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Int. J. Environ. Res. Public Health, Volume 15, Issue 9 (September 2018)

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Open AccessArticle Personal Involvement Moderates Message Framing Effects on Food Safety Education among Medical University Students in Chongqing, China
Int. J. Environ. Res. Public Health 2018, 15(9), 2059; https://doi.org/10.3390/ijerph15092059
Received: 21 August 2018 / Revised: 10 September 2018 / Accepted: 18 September 2018 / Published: 19 September 2018
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Abstract
Objective: This study explored whether the efficacy of food safety education interventions can be increased by message framing among medical university students, and demonstrated the role of personal involvement within the message recipient in moderating framed effects. Methods: A cross-sectional study of food
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Objective: This study explored whether the efficacy of food safety education interventions can be increased by message framing among medical university students, and demonstrated the role of personal involvement within the message recipient in moderating framed effects. Methods: A cross-sectional study of food safety message framing was conducted among medical university students (randomly selected 1353 participants). An online self-administered questionnaire was used to collect information. Wilcoxon rank-sum test and Ordered multivariate logistic regression were utilised in the data analyses. Results: The present study showed significant differences in acceptance between the gain- and loss-framed groups (p < 0.001). Participants with higher personal involvement had higher acceptance than those with low personal involvement in gain- and loss-framed message models (p < 0.001). The acceptance of participants who were concerned about their health condition was higher than those who were neutral regarding their health condition (p < 0.001) and participants who suffered a food safety incident had higher acceptance than those who did not (p < 0.05). Conclusions: This study portrayed the selection preference of message framing on food safety education among medical university students in southwest China. Participants exposed to loss-framed messages had higher message acceptance than those exposed to gain-framed messages. Personal involvement may affect the food safety message framing. Public health advocates and professionals can use framed messages as a strategy to enhance intervention efficacy in the process of food safety education. Full article
Open AccessArticle Quantitative Assessment of Relationship between Population Exposure to PM2.5 and Socio-Economic Factors at Multiple Spatial Scales over Mainland China
Int. J. Environ. Res. Public Health 2018, 15(9), 2058; https://doi.org/10.3390/ijerph15092058
Received: 20 August 2018 / Revised: 14 September 2018 / Accepted: 17 September 2018 / Published: 19 September 2018
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Abstract
Analyzing the association between fine particulate matter (PM2.5) pollution and socio-economic factors has become a major concern in public health. Since traditional analysis methods (such as correlation analysis and geographically weighted regression) cannot provide a full assessment of this relationship, the
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Analyzing the association between fine particulate matter (PM2.5) pollution and socio-economic factors has become a major concern in public health. Since traditional analysis methods (such as correlation analysis and geographically weighted regression) cannot provide a full assessment of this relationship, the quantile regression method was applied to overcome such a limitation at different spatial scales in this study. The results indicated that merely 3% of the population and 2% of the Gross Domestic Product (GDP) occurred under an annually mean value of 35 μg/m3 in mainland China, and the highest population exposure to PM2.5 was located in a lesser-known city named Dazhou in 2014. The analysis results at three spatial scales (grid-level, county-level, and city-level) demonstrated that the grid-level was the optimal spatial scale for analysis of socio-economic effects on exposure due to its tiny uncertainty, and the population exposure to PM2.5 was positively related to GDP. An apparent upward trend of population exposure to PM2.5 emerged at the 80th percentile GDP. For a 10 thousand yuan rise in GDP, population exposure to PM2.5 increases by 1.05 person/km2 at the 80th percentile, and 1.88 person/km2 at the 95th percentile, respectively. Full article
(This article belongs to the Section Environmental Health)
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Open AccessArticle Fuzzy Group Consensus Decision Making and Its Use in Selecting Energy-Saving and Low-Carbon Technology Schemes in Star Hotels
Int. J. Environ. Res. Public Health 2018, 15(9), 2057; https://doi.org/10.3390/ijerph15092057
Received: 24 August 2018 / Revised: 10 September 2018 / Accepted: 17 September 2018 / Published: 19 September 2018
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Abstract
Energy-saving and low-carbon technologies play important roles in reducing environmental risk and developing green tourism. An energy-saving and low-carbon technology scheme selection may often involve multiple criteria and sub-criteria as well as multiple stakeholders or decision makers, and thus can be structured as
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Energy-saving and low-carbon technologies play important roles in reducing environmental risk and developing green tourism. An energy-saving and low-carbon technology scheme selection may often involve multiple criteria and sub-criteria as well as multiple stakeholders or decision makers, and thus can be structured as a hierarchical multi-criteria group decision making problem. This paper proposes a framework to solve group consensus decision making problems, where decision makers’ preferences between the alternatives considered with respective to each criterion are elicited by the paired comparison method, and expressed as triangular fuzzy preference relations (TFPRs). The paper first simplifies the existing computation formulas used to determine triangular fuzzy weights of TFPRs. A consistency index is then devised to measure the inconsistency degree of a TFPR and is used to check acceptable consistency of TFPRs. By introducing a possibility degree formula of comparing any two triangular fuzzy weights, an index is defined to measure the consensus level between an individual ranking order and the group ranking order for all alternatives. A consensus model is developed in detail for solving group decision making problems with TFPRs. A case study of selecting energy-saving and low-carbon technology schemes in star hotels is provided to illustrate how to apply the proposed group decision making consensus model in practice. Full article
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Open AccessArticle Sleep Quality and Its Associated Factors among Low-Income Adults in a Rural Area of China: A Population-Based Study
Int. J. Environ. Res. Public Health 2018, 15(9), 2055; https://doi.org/10.3390/ijerph15092055
Received: 8 July 2018 / Revised: 14 September 2018 / Accepted: 14 September 2018 / Published: 19 September 2018
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Abstract
Background: There is limited population-based research focusing on sleep quality among low-income Chinese adults in rural areas. This study aimed to assess sleep quality among low-income adults in a rural area in China and identify the association between sleep quality and sociodemographic, lifestyle
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Background: There is limited population-based research focusing on sleep quality among low-income Chinese adults in rural areas. This study aimed to assess sleep quality among low-income adults in a rural area in China and identify the association between sleep quality and sociodemographic, lifestyle and health-related factors. Methods: The study was conducted from September to November in 2017 using a cross-sectional survey questionnaire. A total of 6905 participants were recruited via multistage, stratified cluster sampling. Data were collected using the Chinese versions of Pittsburgh Sleep Quality Index and Food Frequency Questionnaire, while we also determined the sociodemographic profiles of the participants. Results: The mean age of the sample was 58.71 ± 14.50 years, with 59.7% being male, while the mean duration of daily sleep was 5.95 ± 1.31 h, with 56.7% reportedly experiencing poor sleep quality. Multiple regression analysis revealed that older age, unemployment, lower income, disability and chronic disease comorbidities were significant factors associated with an increased risk of poor sleep quality for both genders. Moreover, married and higher education level were associated with decreased risk of poor sleep quality for females, while a meat-heavy diet and illness during the past two weeks increased the risk of poor sleep quality for males. Conclusions: Sociodemographic, lifestyle and health-related factors had an impact on the frequently poor sleep quality of low-income Chinese adults in rural areas. Thus, comprehensive measures must be developed to address the modifiable predictive factors that can possibly enhance sleep quality. Full article
(This article belongs to the Special Issue Sleep Health)
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Open AccessCommentary Activity-Friendly Built Environments in a Super-Aged Society, Japan: Current Challenges and toward a Research Agenda
Int. J. Environ. Res. Public Health 2018, 15(9), 2054; https://doi.org/10.3390/ijerph15092054
