Previous Issue
Volume 16, October-1

Table of Contents

Int. J. Environ. Res. Public Health, Volume 16, Issue 20 (October-2 2019)

  • Issues are regarded as officially published after their release is announced to the table of contents alert mailing list.
  • You may sign up for e-mail alerts to receive table of contents of newly released issues.
  • PDF is the official format for papers published in both, html and pdf forms. To view the papers in pdf format, click on the "PDF Full-text" link, and use the free Adobe Readerexternal link to open them.
Cover Story (view full-size image) Our study focuses on the relationships between self-monitoring behavior and health behavior [...] Read more.
Order results
Result details
Select all
Export citation of selected articles as:
Open AccessArticle
Physicochemical and Biological Effects on Activated Sludge Performance and Activity Recovery of Damaged Sludge by Exposure to CeO2 Nanoparticles in Sequencing Batch Reactors
Int. J. Environ. Res. Public Health 2019, 16(20), 4029; https://doi.org/10.3390/ijerph16204029 (registering DOI) - 21 Oct 2019
Abstract
Recently, the growing release of CeO2 nanoparticles (CeO2 NPs) into sewage systems has attracted great concern. Several studies have extensively explored CeO2 NPs’ potential adverse impacts on wastewater treatment plants; however, the impaired activated sludge recovery potentials have seldom been [...] Read more.
Recently, the growing release of CeO2 nanoparticles (CeO2 NPs) into sewage systems has attracted great concern. Several studies have extensively explored CeO2 NPs’ potential adverse impacts on wastewater treatment plants; however, the impaired activated sludge recovery potentials have seldom been addressed to date. To explore the physicochemical and biological effects on the activated sludge performance and activity recovery of damaged sludge by exposure to CeO2 NPs in sequencing batch reactors (SBRs), four reactors and multiple indicators including water quality, key enzymes, microbial metabolites, the microbial community structure and toxicity were used. Results showed that 10-week exposure to higher CeO2 NP concentration (1, 10 mg/L) resulted in a sharp decrease in nitrogen and phosphorus removal efficiencies, which were consistent with the tendencies of key enzymes. Meanwhile, CeO2 NPs at concentrations of 0.1, 1, and 10 mg/L decreased the secretion of tightly bound extracellular polymeric substances to 0.13%, 3.14%, and 28.60%, respectively, compared to the control. In addition, two-week recovery period assays revealed that the functional bacteria Proteobacteria, Nitrospirae and Planctomycetes recovered slightly at the phyla level, as analyzed through high-throughput sequencing, which was consistent with the small amount of improvement of the effluent performance of the system. This reflected the small possibility of the activity recovery of damaged sludge. Full article
(This article belongs to the collection Municipal Wastewater Treatment and Sludge Treatment and Disposal)
Show Figures

Figure 1

Open AccessArticle
The Association Between Health Conditions, Consciousness, Involvement, and Knowledge and Dietary Supplement Intake among University Students in South Korea
Int. J. Environ. Res. Public Health 2019, 16(20), 4028; https://doi.org/10.3390/ijerph16204028 (registering DOI) - 21 Oct 2019
Abstract
Dietary supplements (DSs) are typically used by the elderly in a population, but younger age groups are increasingly purchasing these products. In consideration of this issue, the present study investigated the DS-related behaviors and general lifestyles of university students in South Korea. The [...] Read more.
Dietary supplements (DSs) are typically used by the elderly in a population, but younger age groups are increasingly purchasing these products. In consideration of this issue, the present study investigated the DS-related behaviors and general lifestyles of university students in South Korea. The health conditions, consciousness, involvement, and knowledge, as well as the future behavioral intentions, of DS users and non-users were determined and compared. A survey was administered to the respondents, and measurements were adapted and rephrased to suit the Korean context. Results showed that although the behaviors of DS users and non-users were characterized by similar patterns, significant differences in health involvement and future purchase were found between these groups. Health involvement influenced DSs buying intentions in the future, but no significant differences in the other variables were found. The findings suggested that university students take DSs regardless of their expectations about their efficacy and that their knowledge does not affect their intention to purchase such products. Full article
(This article belongs to the Section Environmental Health)
Open AccessReview
A Scoping Review and Conceptual Model of Social Participation and Mental Health among Refugees and Asylum Seekers
Int. J. Environ. Res. Public Health 2019, 16(20), 4027; https://doi.org/10.3390/ijerph16204027 (registering DOI) - 21 Oct 2019
Abstract
Social participation plays a key role in the integration of refugees and asylum seekers into their host societies, and is also closely tied to the mental health of those populations. The aim of this scoping review was to study how the concept of [...] Read more.
Social participation plays a key role in the integration of refugees and asylum seekers into their host societies, and is also closely tied to the mental health of those populations. The aim of this scoping review was to study how the concept of social participation is described in empirical research, and how it is associated with mental health outcomes. Methods: In total, 64 studies were identified through searches in PubMed, PsycInfo, and Sociological Abstracts. These studies describe various forms of social participation among refugees and asylum seekers, and 33 of them also addressed various forms of mental health outcomes. Results: The identified studies described forms and conditions of social participation—both in the host country and transnationally—that could be synthesized into three broad dimensions: (1) Regulatory frameworks, conditions and initiatives; (2) Established societal organizations and social structures; and (3) Community organized groups. Each of these consisted of several sub-domains. The identified dimensions of social participation were also associated with psychosocial well-being and decreased psychological distress. Conclusions: There is a need for policies to enable and support the participation of refugees and asylum seekers in various dimensions of social structures in host societies. Social participation enhances resilience, re-establishes social lives, and acts as a protective factor against poor mental health outcomes. Full article
(This article belongs to the Section Global Health)
Show Figures

