

Int. J. Environ. Res. Public Health 2018, 15(2), 307; https://doi.org/10.3390/ijerph15020307 - 9 Feb 2018

Cited by 27 | Viewed by 6117

Abstract

Short-term health effects of ambient PM_2.5 have been established with numerous studies, but evidence in Asian countries is limited. This study aimed to investigate the short-term effects of PM_2.5 on acute health outcomes, particularly all-cause, cardiovascular, respiratory, cerebrovascular and neuropsychological outcomes. [...] Read more.

Short-term health effects of ambient PM_2.5 have been established with numerous studies, but evidence in Asian countries is limited. This study aimed to investigate the short-term effects of PM_2.5 on acute health outcomes, particularly all-cause, cardiovascular, respiratory, cerebrovascular and neuropsychological outcomes. We utilized daily emergency ambulance dispatches (EAD) data from eight Japanese cities (2007–2011). Statistical analyses included two stages: (1) City-level generalized linear model with Poisson distribution; (2) Random-effects meta-analysis in pooling city-specific effect estimates. Lag patterns were explored using (1) unconstrained-distributed lags (lag 0 to lag 7) and (2) average lags (lag: 0–1, 0–3, 0–5, 0–7). In all-cause EAD, significant increases were observed in both shorter lag (lag 0: 1.24% (95% CI: 0.92, 1.56)) and average lag 0–1 (0.64% (95% CI: 0.23, 1.06)). Increases of 1.88% and 1.48% in respiratory and neuropsychological EAD outcomes, respectively, were observed at lag 0 per 10 µg/m³ increase in PM_2.5. While respiratory outcomes demonstrated significant average effects, no significant effect was observed for cardiovascular outcomes. Meanwhile, an inverse association was observed in cerebrovascular outcomes. In this study, we observed that effects of PM_2.5 on all-cause, respiratory and neuropsychological EAD were acute, with average effects not exceeding 3 days prior to EAD onset. Full article

(This article belongs to the Section Environmental Health)

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20 pages, 2487 KiB

Open AccessArticle

The Uncertain Geographic Context Problem in the Analysis of the Relationships between Obesity and the Built Environment in Guangzhou

by Pengxiang Zhao, Mei-Po Kwan and Suhong Zhou

Int. J. Environ. Res. Public Health 2018, 15(2), 308; https://doi.org/10.3390/ijerph15020308 - 10 Feb 2018

Cited by 79 | Viewed by 7822

Abstract

Traditionally, static units of analysis such as administrative units are used when studying obesity. However, using these fixed contextual units ignores environmental influences experienced by individuals in areas beyond their residential neighborhood and may render the results unreliable. This problem has been articulated [...] Read more.

Traditionally, static units of analysis such as administrative units are used when studying obesity. However, using these fixed contextual units ignores environmental influences experienced by individuals in areas beyond their residential neighborhood and may render the results unreliable. This problem has been articulated as the uncertain geographic context problem (UGCoP). This study investigates the UGCoP through exploring the relationships between the built environment and obesity based on individuals’ activity space. First, a survey was conducted to collect individuals’ daily activity and weight information in Guangzhou in January 2016. Then, the data were used to calculate and compare the values of several built environment variables based on seven activity space delineations, including home buffers, workplace buffers (WPB), fitness place buffers (FPB), the standard deviational ellipse at two standard deviations (SDE2), the weighted standard deviational ellipse at two standard deviations (WSDE2), the minimum convex polygon (MCP), and road network buffers (RNB). Lastly, we conducted comparative analysis and regression analysis based on different activity space measures. The results indicate that significant differences exist between variables obtained with different activity space delineations. Further, regression analyses show that the activity space delineations used in the analysis have a significant influence on the results concerning the relationships between the built environment and obesity. The study sheds light on the UGCoP in analyzing the relationships between obesity and the built environment. Full article

(This article belongs to the Special Issue Human Mobility, Spatiotemporal Context, and Environmental Health: Recent Advances in Approaches and Methods)

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17 pages, 2115 KiB

Open AccessArticle

Gender Difference and Spatial Heterogeneity in Local Obesity

by Hee-Jung Jun and Mi Namgung

Int. J. Environ. Res. Public Health 2018, 15(2), 311; https://doi.org/10.3390/ijerph15020311 - 10 Feb 2018

Cited by 15 | Viewed by 5246

Abstract

This study asks if there is gender-specific spatial heterogeneity in local obesity. By using the 2015 Korea Community Health Survey and employing spatial analyses, this study found that there is considerable gender-specific spatial heterogeneity in local obesity rates. More specifically, we found that: [...] Read more.

This study asks if there is gender-specific spatial heterogeneity in local obesity. By using the 2015 Korea Community Health Survey and employing spatial analyses, this study found that there is considerable gender-specific spatial heterogeneity in local obesity rates. More specifically, we found that: (1) local obesity rates are more spatially dependent for women than for men; (2) environmental factors, in general, have stronger effects on local obesity rates for women than for men; (3) environmental factors have more spatially varying effects on local obesity rates for women than for men. Based on these findings, we suggest that policies for obesity prevention should not be based on the assumption of spatial homogeneity and gender indifference, but rather should be refined based on gender-specific spatial heterogeneity in local obesity. Full article

(This article belongs to the Special Issue Obesity and Urban Environments)

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12 pages, 1660 KiB

Open AccessArticle

Rapid Screening of Cadmium in Rice and Identification of Geographical Origins by Spectral Method

by Fang Li, Jihua Wang, Li Xu, Songxue Wang, Minghui Zhou, Jingwei Yin and Anxiang Lu

Int. J. Environ. Res. Public Health 2018, 15(2), 312; https://doi.org/10.3390/ijerph15020312 - 11 Feb 2018

Cited by 15 | Viewed by 4783

Abstract

The accuracy, repeatability and detection limits of the energy-dispersive X-ray fluorescence (XRF) spectrometer used in this study were tested to verify its suitability for rapid screening of cadmium in samples. Concentrations of cadmium in rice grain samples were tested by the XRF spectrometer. [...] Read more.

The accuracy, repeatability and detection limits of the energy-dispersive X-ray fluorescence (XRF) spectrometer used in this study were tested to verify its suitability for rapid screening of cadmium in samples. Concentrations of cadmium in rice grain samples were tested by the XRF spectrometer. The results showed that the apparatus had good precision around the national limit value (0.2 mg/kg). Raman spectroscopy has been analyzed in the discrimination of rice grain samples from different geographical origins within China. Scanning time has been discussed in order to obtain better Raman features of rice samples. A total of 31 rice samples were analyzed. After spectral data pre-treatment, principal component analysis (PCA), K-means clustering (KMC), hierarchical clustering (HC) and support vector machine (SVM) were performed to discriminate origins of rice samples. The results showed that the geographical origins of rice could be classified using Raman spectroscopy combined with multivariate analysis. Full article

(This article belongs to the Section Environmental Science and Engineering)

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13 pages, 298 KiB

Open AccessArticle

A Descriptive Longitudinal Study of Changes in Vape Shop Characteristics and Store Policies in Anticipation of the 2016 FDA Regulations of Tobacco Products, Including E-Cigarettes

by Sheila Yu, Patricia Escobedo, Robert Garcia, Tess Boley Cruz, Jennifer B. Unger, Lourdes Baezconde-Garbanati, Leah Meza and Steve Sussman

Int. J. Environ. Res. Public Health 2018, 15(2), 313; https://doi.org/10.3390/ijerph15020313 - 11 Feb 2018

Cited by 17 | Viewed by 6735

Abstract

After proposing the “Deeming Rule” in 2014, the U.S. Food and Drug Administration (FDA) began regulating the manufacturing, marketing, and sales of electronic cigarette (e-cigarette) products as tobacco products in 2016. The current study conducted vape shop store observations and surveyed Los Angeles–area [...] Read more.

After proposing the “Deeming Rule” in 2014, the U.S. Food and Drug Administration (FDA) began regulating the manufacturing, marketing, and sales of electronic cigarette (e-cigarette) products as tobacco products in 2016. The current study conducted vape shop store observations and surveyed Los Angeles–area shop employees (assessing their beliefs, awareness, and perceptions of e-cigarettes and related FDA regulations) at two time points one year apart to better understand what vape shop retailers would do given FDA’s soon-to-be-enacted Deeming Rule. The study also compared retailer beliefs/awareness/actions and store characteristics immediately after the Deeming Rule proposal versus a year after the Rule had been proposed, right before its enactment. Two data collection waves occurred before the Deeming Rule enactment, with Year 1 surveying 77 shops (2014) and Year 2 surveying 61 shops (2015–2016). Between the data collection points, 16 shops had closed. Among the shops that were open at both time points, the majority (95% in Year 1; 74% in Year 2) were aware of some FDA regulations or other policies applying to vape shops. However, overall awareness of FDA regulations and state/local policies governing e-cigarettes significantly decreased from Year 1 to Year 2. At both time points, all shops offered customers free puffs of nicotine-containing e-liquids (prohibited by the then upcoming Deeming Rule). Perceptions of e-cigarette safety also significantly decreased between the years. Exploring vape shop retailer perceptions and store policies (i.e., free puffs/samples displays, perceptions of e-cigarette safety, etc.) over time will help the FDA assess the needs of the vape shop community and develop more effective retailer education campaigns and materials targeted to increase compliance with the newly enacted regulations. Full article

(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)

11 pages, 3856 KiB

Open AccessArticle

Biosorption of Cadmium by Non-Toxic Extracellular Polymeric Substances (EPS) Synthesized by Bacteria from Marine Intertidal Biofilms

by Juan Carlos Camacho-Chab, María Del Refugio Castañeda-Chávez, Manuel Jesús Chan-Bacab, Ruth Noemí Aguila-Ramírez, Itzel Galaviz-Villa, Pascual Bartolo-Pérez, Fabiola Lango-Reynoso, Carolina Tabasco-Novelo, Christine Gaylarde and Benjamín Otto Ortega-Morales

Int. J. Environ. Res. Public Health 2018, 15(2), 314; https://doi.org/10.3390/ijerph15020314 - 11 Feb 2018

Cited by 63 | Viewed by 6744

Abstract

Cadmium is a major heavy metal found in polluted aquatic environments, mainly derived from industrial production processes. We evaluated the biosorption of solubilized Cd²⁺ using the extracellular polymeric substances (EPS) produced by Bacillus sp. MC3B-22 and Microbacterium sp. MC3B-10 (Microbactan); these bacteria [...] Read more.

Cadmium is a major heavy metal found in polluted aquatic environments, mainly derived from industrial production processes. We evaluated the biosorption of solubilized Cd²⁺ using the extracellular polymeric substances (EPS) produced by Bacillus sp. MC3B-22 and Microbacterium sp. MC3B-10 (Microbactan); these bacteria were originally isolated from intertidal biofilms off the coast of Campeche, Mexico. EPS were incubated with different concentrations of cadmium in ultrapure water. Residual Cd²⁺ concentrations were determined by Inductive Coupled Plasma-Optic Emission Spectrometry and the maximum sorption capacity (Qmax) was calculated according to the Langmuir model. EPS were characterized by X-ray photoelectron spectroscopy (XPS) before and after sorption. The Qmax of Cd²⁺ was 97 mg g⁻¹ for Microbactan and 141 mg g⁻¹ for MC3B-22 EPS, these adsorption levels being significantly higher than previously reported for other microbial EPS. In addition, XPS analysis revealed changes in structure of EPS after biosorption and showed that amino functional groups contributed to the binding of Cd²⁺, unlike other studies that show the carbohydrate fraction is responsible for this activity. This work expands the current view of bacterial species capable of synthesizing EPS with biosorbent potential for cadmium and provides evidence that different chemical moieties, other than carbohydrates, participate in this process. Full article

(This article belongs to the Section Environmental Health)

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13 pages, 339 KiB

Open AccessArticle

A Physical Health Profile of Youths Living with a “Hikikomori” Lifestyle

by John W. M. Yuen, Yoyo K. Y. Yan, Victor C. W. Wong, Wilson W. S. Tam, Ka-Wing So and Wai Tong Chien

Int. J. Environ. Res. Public Health 2018, 15(2), 315; https://doi.org/10.3390/ijerph15020315 - 11 Feb 2018

Cited by 29 | Viewed by 9357

Abstract

A cross-sectional study was designed to understand the impacts of “hikikomori” lifestyle on physical health. A total of 104 eligible hikikomori cases were recruited from the social services network of Hong Kong with a mean age of 19.02 ± 3.62 (ranged 13–31) year-old, [...] Read more.

A cross-sectional study was designed to understand the impacts of “hikikomori” lifestyle on physical health. A total of 104 eligible hikikomori cases were recruited from the social services network of Hong Kong with a mean age of 19.02 ± 3.62 (ranged 13–31) year-old, and had completed the set of questionnaires and a series of anthropometric and physical health measurements. Despite SF36 score of 84.0 indicated good physical functioning in general, participants were lived sedentarily with high incidence of hypertension at 15.4% and prehypertension at 31.7%. Occurrence of hypertension and prehypertension in cases living as hikikomori >6 months were 3 times and 1.5 times higher than those newly onset cases, respectively. The blood pressure levels were correlated with age and all obesity index parameters measured including waist circumference and body mass index. Results also observed a shift of body weight from underweight to overweight and obesity along the hikikomori duration. Half of the hypertensive cases involved the elevation of systolic blood pressure, which suggested higher odds of cardiovascular complications. In conclusion, the hikikomori lifestyle could be a risk behavior that may harm the younger generation physically by promoting obesity and hypertension and probably other chronic illnesses. Full article

(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)

19 pages, 566 KiB

Open AccessArticle

PM Origin or Exposure Duration? Health Hazards from PM-Bound Mercury and PM-Bound PAHs among Students and Lecturers

by Grzegorz Majewski, Kamila Widziewicz, Wioletta Rogula-Kozłowska, Patrycja Rogula-Kopiec, Karolina Kociszewska, Tomasz Rozbicki, Małgorzata Majder-Łopatka and Mariusz Niemczyk

Int. J. Environ. Res. Public Health 2018, 15(2), 316; https://doi.org/10.3390/ijerph15020316 - 12 Feb 2018

Cited by 12 | Viewed by 4766

Abstract

This study assessed inhalation exposure to particulate matter (PM₁)-bound mercury (Hg_p) and PM₁-bound polycyclic aromatic hydrocarbons (PAHs) among university students. For this purpose, simultaneous indoor (I) and outdoor (O) measurements were taken from two Polish technical universities [...] Read more.

This study assessed inhalation exposure to particulate matter (PM₁)-bound mercury (Hg_p) and PM₁-bound polycyclic aromatic hydrocarbons (PAHs) among university students. For this purpose, simultaneous indoor (I) and outdoor (O) measurements were taken from two Polish technical universities (in Gliwice and Warsaw) located in distinct areas with respect to ambient concentrations and major sources of PM. The indoor geometric mean concentrations of Hg_p were found to be 1.46 pg·m⁻³ and 6.38 pg·m⁻³ in Warsaw and Gliwice, while the corresponding outdoor concentrations were slightly lower at 1.38 pg·m⁻³ and 3.03 pg·m⁻³, respectively. A distinct pattern was found with respect to PAH concentrations with estimated I/O values of 22.2 ng·m⁻³/22.5 ng·m⁻³ in Gliwice and 10.9 ng·m⁻³/11.12 ng·m⁻³ in Warsaw. Hazard quotients (HQs) as a result of exposure to Hg_p for students aged 21 ranged from 3.47 × 10⁻⁵ (Warsaw) to 1.3 × 10⁻⁴ (Gliwice) in terms of reasonable maximum exposure (RME). The non-cancer human health risk value related to Hg_p exposure was thus found to be below the acceptable risk level value of 1.0 given by the US EPA. Daily exposure values for lecture hall occupants, adjusted to the benzo(a)pyrene (BaP) toxicity equivalent (BaP_eq), were 2.9 and 1.02 ng·m⁻³ for the Gliwice and Warsaw students, respectively. The incremental lifetime cancer risk (ILCR) values with respect to exposure to PM₁-bound PAHs during the students’ time of study were 5.49 × 10⁻⁸ (Warsaw) and 1.43 × 10⁻⁷ (Gliwice). Thus, students’ exposure to indoor PAHs does not lead to increased risk of lung cancer. Full article

(This article belongs to the Collection Environmental Risk Assessment)

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12 pages, 2106 KiB

Open AccessArticle

Chemical and Microbial Quality of Groundwater in Siloam Village, Implications to Human Health and Sources of Contamination

by John Ogony Odiyo and Rachel Makungo

Int. J. Environ. Res. Public Health 2018, 15(2), 317; https://doi.org/10.3390/ijerph15020317 - 12 Feb 2018

Cited by 28 | Viewed by 5518

Abstract

Due to inaccessibility of potable water, rural communities drill boreholes within their homesteads despite vulnerability to groundwater contamination and associated health risks. This study assessed the quality of groundwater, identified potential sources of contamination and potential human health risks in Siloam Village, South [...] Read more.

Due to inaccessibility of potable water, rural communities drill boreholes within their homesteads despite vulnerability to groundwater contamination and associated health risks. This study assessed the quality of groundwater, identified potential sources of contamination and potential human health risks in Siloam Village, South Africa. Statistical difference between similar water quality parameters at different sites was determined at a significance level (α) of 0.05. Water quality parameters with serious potential health effects on human beings were correlated with selected water quality parameters to understand the nature of correlation and possible sources of contamination. Fluorides and nitrates had excessively high concentrations associated with tooth damage and pronounced skeletal fluorosis, and methaemoglobinaemia in infants and mucous membrane irritation in adults, respectively. There were statistically significant differences between means of most water quality parameters. Contrasting correlation of fluoride with calcium and pH indicated the need to further identify local sources and fluoride control mechanisms. Correlation of nitrate with chloride mostly indicated that faecal contamination is the potential source of high nitrates in groundwater. This requires further verification. Presence of total coliforms and E. coli in most boreholes indicated potential presence of faecal contamination. The need to educate borehole owners’ on possible strategies to minimise groundwater pollution was identified. Full article

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15 pages, 13652 KiB

Open AccessArticle

The Physical Clogging of the Landfill Leachate Collection System in China: Based on Filtration Test and Numerical Modelling

by Yili Liu, Weixin Sun, Bing Du and Jianguo Liu

Int. J. Environ. Res. Public Health 2018, 15(2), 318; https://doi.org/10.3390/ijerph15020318 - 12 Feb 2018

Cited by 33 | Viewed by 6247

Abstract

Clogging of the leachate collection system (LCS) has been a common operation problem in municipal solid waste (MSW) landfills in China, which can result in high water levels that threaten the safety of landfill operations. To determine the cause of failure in an [...] Read more.

Clogging of the leachate collection system (LCS) has been a common operation problem in municipal solid waste (MSW) landfills in China, which can result in high water levels that threaten the safety of landfill operations. To determine the cause of failure in an LCS, raw leachate from a municipal solid waste transfer station was collected and the high content of particulate matter was characterized. Based on the parameters obtained in a filtration test, a numerical simulation was performed to estimate the influence of particle deposition on drainage system clogging. The results showed that LCSs were confronted with the risk of clogging due to the deposition of particulate matter resulting from the higher concentration of total suspended solids (TSS level > 2200 mg L⁻¹) and larger particle size (>30% TSS particles > 15 μm) in the leachate. On one hand, the non-woven geotextile, as the upper layer of the LCS, retained most particulate matter of large diameters, reducing its hydraulic conductivity to approximately 10⁻⁸ to 10⁻⁹ m s⁻¹ after 1–2 years of operation and perching significant leachate above it (0.6–0.7 m). On the other hand, the geotextile prevented the gravel layer from physically clogging and minimized the leachate head above the bottom liner. Therefore, the role of geotextile should be balanced to optimize the LCS in MSW landfills in China. Full article

(This article belongs to the Section Environmental Science and Engineering)

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16 pages, 348 KiB

Open AccessFeature PaperArticle

Patient-Centered Care in Breast Cancer Genetic Clinics

by Anne Brédart, Amélie Anota, Julia Dick, Violetta Kuboth, Olivier Lareyre, Antoine De Pauw, Alejandra Cano, Dominique Stoppa-Lyonnet, Rita Schmutzler, Sylvie Dolbeault and Jean-Luc Kop

Int. J. Environ. Res. Public Health 2018, 15(2), 319; https://doi.org/10.3390/ijerph15020319 - 12 Feb 2018

Cited by 8 | Viewed by 5990

Abstract

With advances in breast cancer (BC) gene panel testing, risk counseling has become increasingly complex, potentially leading to unmet psychosocial needs. We assessed psychosocial needs and correlates in women initiating testing for high genetic BC risk in clinics in France and Germany, and [...] Read more.

With advances in breast cancer (BC) gene panel testing, risk counseling has become increasingly complex, potentially leading to unmet psychosocial needs. We assessed psychosocial needs and correlates in women initiating testing for high genetic BC risk in clinics in France and Germany, and compared these results with data from a literature review. Among the 442 counselees consecutively approached, 212 (83%) in France and 180 (97%) in Germany, mostly BC patients (81% and 92%, respectively), returned the ‘Psychosocial Assessment in Hereditary Cancer’ questionnaire. Based on the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) BC risk estimation model, the mean BC lifetime risk estimates were 19% and 18% in France and Germany, respectively. In both countries, the most prevalent needs clustered around the “living with cancer” and “children-related issues” domains. In multivariate analyses, a higher number of psychosocial needs were significantly associated with younger age (b = −0.05), higher anxiety (b = 0.78), and having children (b = 1.51), but not with country, educational level, marital status, depression, or loss of a family member due to hereditary cancer. These results are in line with the literature review data. However, this review identified only seven studies that quantitatively addressed psychosocial needs in the BC genetic counseling setting. Current data lack understandings of how cancer risk counseling affects psychosocial needs, and improves patient-centered care in that setting. Full article

(This article belongs to the Special Issue Quality of Patient-Centered Care)

19 pages, 2018 KiB

Open AccessArticle

Toxicity of Urban PM₁₀ and Relation with Tracers of Biomass Burning

by Rosette Van Den Heuvel, Jeroen Staelens, Gudrun Koppen and Greet Schoeters

Int. J. Environ. Res. Public Health 2018, 15(2), 320; https://doi.org/10.3390/ijerph15020320 - 12 Feb 2018

Cited by 26 | Viewed by 5003

Abstract

The chemical composition of particles varies with space and time and depends on emission sources, atmospheric chemistry and weather conditions. Evidence suggesting that particles differ in toxicity depending on their chemical composition is growing. This in vitro study investigated the biological effects of [...] Read more.

The chemical composition of particles varies with space and time and depends on emission sources, atmospheric chemistry and weather conditions. Evidence suggesting that particles differ in toxicity depending on their chemical composition is growing. This in vitro study investigated the biological effects of PM₁₀ in relation to PM-associated chemicals. PM₁₀ was sampled in ambient air at an urban traffic site (Borgerhout) and a rural background location (Houtem) in Flanders (Belgium). To characterize the toxic potential of PM₁₀, airway epithelial cells (Beas-2B cells) were exposed to particles in vitro. Different endpoints were studied including cell damage and death (cell viability) and the induction of interleukin-8 (IL-8). The mutagenic capacity was assessed using the Ames II Mutagenicity Test. The endotoxin levels in the collected samples were analyzed and the oxidative potential (OP) of PM₁₀ particles was evaluated by electron paramagnetic resonance (EPR) spectroscopy. Chemical characteristics of PM₁₀ included tracers for biomass burning (levoglucosan, mannosan and galactosan), elemental and organic carbon (EC/OC) and polycyclic aromatic hydrocarbons (PAHs). Most samples displayed dose-dependent cytotoxicity and IL-8 induction. Spatial and temporal differences in PM₁₀ toxicity were seen. PM₁₀ collected at the urban site was characterized by increased pro-inflammatory and mutagenic activity as well as higher OP and elevated endotoxin levels compared to the background area. Reduced cell viability (−0.46 < r_s < −0.35, p < 0.01) and IL-8 induction (−0.62 < r_s < −0.67, p < 0.01) were associated with all markers for biomass burning, levoglucosan, mannosan and galactosan. Furthermore, direct and indirect mutagenicity were associated with tracers for biomass burning, OC, EC and PAHs. Multiple regression analyses showed levoglucosan to explain 16% and 28% of the variance in direct and indirect mutagenicity, respectively. Markers for biomass burning were associated with altered cellular responses and increased mutagenic activity. These findings may indicate a role of biomass burning in the observed adverse health effect of particulate matter. Full article

(This article belongs to the Special Issue Ambient Air Pollution and Health Vulnerability)

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17 pages, 1491 KiB

Open AccessArticle

Mindfulness-Based Baduanjin Exercise for Depression and Anxiety in People with Physical or Mental Illnesses: A Systematic Review and Meta-Analysis

by Liye Zou, Albert Yeung, Xinfeng Quan, Stanley Sai-Chuen Hui, Xiaoyue Hu, Jessie S. M. Chan, Chaoyi Wang, Sean David Boyden, Li Sun and Huiru Wang

Int. J. Environ. Res. Public Health 2018, 15(2), 321; https://doi.org/10.3390/ijerph15020321 - 12 Feb 2018

Cited by 120 | Viewed by 12841

Abstract

Objectives: we used a quantitative method to systematically synthesize the emerging literature and critically evaluate the effects of Baduanjin on depression and anxiety in people with physical or mental illnesses. Additionally, we determined if the number of total Baduanjin training sessions is associated [...] Read more.