Received: 1 September 2018 / Revised: 17 September 2018 / Accepted: 18 September 2018 / Published: 19 September 2018
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Abstract
There is a growing recognition of the role of built environment attributes, such as streets, shops, greenways, parks, and public transportation stations, in supporting people’s active behaviors. In particular, surrounding built environments may have an important role in supporting healthy active aging. Nevertheless,
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There is a growing recognition of the role of built environment attributes, such as streets, shops, greenways, parks, and public transportation stations, in supporting people’s active behaviors. In particular, surrounding built environments may have an important role in supporting healthy active aging. Nevertheless, little is known about how built environments may influence active lifestyles in “super-aged societies”. More robust evidence-based research is needed to identify how where people live influences their active behaviors, and how to build beneficial space in the context of super-aged societies. This evidence will also be informative for the broader international context, where having an aging society will be the inevitable future. This commentary sought to move this research agenda forward by identifying key research issues and challenges in examining the role of built environment attributes on active behaviors in Japan, which is experiencing the longest healthy life expectancy, but rapid “super-aging”, with the highest proportion of old adults among its population in the world. Full article
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Open AccessArticle Combined Before-and-After Workplace Intervention to Promote Healthy Lifestyles in Healthcare Workers (STI-VI Study): Short-Term Assessment
Int. J. Environ. Res. Public Health 2018, 15(9), 2053; https://doi.org/10.3390/ijerph15092053
Received: 31 July 2018 / Revised: 7 September 2018 / Accepted: 14 September 2018 / Published: 19 September 2018
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Abstract
Health care workers (HCWs) are prone to a heavy psycho-physical workload. Health promotion programs can help prevent the onset of chronic and work-related diseases. The aim of the STI-VI ‘before-and-after’ study, with assessments scheduled at 6 and 12 months, was to improve the
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Health care workers (HCWs) are prone to a heavy psycho-physical workload. Health promotion programs can help prevent the onset of chronic and work-related diseases. The aim of the STI-VI ‘before-and-after’ study, with assessments scheduled at 6 and 12 months, was to improve the lifestyle of HCWs with at least one cardiovascular risk factor. A tailored motivational counseling intervention, focusing on dietary habits and physical activity (PA) was administered to 167 HCWs (53 males; 114 females). BMI, waist circumference, blood pressure, and cholesterol, triglyceride, and blood glucose levels were measured before and after the intervention. The 6-month results (total sample and by gender) showed a marked effect on lifestyle: PA improved (+121.2 MET, p = 0.01), and diets became more similar to the Mediterranean model (+0.8, p < 0.001). BMI dropped (−0.2, p < 0.03), and waist circumference improved even more (−2.5 cm; p < 0.001). Other variables improved significantly: total and LDL cholesterol (−12.8 and −9.4 mg/dL, p < 0.001); systolic and diastolic blood pressure (−4.4 and −2.5 mmHg, p < 0.001); blood glucose (−1.5 mg/dL, p = 0.05); and triglycerides (significant only in women), (−8.7 mg/dL, p = 0.008); but HDL cholesterol levels dropped too. If consolidated at 12 months, these results indicate that our intervention can help HCWs maintain a healthy lifestyle and work ability. Full article
(This article belongs to the Special Issue Workplace Health Promotion 2018)
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Open AccessArticle Spatial Assessment of Anthropogenic Impact on Trace Metal Accumulation in Farmland Soils from a Rapid Industrializing Region, East China
Int. J. Environ. Res. Public Health 2018, 15(9), 2052; https://doi.org/10.3390/ijerph15092052
Received: 28 August 2018 / Revised: 16 September 2018 / Accepted: 16 September 2018 / Published: 19 September 2018
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Abstract
A better understanding of anthropogenic trace metal accumulation in farmland soils is crucial for local food safety and public health, especially for a rapidly industrializing region. In this study, soil samples at two depths were collected from a typical county in East China
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A better understanding of anthropogenic trace metal accumulation in farmland soils is crucial for local food safety and public health, especially for a rapidly industrializing region. In this study, soil samples at two depths were collected from a typical county in East China and analyzed for total concentrations of Fe, Al, Pb, Cd, Cu, Zn, Cr, and Ni. Results showed that trace metals like Pb, Cd, Cu, Zn, Cr, and Ni have accumulated in the regional farmlands, with average topsoil concentrations 1.62–1.77 times higher than their background concentrations in subsoil. However, they were still much lower than the limits of the Chinese Environmental Quality Standard for Soils. By the proper calculation of enrichment factor (EF), it was found that the accumulations of trace metals in the topsoil have been impacted by anthropogenic activities, which could contribute up to 40.83% of total metal concentration. Two principal components were extracted according to the results of principal component analysis (PCA) for EF values, which indicated two important anthropogenic trace metal sources. With the help of spatial distribution maps based on geographical information system (GIS), the anthropogenic sources of Pb, Cr, and Ni were determined to be mostly associated with atmospheric deposition from the central urban area. However, Cd, Cu, and Zn were further confirmed to originate from different agricultural sources. The anthropogenic Cu and Zn inputs were mostly related to pig manure application in the rural northern and southeastern areas, while extensive fertilizer application was identified as the major contributor to anthropogenic Cd accumulation in this region. Overall, the integrated application of EF, PCA, and GIS mapping is an effective approach to achieve the spatial assessment of anthropogenic impact on trace metal accumulation in regional soils. Full article
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Open AccessArticle Evaluating the Accessibility of Healthcare Facilities Using an Integrated Catchment Area Approach
Int. J. Environ. Res. Public Health 2018, 15(9), 2051; https://doi.org/10.3390/ijerph15092051
Received: 23 July 2018 / Revised: 15 September 2018 / Accepted: 16 September 2018 / Published: 19 September 2018
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Abstract
Accessibility is a major method for evaluating the distribution of service facilities and identifying areas in shortage of service. Traditional accessibility methods, however, are largely model-based and do not consider the actual utilization of services, which may lead to results that are different
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Accessibility is a major method for evaluating the distribution of service facilities and identifying areas in shortage of service. Traditional accessibility methods, however, are largely model-based and do not consider the actual utilization of services, which may lead to results that are different from those obtained when people’s actual behaviors are taken into account. Based on taxi GPS trajectory data, this paper proposed a novel integrated catchment area (ICA) that integrates actual human travel behavior to evaluate the accessibility to healthcare facilities in Shenzhen, China, using the enhanced two-step floating catchment area (E2SFCA) method. This method is called the E2SFCA-ICA method. First, access probability is proposed to depict the probability of visiting a healthcare facility. Then, integrated access probability (IAP), which integrates model-based access probability (MAP) and data-based access probability (DAP), is presented. Under the constraint of IAP, ICA is generated and divided into distinct subzones. Finally, the ICA and subzones are incorporated into the E2SFCA method to evaluate the accessibility of the top-tier hospitals in Shenzhen, China. The results show that the ICA not only reduces the differences between model-based catchment areas and data-based catchment areas, but also distinguishes the core catchment area, stable catchment area, uncertain catchment area and remote catchment area of healthcare facilities. The study also found that the accessibility of Shenzhen’s top-tier hospitals obtained with traditional catchment areas tends to be overestimated and more unequally distributed in space when compared to the accessibility obtained with integrated catchment areas. Full article
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Open AccessFeature PaperArticle Shadow Puppets and Neglected Diseases: Evaluating a Health Promotion Performance in Rural Indonesia
Int. J. Environ. Res. Public Health 2018, 15(9), 2050; https://doi.org/10.3390/ijerph15092050
Received: 10 August 2018 / Revised: 5 September 2018 / Accepted: 6 September 2018 / Published: 19 September 2018
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Abstract
‘Rama and the Worm’ is a shadow puppet production targeting neglected diseases in Central Java. It is an entertainment-based intervention study to promote health by reducing the impact of parasitic diseases such as soil-transmitted helminths (STH). The study uses traditional Javanese shadow puppetry
[...] Read more.