Figure 1

Open AccessArticle
Assessing the Spatial Distribution of Biodiversity in a Changing Temperature Pattern: The Case of Catalonia, Spain
Int. J. Environ. Res. Public Health 2019, 16(20), 4026; https://doi.org/10.3390/ijerph16204026 (registering DOI) - 21 Oct 2019
Abstract
The impacts that climate change and land-use dynamics have on biodiversity are already visible in the distribution and behaviour of a large number of species. By using a Bayesian framework, including land-use, meteorological, topography and other variables as explanatory variables, such as distance [...] Read more.
The impacts that climate change and land-use dynamics have on biodiversity are already visible in the distribution and behaviour of a large number of species. By using a Bayesian framework, including land-use, meteorological, topography and other variables as explanatory variables, such as distance to roads and urban centres, we modeled a number of species within each cell of a regular lattice for Catalonia, Spain, in the period of 2004 to 2010. We estimated a slight increase in daily maximum temperature and a more significant increase in minimum temperature (a 5-year increase of 0.159 °C in maximum temperature, and an increase of 0.332 °C in minimum temperature). The estimation shows that the total number of species was greater than expected in the cells where land use was not urban—38.4%, in forests and 55.2% in mixed forests. Finally, we observed that most invasive species are found in areas where the minimum temperature is expected to increase. Our study can help with making important recommendations as to where, when and how future threats could affect specie distribution and the kind of planning processes needed for when protected natural areas will be unable to continue to support all the species they were designed to protect. Full article
(This article belongs to the Section Global Health)
Show Figures

Figure 1

Open AccessArticle
‘There You Enjoy Life, Here You Work’: Brazilian and Dominican Immigrants’ Views on Work and Health in the U.S.
Int. J. Environ. Res. Public Health 2019, 16(20), 4025; https://doi.org/10.3390/ijerph16204025 (registering DOI) - 21 Oct 2019
Abstract
Structural inequalities in the U.S. work environment place most immigrants in low paying, high-risk jobs. Understanding how work experiences and influence the health of different immigrant populations is essential to address disparities. This article explores how Brazilian and Dominican immigrants feel about their [...] Read more.
Structural inequalities in the U.S. work environment place most immigrants in low paying, high-risk jobs. Understanding how work experiences and influence the health of different immigrant populations is essential to address disparities. This article explores how Brazilian and Dominican immigrants feel about their experiences working in the U.S. and how the relationship between work and culture might impact their health. In partnership with the Dominican Development Center and the Brazilian Worker Center, we held five cultural conversations (CCs) with Brazilians (n = 48) and five with Dominicans (n = 40). CCs are participatory, unstructured groups facilitated by representatives from or embedded in the community. Brazilian immigrants focused on physical health and the American Dream while Dominicans immigrants emphasized concerns about the influence of work on mental health. Dominicans’ longer tenure in the U.S. and differences in how Brazilians and Dominicans are racialized in the region might account for the variation in perspectives between groups. Future studies should further investigate the relationship between health and how immigrants’ work lives are shaped by culture, race and immigrant status. Full article
(This article belongs to the collection Achieving Environmental Health Equity: Great Expectations)
Open AccessArticle
A Bibliometric Analysis of the Health Field Regarding Social Networks and Young People
Int. J. Environ. Res. Public Health 2019, 16(20), 4024; https://doi.org/10.3390/ijerph16204024 (registering DOI) - 21 Oct 2019
Abstract
Social networks have historically been used to share information and support regarding health-related topics, and this usage has increased with the rise of online social media. Young people are high users of social media, both as passive listeners and as active contributors. This [...] Read more.
Social networks have historically been used to share information and support regarding health-related topics, and this usage has increased with the rise of online social media. Young people are high users of social media, both as passive listeners and as active contributors. This study aimed to map the trends in publications focused on social networks, health, and young people over the last 40 years. Scopus and the program VOSviewer were used to map the frequency of the publications, keywords, and clusters of researchers active in the field internationally. A structured keyword search using the Scopus database yielded 11,966 publications. The results reveal a long history of research on social networks, health, and young people. Research articles were the most common type of publication (68%), most of which described quantitative studies (82%). The main discipline represented in this literature was medicine, with 6062 documents. North American researchers dominate the field, both as authors and partners in international research collaborations. The present article adds to the literature by elucidating the growing importance of social networks in health research as a topic of study. This may help to inform future investments in public health research and surveillance using these novel data sources. Full article
(This article belongs to the Special Issue Bibliometric Studies and Worldwide Research Trends on Global Health)
Show Figures

Figure 1

Open AccessArticle
Mediating Effect of Social Support in the Relationship Between Childhood Abuse and Non-Suicidal Self-Injury Among Chinese Undergraduates: The Role of Only-Child Status
Int. J. Environ. Res. Public Health 2019, 16(20), 4023; https://doi.org/10.3390/ijerph16204023 (registering DOI) - 21 Oct 2019
Abstract
Previous research has found a relationship between child abuse and non-suicidal self-injury (NSSI). However, few studies have examined the role of social support underlying this association. Moreover, the influence of the only child status on the mediating effect of social support has not [...] Read more.
Previous research has found a relationship between child abuse and non-suicidal self-injury (NSSI). However, few studies have examined the role of social support underlying this association. Moreover, the influence of the only child status on the mediating effect of social support has not been studied yet. The aim of this study was to investigate the mediating role of social support on the association between specific forms of child abuse and NSSI as well as the role of the only child status on the mediated pathways, among undergraduates. A total of 4799 participants were selected from two medical colleges in the Anhui province using stratified cluster sampling. Pearson's correlation analysis was used in analyzing the relationship. Bootstrapping procedures were applied to examine the mediating effects. After adjusting for confounders, the results showed that the mediating effect of social support on the association between childhood abuse and NSSI was not significant in the total sample. However, among only children, the mediating effects of social support between overall childhood abuse, physical abuse, emotional abuse, and NSSI were 9.65%, 14.82%, and 8.12%, respectively. Moreover, the mediating effect of social support from family and relatives was relatively higher than that from other sources. Social support had a mediating effect on the relationship between childhood abuse and NSSI among only-children. The enhancing of social support may contribute to the prevention and control of NSSI for those who were only-children in undergraduates, especially those who have experienced childhood abuse. Full article
Show Figures