Objectives: we used a quantitative method to systematically synthesize the emerging literature and critically evaluate the effects of Baduanjin on depression and anxiety in people with physical or mental illnesses. Additionally, we determined if the number of total Baduanjin training sessions is associated with decreased anxiety and depression levels. Methods: both English and Chinese databases were searched for potential studies published between January 1982 and October 2017. The eligible randomized controlled trials were considered for meta-analysis. Effect size (Hedge’s g) was computed for the pooled effects while the random-effect model was set. For moderator analysis; Subgroup meta-analysis for categorical variables and meta-regression for continuous variables were performed. Results: the aggregated result has shown a significant benefit in favour of Baduanjin on anxiety (Hedge’s g = −0.99; CI −1.63 to −0.74) and depression (Hedge’s g = −1.07; CI −1.3 to −0.83). For continuous potential moderators; meta-regression indicated a significant effect for total hours in Baduanjin practice (β = −0.0053; 95% CI −0.009 to −0.0014; p = 0.008). With regard to depression; meta-regression indicated a significant effect for total sessions of Baduanjin practice (β = −0.0023; 95% CI −0.006 to −0.0004; p = 0.028). Conclusions: the encouraging findings indicate the efficacy of Baduanjin exercise in reducing depression and anxiety symptoms in people with physical or mental illnesses. However; the results should be interpreted with caution because of existing methodological limitations (e.g., high risk of bias; Baduanjin combined with other behavioral interventions; and heterogeneity of control groups). Full article

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14 pages, 891 KiB

Open AccessArticle

Qualitative Analysis of E-Liquid Emissions as a Function of Flavor Additives Using Two Aerosol Capture Methods

by Nathan Eddingsaas, Todd Pagano, Cody Cummings, Irfan Rahman, Risa Robinson and Edward Hensel

Int. J. Environ. Res. Public Health 2018, 15(2), 323; https://doi.org/10.3390/ijerph15020323 - 13 Feb 2018

Cited by 36 | Viewed by 8241

Abstract

This work investigates emissions sampling methods employed for qualitative identification of compounds in e-liquids and their resultant aerosols to assess what capture methods may be sufficient to identify harmful and potentially harmful constituents present. Three popular e-liquid flavors (cinnamon, mango, vanilla) were analyzed [...] Read more.

This work investigates emissions sampling methods employed for qualitative identification of compounds in e-liquids and their resultant aerosols to assess what capture methods may be sufficient to identify harmful and potentially harmful constituents present. Three popular e-liquid flavors (cinnamon, mango, vanilla) were analyzed using qualitative gas chromatography-mass spectrometry (GC-MS) in the un-puffed state. Each liquid was also machine-puffed under realistic-use flow rate conditions and emissions were captured using two techniques: filter pads and methanol impingers. GC-MS analysis was conducted on the emissions captured using both techniques from all three e-liquids. The e-liquid GC-MS analysis resulted in positive identification of 13 compounds from the cinnamon flavor e-liquid, 31 from mango, and 19 from vanilla, including a number of compounds observed in all e-liquid experiments. Nineteen compounds were observed in emissions which were not present in the un-puffed e-liquid. Qualitative GC-MS analysis of the emissions samples identify compounds observed in all three samples: e-liquid, impinge, and filter pads, and each subset thereof. A limited number of compounds were observed in emissions captured with impingers, but were not observed in emissions captured using filter pads; a larger number of compounds were observed on emissions collected from the filter pads, but not those captured with impingers. It is demonstrated that sampling methods have different sampling efficiencies and some compounds might be missed using only one method. It is recommended to investigate filter pads, impingers, thermal desorption tubes, and solvent extraction resins to establish robust sampling methods for emissions testing of e-cigarette emissions. Full article

(This article belongs to the Special Issue Electronic Cigarette Use and Public Health)

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14 pages, 653 KiB

Open AccessArticle

Diversity and Antimicrobial Resistance Genotypes in Non-Typhoidal Salmonella Isolates from Poultry Farms in Uganda

by Terence Odoch, Camilla Sekse, Trine M. L’Abee-Lund, Helge Christoffer Høgberg Hansen, Clovice Kankya and Yngvild Wasteson

Int. J. Environ. Res. Public Health 2018, 15(2), 324; https://doi.org/10.3390/ijerph15020324 - 13 Feb 2018

Cited by 26 | Viewed by 6367

Abstract

Non-typhoidal Salmonella (NTS) are foodborne pathogens of global public health significance. The aim of this study was to subtype a collection of 85 NTS originating from poultry farms in Uganda, and to evaluate a subgroup of phenotypically resistant isolates for common antimicrobial resistance [...] Read more.

Non-typhoidal Salmonella (NTS) are foodborne pathogens of global public health significance. The aim of this study was to subtype a collection of 85 NTS originating from poultry farms in Uganda, and to evaluate a subgroup of phenotypically resistant isolates for common antimicrobial resistance genes and associated integrons. All isolates were subtyped by pulsed-field gel electrophoresis (PFGE). Phenotypically resistant isolates (n = 54) were screened by PCR for the most relevant AMR genes corresponding to their phenotypic resistance pattern, and all 54 isolates were screened by PCR for the presence of integron class 1 and 2 encoding genes. These genes are known to commonly encode resistance to ampicillin, tetracycline, ciprofloxacin, trimethoprim, sulfonamide and chloramphenicol. PFGE revealed 15 pulsotypes representing 11 serotypes from 75 isolates, as 10 were non-typable. Thirty one (57.4%) of the 54 resistant isolates carried at least one of the seven genes (bla_TEM-1, cmlA, tetA, qnrS, sul1, dhfrI, dhfrVII) identified by PCR and six (11%) carried class 1 integrons. This study has shown that a diversity of NTS-clones are present in Ugandan poultry farm settings, while at the same time similar NTS-clones occur in different farms and areas. The presence of resistance genes to important antimicrobials used in human and veterinary medicine has been demonstrated, hence the need to strengthen strategies to combat antimicrobial resistance at all levels. Full article

(This article belongs to the Special Issue Antimicrobials and Antimicrobial Resistance in the Environment)

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11 pages, 295 KiB

Open AccessArticle

Are Kazakhstani Women Satisfied with Antenatal Care? Implementing the WHO Tool to Assess the Quality of Antenatal Services

by Marzhan A. Dauletyarova, Yuliya M. Semenova, Galiya Kaylubaeva, Gulshat K. Manabaeva, Bakytkul Toktabayeva, Maryash S. Zhelpakova, Oxana A. Yurkovskaya, Aidos S. Tlemissov, Galina Antonova and Andrej M. Grjibovski

Int. J. Environ. Res. Public Health 2018, 15(2), 325; https://doi.org/10.3390/ijerph15020325 - 13 Feb 2018

Cited by 32 | Viewed by 5144

Abstract

Women’s satisfaction is a part of the quality assurance process with potential to improve antenatal health services. The objective of this study was to assess the prevalence of women’s satisfaction with antenatal care in an urban Kazakhstani setting and investigate associated factors. A [...] Read more.

Women’s satisfaction is a part of the quality assurance process with potential to improve antenatal health services. The objective of this study was to assess the prevalence of women’s satisfaction with antenatal care in an urban Kazakhstani setting and investigate associated factors. A total of 1496 women who delivered in all maternity clinics from 6 February through 11 July 2013 in Semey, East Kazakhstan, filled out a standardized pretested questionnaire on satisfaction with antenatal care. Independent associations between dissatisfaction and its correlates were studied by logistic regression. Ninety percent of the women were satisfied with the antenatal care. Women who were dissatisfied had lower education. These women would have preferred more checkups, shorter intervals between checkups, more time with care providers, and shorter waiting times. The overall dissatisfaction was associated with long waiting times and insufficient information on general health in pregnancy, results of laboratory tests, treatment during pregnancy, and breastfeeding. Although most of the women in the study setting were satisfied with the new antenatal care model, we identified the main sources of dissatisfaction that should be addressed. Given that Semey is a typical Kazakhstani city, the results can be generalized to other Kazakhstani urban settings. Full article

(This article belongs to the Special Issue Teenage Reproductive Health: Pregnancy, Contraception, Unsafe Abortion, Fertility)

14 pages, 809 KiB

Open AccessArticle

Meta-Prediction of MTHFR Gene Polymorphisms and Air Pollution on the Risk of Hypertensive Disorders in Pregnancy Worldwide

by Ya-Ling Yang, Hsiao-Ling Yang and S. Pamela K. Shiao

Int. J. Environ. Res. Public Health 2018, 15(2), 326; https://doi.org/10.3390/ijerph15020326 - 13 Feb 2018

Cited by 20 | Viewed by 5300

Abstract

Hypertensive disorders in pregnancy (HDP) are devastating health hazards for both women and children. Both methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and air pollution can affect health status and result in increased risk of HDP for women. The major objective of this [...] Read more.

Hypertensive disorders in pregnancy (HDP) are devastating health hazards for both women and children. Both methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and air pollution can affect health status and result in increased risk of HDP for women. The major objective of this study was to investigate the effect of MTHFR polymorphisms, air pollution, and their interaction on the risk of HDP by using meta-predictive analytics. We searched various databases comprehensively to access all available studies conducted for various ethnic populations from countries worldwide, from 1997 to 2017. Seventy-one studies with 8064 cases and 13,232 controls for MTHFR C677T and 11 studies with 1425 cases and 1859 controls for MTHFR A1298C were included. MTHFR C677T homozygous TT (risk ratio (RR) = 1.28, p < 0.0001) and CT plus TT (RR = 1.07, p = 0.0002) were the risk genotypes, while wild-type CC played a protective role (RR = 0.94, p = 0.0017) for HDP. The meta-predictive analysis found that the percentage of MTHFR C677T TT plus CT (p = 0.044) and CT (p = 0.043) genotypes in the HDP case group were significantly increased with elevated levels of air pollution worldwide. Additionally, in countries with higher air pollution levels, the pregnant women with wild-type CC MTHFR 677 had a protection effect against HDP (p = 0.014), whereas, the homozygous TT of MTHFR C677T polymorphism was a risk genotype for developing HDP. Air pollution level is an environmental factor interacting with increased MTHFR C677T polymorphisms, impacting the susceptibility of HDP for women. Full article

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17 pages, 1155 KiB

Open AccessArticle

Cocoa Farmers’ Compliance with Safety Precautions in Spraying Agrochemicals and Use of Personal Protective Equipment (PPE) in Cameroon

by Abayomi Samuel Oyekale

Int. J. Environ. Res. Public Health 2018, 15(2), 327; https://doi.org/10.3390/ijerph15020327 - 13 Feb 2018

Cited by 27 | Viewed by 7749

Abstract

The inability of farmers to comply with essential precautions in the course of spraying agrochemicals remains a policy dilemma, especially in developing countries. The objectives of this paper were to assess compliance of cocoa farmers with agrochemical safety measures, analyse the factors explaining [...] Read more.

The inability of farmers to comply with essential precautions in the course of spraying agrochemicals remains a policy dilemma, especially in developing countries. The objectives of this paper were to assess compliance of cocoa farmers with agrochemical safety measures, analyse the factors explaining involvement of cocoa farmers in the practice of reusing agrochemical containers and wearing of personal protective equipment (PPE). Data were collected with structured questionnaires from 667 cocoa farmers from the Centre and South West regions in Cameroon. Data analyses were carried out with Probit regression and Negative Binomial regression models. The results showed that average cocoa farm sizes were 3.55 ha and 2.82 ha in South West and Centre regions, respectively, and 89.80% and 42.64% complied with manufacturers’ instructions in the use of insecticides. Eating or drinking while spraying insecticides and fungicides was reported by 4.20% and 5.10% of all farmers in the two regions, respectively. However, 37.78% and 57.57% of all farmers wore hand gloves and safety boots while spraying insecticides in the South West and Centre regions of Cameroon, respectively. In addition, 7.80% of all the farmers would wash agrochemical containers and use them at home, while 42.43% would wash and use them on their farms. Probit regression results showed that probability of reusing agrochemical containers was significantly influenced (p < 0.05) by region of residence of cocoa farmers, gender, possession of formal education and farming as primary occupation. The Negative Binomial regression results showed that the log of number PPE worn was significantly influenced (p < 0.10) by region, marital status, attainment of formal education, good health, awareness of manufacturers’ instructions, land area and contact index. It was among others concluded that efforts to train farmers on the need to be familiar with manufacturers’ instructions and use PPE would enhance their safety in the course of spraying agrochemicals. Full article

(This article belongs to the Special Issue Occupational Pesticides Exposure)

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10 pages, 984 KiB

Open AccessFeature PaperCommunication

Changing the Paradigm in Public Health and Disability through a Knowledge Translation Center

by Kerri A. Vanderbom, Yochai Eisenberg, Allison H. Tubbs, Teneasha Washington, Alex X. Martínez and Amy Rauworth

Int. J. Environ. Res. Public Health 2018, 15(2), 328; https://doi.org/10.3390/ijerph15020328 - 13 Feb 2018

Cited by 9 | Viewed by 5654

Abstract

People with disabilities are a health disparity population that face many barriers to health promotion opportunities in their communities. Inclusion in public health initiatives is a critical approach to address the health disparities that people with disabilities experience. The National Center on Health, [...] Read more.

People with disabilities are a health disparity population that face many barriers to health promotion opportunities in their communities. Inclusion in public health initiatives is a critical approach to address the health disparities that people with disabilities experience. The National Center on Health, Physical Activity and Disability (NCHPAD) is tackling health disparities in the areas of physical activity, healthy nutrition, and healthy weight management. Using the NCHPAD Knowledge Adaptation, Translation, and Scale-up Framework, NCHPAD is systematically facilitating, monitoring, and evaluating inclusive programmatic, policy, systems, and environmental (PPSE) changes in communities and organizations at a local and national level. Through examples we will highlight the importance of adapting knowledge, facilitating uptake, developing strategic partnerships and building community capacity that ultimately creates sustainable, inclusive change. Full article

(This article belongs to the Special Issue Health Promotion Interventions for People with Disabilities)

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13 pages, 729 KiB

Open AccessArticle

Factors Influencing Abortion Decision-Making Processes among Young Women

by Mónica Frederico, Kristien Michielsen, Carlos Arnaldo and Peter Decat

Int. J. Environ. Res. Public Health 2018, 15(2), 329; https://doi.org/10.3390/ijerph15020329 - 13 Feb 2018

Cited by 62 | Viewed by 21519

Abstract

Background: Decision-making about if and how to terminate a pregnancy is a dilemma for young women experiencing an unwanted pregnancy. Those women are subject to sociocultural and economic barriers that limit their autonomy and make them vulnerable to pressures that influence or force [...] Read more.

Background: Decision-making about if and how to terminate a pregnancy is a dilemma for young women experiencing an unwanted pregnancy. Those women are subject to sociocultural and economic barriers that limit their autonomy and make them vulnerable to pressures that influence or force decisions about abortion. Objective: The objective of this study was to explore the individual, interpersonal and environmental factors behind the abortion decision-making process among young Mozambican women. Methods: A qualitative study was conducted in Maputo and Quelimane. Participants were identified during a cross-sectional survey with women in the reproductive age (15–49). In total, 14 women aged 15 to 24 who had had an abortion participated in in-depth interviews. A thematic analysis was used. Results: The study found determinants at different levels, including the low degree of autonomy for women, the limited availability of health facilities providing abortion services and a lack of patient-centeredness of health services. Conclusions: Based on the results of the study, the authors suggest strategies to increase knowledge of abortion rights and services and to improve the quality and accessibility of abortion services in Mozambique. Full article

(This article belongs to the Special Issue Teenage Reproductive Health: Pregnancy, Contraception, Unsafe Abortion, Fertility)

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16 pages, 5933 KiB

Open AccessArticle

Development of an mHealth Application for Women Newly Diagnosed with Osteoporosis without Preceding Fractures: A Participatory Design Approach

by Pernille Ravn Jakobsen, Anne Pernille Hermann, Jens Søndergaard, Uffe Kock Wiil and Jane Clemensen

Int. J. Environ. Res. Public Health 2018, 15(2), 330; https://doi.org/10.3390/ijerph15020330 - 13 Feb 2018

Cited by 33 | Viewed by 7785

Abstract

mHealth is a useful tool to improve health outcome within chronic disease management. However, mHealth is not implemented in the field of postmenopausal osteoporosis even though it is a major worldwide health challenge. Therefore, this study aims to design and develop an mHealth [...] Read more.

mHealth is a useful tool to improve health outcome within chronic disease management. However, mHealth is not implemented in the field of postmenopausal osteoporosis even though it is a major worldwide health challenge. Therefore, this study aims to design and develop an mHealth app to support women in self-management of osteoporosis when they are diagnosed without preceding fractures. Participatory design is conducted in three phases. Based on identified needs in the first phase, a prototype is designed and developed in an iterative process in the second phase before the mHealth app is tested in the third phase. This paper focuses on the user activities in phase two and describes how a team of researchers, women, physicians, healthcare professionals, and app designers are involved in the participatory design process. The study shows that participatory design is a viable approach when developing an mHealth app for women with asymptomatic osteoporosis. Results obtained from the workshops and laboratory tests demonstrate the importance of feedback from users in the iterative process, as well as the participation of users and app designers in workshops and laboratory tests to enable mutual learning when developing new mHealth solutions. The regular member-checks and involvement of users helped to identify challenges associated with providing healthcare services through an app. Full article

(This article belongs to the Special Issue eHealth: The Impact of Technology on Healthcare)

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20 pages, 449 KiB

Open AccessArticle

Work Stress Interventions in Hospital Care: Effectiveness of the DISCovery Method

by Irene Niks, Jan De Jonge, Josette Gevers and Irene Houtman

Int. J. Environ. Res. Public Health 2018, 15(2), 332; https://doi.org/10.3390/ijerph15020332 - 13 Feb 2018

Cited by 21 | Viewed by 6596

Abstract

Effective interventions to prevent work stress and to improve health, well-being, and performance of employees are of the utmost importance. This quasi-experimental intervention study presents a specific method for diagnosis of psychosocial risk factors at work and subsequent development and implementation of tailored [...] Read more.

Effective interventions to prevent work stress and to improve health, well-being, and performance of employees are of the utmost importance. This quasi-experimental intervention study presents a specific method for diagnosis of psychosocial risk factors at work and subsequent development and implementation of tailored work stress interventions, the so-called DISCovery method. This method aims at improving employee health, well-being, and performance by optimizing the balance between job demands, job resources, and recovery from work. The aim of the study is to quantitatively assess the effectiveness of the DISCovery method in hospital care. Specifically, we used a three-wave longitudinal, quasi-experimental multiple-case study approach with intervention and comparison groups in health care work. Positive changes were found for members of the intervention groups, relative to members of the corresponding comparison groups, with respect to targeted work-related characteristics and targeted health, well-being, and performance outcomes. Overall, results lend support for the effectiveness of the DISCovery method in hospital care. Full article

(This article belongs to the Special Issue Work Stress and the Development of Chronic Diseases)

16 pages, 1710 KiB

Open AccessArticle

Comparison of Toxic Metal Distribution Characteristics and Health Risk between Cultured and Wild Fish Captured from Honghu City, China

by Jingdong Zhang, Liyun Zhu, Fei Li, Chaoyang Liu, Zhenzhen Qiu, Minsi Xiao and Ying Cai

Int. J. Environ. Res. Public Health 2018, 15(2), 334; https://doi.org/10.3390/ijerph15020334 - 14 Feb 2018

Cited by 21 | Viewed by 5538

Abstract

Honghu Lake, which listed in the “Ramsar Convention”, is the seventh largest freshwater lake in China and is regarded as one of the biggest freshwater product output areas in China. The toxic element distribution in cultured and wild fish and the corresponding health [...] Read more.

Honghu Lake, which listed in the “Ramsar Convention”, is the seventh largest freshwater lake in China and is regarded as one of the biggest freshwater product output areas in China. The toxic element distribution in cultured and wild fish and the corresponding health risks through fish consumption from Honghu area were investigated. The mean concentration in the muscle of cultured and wild fish (Carassius auratus and Ctenopharyngodon idellus) decreased in the order: Zn (18.94) > Cu (0.8489) > Cr (0.2840) > Pb (0.2052) and Zn (16.30) > Cr (1.947) > Cu (0.4166) > Pb (0.0525) > Cd (0.0060) (mean; mg/kg, wet weight). Scales (Multi factor pollution index (MPI) = 3.342) and the liver (MPI = 1.276) were regarded as the main accumulation tissues for cultured fish, and the bladder (MPI = 0.640) and intestine (MPI = 0.477) were regarded as the main accumulation tissues for wild fish. There were no obvious health risks associated with the consumption of cultured and wild fish based on the calculated results of the target hazard quotient (THQ), carcinogenic risk (CR), and estimated weekly intake (EWI). Pb and Cr were recognized as the major health risk contributors for inhabitants through wild and cultured fish consumption. Cultured fish had a greater health risk than wild fish based on the calculation results of THQ and CR. Muscle consumption resulted in more health risks than mixed edible tissues for cultured fish, but for wild fish, the conclusion was the opposite. Mixed fish (cultured:wild = 1:1) muscle consumption had relatively lower risks than the consumption of cultured or wild fish muscle separately. Consuming no more than 465 g/day (wet wt) of cultured fish muscle, 68 g/day (wet wt) of wild fish muscle, 452 g/day (wet wt) of mixed cultured fish edible tissues or 186 g/day (wet wt) of mixed wild fish edible tissues from the Honghu area can assure human health. Full article

(This article belongs to the Collection Environmental Risk Assessment)

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15 pages, 320 KiB

Open AccessArticle

Drugs and Mental Health Problems among the Roma: Protective Factors Promoted by the Iglesia Evangélica Filadelfia

by Jelen Amador López, Ramón Flecha García and Teresa Sordé Martí

Int. J. Environ. Res. Public Health 2018, 15(2), 335; https://doi.org/10.3390/ijerph15020335 - 14 Feb 2018

Cited by 19 | Viewed by 7444

Abstract

Background: High incidences of drug consumption and mental health problems are found among the Roma population in Spain, a reality that remains understudied. Past studies have indicated the positive role played by the Iglesia Evangélica Filadelfia (IEF) in promoting rehabilitation and prevention of [...] Read more.