‘Rama and the Worm’ is a shadow puppet production targeting neglected diseases in Central Java. It is an entertainment-based intervention study to promote health by reducing the impact of parasitic diseases such as soil-transmitted helminths (STH). The study uses traditional Javanese shadow puppetry (wayang kulit) as a vehicle in village communities to disseminate health messages and promote behaviour change to prevent diseases caused, primarily, by inadequate sanitation and poor hygiene. The health education messages contained in the play, although using traditional characters and themes, required the creation of a completely new narrative script, using characters and plot lines familiar to the wayang kulit repertoire, but placing them in new situations that relate specifically to health promotion objectives. The intervention was piloted in a village in Central Java, Indonesia using a pre/post design with both qualitative and quantitative analysis. A total of 96 male and female villagers, aged between 7 and 87 years, provided both baseline and follow up data. Participant knowledge and behaviours related to gastrointestinal and helminth-related disease were assessed before and after the intervention through a questionnaire administered by interview. Results revealed statistically significant improvements in both knowledge (48.6% pre-intervention score vs. 62.8% post-intervention score, p < 0.001) and behaviour (77.4% vs. 80.6%, p = 0.004) related to gastrointestinal and helminth disease. Findings of the study indicate the wayang kulit performance is an effective health education tool. The results provide proof of concept with scaling up the next step forward. The wayang kulit production provides a significant additional component for an integrated, comprehensive approach to reduction and elimination of STH infection. Full article
(This article belongs to the Special Issue Water, Sanitation and Hygiene Related Disease)
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Open AccessArticle Changes in Work Practices for Safe Use of Formaldehyde in a University-Based Anatomy Teaching and Research Facility
Int. J. Environ. Res. Public Health 2018, 15(9), 2049; https://doi.org/10.3390/ijerph15092049
Received: 3 August 2018 / Revised: 2 September 2018 / Accepted: 12 September 2018 / Published: 19 September 2018
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Abstract
Anatomy teaching and research relies on the use of formaldehyde (FA) as a preservation agent for human and animal tissues. Due to the recent classification of FA as a carcinogen, university hospitals are facing a challenge to (further) reduce exposure to FA. The
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Anatomy teaching and research relies on the use of formaldehyde (FA) as a preservation agent for human and animal tissues. Due to the recent classification of FA as a carcinogen, university hospitals are facing a challenge to (further) reduce exposure to FA. The aim of this study was to reduce exposure to FA in the anatomy teaching and research facility. Workers participated in the development of improved work practices, both technical and organizational solutions. Over a period of 6 years mitigating measures were introduced, including improvement of a down-flow ventilation system, introduction of local exhaust ventilation, collection of drain liquid from displayed specimens in closed containers and leak prevention. Furthermore, some organizational changes were made to reduce the number of FA peak exposures. Stationary and personal air sampling was performed in three different campaigns to assess the effect of these new work practices on inhalation exposure to FA. Samples were collected over 8 h (full shift) and 15 min (task-based) to support mitigation of exposure and improvement of work practices. Air was collected on an adsorbent coated with 2,4-dinitrophenylhydrazine (DNPH) and analyzed by HPLC-UV. Geometric mean (GM) concentrations of FA in the breathing zone over a work-shift were 123 µg/m3 in 2012 and 114 µg/m3 in 2014, exceeding the workplace standard of 150 µg/m3 (8 h time-weighted average, TWA) on 46% of the workdays in 2012 and 38% of the workdays in 2014. This exposure was reduced to an average of 28.8 µg/m3 in 2017 with an estimated probability of exceeding the OEL of 0.6%. Task-based measurements resulted in a mean peak exposures of 291 µg/m3 in 2012 (n = 19) and a mean of 272 µg/m3 in 2014 (n = 21), occasionally exceeding the standard of 500 µg/m3 (15 min TWA), and were reduced to a mean of 88.7 µg/m3 in 2017 (n = 12) with an estimated probability of exceeding the OEL of 1.6%. Full article
(This article belongs to the Section Occupational Safety and Health)
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Open AccessArticle Establishing Heat Alert Thresholds for the Varied Climatic Regions of British Columbia, Canada
Int. J. Environ. Res. Public Health 2018, 15(9), 2048; https://doi.org/10.3390/ijerph15092048
Received: 31 July 2018 / Revised: 14 September 2018 / Accepted: 18 September 2018 / Published: 19 September 2018
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Following an extreme heat event in 2009, a Heat Alert and Response System (HARS) was implemented for the greater Vancouver area of British Columbia (BC), Canada. This system has provided a framework for guiding public health interventions and assessing population response and adaptation
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Following an extreme heat event in 2009, a Heat Alert and Response System (HARS) was implemented for the greater Vancouver area of British Columbia (BC), Canada. This system has provided a framework for guiding public health interventions and assessing population response and adaptation to extreme heat in greater Vancouver, but no other parts of BC were covered by HARS. The objective of this study was to identify evidence-based heat alert thresholds for the Southwest, Southeast, Northwest, and Northeast regions to facilitate the introduction of HARS across BC. This was done based on a national approach that considers high temperatures on two consecutive days and the intervening overnight low, referred to as the high-low-high approach. Daily forecast and observed air temperatures and daily mortality counts for May through September of 2004 through 2016 were obtained. For each date (dayt), dayt−2 forecasts were used to assign high temperatures for dayt and dayt+1 and the overnight low. A range of high-low-high threshold combinations was assessed for each region by finding associations with daily mortality using time-series models and other considerations. The following thresholds were established: 29-16-29 °C in the Southwest; 35-18-35 °C in the Southeast; 28-13-28 °C in the Northwest; and 29-14-29 °C in the Northeast. Heat alert thresholds for all regions in BC provide health authorities with information on dangerously hot temperature conditions and inform the activation of protective public health interventions. Full article
(This article belongs to the Special Issue Climate Change and Health Vulnerability and Adaptation Assessments)
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Open AccessArticle Building-Related Environmental Intolerance and Associated Health in the General Population
Int. J. Environ. Res. Public Health 2018, 15(9), 2047; https://doi.org/10.3390/ijerph15092047
Received: 19 August 2018 / Revised: 15 September 2018 / Accepted: 17 September 2018 / Published: 19 September 2018
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Abstract
People frequently attribute adverse symptoms to particular buildings when exposure to pollutants is low, within nonhazardous levels. Our aim was to characterize building-related intolerance (BRI) in the general population. Data were derived from two population-based questionnaire surveys, the Västerbotten and Österbotten Environmental Health
