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Int. J. Environ. Res. Public Health, Volume 15, Issue 6 (June 2018)

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Cover Story (view full-size image) In this original, community-based study, we examined factors associated with alcohol-related [...] Read more.
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Open AccessArticle Estimates of the Lung Cancer Cases Attributable to Radon in Municipalities of Two Apulia Provinces (Italy) and Assessment of Main Exposure Determinants
Int. J. Environ. Res. Public Health 2018, 15(6), 1294; https://doi.org/10.3390/ijerph15061294
Received: 10 May 2018 / Revised: 31 May 2018 / Accepted: 15 June 2018 / Published: 20 June 2018
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Abstract
Indoor radon exposure is responsible for increased incidence of lung cancer in communities. Building construction characteristics, materials, and environmental determinants are associated with increased radon concentration at specific sites. In this study, routine data related to radon measurements available from the Apulia (Italy)
[...] Read more.
Indoor radon exposure is responsible for increased incidence of lung cancer in communities. Building construction characteristics, materials, and environmental determinants are associated with increased radon concentration at specific sites. In this study, routine data related to radon measurements available from the Apulia (Italy) Regional Environmental Protection Agency (ARPA) were combined with building and ground characteristics data. An algorithm was created based on the experience of miners and it was able to produce estimates of lung cancer cases attributable to radon in different municipalities with the combined data. In the province of Lecce, the sites with a higher risk of lung cancer are Campi Salentina and Minervino, with 1.18 WLM (working level months) and 1.38 WLM, respectively, corresponding to lung cancer incidence rates of 3.34 and 3.89 per 10 × 103 inhabitants. The sites in the province of Bari with higher risks of lung cancer are Gravina di Puglia and Locorotondo, measuring 1.89 WLM and 1.22 WLM, respectively, which correspond to an incidence rate of lung cancer of 5.36 and 3.44 per 10 × 103 inhabitants. The main determinants of radon exposure are whether the buildings were built between 1999 and 2001, were one-room buildings with porous masonry, and were built on soil consisting of pelvis, clayey sand, gravel and conglomerates, calcarenites, and permeable lithotypes. Full article
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Open AccessFeature PaperArticle Deriving A Drinking Water Guideline for A Non-Carcinogenic Contaminant: The Case of Manganese
Int. J. Environ. Res. Public Health 2018, 15(6), 1293; https://doi.org/10.3390/ijerph15061293
Received: 19 May 2018 / Revised: 14 June 2018 / Accepted: 16 June 2018 / Published: 20 June 2018
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Abstract
Manganese is a natural contaminant of water sources. It is an essential oligo-element, which may exert toxicity at high doses, particularly via inhalation. Its toxicity by the oral route is less known, but epidemiological and experimental studies tend to support its neurodevelopmental toxicity
[...] Read more.
Manganese is a natural contaminant of water sources. It is an essential oligo-element, which may exert toxicity at high doses, particularly via inhalation. Its toxicity by the oral route is less known, but epidemiological and experimental studies tend to support its neurodevelopmental toxicity in infants and children. This paper describes the method used by a middle-size public health institution to derive a Drinking Water Guideline (DWG) for manganese. After reviewing the work done by major public health institutions, authors confirmed the use of experimental data to derive a point-of-departure (POD) of 25 mg of manganese/kg/day, based on neurodevelopmental effects on pup rats. Then, a total uncertainty factor of 450 was applied to calculate a Toxicological Reference Value (TRV) of 55 µg/kg/day. The final DWG proposed for manganese is 60 µg/L and is based on a relative source contribution (RSC) of water of 20% and an infant drinking scenario of 182 mL/kg of body weight (BW) of water (95th percentile of the ingestion rate distribution for 0–6 months). Despite its limitations, e.g., starting with the work done by other agencies, such an approach demonstrates in a transparent way the rationale and challenging choices made by regulators when deriving a DWG. Full article
(This article belongs to the Special Issue Drinking Water Quality and Human Health)
Open AccessReview Effects of Mind–Body Movements on Balance Function in Stroke Survivors: A Meta-Analysis of Randomized Controlled Trials
Int. J. Environ. Res. Public Health 2018, 15(6), 1292; https://doi.org/10.3390/ijerph15061292
Received: 26 May 2018 / Revised: 15 June 2018 / Accepted: 17 June 2018 / Published: 20 June 2018
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Abstract
Objective: We performed a systematic review with meta-analysis and meta-regression to determine if mind–body movements (MBM) could be effective in rehabilitating balance function among stroke survivors. Methods: A literature search was conducted using major Chinese and English electronic databases from an
[...] Read more.
Objective: We performed a systematic review with meta-analysis and meta-regression to determine if mind–body movements (MBM) could be effective in rehabilitating balance function among stroke survivors. Methods: A literature search was conducted using major Chinese and English electronic databases from an inception until January 2018. Randomized controlled studies were included in our meta-analysis. Data was independently extracted by two review authors using a pre-developed table and confirmed by a third party to reach a consensus. Pooled effect size (Hedge’s g) was computed while the random-effect model was set. Results: The meta-analytic results showed a significant benefit of the MBM intervention on increased balance function compared to the control groups (Hedge’s g = 1.59, CI 0.98 to 2.19, p < 0.001, I2 = 94.95%). Additionally, the meta-regression indicated that the total number of sessions (β = 0.00142, 95% CI 0.0039 to 0.0244, p = 0.0067) and dose of weekly training (β = 0.00776, 95% CI 0.00579 to 0.00972, p = 0.00) had significantly positive effects on balance function. Conclusions: The study encouraging findings indicate the rehabilitative effect of a MBM intervention for balance function in stroke survivors. However, there were significant limitations in the design among several of the included trials. Additional studies with more robust methodologies are needed to provide a more definitive conclusion. Full article
(This article belongs to the Special Issue Effect of Sport Activity on Health Promotion)
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Open AccessArticle Knowledge Discovery from Posts in Online Health Communities Using Unified Medical Language System
Int. J. Environ. Res. Public Health 2018, 15(6), 1291; https://doi.org/10.3390/ijerph15061291
Received: 31 May 2018 / Revised: 15 June 2018 / Accepted: 16 June 2018 / Published: 19 June 2018
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Abstract
Patient-reported posts in Online Health Communities (OHCs) contain various valuable information that can help establish knowledge-based online support for online patients. However, utilizing these reports to improve online patient services in the absence of appropriate medical and healthcare expert knowledge is difficult. Thus,
[...] Read more.