Figure 1

Open AccessArticle
Target, Suspect and Non-Target Screening of Silylated Derivatives of Polar Compounds Based on Single Ion Monitoring GC-MS
Int. J. Environ. Res. Public Health 2019, 16(20), 4022; https://doi.org/10.3390/ijerph16204022 - 21 Oct 2019
Abstract
There is growing interest in determining the unidentified peaks within a sample spectra besides the analytes of interest. Availability of reference standards and hyphenated instruments has been a key and limiting factor in the rapid determination of emerging pollutants in the environment. In [...] Read more.
There is growing interest in determining the unidentified peaks within a sample spectra besides the analytes of interest. Availability of reference standards and hyphenated instruments has been a key and limiting factor in the rapid determination of emerging pollutants in the environment. In this work, polar compounds were silylated and analyzed with gas chromatography mass spectrometry (GC-MS) to determine the abundant fragments within the single ion monitoring (SIM) mode and methodology. Detection limits and recoveries of the compounds were established in river water, wastewater, biosolid and sediment matrices. Then, specific types of polar compounds that are classified as emerging contaminants, pharmaceuticals and personal care products, in the environment were targeted in the Mgeni and Msunduzi Rivers. We also performed suspect and non-target analysis screening to identify several other polar compounds in these rivers. A total of 12 compounds were quantified out of approximately 50 detected emerging contaminants in the Mgeni and Msunduzi Rivers. This study is significant for Africa, where the studies of emerging contaminants are limited and not usually prioritized. Full article
Show Figures

Figure 1

Open AccessArticle
Premature Mortality for Chronic Diseases in the EU Member States
Int. J. Environ. Res. Public Health 2019, 16(20), 4021; https://doi.org/10.3390/ijerph16204021 - 21 Oct 2019
Abstract
Premature mortality, and especially premature mortality for chronic diseases, is a very important topic of public health, health care, or lifestyle of population. The main aim of countries is to reduce premature mortality, and therefore an analysis of the development and status of [...] Read more.
Premature mortality, and especially premature mortality for chronic diseases, is a very important topic of public health, health care, or lifestyle of population. The main aim of countries is to reduce premature mortality, and therefore an analysis of the development and status of premature standardized death rates (SDR) is key for disclosure of successes or failures in this topic. A boxplot chart was used to detect extremes of SDR for both sexes. The gender ratio revealed the differences of mortality rates between men and women. Premature mortality declined steadily in the EU between 2000 and 2016. The men’s premature SDR decreased from 390 to 275.9 between 2000 and 2016, while the women’s rate declined from 180.1 to 138.2. On average, annual premature SDR dropped by 2.14% for men and 1.64% for women. Thus, the gender ratio (male/female) declined from 2.17 in 2000 to 2.0 in 2016, which is a positive change for gender gap closing. The highest proportion of premature mortality belonged to mortality for malignant neoplasms, where the rate was as high as 47% for women and 32% for men in 2016. Premature mortality for chronic disease is especially high in the “new” EU member states. Full article
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
Show Figures

Figure 1

Open AccessArticle
Two Approaches to Increase Physical Activity for Preschool Children in Child Care Centers: A Matched-Pair Cluster-Randomized Trial
Int. J. Environ. Res. Public Health 2019, 16(20), 4020; https://doi.org/10.3390/ijerph16204020 - 21 Oct 2019
Viewed by 52
Abstract
Early childhood education settings are critical for promoting physical activity (PA) but intervention effects are often small. The aim of this study was to develop, test, and compare two approaches to increasing physical activity among preschoolers at child care centers: one focused on [...] Read more.
Early childhood education settings are critical for promoting physical activity (PA) but intervention effects are often small. The aim of this study was to develop, test, and compare two approaches to increasing physical activity among preschoolers at child care centers: one focused on a teacher-led PA curriculum (Active Play!) and the other on increasing outdoor child-initiated free play time (Outdoor Play!). We conducted a matched-pair cluster-randomized study in 10 centers in and around Seattle, WA, USA (n = 97 children, mean age 4.6). Pre- and post-intervention data were collected from observations and accelerometers. At pre-intervention, 19% of Active Play! and 25% of Outdoor Play! children achieved >120 min/day of PA during child care. The total opportunity for PA increased in both interventions (Active Play! = 11 min/day; Outdoor Play! = 14 min/day), with the largest increase in outdoor child-initiated free playtime (Active Play! = 19 min/day; Outdoor Play! = 24 min/day). No changes in sedentary time, light or moderate- to vigorous-intensity PA (MVPA) were observed in either intervention and there was no difference between interventions in the percentage of children attaining more than 120 min/day of PA. A small (<3 min/day) relative increase in teacher-led outdoor activity was observed in the Active Play! intervention. Both intervention strategies led to an increase in active play opportunities, predominantly outdoors, but neither was able to substantially increase the intensity and/or duration of children’s PA. Future studies are needed to better understand and inform sustainable approaches to increase PA in early learning settings. Full article
(This article belongs to the Section Children's Health)
Open AccessArticle
Evaluation of the Effectiveness of Comprehensive Smoke-Free Legislation in Indoor Public Places in Shanghai, China
Int. J. Environ. Res. Public Health 2019, 16(20), 4019; https://doi.org/10.3390/ijerph16204019 - 21 Oct 2019
Viewed by 59
Abstract
This study evaluated compliance with the comprehensive smoke-free law in public indoor places introduced in Shanghai in March 2017. Observations and PM2.5 monitoring over 30 min intervals in 8 types of the venue were conducted three times: within a month before implementation and [...] Read more.
This study evaluated compliance with the comprehensive smoke-free law in public indoor places introduced in Shanghai in March 2017. Observations and PM2.5 monitoring over 30 min intervals in 8 types of the venue were conducted three times: within a month before implementation and 3- and 12-months post implementation. Observations of evidence of smoking decreased from 66.2% before legislation to 52.8% three months after (p = 0.002) and 49.7% one year after (p < 0.001). The density of lit cigarettes also reduced significantly after implementation (p < 0.001). When adjusting for outdoor, indoor PM2.5 levels were significantly lower after the legislation, but only by a small amount (three months later: −0.27, p = 0.08; one year later: −0.12; p = 0.03). Evidence of compliance was weakest in farmer’s markets and bars, and smoking in male toilets did not change significantly. The reduction in smoking was affected by the management performance of their obligations. The comprehensive smoke-free law led to modest reductions in smoking and PM2.5 levels as a result, but from levels suggesting quite high levels of pre-compliance. However, compliance was limited in some areas, suggesting more effort is required on management to gain better compliance in some places like farmer’s markets, bars, and toilets. Full article
Show Figures