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People frequently attribute adverse symptoms to particular buildings when exposure to pollutants is low, within nonhazardous levels. Our aim was to characterize building-related intolerance (BRI) in the general population. Data were derived from two population-based questionnaire surveys, the Västerbotten and Österbotten Environmental Health Study. We identified cases of BRI if respondents reported symptoms emerging from residing in certain buildings, when most other people had none. The questionnaires covered lifestyle factors, perceived general health, BRI duration and symptom frequency, the emotional and behavioral impact of BRI, coping strategies, and physician-diagnosed diseases. From the total of 4941 participants, we formed two case groups, 275 (5.6%) fulfilled criteria for self-reported BRI, and 123 (2.5%) for BRI with wide-ranging symptoms. Individuals in both case groups were significantly more often female, single, and perceived their general health as poorer than the referents, i.e., those reporting no BRI symptoms. The mean duration of BRI was 12 years. In both case groups, avoidance behavior was found in over 60%, and nearly half of the sample had sought medical care. BRI with wide-ranging symptoms was associated with elevated odds for all studied comorbidities (somatic and psychiatric diseases and functional somatic syndromes). The perceived health of individuals with BRI is poorer and comorbidities are more frequent than among referents. BRI seems to be similar to other environmental intolerances and shares features with functional somatic syndromes. Full article
(This article belongs to the Section Environmental Health)
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Open AccessArticle Air Pollutant and Health-Efficiency Evaluation Based on a Dynamic Network Data Envelopment Analysis
Int. J. Environ. Res. Public Health 2018, 15(9), 2046; https://doi.org/10.3390/ijerph15092046
Received: 26 August 2018 / Accepted: 15 September 2018 / Published: 18 September 2018
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Environmental pollution and the associated societal health issues have attracted recent research attention. While most research has focused on the effect of air pollution on human health and local economies, few articles have discussed the environment, health, and economic development in in an
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Environmental pollution and the associated societal health issues have attracted recent research attention. While most research has focused on the effect of air pollution on human health and local economies, few articles have discussed the environment, health, and economic development in in an integrated analysis. This paper used a Dynamic Network SBM Model to evaluate production and health efficiencies in Chinese cities and found that the production efficiency scores were slightly higher than the health efficiency scores, with the two-stage efficiency scores in most cities having significant fluctuations. Labor, fixed assets, energy, GDP, and lung disease and mortality reduction efficiencies in the first stage were generally high; however, the medical input efficiencies in the second stage were low, indicating that there was there significant room for improvement in many cities. Full article
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Open AccessFeature PaperArticle Passive Smoking Indicators in Italy: Does the Gross Domestic Product Matter?
Int. J. Environ. Res. Public Health 2018, 15(9), 2045; https://doi.org/10.3390/ijerph15092045
Received: 7 August 2018 / Revised: 3 September 2018 / Accepted: 14 September 2018 / Published: 18 September 2018
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Background: The aim of this study is to analyse the correlation between regional values of Gross Domestic Product (GDP) and passive smoking in Italy. Methods: The outcome measures were smoking ban respect in public places, workplaces and at home, derived from the PASSI
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Background: The aim of this study is to analyse the correlation between regional values of Gross Domestic Product (GDP) and passive smoking in Italy. Methods: The outcome measures were smoking ban respect in public places, workplaces and at home, derived from the PASSI surveillance for the period 2011–2017. The explanatory variable was GDP per capita. The statistical analysis was carried out using bivariate and linear regression analyses, taking into consideration two different periods, Years 2011–2014 and 2014–2017. Results: GDP is showed to be positively correlated with smoking ban respect in public places (r = 0.779 p < 0.001; r = 0.723 p < 0.001 in the two periods, respectively), as well as smoking ban respect in the workplace (r = 0.662 p = 0.001; r = 0.603 p = 0.004) and no smoking at home adherence (r = 0.424 p = 0.056; r = 0.362 p = 0.107). In multiple linear regression GDP is significantly associated to smoking ban respect in public places (adjusted β = 0.730 p < 0.001; β = 0.698 p < 0.001 in the two periods, respectively), smoking ban in workplaces (adjusted β = 0.525 p = 0.020; β = 0.570 p = 0.009) and no smoking at home (adjusted β = 0.332 p = 0.070; β = 0.362 p = 0.052). Conclusions: Smoking ban is more respected in Regions with higher GDP. For a better health promotion, systematic vigilance and sanctions should be maintained and strengthened, particularly in regions with low compliance with smoking bans. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke: Exposure and Effects)
Open AccessArticle Short-Term and Long-Term Effects of Off-Job Activities on Recovery and Sleep: A Two-Wave Panel Study among Health Care Employees
Int. J. Environ. Res. Public Health 2018, 15(9), 2044; https://doi.org/10.3390/ijerph15092044
Received: 24 August 2018 / Revised: 17 September 2018 / Accepted: 17 September 2018 / Published: 18 September 2018
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Abstract
This study examined whether particular recovery activities after work have a positive or negative effect on employee recovery from work (i.e., cognitive, emotional, and physical detachment) and sleep quality. We used a two-wave panel study of 230 health care employees which enabled looking
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This study examined whether particular recovery activities after work have a positive or negative effect on employee recovery from work (i.e., cognitive, emotional, and physical detachment) and sleep quality. We used a two-wave panel study of 230 health care employees which enabled looking at both short-term and long-term effects (i.e., two-year time interval). Gender, age, marital status, children at home, education level, management position, and working hours were used as control variables. Hierarchical multiple regression analyses showed that work-related off-job activities were negatively associated with cognitive and emotional detachment in both the short and long run, whereas low-effort off-job activities were positively related to cognitive detachment in the short run. Moreover, household/care off-job activities were positively related to sleep quality in the long run, whereas physical off-job activities were negatively associated with sleep quality in the long run. The long-term findings existed beyond the strong effects of baseline detachment and sleep quality. This study highlights the importance of off-job recovery activities for health care employees’ detachment from work and sleep quality. Practical implications and avenues for further research are discussed. Full article
(This article belongs to the Section Occupational Safety and Health)
Open AccessArticle The Epidemiology of Food Allergy in the Global Context
Int. J. Environ. Res. Public Health 2018, 15(9), 2043; https://doi.org/10.3390/ijerph15092043
Received: 2 August 2018 / Revised: 6 September 2018 / Accepted: 13 September 2018 / Published: 18 September 2018
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Abstract
There is a lack of high-quality evidence based on the gold standard of oral food challenges to determine food allergy prevalence. Nevertheless, studies using surrogate measures of food allergy, such as health service utilization and clinical history, together with allergen-specific immunoglobulin E (sIgE),