Background: High incidences of drug consumption and mental health problems are found among the Roma population in Spain, a reality that remains understudied. Past studies have indicated the positive role played by the Iglesia Evangélica Filadelfia (IEF) in promoting rehabilitation and prevention of these practices. Objective: In this article, authors analyze in which ways the IEF favors processes of drug rehabilitation and mental health recovery as well as the prevention of these problems among its Roma members. Methods: A communicative qualitative approach was developed. It was communicative because new knowledge was created by dialogically contrasting the existing state of the art with study participants. It was qualitative because everyday life stories were collected, gathering the experiences, perceptions and interpretations of Roma people who are actively involved in three different IEF churches based in Barcelona. Results: This article identifies these protective factors: anti-drug discourse, a supportive environment, new social relations, role model status, the promotion of interactions, the revaluation of oneself, spiritual activities and the improvement of the feeling of belonging and the creation of meaning. Conclusion: The present research contributes new evidence to the current understanding of the role played by the IEF in improving Roma health status and how the identified protective factors can contribute to rehabilitation and recovery from such problems in other contexts. Full article

(This article belongs to the Special Issue Roma Health)

11 pages, 1019 KiB

Open AccessArticle

Assessing the Potential for Rooftop Rainwater Harvesting from Large Public Institutions

by Dagnachew Adugna, Marina Bergen Jensen, Brook Lemma and Geremew Sahilu Gebrie

Int. J. Environ. Res. Public Health 2018, 15(2), 336; https://doi.org/10.3390/ijerph15020336 - 14 Feb 2018

Cited by 41 | Viewed by 8326

Abstract

As in many other cities, urbanization coupled with population growth worsens the water supply problem of Addis Ababa, Ethiopia, with a water supply deficit of 41% in 2016. To investigate the potential contribution of rooftop rainwater harvesting (RWH) from large public institutions, 320 [...] Read more.

As in many other cities, urbanization coupled with population growth worsens the water supply problem of Addis Ababa, Ethiopia, with a water supply deficit of 41% in 2016. To investigate the potential contribution of rooftop rainwater harvesting (RWH) from large public institutions, 320 such institutions were selected and grouped into 11 categories, from which 25–30% representative 588 rooftops were digitalized and the potential RWH volume computed based on a ten-year rainfall dataset. When comparing the resulting RWH potential with the water consumption, up to 2.3% of the annual, potable water supply can be provided. If reused only within one’s own institution, the self-sufficiency varies from 0.9 to 649%. Non-uniform rainfall patterns add uncertainty to these numbers, since the size of the storage tank becomes critical for coverage in the dry season from October to May. Despite the low replacement potential at the city level, RWH from large institutions will enable a significant volume of potable water to be transferred to localities critically suffering from water shortage. Further, large institutions may demonstrate how RWH can be practiced, thus acting as a frontrunner for the dissemination of RWH to other types of rooftops. To narrow the water supply gap, considering rooftop RWH as an alternative water supply source is recommended. However, the present study assumed that financial constraints to install large sized storage tanks are considered as a possible challenge. Thus, future research is needed to investigate the cost-benefit balance along with the invention of a cheap storage tank as they may affect the potential contribution of RWH from rooftops. Full article

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13 pages, 289 KiB

Open AccessArticle

An Exploration of Underrepresentation of Aboriginal Cancer Patients Attending a Regional Radiotherapy Service in Western Australia

by Marilyn Lyford, Margaret M. Haigh, Siddhartha Baxi, Shelley Cheetham, Shaouli Shahid and Sandra C. Thompson

Int. J. Environ. Res. Public Health 2018, 15(2), 337; https://doi.org/10.3390/ijerph15020337 - 14 Feb 2018

Cited by 13 | Viewed by 5648

Abstract

Travel logistics impede Aboriginal patients’ uptake of cancer treatments and is one reason for the poorer outcomes of Aboriginal people with cancer. This research examined benefits of a newly established rurally based radiotherapy unit in southwest Western Australia (WA), and included exploring the [...] Read more.

Travel logistics impede Aboriginal patients’ uptake of cancer treatments and is one reason for the poorer outcomes of Aboriginal people with cancer. This research examined benefits of a newly established rurally based radiotherapy unit in southwest Western Australia (WA), and included exploring the experience of Aboriginal patients and possible reasons for Aboriginal people’s underrepresentation in treatment. Semi-structured in-depth interviews with 21 service providers involved in the treatment and care of people with cancer, and 3 Aboriginal patients with cancer who undertook radiotherapy at the Service were undertaken. Data were subject to thematic analysis involving immersion in the data for familiarization, inductive coding, investigator discussion and refining of emerging themes and triangulation of patient and provider interviews. Aboriginal cancer patients were positive about the treatment and support they had received, highlighting the often complex challenges faced by rural Aboriginal cancer patients in accessing and maintaining treatment. Service providers offered suggestions for small numbers presenting to the Service, including late presentation, potential perceptions of cultural insensitivity on the part of service providers, out-of-pocket costs and under-ascertainment of Aboriginal status. The Service has put in place practices and initiatives to support patient health and wellbeing, including making the facility more welcoming towards Aboriginal people and ensuring culturally appropriate care. Full article

(This article belongs to the Special Issue Indigenous Health and Wellbeing)

12 pages, 3161 KiB

Open AccessArticle

A Comparison of Military and Law Enforcement Body Armour

by Robin Orr, Ben Schram and Rodney Pope

Int. J. Environ. Res. Public Health 2018, 15(2), 339; https://doi.org/10.3390/ijerph15020339 - 14 Feb 2018

Cited by 16 | Viewed by 6791

Abstract

Law-enforcement officers increasingly wear body armour for protection; wearing body armour is common practice in military populations. Law-enforcement and military occupational demands are vastly different and military-styled body armour may not be suitable for law-enforcement. This study investigated differences between selected military body [...] Read more.

Law-enforcement officers increasingly wear body armour for protection; wearing body armour is common practice in military populations. Law-enforcement and military occupational demands are vastly different and military-styled body armour may not be suitable for law-enforcement. This study investigated differences between selected military body armour (MBA: 6.4 kg) and law-enforcement body armour (LEBA: 2.1 kg) in impacts on postural sway, vertical jump, agility, a functional movement screen (FMS), task simulations (vehicle exit; victim recovery), and subjective measures. Ten volunteer police officers (six females, four males) were randomly allocated to one of the designs on each of two days. Body armour type did not significantly affect postural sway, vertical jump, vehicle exit and 5 m sprint times, or victim recovery times. Both armour types increased sway velocity and sway-path length in the final five seconds compared to the first 5 s of a balance task. The MBA was associated with significantly slower times to complete the agility task, poorer FMS total scores, and poorer subjective ratings of performance and comfort. The LEBA was perceived as more comfortable and received more positive performance ratings during the agility test and task simulations. The impacts of MBA and LEBA differed significantly and they should not be considered interchangeable. Full article

(This article belongs to the Section Occupational Safety and Health)

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12 pages, 922 KiB

Open AccessArticle

Relationships between Characteristics of Urban Green Land Cover and Mental Health in U.S. Metropolitan Areas

by Wei-Lun Tsai, Melissa R. McHale, Viniece Jennings, Oriol Marquet, J. Aaron Hipp, Yu-Fai Leung and Myron F. Floyd

Int. J. Environ. Res. Public Health 2018, 15(2), 340; https://doi.org/10.3390/ijerph15020340 - 14 Feb 2018

Cited by 87 | Viewed by 9890

Abstract

Urbanization increases risk for depression and other mental disorders. A growing body of research indicates the natural environment confers numerous psychological benefits including alleviation of mental distress. This study examined land cover types and landscape metrics in relation to mental health for 276 [...] Read more.

Urbanization increases risk for depression and other mental disorders. A growing body of research indicates the natural environment confers numerous psychological benefits including alleviation of mental distress. This study examined land cover types and landscape metrics in relation to mental health for 276 U.S. counties within metropolitan areas having a population of 1 million or more. County Health Rankings and Behavioral Risk and Factor Surveillance System (BRFSS) provided a measure of mental health. The 2011 National Land Cover Database (NLCD) provided data on green land cover types, from which seven landscape metrics were generated to characterize landscape patterns. Spearman’s rho correlation and stepwise logistic regression models, respectively, were employed to examine bivariate and multivariate relationships. Models were adjusted for county population and housing density, region, race, and income to account for potential confounding. Overall, individual measures of landscape patterns showed stronger associations with mental health than percent total cover alone. Greater edge contrast was associated with 3.81% lower odds of Frequent Mental Distress (FMD) (Adjusted Odd’s Ratio (AOR) = 0.9619, 95% CI = 0.9371, 0.9860). Shrubland cohesion was associated with greater odds of FMD (AOR = 1.0751, 95% CI = 1.0196, 1.1379). In addition, distance between shrubland cover was associated with greater odds of FMD (AOR = 1.0027, 95% CI = 1.0016, 1.0041). Although effect sizes were small, findings suggest different types of landscape characteristics may have different roles in improving mental health. Full article

(This article belongs to the Special Issue Natural Environment and Health: The Effect of Socio-Cultural Context on Health Effects of Natural Environments)

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13 pages, 304 KiB

Open AccessArticle

Shared Housing Arrangements in Germany—An Equitable Alternative to Long Term Care Services beyond Homes and Institutions?

by Lorraine Frisina Doetter and Achim Schmid

Int. J. Environ. Res. Public Health 2018, 15(2), 342; https://doi.org/10.3390/ijerph15020342 - 14 Feb 2018

Cited by 4 | Viewed by 5080

Abstract

Given the saliency of socio-demographic pressures, the highly restrictive definition of “need for care” characterizing the German long-term care system at its foundations in 1994 has since been subject to various expansionary reforms. This has translated into greater interest in innovative care models [...] Read more.

Given the saliency of socio-demographic pressures, the highly restrictive definition of “need for care” characterizing the German long-term care system at its foundations in 1994 has since been subject to various expansionary reforms. This has translated into greater interest in innovative care models that provide more choice and flexibility to beneficiaries. One such model is ‘shared housing arrangements’ (“ambulant betreute Wohngemeinschaften”), where a small group of people rent private rooms, while sharing a common space, domestic support, and nursing care. Using interview and secondary data, this study examines the potential for such arrangements to provide an equitable alternative to care that is accessible to a larger population of beneficiaries than presently seen in Germany. Full article

(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)

14 pages, 311 KiB

Open AccessArticle

Physical Health Care for People with Severe Mental Illness: the Attitudes, Practices, and Training Needs of Nurses in Three Asian Countries

by Daniel Bressington, Ashish Badnapurkar, Sachiko Inoue, Hin Yeung Ma, Wai Tong Chien, Deborah Nelson and Richard Gray

Int. J. Environ. Res. Public Health 2018, 15(2), 343; https://doi.org/10.3390/ijerph15020343 - 15 Feb 2018

Cited by 37 | Viewed by 9515

Abstract

People with severe mental illness (SMI) have considerable unmet physical health needs and an increased risk of early mortality. This cross-sectional survey utilized the Physical Health Attitude Scale (PHASe) to examine the attitudes, practices, and training needs of nurses towards physical health care [...] Read more.

People with severe mental illness (SMI) have considerable unmet physical health needs and an increased risk of early mortality. This cross-sectional survey utilized the Physical Health Attitude Scale (PHASe) to examine the attitudes, practices, and training needs of nurses towards physical health care of people with SMI in three Asian countries (Hong Kong, Japan, Qatar). Cross-country differences were explored and linear regression was used to investigate if nurses’ attitudes and confidence were associated with their level of involvement in physical health care. A total of 481 questionnaires were returned. Hong Kong nurses were less involved in physical health care than those from Japan and Qatar. Nurses’ attitudes and confidence were significant predictors of their participation in managing physical health. Compared with western countries, more nurses in this study felt that mental illness was a barrier to improving physical health. Three-quarters reported that they needed additional training in promoting cardiometabolic health. The perceived need for additional training in physical health care was held by Mental Health Nurses (MHN) irrespective of their type of nursing registration and nationality. Nurse educators and service providers should reconsider the physical health care training requirements of nurses working in mental health settings in order to improve the physical health of people with SMI. Full article

(This article belongs to the Section Health Economics)

23 pages, 1024 KiB

Open AccessArticle

Work-Family Conflict, Perceived Organizational Support and Professional Commitment: A Mediation Mechanism for Chinese Project Professionals

by Junwei Zheng and Guangdong Wu

Int. J. Environ. Res. Public Health 2018, 15(2), 344; https://doi.org/10.3390/ijerph15020344 - 15 Feb 2018

Cited by 63 | Viewed by 10566

Abstract

Projects are characterized by long working hours, complex tasks and being a kind of temporary organization. As such, work-family conflict is particularly prominent for project employees. This research examined whether and how work-family conflict affects professional commitment among Chinese project professionals. Research hypotheses [...] Read more.

Projects are characterized by long working hours, complex tasks and being a kind of temporary organization. As such, work-family conflict is particularly prominent for project employees. This research examined whether and how work-family conflict affects professional commitment among Chinese project professionals. Research hypotheses were developed to explore the relationship between work-family conflict, professional commitment to the project and the mediating effects of perceived organizational support. Data were collected from 327 project managers or professionals working in construction enterprises in China; data were analyzed using structural equation modeling, applying the bootstrapping method. Results showed that there were three dimensions of work-family conflict: time-based conflict, strain-based conflict and behavior-based conflict. There were two dimensions of perceived organizational support: emotional support and instrumental support. The study also tested the negative effect of work-family conflict on professional commitment and the positive effect of perceived organizational support on professional commitment. Specifically, time-based conflict and emotional support had positive effects on professional commitment. Perceived organizational support had a total mediating effect between work-family conflict and professional commitment. The strain-based conflict dimension of work-family conflict had negative impacts on professional commitment through perceived emotional support and instrumental support. Overall, our findings extend a better understanding of work-family conflict and professional commitment in the project setting and verify the importance of social support in balancing work and family and improving employee mobility. Full article

(This article belongs to the Special Issue Improving Safety, Health, and Wellbeing in Construction)

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25 pages, 1082 KiB

Open AccessArticle

Evaluating the Impacts of Health, Social Network and Capital on Craft Efficiency and Productivity: A Case Study of Construction Workers in China

by Jingfeng Yuan, Wen Yi, Mengyi Miao and Lei Zhang

Int. J. Environ. Res. Public Health 2018, 15(2), 345; https://doi.org/10.3390/ijerph15020345 - 15 Feb 2018

Cited by 40 | Viewed by 9377

Abstract

The construction industry has been recognized, for many years, as among those having a high likelihood of accidents, injuries and occupational illnesses. Such risks of construction workers can lead to low productivity and social problems. As a result, construction workers’ well-being should be [...] Read more.

The construction industry has been recognized, for many years, as among those having a high likelihood of accidents, injuries and occupational illnesses. Such risks of construction workers can lead to low productivity and social problems. As a result, construction workers’ well-being should be highly addressed to improve construction workers’ efficiency and productivity. Meanwhile, the social support from a social network and capital (SNC) of construction workers has been considered as an effective approach to promote construction workers’ physical and mental health (P&M health), as well as their work efficiency and productivity. Based on a comprehensive literature review, a conceptual model, which aims to improve construction workers’ efficiency and productivity from the perspective of health and SNC, was proposed. A questionnaire survey was conducted to investigate the construction workers’ health, SNC and work efficiency and productivity in Nanjing, China. A structural equation model (SEM) was employed to test the three hypothetical relationships among construction workers’ P&M health, SNC and work efficiency and productivity. The results indicated that the direct impacts from construction workers’ P&M health on work efficiency and productivity were more significant than that from the SNC. In addition, the construction workers’ social capital and the network can indirectly influence the work efficiency and productivity by affecting the construction workers’ P&M health. Therefore, strategies for enhancing construction workers’ efficiency and productivity were proposed. Furthermore, many useable suggestions can be drawn from the research findings from the perspective of a government. The identified indicators and relationships would contribute to the construction work efficiency and productivity assessment and health management from the perspective of the construction workers. Full article

(This article belongs to the Special Issue Improving Safety, Health, and Wellbeing in Construction)

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15 pages, 543 KiB

Open AccessArticle

Evaluation of a Computer-Tailored Healthy Ageing Intervention to Promote Physical Activity among Single Older Adults with a Chronic Disease

by Janet M. Boekhout, Brenda A. J. Berendsen, Denise A. Peels, Catherine A. W. Bolman and Lilian Lechner

Int. J. Environ. Res. Public Health 2018, 15(2), 346; https://doi.org/10.3390/ijerph15020346 - 15 Feb 2018

Cited by 22 | Viewed by 6162

Abstract

This study explores the effectiveness of the Active Plus65 intervention designed to stimulate physical activity among single older adults with a chronic physical impairment. A quasi-experimental pre-test post-test study was performed. The intervention group (n = 411; mean age = 76.75; SD [...] Read more.

This study explores the effectiveness of the Active Plus65 intervention designed to stimulate physical activity among single older adults with a chronic physical impairment. A quasi-experimental pre-test post-test study was performed. The intervention group (n = 411; mean age = 76.75; SD = 7.75) was assessed at baseline, three months, and six months. Data of comparable older adults who completed the original Active Plus intervention served as reference group (n = 87; mean age = 74.36; SD = 6.26). Multilevel regression analyses were applied: outcome measures were weekly minutes of moderate to vigorous physical activity (MVPA) and days per week with at least 30 min of MVPA. Although Active Plus65 did not outperform the original intervention, in itself Active Plus65 effectuated a significant increase in the weekly minutes of MVPA (B = 208.26; p < 0.001; Effect Size (ES) = 0.45) and in the days per week with sufficient MVPA (B = 1.20; p < 0.001; ES = 0.61) after three months. After six months, it effectuated a significant increase in the days per week with sufficient MVPA (B = 0.67; p = 0.001; ES = 0.34) but not for the weekly minutes of MVPA (p = 0.745). As Active Plus65 increased MVPA at three months with a higher ES than average interventions for this vulnerable target group, it potentially makes an interesting intervention. Further development should focus on long-term maintenance of effects. Full article

(This article belongs to the Collection Aging and Public Health)

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14 pages, 359 KiB

Open AccessArticle

Effects of Vacation Rental Websites on the Concentration of Tourists—Potential Environmental Impacts. An Application to the Balearic Islands in Spain

by José María Martín Martín, José Antonio Rodriguez Martín, Karla Aída Zermeño Mejía and José Antonio Salinas Fernández

Int. J. Environ. Res. Public Health 2018, 15(2), 347; https://doi.org/10.3390/ijerph15020347 - 15 Feb 2018

Cited by 50 | Viewed by 6305

Abstract

The concentration of tourists at certain times of the year can damage sensitive environments. The use of peer-to-peer vacation rental websites has increased greatly during the last decade. This system could either reduce seasonality in touristic destinations where the tourist activity takes place [...] Read more.

The concentration of tourists at certain times of the year can damage sensitive environments. The use of peer-to-peer vacation rental websites has increased greatly during the last decade. This system could either reduce seasonality in touristic destinations where the tourist activity takes place throughout the year at a lower price or on the contrary, it could increase the number of visitors at certain times of the year even more. This paper intends to analyze the effect that these platforms have on tourism seasonality in order to calculate if they help reduce or increase the pressure on the destinations. To do so, the Gini Index has been applied to one of the main touristic spots in Europe, the Balearic Islands in Spain. The conclusion is that this type of accommodation has aggravated the problem, generating a greater concentration of tourists and a higher pressure on the resources of the islands. Full article

(This article belongs to the Special Issue Green Environment, Green Operations and Sustainability)

18 pages, 330 KiB

Open AccessArticle

Ten Years of Experience in Contraception Options for Teenagers in a Family Planning Center in Thrace and Review of the Literature

by Panagiotis Tsikouras, Dorelia Deuteraiou, Anastasia Bothou, Xanthi Anthoulaki, Anna Chalkidou, Eleftherios Chatzimichael, Fotini Gaitatzi, Bachar Manav, Zacharoula Koukouli, Stefanos Zervoudis, Grigorios Trypsianis and George Galazios

Int. J. Environ. Res. Public Health 2018, 15(2), 348; https://doi.org/10.3390/ijerph15020348 - 15 Feb 2018

Cited by 5 | Viewed by 6224

Abstract

Introduction: The goal of our study was to investigate and evaluate the contraceptive behavior in teenagers from our family planning centre that services two different religious and socioeconomic populations living in the Thrace area. Methods: During the last 10 years 115 [...] Read more.

Introduction: The goal of our study was to investigate and evaluate the contraceptive behavior in teenagers from our family planning centre that services two different religious and socioeconomic populations living in the Thrace area. Methods: During the last 10 years 115 Christian Orthodox (group A) and 53 Muslim teenagers (group B) were enrolled in our retrospective study. Contraceptive practice attitudes were assessed by a questionnaire. Religion, demographics, socio-economic characteristics were key factors used to discuss contraception and avoid unplanned pregnancy in each group and to compare with the contraceptive method used. Results: The most used contraceptive method—about two times more frequently—among Christian Orthodox participants was the oral contraceptive pill (p = 0.015; OR = 1.81, 95% CI = 1.13–2.90), while in the other group the use of condoms and IUDs was seven and three times more frequent, respectively. Our family planning centre was the main source of information for contraception. Conclusions: During adolescence, the existence of a family planning centre and participation in family planning programs plays a crucial role to help the teenagers to improve their knowledge and choose an effective contraception method. Full article

(This article belongs to the Special Issue Teenage Reproductive Health: Pregnancy, Contraception, Unsafe Abortion, Fertility)

18 pages, 332 KiB

Open AccessArticle

“I Wouldn’t Be Friends with Someone If They Were Liking Too Much Rubbish”: A Qualitative Study of Alcohol Brands, Youth Identity and Social Media

by Richard I. Purves, Martine Stead and Douglas Eadie

Int. J. Environ. Res. Public Health 2018, 15(2), 349; https://doi.org/10.3390/ijerph15020349 - 16 Feb 2018

Cited by 24 | Viewed by 8941

Abstract

The consumption of alcohol by young people remains a major public health concern at both the national and international level. Levels of drinking among 15-yearolds in the United Kingdom (UK) remain significantly higher than the European average. This study explored how alcohol brands [...] Read more.

The consumption of alcohol by young people remains a major public health concern at both the national and international level. Levels of drinking among 15-yearolds in the United Kingdom (UK) remain significantly higher than the European average. This study explored how alcohol brands are used by young people to develop their desired identities and how these acts of consumption extend to young people’s profiles on social media. It also deepens understanding of how alcohol brands are connected to young peoples’ concerns about image and peer group dynamics. This involved qualitative focus groups with young people aged 14–17 in Central Scotland. Certain alcohol brands were approved and viewed as socially acceptable by young people, while others were rejected. Children as young as 14 were selecting products to portray a drinking identity that was appropriately aligned to their gender and sexuality. Participants displayed a desire to associate themselves with the mature drinking culture personified by some brands, whilst simultaneously distancing themselves from immature drinking practices associated with others. Publicly associating with alcohol brands on social media carried with it potential risks to peer group acceptance. Understanding how young people perceive alcohol brands, the importance of social media in communicating that identity to their peers and the role that alcohol brands play in adolescent identity formation is an important first step to reforming alcohol marketing regulations. Full article

23 pages, 531 KiB

Open AccessArticle

Working towards More Effective Implementation, Dissemination and Scale-Up of Lower-Limb Injury-Prevention Programs: Insights from Community Australian Football Coaches

by Angela McGlashan, Glenda Verrinder and Evert Verhagen

Int. J. Environ. Res. Public Health 2018, 15(2), 351; https://doi.org/10.3390/ijerph15020351 - 16 Feb 2018

Cited by 9 | Viewed by 7130

Abstract

Disseminating lower-limb injury-prevention exercise programs (LL-IPEPs) with strategies that effectively reach coaches across sporting environments is a way of preventing lower-limb injuries (LLIs) and ensuring safe and sustainable sport participation. The aim of this study was to explore community-Australian Football (community-AF) coaches’ perspectives [...] Read more.