Figure 1

Open AccessArticle
Health Inequality Among the Elderly in Rural China and Influencing Factors: Evidence from the Chinese Longitudinal Healthy Longevity Survey
Int. J. Environ. Res. Public Health 2019, 16(20), 4018; https://doi.org/10.3390/ijerph16204018 - 20 Oct 2019
Viewed by 200
Abstract
Based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this paper calculates the health distribution of the elderly using the Quality of Well-Being Scale (QWB) score, and then estimates health inequality among the elderly in rural China using the Wagstaff index [...] Read more.
Based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this paper calculates the health distribution of the elderly using the Quality of Well-Being Scale (QWB) score, and then estimates health inequality among the elderly in rural China using the Wagstaff index (WI) and Erreygers index (EI). Following this, it compares health inequalities among the elderly in different age groups, and finally, uses the Shapley and recentered influence function-index-ordinary least squares (RIF-I-OLS) model to decompose the effect of four factors on health inequality among the elderly in rural China. The QWB score distribution shows that the health of the elderly in rural China improved with social economic development and medical reform from 2002 to 2014. However, at the same time, we were surprised to find that the health level of the 65–74 years old group has been declining steadily since 2008. This phenomenon implies that the incidence of chronic diseases is moving towards the younger elderly. The WI and EI show that there is indeed pro-rich health inequality among the rural elderly, the health inequality of the younger age groups is more serious than that of the older age groups, and the former incidence of health inequality is higher. Health inequality in the age group of 65–74 years old is higher than that in other groups, and the trend of change fluctuated downward from 2002 to 2014. Health inequality in the age group of 75–84 years old is lower than that in the group of 65–74 years old, but higher than that in the other age groups. The results of Shapley decomposition show that demographic characteristics, socioeconomic status (SES), health care access, and quality of later life contributed 0.0054, 0.0130, 0.0442, and 0.0218 to the health inequality index of the elderly, which accounted for 6.40%, 15.39%, 52.41%, and 25.80% of health inequality index. From the results of RIF-I-OLS decomposition, this paper has analyzed detailed factors’ marginal effects on health inequality from four dimensions, which indicates that the health inequality among the elderly in rural China was mainly caused by the disparity of income, medical expenses, and living arrangement. Full article
Open AccessArticle
Effects of Slope Ecological Restoration on Runoff and Its Response to Climate Change
Int. J. Environ. Res. Public Health 2019, 16(20), 4017; https://doi.org/10.3390/ijerph16204017 - 20 Oct 2019
Viewed by 189
Abstract
Slope ecological restoration and climate change are important factors affecting the hydrological processes of the Huangshui River Basin in Qinghai province, China. How to quantitatively identify the impact of slope ecological restoration on runoff and whether slope ecological restoration can mitigate the impact [...] Read more.
Slope ecological restoration and climate change are important factors affecting the hydrological processes of the Huangshui River Basin in Qinghai province, China. How to quantitatively identify the impact of slope ecological restoration on runoff and whether slope ecological restoration can mitigate the impact of future climate change on runoff are both very important. In this paper, the Huangshui River above the center of Minhe county was taken as the research area, and the Pinus tabulaeformis and shrubs were taken as the main forest land types of slope ecological restoration. First, based on the law of forest land variation, the construction scales of slope ecological restoration in different periods were identified. The influence of slope ecological restoration on runoff was then quantitatively evaluated by using a distributed hydrological model. Second, the future climate scenarios of five general circulation models (GCMs) under three representative concentration pathways (RCPs) (i.e., RCP2.6, RCP4.5, and RCP8.5) from 2021 to 2050 were selected and modified by model integration. Combined with the slope ecological restoration scenarios, the influence of slope ecological restoration on runoff under future climate scenarios was explored. The results showed that the effect of slope ecological restoration was significant. Compared with 1980, the area of slope ecological restoration increased by 24% in 2017. Under the present climate conditions (1960–2017), different periods of slope ecological restoration have an effect on the process of runoff in the wet season (June, July, August, and September) and dry season (January, February, March, and December), which eliminates the maximum, replenishes the minimum, and reduces the variability of runoff processes in the watershed. Under the future climate scenario (2021–50), slope ecological restoration will reduce runoff. On the other hand, climate change will increase runoff, and the combination of the two effects will have a certain offsetting effect. On the whole, comparing the influence of slope ecological restoration on the runoff process with that of climate change in different seasons, due to the main influence of slope ecological restoration, the runoff decreased by about 55% in the temperate season (April, May, October, and November), and increased by about 50% in the dry season or wet season due to the main influence of future climate scenarios. Full article
(This article belongs to the Special Issue Climate Change Impacts on Hydrology and Water Resources Management)
Show Figures

Figure 1

Open AccessArticle
The Contextual Effect of Area-Level Unemployment Rate on Lower Back Pain: A Multilevel Analysis of Three Consecutive Surveys of 962,586 Workers in Japan
Int. J. Environ. Res. Public Health 2019, 16(20), 4016; https://doi.org/10.3390/ijerph16204016 - 20 Oct 2019
Viewed by 206
Abstract
This study examined the associations between area-level unemployment rates and lower back pain using large-scale data provided by the Japanese working population. We analyzed data from a nationally representative, repeated, cross-sectional study across three waves from 2010, 2013, and 2016 in 47 Japanese [...] Read more.
This study examined the associations between area-level unemployment rates and lower back pain using large-scale data provided by the Japanese working population. We analyzed data from a nationally representative, repeated, cross-sectional study across three waves from 2010, 2013, and 2016 in 47 Japanese subnational level areas. Workers aged 18–64 years (n = 962,586) were eligible to participate in the study. A multilevel logistic model was used to examine the association between the unemployment rate and lower back pain. The self-report of lower back pain was a dependent variable. The prefecture-level unemployment rate was analyzed as an independent variable, adjusted for individual-level covariates (e.g., gender, age, socioeconomic status). After adjusting for all covariates, the main effect of the prefecture-level unemployment rate was statistically significant: the odds ratio (OR) (95% credible interval (CrI)) was 1.01 (1.002, 1.03). Additionally, the OR (95% CrI) for the interaction between gender and the prefecture-level unemployment rate was 1.02 (1.01, 1.03) indicating that women were more affected by area-level employment status than men. In conclusion, a significant association between the unemployment rate and lower back pain was observed in the Japanese working population. Women were more sensitive to the unemployment rate. Full article
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
Show Figures