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There is a lack of high-quality evidence based on the gold standard of oral food challenges to determine food allergy prevalence. Nevertheless, studies using surrogate measures of food allergy, such as health service utilization and clinical history, together with allergen-specific immunoglobulin E (sIgE), provide compelling data that the prevalence of food allergy is increasing in both Western and developing countries. In Western countries, challenge-diagnosed food allergy has been reported to be as high as 10%, with the greatest prevalence noted among younger children. There is also growing evidence of increasing prevalence in developing countries, with rates of challenge-diagnosed food allergy in China and Africa reported to be similar to that in Western countries. An interesting observation is that children of East Asian or African descent born in a Western environment are at higher risk of food allergy compared to Caucasian children; this intriguing finding emphasizes the importance of genome-environment interactions and forecasts future increases in food allergy in Asia and Africa as economic growth continues in these regions. While cow’s milk and egg allergy are two of the most common food allergies in most countries, diverse patterns of food allergy can be observed in individual geographic regions determined by each country’s feeding patterns. More robust studies investigating food allergy prevalence, particularly in Asia and the developing world, are necessary to understand the extent of the food allergy problem and identify preventive strategies to cope with the potential increase in these regions. Full article
(This article belongs to the Special Issue The Epidemiology of Allergy)
Open AccessArticle A Bayesian Quantile Modeling for Spatiotemporal Relative Risk: An Application to Adverse Risk Detection of Respiratory Diseases in South Carolina, USA
Int. J. Environ. Res. Public Health 2018, 15(9), 2042; https://doi.org/10.3390/ijerph15092042
Received: 30 July 2018 / Revised: 11 September 2018 / Accepted: 15 September 2018 / Published: 18 September 2018
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Abstract
Quantile modeling has been seen as an alternative and useful complement to ordinary regression mainly focusing on the mean. To directly apply quantile modeling to areal data the discrete conditional quantile function of the data can be an issue. Although jittering by adding
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Quantile modeling has been seen as an alternative and useful complement to ordinary regression mainly focusing on the mean. To directly apply quantile modeling to areal data the discrete conditional quantile function of the data can be an issue. Although jittering by adding a small number from a uniform distribution to impose pseudo-continuity has been proposed, the approach can have a great influence on responses with small values. Thus we proposed an alternative to model the quantiles of relative risk for spatiotemporal areal health data within a Bayesian framework using the log-Laplace distribution. A simulation study was conducted to assess the performance of the proposed method and examine whether the model could robustly estimate quantiles of spatiotemporal count data. To perform a test with a real data example, we evaluated the potential application of clustering under the proposed log-Laplace and mean regression. The data were obtained from the total number of emergency room discharges for respiratory conditions, both infectious and non-infectious diseases, in the U.S. state of South Carolina in 2009. From both simulation and case studies, the proposed quantile modeling demonstrated potential for broad applicability in various areas of spatial health studies including anomaly detection. Full article
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Open AccessArticle A Cross Sectional Examination of the Relation Between Depression and Frequency of Leisure Time Physical Exercise among the Elderly in Jinan, China
Int. J. Environ. Res. Public Health 2018, 15(9), 2041; https://doi.org/10.3390/ijerph15092041
Received: 28 August 2018 / Revised: 9 September 2018 / Accepted: 14 September 2018 / Published: 18 September 2018
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Abstract
Depression has become a major global public health problem. Many studies have shown the positive effects of physical exercise on depression. However, few studies have examined the relationship between frequency of leisure time physical exercise and depression without considering the time and intensity
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Depression has become a major global public health problem. Many studies have shown the positive effects of physical exercise on depression. However, few studies have examined the relationship between frequency of leisure time physical exercise and depression without considering the time and intensity of exercise among middle-aged and elderly people of urban communities in northern China. We conducted a cross-sectional survey that included 1604 participants among urban residents aged 50 years or older in China to evaluate how the frequency of physical exercise was related to depression. Our study showed that the prevalence of depression in the urban community of Jinan is 16.52%. For physical exercise, the odds ratios (ORs) and 95% confidence intervals (CIs) for 1~2 times per week, 3~4 times per week and ≥5 times per week were 1.137 (0.661, 1.953), 0.516 (0.304, 0.875) and 0.548 (0.392, 0.768) respectively, with adjustment for age, gender, marital status, BMI, hypertension, previously diagnosed type 2 diabetes, triglyceride, total cholesterol, soy food intake, milk food intake, vegetable and fruit intake and meat intake. We concluded that physically exercising three times a week is associated with a low prevalence of depression. Full article
(This article belongs to the collection Physical Activity and Public Health)
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Open AccessFeature PaperArticle The Measure of the Family Caregivers’ Experience
Int. J. Environ. Res. Public Health 2018, 15(9), 2040; https://doi.org/10.3390/ijerph15092040
Received: 16 July 2018 / Revised: 31 August 2018 / Accepted: 15 September 2018 / Published: 18 September 2018
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Abstract
Objective: Design and validate a measure of the experience of family caregivers with the integrated care that receive the persons they care for. Methods: The new instrument for measuring the experience of caregivers is based on the Instrument to Evaluate the
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Objective: Design and validate a measure of the experience of family caregivers with the integrated care that receive the persons they care for. Methods: The new instrument for measuring the experience of caregivers is based on the Instrument to Evaluate the EXperience of PAtients with Chronic Diseases (acronym in Spanish: IEXPAC) scale instrument. With the qualitative technique of the discussion group, nine professionals and eight caregivers assessed the face validity of the instrument and they advised on issues to explore and the measuring scale to use. The instrument’s items were analyzed individually, as well as its consistency, reliability, and construct and empirical validity. Results: 235 caregivers responded, of which 186 (79%) were women. The average age of the persons under their care was 83.9 years (SD 9.7). The scale’s score when eliminating its items one by one ranged between 38.6 and 41.1. The factorial saturations of the items ranged between 0.53 and 0.82. Cronbach’s alpha (12 elements) was 0.88 and the Kuder-Richardson coefficient was 0.91. The factorial solution explained 64.3% of the total variance and allowed isolating two factors (with 11 items with saturations greater than 0.65): care for the patient, and care for the caregiver. The internal consistency of both factors was greater than 0.80. The scale’s score was 41.1 (SD 9.7). Conclusions: The Caregivers Experience Instrument combines acceptability, ease of comprehension, and perceived usefulness for the caregivers. It has adequate internal consistency, reliability, and construct and empirical validity. Full article
(This article belongs to the Special Issue Patient Satisfaction with Health Services)
Open AccessArticle Health Risks Associated with Occupational Exposure to Ambient Air Pollution in Commercial Drivers: A Systematic Review
Int. J. Environ. Res. Public Health 2018, 15(9), 2039; https://doi.org/10.3390/ijerph15092039
Received: 12 August 2018 / Revised: 13 September 2018 / Accepted: 15 September 2018 / Published: 18 September 2018
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Abstract
Ambient air pollution is a major global health problem and commercial drivers are particularly exposed to it. As no systematic assessment of the health risks associated with occupational exposure to ambient air pollution in this population had yet been carried out, we conducted