Disseminating lower-limb injury-prevention exercise programs (LL-IPEPs) with strategies that effectively reach coaches across sporting environments is a way of preventing lower-limb injuries (LLIs) and ensuring safe and sustainable sport participation. The aim of this study was to explore community-Australian Football (community-AF) coaches’ perspectives on the strategies they believed would enhance the dissemination and scale-up of LL-IPEPs. Using a qualitative multiple case study design, semi-structured interviews with community-AF coaches in Victoria, Australia, were conducted. Overall, coaches believed a range of strategies were important including: coach education, policy drivers, overcoming potential problem areas, a ‘try before you buy approach’, presenting empirical evidence and guidelines for injury-prevention exercise programs (IPEPs), forming strategic collaboration and working in partnership, communication and social marketing, public meetings, development of a coach hotline, and targeted multi-focused approaches. A shift to a culture whereby evidence-based IPEP practices in community-AF will take time, and persistent commitment by all involved in the sport is important. This will support the creation of strategies that will enhance the dissemination and scale-up of LL-IPEPs across community sport environments. The focus of research needs to continue to identify effective, holistic and multi-level interventions to support coaches in preventing LLIs. This could lead to the determination of successful strategies such as behavioural regulation strategies and emotional coping resources to implement LL-IPEPs into didactic curricula and practice. Producing changes in practice will require attention to which strategies are a priority and the most effective. Full article

(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)

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11 pages, 977 KiB

Open AccessArticle

Socioeconomic Inequality in One-Year Mortality of Elderly People with Hip Fracture in Taiwan

by I-Lin Hsu, Chia-Ming Chang, Deng-Chi Yang, Ya-Hui Chang, Chia-Chun Li, Susan C. Hu and Chung-Yi Li

Int. J. Environ. Res. Public Health 2018, 15(2), 352; https://doi.org/10.3390/ijerph15020352 - 16 Feb 2018

Cited by 10 | Viewed by 3937

Abstract

Hip fracture commonly results in considerable consequences in terms of disability, mortality, long-term institutional care and cost. Taiwan launched its universal health insurance coverage in 1995, which largely removes financial barriers to health care. This study aims to investigate whether socioeconomic inequality in [...] Read more.

Hip fracture commonly results in considerable consequences in terms of disability, mortality, long-term institutional care and cost. Taiwan launched its universal health insurance coverage in 1995, which largely removes financial barriers to health care. This study aims to investigate whether socioeconomic inequality in one-year mortality exists among Taiwanese elderly people. This population-based cohort study included 193,158 elderly patients (≥65 years) admitted for hip fracture between 2000 and 2012. With over a one-year follow-up, 10.52% of the participants died from all causes. The mortality rate was low in the northern part of Taiwan and in urban and high-family-income areas. Multiple Poisson regression models further suggested that the level of >Q1–Q3 and >Q3–Max showed significantly reduced odds ratio of one-year mortality at 0.90 (95% confidence interval (CI), 0.87–0.93) and 0.77 (95% CI, 0.74–0.81), respectively, compared with that of the lowest family income level (i.e., Min.–Q1). Despite a monotonic decline in overall one-year mortality during the study period, socioeconomic inequality in one-year mortality rate remained evident. The annual percentage change in one-year mortality was higher (−2.86) in elderly people from families with high income (>Q3–Max.) than that for elderly patients from family with low income (Min.–Q1, −1.94). Accessibility, rather than affordability, to health care for hip fracture is probably responsible for the observed socioeconomic inequality. Full article

(This article belongs to the Section Health Economics)

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22 pages, 690 KiB

Open AccessArticle

Is the Definition of Roma an Important Matter? The Parallel Application of Self and External Classification of Ethnicity in a Population-Based Health Interview Survey

by Eszter Anna Janka, Ferenc Vincze, Róza Ádány and János Sándor

Int. J. Environ. Res. Public Health 2018, 15(2), 353; https://doi.org/10.3390/ijerph15020353 - 16 Feb 2018

Cited by 20 | Viewed by 5296

Abstract

The Roma population is typified by a poor and, due to difficulties in ethnicity assessment, poorly documented health status. We aimed to compare the usefulness of self-reporting and observer-reporting in Roma classification for surveys investigating differences between Roma and non-Roma populations. Both self-reporting [...] Read more.

The Roma population is typified by a poor and, due to difficulties in ethnicity assessment, poorly documented health status. We aimed to compare the usefulness of self-reporting and observer-reporting in Roma classification for surveys investigating differences between Roma and non-Roma populations. Both self-reporting and observer-reporting of Roma ethnicity were applied in a population-based health interview survey. A questionnaire was completed by 1849 people aged 18–64 years; this questionnaire provided information on 52 indicators (morbidity, functionality, lifestyle, social capital, accidents, healthcare use) indicators. Multivariate logistic regression models controlling for age, sex, education and employment were used to produce indicators for differences between the self-reported Roma (N = 124) and non-Roma (N = 1725) populations, as well as between observer-reported Roma (N = 179) and non-Roma populations (N = 1670). Differences between interviewer-reported and self-reported individuals of Roma ethnicity in statistical inferences were observed for only seven indicators. The self-reporting approach was more sensitive for two indicators, and the observer-reported assessment for five indicators. Based on our results, the self-reported identity can be considered as a useful approach, and the application of observer-reporting cannot considerably increase the usefulness of a survey, because the differences between Roma and non-Roma individuals are much bigger than the differences between indicators produced by self-reported or observer-reported data on individuals of Roma ethnicity. Full article

(This article belongs to the Special Issue Roma Health)

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12 pages, 488 KiB

Open AccessArticle

A Theoretical and Empirical Linkage between Road Accidents and Binge Eating Behaviors in Adolescence

by Silvia Cimino, Alessandra Simonelli, Micol Parolin, Giulia Ballarotto, Paola Carbone and Luca Cerniglia

Int. J. Environ. Res. Public Health 2018, 15(2), 355; https://doi.org/10.3390/ijerph15020355 - 17 Feb 2018

Cited by 11 | Viewed by 4284

Abstract

This study aimed at identifying specific clusters of maladaptive emotional–behavioral symptoms in adolescent victims of motorbike collisions considering their scores on alexithymia and impulsivity in addition to examining the prevalence of clinical binge eating behaviors (respectively through the Youth Self-Report (YSR), Toronto Alexithymia [...] Read more.

This study aimed at identifying specific clusters of maladaptive emotional–behavioral symptoms in adolescent victims of motorbike collisions considering their scores on alexithymia and impulsivity in addition to examining the prevalence of clinical binge eating behaviors (respectively through the Youth Self-Report (YSR), Toronto Alexithymia Scale-20 (TAS-20), Barratt Impulsiveness Scale-11 (BIS-11), and Binge Eating Scale (BES)). Emotional–behavioral profiles, difficulties in identifying and describing feelings, impulsivity, and binge eating behaviors have been assessed in 159 adolescents addressing emergency departments following motorbike collisions. Our results showed a cluster of adolescents with clinical binge eating behaviors, high rates of motorbike accidents, and high levels of internalizing and externalizing problems, alexithymia, and impulsivity (23.3% of the sample); a second cluster of adolescents with clinical binge eating behaviors, a moderate number of collisions, and moderate levels of emotional and behavioral problems on the above four dimensions (25.8% of the sample); and a third cluster of youth without clinical binge eating behaviors, with a moderate number of accidents, and with low scores on the four dimensions (50.9% of the sample). Adolescents of Cluster 1 showed a higher likelihood to be involved in motorbike collisions than the youth in Clusters 2 and 3 (p < 0.0001). We suggest that adolescents’ motor collisions could be associated with their difficulties in emotion regulation and with their impaired psychological profiles, which could also underpin their disordered eating. The identification of specific clusters of psychopathological symptoms among this population could be useful for the construction of prevention and intervention programs aimed at reducing motor collision recidivism and alleviating co-occurring psychopathologies. Full article

(This article belongs to the Special Issue Stress, Coping, and Resilience in Adolescents)

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12 pages, 609 KiB

Open AccessArticle

I Can Stand Learning: A Controlled Pilot Intervention Study on the Effects of Increased Standing Time on Cognitive Function in Primary School Children

by Katharina Wick, Oliver Faude, Susanne Manes, Lukas Zahner and Lars Donath

Int. J. Environ. Res. Public Health 2018, 15(2), 356; https://doi.org/10.3390/ijerph15020356 - 17 Feb 2018

Cited by 25 | Viewed by 5588

Abstract

Sedentarism is considered an independent cardiovascular risk factor. Thus, the present study investigated the effects of employing standing desks in classrooms on cognitive function. The intervention class (IG; n = 19) was supplied with standing desks and balance pads for 11 weeks. The [...] Read more.

Sedentarism is considered an independent cardiovascular risk factor. Thus, the present study investigated the effects of employing standing desks in classrooms on cognitive function. The intervention class (IG; n = 19) was supplied with standing desks and balance pads for 11 weeks. The control class (CG; n = 19) received lessons as usual. Standing time was assessed objectively (accelerometers) and subjectively (self-report sheets, external classroom observers). The impact of standing on the digit span task and Eriksen flanker task was analysed. The standing time of the IG was higher during the school day in comparison to the CG (lesson: p = 0.004; break: p = 0.003). The intra-class correlation coefficient between self-reports and external observation was high (ICC = 0.94). The IG improved slightly on the Digit Span Task compared to CG. Employing standing desks for at least 1 h per school day serves as a feasible and effective opportunity to improve cognitive function. Full article

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16 pages, 5068 KiB

Open AccessArticle

Mechanisms of Phosphorus Removal by Recycled Crushed Concrete

by Yihuan Deng and Andrew Wheatley

Int. J. Environ. Res. Public Health 2018, 15(2), 357; https://doi.org/10.3390/ijerph15020357 - 17 Feb 2018

Cited by 36 | Viewed by 4903

Abstract

Due to urbanisation, there are large amounts of waste concrete, particularly in rapidly industrialising countries. Currently, demolished concrete is mainly recycled as aggregate for reconstruction. This study has shown that larger sizes (2–5 mm) of recycled concrete aggregate (RCA) removed more than 90% [...] Read more.

Due to urbanisation, there are large amounts of waste concrete, particularly in rapidly industrialising countries. Currently, demolished concrete is mainly recycled as aggregate for reconstruction. This study has shown that larger sizes (2–5 mm) of recycled concrete aggregate (RCA) removed more than 90% of P from effluent when at pH 5. Analysis of the data, using equilibrium models, indicated a best fit with the Langmuir which predicated an adsorption capacity of 6.88 mg/g. Kinetic analysis indicated the equilibrium adsorption time was 12 h, with pseudo second-order as the best fit. The thermal dynamic tests showed that the adsorption was spontaneous and, together with the evidence from the sequential extraction and desorption experiments, indicated the initial mechanism was physical attraction to the surface followed by chemical reactions which prevented re-release. These results suggested that RCA could be used for both wastewater treatment and P recovery. Full article

(This article belongs to the Special Issue Municipal Wastewater Treatment)

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14 pages, 1241 KiB

Open AccessArticle

Exploration of Rice Husk Compost as an Alternate Organic Manure to Enhance the Productivity of Blackgram in Typic Haplustalf and Typic Rhodustalf

by Subramanium Thiyageshwari, Pandurangan Gayathri, Ramasamy Krishnamoorthy, Rangasamy Anandham and Diby Paul

Int. J. Environ. Res. Public Health 2018, 15(2), 358; https://doi.org/10.3390/ijerph15020358 - 17 Feb 2018

Cited by 42 | Viewed by 7009

Abstract

The present study was aimed at using cellulolytic bacterium Enhydrobacter and fungi Aspergillus sp. for preparing compost from rice husk (RH). Further, the prepared compost was tested for their effect on blackgram growth promotion along with different levels of recommended dose of fertilizer [...] Read more.

The present study was aimed at using cellulolytic bacterium Enhydrobacter and fungi Aspergillus sp. for preparing compost from rice husk (RH). Further, the prepared compost was tested for their effect on blackgram growth promotion along with different levels of recommended dose of fertilizer (RDF) in black soil (typic Haplustalf) and red soil (typic Rhodustalf) soil. The results revealed that, inoculation with lignocellulolytic fungus (LCF) Aspergillus sp. @ 2% was considered as the most efficient method of composting within a short period. Characterization of composted rice husk (CRH) was examined through scanning electron microscope (SEM) for identifying significant structural changes. At the end of composting, N, P and K content increased with decrease in CO2 evolution, C:N and C:P ratios. In comparison to inorganic fertilization, an increase in grain yield of 16% in typic Haplustalf and 17% in typic Rhodustalf soil over 100% RDF was obtained from the integrated application of CRH@ 5 t ha−1 with 50% RDF and biofertilizers. The crude protein content was maximum with the combined application of CRH, 50% RDF and biofertilizers of 20% and 21% in typic Haplustalf and typic Rhodustalf soils, respectively. Nutrient rich CRH has proved its efficiency on crop growth and soil fertility. Full article

(This article belongs to the Special Issue Sustainable Management of Waste)

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20 pages, 340 KiB

Open AccessArticle

Improving Behavioral Support for Smoking Cessation in Pregnancy: What Are the Barriers to Stopping and Which Behavior Change Techniques Can Influence Them? Application of Theoretical Domains Framework

by Katarzyna A Campbell, Libby Fergie, Tom Coleman-Haynes, Sue Cooper, Fabiana Lorencatto, Michael Ussher, Jane Dyas and Tim Coleman

Int. J. Environ. Res. Public Health 2018, 15(2), 359; https://doi.org/10.3390/ijerph15020359 - 17 Feb 2018

Cited by 50 | Viewed by 10942

Abstract

Behavioral support interventions are used to help pregnant smokers stop; however, of those tested, few are proven effective. Systematic research developing effective pregnancy-specific behavior change techniques (BCTs) is ongoing. This paper reports contributory work identifying potentially-effective BCTs relative to known important barriers and [...] Read more.

Behavioral support interventions are used to help pregnant smokers stop; however, of those tested, few are proven effective. Systematic research developing effective pregnancy-specific behavior change techniques (BCTs) is ongoing. This paper reports contributory work identifying potentially-effective BCTs relative to known important barriers and facilitators (B&Fs) to smoking cessation in pregnancy; to detect priority areas for BCTs development. A Nominal Group Technique with cessation experts (n = 12) elicited an expert consensus on B&Fs most influencing women’s smoking cessation and those most modifiable through behavioral support. Effective cessation interventions in randomized trials from a recent Cochrane review were coded into component BCTs using existing taxonomies. B&Fs were categorized using Theoretical Domains Framework (TDF) domains. Matrices, mapping BCT taxonomies against TDF domains, were consulted to investigate the extent to which BCTs in existing interventions target key B&Fs. Experts ranked ‘smoking a social norm’ and ‘quitting not a priority’ as most important barriers and ‘desire to protect baby’ an important facilitator to quitting. From 14 trials, 23 potentially-effective BCTs were identified (e.g., ‘information about consequences). Most B&Fs fell into ‘Social Influences’, ‘Knowledge’, ‘Emotions’ and ‘Intentions’ TDF domains; few potentially-effective BCTs mapped onto every TDF domain. B&Fs identified by experts as important to cessation, are not sufficiently targeted by BCT’s currently within interventions for smoking cessation in pregnancy. Full article

5 pages, 272 KiB

Open AccessArticle

Health Differences between Roma and Non-Roma in the Slovak Dialyzed Population

by Gabriel Kolvek, Zuzana Straussova, Maria Majernikova, Jaroslav Rosenberger and Jitse P. van Dijk

Int. J. Environ. Res. Public Health 2018, 15(2), 360; https://doi.org/10.3390/ijerph15020360 - 18 Feb 2018

Cited by 5 | Viewed by 3867

Abstract

Background: Roma health has not been studied systematically. Thus far, it has been shown that Roma compared to non-Roma have a significantly higher likelihood of getting end-stage renal disease and that their chances for survival on dialysis are lower. Evidence is lacking regarding [...] Read more.

Background: Roma health has not been studied systematically. Thus far, it has been shown that Roma compared to non-Roma have a significantly higher likelihood of getting end-stage renal disease and that their chances for survival on dialysis are lower. Evidence is lacking regarding morbidity between Roma and non-Roma. The aim was to compare the health status of dialyzed Roma and non-Roma using the Charlson comorbidity index (CCI). All Slovak dialysis centers for adults were asked to fill in a questionaire with demographic and clinical data, including comorbidity. Cross-sectional analysis of 2082 patients with an average age of 63.8 ± 13.8 years was performed. Comorbidity was expressed as the CCI, and ethnic differences were calculated. Linear regression was performed to adjust for differences in gender and age in both ethnic groups. Roma represented 13.0% of the whole dialyzed population (n = 270). Comorbidity expressed as CCI was significantly lower in the Roma population (p < 0.001). After adjusting for gender and age, ethnicity failed to be associated with the CCI in the linear regression analysis (p = 0.965, variance of the model—adjusted R² 38.6%). The health status of dialyzed Slovak Roma does not differ cross-sectionally when adjusted for age and gender from the health status of dialyzed non-Roma. Full article

(This article belongs to the Special Issue Roma Health)

20 pages, 5997 KiB

Open AccessArticle

Dynamics of Bacterial and Fungal Communities during the Outbreak and Decline of an Algal Bloom in a Drinking Water Reservoir

by Haihan Zhang, Jingyu Jia, Shengnan Chen, Tinglin Huang, Yue Wang, Zhenfang Zhao, Ji Feng, Huiyan Hao, Sulin Li and Xinxin Ma

Int. J. Environ. Res. Public Health 2018, 15(2), 361; https://doi.org/10.3390/ijerph15020361 - 18 Feb 2018

Cited by 61 | Viewed by 6354

Abstract

The microbial communities associated with algal blooms play a pivotal role in organic carbon, nitrogen and phosphorus cycling in freshwater ecosystems. However, there have been few studies focused on unveiling the dynamics of bacterial and fungal communities during the outbreak and decline of [...] Read more.

The microbial communities associated with algal blooms play a pivotal role in organic carbon, nitrogen and phosphorus cycling in freshwater ecosystems. However, there have been few studies focused on unveiling the dynamics of bacterial and fungal communities during the outbreak and decline of algal blooms in drinking water reservoirs. To address this issue, the compositions of bacterial and fungal communities were assessed in the Zhoucun drinking water reservoir using 16S rRNA and internal transcribed spacer (ITS) gene Illumina MiSeq sequencing techniques. The results showed the algal bloom was dominated by Synechococcus, Microcystis, and Prochlorothrix. The bloom was characterized by a steady decrease of total phosphorus (TP) from the outbreak to the decline period (p < 0.05) while Fe concentration increased sharply during the decline period (p < 0.05). The highest algal biomass and cell concentrations observed during the bloom were 51.7 mg/L and 1.9×108 cell/L, respectively. The cell concentration was positively correlated with CODMn (r = 0.89, p = 0.02). Illumina Miseq sequencing showed that algal bloom altered the water bacterial and fungal community structure. During the bloom, the dominant bacterial genus were Acinetobacter sp., Limnobacter sp., Synechococcus sp., and Roseomonas sp. The relative size of the fungal community also changed with algal bloom and its composition mainly contained Ascomycota, Basidiomycota and Chytridiomycota. Heat map profiling indicated that algal bloom had a more consistent effect upon fungal communities at genus level. Redundancy analysis (RDA) also demonstrated that the structure of water bacterial communities was significantly correlated to conductivity and ammonia nitrogen. Meanwhile, water temperature, Fe and ammonia nitrogen drive the dynamics of water fungal communities. The results from this work suggested that water bacterial and fungal communities changed significantly during the outbreak and decline of algal bloom in Zhoucun drinking water reservoir. Our study highlights the potential role of microbial diversity as a driving force for the algal bloom and biogeochemical cycling of reservoir ecology. Full article

(This article belongs to the Special Issue Aquatic Ecosystem Health)

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12 pages, 1697 KiB

Open AccessArticle

Disaster Reintegration Model: A Qualitative Analysis on Developing Korean Disaster Mental Health Support Model

by Yun-Jung Choi, Hwa-Bok Choi and Meaghan O’Donnell

Int. J. Environ. Res. Public Health 2018, 15(2), 362; https://doi.org/10.3390/ijerph15020362 - 18 Feb 2018

Cited by 16 | Viewed by 7551

Abstract

This study sought to describe the mental health problems experienced by Korean disaster survivors, using a qualitative research method to provide empirical resources for effective disaster mental health support in Korea. Participants were 16 adults or elderly adults who experienced one or more [...] Read more.

This study sought to describe the mental health problems experienced by Korean disaster survivors, using a qualitative research method to provide empirical resources for effective disaster mental health support in Korea. Participants were 16 adults or elderly adults who experienced one or more disasters at least 12 months ago recruited via theoretical sampling. Participants underwent in-depth individual interviews on their disaster experiences, which were recorded and transcribed for qualitative analysis, which followed Strauss and Corbin’s (1998) Grounded theory. After open coding, participants’ experiences were categorized into 130 codes, 43 sub-categories and 17 categories. The categories were further analyzed in a paradigm model, conditional model and the Disaster Reintegration Model, which proposed potentially effective mental health recovery strategies for disaster survivors, health providers and administrators. To provide effective assistance for mental health recovery of disaster survivors, both personal and public resilience should be promoted while considering both cultural and spiritual elements. Full article

(This article belongs to the Special Issue Mental Health and its Social and Cultural Implications)

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14 pages, 785 KiB

Open AccessArticle

Associations between Ambient Particulate Matter and Nitrogen Dioxide and Chronic Obstructive Pulmonary Diseases in Adults and Effect Modification by Demographic and Lifestyle Factors

by Dirga Kumar Lamichhane, Jong Han Leem and Hwan Cheol Kim

Int. J. Environ. Res. Public Health 2018, 15(2), 363; https://doi.org/10.3390/ijerph15020363 - 19 Feb 2018

Cited by 48 | Viewed by 4998

Abstract

This study was undertaken to investigate the associations between chronic exposure to particulate matter of medium aerodynamic diameter ≤10 or ≤2.5 µm (PM₁₀ or PM_2.5) and nitrogen dioxide (NO₂) levels and lung function and to examine a possible [...] Read more.

This study was undertaken to investigate the associations between chronic exposure to particulate matter of medium aerodynamic diameter ≤10 or ≤2.5 µm (PM₁₀ or PM_2.5) and nitrogen dioxide (NO₂) levels and lung function and to examine a possible change in these relationships by demographic and lifestyle factors. Chronic obstructive pulmonary disease (COPD) was defined using the Global Initiative for COPD criteria (forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of <70%). Associations of lung function and COPD with PM₁₀ or PM_2.5 or NO₂ were examined using linear and logistic regression analyses among 1264 Korean adults. The highest tertiles of PM_2.5 (≥37.1 μg/m³) and NO₂ (≥53.8 μg/m³) exposure were significantly associated with COPD (highest versus lowest tertile of PM_2.5: adjusted odds ratio (OR) = 1.79, 95% CI: 1.02–3.13; highest versus lowest tertile of NO₂: adjusted OR = 1.83, 95% CI: 1.04–3.21). A 10 μg/m³ increase in PM₁₀ concentration was associated with a 1.85 L (95% CI –3.65 to –0.05) decrease in FEV1 and a 1.73 L (95% CI –3.35 to –0.12) decrease in FVC, with the strongest negative association among older people and those with less education. Reduced lung function was associated with PM_2.5 exposure in subjects with no physical activity. This study provides evidence that exposure to ambient air pollution has adverse effects on lung function in adults. Full article

(This article belongs to the Special Issue Lung Diseases Associated with Environmental Pollutants)

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11 pages, 471 KiB

Open AccessArticle

Bullying as a Stressor in Mid-Adolescent Girls and Boys–Associations with Perceived Stress, Recurrent Pain, and Salivary Cortisol

by Viveca Östberg, Sara B. Låftman, Bitte Modin and Petra Lindfors

Int. J. Environ. Res. Public Health 2018, 15(2), 364; https://doi.org/10.3390/ijerph15020364 - 20 Feb 2018

Cited by 46 | Viewed by 6889

Abstract

Bullying involves repeated exposure to negative actions while also invoking a power asymmetry between the involved parties. From a stress perspective, being bullied can be seen as a severe and chronic stressor, and an everyday social-evaluative threat, coupled with a shortage of effective [...] Read more.