Figure 1

Open AccessArticle
Future Temperature Extremes Will Be More Harmful: A New Critical Factor for Improved Forecasts
Int. J. Environ. Res. Public Health 2019, 16(20), 4015; https://doi.org/10.3390/ijerph16204015 - 20 Oct 2019
Viewed by 168
Abstract
There is increasing evidence that extreme weather events such as frequent and intense cold spells and heat waves cause unprecedented deaths and diseases in both developed and developing countries. Thus, they require extensive and immediate research to limit the risks involved. Average temperatures [...] Read more.
There is increasing evidence that extreme weather events such as frequent and intense cold spells and heat waves cause unprecedented deaths and diseases in both developed and developing countries. Thus, they require extensive and immediate research to limit the risks involved. Average temperatures in Europe in June–July 2019 were the hottest ever measured and attributed to climate change. The problem, however, of a thorough study of natural climate change is the lack of experimental data from the long past, where anthropogenic activity was then very limited. Today, this problem can be successfully resolved using, inter alia, biological indicators that have provided reliable environmental information for thousands of years in the past. The present study used high-resolution quantitative reconstruction data derived from biological records of Lake Silvaplana sediments covering the period 1181–1945. The purpose of this study was to determine whether a slight temperature change in the past could trigger current or future intense temperature change or changes. Modern analytical tools were used for this purpose, which eventually showed that temperature fluctuations were persistent. That is, they exhibit long memory with scaling behavior, which means that an increase (decrease) in temperature in the past was always followed by another increase (decrease) in the future with multiple amplitudes. Therefore, the increase in the frequency, intensity, and duration of extreme temperature events due to climate change will be more pronounced than expected. This will affect human well-being and mortality more than that estimated in today’s modeling scenarios. The scaling property detected here can be used for more accurate monthly to decadal forecasting of extreme temperature events. Thus, it is possible to develop improved early warning systems that will reduce the public health risk at local, national, and international levels. Full article
(This article belongs to the Special Issue Environmental Issues in Aerospace and their Impact on Public Health)
Show Figures

Figure 1

Open AccessArticle
Parental Approach to the Management of Childhood Fever: Differences between Health Professional and Non-Health Professional Parents
Int. J. Environ. Res. Public Health 2019, 16(20), 4014; https://doi.org/10.3390/ijerph16204014 - 20 Oct 2019
Viewed by 160
Abstract
Fever is responsible for 30% of pediatric consultations at primary care services. The aim of this study was to explore the parental approach to fever in children aged between 0 and 12 years old by both health professional and non-health professional parents. A [...] Read more.
Fever is responsible for 30% of pediatric consultations at primary care services. The aim of this study was to explore the parental approach to fever in children aged between 0 and 12 years old by both health professional and non-health professional parents. A qualitative study based on grounded theory was performed. Focus groups were conducted, segmented by sex, place of residence, and healthcare training, using a triangulated sample (theoretical and snowball sampling) of parents of children aged between 0 and 12 years who were treated for fever at primary care emergency services. The constant comparative method and a process of coding was used for the analysis. The study findings reveal that the health training of parents, their former experience, family pressures, the age of the child, and the parents’ work outside the home, all influenced how they approached fever management. These findings could be incorporated into clinical practice to improve care and compliance with fever treatment. Full article
(This article belongs to the Section Children's Health)
Show Figures