Patient-reported posts in Online Health Communities (OHCs) contain various valuable information that can help establish knowledge-based online support for online patients. However, utilizing these reports to improve online patient services in the absence of appropriate medical and healthcare expert knowledge is difficult. Thus, we propose a comprehensive knowledge discovery method that is based on the Unified Medical Language System for the analysis of narrative posts in OHCs. First, we propose a domain-knowledge support framework for OHCs to provide a basis for post analysis. Second, we develop a Knowledge-Involved Topic Modeling (KI-TM) method to extract and expand explicit knowledge within the text. We propose four metrics, namely, explicit knowledge rate, latent knowledge rate, knowledge correlation rate, and perplexity, for the evaluation of the KI-TM method. Our experimental results indicate that our proposed method outperforms existing methods in terms of providing knowledge support. Our method enhances knowledge support for online patients and can help develop intelligent OHCs in the future. Full article
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Open AccessArticle Red-Light-Running Crashes’ Classification, Comparison, and Risk Analysis Based on General Estimates System (GES) Crash Database
Int. J. Environ. Res. Public Health 2018, 15(6), 1290; https://doi.org/10.3390/ijerph15061290
Received: 10 April 2018 / Revised: 4 June 2018 / Accepted: 4 June 2018 / Published: 19 June 2018
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Abstract
Red-light running (RLR) has been identified as one of the prominent contributing factors involved in signalized intersection crashes. In order to reduce RLR crashes, primarily, a better understanding of RLR behavior and crashes is needed. In this study, three RLR crash types were
[...] Read more.
Red-light running (RLR) has been identified as one of the prominent contributing factors involved in signalized intersection crashes. In order to reduce RLR crashes, primarily, a better understanding of RLR behavior and crashes is needed. In this study, three RLR crash types were extracted from the general estimates system (GES), including go-straight (GS) RLR vehicle colliding with go-straight non-RLR vehicle, go-straight RLR vehicle colliding with left-turn (LT) non-RLR vehicle, and left-turn RLR vehicle colliding with go-straight non-RLR vehicle. Then, crash features within each crash type scenario were compared, and risk analyses of GS RLR and LT RLR were also conducted. The results indicated that for the GS RLR driver, the speed limit displayed the highest effects on the percentages of GS RLR collision scenarios. For the LT RLR driver, the number of lanes displayed the highest effects on the percentages of LT RLR collision scenarios. Additionally, the drivers who were older than 50 years, distracted, and had a limited view were more likely to be involved in LT RLR accidents. Furthermore, the speeding drivers were more likely to be involved in GS RLR accidents. These findings could give a comprehensive understanding of RLR crash features and propensities for each RLR crash type. Full article
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
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Open AccessArticle Understanding Intersectionality and Resiliency among Transgender Adolescents: Exploring Pathways among Peer Victimization, School Belonging, and Drug Use
Int. J. Environ. Res. Public Health 2018, 15(6), 1289; https://doi.org/10.3390/ijerph15061289
Received: 20 April 2018 / Revised: 14 June 2018 / Accepted: 16 June 2018 / Published: 19 June 2018
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Abstract
Transgender youth experience elevated levels of victimization and may therefore report greater drug use than their cisgender peers, yet little is known about protective factors like school belonging that may mediate this relationship. Further, scant research has explored the experiences of youth at
[...] Read more.
Transgender youth experience elevated levels of victimization and may therefore report greater drug use than their cisgender peers, yet little is known about protective factors like school belonging that may mediate this relationship. Further, scant research has explored the experiences of youth at the intersection of transgender identity and youth of color status or low socioeconomic status, especially with respect to these multiple minority statuses’ associations with peer victimization, drug use, and school belonging. Using data from the California Healthy Kids Survey, the current study employs structural equation modeling to explore the relationships among school belonging, peer victimization, and drug use for transgender youth. Findings indicate that school belonging does mediate the pathway between peer victimization and drug use for transgender youth and that although youth of color experience greater victimization, they do not engage in greater drug use than their white transgender peers. Based on these results, those concerned with the healthy futures of transgender youth should advocate for more open and affirming school climates that engender a sense of belonging and treat transgender youth with dignity and fairness. Full article
(This article belongs to the Special Issue Breakthroughs in LGBT Health Research)
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Open AccessArticle Differences in the Perception of Social Support Among Rural Area Seniors—A Cross-Sectional Survey of Polish Population
Int. J. Environ. Res. Public Health 2018, 15(6), 1288; https://doi.org/10.3390/ijerph15061288
Received: 20 April 2018 / Revised: 10 June 2018 / Accepted: 16 June 2018 / Published: 19 June 2018
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Abstract
Introduction and objective: Social support constitutes an important determinant of an elderly person’s health and of functioning in his or her living environment. It depends on available support networks and the type of help received. Measurement of social support should encompass both
[...] Read more.
Introduction and objective: Social support constitutes an important determinant of an elderly person’s health and of functioning in his or her living environment. It depends on available support networks and the type of help received. Measurement of social support should encompass both its structure and the functions it fulfills, which enables detailed assessment of the phenomenon. The aim of the study was to compare the perception of social support among rural area seniors provided with institutional care with those living in a home setting. Material and method: Using the diagnostic survey method and the technique of the distribution of a direct questionnaire, 364 respondents from rural areas were examined: those living in an institutional environment (n = 190) and those living in their home (natural) environment (n = 174). The respondents were selected on the basis of a combined sampling method: proportionate, stratified, and systematic. Variables were measured with the following questionnaires: Courage Social Network Index (CSNI) and Social Support Scale (SSS). Results: The living environment has been proved to differentiate average values of support both in the structural and functional dimensions in a statistically significant way (p < 0.001). An untypical phenomenon was higher average values pertaining to emotional bonds, frequency of direct contacts, and help received in the group of respondents living in an institutional environment. Conclusions: The living environment and demographic variables affect the perception of social support among elderly people. Full-time institutional care of a senior citizen leads to the deterioration of social support; therefore, keeping an elderly person in a home environment should be one of the primary goals of the senior policy. Full article
(This article belongs to the Special Issue Social Networks and Health)
Open AccessReview Trends and Knowledge Gaps in the Study of Nature-Based Participation by Latinos in the United States
Int. J. Environ. Res. Public Health 2018, 15(6), 1287; https://doi.org/10.3390/ijerph15061287
Received: 3 April 2018 / Revised: 11 June 2018 / Accepted: 14 June 2018 / Published: 19 June 2018
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Abstract
Mounting evidence supports health and well-being benefits associated with nature experiences, while also highlighting race- and class-based inequalities in access and exposure. We synthesized the literature on nature contact by Latinos in the United States to assess the state of knowledge and strategically
[...] Read more.