Bullying involves repeated exposure to negative actions while also invoking a power asymmetry between the involved parties. From a stress perspective, being bullied can be seen as a severe and chronic stressor, and an everyday social-evaluative threat, coupled with a shortage of effective social resources for dealing with this particular stressor. The aim of this study was to investigate whether exposure to bullying among mid-adolescent girls and boys is associated with subjective and objective stress-related outcomes in terms of perceived stress, recurrent pain, and salivary cortisol. The data came from the School Stress and Support Study (TriSSS) including students in grades 8–9 in two schools in Stockholm, Sweden, in 2010 (study sample n = 392; cortisol subsample n = 198). Bullying was self-reported and measured by multiple items. The statistical analyses included binary logistic and linear (OLS) regression. Being bullied was associated with greater perceived stress and an increased risk of recurrent pain, among both boys and girls. Also, bullied students had lower cortisol output (AUC_G) and lower cortisol awakening response (CAR_G) as compared to those who were not bullied. Gender-stratified analyses demonstrated that these associations were statistically significant for boys but not for girls. In conclusion, this study demonstrated that being bullied was related to both subjective and objective stress markers among mid-adolescent girls and boys, pointing to the necessity of continuously working against bullying. Full article

(This article belongs to the Special Issue Youth Violence as a Public Health Issue)

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13 pages, 307 KiB

Open AccessArticle

Heavy Metals in Notifications of Rapid Alert System for Food and Feed

by Marcin Pigłowski

Int. J. Environ. Res. Public Health 2018, 15(2), 365; https://doi.org/10.3390/ijerph15020365 - 20 Feb 2018

Cited by 30 | Viewed by 5676

Abstract

Heavy metals represent the fourth most often notified hazard category in the Rapid Alert System for Food and Feed (RASFF) from 1980–2016. The goal of the study was to examine the similarities in notifications of particular heavy metals within the RASFF year, product [...] Read more.

Heavy metals represent the fourth most often notified hazard category in the Rapid Alert System for Food and Feed (RASFF) from 1980–2016. The goal of the study was to examine the similarities in notifications of particular heavy metals within the RASFF year, product category, notifying country, country of origin, notification basis, notification type, distribution status, risk decision, and action taken, taking into account the particular product type, such as food, food contact material, and feed. The data originated from the RASFF database. Cluster analysis on pivot tables was applied using joining and two-way joining methods. Most notifications concerned food, in which the highest number were related to mercury, cadmium, chromium, lead, arsenic, and nickel. Notifications were mainly related to fish and food contact materials, in addition to fruits and vegetables, seafood, and dietetic food. The number of notifications decreased in 2015 and 2016. The majority of products were notified by Italy, Spain, Germany, and France. The notified products originated mainly from China and Spain. The notification was usually based on official controls on the market, as well as border controls. The notification types were mainly information, alert, and border rejections. Products were not frequently distributed due to distribution restriction to the notifying country or the possibility of distribution to the market. A risk decision was not usually made. The taken actions included re-dispatch of products, withdrawal from the market, or destruction. The data on heavy metals from the RASFF database can help European and national authorities in shaping public health. Full article

(This article belongs to the Special Issue Studies on Heavy Metals and Health)

14 pages, 320 KiB

Open AccessArticle

Parental Education and Pre-School Children’s Objectively Measured Sedentary Time: The Role of Co-Participation in Physical Activity

by Suvi Määttä, Carola Ray, Henna Vepsäläinen, Elviira Lehto, Riikka Kaukonen, Anna Ylönen and Eva Roos

Int. J. Environ. Res. Public Health 2018, 15(2), 366; https://doi.org/10.3390/ijerph15020366 - 20 Feb 2018

Cited by 19 | Viewed by 6443

Abstract

Parental co-participation in physical activity (PA) may be a beneficial parenting practice for diminishing children’s sedentary time (ST). Less information is available, however, on the explanatory role of co-participation in PA regarding parental educational differences in children's ST. Preschool-aged children (N = 864, [...] Read more.

Parental co-participation in physical activity (PA) may be a beneficial parenting practice for diminishing children’s sedentary time (ST). Less information is available, however, on the explanatory role of co-participation in PA regarding parental educational differences in children's ST. Preschool-aged children (N = 864, mean age 4.8, 52% boys) with their parents participated in a cross-sectional DAGIS (Increased Health and Wellbeing in Pre-schools) study between years 2015 and 2016. Children (N = 821) wore an accelerometer for one week. Parents were informed of their educational background, and the frequency of visits with their child in nature, to parks or playgrounds, their own yard, and indoor sport facilities (N = 808). Testing the associations required multiple regression analyses. Parents with a low educational background reported more frequent visits with their child to their own yard, and these visits were associated with children’s lower ST. More highly educated parents co-visited indoor sport facilities more frequently, although this did not have a significant association with children’s ST. More frequent visits in nature were associated with a lower ST at weekdays, regardless of educational background. Future health promotion strategies should inform parents that frequent co-participation in PA, for example, in one’s own yard, is beneficial for lowering children’s ST. Full article

(This article belongs to the Special Issue Eating and Exercise in Children and Adolescents)

20 pages, 1404 KiB

Open AccessArticle

Managing Risk Aversion for Low-Carbon Supply Chains with Emission Abatement Outsourcing

by Qinpeng Wang and Longfei He

Int. J. Environ. Res. Public Health 2018, 15(2), 367; https://doi.org/10.3390/ijerph15020367 - 21 Feb 2018

Cited by 22 | Viewed by 5043

Abstract

Reducing carbon emissions, including emission abatement outsourcing at the supply-chain level, is becoming a significant but challenging problem in practice. Confronting this challenge, we therefore break down the practice to focus on a low-carbon supply chain consisting of one supplier, one manufacturer and [...] Read more.

Reducing carbon emissions, including emission abatement outsourcing at the supply-chain level, is becoming a significant but challenging problem in practice. Confronting this challenge, we therefore break down the practice to focus on a low-carbon supply chain consisting of one supplier, one manufacturer and one third-party emission-reducing contractor. The contractor offers a carbon reduction service to the manufacturer. In view of the increasing proportion of Greenhouse Gases (GHG) emissions and absence of carbon reduction policies in developing countries, we adopt the prospect of consumers’ low-carbon preferences to capture the demand sensitivity on carbon emission. By exploiting the Mean-Variance (MV) model, we develop a supply chain game model considering risk aversion. Comparing the supply chain performances of the cases under risk neutrality and risk aversion, we investigate the impact of the risk aversion of the supplier and the manufacturer on the low-carbon supply chain performances, respectively. We show that the risk aversion of chain members will not influence the relationship underlain by the profit-sharing contract between the manufacturer and contractor, whereas they may extend the supplier’s concerning range. Although the manufacturer’s risk aversion has a positive impact on the wholesale price, interestingly, the supplier’s impact on the wholesale price is negative. Furthermore, we propose a contract to coordinate the risk-averse low-carbon supply chain by tuning the aversion levels of the supplier and the manufacturer, respectively. Through numerical study, we draw on managerial insights for industrial practitioners to adopt a low carbon strategy potentially by managing the risk attitudes along the supply chain channel. Full article

(This article belongs to the Special Issue Green Environment, Green Operations and Sustainability)

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11 pages, 472 KiB

Open AccessArticle

The Impact of Brain Breaks Classroom-Based Physical Activities on Attitudes toward Physical Activity in Polish School Children in Third to Fifth Grade

by Agata Glapa, Joanna Grzesiak, Ida Laudanska-Krzeminska, Ming-Kai Chin, Christopher R. Edginton, Magdalena Mo Ching Mok and Michal Bronikowski

Int. J. Environ. Res. Public Health 2018, 15(2), 368; https://doi.org/10.3390/ijerph15020368 - 21 Feb 2018

Cited by 43 | Viewed by 20026

Abstract

The purpose of this study was to examine the effectiveness of the Brain Breaks^® Physical Activity Solutions in changing attitudes toward physical activity of school children in a community in Poland. In 2015, a sample of 326 pupils aged 9–11 years old [...] Read more.

The purpose of this study was to examine the effectiveness of the Brain Breaks^® Physical Activity Solutions in changing attitudes toward physical activity of school children in a community in Poland. In 2015, a sample of 326 pupils aged 9–11 years old from 19 classes at three selected primary schools were randomly assigned to control and experimental groups within the study. During the classes, children in the experimental group performed physical activities two times per day in three to five minutes using Brain Breaks^® videos for four months, while the control group did not use the videos during the test period. Students’ attitudes toward physical activities were assessed before and after the intervention using the “Attitudes toward Physical Activity Scale”. Repeated measures of ANOVA were used to examine the change from pre- to post-intervention. Overall, a repeated measures ANOVA indicated time-by-group interaction effects in ‘Self-efficacy on learning with video exercises’, F(1.32) = 75.28, p = 0.00, η² = 0.19. Although the changes are minor, there were benefits of the intervention. It may be concluded that HOPSports Brain Breaks^® Physical Activity Program contributes to better self-efficacy on learning while using video exercise of primary school children. Full article

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18 pages, 1123 KiB

Open AccessArticle

Different Risk Factors for Very Low Birth Weight, Term-Small-for-Gestational-Age, or Preterm Birth in Japan

by Naomi Tamura, Tomoyuki Hanaoka, Kumiko Ito, Atsuko Araki, Chihiro Miyashita, Sachiko Ito, Hisanori Minakami, Kazutoshi Cho, Toshiaki Endo, Kazuo Sengoku, Katsuhiko Ogasawara and Reiko Kishi

Int. J. Environ. Res. Public Health 2018, 15(2), 369; https://doi.org/10.3390/ijerph15020369 - 21 Feb 2018

Cited by 44 | Viewed by 8584

Abstract

From 1985 to 2013, the mean birth weight of infants in Japan decreased from 3120 g to 3000 g, and the low-birth-weight rate among live births increased from 6.3% to 9.6%. No prospective study has elucidated the risk factors for poor fetal growth [...] Read more.

From 1985 to 2013, the mean birth weight of infants in Japan decreased from 3120 g to 3000 g, and the low-birth-weight rate among live births increased from 6.3% to 9.6%. No prospective study has elucidated the risk factors for poor fetal growth and preterm birth in recent Japanese parents, such as increased parental age, maternal body figure, assisted reproductive technology (ART), and socioeconomic status. Participants were mother–infant pairs (n = 18,059) enrolled in a prospective birth cohort in Hokkaido, Japan from 2002 to 2013. Parental characteristics were obtained via self-reported questionnaires during pregnancy. Medical records helped identify very-low-birth-weight (VLBW; <1500g), term-small-for-gestational-age (term-SGA), and preterm-birth (PTB; <37 weeks) infants. We calculated relative risks (RRs) for PTB, VLBW, and term-SGA birth based on parental characteristics. The prevalence of PTB, VLBW, and term-SGA was 4.5%, 0.4%, and 6.5%, respectively. Aged parents and ART were risk factors for PTB and VLBW. Maternal alcohol drinking during pregnancy increased the risk; a parental educational level of ≥16 years reduced risk of term-SGA. Maternal pre-pregnancy BMI of <18.5 kg/m² increased the risk of PTB and term-SGA. The RR for low BMI was highest among mothers who have low educational level. Among various factors, appropriate nutritional education to maintain normal BMI is important to prevent PTB and term-SGA in Japan. Full article

(This article belongs to the Special Issue Maternal and Child Health 2018)

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9 pages, 591 KiB

Open AccessArticle

The Use of Manual Vacuum Aspiration in the Treatment of Incomplete Abortions: A Descriptive Study from Three Public Hospitals in Malawi

by Maria Lisa Odland, Gladys Membe-Gadama, Ursula Kafulafula, Geir W. Jacobsen, James Kumwenda and Elisabeth Darj

Int. J. Environ. Res. Public Health 2018, 15(2), 370; https://doi.org/10.3390/ijerph15020370 - 21 Feb 2018

Cited by 18 | Viewed by 8523

Abstract

Malawi has a high maternal mortality rate, of which unsafe abortion is a major cause. About 140,000 induced abortions are estimated every year, despite there being a restrictive abortion law in place. This leads to complications, such as incomplete abortions, which need to [...] Read more.

Malawi has a high maternal mortality rate, of which unsafe abortion is a major cause. About 140,000 induced abortions are estimated every year, despite there being a restrictive abortion law in place. This leads to complications, such as incomplete abortions, which need to be treated to avoid further harm. Although manual vacuum aspiration (MVA) is a safe and cheap method of evacuating the uterus, the most commonly used method in Malawi is curettage. Medical treatment is used sparingly in the country, and the Ministry of Health has been trying to increase the use of MVA. The aim of this study was to investigate the treatment of incomplete abortions in three public hospitals in Southern Malawi during a three-year period. All medical files from the female/gynecological wards from 2013 to 2015 were reviewed. In total, information on obstetric history, demographics, and treatment were collected from 7270 women who had been treated for incomplete abortions. The overall use of MVA at the three hospitals during the study period was 11.4% (95% CI, 10.7–12.1). However, there was a major increase in MVA application at one District Hospital. Why there was only one successful hospital in this study is unclear, but may be due to more training and dedicated leadership at this particular hospital. Either way, the use of MVA in the treatment of incomplete abortions continues to be low in Malawi, despite recommendations from the World Health Organization (WHO) and the Malawi Ministry of Health. Full article

(This article belongs to the Special Issue Teenage Reproductive Health: Pregnancy, Contraception, Unsafe Abortion, Fertility)

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15 pages, 635 KiB

Open AccessArticle

The Interrelationship between Family Violence, Adolescent Violence, and Adolescent Violent Victimization: An Application and Extension of the Cultural Spillover Theory in China

by Yiwei Xia, Spencer D. Li and Tzu-Hsuan Liu

Int. J. Environ. Res. Public Health 2018, 15(2), 371; https://doi.org/10.3390/ijerph15020371 - 21 Feb 2018

Cited by 29 | Viewed by 9242

Abstract

The current study is the first study to emphasize family systems, violent norms, and violent peer association as three domains of the social environment that influence both adolescent violent offending and victimization among Chinese adolescents using a longitudinal sample. Under the framework of [...] Read more.

The current study is the first study to emphasize family systems, violent norms, and violent peer association as three domains of the social environment that influence both adolescent violent offending and victimization among Chinese adolescents using a longitudinal sample. Under the framework of cultural spillover theory, the purpose of the current study was to explore how these three factors influenced adolescent violent offending and victimization. A total of 1192 middle and high school students were randomly selected from one of the largest cities in Southwest China. Structural equation model analysis was applied to investigate the direct and indirect effect of violence in the family system on violent offending and victimization. The results indicated that violent offending and victimization overlapped among Chinese adolescents. Violent peer association and acceptance of the violence norm fully mediated the effect of violence in the family system on violent offending, and partially mediated the effect of violence in the family system on violent victimization. In conclusion, adolescents who had experienced violence in their family system were more likely to be exposed to violent peer influences and to accept violent norms, which increased the likelihood of violence perpetration and victimization later in their life. Full article

(This article belongs to the Special Issue Youth Violence as a Public Health Issue)

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10 pages, 291 KiB

Open AccessArticle

Adolescents’ Sexual Wellbeing in Southwestern Uganda: A Cross-Sectional Assessment of Body Image, Self-Esteem and Gender Equitable Norms

by Elizabeth Kemigisha, Viola N. Nyakato, Katharine Bruce, Gad Ndaruhutse Ruzaaza, Wendo Mlahagwa, Anna B. Ninsiima, Gily Coene, Els Leye and Kristien Michielsen

Int. J. Environ. Res. Public Health 2018, 15(2), 372; https://doi.org/10.3390/ijerph15020372 - 22 Feb 2018

Cited by 22 | Viewed by 6233

Abstract

Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its [...] Read more.

Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense—i.e., body image, self-esteem, and gender equitable norms—and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10–14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7–28) and median 22 (IQR: 19, 24, possible range: 5–25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11–44). We noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended. Full article

(This article belongs to the Special Issue Teenage Reproductive Health: Pregnancy, Contraception, Unsafe Abortion, Fertility)

15 pages, 293 KiB

Open AccessArticle

Young Women’s Perspectives of Their Adolescent Treatment Programs: A Qualitative Study

by Miriam Clark, Rohanna Buchanan and Leslie D. Leve

Int. J. Environ. Res. Public Health 2018, 15(2), 373; https://doi.org/10.3390/ijerph15020373 - 22 Feb 2018

Cited by 5 | Viewed by 4724

Abstract

The perspectives of at-risk adolescent clients can play an important role in informing treatment services. The current study examines qualitative interview data from 15 young women with histories of maltreatment. Using a semi-structured qualitative interview approach, we asked the women to think retrospectively [...] Read more.

The perspectives of at-risk adolescent clients can play an important role in informing treatment services. The current study examines qualitative interview data from 15 young women with histories of maltreatment. Using a semi-structured qualitative interview approach, we asked the women to think retrospectively about their treatment experiences as adolescent girls. Results highlight the need for providing adolescent girls with reliable and practical information about risky sexual behavior and drug use from relatable and trustworthy helping professionals. We discuss strategies for developing and maintaining trust and delivering specific content. Full article

(This article belongs to the Special Issue Teenage Reproductive Health: Pregnancy, Contraception, Unsafe Abortion, Fertility)

12 pages, 3077 KiB

Open AccessArticle

Monitoring Heavy Metal Contents with Sphagnum Junghuhnianum Moss Bags in Relation to Traffic Volume in Wuxi, China

by Rong Hu, Yun Yan, Xiaoli Zhou, Yanan Wang and Yanming Fang

Int. J. Environ. Res. Public Health 2018, 15(2), 374; https://doi.org/10.3390/ijerph15020374 - 22 Feb 2018

Cited by 41 | Viewed by 5956

Abstract

Despite its small size, a moss bag can reveal the different temporal and spatial deposition patterns of pollutants at a particular site; therefore, researchers can use moss bags to determine pollution sources and to put forward strategies for pollution control. Although the use [...] Read more.

Despite its small size, a moss bag can reveal the different temporal and spatial deposition patterns of pollutants at a particular site; therefore, researchers can use moss bags to determine pollution sources and to put forward strategies for pollution control. Although the use of moss bags to monitor atmospheric pollution has been widely reported in Europe, there are few such empirical studies in China. Thus, in this study, bags containing the moss Sphagnum junghuhnianum were used to assess the concentrations of heavy metals (chromium (Cr), copper (Cu), lead (Pb), vanadium (V), and zinc (Zn)) at five sampling sites (four roads and a forest park) during the summer and winter of 2012. According to the relative accumulation factor (RAF) and contamination factor (CF) results, pollution in winter was heavier than that in summer, and Cr was found to be the most contaminating, having the highest mean CF. There was a significant positive correlation (p < 0.05) between traffic volume and concentration for three heavy metals (Cr, Cu, and V) in winter, whereas a significant positive correlation (p < 0.05) was observed between traffic volume and concentrations for four heavy metal elements (Cr, Pb, V, and Zn) in summer, indicating a close relationship between heavy metal contents and traffic volume. Although there was substantial variation in the concentrations of the five heavy metals in the moss bags, significant correlations between heavy metals suggested that the contaminants originated from a common source, namely vehicle emissions. The results demonstrated that the four roads were subject to different degrees of pollution depending on the volume of traffic using each road. Therefore, the results of this study suggest that traffic volume is a major reason for heavy metal pollution. Full article

(This article belongs to the Special Issue Transportation-Related Air Pollution and Human Health)

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15 pages, 1812 KiB

Open AccessArticle

Empirical Examinations of Effects of Three-Level Green Exercise on Engagement with Nature and Physical Activity

by Ke-Tsung Han and Po-Ching Wang

Int. J. Environ. Res. Public Health 2018, 15(2), 375; https://doi.org/10.3390/ijerph15020375 - 22 Feb 2018

Cited by 15 | Viewed by 5177

Abstract

Green exercise can be classified into three levels based on engagement with nature. Although this classification was proposed more than a decade ago, few studies have investigated it since. The present study examined the effects of green exercise levels on engagement with nature [...] Read more.

Green exercise can be classified into three levels based on engagement with nature. Although this classification was proposed more than a decade ago, few studies have investigated it since. The present study examined the effects of green exercise levels on engagement with nature and physical activity (PA) through a field experiment. A questionnaire was distributed to 95 students from a technology university in Central Taiwan to measure their level of engagement with nature in people-environment transactions, while their PA was measured using three instruments. In addition, because social interaction may distract individual attention from activities or their environments, the present study incorporated the presence of partners as a control variable. The results revealed that (1) engagement with nature and PA significantly differed between the levels of green exercise, and the higher the level of green exercise participated in, the greater the level of engagement with nature; and (2) although the presence of partners did not influence the level of engagement with nature, it significantly affected the level of PA. Full article

(This article belongs to the Section Environmental Health)

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12 pages, 307 KiB

Open AccessArticle

Determinants of Quality of Life and Satisfaction with Life in Women with Polycystic Ovary Syndrome

by Ewa Rzońca, Agnieszka Bień, Artur Wdowiak, Ryszard Szymański and Grażyna Iwanowicz-Palus

Int. J. Environ. Res. Public Health 2018, 15(2), 376; https://doi.org/10.3390/ijerph15020376 - 22 Feb 2018

Cited by 39 | Viewed by 8871

Abstract

The purpose of the study was to assess the quality of life (QoL) and satisfaction with life (SwL) of women with polycystic ovary syndrome (PCOS) in comparison with those of healthy controls, and to identify and analyze factors determining QoL and SwL in [...] Read more.

The purpose of the study was to assess the quality of life (QoL) and satisfaction with life (SwL) of women with polycystic ovary syndrome (PCOS) in comparison with those of healthy controls, and to identify and analyze factors determining QoL and SwL in women with PCOS. The cross-sectional study was performed between January and November 2016 in 504 women using health care services in Poland. The study group comprised women with PCOS, the control group women without PCOS. The study used a diagnostic survey with questionnaires. Research instruments included the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, the satisfaction with life scale (SWLS), and a standardized interview questionnaire comprising questions on the participants’ characteristics. Women with PCOS have lower QoL and SwL than healthy controls (p < 0.05). Factors affecting QoL in PCOS patients included socio-economic standing, time from PCOS diagnosis, BMI, age, and professional activity (p < 0.05). Factors affecting SwL in PCOS patients included socio-economic standing, having children, BMI, and time from PCOS diagnosis (p < 0.05). The higher the PCOS patients’ QoL, the higher their SwL (p < 0.05). Further studies are required, focusing both on PCOS and its etiology, and on its impact on the women diagnosed with the disease. Full article

19 pages, 368 KiB

Open AccessArticle

Exploring the Barriers: A Qualitative Study about the Experiences of Mid-SES Roma Navigating the Spanish Healthcare System

by Emilia Aiello, Ainhoa Flecha and Olga Serradell

Int. J. Environ. Res. Public Health 2018, 15(2), 377; https://doi.org/10.3390/ijerph15020377 - 22 Feb 2018

Cited by 27 | Viewed by 7422

Abstract

Whereas the topic of the ‘cultural sensitivity’ of healthcare systems has been addressed extensively in the US and the UK, literature on the subject in most European countries, specifically looking at the situation of Roma, is still scarce. Drawing on qualitative research conducted [...] Read more.

Whereas the topic of the ‘cultural sensitivity’ of healthcare systems has been addressed extensively in the US and the UK, literature on the subject in most European countries, specifically looking at the situation of Roma, is still scarce. Drawing on qualitative research conducted mainly in the city of Barcelona under the communicative approach with Roma subjects who have stable socioeconomic positions and higher cultural capitals (end-users, professionals of the healthcare system, and key informants of a regional policy oriented to the improvement of Roma living conditions), the present study aims to fill this gap. We explore the barriers that the Roma face in accessing the healthcare system, reflecting on how these barriers are accentuated by the existing anti-Roma prejudices and institutional arrangements that do not account for minority cultures. Our results point out a series of obstacles at two levels, in the interaction with healthcare professionals, and in relation to existing institutional arrangements, which prevent Roma families from having equal access to the healthcare system. Education stands up as a mechanism to contest anti-Roma sentiments among healthcare professionals. Full article

(This article belongs to the Special Issue Roma Health)

18 pages, 1020 KiB

Open AccessArticle

The Impacts of Regulations and Financial Development on the Operations of Supply Chains with Greenhouse Gas Emissions

by Zhuang Xiao, Yixiang Tian and Zheng Yuan

Int. J. Environ. Res. Public Health 2018, 15(2), 378; https://doi.org/10.3390/ijerph15020378 - 22 Feb 2018

Cited by 5 | Viewed by 4729

Abstract

To establish a micro foundation to understand the impacts of greenhouse gas (GHG) emission regulations and financial development levels on firms’ GHG emissions, we build a two-stage dynamic game model to incorporate GHG emission regulations (in terms of an emission tax) and financial [...] Read more.