Figure 1

Open AccessEditorial
Frailty and Sarcopenia as a Geriatric Syndrome in Community-Dwelling Older Adults
Int. J. Environ. Res. Public Health 2019, 16(20), 4013; https://doi.org/10.3390/ijerph16204013 - 19 Oct 2019
Viewed by 211
Abstract
Geriatric syndrome refers to a series of symptoms and observations caused by a variety of factors associated with aging, where the older adults show the treatment consciously or otherwise, and long-term care becomes important at the same time [...] Full article
(This article belongs to the Special Issue Geriatrics Syndromes Prevention)
Open AccessArticle
Improved Estimates of Population Exposure in Low-Elevation Coastal Zones of China
Int. J. Environ. Res. Public Health 2019, 16(20), 4012; https://doi.org/10.3390/ijerph16204012 - 19 Oct 2019
Viewed by 239
Abstract
With sea level predicted to rise and the frequency and intensity of coastal flooding expected to increase due to climate change, high-resolution gridded population datasets have been extensively used to estimate the size of vulnerable populations in low-elevation coastal zones (LECZ). China is [...] Read more.
With sea level predicted to rise and the frequency and intensity of coastal flooding expected to increase due to climate change, high-resolution gridded population datasets have been extensively used to estimate the size of vulnerable populations in low-elevation coastal zones (LECZ). China is the most populous country, and populations in its LECZ grew rapidly due to urbanization and remarkable economic growth in coastal areas. In assessing the potential impacts of coastal hazards, the spatial distribution of population exposure in China’s LECZ should be examined. In this study, we propose a combination of multisource remote sensing images, point-of-interest data, and machine learning methods to improve the performance of population disaggregation in coastal China. The resulting population grid map of coastal China for the reference year 2010, with a spatial resolution of 100 × 100 m, is presented and validated. Then, we analyze the distribution of population in LECZ by overlaying the new gridded population data and LECZ footprints. Results showed that the total population exposed in China’s LECZ in 2010 was 158.2 million (random forest prediction) and 160.6 million (Cubist prediction), which account for 12.17% and 12.36% of the national population, respectively. This study also showed the considerable potential in combining geospatial big data for high-resolution population estimation. Full article
Open AccessArticle
Periodontal Treatment Experience Associated with Oral Health-Related Quality of Life in Patients with Poor Glycemic Control in Type 2 Diabetes: A Case-Control Study
Int. J. Environ. Res. Public Health 2019, 16(20), 4011; https://doi.org/10.3390/ijerph16204011 - 19 Oct 2019
Viewed by 213
Abstract
Severe periodontitis is a risk factor for poor glycemic control. The appropriate medical
treatment and plaque control of periodontitis positively affects blood-sugar control in diabetes
patients. We aimed to identify the factors associated with glycemic control and examine the
periodontal treatment (PT) experience [...] Read more.
Severe periodontitis is a risk factor for poor glycemic control. The appropriate medical
treatment and plaque control of periodontitis positively affects blood-sugar control in diabetes
patients. We aimed to identify the factors associated with glycemic control and examine the
periodontal treatment (PT) experience and oral health-related quality of life (OHQoL) for patients
with poor glycemic control in type 2 diabetes mellitus (T2DM). This multicenter case–control study
recruited 242 patients with poor glycemic control and 198 patients with good glycemic control. We
collected patients’ information through face-to-face interviews using a structured questionnaire.
The Oral Health Impact Profile-14 (OHIP-14) was used to measure OHQoL. Based on PT status, the
patients were classified into three groups: a non-periodontal disease group, a PT group, and a non-
PT (NPT) group. Regression models were used to analyze the data. No interdental cleaning
(adjusted odds ratio (aOR) = 1.78) and positive attitudes toward periodontal health (aOR = 1.11)
were significantly more likely to be associated with poor glycemic control in patients with T2DM.
The PT group had a significantly lower OHIP-14 score than the NPT group (6.05 vs. 9.02, p < 0.001),
indicating a better OHQoL among patients with poorly controlled T2DM. However, the OHQoL
did not differ significantly in patients with well-controlled T2DM between the PT and NPT groups.
This suggested that diabetic patients with poor glycemic control must improve periodontal care
practices and receive proper PT, if necessary, to improve their OHQoL. Full article
Open AccessCommunication
Working with Institutional Stakeholders: Propositions for Alternative Approaches to Community Engagement
Int. J. Environ. Res. Public Health 2019, 16(20), 4010; https://doi.org/10.3390/ijerph16204010 - 19 Oct 2019
Viewed by 215
Abstract
Community engagement is a vital aspect of addressing environmental contamination and remediation. In the United States, the Superfund Research Program (SRP) forms groups of academic researchers from the social and physical sciences into Community Engagement Cores (CECs) and Research Translation Cores (RTCs), which [...] Read more.
Community engagement is a vital aspect of addressing environmental contamination and remediation. In the United States, the Superfund Research Program (SRP) forms groups of academic researchers from the social and physical sciences into Community Engagement Cores (CECs) and Research Translation Cores (RTCs), which focus on various aspects of informing and working with communities during and through the resolution of environmental crises. While this work typically involves engaging directly with members of affected communities, no two situations are the same. In some cases, alternative approaches to community engagement can be more appropriate for community improvement than traditional approaches. In particular, when research teams become involved in contamination crises at a late point in the process, their contributions can be better directed at supporting and reinforcing the work of institutional stakeholders charged with remediating pollution. Relevant factors include issue fatigue among a local population, and contamination that is due to a major employer. Supported by literature and experience, we offer several propositions that we believe lay out conditions that warrant such an approach by academic teams, rather than their direct engagement with unaffiliated individuals in communities. Full article
(This article belongs to the Special Issue New Directions in Environmental Communication Research)
Open AccessArticle
Distributional Regression Techniques in Socioeconomic Research on the Inequality of Health with an Application on the Relationship between Mental Health and Income
Int. J. Environ. Res. Public Health 2019, 16(20), 4009; https://doi.org/10.3390/ijerph16204009 - 19 Oct 2019
Viewed by 217
Abstract
This study addresses the much-discussed issue of the relationship between health and income. In particular, it focuses on the relation between mental health and household income by using generalized additive models of location, scale and shape and thus employing a distributional perspective. Furthermore, [...] Read more.
This study addresses the much-discussed issue of the relationship between health and income. In particular, it focuses on the relation between mental health and household income by using generalized additive models of location, scale and shape and thus employing a distributional perspective. Furthermore, this study aims to give guidelines to applied researchers interested in taking a distributional perspective on health inequalities. In our analysis we use cross-sectional data of the German socioeconomic Panel (SOEP). We find that when not only looking at the expected mental health score of an individual but also at other distributional aspects, like the risk of moderate and severe mental illness, that the relationship between income and mental health is much more pronounced. We thus show that taking a distributional perspective, can add to and indeed enrich the mostly mean-based assessment of existent health inequalities. Full article
(This article belongs to the Special Issue Socioeconomic Inequality of Health)
Show Figures

Figure 1

Open AccessArticle
Environmental Impact of Burning Composite Materials Used in Aircraft Construction on the Air
Int. J. Environ. Res. Public Health 2019, 16(20), 4008; https://doi.org/10.3390/ijerph16204008 - 19 Oct 2019
Viewed by 229
Abstract
The negative impact of air incidents and emergency situations results from the leakage of liquids into the soil and water and the leakage of flue gases and combustion products of aircraft structural materials into the air during fires. This article deals with air [...] Read more.
The negative impact of air incidents and emergency situations results from the leakage of liquids into the soil and water and the leakage of flue gases and combustion products of aircraft structural materials into the air during fires. This article deals with air pollution caused by the combustion of composite materials commonly used in general aviation. Samples of composite materials of aircraft registered in the Czech Republic were selected. These samples of composite materials were tested for flammability, according to ISO 5660-1:2002 Reaction to fire tests—Heat Release, smoke production and mass loss rate (ISO—International Organization for Standardization). Total smoke release and total oxygen consumed were assessed in this study, both of which have a significant impact on air quality in the case of an air incident. Based on the results of the research, differences resulting from the diversity of the structures of the tested composite materials were found. The most hazardous composite material was evaluated from the point of view of its impact on air quality during combustion. Full article
(This article belongs to the Special Issue Environmental Issues in Aerospace and their Impact on Public Health)
Show Figures

Figure 1

Open AccessArticle
A Risk-Averse Shelter Location and Evacuation Routing Assignment Problem in an Uncertain Environment
Int. J. Environ. Res. Public Health 2019, 16(20), 4007; https://doi.org/10.3390/ijerph16204007 - 19 Oct 2019
Viewed by 146
Abstract
Disasters such as hurricanes, earthquakes and floods continue to have devastating socioeconomic impacts and endanger millions of lives. Shelters are safe zones that protect victims from possible damage, and evacuation routes are the paths from disaster zones toward shelter areas. To enable the [...] Read more.
Disasters such as hurricanes, earthquakes and floods continue to have devastating socioeconomic impacts and endanger millions of lives. Shelters are safe zones that protect victims from possible damage, and evacuation routes are the paths from disaster zones toward shelter areas. To enable the timely evacuation of disaster zones, decisions regarding shelter location and routing assignment (i.e., traffic assignment) should be considered simultaneously. In this work, we propose a risk-averse stochastic programming model with a chance constraint that takes into account the uncertainty in the demand of disaster sites while minimizing the total evacuation time. The total evacuation time reflects the efficacy of emergency management from a system optimal (SO) perspective. A conditional value-at-risk (CVaR) is incorporated into the objective function to account for risk measures in the presence of uncertain post-disaster demand. We resolve the non-linear travel time function of traffic flow by employing a second-order cone programming (SOCP) approach and linearizing the non-linear chance constraints into a new mixed-integer linear programming (MILP) reformulation so that the problem can be directly solved by state-of-the-art optimization solvers. We illustrate the application of our model using two case studies. The first case study is used to demonstrate the difference between a risk-neutral model and our proposed model. An extensive computational study provides practical insight into the proposed modeling approach using another case study concerning the Black Saturday bushfire in Australia. Full article
(This article belongs to the Special Issue Managing Disaster Risk in a Changing World)
Show Figures