Mounting evidence supports health and well-being benefits associated with nature experiences, while also highlighting race- and class-based inequalities in access and exposure. We synthesized the literature on nature contact by Latinos in the United States to assess the state of knowledge and strategically identify research needs to improve outcomes and reduce health disparities for this rapidly growing ethnic group. Our systematic review revealed 108 articles with a notable increase in number of papers over the past 3 decades. We noted that the body of research is focused on certain demographic targets (adults in urban areas) with a relative dearth of knowledge for others (children, seniors, and rural areas). Our analysis also revealed strong compartmentalizing of studies into research “clusters” based on nonoverlapping topics and types of outcomes that are measured. Although one-third of studies explored health outcomes, these studies rarely examined other outcomes or research topics. Moreover, less than 7% of studies reported on interventions. Given the potential for nature contact to enhance health and well-being, there is substantial need for multidisciplinary research that explores interactions between social, cultural, and economic factors, and how those ultimately relate to nature contact and outcomes for Latinos in the United States. Full article
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Open AccessFeature PaperArticle Susceptibility to Alcohol Hangovers: The Association with Self-Reported Immune Status
Int. J. Environ. Res. Public Health 2018, 15(6), 1286; https://doi.org/10.3390/ijerph15061286
Received: 29 May 2018 / Revised: 10 June 2018 / Accepted: 12 June 2018 / Published: 18 June 2018
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Abstract
Increasing evidence points at a role for the immune system in the genesis of the alcohol hangover. This study investigated the association between self-reported immune function and experiencing hangovers. Dutch students aged 18 to 30 years old were invited to complete an online
[...] Read more.
Increasing evidence points at a role for the immune system in the genesis of the alcohol hangover. This study investigated the association between self-reported immune function and experiencing hangovers. Dutch students aged 18 to 30 years old were invited to complete an online survey. Eighteen items on immune-related complaints were completed to assess self-reported immune function. Alcohol consumption in the past month (with respect to usual consumption and the occasion of heaviest drinking) was also recorded. Subjects with an estimated blood alcohol concentration (eBAC) of 0.18% or higher on their heaviest drinking occasion in the prior month were included in the analyses. Self-reported immune function was compared between drinkers with a hangover and those who claimed to be hangover resistant. In total, of 481 subjects (79.2% women) with a mean (SD) age of 21.1 (1.9) years old were included in the analysis. Of these, 83.3% (n = 400) reported having hangovers and 16.8% (n = 81) claimed to be hangover resistant. Drinkers with hangovers had significantly higher self-reported overall immune function scores when compared to hangover-resistant drinkers (mean ± SD = 10.5 ± 3.6 versus 13.1 ± 4.9, p = 0.0001), indicating a poorer immune status. In conclusion, experiencing alcohol hangovers is associated with significantly poorer self-reported immune function. Full article
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Open AccessArticle Association between Access to Public Open Spaces and Physical Activity in a Mediterranean Population at High Cardiovascular Risk
Int. J. Environ. Res. Public Health 2018, 15(6), 1285; https://doi.org/10.3390/ijerph15061285
Received: 3 May 2018 / Revised: 14 June 2018 / Accepted: 14 June 2018 / Published: 17 June 2018
Cited by 1 | PDF Full-text (1381 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Background: Regular physical activity is an important preventive factor of cardiovascular disease. Proximity and density of public open spaces are important modifying factors on the practice of physical activity. This article explores the cross-sectional relationship between access to public open spaces (POS)
[...] Read more.
Background: Regular physical activity is an important preventive factor of cardiovascular disease. Proximity and density of public open spaces are important modifying factors on the practice of physical activity. This article explores the cross-sectional relationship between access to public open spaces (POS) and leisure time physical activity (LTPA) in elderly participants at high cardiovascular risk from PREDIMED-Baleares. Method: 428 elderly subjects at high cardiovascular risk, participating in the PREDIMED trial, from Palma de Mallorca (Spain) were assessed using Geographic Information Systems, and access to POS was determined. The quantity and intensity of LTPA was calculated using the Minnesota Leisure-Time Physical Activity Questionnaire. In order investigate the association between access to POS and LTPA, generalized linear regression models were used. Results: Better access to POS was not consistently associated with total LTPA. Only distance to the nearest park showed a borderline significant positive associated with total LTPA and moderate-vigorous LTPA but was not associated with light LTPA. Conclusions: Although living near POS was not associated to total LTPA, higher levels of moderate-vigorous LTPA were associated to distances to the nearest park. Future work should be conducted on a larger sample size, integrating a longitudinal design, and greater heterogeneity in POS access and introducing objective measures of physical activity. Full article
(This article belongs to the Special Issue Obesity and Urban Environments)
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Open AccessArticle Antimicrobial Resistance in Food Animals and the Environment in Nigeria: A Review
Int. J. Environ. Res. Public Health 2018, 15(6), 1284; https://doi.org/10.3390/ijerph15061284
Received: 4 April 2018 / Revised: 14 June 2018 / Accepted: 14 June 2018 / Published: 17 June 2018
Cited by 1 | PDF Full-text (3270 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Antimicrobial resistance (AMR) has emerged as a global health threat, which has elicited a high-level political declaration at the United Nations General Assembly, 2016. In response, member countries agreed to pay greater attention to the surveillance and implementation of antimicrobial stewardship. The Nigeria
[...] Read more.
Antimicrobial resistance (AMR) has emerged as a global health threat, which has elicited a high-level political declaration at the United Nations General Assembly, 2016. In response, member countries agreed to pay greater attention to the surveillance and implementation of antimicrobial stewardship. The Nigeria Centre for Disease Control called for a review of AMR in Nigeria using a “One Health approach”. As anecdotal evidence suggests that food animal health and production rely heavily on antimicrobials, it becomes imperative to understand AMR trends in food animals and the environment. We reviewed previous studies to curate data and evaluate the contributions of food animals and the environment (2000–2016) to the AMR burden in Nigeria using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart focused on three areas: Antimicrobial resistance, residues, and antiseptics studies. Only one of the 48 antimicrobial studies did not report multidrug resistance. At least 18 bacterial spp. were found to be resistant to various locally available antimicrobials. All 16 residue studies reported high levels of drug residues either in the form of prevalence or concentration above the recommended international limit. Fourteen different “resistotypes” were found in some commonly used antiseptics. High levels of residues and AMR were found in food animals destined for the human food chain. High levels of residues and antimicrobials discharged into environments sustain the AMR pool. These had evolved into potential public health challenges that need attention. These findings constitute public health threats for Nigeria’s teeming population and require attention. Full article
(This article belongs to the Special Issue Antimicrobials and Antimicrobial Resistance in the Environment)
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Open AccessArticle A US/Mexico Study of Joint Associations of Physical Activity and Sedentary Behavior on Anthropometric Indicators, Migration Status, Country of Birth and Country of Residence
Int. J. Environ. Res. Public Health 2018, 15(6), 1283; https://doi.org/10.3390/ijerph15061283
Received: 15 April 2018 / Revised: 31 May 2018 / Accepted: 11 June 2018 / Published: 17 June 2018
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Abstract
Background: This study examined the influence of migration status, nativity and country of residence on joint associations of physical activity (PA) and sedentary behavior (SB) in anthropometric indicators of Mexicans and Mexican-Americans living in the US and in Mexico. Methods: We examined data
[...] Read more.