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Ambient air pollution is a major global health problem and commercial drivers are particularly exposed to it. As no systematic assessment of the health risks associated with occupational exposure to ambient air pollution in this population had yet been carried out, we conducted a systematic review using a protocol-driven strategy. Papers published from inception to April 20, 2018 in MEDLINE, EMBASE, CINAHL, African journals online, the Cochrane library, ISRCTN WHO ICTRP, and the Web of Science and Scopus databases were screened for inclusion by two independent reviewers. Original articles with at least an available abstract in English or French were included. The initial search retrieved 1454 published articles of which 20 articles were included. Three studies reported a significant difference in white blood cells (106/L) among commercial motorcyclists compared to rural inhabitants (5.041 ± 1.209 vs. 5.900 ± 1.213, p = 0.001), an increased risk of lung cancer (RR = 1.6, 95%CI 1.5–1.8) in bus drivers and an increased standardized mortality ratio (SMR) in bus drivers from Hodgkin’s lymphoma (SMR 2.17, 95%CI 1.19–3.87) compared to white-collar workers. Other studies also found that drivers had more oxidative DNA damage and chromosome breaks. Four papers failed to demonstrate that the drivers were more exposed to air pollution than the controls. Three other studies also reported no significant difference in lung function parameters and respiratory symptoms. The genetic polymorphisms of detoxifying enzymes were also not homogeneously distributed compared to the controls. There is some evidence that occupational exposure to ambient air pollution among commercial drivers is associated with adverse health outcomes, but the existing literature is limited, with few studies on small sample size, methodological weaknesses, and contradictory findings—thus, further research is recommended. Full article
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Open AccessArticle Effects of Clockwise and Counterclockwise Job Shift Work Rotation on Sleep and Work-Life Balance on Hospital Nurses
Int. J. Environ. Res. Public Health 2018, 15(9), 2038; https://doi.org/10.3390/ijerph15092038
Received: 30 July 2018 / Revised: 27 August 2018 / Accepted: 8 September 2018 / Published: 18 September 2018
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Abstract
Rotational shift work is associated with sleep disturbances, increased risk of cardiovascular and psychological disorders, and may negatively impact work–life balance. The direction of shift rotation (Clockwise, CW or counterclockwise, CCW) and its role in these disorders are poorly understood. The aim of
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Rotational shift work is associated with sleep disturbances, increased risk of cardiovascular and psychological disorders, and may negatively impact work–life balance. The direction of shift rotation (Clockwise, CW or counterclockwise, CCW) and its role in these disorders are poorly understood. The aim of the study was to investigate the effect of the shift schedule direction on sleep quantity and quality, alertness and work performance, and on work–life balance on hospital nurses. One-hundred female nurses, working a continuous rapid shift schedule in hospitals in the north of Italy, participated in this cross-sectional study. Fifty worked on CW rotation schedule (Morning: 6 a.m.–2 p.m., Afternoon: 2 p.m.–10 p.m., Night: 10 p.m.–6 a.m., 2 rest days) and fifty on CCW rotation (Afternoon, Morning, Morning, Night, 3 rest days). Data were collected by ad hoc questionnaire and daily diary. During the shift cycle CW nurses slept longer (7.40 ± 2.24 h) than CCW (6.09 ± 1.73; p < 0.001). CW nurses reported less frequently than CCW awakening during sleep (40% vs. 80%; p < 0.001), attention disturbance during work (20% vs. 64%; p < 0.001), and interference with social and family life (60% vs. 96% and 20% vs. 70%, respectively; p < 0.001). CCW rotating shift schedule seems to be characterized by higher sleep disturbances and a worse work–life balance. Full article
(This article belongs to the Special Issue Workplace Health Promotion 2018)
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Open AccessArticle The Quality of Tuberculosis Care in Urban Migrant Clinics in China
Int. J. Environ. Res. Public Health 2018, 15(9), 2037; https://doi.org/10.3390/ijerph15092037
Received: 9 August 2018 / Revised: 11 September 2018 / Accepted: 13 September 2018 / Published: 18 September 2018
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Abstract
Large and increasing numbers of rural-to-urban migrants provided new challenges for tuberculosis control in large cities in China and increased the need for high quality tuberculosis care delivered by clinics in urban migrant communities. Based on a household survey in migrant communities, we
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Large and increasing numbers of rural-to-urban migrants provided new challenges for tuberculosis control in large cities in China and increased the need for high quality tuberculosis care delivered by clinics in urban migrant communities. Based on a household survey in migrant communities, we selected and separated clinics into those that mainly serve migrants and those that mainly serve local residents. Using standardized patients, this study provided an objective comparison of the quality of tuberculosis care delivered by both types of clinics and examined factors related to quality care. Only 27% (95% confidence interval (CI) 14–46) of cases were correctly managed in migrant clinics, which is significantly worse than it in local clinics (50%, 95% CI 28–72). Clinicians with a base salary were 41 percentage points more likely to demonstrate better case management. Furthermore, clinicians with upper secondary or higher education level charged 20 RMB lower out of pocket fees than less-educated clinicians. In conclusion, the quality of tuberculosis care accessed by migrants was very poor and policies to improve the quality should be prioritized in current health reforms. Providing a base salary was a possible way to improve quality of care and increasing the education attainment of urban community clinicians might reduce the heavy barrier of medical expenses for migrants Full article
(This article belongs to the Special Issue Poverty, Inequality and Public Health in China)
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Open AccessArticle Relationship of Time-Activity-Adjusted Particle Number Concentration with Blood Pressure
Int. J. Environ. Res. Public Health 2018, 15(9), 2036; https://doi.org/10.3390/ijerph15092036
Received: 22 August 2018 / Revised: 8 September 2018 / Accepted: 13 September 2018 / Published: 18 September 2018
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Abstract
Emerging evidence suggests long-term exposure to ultrafine particulate matter (UFP, aerodynamic diameter < 0.1 µm) is associated with adverse cardiovascular outcomes. We investigated whether annual average UFP exposure was associated with measured systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP),
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Emerging evidence suggests long-term exposure to ultrafine particulate matter (UFP, aerodynamic diameter < 0.1 µm) is associated with adverse cardiovascular outcomes. We investigated whether annual average UFP exposure was associated with measured systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and hypertension prevalence among 409 adults participating in the cross-sectional Community Assessment of Freeway Exposure and Health (CAFEH) study. We used measurements of particle number concentration (PNC, a proxy for UFP) obtained from mobile monitoring campaigns in three near-highway and three urban background areas in and near Boston, Massachusetts to develop PNC regression models (20-m spatial and hourly temporal resolution). Individual modeled estimates were adjusted for time spent in different micro-environments (time-activity-adjusted PNC, TAA-PNC). Mean TAA-PNC was 22,000 particles/cm3 (sd = 6500). In linear models (logistic for hypertension) adjusted for the minimally sufficient set of covariates indicated by a directed acyclic graph (DAG), we found positive, non-significant associations between natural log-transformed TAA-PNC and SBP (β = 5.23, 95%CI: −0.68, 11.14 mmHg), PP (β = 4.27, 95%CI: −0.79, 9.32 mmHg), and hypertension (OR = 1.81, 95%CI: 0.94, 3.48), but not DBP (β = 0.96, 95%CI: −2.08, 4.00 mmHg). Associations were stronger among non-Hispanic white participants and among diabetics in analyses stratified by race/ethnicity and, separately, by health status. Full article