Figure 1

Open AccessArticle
Factors Influencing Unintended Pregnancies amongst Adolescent Girls and Young Women in Cambodia
Int. J. Environ. Res. Public Health 2019, 16(20), 4006; https://doi.org/10.3390/ijerph16204006 - 19 Oct 2019
Viewed by 142
Abstract
Background: Unintended pregnancies in Cambodian youth are a major reproductive health concern with detrimental personal and socioeconomic consequences. A social ecological model was used to identify sociodemographic factors potentially associated with unintended pregnancies, and an analysis of data from the 2014 Cambodian Demographic [...] Read more.
Background: Unintended pregnancies in Cambodian youth are a major reproductive health concern with detrimental personal and socioeconomic consequences. A social ecological model was used to identify sociodemographic factors potentially associated with unintended pregnancies, and an analysis of data from the 2014 Cambodian Demographic and Health Survey was used to determine associations. Methods: Weighted data were analysed using multiple logistic regression analyses for 3406 Cambodian sexually active single, in union or married females aged 15–29 years. Results: The prevalence of unintended pregnancy was 12.3%. Unintended pregnancy was significantly associated with younger age groups (15–24 years), multiparity, history of abortion, and current use of modern contraceptive methods. All women had an increased likelihood of unintended pregnancy when the husband alone or someone else in the household made decisions about their access to healthcare. Conclusion: The burden of unintended pregnancies is associated with young age, multiparity, history of abortions, unemployment, and low autonomy for accessing healthcare. Multi-pronged, holistic reproductive and sexual health program interventions are needed to increase literacy and accessibility to modern contraception and to raise awareness about women’s health and status in Cambodia. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
Open AccessArticle
Parental Socialization, School Adjustment and Cyber-Aggression among Adolescents
Int. J. Environ. Res. Public Health 2019, 16(20), 4005; https://doi.org/10.3390/ijerph16204005 - 19 Oct 2019
Viewed by 241
Abstract
The objective of the present study is to analyse the relationships between parental socialization styles—indulgent, authoritarian, authoritative and negligent, school adjustment (social integration, academic competence and family involvement) and cyber-aggression (direct and indirect) in adolescents. Participating in this study were 1304 Spanish students [...] Read more.
The objective of the present study is to analyse the relationships between parental socialization styles—indulgent, authoritarian, authoritative and negligent, school adjustment (social integration, academic competence and family involvement) and cyber-aggression (direct and indirect) in adolescents. Participating in this study were 1304 Spanish students of both sexes (53.1% girls), aged between 12 and 18 years (M = 13.87, SD = 1.33). Multivariate analyses of variance were performed. The results showed significant relationships between parental socialization styles, school adjustment and cyber-aggression. It was observed that adolescents from indulgent and authoritative families showed greater academic competence and greater family involvement. Additionally, the children from authoritarian families displayed greater involvement in direct and indirect cyber-aggression behaviours. The results obtained and their implications are discussed in the final section. Full article
(This article belongs to the Special Issue Emotional and Behavioural Adjustment in Adolescence)
Show Figures

Figure 1

Open AccessArticle
Identifying Driving Factors of Jiangsu’s Regional Sulfur Dioxide Emissions: A Generalized Divisia Index Method
Int. J. Environ. Res. Public Health 2019, 16(20), 4004; https://doi.org/10.3390/ijerph16204004 - 19 Oct 2019
Viewed by 154
Abstract
The Chinese government has made some good achievements in reducing sulfur dioxide emissions through end-of-pipe treatment. However, in order to implement the stricter target of sulfur dioxide emission reduction during the 13th “Five-Year Plan” period, it is necessary to find a new solution [...] Read more.
The Chinese government has made some good achievements in reducing sulfur dioxide emissions through end-of-pipe treatment. However, in order to implement the stricter target of sulfur dioxide emission reduction during the 13th “Five-Year Plan” period, it is necessary to find a new solution as quickly as possible. Thus, it is of great practical significance to identify driving factors of regional sulfur dioxide emissions to formulate more reasonable emission reduction policies. In this paper, a distinctive decomposition approach, the generalized Divisia index method (GDIM), is employed to investigate the driving forces of regional industrial sulfur dioxide emissions in Jiangsu province and its three regions during 2004–2016. The contribution rates of each factor to emission changes are also assessed. The decomposition results demonstrate that: (i) the factors promoting the increase of industrial sulfur dioxide emissions are the economic scale effect, industrialization effect, and energy consumption effect, while technology effect, energy mix effect, sulfur efficiency effect, energy intensity effect, and industrial structure effect play a mitigating role in the emissions; (ii) energy consumption effect, energy mix effect, technology effect, sulfur efficiency effect, and industrial structure effect show special contributions in some cases; (iii) industrial structure effect and energy intensity effect need to be further optimized. Full article
Show Figures