Background: This study examined the influence of migration status, nativity and country of residence on joint associations of physical activity (PA) and sedentary behavior (SB) in anthropometric indicators of Mexicans and Mexican-Americans living in the US and in Mexico. Methods: We examined data from two large national surveys, the National Health and Nutrition Examination Survey from the US (NHANES, 2011–2012) and Mexico (ENSANUT, 2012). Using self-reported minutes of moderate to vigorous physical activity and SB, we calculated four categories for analyses. Anthropometric measures consisted of body mass index (BMI) and waist circumference (WC). We used data of migration status, nativity and country of residence. Linear regression models examined how joint categories of PA and SB were associated with BMI and WC according to migration status, nativity and country of residence, controlling for health risk behaviors. Results: Analyses showed that even among those in the category with the lowest risk behavior, “physically active and low sedentary”, there were differences in BMI and WC by migration status, nativity and country of residence. Within this lower risk category, Mexican immigrants living in the US had the greatest association with high BMI, while US-born Mexican-Americans living in the US had the highest WC values when compared with the group of Mexicans living in Mexico. Conclusions: Joint categories of PA and SB were associated with BMI and WC by migration status, nativity and country of residence among populations with Mexican ethnicity. Full article
(This article belongs to the collection Sedentary Behaviour and Health)
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Open AccessReview Farming for Life Quality and Sustainability: A Literature Review of Green Care Research Trends in Europe
Int. J. Environ. Res. Public Health 2018, 15(6), 1282; https://doi.org/10.3390/ijerph15061282
Received: 9 April 2018 / Revised: 6 June 2018 / Accepted: 13 June 2018 / Published: 17 June 2018
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Abstract
Green care is an innovative approach that combines simultaneously caring for people and caring for land through three elements that have not been previously connected: (1) multifunctional agriculture and recognition of the plurality of agricultural system values; (2) social services and health care;
[...] Read more.
Green care is an innovative approach that combines simultaneously caring for people and caring for land through three elements that have not been previously connected: (1) multifunctional agriculture and recognition of the plurality of agricultural system values; (2) social services and health care; and (3) the possibility of strengthening the farming sector and local communities. The current research provides a comprehensive overview of green care in Europe as a scientific discipline through a literature review (n = 98 studies). According to our results, the Netherlands, the UK, Norway and Sweden followed by Italy have led the scientific studies published in English. Green care research comprises a wide range of perspectives and frameworks (social farming, care farming, nature-based solutions, etc.) with differences in their specificities. Green care studies have mainly focused on measuring the effectiveness of therapeutic interventions. Studies that evaluate its relevance in socio-economic and environmental terms are still limited. According to our results, the most common users studied were people suffering from psychological and mental ill health, while the most common activities were horticulture, animal husbandry and gardening. Finally, we discuss the potential of green care to reconnect people with nature and to diversify the farming sector providing new public services associated with the relational values society obtains from the contact with agricultural systems. Full article
(This article belongs to the Special Issue Green Environment, Green Operations and Sustainability)
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Open AccessArticle Seasonal Variations in Water-Quality, Antibiotic Residues, Resistant Bacteria and Antibiotic Resistance Genes of Escherichia coli Isolates from Water and Sediments of the Kshipra River in Central India
Int. J. Environ. Res. Public Health 2018, 15(6), 1281; https://doi.org/10.3390/ijerph15061281
Received: 28 May 2018 / Revised: 14 June 2018 / Accepted: 14 June 2018 / Published: 17 June 2018
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Abstract
Objectives: To characterize the seasonal variation, over one year, in water-quality, antibiotic residue levels, antibiotic resistance genes and antibiotic resistance in Escherichia coli isolates from water and sediment of the Kshipra River in Central India. Methods: Water and sediment samples were collected from
[...] Read more.
Objectives: To characterize the seasonal variation, over one year, in water-quality, antibiotic residue levels, antibiotic resistance genes and antibiotic resistance in Escherichia coli isolates from water and sediment of the Kshipra River in Central India. Methods: Water and sediment samples were collected from seven selected points from the Kshipra River in the Indian city of Ujjain in the summer, rainy season, autumn and winter seasons in 2014. Water quality parameters (physical, chemical and microbiological) were analyzed using standard methods. High-performance liquid chromatography–tandem mass spectrometry was used to determine the concentrations of antibiotic residues. In river water and sediment samples, antibiotic resistance and multidrug resistance patterns of isolated E. coli to 17 antibiotics were tested and genes coding for resistance and phylogenetic groups were detected using multiplex polymerase chain reaction. One-way analysis of variance (ANOVA) and Fisher tests were applied to determine seasonal variation. Results: In river water, seasonal variation was significantly associated with various water quality parameters, presence of sulfamethoxazole residues, bacteria resistant to ampicillin, cefepime, meropenem, amikacin, gentamicin, tigecycline, multidrug resistance and CTX-M-1 gene. The majority of the Extended Spectrum Beta-Lactamase (ESBL)-producing E. coli isolates from river water and sediment in all different seasons belonged to phylogenetic group A or B1. Conclusions: Antibiotic pollution, resistance and resistance genes in the Kshipra River showed significant seasonal variation. Guidelines and regulatory standards are needed to control environmental dissemination of these “pollutants” in this holy river. Full article
(This article belongs to the Section Environmental Health)
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Open AccessArticle Short-Term Effects of Tourmaline on Nitrogen Removals and Microbial Communities in a Sequencing Batch Reactor at Low Temperatures
Int. J. Environ. Res. Public Health 2018, 15(6), 1280; https://doi.org/10.3390/ijerph15061280
Received: 30 March 2018 / Revised: 1 June 2018 / Accepted: 14 June 2018 / Published: 17 June 2018
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Abstract
Tourmaline is a ring borosilicate with unique pyro-electricity and piezoelectricity values. Non-gem tourmaline is usually used as an environmental material. The short-term effects of ultrafine tourmaline particles on nitrogen removal performs microbial population dynamics. Key functional species in a sequencing batch reactor were
[...] Read more.