To establish a micro foundation to understand the impacts of greenhouse gas (GHG) emission regulations and financial development levels on firms’ GHG emissions, we build a two-stage dynamic game model to incorporate GHG emission regulations (in terms of an emission tax) and financial development (represented by the corresponding financing cost) into a two-echelon supply chain. With the subgame perfect equilibrium, we identify the conditions to determine whether an emission regulatory policy and/or financial development can affect GHG emissions in the supply chain. We also reveal the impacts of the strictness of GHG emission regulation, the financial development level, and the unit GHG emission rate on the operations of the supply chain and the corresponding profitability implications. Managerial insights are also discussed. Full article

(This article belongs to the Special Issue Decision Models in Green Growth and Sustainable Development)

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7 pages, 436 KiB

Open AccessArticle

Prevalence of Oral Clefts among Live Births in Gansu Province, China

by Mengying Wang, Ruogu Meng, Zhuqing Wang, Dongjing Liu, Hui Huang, Chuyun Kang, Hongtian Li, Tao Wu and Siyan Zhan

Int. J. Environ. Res. Public Health 2018, 15(2), 380; https://doi.org/10.3390/ijerph15020380 - 23 Feb 2018

Cited by 11 | Viewed by 6121

Abstract

Background: Oral clefts (OCs) are common human birth defects. Children with OCs in underdeveloped regions are more likely to suffer from poverty and hardship in their future lives. Here, we attempted to estimate the prevalence of OCs among live births in Gansu Province [...] Read more.

Background: Oral clefts (OCs) are common human birth defects. Children with OCs in underdeveloped regions are more likely to suffer from poverty and hardship in their future lives. Here, we attempted to estimate the prevalence of OCs among live births in Gansu Province in 2008 to understand the epidemiologic pattern of the disease. Methods: A cross-sectional study was conducted from January 2008 to December 2008 in Gansu Province. The live births delivered between January and December 2008 with OCs were investigated through face-to-face questionnaire survey. Results: A total of 468 infants with OCs were identified among 347,137 live births in 2008 in Gansu Province, which yielded a prevalence of 1.35 per 1000 live births. The majority of these cases were CL (cleft lip) (prevalence = 0.85 per 1000 live births), and the prevalence of CLP (cleft lip and palate) and CP (cleft palate) was 0.34 and 0.11 per 1000 live births, respectively. We also found that the prevalence of OCs in Jiayuguan (3.39 per 1000 live births) and Dingxi (2.71 per 1000 live births) was higher than those of other cities in Gansu Province. Additionally, we failed to detect significant correlation between economic conditions of the cities and the prevalence of OCs in our study. Conclusions: The prevalence of OCs among live births in Gansu Province in 2008 was higher than the prevalence of OCs in other provinces in China. The high prevalence may reflect the need for further etiological studies to explore the potential risk factors in this region. In addition, more subtype information needs to be collected in future prevalence studies for better understanding of the epidemiologic pattern of the disease. Full article

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6 pages, 286 KiB

Open AccessArticle

Applicability of the Nordic Occupational Skin Questionnaire for Screening Contact Dermatological Disorders in Sea Fishers

by Piero Lovreglio, Rossana Rotondi, Patrizia Chiarappa, Paolo Romita, Ignazio Drago, Fabrizio Guarneri, Antonella Basso, Leonardo Soleo and Caterina Foti

Int. J. Environ. Res. Public Health 2018, 15(2), 381; https://doi.org/10.3390/ijerph15020381 - 23 Feb 2018

Cited by 4 | Viewed by 4100

Abstract

This survey aimed to evaluate the applicability of the Nordic Occupational Skin Questionnaire (NOSQ) as a preliminary screening tool to investigate the presence of contact dermatological disorders in sea fishermen. The Italian version of the NOSQ was administered to 143 male fishermen working [...] Read more.

This survey aimed to evaluate the applicability of the Nordic Occupational Skin Questionnaire (NOSQ) as a preliminary screening tool to investigate the presence of contact dermatological disorders in sea fishermen. The Italian version of the NOSQ was administered to 143 male fishermen working at an Apulia (Southern Italy) Fisheries, and 136 male workers who had never worked as sea fishers (controls). A significantly higher rate of frequency of transient itchy wheals on the hands, wrists, and forearms was recorded in the fishermen as compared to the controls (49.6% vs. 8.1%; p < 0.001), while there was no significant difference in the frequency of eczema (8.4% vs. 6.6%). In 46.1% of the fishermen, the onset of transient itchy wheals was associated with contact with specific agents and the most common causes were algae and aquatic plants (49.3%) and seabed sludge (25.3%). In conclusion, the administration of the NOSQ can be useful in preliminary screening for dermatitis in fishermen, although it could show a possible overestimation of the prevalence of transient itchy wheals. Full article

(This article belongs to the Section Occupational Safety and Health)

13 pages, 334 KiB

Open AccessArticle

Prevalence and Gender-Specific Influencing Factors of Hypertension among Chinese Adults: A Cross-Sectional Survey Study in Nanchang, China

by Hui Zhou, Kai Wang, Xiaojun Zhou, Shiying Ruan, Shaohui Gan, Siyuan Cheng and Yuanan Lu

Int. J. Environ. Res. Public Health 2018, 15(2), 382; https://doi.org/10.3390/ijerph15020382 - 23 Feb 2018

Cited by 15 | Viewed by 5759

Abstract

Hypertension has become the leading cause of death worldwide; data on hypertension among Nanchang adults are sparse. The aim of this study was to investigate the prevalence and gender-specific influencing factors of hypertension in adults in Nanchang, China. A cross-sectional survey was conducted [...] Read more.

Hypertension has become the leading cause of death worldwide; data on hypertension among Nanchang adults are sparse. The aim of this study was to investigate the prevalence and gender-specific influencing factors of hypertension in adults in Nanchang, China. A cross-sectional survey was conducted with a representative sample of 2722 Chinese residents aged 18 years and above between May and September 2016, with a response rate of 92.4% (2516/2722). A stratified cluster sampling method was adopted in this study. Data on prevalence and influencing factors were obtained from a standard questionnaire and physical measurements. Univariate and multivariate logistic regressions were performed to analyze the influencing factors. The age-standardized prevalence was 19.8% (18.2–21.3) (male: 19.5% (18.0–21.1); female, 20.01% (18.5–21.6)). Factors positively associated with hypertension prevalence were past smoking, diabetes mellitus (DM), and overweight and obesity in both genders. Abdominal obesity and family history of cardiovascular diseases (CVD) were risk factors only in males; sleeping time and consumption of fresh vegetables and fruits were related to the prevalence of hypertension only in females. These findings will form the baseline information for the development of more effective approaches to enhance current prevention and control management of hypertension. Full article

20 pages, 818 KiB

Open AccessArticle

New Evidence on the Effect of Medical Insurance on the Obesity Risk of Rural Residents: Findings from the China Health and Nutrition Survey (CHNS, 2004–2011)

by Jian Zhao, Chang Su, Huijun Wang, Zhihong Wang and Bing Zhang

Int. J. Environ. Res. Public Health 2018, 15(2), 383; https://doi.org/10.3390/ijerph15020383 - 23 Feb 2018

Cited by 9 | Viewed by 5902

Abstract

The obesity rate in China has risen significantly in the past few decades. While a number of causes for the rise in obesity have been explored, little attention has been paid to the role of health insurance per se. This study aims to [...] Read more.

The obesity rate in China has risen significantly in the past few decades. While a number of causes for the rise in obesity have been explored, little attention has been paid to the role of health insurance per se. This study aims to investigate the impact of health insurance on the risk of obesity in rural China using longitudinal data from the China Health and Nutrition Survey (CHNS). We employed pooled ordinary least squares (OLS), probit estimation, and pooled two-stage least squares (2SLS) for an instrumental variable (IV). The IV model revealed that New rural cooperative medical insurance (NRCMS) participation had a significant positive impact on people’s tendency towards unhealthy lifestyles, for instances, high-fat food (8.01% for female and 7.35% for male), cigarette smoking (25% for male), heavy drinking (25% for female), sedentary activity (6.48 h/w for female and 6.48 h/w for male), waist circumference (1.97 cm for female and 1.80 cm for male), body mass index (0.58 kg/m² for female), which in turn leads to an elevated probability of general obesity (51% for female) and abdominal obesity (24% for female and 20% for male). An “ex ante moral hazard” is prevalent in rural China, which should not be ignored by policymakers so as to minimize the related low efficiency in the process of promoting the universal coverage of insurance. Full article

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14 pages, 938 KiB

Open AccessArticle

Australia’s Ongoing Legacy of Asbestos: Significant Challenges Remain Even after the Complete Banning of Asbestos Almost Fifteen Years Ago

by Matthew Soeberg, Deborah A. Vallance, Victoria Keena, Ken Takahashi and James Leigh

Int. J. Environ. Res. Public Health 2018, 15(2), 384; https://doi.org/10.3390/ijerph15020384 - 23 Feb 2018

Cited by 22 | Viewed by 10447

Abstract

The most effective way of reducing the global burden of asbestos-related diseases is through the implementation of asbestos bans and minimising occupational and non-occupational exposure to respirable asbestos fibres. Australia’s asbestos consumption peaked in the 1970s with Australia widely thought to have had [...] Read more.

The most effective way of reducing the global burden of asbestos-related diseases is through the implementation of asbestos bans and minimising occupational and non-occupational exposure to respirable asbestos fibres. Australia’s asbestos consumption peaked in the 1970s with Australia widely thought to have had among the highest per-capita asbestos consumption level of any country. Australia’s discontinuation of all forms of asbestos and asbestos-containing products and materials did not occur at a single point of time. Crocidolite consumption ceased in the late 1960s, followed by amosite consumption stopping in the mid 1980s. Despite significant government reports being published in 1990 and 1999, it was not until the end of 2003 that a complete ban on all forms of asbestos (crocidolite, amosite, and chrysotile) was introduced in Australia. The sustained efforts of trade unions and non-governmental organisations were essential in forcing the Australian government to finally implement the 2003 asbestos ban. Trade unions and non-government organisations continue to play a key role today in monitoring the government’s response to Australian asbestos-related disease epidemic. There are significant challenges that remain in Australia, despite a complete asbestos ban being implemented almost fifteen years ago. The Australian epidemic of asbestos-related disease has only now reached its peak. A total of 16,679 people were newly diagnosed with malignant mesothelioma between 1982 and 2016, with 84% of cases occurring in men. There has been a stabilisation of the age-standardised malignant mesothelioma incidence rate in the last 10 years. In 2016, the incidence rate per 100,000 was 2.5 using the Australian standard population and 1.3 using the Segi world standard population. Despite Australia’s complete asbestos ban being in place since 2003, public health efforts must continue to focus on preventing the devastating effects of avoidable asbestos-related diseases, including occupational and non-occupational groups who are potentially at risk from exposure to respirable asbestos fibres. Full article

(This article belongs to the Special Issue Global Panorama of National Experiences in Public Health Actions to Ban Asbestos)

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8 pages, 325 KiB

Open AccessArticle

Qualification of Food Intake by the Roma Population in the Region of South Bohemia

by Lenka Sedova, Valerie Tothova, Dita Novakova, Vera Olisarova, Sylva Bartlova, Frantisek Dolak, Alena Kajanova, Radka Prokesova and Vera Adamkova

Int. J. Environ. Res. Public Health 2018, 15(2), 386; https://doi.org/10.3390/ijerph15020386 - 23 Feb 2018

Cited by 7 | Viewed by 4308

Abstract

The article presents the results of a correlation study, aimed at quantifying the food intake of the Roma population in the South Bohemian Region. To achieve the goal, we applied the method of one-day dietary recall and frequency food analysis (non-standardized). The quantification [...] Read more.

The article presents the results of a correlation study, aimed at quantifying the food intake of the Roma population in the South Bohemian Region. To achieve the goal, we applied the method of one-day dietary recall and frequency food analysis (non-standardized). The quantification was carried out by analysis in the Nutridan program. The study involved 302 Roma persons and 298 persons in the control group. Both groups had the same representation of males and females (50:50). The age categories of both sets differed; the average age of the Roma was lower (39.2 years) (p < 0.001). The probands from the Roma population were chosen with the help of the snowball method through known respondents. The statistical analysis shows differences in nutritional estimate between the Roma population and the control sample. The Roma differ in their energy intake. Both groups showed lower intake of sugars, below 50% total energy intake (TEI) and higher intake of fats, above 30% TEI. The respondents from both groups consume little fruits and vegetables, which may be connected with their low dietary fiber intake. In addition to the differences in the nutritional estimates, we recorded statistically significant differences in body mass index (BMI; p < 0.001), in age (p < 0.001), regular alimentation (p = 0) and demanding physical activities (p = 0). In spite of the fact our groups differed in age (the Roma are younger), it can be assumed that the obesity of the Roma may be caused by unbalanced alimentation and lack of physical activities. Full article

(This article belongs to the Special Issue Roma Health)

26 pages, 18742 KiB

Open AccessArticle

Advances in Residential Design Related to the Influence of Geomagnetism

by Francisco Glaria, Israel Arnedo and Ana Sánchez-Ostiz

Int. J. Environ. Res. Public Health 2018, 15(2), 387; https://doi.org/10.3390/ijerph15020387 - 23 Feb 2018

Cited by 3 | Viewed by 5183

Abstract

Since the origin of the Modern Movement, there has been a basic commitment to improving housing conditions and the well-being of occupants, especially given the prediction that 2/3 of humanity will reside in cities by 2050. Moreover, a compact model of the city [...] Read more.

Since the origin of the Modern Movement, there has been a basic commitment to improving housing conditions and the well-being of occupants, especially given the prediction that 2/3 of humanity will reside in cities by 2050. Moreover, a compact model of the city with tall buildings and urban densification at this scale will be generated. Continuous constructive and technological advances have developed solid foundations on safety, energy efficiency, habitability, and sustainability in housing design. However, studies on improving the quality of life in these areas continue to be a challenge for architects and engineers. This paper seeks to contribute health-related information to the study of residential design, specifically the influence of the geomagnetic field on its occupants. After compiling information on the effects of geomagnetic fields from different medical studies over 23 years, a case study of a 16-story high-rise building is presented, with the goal of proposing architectural design recommendations for long-term occupation in the same place. The purpose of the present work is three-fold: first, to characterize the geomagnetic field variability of buildings; second, to identify the causes and possible related mechanisms; and third, to define architectural criteria on the arrangement of uses and constructive elements for housing. Full article

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10 pages, 542 KiB

Open AccessArticle

Comparative Analysis of Major Mosquito Vectors Response to Seed-Derived Essential Oil and Seed Pod-Derived Extract from Acacia nilotica

by Perumal Vivekanandhan, Raji Venkatesan, Govindaraju Ramkumar, Sengodan Karthi, Sengottayan Senthil-Nathan and Muthugoundar Subramanian Shivakumar

Int. J. Environ. Res. Public Health 2018, 15(2), 388; https://doi.org/10.3390/ijerph15020388 - 23 Feb 2018

Cited by 86 | Viewed by 7066

Abstract

Botanical metabolites are increasingly realized as potential replacements to chemical insecticides. In the present study, Acacia nilotica seed essential oil and seed pod solvent extracts were tested for bioefficacy against three important types of mosquitoes. Mortality was recorded 24 h post-treatment, while smoke [...] Read more.

Botanical metabolites are increasingly realized as potential replacements to chemical insecticides. In the present study, Acacia nilotica seed essential oil and seed pod solvent extracts were tested for bioefficacy against three important types of mosquitoes. Mortality was recorded 24 h post-treatment, while smoke toxicity of adult mosquitoes was recorded at 10 min intervals for 40 min. Seed pod powder was extracted with different solvents and hydrodistilled seed oil chemical constituents were determined by using Gas chromatography mass spectroscopy (GC-MS) -. Larvicidal and adulticidal efficacy of seed hydrodistilled essential oil and solvent extracts were tested against larval and adult mosquitoes. The seed hydrodistilled oil provided strong larvicidal activity against Anopheles stephensi, (LC50 (lethal concentration that kills 50% of the exposed larvae) = 5.239, LC90 (lethal concentration that kills 90% of the exposed larvae) = 9.713 mg/L); Aedes aegypti, (LC50 = 3.174, LC90 = 11.739 mg/L); and Culex quinquefasciatus, (LC50 = 4.112, LC90 = 12.325 mg/L). Smoke toxicities were 82% in Cx. quinquefasciatus, 90% in Ae. aegypti, and 80% mortality in An. stephensi adults, whereas 100% mortality was recorded for commercial mosquito coil. The GC-MS profile of seed essential oil from A. nilotica showed the presence of hexadecane (18.440%) and heptacosane (15.914%), which are the main and active compounds, and which may be involved in insecticidal activity. Overall findings suggest that the seed oil showed strong mosquitocidal activity against mosquito vectors and therefore may provide an ecofriendly replacement to chemical insecticides. Full article

(This article belongs to the Special Issue Together in the Fight against Arthropod-Borne Diseases: A One Health Perspective)

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19 pages, 13472 KiB

Open AccessArticle

Assessment of Pressure Sources and Water Body Resilience: An Integrated Approach for Action Planning in a Polluted River Basin

by Domenica Mirauda and Marco Ostoich

Int. J. Environ. Res. Public Health 2018, 15(2), 390; https://doi.org/10.3390/ijerph15020390 - 23 Feb 2018

Cited by 15 | Viewed by 4541

Abstract

The present study develops an integrated methodology combining the results of the water-quality classification, according to the Water Framework Directive 2000/60/EC—WFD, with those of a mathematical integrity model. It is able to analyse the potential anthropogenic impacts on the receiving water body and [...] Read more.

The present study develops an integrated methodology combining the results of the water-quality classification, according to the Water Framework Directive 2000/60/EC—WFD, with those of a mathematical integrity model. It is able to analyse the potential anthropogenic impacts on the receiving water body and to help municipal decision-makers when selecting short/medium/long-term strategic mitigation actions to be performed in a territory. Among the most important causes of water-quality degradation in a river, the focus is placed on pollutants from urban wastewater. In particular, the proposed approach evaluates the efficiency and the accurate localisation of treatment plants in a basin, as well as the capacity of its river to bear the residual pollution loads after the treatment phase. The methodology is applied to a sample catchment area, located in northern Italy, where water quality is strongly affected by high population density and by the presence of agricultural and industrial activities. Nearly 10 years of water-quality data collected through official monitoring are considered for the implementation of the system. The sample basin shows different real and potential pollution conditions, according to the resilience of the river and surroundings, together with the point and diffuse pressure sources acting on the receiving body. Full article

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14 pages, 2467 KiB

Open AccessArticle

Sharply Reduced but Still Heavy Self-Harm Burdens in Hubei Province, China, 1990–2015

by Jingju Pan, Lan Zhang, Yumeng Tang, Qian Li, Chuanhua Yu and Tianjing He

Int. J. Environ. Res. Public Health 2018, 15(2), 391; https://doi.org/10.3390/ijerph15020391 - 24 Feb 2018

Cited by 7 | Viewed by 5141

Abstract

The aims of this study were to describe fatal and non-fatal self-harm burdens, as well as burdens from the main preventable risk factors, and to investigate the different suicide methods in Hubei province in central China utilizing data from both Global Burden of [...] Read more.

The aims of this study were to describe fatal and non-fatal self-harm burdens, as well as burdens from the main preventable risk factors, and to investigate the different suicide methods in Hubei province in central China utilizing data from both Global Burden of Disease Study 2015 and Hubei Disease Surveillance Points system. All self-harm burdens including mortality, years of life lost (YLLs), prevalence, years lived with disability (YLDs), and disability adjusted life-years (DALYs) consistently demonstrated downward trends in Hubei from 1990 to 2015, with a bigger decline gap observed among females and narrower decreasing amplitudes among the elderly. Hubei experienced much higher age-standardized rates for self-harm mortality (22.0 per 100,000), YLLs (560.1 per 100,000) and DALYs (563.9 per 100,000) than the national (9.0, 292.3 and 295.0 per 100,000 respectively) and global levels (11.5, 453.3 and 457.9 per 100,000 respectively) in 2015. Self-harm burdens have begun shifting from females to males and the elderly suffered more self-harm burdens than other age groups. Alcohol use accounted for 20.9% of all self-harm DALYs for males, whereas intimate partner violence accounted for 24.4% of all self-harm DALYs for females. Poisoning, mainly pesticide self-poisoning, was still the most common method of suicide. Effective interventions by multi-sectoral collaboration are urgently needed to reduce the alarmingly heavy self-harm burdens in Hubei. Full article

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11 pages, 660 KiB

Open AccessArticle

Investigation of a Brownfield Conflict Considering the Strength of Preferences

by Jing Yu and Ling-Ling Pei

Int. J. Environ. Res. Public Health 2018, 15(2), 393; https://doi.org/10.3390/ijerph15020393 - 24 Feb 2018

Cited by 13 | Viewed by 4268

Abstract

By employing the Graph Model for Conflict Resolution methodology, this paper models and analyzes a brownfield conflict that occurred at the Changzhou Foreign Language School in Jiangsu, China, in 2016. This conflict made national headlines when news reports revealed that a large number [...] Read more.

By employing the Graph Model for Conflict Resolution methodology, this paper models and analyzes a brownfield conflict that occurred at the Changzhou Foreign Language School in Jiangsu, China, in 2016. This conflict made national headlines when news reports revealed that a large number of students and staff suffered from health issues after the school moved to a new site that is built on recently restored land adjacent to the original “Chang Long Chemical” block. Since stakeholders in the conflict hold different strengths of preference, a new option prioritization technique is employed to elicit both crisp preferences and the strength of preferences for the decision-makers (DMs) in the conflict. The conflict analysis result is consistent with the actual trajectory of the conflict and provides strategic insights into the conflict. More specifically, equilibrium results suggest that the firm should have been required to thoroughly clean the site, the local government should not have relocated the school, and the environmental agency and other stakeholders should have closely monitored the firm’s activities. In short, strategic insights garnered from this case study indicate that positive interactions should be fostered among the local government, the enterprise, and the public to ensure sustainable brownfield land redevelopment in the future. Full article

(This article belongs to the Special Issue Decision Models in Green Growth and Sustainable Development)

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Review

Jump to: Research, Other

16 pages, 1301 KiB

Open AccessReview

Physical Activity, a Critical Exposure Factor of Environmental Pollution in Children and Adolescents Health Risk Assessment

by Jingmei Dong, Su Zhang, Li Xia, Yi Yu, Shuangshuang Hu, Jingyu Sun, Ping Zhou and Peijie Chen

Int. J. Environ. Res. Public Health 2018, 15(2), 176; https://doi.org/10.3390/ijerph15020176 - 23 Jan 2018

Cited by 23 | Viewed by 7459

Abstract

It is an extremely urgent problem that physical fitness promotion must face not only the increasing air pollution but also the decline of physical activity level of children and adolescents worldwide at present, which is the major reason that forms an inactive lifestyle [...] Read more.