(This article belongs to the Special Issue Transportation-Related Air Pollution and Human Health)
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Open AccessArticle Socio-Cultural Reasons and Community Perceptions Regarding Indoor Cooking Using Biomass Fuel and Traditional Stoves in Rural Ethiopia: A Qualitative Study
Int. J. Environ. Res. Public Health 2018, 15(9), 2035; https://doi.org/10.3390/ijerph15092035
Received: 7 August 2018 / Revised: 10 September 2018 / Accepted: 14 September 2018 / Published: 18 September 2018
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Abstract
Around three billion people in the world and 90% of the rural households in low-and middle-income countries are exposed to wood smoke with varying exposure levels and resulting health risks. We aimed to explore perceptions of the community towards indoor cooking and the
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Around three billion people in the world and 90% of the rural households in low-and middle-income countries are exposed to wood smoke with varying exposure levels and resulting health risks. We aimed to explore perceptions of the community towards indoor cooking and the socio-cultural barriers to bring change in Butajira, rural Ethiopia. We conducted a qualitative study involving ten separate focus group discussions with purposively selected members of the community and two key informant interviews with health extension workers. Content analysis was carried out using ATLAS.ti software. Participants reported the use of fuel wood and traditional three-stone cook stove to cook food. Economic status, lack of commitment, cultural views and concern along with safety and security issues were found to be barriers to change from traditional to cleaner methods of cooking. The community perceived wood smoke to have effects on their eyes and respiratory health, though they culturally viewed it as beneficial for postpartum mothers and newborns, avoiding bad smell and insects and in order to strengthen the fabric of their houses. Health education at community level is essential in order to bring about change in the cultural views and cooking behaviors focusing on opening windows and keeping young children away during cooking. Full article
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Open AccessArticle Influenza Vaccinations for All Pregnant Women? Better Evidence Is Needed
Int. J. Environ. Res. Public Health 2018, 15(9), 2034; https://doi.org/10.3390/ijerph15092034
Received: 5 July 2018 / Revised: 23 August 2018 / Accepted: 14 September 2018 / Published: 18 September 2018
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Abstract
Pregnant women are a World Health Organization (WHO) priority group for influenza vaccination, but evidence of effectiveness and safety for pregnant women comes from observational studies, which are notoriously prone to confounding by indication and healthy-vaccinee bias. The latter type of bias leads
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Pregnant women are a World Health Organization (WHO) priority group for influenza vaccination, but evidence of effectiveness and safety for pregnant women comes from observational studies, which are notoriously prone to confounding by indication and healthy-vaccinee bias. The latter type of bias leads to an overestimation of the effectiveness and safety of the vaccine, which may be what occurs in pregnant women. Indeed, better educated women with healthier behaviors and who seek better medical care may be more adherent to vaccinations recommended by doctors, scientific societies and health authorities. Therefore, it is fundamental to obtain information about vaccine effectiveness and safety from randomized controlled trials (RCTs). Cochrane reviews have identified only one RCT with “low risk of bias”. Its results were unclear in terms of maternal, perinatal, and infant deaths and hospitalization, and showed a Number Needed to Vaccine (NNV) of 55 for mothers, with an excess of local adverse effects. A Cochrane review concluded that the inactivated influenza vaccine provides pregnant women with uncertain or very limited protection against influenza-like illnesses and influenza. Some observational studies have suggested possible adverse effects of the inflammation following the vaccination. Consistent with the Cochrane reviewers’ conclusions, further trials for influenza vaccines with appropriate study designs and comparison groups are required before promoting universal seasonal influenza vaccinations of pregnant women. Meanwhile, vaccination in second to third trimester should be offered while communicating the uncertainties that still exist, promoting informed choices. Vaccination in the first trimester is debatable and debated. This does not mean leaving women defenseless; many other useful behavioral and environmental measures can reduce infectious disease. Full article
(This article belongs to the Special Issue Vaccination and Health Outcomes)
Open AccessArticle Emergency Department Discharge Outcome and Psychiatric Consultation in North African Patients
Int. J. Environ. Res. Public Health 2018, 15(9), 2033; https://doi.org/10.3390/ijerph15092033
Received: 30 July 2018 / Revised: 2 September 2018 / Accepted: 12 September 2018 / Published: 17 September 2018
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Abstract
Studies in Europe have found that immigrants, compared to the local population, are more likely to seek out medical care in Emergency Departments (EDs). In addition, studies show that immigrants utilize medical services provided by EDs for less acute issues. Despite these observed
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Studies in Europe have found that immigrants, compared to the local population, are more likely to seek out medical care in Emergency Departments (EDs). In addition, studies show that immigrants utilize medical services provided by EDs for less acute issues. Despite these observed differences, little is known about the characteristics of ED use by North African (NA) immigrants. The main objective of this study was to examine whether there were differences in ED discharge outcomes and psychiatric referrals between NA immigrants and Swiss nationals. A retrospective analysis was conducted using patient records from NA and Swiss adults who were admitted to the ED of the University Hospital in Bern (Switzerland) from 2013–2016. Measures included demographic information as well as data on types of admission. Outcome variables included discharge type and psychiatric referral. A total of 77,619 patients generated 116,859 consultations to the ED, of which 1.1 per cent (n = 1338) were consultations by NA patients. Compared to Swiss national patients, NA patients were younger, with a median age of 38.0 (IQR 28–51 years vs. 52.0 (IQR 32–52) for Swiss and predominantly male (74.4% vs. 55.6% in the Swiss). NA patient admission type was more likely to be “walk-in” or legal admission (7.5% vs 0.8 in Swiss,). Logistic regressions indicated that NA patients had 1.2 times higher odds (95% CI 1.07–1.40, p < 0.003) of receiving ambulatory care. An effect modification by age group and sex was observed for the primary outcome “seen by a psychiatrist”, especially for men in the 16–25 years age group, whereby male NA patients had 3.45 times higher odds (95% CI: 2.22–5.38) of having being seen by a psychiatrist. In conclusion differences were observed between NA and Swiss national patients in ED consultations referrals and outcomes, in which NA had more ambulatory discharges and NA males, especially young, were more likely to have been seen by psychiatrist. Future studies would benefit from identifying those factors underlying these differences in ED utilization. Full article
(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)
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Open AccessArticle Prevalence and Predictors of Malaria in Human Immunodeficiency Virus Infected Patients in Beira, Mozambique