Figure 1

Open AccessArticle
Diet Education as a Success Factor of Glycemia Regulation in Diabetes Patients: A Prospective Study
Int. J. Environ. Res. Public Health 2019, 16(20), 4003; https://doi.org/10.3390/ijerph16204003 - 19 Oct 2019
Viewed by 171
Abstract
Background: The aim of this study was to examine the effect of dietary education on glycemic control in patients with any type of diabetes at four-week and two-year follow-ups. Methods: A two-year prospective study was conducted in three phases: before, four weeks after, [...] Read more.
Background: The aim of this study was to examine the effect of dietary education on glycemic control in patients with any type of diabetes at four-week and two-year follow-ups. Methods: A two-year prospective study was conducted in three phases: before, four weeks after, and two years after an educational program. The participants were patients diagnosed with diabetes who were receiving insulin or oral hypoglycemics and who attended the Diabetes Clinic of the General County Hospital Našice, Croatia to receive their treatment. The questionnaire and educational program were created for the purpose of this study. Measurements were made (fasting blood glucose, glycated hemoglobin, body mass index, blood pressure, knowledge test) at baseline, four weeks and two years after education. Results: A total of 109 participants took part in the study, of which 56 (51.4%) were on insulin therapy and 53 (48.6%) were on oral therapy, after two years, 78 (72%) subjects were followed up with. There was no control group. At the two-year follow-up, participants with insulin therapy had significantly higher glycated hemoglobin (Mann–Whitney U test, p = 0.035). Significant differences were observed in fasted blood glucose (Friedman’s test, p = 0.001), diastolic pressure (Friedman’s test, P = 0.018), and glycated hemoglobin (Wilcoxon test, p < 0.001) between Phase 1 and Phase 3. Conclusions: Education has a positive effect on adherence to recommended diet and glycemia regulation in diabetes patients after four-week follow-ups. However, after two years, participants showed a decrease in adherence to recommended diet and increased glycemia. Full article
(This article belongs to the collection Health Care and Diabetes)
Open AccessArticle
Men’s Intentions to Recommend Professional Help-Seeking to Their Partners in the Postpartum Period: the Direct and Indirect Effects of Gender-Role Conflict
Int. J. Environ. Res. Public Health 2019, 16(20), 4002; https://doi.org/10.3390/ijerph16204002 - 19 Oct 2019
Viewed by 146
Abstract
Women’s partners may act as facilitators of professional help-seeking for mental health problems in the postpartum period. This study aimed to examine the sociodemographic and clinical correlates of men’s intentions to recommend professional help-seeking to their partners if they display postpartum mood and [...] Read more.
Women’s partners may act as facilitators of professional help-seeking for mental health problems in the postpartum period. This study aimed to examine the sociodemographic and clinical correlates of men’s intentions to recommend professional help-seeking to their partners if they display postpartum mood and anxiety disorders and to explore the relationship between gender-role conflict and the intention to recommend help-seeking. A cross-sectional study included 214 adult men in a heterosexual relationship with a partner within the reproductive age. Men presented a high intention to recommend professional help to their partners. All dimensions of gender-role conflict were directly associated with the intention to recommend professional help-seeking (p < 0.05). High levels of gender-role conflict (dimensions success, power and competition, and restricted emotionality) were found to lead to increased levels of stigma and lower levels of intention to seek professional help, which, in turn, translated into lower intention to recommend help-seeking. These results emphasize the importance of developing universal awareness-raising and education campaigns directed at men aiming to reduce levels of gender-role conflict and stigma, and normalize the use of mental health services, to increase men’s intentions to recommend professional help-seeking to their partners. Full article
(This article belongs to the Special Issue Stigma, Health and Wellbeing)
Show Figures

Figure 1

Open AccessArticle
Removal of Pollutants in Mine Wastewater by a Non-Cytotoxic Polymeric Bioflocculant from Alcaligenes faecalis HCB2
Int. J. Environ. Res. Public Health 2019, 16(20), 4001; https://doi.org/10.3390/ijerph16204001 - 19 Oct 2019
Viewed by 149
Abstract
Bioflocculation is a physicochemical technique often employed to efficiently remove colloidal water pollutants. Consequently, in this study, a bioflocculant was produced, characterised and applied to remove pollutants in mine wastewater. The maximum flocculation activity of 92% was recorded at 30 °C, pH 9.0 [...] Read more.
Bioflocculation is a physicochemical technique often employed to efficiently remove colloidal water pollutants. Consequently, in this study, a bioflocculant was produced, characterised and applied to remove pollutants in mine wastewater. The maximum flocculation activity of 92% was recorded at 30 °C, pH 9.0 when maltose and urea were used as energy sources and 72 h of fermentation at the inoculum size of 1% (v/v). K+ proved to be a favourable cation. The bioflocculant yield of 4 g/L was obtained. Scanning electron microscopy illustrated a hexagonal-like structure of the bioflocculant. It is composed of carbohydrates and proteins in mass proportion of 88.6 and 9.5%, respectively. The Fourier transform infrared spectrum revealed the presence of hydroxyl, amide and amino functional groups. More than 73% of the bioflocculant was obtained after exposure to 600 °C using the thermogravimetric analyser. Human embryonic kidney 293 (HEK 293) cells exhibited 95% viability after being treated with 200 µg/µL of the bioflocculant. The flocculation mechanisms were proposed to be as a result of a double layer compression by K+, chemical reactions and bridging mechanism. The removal efficiencies of 59, 72, and 75% on biological oxygen demand, chemical oxygen demand and sulphur, were obtained respectively. Thus, the bioflocculant have potential use in wastewater treatment. Full article
Show Figures

Figure 1

Open AccessReview
Toileting Behaviors Related to Urination in Women: A Scoping Review
Int. J. Environ. Res. Public Health 2019, 16(20), 4000; https://doi.org/10.3390/ijerph16204000 - 19 Oct 2019
Viewed by 124
Abstract
This scoping review explores the state of science regarding women’s toileting behaviors, gaps in knowledge, and areas for future research. Online databases were searched to identify papers published in English between January 2010 through July 2019; the search identified 25 articles. The Toileting [...] Read more.
This scoping review explores the state of science regarding women’s toileting behaviors, gaps in knowledge, and areas for future research. Online databases were searched to identify papers published in English between January 2010 through July 2019; the search identified 25 articles. The Toileting Behaviors–Women’s Elimination Behaviors scale has been published in four validated language versions and used in 17 of the 25 studies. The most frequent behaviors include concern about public toilet cleanliness, delaying urination when busy or away from home, and using different toileting postures at and away from home. Determinants of toileting behaviors include environmental factors, chronic health conditions, and cognitive/psychological factors. Associations were found between toileting behaviors and lower urinary tract symptoms and between toileting postures and uroflowmetric parameters and post-void residual volume. Strategies that address modifiable determinants of toileting behaviors should be developed and tested in future research. Furthermore, little is known about the toileting behaviors and bladder health in older women and women from developing countries. Rigorous studies are needed to better understand the underlying mechanisms of toileting behaviors, the nature of associations between toileting behaviors and lower urinary tract symptoms, and effects of the environment on women’s toileting behaviors. Full article
(This article belongs to the Special Issue Bladder Health in Women)
Show Figures

Figure 1

Previous Issue
Back to TopTop