It is an extremely urgent problem that physical fitness promotion must face not only the increasing air pollution but also the decline of physical activity level of children and adolescents worldwide at present, which is the major reason that forms an inactive lifestyle and does harm to adolescents’ health. Thus, it is necessary to focus on the exposure factor in environmental health risk assessment (EHRA) which conducts supervision of environmental pollution and survey of adolescents’ activity patterns according to the harmful characteristics of air pollutant and relationship between dose and response. Some countries, such as USA, Canada and Australia, regard both respiratory rate and physical activity pattern as main exposure factors for adolescents in both air pollution health risk assessment and exercise risk assessment to forecast a safe exposing condition of pollutant for adolescents while they are doing exercise outdoors. In addition, it suggests that the testing indexes and testing methods of these two exposure factors, such as investigating the time of daily physical activity, strength, and characteristic of frequency, help to set up the quantitative relationship between environmental pollution index and the time, strength, frequency of daily activities, and formulate children’s and adolescents’ activity instructions under different levels of environmental pollutions. As smog becomes increasingly serious at present, it is meaningful to take physical activity as a critical composition of exposure factor and establish physical activity guideline, so as to reduce the risk of air pollution, and promote physical health of children and adolescents effectively. Full article

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19 pages, 4409 KiB

Open AccessFeature PaperReview

Groundwater Arsenic Contamination in the Ganga River Basin: A Future Health Danger

by Dipankar Chakraborti, Sushant K. Singh, Mohammad Mahmudur Rahman, Rathindra Nath Dutta, Subhas Chandra Mukherjee, Shyamapada Pati and Probir Bijoy Kar

Int. J. Environ. Res. Public Health 2018, 15(2), 180; https://doi.org/10.3390/ijerph15020180 - 23 Jan 2018

Cited by 201 | Viewed by 21075

Abstract

This study highlights the severity of arsenic contamination in the Ganga River basin (GRB), which encompasses significant geographic portions of India, Bangladesh, Nepal, and Tibet. The entire GRB experiences elevated levels of arsenic in the groundwater (up to 4730 µg/L), irrigation water (~1000 [...] Read more.

This study highlights the severity of arsenic contamination in the Ganga River basin (GRB), which encompasses significant geographic portions of India, Bangladesh, Nepal, and Tibet. The entire GRB experiences elevated levels of arsenic in the groundwater (up to 4730 µg/L), irrigation water (~1000 µg/L), and in food materials (up to 3947 µg/kg), all exceeding the World Health Organization’s standards for drinking water, the United Nations Food and Agricultural Organization’s standard for irrigation water (100 µg/L), and the Chinese Ministry of Health’s standard for food in South Asia (0.15 mg/kg), respectively. Several individuals demonstrated dermal, neurological, reproductive, cognitive, and cancerous effects; many children have been diagnosed with a range of arsenicosis symptoms, and numerous arsenic-induced deaths of youthful victims are reported in the GRB. Victims of arsenic exposure face critical social challenges in the form of social isolation and hatred by their respective communities. Reluctance to establish arsenic standards and unsustainable arsenic mitigation programs have aggravated the arsenic calamity in the GRB and put millions of lives in danger. This alarming situation resembles a ticking time bomb. We feel that after 29 years of arsenic research in the GRB, we have seen the tip of the iceberg with respect to the actual magnitude of the catastrophe; thus, a reduced arsenic standard for drinking water, testing all available drinking water sources, and sustainable and cost-effective arsenic mitigation programs that include the participation of the people are urgently needed. Full article

(This article belongs to the Special Issue Arsenic Contamination, Bioavailability and Public Health)

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14 pages, 297 KiB

Open AccessReview

Do Carpets Impair Indoor Air Quality and Cause Adverse Health Outcomes: A Review

by Rune Becher, Johan Øvrevik, Per E. Schwarze, Steinar Nilsen, Jan K. Hongslo and Jan Vilhelm Bakke

Int. J. Environ. Res. Public Health 2018, 15(2), 184; https://doi.org/10.3390/ijerph15020184 - 23 Jan 2018

Cited by 43 | Viewed by 12602

Abstract

Several earlier studies have shown the presence of more dust and allergens in carpets compared with non-carpeted floors. At the same time, adverse effects of carpeted floors on perceived indoor air quality as well as worsening of symptoms in individuals with asthma and [...] Read more.

Several earlier studies have shown the presence of more dust and allergens in carpets compared with non-carpeted floors. At the same time, adverse effects of carpeted floors on perceived indoor air quality as well as worsening of symptoms in individuals with asthma and allergies were reported. Avoiding extensive carpet use in offices, schools, kindergartens and bedrooms has therefore been recommended by several health authorities. More recently, carpet producers have argued that former assessments were obsolete and that modern rugs are unproblematic, even for those with asthma and allergies. To investigate whether the recommendation to be cautious with the use of carpets is still valid, or whether there are new data supporting that carpet flooring do not present a problem for indoor air quality and health, we have reviewed the literature on this matter. We have not found updated peer reviewed evidence that carpeted floor is unproblematic for the indoor environment. On the contrary, also more recent data support that carpets may act as a repository for pollutants which may become resuspended upon activity in the carpeted area. Also, the use of carpets is still linked to perception of reduced indoor air quality as well as adverse health effects as previously reported. To our knowledge, there are no publications that report on deposition of pollutants and adverse health outcomes associated with modern rugs. However, due to the three-dimensional structure of carpets, any carpet will to some extent act like a sink. Thus, continued caution should still be exercised when considering the use of wall-to-wall carpeted floors in schools, kindergartens and offices, as well as in children’s bedrooms unless special needs indicate that carpets are preferable. Full article

(This article belongs to the Special Issue Air Quality and Health)

11 pages, 1292 KiB

Open AccessReview

Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person’s Pathway

by Éidín Ní Shé, Fiona Keogan, Eilish McAuliffe, Diarmuid O’Shea, Mary McCarthy, Rosa McNamara and Marie Therese Cooney

Int. J. Environ. Res. Public Health 2018, 15(2), 199; https://doi.org/10.3390/ijerph15020199 - 25 Jan 2018

Cited by 24 | Viewed by 9752

Abstract

We addressed the research question “what factors enable the successful development and implementation of a frail older person’s pathway within the acute setting”. A rapid realist review (RRR) was conducted by adopting the RAMESES standards. We began with a sample of 232 articles [...] Read more.

We addressed the research question “what factors enable the successful development and implementation of a frail older person’s pathway within the acute setting”. A rapid realist review (RRR) was conducted by adopting the RAMESES standards. We began with a sample of 232 articles via database searches supplemented with 94 additional records including inputs from a twitter chat and a hospital site visit. Our final sample consisted of 18 documents. Following review and consensus by an expert panel we identified a conceptual model of context-mechanism-(resources)-outcomes. There was overall agreement frailty should be identified at the front door of the acute hospital. Significant challenges identified related to organisational boundaries both within the acute setting and externally, the need to shift outcomes to patient orientated ones, to support staff to sustain the pathway by providing ongoing education and by providing role clarity. RRRs can support research such as the systematic approach to improving care for frail older adults (SAFE) study by producing accounts of what works based on a wide range of sources and innovative engagement with stakeholders. It is evident from our provisional model that numerous factors need to combine and interact to enable and sustain a successful frail older person’s pathway. Full article

(This article belongs to the Special Issue Health Systems and Services)

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12 pages, 285 KiB

Open AccessReview

The Weakening of Kin Ties: Exploring the Need for Life-World Led Interventions

by Gert Schout and Gideon De Jong

Int. J. Environ. Res. Public Health 2018, 15(2), 203; https://doi.org/10.3390/ijerph15020203 - 25 Jan 2018

Cited by 4 | Viewed by 5350

Abstract

The protective features that families and wider social relationships can have are required to meet the demands of life in contemporary Western societies. Choice and detraditionalization, however; impede this source of solidarity. Family Group Conferencing (FGC) and other life-world led interventions have the [...] Read more.

The protective features that families and wider social relationships can have are required to meet the demands of life in contemporary Western societies. Choice and detraditionalization, however; impede this source of solidarity. Family Group Conferencing (FGC) and other life-world led interventions have the potential to strengthen primary groups. This paper explores the need for such a social intervention, using insights from sociological and philosophical theories and empirical findings from a case study of the research project ‘FGC in mental health’. This need is understandable considering the weakening of kin ties, the poor qualities of state agencies to mobilise self-care and informal care, its capacity to produce a shift of power from public to private spheres and its capacity to mitigate the co-isolation of individuals, families and communities. A life-world led intervention like FGC with a specific and modest ambition contributes to small-scale solidarity. This ambition is not inclined to establish a broad social cohesion within society but to restore; in terms of the German philosopher Peter Sloterdijk; immunity (protection) and solidarity in primary groups, and consequently, resolve issues with those (family, neighbours, colleagues) who share a sphere (a situation, a process, a fate). Full article

(This article belongs to the Special Issue Mental Health and Social Care and Social Interventions)

19 pages, 3014 KiB

Open AccessReview

A Systematic Review and Meta-Analysis of Mindfulness-Based (Baduanjin) Exercise for Alleviating Musculoskeletal Pain and Improving Sleep Quality in People with Chronic Diseases

by Liye Zou, Albert Yeung, Xinfeng Quan, Sean David Boyden and Huiru Wang

Int. J. Environ. Res. Public Health 2018, 15(2), 206; https://doi.org/10.3390/ijerph15020206 - 25 Jan 2018

Cited by 122 | Viewed by 16209

Abstract

Objective: we performed the first systematic review with meta-analyses of the existing studies that examined mindfulness-based Baduanjin exercise for its therapeutic effects for individuals with musculoskeletal pain or insomnia. Methods: Both English- (PubMed, Web of Science, Elsevier, and Google Scholar) and Chinese-language (CNKI [...] Read more.

Objective: we performed the first systematic review with meta-analyses of the existing studies that examined mindfulness-based Baduanjin exercise for its therapeutic effects for individuals with musculoskeletal pain or insomnia. Methods: Both English- (PubMed, Web of Science, Elsevier, and Google Scholar) and Chinese-language (CNKI and Wangfang) electronic databases were used to search relevant articles. We used a modified PEDro scale to evaluate risk of bias across studies selected. All eligible RCTS were considered for meta-analysis. The standardized mean difference was calculated for the pooled effects to determine the magnitude of the Baduanjin intervention effect. For the moderator analysis, we performed subgroup meta-analysis for categorical variables and meta-regression for continuous variables. Results: The aggregated result has shown a significant benefit in favour of Baduanjin at alleviating musculoskeletal pain (SMD = −0.88, 95% CI −1.02 to −0.74, p < 0.001, I² = 10.29%) and improving overall sleep quality (SMD = −0.48, 95% CI −0.95 to −0.01, p = 004, I² = 84.42%). Conclusions: Mindfulness-based Baduanjin exercise may be effective for alleviating musculoskeletal pain and improving overall sleep quality in people with chronic illness. Large, well-designed RCTs are needed to confirm these findings. Full article

(This article belongs to the Special Issue Effect of Sport Activity on Health Promotion)

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29 pages, 847 KiB

Open AccessReview

Do Natural Experiments of Changes in Neighborhood Built Environment Impact Physical Activity and Diet? A Systematic Review

by Freya MacMillan, Emma S. George, Xiaoqi Feng, Dafna Merom, Andrew Bennie, Amelia Cook, Taren Sanders, Genevieve Dwyer, Bonnie Pang, Justin M. Guagliano, Gregory S. Kolt and Thomas Astell-Burt

Int. J. Environ. Res. Public Health 2018, 15(2), 217; https://doi.org/10.3390/ijerph15020217 - 26 Jan 2018

Cited by 72 | Viewed by 10148

Abstract

Physical activity and diet are major modifiable risk factors for chronic disease and have been shown to be associated with neighborhood built environment. Systematic review evidence from longitudinal studies on the impact of changing the built environment on physical activity and diet is [...] Read more.

Physical activity and diet are major modifiable risk factors for chronic disease and have been shown to be associated with neighborhood built environment. Systematic review evidence from longitudinal studies on the impact of changing the built environment on physical activity and diet is currently lacking. A systematic review of natural experiments of neighborhood built environment was conducted. The aims of this systematic review were to summarize study characteristics, study quality, and impact of changes in neighborhood built environment on physical activity and diet outcomes among residents. Natural experiments of neighborhood built environment change, exploring longitudinal impacts on physical activity and/or diet in residents, were included. From five electronic databases, 2084 references were identified. A narrative synthesis was conducted, considering results in relation to study quality. Nineteen papers, reporting on 15 different exposures met inclusion criteria. Four studies included a comparison group and 11 were pre-post/longitudinal studies without a comparison group. Studies reported on the impact of redeveloping or introducing cycle and/or walking trails (n = 5), rail stops/lines (n = 4), supermarkets and farmers’ markets (n = 4) and park and green space (n = 2). Eight/15 studies reported at least one beneficial change in physical activity, diet or another associated health outcome. Due to limitations in study design and reporting, as well as the wide array of outcome measures reported, drawing conclusions to inform policy was challenging. Future research should consider a consistent approach to measure the same outcomes (e.g., using measurement methods that collect comparable physical activity and diet outcome data), to allow for pooled analyses. Additionally, including comparison groups wherever possible and ensuring high quality reporting is essential. Full article

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20 pages, 1505 KiB

Open AccessReview

Aedes Mosquitoes and Aedes-Borne Arboviruses in Africa: Current and Future Threats

by David Weetman, Basile Kamgang, Athanase Badolo, Catherine L. Moyes, Freya M. Shearer, Mamadou Coulibaly, João Pinto, Louis Lambrechts and Philip J. McCall

Int. J. Environ. Res. Public Health 2018, 15(2), 220; https://doi.org/10.3390/ijerph15020220 - 28 Jan 2018

Cited by 178 | Viewed by 17359

Abstract

The Zika crisis drew attention to the long-overlooked problem of arboviruses transmitted by Aedes mosquitoes in Africa. Yellow fever, dengue, chikungunya and Zika are poorly controlled in Africa and often go unrecognized. However, to combat these diseases, both in Africa and worldwide, it [...] Read more.

The Zika crisis drew attention to the long-overlooked problem of arboviruses transmitted by Aedes mosquitoes in Africa. Yellow fever, dengue, chikungunya and Zika are poorly controlled in Africa and often go unrecognized. However, to combat these diseases, both in Africa and worldwide, it is crucial that this situation changes. Here, we review available data on the distribution of each disease in Africa, their Aedes vectors, transmission potential, and challenges and opportunities for Aedes control. Data on disease and vector ranges are sparse, and consequently maps of risk are uncertain. Issues such as genetic and ecological diversity, and opportunities for integration with malaria control, are primarily African; others such as ever-increasing urbanization, insecticide resistance and lack of evidence for most control-interventions reflect problems throughout the tropics. We identify key knowledge gaps and future research areas, and in particular, highlight the need to improve knowledge of the distributions of disease and major vectors, insecticide resistance, and to develop specific plans and capacity for arboviral disease surveillance, prevention and outbreak responses. Full article

(This article belongs to the Special Issue Global Epidemics of Zika? Implications for Public Health)

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17 pages, 463 KiB

Open AccessReview

Review of Non-Respiratory, Non-Cancer Physical Health Conditions from Exposure to the World Trade Center Disaster

by Lisa M. Gargano, Kimberly Mantilla, Monique Fairclough, Shengchao Yu and Robert M. Brackbill

Int. J. Environ. Res. Public Health 2018, 15(2), 253; https://doi.org/10.3390/ijerph15020253 - 3 Feb 2018

Cited by 12 | Viewed by 5369

Abstract

After the World Trade Center attacks on 11 September 2001 (9/11), multiple cohorts were developed to monitor the health outcomes of exposure. Respiratory and cancer effects have been covered at length. This current study sought to review the literature on other physical conditions [...] Read more.

After the World Trade Center attacks on 11 September 2001 (9/11), multiple cohorts were developed to monitor the health outcomes of exposure. Respiratory and cancer effects have been covered at length. This current study sought to review the literature on other physical conditions associated with 9/11-exposure. Researchers searched seven databases for literature published in English from 2002 to October 2017, coded, and included articles for health condition outcome, population, 9/11-exposures, and comorbidity. Of the 322 titles and abstracts screened, 30 studies met inclusion criteria, and of these, 28 were from three cohorts: the World Trade Center Health Registry, Fire Department of New York, and World Trade Center Health Consortium. Most studies focused on rescue and recovery workers. While many of the findings were consistent across different populations and supported by objective measures, some of the less studied conditions need additional research to substantiate current findings. In the 16 years after 9/11, longitudinal cohorts have been essential in investigating the health consequences of 9/11-exposure. Longitudinal studies will be vital in furthering our understanding of these emerging conditions, as well as treatment effectiveness. Full article

(This article belongs to the Section Environmental Health)

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19 pages, 473 KiB

Open AccessReview

Air Pollution and Otitis Media in Children: A Systematic Review of Literature

by Gayan Bowatte, Rachel Tham, Jennifer L. Perret, Michael S. Bloom, Guanghui Dong, Nilakshi Waidyatillake, Dinh Bui, Geoffrey G. Morgan, Bin Jalaludin, Caroline J. Lodge and Shyamali C. Dharmage

Int. J. Environ. Res. Public Health 2018, 15(2), 257; https://doi.org/10.3390/ijerph15020257 - 3 Feb 2018

Cited by 52 | Viewed by 8969

Abstract

Young children are particularly vulnerable to otitis media (OM) which globally affects over 80% of children below the age of 3 years. Although there is convincing evidence for an association between environmental tobacco smoke exposure and OM in children, the relationship with ambient [...] Read more.

Young children are particularly vulnerable to otitis media (OM) which globally affects over 80% of children below the age of 3 years. Although there is convincing evidence for an association between environmental tobacco smoke exposure and OM in children, the relationship with ambient air pollution is not clear. We aimed to systematically review the literature on the relationship between ambient air pollution exposure and OM in children. A systematic search was performed in PubMed and EMBASE databases. Of 934 references identified, 24 articles were included. There is an increasing body of evidence supporting an association between higher ambient air pollution exposure and a higher risk of OM in children. While NO₂ showed the most consistent association with OM, other specific pollutants showed inconsistent associations. Studies were mainly conducted in high/middle income countries with limited evidence from low-income countries. Although there was a general consensus that higher air pollution exposure is associated with a greater prevalence of OM, the evidence for associations with specific pollutants is inconsistent. More well-designed studies on associations between specific air pollutants as risk factors for OM are warranted, especially in low income countries with high air pollution levels. Full article

(This article belongs to the Special Issue Air Quality and Health)

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26 pages, 1698 KiB

Open AccessReview

Converging Human and Malaria Vector Diagnostics with Data Management towards an Integrated Holistic One Health Approach

by Konstantinos Mitsakakis, Sebastian Hin, Pie Müller, Nadja Wipf, Edward Thomsen, Michael Coleman, Roland Zengerle, John Vontas and Konstantinos Mavridis

Int. J. Environ. Res. Public Health 2018, 15(2), 259; https://doi.org/10.3390/ijerph15020259 - 3 Feb 2018

Cited by 15 | Viewed by 8805

Abstract

Monitoring malaria prevalence in humans, as well as vector populations, for the presence of Plasmodium, is an integral component of effective malaria control, and eventually, elimination. In the field of human diagnostics, a major challenge is the ability to define, precisely, the [...] Read more.

Monitoring malaria prevalence in humans, as well as vector populations, for the presence of Plasmodium, is an integral component of effective malaria control, and eventually, elimination. In the field of human diagnostics, a major challenge is the ability to define, precisely, the causative agent of fever, thereby differentiating among several candidate (also non-malaria) febrile diseases. This requires genetic-based pathogen identification and multiplexed analysis, which, in combination, are hardly provided by the current gold standard diagnostic tools. In the field of vectors, an essential component of control programs is the detection of Plasmodium species within its mosquito vectors, particularly in the salivary glands, where the infective sporozoites reside. In addition, the identification of species composition and insecticide resistance alleles within vector populations is a primary task in routine monitoring activities, aiming to support control efforts. In this context, the use of converging diagnostics is highly desirable for providing comprehensive information, including differential fever diagnosis in humans, and mosquito species composition, infection status, and resistance to insecticides of vectors. Nevertheless, the two fields of human diagnostics and vector control are rarely combined, both at the diagnostic and at the data management end, resulting in fragmented data and mis- or non-communication between various stakeholders. To this direction, molecular technologies, their integration in automated platforms, and the co-assessment of data from multiple diagnostic sources through information and communication technologies are possible pathways towards a unified human vector approach. Full article

(This article belongs to the Special Issue Malaria Epidemiology and Control: Current Situation and Perspectives)

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23 pages, 522 KiB

Open AccessReview

WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Cognition

by Charlotte Clark and Katarina Paunovic

Int. J. Environ. Res. Public Health 2018, 15(2), 285; https://doi.org/10.3390/ijerph15020285 - 7 Feb 2018

Cited by 169 | Viewed by 19290

Abstract

This systematic review assesses the quality of the evidence across individual studies on the effect of environmental noise (road traffic, aircraft, and train and railway noise) on cognition. Quantitative non-experimental studies of the association between environmental noise exposure on child and adult cognitive [...] Read more.

This systematic review assesses the quality of the evidence across individual studies on the effect of environmental noise (road traffic, aircraft, and train and railway noise) on cognition. Quantitative non-experimental studies of the association between environmental noise exposure on child and adult cognitive performance published up to June 2015 were reviewed: no limit was placed on the start date for the search. A total of 34 papers were identified, all of which were of child populations. 82% of the papers were of cross-sectional design, with fewer studies of longitudinal or intervention design. A range of cognitive outcomes were examined. The quality of the evidence across the studies for each individual noise source and cognitive outcome was assessed using an adaptation of GRADE methodology. This review found, given the predominance of cross-sectional studies, that the quality of the evidence across studies ranged from being of moderate quality for an effect for some outcomes, e.g., aircraft noise effects on reading comprehension and on long-term memory, to no effect for other outcomes such as attention and executive function and for some noise sources such as road traffic noise and railway noise. The GRADE evaluation of low quality evidence across studies for some cognitive domains and for some noise sources does not necessarily mean that there are no effects: rather, that more robust and a greater number of studies are required. Full article

(This article belongs to the Special Issue WHO Noise and Health Evidence Reviews)

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21 pages, 740 KiB

Open AccessReview

Improving Health Care Management in Primary Care for Homeless People: A Literature Review

by Maeva Jego, Julien Abcaya, Diana-Elena Ștefan, Céline Calvet-Montredon and Stéphanie Gentile

Int. J. Environ. Res. Public Health 2018, 15(2), 309; https://doi.org/10.3390/ijerph15020309 - 10 Feb 2018

Cited by 76 | Viewed by 18102

Abstract

Background: Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of [...] Read more.

Background: Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. Methods: We performed a literature review that included articles which described and evaluated primary care programs for homeless people. Results: Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions: Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model. Full article

(This article belongs to the Special Issue Health and Health Care for Homeless People in Various Contexts)

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14 pages, 669 KiB

Open AccessReview

Inappropriate Use of Medication by Elderly, Polymedicated, or Multipathological Patients with Chronic Diseases

by Virtudes Pérez-Jover, José J. Mira, Concepción Carratala-Munuera, Vicente F. Gil-Guillen, Josep Basora, Adriana López-Pineda and Domingo Orozco-Beltrán

Int. J. Environ. Res. Public Health 2018, 15(2), 310; https://doi.org/10.3390/ijerph15020310 - 10 Feb 2018

Cited by 73 | Viewed by 13931

Abstract

The growth of the aging population leads to the increase of chronic diseases, of the burden of multimorbility, and of the complexity polypharmacy. The prevalence of medication errors rises in patients with polypharmacy in primary care, and this is a major concern to [...] Read more.