Int. J. Environ. Res. Public Health 2018, 15(9), 2032; https://doi.org/10.3390/ijerph15092032
Received: 31 July 2018 / Revised: 13 September 2018 / Accepted: 14 September 2018 / Published: 17 September 2018
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Abstract
Co-infection between malaria and HIV has major public health implications. The aims of this study were to assess the malaria prevalence and to identify predictors of positivity to malaria Test in HIV positive patients admitted to the health center São Lucas of Beira,
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Co-infection between malaria and HIV has major public health implications. The aims of this study were to assess the malaria prevalence and to identify predictors of positivity to malaria Test in HIV positive patients admitted to the health center São Lucas of Beira, Mozambique. A retrospective cross-sectional study was performed from January 2016 to December 2016. Overall, 701 adult HIV patients were enrolled, positivity to malaria test was found in 232 (33.0%). These patients were found to be more frequently unemployed (76.3%), aged under 40 (72.0%), with a HIV positive partner (22.4%) and with a CD4 cell count <200 (59.9%). The following variables were predictors of malaria: age under 40 (O.R. = 1.56; 95%CI: 1.22–2.08), being unemployed (O.R. = 1.74; 95%CI: 1.24–2.21), irregularity of cotrimoxazole prophylaxis’s (O.R. = 1.42; 95%CI: 1.10–1.78), CD4 cell count <200 (O.R. = 2.01; 95%CI: 1.42–2.32) and tuberculosis comorbidity (O.R. = 1.58; 95%CI: 1.17–2.79). In conclusion, high malaria prevalence was found in HIV patients accessing the out-patients centre of São Lucas of Beira. Our findings allowed us to identify the profile of HIV patients needing more medical attention: young adults, unemployed, with a low CD4 cell count and irregularly accessing to ART and cotrimoxazole prophylaxis. Full article
(This article belongs to the Special Issue Mosquito-Borne Disease)
Open AccessArticle Prevalence of Metabolic Syndrome and Its Associated Factors among Vegetarians in Malaysia
Int. J. Environ. Res. Public Health 2018, 15(9), 2031; https://doi.org/10.3390/ijerph15092031
Received: 20 June 2018 / Revised: 3 September 2018 / Accepted: 5 September 2018 / Published: 17 September 2018
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The prevalence and factors associated with metabolic syndrome (MetS) remain unknown in Malaysian vegetarians. This cross-sectional study aimed to determine the prevalence of MetS among vegetarians in Kuala Lumpur and Selangor and its associated factors. The data on socio-demographic characteristics, vegetarianism practises, lifestyle
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The prevalence and factors associated with metabolic syndrome (MetS) remain unknown in Malaysian vegetarians. This cross-sectional study aimed to determine the prevalence of MetS among vegetarians in Kuala Lumpur and Selangor and its associated factors. The data on socio-demographic characteristics, vegetarianism practises, lifestyle behaviours, body weight, height, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), and blood lipid profiles were collected from 273 vegetarians. A majority of the respondents were lacto-ovo vegetarians (44.0%), females (64.8%) and Chinese (54.9%). The prevalence of MetS was 24.2%. High BP (48.7%) and high WC (43.6%) were the most common MetS components. Females had lower WC, SBP, DBP, FBG, TG and higher HDL-c (p < 0.05) as compared to males. Multiple logistic regression analysis showed that being overweight and obese (Odds Ratio (OR) = 7.74, 95% Confidence Interval (CI): 4.04–14.82) was the main risk factor of MetS after being adjusted for sex and age. This study found that one in four vegetarians had MetS. An intervention programme should be developed to reduce Body Mass Index (BMI) among vegetarians, especially among those who are found to be overweight and obese. Full article
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
Open AccessBrief Report Associations between Bystanders and Perpetrators of Online Hate: The Moderating Role of Toxic Online Disinhibition
Int. J. Environ. Res. Public Health 2018, 15(9), 2030; https://doi.org/10.3390/ijerph15092030
Received: 29 August 2018 / Revised: 12 September 2018 / Accepted: 15 September 2018 / Published: 17 September 2018
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Abstract
Hatred directed at members of groups due to their origin, race, gender, religion, or sexual orientation is not new, but it has taken on a new dimension in the online world. To date, very little is known about online hate among adolescents. It
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Hatred directed at members of groups due to their origin, race, gender, religion, or sexual orientation is not new, but it has taken on a new dimension in the online world. To date, very little is known about online hate among adolescents. It is also unknown how online disinhibition might influence the association between being bystanders and being perpetrators of online hate. Thus, the present study focused on examining the associations among being bystanders of online hate, being perpetrators of online hate, and the moderating role of toxic online disinhibition in the relationship between being bystanders and perpetrators of online hate. In total, 1480 students aged between 12 and 17 years old were included in this study. Results revealed positive associations between being online hate bystanders and perpetrators, regardless of whether adolescents had or had not been victims of online hate themselves. The results also showed an association between toxic online disinhibition and online hate perpetration. Further, toxic online disinhibition moderated the relationship between being bystanders of online hate and being perpetrators of online hate. Implications for prevention programs and future research are discussed. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
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Open AccessArticle The Oakville Oil Refinery Closure and Its Influence on Local Hospitalizations: A Natural Experiment on Sulfur Dioxide
Int. J. Environ. Res. Public Health 2018, 15(9), 2029; https://doi.org/10.3390/ijerph15092029
Received: 31 July 2018 / Revised: 11 September 2018 / Accepted: 11 September 2018 / Published: 17 September 2018
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Background: An oil refinery in Oakville, Canada, closed over 2004–2005, providing an opportunity for a natural experiment to examine the effects on oil refinery-related air pollution and residents’ health. Methods: Environmental and health data were collected for the 16 years around
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Background: An oil refinery in Oakville, Canada, closed over 2004–2005, providing an opportunity for a natural experiment to examine the effects on oil refinery-related air pollution and residents’ health. Methods: Environmental and health data were collected for the 16 years around the refinery closure. Toronto (2.5 million persons) and the Greater Toronto Area (GTA, 6.3 million persons) were used as control and reference populations, respectively, for Oakville (160,000 persons). We compared sulfur dioxide and age- and season-standardized hospitalizations, considering potential factors such as changes in demographics, socio-economics, drug prescriptions, and environmental variables. Results: The closure of the refinery eliminated 6000 tons/year of SO2 emissions, with an observed reduction of 20% in wind direction-adjusted ambient concentrations in Oakville. After accounting for trends, a decrease in cold-season peak-centered respiratory hospitalizations was observed for Oakville (reduction of 2.2 cases/1000 persons per year, p = 0.0006 ) but not in Toronto (p = 0.856) and the GTA (p = 0.334). The reduction of respiratory hospitalizations in Oakville post closure appeared to have no observed link to known confounders or effect modifiers. Conclusion: The refinery closure allowed an assessment of the change in community health. This natural experiment provides evidence that a reduction in emissions was associated with improvements in population health. This study design addresses the impact of a removed source of air pollution. Full article
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