Tourmaline is a ring borosilicate with unique pyro-electricity and piezoelectricity values. Non-gem tourmaline is usually used as an environmental material. The short-term effects of ultrafine tourmaline particles on nitrogen removal performs microbial population dynamics. Key functional species in a sequencing batch reactor were investigated at 9 ± 1 °C. The investigation results showed that 1 g·L−1 ultrafine tourmaline particles could resist the effect of temperature shock on the metabolism of NH4+-N and were beneficial to the restoration of the metabolism capacity of NH4+-N. 1 g·L−1 ultrafine tourmaline particles, which increased the oxidation rate of NH4+-N in the aerobic phase, the formation rate of NO3-N in the aerobic phase, and the denitrification rate in the hypoxia phase at low temperatures. However, the community richness or diversities were not changed after short-term exposure to 1 g·L−1 ultrafine tourmaline particles at low temperatures and 1 g·L−1 ultrafine tourmaline particles could not change the relative abundances of functional microbes except nitrite oxidizing bacteria. Full article
(This article belongs to the Section Environmental Science and Engineering)
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Open AccessReview The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies
Int. J. Environ. Res. Public Health 2018, 15(6), 1279; https://doi.org/10.3390/ijerph15061279
Received: 9 May 2018 / Revised: 13 June 2018 / Accepted: 14 June 2018 / Published: 16 June 2018
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Abstract
Community-based mental health services are emphasized in the World Health Organization’s Mental Health Action Plan, the World Bank’s Disease Control Priorities, and the Action Plan of the World Psychiatric Association. There is increasing evidence for effectiveness of mental health interventions delivered
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Community-based mental health services are emphasized in the World Health Organization’s Mental Health Action Plan, the World Bank’s Disease Control Priorities, and the Action Plan of the World Psychiatric Association. There is increasing evidence for effectiveness of mental health interventions delivered by non-specialists in community platforms in low- and middle-income countries (LMIC). However, the role of community components has yet to be summarized. Our objective was to map community interventions in LMIC, identify competencies for community-based providers, and highlight research gaps. Using a review-of-reviews strategy, we identified 23 reviews for the narrative synthesis. Motivations to employ community components included greater accessibility and acceptability compared to healthcare facilities, greater clinical effectiveness through ongoing contact and use of trusted local providers, family involvement, and economic benefits. Locations included homes, schools, and refugee camps, as well as technology-aided delivery. Activities included awareness raising, psychoeducation, skills training, rehabilitation, and psychological treatments. There was substantial variation in the degree to which community components were integrated with primary care services. Addressing gaps in current practice will require assuring collaboration with service users, utilizing implementation science methods, creating tools to facilitate community services and evaluate competencies of providers, and developing standardized reporting for community-based programs. Full article
(This article belongs to the Special Issue Mental Health and Social Care and Social Interventions)
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Open AccessArticle Spatiotemporal Assessment of PM2.5-Related Economic Losses from Health Impacts during 2014–2016 in China
Int. J. Environ. Res. Public Health 2018, 15(6), 1278; https://doi.org/10.3390/ijerph15061278
Received: 28 April 2018 / Revised: 6 June 2018 / Accepted: 14 June 2018 / Published: 16 June 2018
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Abstract
Background: Particulate air pollution, especially PM2.5, is highly correlated with various adverse health impacts and, ultimately, economic losses for society, however, few studies have undertaken a spatiotemporal assessment of PM2.5-related economic losses from health impacts covering all of
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Background: Particulate air pollution, especially PM2.5, is highly correlated with various adverse health impacts and, ultimately, economic losses for society, however, few studies have undertaken a spatiotemporal assessment of PM2.5-related economic losses from health impacts covering all of the main cities in China. Methods: PM2.5 concentration data were retrieved for 190 Chinese cities for the period 2014–2016. We used a log-linear exposure–response model and monetary valuation methods, such as value of a statistical life (VSL), amended human capital (AHC), and cost of illness to evaluate PM2.5-related economic losses from health impacts at the city level. In addition, Monte Carlo simulation was used to analyze uncertainty. Results: The average economic loss was 0.3% (AHC) to 1% (VSL) of the total gross domestic product (GDP) of 190 Chinese cities from 2014 to 2016. Overall, China experienced a downward trend in total economic losses over the three-year period, but the Beijing–Tianjin–Hebei, Shandong Peninsula, Yangtze River Delta, and Chengdu-Chongqing regions experienced greater annual economic losses. Conclusions: Exploration of spatiotemporal variations in PM2.5-related economic losses from long-term health impacts could provide new information for policymakers regarding priority areas for PM2.5 pollution prevention and control in China. Full article
(This article belongs to the Special Issue Economic Evaluation of Environmental Policies and Interventions)
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Open AccessArticle Lateral Sinus Floor Elevation Performed with Trapezoidal and Modified Triangular Flap Designs: A Randomized Pilot Study of Post-Operative Pain Using Thermal Infrared Imaging
Int. J. Environ. Res. Public Health 2018, 15(6), 1277; https://doi.org/10.3390/ijerph15061277
Received: 22 May 2018 / Revised: 11 June 2018 / Accepted: 12 June 2018 / Published: 16 June 2018
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Abstract
Purpose: Post-operative pain and swelling are frequently observed after sinus lift procedures. The aim of the present study was the clinical evaluation of swelling and pain of two different sinus flap lift techniques using a visual analogue scale (VAS), verbal rating scale (VRS),
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Purpose: Post-operative pain and swelling are frequently observed after sinus lift procedures. The aim of the present study was the clinical evaluation of swelling and pain of two different sinus flap lift techniques using a visual analogue scale (VAS), verbal rating scale (VRS), and infrared thermal imaging (i.e., thermography). Materials Methods: A randomized controlled trial was conducted with 15 patients (30 sinuses in total) randomly allocated into two groups. For the sinuses of Group I a trapezoidal flap was used, while for Group II a modified triangular flap without anterior release was utilized. Postoperative pain was scored by means of a 100-mm VAS ranging from 0 (no pain) to 100 (worst pain imaginable), and was recorded at 2, 4, 6 and 14 days after surgery. Swelling was recorded by a verbal rating scale (VRS) and was classified into four categories: a score of 1 referred the absence of swelling, patients with intra-oral swelling in the surgical zone scored 2, any extra-oral swelling in the surgical zone scored 3, and intense swelling exhibited by extra-oral swelling extending beyond the surgical zone scored 4. The facial temperature was recorded before and after sinus augmentation, and at 2, 4, 6, and 14 days post-surgery to check the course of healing. Results: In Group I pain intensity was recorded at 2 days after surgery with a mean score of 38.67 ± 6.4 mm. Swelling was greater at 2 and 4 days, and was absent at day 6. The facial temperature difference before and after the procedure was 4.737 °C ± 0.37. In Group II the pain score were lower than in Group I (p < 0.05). The score for swelling was 2 on the first and second days, and was reduced on day 4. After the second day the difference in temperature was significantly reduced as compared to the day of surgery (0.77 °C); at 2 and 4 days no difference was registered. Conclusions: The results of this clinical study show the significant effectiveness of the modified triangular flap in the sinus lift procedure for reducing pain and swelling. Full article