The growth of the aging population leads to the increase of chronic diseases, of the burden of multimorbility, and of the complexity polypharmacy. The prevalence of medication errors rises in patients with polypharmacy in primary care, and this is a major concern to healthcare systems. This study reviews the published literature on the inappropriate use of medicines in order to articulate recommendations on how to reduce it in chronic patients, particularly in those who are elderly, polymedicated, or multipathological. A systematic review of articles published from January 2000 to October 2015 was performed using MEDLINE, EMBASE, PsychInfo, Scopus, The Cochrane Library, and Index Medicus databases. We selected 80 studies in order to analyse the content that addressed the question under consideration. Our literature review found that half of patients know what their prescribed treatment is; that most of elderly people take five or more medications a day; that in elderly, polymedicated people, the probability of a medication error occurring is higher; that new tools have been recently developed to reduce errors; that elderly patients can understand written information but the presentation and format is an important factor; and that a high percentage of patients have remaining doubts after their visit. Thus, strategies based on the evidence should be applied in order to reduce medication errors. Full article

(This article belongs to the Special Issue Community Health Intervention to Reduce Chronic Disease)

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19 pages, 595 KiB

Open AccessReview

A Comparative Analysis of Climate-Risk and Extreme Event-Related Impacts on Well-Being and Health: Policy Implications

by Walter Leal Filho, Abul Quasem Al-Amin, Gustavo J. Nagy, Ulisses M. Azeiteiro, Laura Wiesböck, Desalegn Y. Ayal, Edward A. Morgan, Paschal Mugabe, Marilyn Aparicio-Effen, Hubert Fudjumdjum and Charbel Jose Chiappetta Jabbour

Int. J. Environ. Res. Public Health 2018, 15(2), 331; https://doi.org/10.3390/ijerph15020331 - 13 Feb 2018

Cited by 31 | Viewed by 12066

Abstract

There are various climate risks that are caused or influenced by climate change. They are known to have a wide range of physical, economic, environmental and social impacts. Apart from damages to the physical environment, many climate risks (climate variability, extreme events and [...] Read more.

There are various climate risks that are caused or influenced by climate change. They are known to have a wide range of physical, economic, environmental and social impacts. Apart from damages to the physical environment, many climate risks (climate variability, extreme events and climate-related hazards) are associated with a variety of impacts on human well-being, health, and life-supporting systems. These vary from boosting the proliferation of vectors of diseases (e.g., mosquitos), to mental problems triggered by damage to properties and infrastructure. There is a great variety of literature about the strong links between climate change and health, while there is relatively less literature that specifically examines the health impacts of climate risks and extreme events. This paper is an attempt to address this knowledge gap, by compiling eight examples from a set of industrialised and developing countries, where such interactions are described. The policy implications of these phenomena and the lessons learned from the examples provided are summarised. Some suggestions as to how to avert the potential and real health impacts of climate risks are made, hence assisting efforts to adapt to a problem whose impacts affect millions of people around the world. All the examples studied show some degree of vulnerability to climate risks regardless of their socioeconomic status and need to increase resilience against extreme events. Full article

(This article belongs to the Special Issue Climate Change and Human Health)

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18 pages, 2260 KiB

Open AccessReview

Toxicology of Engineered Nanoparticles: Focus on Poly(amidoamine) Dendrimers

by Pratap C. Naha, Sourav P. Mukherjee and Hugh J. Byrne

Int. J. Environ. Res. Public Health 2018, 15(2), 338; https://doi.org/10.3390/ijerph15020338 - 14 Feb 2018

Cited by 51 | Viewed by 5877

Abstract

Engineered nanomaterials are increasingly being developed for paints, sunscreens, cosmetics, industrial lubricants, tyres, semiconductor devices, and also for biomedical applications such as in diagnostics, therapeutics, and contrast agents. As a result, nanomaterials are being manufactured, transported, and used in larger and larger quantities, [...] Read more.

Engineered nanomaterials are increasingly being developed for paints, sunscreens, cosmetics, industrial lubricants, tyres, semiconductor devices, and also for biomedical applications such as in diagnostics, therapeutics, and contrast agents. As a result, nanomaterials are being manufactured, transported, and used in larger and larger quantities, and potential impacts on environmental and human health have been raised. Poly(amidoamine) (PAMAM) dendrimers are specifically suitable for biomedical applications. They are well-defined nanoscale molecules which contain a 2-carbon ethylenediamine core and primary amine groups at the surface. The systematically variable structural architecture and the large internal free volume make these dendrimers an attractive option for drug delivery and other biomedical applications. Due to the wide range of applications, the Organisation for Economic Co-Operation and Development (OECD) have included them in their list of nanoparticles which require toxicological assessment. Thus, the toxicological impact of these PAMAM dendrimers on human health and the environment is a matter of concern. In this review, the potential toxicological impact of PAMAM dendrimers on human health and environment is assessed, highlighting work to date exploring the toxicological effects of PAMAM dendrimers. Full article

(This article belongs to the Special Issue Nano-Bio Interactions: Nanomedicine and Nanotoxicology)

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23 pages, 605 KiB

Open AccessReview

Mental Health Interventions for Parent Carers of Children with Autistic Spectrum Disorder: Practice Guidelines from a Critical Interpretive Synthesis (CIS) Systematic Review

by Denise Catalano, Linda Holloway and Elias Mpofu

Int. J. Environ. Res. Public Health 2018, 15(2), 341; https://doi.org/10.3390/ijerph15020341 - 14 Feb 2018

Cited by 115 | Viewed by 17927

Abstract

Parent carers of children with Autism Spectrum Disorder (ASD) often report increased levels of stress, depression, and anxiety. Unmet parent carer mental health needs pose a significant risk to the psychological, physical, and social well-being of the parents of the child affected by [...] Read more.

Parent carers of children with Autism Spectrum Disorder (ASD) often report increased levels of stress, depression, and anxiety. Unmet parent carer mental health needs pose a significant risk to the psychological, physical, and social well-being of the parents of the child affected by ASD and jeopardize the adaptive functioning of the family as well as the potential of the child affected by ASD. This systematic review identifies key qualities of interventions supporting the mental health of parent carers and proposes practitioner-parent carer support guidelines. A search of four databases (Medline, PubMed, PsycINFO, and Social Science Data) was conducted to identify studies that met the following criteria: (1) an intervention was delivered to parent carers of a child with ASD under the age of 18 years; (2) the research design allowed for a comparison on outcomes across groups; and (3) outcome measures of the parent carers’ mental health were used. A total of 23 studies met the inclusion criteria. A critical interpretive synthesis approach was used to produce an integrated conceptualization of the evidence. Findings suggest practitioner guidelines to support the mental health and wellbeing of parent carers should include addressing the parent’s self-perspective taking and skill for real time problem-solving. Full article

(This article belongs to the Special Issue Health Promotion Interventions for People with Disabilities)

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20 pages, 380 KiB

Open AccessReview

Diversity of Concerns in Recovery after a Nuclear Accident: A Perspective from Fukushima

by Akiko Sato and Yuliya Lyamzina

Int. J. Environ. Res. Public Health 2018, 15(2), 350; https://doi.org/10.3390/ijerph15020350 - 16 Feb 2018

Cited by 26 | Viewed by 8735

Abstract

Since the 2011 Fukushima nuclear accident, tremendous resources have been devoted to recovery, and the Japanese Government is gradually lifting evacuation orders. However, public concerns remain prevalent, affecting some people’s return to a normal life and threatening their well-being. This study reviews government [...] Read more.

Since the 2011 Fukushima nuclear accident, tremendous resources have been devoted to recovery, and the Japanese Government is gradually lifting evacuation orders. However, public concerns remain prevalent, affecting some people’s return to a normal life and threatening their well-being. This study reviews government reports, academic papers, newspaper articles and conference presentations with the aim of obtaining a better understanding of issues which relate to radiation concerns in the recovery process in the aftermath of the accident. It looks extensively at: (1) the current status of the post-accident operations and existing radiation issues in Fukushima, and (2) approaches taken to engage the public during recovery from five previous comparable nuclear and radiological events: Three Mile Island, Buenos Aires (RA-2 facility), Chernobyl, Goiânia and Tokai-mura. The findings indicate that the limitations and emerging challenges of the current recovery operations cause concerns about radiation exposure in various aspects of day-to-day life. Past experiences suggest that long-term management that take a holistic and cohesive approach is critical for restoration of sustainable livelihoods and for social re-integration. Not only actual risks but also public perceptions of risks should be carefully assessed and addressed in the process of environmental remediation. Full article

(This article belongs to the Special Issue Public Health Preparedness for and Response to Nuclear Disasters)

27 pages, 752 KiB

Open AccessReview

The Use of Biomass for Electricity Generation: A Scoping Review of Health Effects on Humans in Residential and Occupational Settings

by Alice Freiberg, Julia Scharfe, Vanise C. Murta and Andreas Seidler

Int. J. Environ. Res. Public Health 2018, 15(2), 354; https://doi.org/10.3390/ijerph15020354 - 16 Feb 2018

Cited by 36 | Viewed by 6753

Abstract

The utilization of biomass for power generation has become more prevalent globally. To survey the status of evidence concerning resulting health impacts and to depict potential research needs, a scoping-review was conducted. Biomass life cycle phases of interest were the conversion and combustion [...] Read more.

The utilization of biomass for power generation has become more prevalent globally. To survey the status of evidence concerning resulting health impacts and to depict potential research needs, a scoping-review was conducted. Biomass life cycle phases of interest were the conversion and combustion phases. Studies from occupational and residential settings were considered. The scoping review was conducted systematically, comprising an extensive literature search, a guided screening process, in-duplicate data extraction, and critical appraisal. Two reviewers executed most review steps. Nine articles of relevance were identified. In occupational settings of biomass plants, exposure to endotoxins and fungi might be associated with respiratory disorders. An accidental leakage of hydrogen sulfide in biogas plants may lead to fatalities or severe health impacts. Living near biomass power plants (and the accompanied odorous air pollution) may result in an increased risk for several symptoms and odor annoyance, mediated by perception about air pollution or an evaluation of a resulting health risk. The methodological quality of included studies varied a lot. Overall, the body of evidence on the topic is sparse and future high-quality research is strongly recommended. Full article

(This article belongs to the Section Occupational Safety and Health)

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59 pages, 517 KiB

Open AccessReview

WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Cardiovascular and Metabolic Effects: A Summary

by Elise Van Kempen, Maribel Casas, Göran Pershagen and Maria Foraster

Int. J. Environ. Res. Public Health 2018, 15(2), 379; https://doi.org/10.3390/ijerph15020379 - 22 Feb 2018

Cited by 521 | Viewed by 29889

Abstract

To update the current state of evidence and assess its quality, we conducted a systematic review on the effects of environmental noise exposure on the cardio-metabolic systems as input for the new WHO environmental noise guidelines for the European Region. We identified 600 [...] Read more.

To update the current state of evidence and assess its quality, we conducted a systematic review on the effects of environmental noise exposure on the cardio-metabolic systems as input for the new WHO environmental noise guidelines for the European Region. We identified 600 references relating to studies on effects of noise from road, rail and air traffic, and wind turbines on the cardio-metabolic system, published between January 2000 and August 2015. Only 61 studies, investigating different end points, included information enabling estimation of exposure response relationships. These studies were used for meta-analyses, and assessments of the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). A majority of the studies concerned traffic noise and hypertension, but most were cross-sectional and suffering from a high risk of bias. The most comprehensive evidence was available for road traffic noise and Ischeamic Heart Diseases (IHD). Combining the results of 7 longitudinal studies revealed a Relative Risk (RR) of 1.08 (95% CI: 1.01–1.15) per 10 dB (L_DEN) for the association between road traffic noise and the incidence of IHD. We rated the quality of this evidence as high. Only a few studies reported on the association between transportation noise and stroke, diabetes, and/or obesity. The quality of evidence for these associations was rated from moderate to very low, depending on transportation noise source and outcome. For a comprehensive assessment of the impact of noise exposure on the cardiovascular and metabolic system, we need more and better quality evidence, primarily based on longitudinal studies. Full article

(This article belongs to the Special Issue WHO Noise and Health Evidence Reviews)

12 pages, 582 KiB

Open AccessFeature PaperReview

Immune Responses to Dengue and Zika Viruses—Guidance for T Cell Vaccine Development

by Claude Roth, Félix G. Delgado, Etienne Simon-Lorière and Anavaj Sakuntabhai

Int. J. Environ. Res. Public Health 2018, 15(2), 385; https://doi.org/10.3390/ijerph15020385 - 23 Feb 2018

Cited by 14 | Viewed by 7744

Abstract

Despite numerous efforts to identify the molecular and cellular effectors of the adaptive immunity that induce a long-lasting immunity against dengue or Zika virus infection, the specific mechanisms underlying such protective immunity remain largely unknown. One of the major challenges lies in the [...] Read more.

Despite numerous efforts to identify the molecular and cellular effectors of the adaptive immunity that induce a long-lasting immunity against dengue or Zika virus infection, the specific mechanisms underlying such protective immunity remain largely unknown. One of the major challenges lies in the high level of dengue virus (DENV) seroprevalence in areas where Zika virus (ZIKV) is circulating. In the context of such a pre-existing DENV immunity that can exacerbate ZIKV infection and disease, and given the lack of appropriate treatment for ZIKV infection, there is an urgent need to develop an efficient vaccine against DENV and ZIKV. Notably, whereas several ZIKV vaccine candidates are currently in clinical trials, all these vaccine candidates have been designed to induce neutralizing antibodies as the primary mechanism of immune protection. Given the difficulty to elicit simultaneously high levels of neutralizing antibodies against the different DENV serotypes, and the potential impact of pre-existing subneutralizing antibodies induced upon DENV infection or vaccination on ZIKV infection and disease, additional or alternative strategies to enhance vaccine efficacy, through T cell immunity, are now being considered. In this review, we summarize recent discoveries about cross-reactive B and T cell responses against DENV and ZIKV and propose guidelines for the development of safe and efficient T cell vaccines targeting both viruses. Full article

(This article belongs to the Special Issue Global Epidemics of Zika? Implications for Public Health)

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30 pages, 1814 KiB

Open AccessReview

The Role of Culex pipiens L. (Diptera: Culicidae) in Virus Transmission in Europe

by Victor A. Brugman, Luis M. Hernández-Triana, Jolyon M. Medlock, Anthony R. Fooks, Simon Carpenter and Nicholas Johnson

Int. J. Environ. Res. Public Health 2018, 15(2), 389; https://doi.org/10.3390/ijerph15020389 - 23 Feb 2018

Cited by 120 | Viewed by 10680

Abstract

Over the past three decades, a range of mosquito-borne viruses that threaten public and veterinary health have emerged or re-emerged in Europe. Mosquito surveillance activities have highlighted the Culex pipiens species complex as being critical for the maintenance of a number of these [...] Read more.

Over the past three decades, a range of mosquito-borne viruses that threaten public and veterinary health have emerged or re-emerged in Europe. Mosquito surveillance activities have highlighted the Culex pipiens species complex as being critical for the maintenance of a number of these viruses. This species complex contains morphologically similar forms that exhibit variation in phenotypes that can influence the probability of virus transmission. Critical amongst these is the choice of host on which to feed, with different forms showing different feeding preferences. This influences the ability of the mosquito to vector viruses and facilitate transmission of viruses to humans and domestic animals. Biases towards blood-feeding on avian or mammalian hosts have been demonstrated for different Cx. pipiens ecoforms and emerging evidence of hybrid populations across Europe adds another level of complexity to virus transmission. A range of molecular methods based on DNA have been developed to enable discrimination between morphologically indistinguishable forms, although this remains an active area of research. This review provides a comprehensive overview of developments in the understanding of the ecology, behaviour and genetics of Cx. pipiens in Europe, and how this influences arbovirus transmission. Full article

(This article belongs to the Special Issue Emerging Infectious Disease (EID) Research, Management and Response)

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9 pages, 949 KiB

Open AccessFeature PaperCase Report

Near-Patient Sampling to Assist Infection Control—A Case Report and Discussion

by Julian W. Tang, Elizabeth Hoyle, Sammy Moran and Manish Pareek

Int. J. Environ. Res. Public Health 2018, 15(2), 238; https://doi.org/10.3390/ijerph15020238 - 31 Jan 2018

Cited by 6 | Viewed by 4239

Abstract

Air sampling as an aid to infection control is still in an experimental stage, as there is no consensus about which air samplers and pathogen detection methods should be used, and what thresholds of specific pathogens in specific exposed populations (staff, patients, or [...] Read more.

Air sampling as an aid to infection control is still in an experimental stage, as there is no consensus about which air samplers and pathogen detection methods should be used, and what thresholds of specific pathogens in specific exposed populations (staff, patients, or visitors) constitutes a true clinical risk. This case report used a button sampler, worn or held by staff or left free-standing in a fixed location, for environmental sampling around a child who was chronically infected by a respiratory adenovirus, to determine whether there was any risk of secondary adenovirus infection to the staff managing the patient. Despite multiple air samples taken on difference days, coinciding with high levels of adenovirus detectable in the child’s nasopharyngeal aspirates (NPAs), none of the air samples contained any detectable adenovirus DNA using a clinically validated diagnostic polymerase chain reaction (PCR) assay. Although highly sensitive, in-house PCR assays have been developed to detect airborne pathogen RNA/DNA, it is still unclear what level of specific pathogen RNA/DNA constitutes a true clinical risk. In this case, the absence of detectable airborne adenovirus DNA using a conventional diagnostic assay removed the requirement for staff to wear surgical masks and face visors when they entered the child’s room. No subsequent staff infections or outbreaks of adenovirus have so far been identified. Full article

(This article belongs to the Special Issue Environmental Hygiene)

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14 pages, 577 KiB

Open AccessProtocol

Adapting, Pilot Testing and Evaluating the Kick.it App to Support Smoking Cessation for Smokers with Severe Mental Illness: A Study Protocol

by Sharon Lawn, Joseph Van Agteren, Sara Zabeen, Sue Bertossa, Christopher Barton and James Stewart

Int. J. Environ. Res. Public Health 2018, 15(2), 254; https://doi.org/10.3390/ijerph15020254 - 3 Feb 2018

Cited by 11 | Viewed by 7030

Abstract

(1) Background: While the prevalence of tobacco smoking in the general population has declined, it remains exceptionally high for smokers with severe mental illness (SMI), despite significant public health measures. This project aims to adapt, pilot test and evaluate a novel e-health smoking [...] Read more.

(1) Background: While the prevalence of tobacco smoking in the general population has declined, it remains exceptionally high for smokers with severe mental illness (SMI), despite significant public health measures. This project aims to adapt, pilot test and evaluate a novel e-health smoking cessation intervention to assist relapse prevention and encourage sustained smoking cessation for young adults (aged 18–29 years) with SMI. (2) Methods: Using co-design principles, the researchers will adapt the Kick.it smartphone App in collaboration with a small sample of current and ex-smokers with SMI. In-depth interviews with smokers with SMI who have attempted to quit in the past 12 months and ex-smokers (i.e., those having not smoked in the past seven days) will explore their perceptions of smoking cessation support options that have been of value to them. Focus group participants will then give their feedback on the existing Kick.it App and any adaptations needed. The adapted App will then be pilot-tested with a small sample of young adult smokers with SMI interested in attempting to cut down or quit smoking, measuring utility, feasibility, acceptability, and preliminary outcomes in supporting their quit efforts. (3) Conclusions: This pilot work will inform a larger definitive trial. Dependent on recruitment success, the project may extend to also include smokers with SMI who are aged 30 years or more. Full article

(This article belongs to the Special Issue Development and Evaluation of New Tobacco Control Interventions)

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3 pages, 245 KiB

Open AccessComment

Comment on Tomaskova et al. Mortality in Miners with Coal-Workers’ Pneumoconiosis in the Czech Republic in the Period 1992–2013. Int. J. Environ. Res. Public Health, 2017, 14, 269

by Mei Yong

Int. J. Environ. Res. Public Health 2018, 15(2), 276; https://doi.org/10.3390/ijerph15020276 - 6 Feb 2018

Cited by 2 | Viewed by 3092

Abstract

With interest, I read the recent analysis by Tomaskova and co-workers (2017) about mortality from coal workers’ pneumoconiosis (CWP). The research question remains unclear whether coal workers’ pneumoconiosis (CWP) resulting from exposure to respirable coal dust containing crystalline silica accelerates the development of [...] Read more.

With interest, I read the recent analysis by Tomaskova and co-workers (2017) about mortality from coal workers’ pneumoconiosis (CWP). The research question remains unclear whether coal workers’ pneumoconiosis (CWP) resulting from exposure to respirable coal dust containing crystalline silica accelerates the development of lung cancer or whether it is an intermediate stage in the pathway. I made several points of considerations with respect to (1) qualified data; (2) alternate measures for excessive risks; and (3) methodological flaws that should be avoided. Full article

(This article belongs to the Section Occupational Safety and Health)

4 pages, 288 KiB

Open AccessReply

A response to the Comment on Tomaskova et al. Mortality in Miners with Coal-Workers’ Pneumoconiosis in the Czech Republic in the Period 1992–2013. Int. J. Environ. Res. Public Health, 2017, 14, 269 by the Author Mei Yong

by Hana Tomášková, Anna Šplíchalová, Hana Šlachtová, Daniela Pelclová, Pavel Urban and Zdeněk Jirák

Int. J. Environ. Res. Public Health 2018, 15(2), 322; https://doi.org/10.3390/ijerph15020322 - 13 Feb 2018

Cited by 1 | Viewed by 3063

Abstract

At first, we would like to thank Mei Yong for the comments on our article Mortality in Miners with Coal-Workers’ Pneumoconiosis in the Czech Republic in the Period 1992–2013 [...] Full article

15 pages, 2004 KiB

Open AccessProtocol

Examining the Influence of a New Light Rail Line on the Health of a Demographically Diverse and Understudied Population within the Washington, D.C. Metropolitan Area: A Protocol for a Natural Experiment Study

by Jennifer D. Roberts, Ming Hu, Brit Irene Saksvig, Micah L. Brachman and Casey P. Durand

Int. J. Environ. Res. Public Health 2018, 15(2), 333; https://doi.org/10.3390/ijerph15020333 - 13 Feb 2018

Cited by 7 | Viewed by 7657

Abstract

Approximately two-thirds of adults and youth in Prince George’s County, Maryland, a suburb of Washington, D.C. are overweight or obese and less than half are achieving daily physical activity recommendations. Active transportation (AT), such as walking, biking or using public transportation (PT), is [...] Read more.

Approximately two-thirds of adults and youth in Prince George’s County, Maryland, a suburb of Washington, D.C. are overweight or obese and less than half are achieving daily physical activity recommendations. Active transportation (AT), such as walking, biking or using public transportation (PT), is a strategic pathway to improving physical activity levels and thus reducing excess weight. Utilizing an expansion of the Washington, D.C. area transportation system with a new light rail line, the Purple Line Outcomes on Transportation (PLOT) Study will exam pre- and post-Purple Line PT use, AT behaviors and attitudes and physical activity among Prince George’s County adults and youth. The PLOT Study will take advantage of this natural experiment in an area enduring significant racial/ethnic and gender-based overweight or obesity and physical inactivity disparities. While similar natural experiments on AT have been conducted in other U.S. cities, those studies lacked diverse and representative samples. To effectively evaluate these physical activity outcomes among this population, efforts will be used to recruit African American and Latino populations, the first and second most common racial/ethnic groups in Prince George’s County. Finally, the PLOT Study will also examine how contextual effects (e.g., neighborhood built environment) impact PT, AT and physical activity. Full article

(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)

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12 pages, 273 KiB

Open AccessFeature PaperCommentary

Preparing Physical and Occupational Therapists to Be Health Promotion Practitioners: A Call for Action

by David M. Morris and Gavin R. Jenkins

Int. J. Environ. Res. Public Health 2018, 15(2), 392; https://doi.org/10.3390/ijerph15020392 - 24 Feb 2018

Cited by 32 | Viewed by 19617

Abstract

Experts around the world support the integration of health promotion and wellness (HPW) services into traditional health care services. If successfully executed, the addition of HPW services would reduce rates of death and disability and significantly reduce health care costs. While all health [...] Read more.

Experts around the world support the integration of health promotion and wellness (HPW) services into traditional health care services. If successfully executed, the addition of HPW services would reduce rates of death and disability and significantly reduce health care costs. While all health care providers should be engaged in providing HPW services, many believe that physical therapists (PTs) and occupational therapists (OTs) are uniquely positioned to provide these services. However, research suggests that clinicians in both fields may fall short in doing so. Likewise, research indicates that entry-level educational programs inadequately prepare PT and OT students to be HPW practitioners. The overall purpose of this paper is to provide recommendations to educators for preparing PT and OT students and clinicians to better meet the HPW needs of the clients and patients they serve. Full article

(This article belongs to the Special Issue Health Promotion Interventions for People with Disabilities)

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Int. J. Environ. Res. Public Health, Volume 15, Issue 2 (February 2018) – 218 articles

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