(This article belongs to the Special Issue Digital Dentistry: The Evolution of Dental Care)
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Open AccessArticle Influence of Ammonium Ions, Organic Load and Flow Rate on the UV/Chlorine AOP Applied to Effluent of a Wastewater Treatment Plant at Pilot Scale
Int. J. Environ. Res. Public Health 2018, 15(6), 1276; https://doi.org/10.3390/ijerph15061276
Received: 8 May 2018 / Revised: 14 June 2018 / Accepted: 14 June 2018 / Published: 16 June 2018
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Abstract
This work investigates the influence of ammonium ions and the organic load (chemical oxygen demand (COD)) on the UV/chlorine AOP regarding the maintenance of free available chlorine (FAC) and elimination of 16 emerging contaminants (ECs) from wastewater treatment plant effluent (WWTE) at pilot
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This work investigates the influence of ammonium ions and the organic load (chemical oxygen demand (COD)) on the UV/chlorine AOP regarding the maintenance of free available chlorine (FAC) and elimination of 16 emerging contaminants (ECs) from wastewater treatment plant effluent (WWTE) at pilot scale (UV chamber at 0.4 kW). COD inhibited the FAC maintenance in the UV chamber influent at a ratio of 0.16 mg FAC per mg COD (kHOCl–COD = 182 M−1s−1). An increase in ammonium ion concentration led to a stoichiometric decrease of the FAC concentration in the UV chamber influent. Especially in cold seasons due to insufficient nitrification, the ammonium ion concentration in WWTE can become so high that it becomes impossible to achieve sufficiently high FAC concentrations in the UV chamber influent. For all ECs, the elimination effect by the UV/combined Cl2 AOP (UV/CC) was not significantly higher than that by sole UV treatment. Accordingly, the UV/chlorine AOP is very sensitive and loses its effectiveness drastically as soon as there is no FAC but only CC in the UV chamber influent. Therefore, within the electrical energy consumption range tested (0.13–1 kWh/m3), a stable EC elimination performance of the UV/chlorine AOP cannot be maintained throughout the year. Full article
(This article belongs to the Special Issue Municipal Wastewater Treatment)
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Open AccessArticle Screen Time, Physical Activity and Self-Esteem in Children: The Ulm Birth Cohort Study
Int. J. Environ. Res. Public Health 2018, 15(6), 1275; https://doi.org/10.3390/ijerph15061275
Received: 11 May 2018 / Revised: 8 June 2018 / Accepted: 14 June 2018 / Published: 16 June 2018
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Abstract
Screen time is a central activity of children’s daily life and jeopardizes mental health. However, results appear inconclusive and are often based on small cross-sectional studies. We aimed to investigate the temporal sequence of the association between screen time and self-esteem taking into
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Screen time is a central activity of children’s daily life and jeopardizes mental health. However, results appear inconclusive and are often based on small cross-sectional studies. We aimed to investigate the temporal sequence of the association between screen time and self-esteem taking into account further indirect effects through family or friendship relationship. In our population-based birth cohort study (baseline November 2000–November 2001, Ulm, Germany), these relationships were explored in n = 519 11- and 13-year-old children and their parents who both provided information on children’s screen time: time spent watching television or videos (TV), time spent on computers, video game consoles, mobile devices, or cell phones; so called “other screen time”, and children’s self-esteem (KINDL-R). Time watching TV (self-reported) at age 11 was negatively associated with girls’ self-esteem at the same age but positively with an increase of self-esteem between age 11 and 13. However, the latter association was restricted to low to moderate TV viewers. In boys, a higher increase of other screen time between age 11 and age 13 was associated with lower self-reported self-esteem at age 13. Additionally, friendship relationship mediated the association between watching TV and self-esteem in girls. For parental reports similar associations were observed. These findings indicate that time sequence and potential mediators need further investigation in cohort studies with multiple assessments of screen time and self-esteem. Full article
(This article belongs to the collection Sedentary Behaviour and Health)
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Open AccessArticle Prevalence and Consequences of Aggression and Violence towards Nursing and Care Staff in Germany—A Survey
Int. J. Environ. Res. Public Health 2018, 15(6), 1274; https://doi.org/10.3390/ijerph15061274
Received: 4 May 2018 / Revised: 8 June 2018 / Accepted: 13 June 2018 / Published: 15 June 2018
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Abstract
Acts of aggression by patients or clients are a part of the average working day for many Health care employees. The objective of the survey was to study the frequency and nature of violence and the handling of aggressive behavior by facility management.
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Acts of aggression by patients or clients are a part of the average working day for many Health care employees. The objective of the survey was to study the frequency and nature of violence and the handling of aggressive behavior by facility management. The cross-sectional study was conducted in 2017, 81 different healthcare facilities and 1984 employees participated. The questionnaire encompassed socio-demographic details, the frequency of physical violence and verbal abuse, consequences of violence and the stress of employees. In the previous twelve months, 94.1% of the employees in the survey had experienced verbal abuse and 69.8% had experienced physical aggression. Acts of aggression were most commonly encountered in hospitals and residential facilities for the disabled. One third of the employees felt under high levels of stress as a result of the incidents. If the workplace prepares effectively, however, this reduces the perceived stress odds ratio (OR) 0.6, 95% CI 0.4–0.8). Violence and aggression are very common. Healthcare facilities are increasingly dealing with this topic. Awareness raising is likely to lead to higher incident reporting rates. Good preparation and an open approach to the topic in the facilities have a positive effect on the feeling of stress and work ability. Full article
(This article belongs to the Section Occupational Safety and Health)
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Open AccessFeature PaperArticle Observing Maternal Restriction of Food with 3–5-Year-Old Children: Relationships with Temperament and Later Body Mass Index (BMI)
Int. J. Environ. Res. Public Health 2018, 15(6), 1273; https://doi.org/10.3390/ijerph15061273
Received: 5 June 2018 / Accepted: 13 June 2018 / Published: 15 June 2018
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Abstract
Overt parental restriction of food has previously been associated with child weight; however, most research has relied on self-reported feeding behaviour, or observations which give little opportunity to observe restriction of food. Using a novel lab-based observational technique to increase the opportunity to
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Overt parental restriction of food has previously been associated with child weight; however, most research has relied on self-reported feeding behaviour, or observations which give little opportunity to observe restriction of food. Using a novel lab-based observational technique to increase the opportunity to observe maternal feeding restriction, we explored the relationships between maternal restriction, child responses to restriction and child temperament with child body mass index (BMI) Z-scores over time. Sixty-two mother child dyads were recruited to the study when their children were aged 3–5 years and were followed up 2 years later (N = 39 dyads). Families were observed during a feeding interaction in the laboratory where cookies were offered with the main meal to increase the opportunity for maternal restriction of food. Feeding observations were coded and child temperament and BMI were measured. Controlling for current child BMI Z-scores, greater maternal verbal and physical restriction of food at 3–5 years was related to higher child BMI Z-scores at 5–7 years. More emotional children were less likely to experience restriction and less likely to accept attempts to restrict their food intake. Further research should consider children’s reactions to parental feeding behaviours in greater depth and explore how feeding practices interact with child temperament in the prediction of changes in child weight. Full article
(This article belongs to the Special Issue Eating and Exercise in Children and Adolescents)
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Open AccessArticle Taking One’s Own Life in Hospital? Patients and Health Care Professionals Vis-à-Vis the Tension between Assisted Suicide and Suicide Prevention in Switzerland
Int. J. Environ. Res. Public Health 2018, 15(6), 1272; https://doi.org/10.3390/ijerph15061272
Received: 6 May 2018 / Revised: 7 June 2018 / Accepted: 7 June 2018 / Published: 15 June 2018
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Abstract
In Switzerland, the practice of lay right-to-die societies (RTDS) organizing assisted suicide (AS) is tolerated by the state. Patient counseling and accompaniment into the dying process is overtaken by RTDS lay members, while the role of physicians may be restricted to prescribing the
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In Switzerland, the practice of lay right-to-die societies (RTDS) organizing assisted suicide (AS) is tolerated by the state. Patient counseling and accompaniment into the dying process is overtaken by RTDS lay members, while the role of physicians may be restricted to prescribing the mortal dose after a more or less rigorous exploration of the patient’s decisional capacity. However, Swiss health care facilities and professionals are committed to providing suicide prevention. Despite the liberal attitude in society, the legitimacy of organized AS is ethically questioned. How can health professionals be supported in their moral uncertainty when confronted with patient wishes for suicide? As an approach towards reaching this objective, two ethics policies were developed at the Basel University Hospital to offer orientation in addressing twofold and divergent duties: handling requests for AS and caring for patients with suicidal thoughts or after a suicide attempt. According to the Swiss tradition of “consultation” (“Vernehmlassung”), controversial views were acknowledged in the interdisciplinary policy development processes. Both institutional policies mirror the clash of values and suggest consistent ways to meet the challenges: respect and tolerance regarding a patient’s wish for AS on the one hand, and the determination to offer help and prevent harm by practicing suicide prevention on the other. Given the legal framework lacking specific norms for the practice of RTDS, orientation is sought in ethical guidelines. The comparison between the previous and newly revised guideline of the Swiss Academy of Medical Sciences reveals, in regard to AS, a shift from the medical criterion, end of life is near, to a patient rights focus, i.e., decisional capacity, consistent with the law. Future experience will show whether and how this change will be integrated into clinical practice. In this process, institutional ethics policies may—in addition to the law, national guidelines, or medical standards—be helpful in addressing conflicting duties at the bedside. The article offers an interdisciplinary theoretical reflection with practical illustration. Full article
(This article belongs to the Special Issue Suicide Risk and Mental Disorders)
Open AccessArticle The Impact of Road Construction on Subjective Well-Being in Communities in Madre de Dios, Peru
Int. J. Environ. Res. Public Health 2018, 15(6), 1271; https://doi.org/10.3390/ijerph15061271
Received: 2 April 2018 / Revised: 9 June 2018 / Accepted: 11 June 2018 / Published: 15 June 2018
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Abstract
The interoceanic highway (IOH) in Madre de Dios, Peru has driven dramatic change in the Peruvian Amazon basin. We conducted a mixed methods study to examine the impact of these changes on the subjective well-being (SWB) of four communities on the IOH. Themes
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The interoceanic highway (IOH) in Madre de Dios, Peru has driven dramatic change in the Peruvian Amazon basin. We conducted a mixed methods study to examine the impact of these changes on the subjective well-being (SWB) of four communities on the IOH. Themes that emerged qualitatively included changing health threats, environmental degradation, and the impact of increased migration. To achieve a higher level of SWB, respondents emphasized the need for higher incomes, opportunities to learn new skills, and a better education for their children. Potential threats to SWB included marital problems and poorer health. Quantitative analyses suggested that social support and a sense of security impacted reported SWB scores based on life satisfaction, and the impact of income on life satisfaction was mediated by food security. Although long-term residents felt that specific determinants of SWB had both increased (food variety, transport and access to work) and decreased (access to natural resources and hunting), the majority reported that their lives had improved overall. Health had been affected by the IOH in both negative ways (increased dengue and road accidents) and positive ways (improved access to health services). Our results suggest that the rapidly-changing communities near the IOH link well-being to health, income, community, and the environment. Full article
(This article belongs to the Section Global Health)
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Open AccessArticle Areas with High Hazard Potential for Autochthonous Transmission of Aedes albopictus-Associated Arboviruses in Germany
Int. J. Environ. Res. Public Health 2018, 15(6), 1270; https://doi.org/10.3390/ijerph15061270
Received: 21 April 2018 / Revised: 6 June 2018 / Accepted: 12 June 2018 / Published: 15 June 2018
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Abstract
The intensity and extent of transmission of arboviruses such as dengue, chikungunya, and Zika virus have increased markedly over the last decades. Autochthonous transmission of dengue and chikungunya by Aedes albopictus has been recorded in Southern Europe where the invasive mosquito was already
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The intensity and extent of transmission of arboviruses such as dengue, chikungunya, and Zika virus have increased markedly over the last decades. Autochthonous transmission of dengue and chikungunya by Aedes albopictus has been recorded in Southern Europe where the invasive mosquito was already established and viraemic travelers had imported the virus. Ae. albopictus populations are spreading northward into Germany. Here, we model the current and future climatically suitable regions for Ae. albopictus establishment in Germany, using climate data of spatially high resolution. To highlight areas where vectors and viraemic travellers are most likely to come into contact, reported dengue and chikungunya incidences are integrated at the county level. German cities with the highest likelihood of autochthonous transmission of Aedes albopictus-borne arboviruses are currently located in the western parts of the country: Freiburg im Breisgau, Speyer, and Karlsruhe, affecting about 0.5 million people. In addition, 8.8 million people live in regions considered to show elevated hazard potential assuming further spread of the mosquito: Baden-Württemberg (Upper Rhine, Lake Constance regions), southern parts of Hesse, and North Rhine-Westphalia (Lower Rhine). Overall, a more targeted and thus cost-efficient implementation of vector control measures and health surveillance will be supported by the detailed maps provided here. Full article
(This article belongs to the Section Climate Change and Health)
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Open AccessArticle The Influence of Phosphogypsum Addition on Phosphorus Release in Biochemical Treatment of Sewage Sludge
Int. J. Environ. Res. Public Health 2018, 15(6), 1269; https://doi.org/10.3390/ijerph15061269
Received: 15 May 2018 / Revised: 5 June 2018 / Accepted: 11 June 2018 / Published: 15 June 2018
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Abstract
The paper is focused on the research of biochemical treatment of sewage sludge and phosphogypsum under sulphate-reducing conditions with a phosphorus release process. The theoretical foundations of the work were based on the biochemical formalization using the principles of autocatalysis of natural systems.
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The paper is focused on the research of biochemical treatment of sewage sludge and phosphogypsum under sulphate-reducing conditions with a phosphorus release process. The theoretical foundations of the work were based on the biochemical formalization using the principles of autocatalysis of natural systems. During the experimental research for the control of physicochemical parameters of the process spectroquantic, X-ray fluorescence analysis and other techniques were used. A schematic model of the dephosphatation process under anaerobic stabilization of sewage sludge and phosphogypsum was developed. The increase of phosphogypsum dosage had a close correlation with the release of phosphate ions. At the stimulating action of the phosphogypsum additive, a 2.5–5.0-fold increase in soluble phosphate concentration was observed. The rational dose of phosphogypsum was determined. Along with an increase the ratio of COD (Chemical Oxygen Demand)/phosphogypsum to 0.1, an increase in the phosphate ions in solution was observed. A further increase in the ratio of COD/phosphogypsum did not affect the concentration of phosphate ions in solution. Full article
(This article belongs to the Section Environmental Science and Engineering)
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Open AccessArticle Moving towards a Comprehensive Approach for Health Literacy Interventions: The Development of a Health Literacy Intervention Model
Int. J. Environ. Res. Public Health 2018, 15(6), 1268; https://doi.org/10.3390/ijerph15061268
Received: 30 April 2018 / Revised: 6 June 2018 / Accepted: 12 June 2018 / Published: 15 June 2018
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Abstract
Low health literacy (HL) is associated with many negative health outcomes, and is a major challenge in public health and healthcare. Interventions to improve outcomes associated with HL are needed. In this paper, we aim to develop a comprehensive HL intervention model. We
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Low health literacy (HL) is associated with many negative health outcomes, and is a major challenge in public health and healthcare. Interventions to improve outcomes associated with HL are needed. In this paper, we aim to develop a comprehensive HL intervention model. We used a multimethod approach, consisting of (1) a literature review of articles listed in MEDLINE, presenting HL intervention models, (2) online consultation of international HL experts, and (3) two consensus meetings with members (n = 36 and 27) of a consortium studying HL among older adults (50+) in Europe. In our literature review, we identified twenty-two HL models, only a few of which focused explicitly on interventions. Sixty-eight health literacy experts took part in the online survey. The results from all three methods came together in a comprehensive HL intervention model. This model conceptualized interventions as potentially targeting five factors affecting HL outcomes: (1) individuals’ personal characteristics, (2) individuals’ social context, (3) communication between individuals and health professionals, (4) health professionals’ HL capacities, and (5) health systems. Our model is the first comprehensive HL model focused specifically on interventions. The model can support the further development of HL interventions to improve the health outcomes of people with low HL. Full article
(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)
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Open AccessArticle Traditional Chinese Medical Care and Incidence of Stroke in Elderly Patients Treated with Antidiabetic Medications
Int. J. Environ. Res. Public Health 2018, 15(6), 1267; https://doi.org/10.3390/ijerph15061267
Received: 5 May 2018 / Revised: 4 June 2018 / Accepted: 13 June 2018 / Published: 15 June 2018
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Abstract
Objectives: Experimental research has shown that herbal and traditional Chinese medicines (TCM) may serve as complements to Western medicine treatments in the control of blood glucose and cardiovascular complications, but population-based studies are limited. We investigated the association between TCM use and subsequent
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Objectives: Experimental research has shown that herbal and traditional Chinese medicines (TCM) may serve as complements to Western medicine treatments in the control of blood glucose and cardiovascular complications, but population-based studies are limited. We investigated the association between TCM use and subsequent risk of stroke in older patients with diabetes. Study design: The database used in this cohort study contained longitudinal medical claims for one million subjects randomly selected among beneficiaries of a universal health care program in Taiwan. We identified a cohort of patients with diabetes aged 65 years and older who initiated anti-diabetic medications from 2000 to 2012. Patients who had at least two TCM outpatient visits after their initiation of anti-diabetic medications were considered TCM users. Main outcome measures: The incidence of stroke was measured until 2013. Cox regression models with TCM use as a time-dependent variable were used to calculate the adjusted hazard ratios (HRs) comparing TCM use with no use. Results: Over the 13-year period, 17,015 patients were identified; 4912 (28.9%) of them were TCM users. The incidence of stroke during the follow-up (per 1000 person-years) was 22.8 in TCM users and 25.7 in non-users. TCM users had an adjusted HR of 0.93 for the incidence of ischemic stroke (95% confidence interval [CI] 0.83, 1.04) and of 0.89 for developing hemorrhagic stroke (95% CI 0.66, 1.19), compared with non-users. Conclusions: In this study, in older patients receiving Western medicine treatments for diabetes, TCM use was not associated with an increased risk of developing ischemic stroke and hemorrhagic stroke. Full article
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Open AccessReview Vibrio Species in Wastewater Final Effluents and Receiving Watershed in South Africa: Implications for Public Health
Int. J. Environ. Res. Public Health 2018, 15(6), 1266; https://doi.org/10.3390/ijerph15061266
Received: 7 April 2018 / Revised: 21 May 2018 / Accepted: 7 June 2018 / Published: 15 June 2018
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Abstract
Wastewater treatment facilities in South Africa are obliged to make provision for wastewater effluent quality management, with the aim of securing the integrity of the surrounding watersheds and environments. The Department of Water Affairs has documented regulatory parameters that have, over the years,
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Wastewater treatment facilities in South Africa are obliged to make provision for wastewater effluent quality management, with the aim of securing the integrity of the surrounding watersheds and environments. The Department of Water Affairs has documented regulatory parameters that have, over the years, served as a guideline for quality monitoring/management purposes. However, these guidelines have not been regularly updated and this may have contributed to some of the water quality anomalies. Studies have shown that promoting the monitoring of the current routinely monitored parameters (both microbial and physicochemical) may not be sufficient. Organisms causing illnesses or even outbreaks, such as Vibrio pathogens with their characteristic environmental resilience, are not included in the guidelines. In South Africa, studies that have been conducted on the occurrence of Vibrio pathogens in domestic and wastewater effluent have made it apparent that these pathogens should also be monitored. The importance of effective wastewater management as one of the key aspects towards protecting surrounding environments and receiving watersheds, as well as protecting public health, is highlighted in this review. Emphasis on the significance of the Vibrio pathogen in wastewater is a particular focus. Full article
(This article belongs to the Special Issue Municipal Wastewater Treatment)
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Open AccessArticle Comparison of Wearable Trackers’ Ability to Estimate Sleep
Int. J. Environ. Res. Public Health 2018, 15(6), 1265; https://doi.org/10.3390/ijerph15061265
Received: 15 April 2018 / Revised: 15 May 2018 / Accepted: 11 June 2018 / Published: 15 June 2018
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Abstract
Tracking physical activity and sleep patterns using wearable trackers has become a current trend. However, little information exists about the comparability of wearable trackers measuring sleep. This study examined the comparability of wearable trackers for estimating sleep measurement with a sleep diary (SD)
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Tracking physical activity and sleep patterns using wearable trackers has become a current trend. However, little information exists about the comparability of wearable trackers measuring sleep. This study examined the comparability of wearable trackers for estimating sleep measurement with a sleep diary (SD) for three full nights. A convenience sample of 78 adults were recruited in this research with a mean age of 27.6 ± 11.0 years. Comparisons between wearable trackers and sleep outcomes were analyzed using the mean absolute percentage errors, Pearson correlations, Bland–Altman Plots, and equivalent testing. Trackers that showed the greatest equivalence with the SD for total sleep time were the Jawbone UP3 and Fitbit Charge Heart Rate (effect size = 0.09 and 0.23, respectively). The greatest equivalence with the SD for time in bed was seen with the SenseWear Armband, Garmin Vivosmart, and Jawbone UP3 (effect size = 0.09, 0.16, and 0.07, respectively). Some of the wearable trackers resulted in closer approximations to self-reported sleep outcomes than a previously sleep research-grade device, these trackers offer a lower-cost alternative to tracking sleep in healthy populations. Full article
(This article belongs to the Special Issue Sleep Health)
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