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Int. J. Environ. Res. Public Health, Volume 16, Issue 21 (November-1 2019)

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Cover Story (view full-size image) Chronic exposure to metals or toxic elements may threaten the health of metal industrial workers, [...] Read more.
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Open AccessArticle
Dissipation Theory-Based Ecological Protection and Restoration Scheme Construction for Reclamation Projects and Adjacent Marine Ecosystems
Int. J. Environ. Res. Public Health 2019, 16(21), 4303; https://doi.org/10.3390/ijerph16214303 - 05 Nov 2019
Abstract
According to the 2017 results of the Special Inspector of Sea Reclamation, a substantial number of idle reclamation zones existed in 11 provinces (cities) along the coast of China. To improve the protection level of coastal wetlands and strictly control reclamation activities, it [...] Read more.
According to the 2017 results of the Special Inspector of Sea Reclamation, a substantial number of idle reclamation zones existed in 11 provinces (cities) along the coast of China. To improve the protection level of coastal wetlands and strictly control reclamation activities, it is necessary to carry out ecological restoration of reclamation projects and adjacent marine ecosystems. The characteristics of Guanghai Bay and its reclamation project are typical in China’s coastal areas, making it an optimal representative site for this study. The dissipative structure and entropy theory was used to analyze ecological problems and environmental threats. The analytic hierarchy process was applied to determine the order of the negative entropy flow importance. The entropy increase and decrease mechanism was used to determine an ecological protection and restoration scheme for the reclamation, including the reclamation of wetland resource restoration, shoreline landscape restoration, environmental pollution control, and marine biological resource restoration. Finally, based on system logic, a typical ecological restoration system was constructed east of Guanghai Bay, with the mangrove wetland area as the model in the north and the artificial sandbeach recreation area as the focus in the south. Full article
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Open AccessConference Report
Eighth Annual Conference of inVIVO Planetary Health: From Challenges to Opportunities
Int. J. Environ. Res. Public Health 2019, 16(21), 4302; https://doi.org/10.3390/ijerph16214302 - 05 Nov 2019
Abstract
inVIVO Planetary Health (inVIVO) is a progressive scientific movement providing evidence, advocacy, and inspiration to align the interests and vitality of people, place, and planet. Our goal is to transform personal and planetary health through awareness, attitudes, and actions, and a deeper understanding [...] Read more.
inVIVO Planetary Health (inVIVO) is a progressive scientific movement providing evidence, advocacy, and inspiration to align the interests and vitality of people, place, and planet. Our goal is to transform personal and planetary health through awareness, attitudes, and actions, and a deeper understanding of how all systems are interconnected and interdependent. Here, we present the abstracts and proceedings of our 8th annual conference, held in Detroit, Michigan in May 2019, themed “From Challenges, to Opportunities”. Our far-ranging discussions addressed the complex interdependent ecological challenges of advancing global urbanization, including the biopsychosocial interactions in our living environment on physical, mental, and spiritual wellbeing, together with the wider community and societal factors that govern these. We had a strong solutions focus, with diverse strategies spanning from urban-greening and renewal, nature-relatedness, nutritional ecology, planetary diets, and microbiome rewilding, through to initiatives for promoting resilience, positive emotional assets, traditional cultural narratives, creativity, art projects for personal and community health, and exploring ways of positively shifting mindsets and value systems. Our cross-sectoral agenda underscored the importance and global impact of local initiatives everywhere by contributing to new normative values as part of a global interconnected grass-roots movement for planetary health. Full article
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Open AccessArticle
Knowledge towards Cervical and Breast Cancers among Industrial Workers: Results from a Multisite Study in Northern Vietnam
Int. J. Environ. Res. Public Health 2019, 16(21), 4301; https://doi.org/10.3390/ijerph16214301 - 05 Nov 2019
Abstract
Breast and cervical cancer cases are rising among service and industrial women workers in Vietnam. We conducted a cross-sectional study among 287 workers in three factories in Hanoi and Bac Ninh from July to September 2018 to describe the knowledge of these cancers [...] Read more.
Breast and cervical cancer cases are rising among service and industrial women workers in Vietnam. We conducted a cross-sectional study among 287 workers in three factories in Hanoi and Bac Ninh from July to September 2018 to describe the knowledge of these cancers among industrial workers in Northern Vietnam using a structured questionnaire. Factors associated with knowledge of breast and cervical cancer were identified using generalized linear models (GLM). In our study, approximately one-third of participants believed breast cancer was caused by the lack of breastfeeding, exposure to pollution, and chemicals. Less than 50% knew about sexually transmitted infections that can cause cervical cancer or were aware of a vaccine for cervical cancer. Having one sexual partner within the last year was positively associated with having a higher score of knowledge for both diseases. Receiving a medical checkup within the last 12 months and seeking health information via the internet were related to greater breast cancer knowledge. Targeted education campaigns are needed to ensure proper knowledge and improve awareness of breast cancer and cervical cancer among industrial workers. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
Open AccessReview
Patient Perspectives to Inform a Health Literacy Educational Program: A Systematic Review and Thematic Synthesis of Qualitative Studies
Int. J. Environ. Res. Public Health 2019, 16(21), 4300; https://doi.org/10.3390/ijerph16214300 - 05 Nov 2019
Abstract
Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with [...] Read more.
Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with LHL within the curricula of (future) healthcare providers (HCP). This systematic review aimed to explore and synthesize evidence on the needs, experiences and preferences of patients with LHL and to inform an existing educational framework. We searched three databases: PsychInfo, Medline and Cinahl, and extracted 798 articles. One-hundred and three articles met the inclusion criteria. After data extraction and thematic synthesis, key themes were identified. Patients with LHL and chronic diseases encounter multiple problems in the care process, which are often related to a lack of person-centeredness. Patient perspectives were categorized into four key themes: (1) Support system; (2) Patient self-management; (3) Capacities of HCPs; (4) Barriers in healthcare systems. “Cultural sensitivity” and “eHealth” were identified as recurring themes. A set of learning outcomes for (future) HCPs was developed based on our findings. The perspectives of patients with LHL provided valuable input for a comprehensive and person-centred educational framework that can enhance the relevance and quality of education for (future) HCPs, and contribute to better person-centred care for patients with LHL. Full article
(This article belongs to the Special Issue Routes to Improve Health Literacy during the Life-Course)
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Open AccessArticle
Ten-Year Follow-Up of Clinical Governance Implementation in Primary Care: Improving Screening, Diagnosis and Control of Cardiovascular Risk Factors
Int. J. Environ. Res. Public Health 2019, 16(21), 4299; https://doi.org/10.3390/ijerph16214299 - 05 Nov 2019
Abstract
Current improvement strategies for the control of cardiovascular risk factors (CRFs) in Europe are based on quality management policies. With the aim of understanding the effect of interventions delivered by primary healthcare systems, we evaluated the impact of clinical governance on cardiovascular health [...] Read more.
Current improvement strategies for the control of cardiovascular risk factors (CRFs) in Europe are based on quality management policies. With the aim of understanding the effect of interventions delivered by primary healthcare systems, we evaluated the impact of clinical governance on cardiovascular health after ten years of implementation in Catalonia. A cohort study that included 1878 patients was conducted in 19 primary care centres (PCCs). Audits that comprised 13 cardiovascular health indicators were performed and general practitioners received periodic (annual, biannual or monthly) feedback about their clinical practice. We evaluated improvement in screening, diagnosis and control of the main CRFs and the effects of the feedback on cardiovascular risk (CR), incidence of cardiovascular disease (CVD) and mortality, comparing baseline data with data at the end of the study (after a 10-year follow-up). The impact of the intervention was assessed globally and with respect to feedback frequency. General improvement was observed in screening, percentage of diagnoses and control of CRFs. At the end of the study, few clinically significant differences in CRFs were observed between groups. However, the reduction in CR was greater in the group receiving high frequency feedback, specifically in relation to smoking and control of diabetes and cholesterol (Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL)). A protective effect of having a cardiovascular event (hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.44–0.94) or death (HR = 0.55, 95% CI = 0.35–0.88) was observed in patients from centres where general practitioners received high frequency feedback. Additionally, these PCCs presented improved cardiovascular health indicators and lower incidence and mortality by CVD, illustrating the impact of this intervention. Full article
(This article belongs to the Section Health Care Sciences & Services)
Open AccessArticle
Linkages between Trade, CO2 Emissions and Healthcare Spending in China
Int. J. Environ. Res. Public Health 2019, 16(21), 4298; https://doi.org/10.3390/ijerph16214298 - 05 Nov 2019
Abstract
China has remained top among the carbon dioxide (CO2) emitting countries in the world, while it has a significant contribution to world trade after World Trade Organization (WTO) reforms in China. The dramatic increase in CO2 emissions has been witnessed. [...] Read more.
China has remained top among the carbon dioxide (CO2) emitting countries in the world, while it has a significant contribution to world trade after World Trade Organization (WTO) reforms in China. The dramatic increase in CO2 emissions has been witnessed. This study examines the linkages between trade openness, CO2 emissions, and healthcare expenditures in China using time series data for the period 1990–2017. The study extended a theoretical model by adding healthcare expenditures, CO2 emissions, and trade openness with some constraints. We used simultaneous equation method for the analysis, and the outcomes suggest that trade is significantly affecting the CO2 emissions in the country, resulting in an increase of healthcare expenditures. The government needs reforms and trade policy embodied green energy consumption in the industrial sector, especially in export sector industries. In addition, carbon tax may be an important tool to reduce CO2 emissions and it may compensate the healthcare spending in the country. Full article
(This article belongs to the Section Health Care Sciences & Services)
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Open AccessArticle
Development and Validation of an Evaluation Tool to Measure the Effectiveness of a Smoking Cessation Training among Healthcare Providers in Malaysia: The Providers’ Smoking Cessation Training Evaluation (ProSCiTE)
Int. J. Environ. Res. Public Health 2019, 16(21), 4297; https://doi.org/10.3390/ijerph16214297 - 05 Nov 2019
Abstract
Background: In line with Article 14 of the Framework Convention for Tobacco Control, we have witnessed vast developments in smoking cessation training for healthcare providers, offering help for smokers. However, there is no specific evaluation tool to monitor and evaluate the effectiveness [...] Read more.
Background: In line with Article 14 of the Framework Convention for Tobacco Control, we have witnessed vast developments in smoking cessation training for healthcare providers, offering help for smokers. However, there is no specific evaluation tool to monitor and evaluate the effectiveness of these programs for future enhancement and sustainability. Objective: To develop and validate a new tool for evaluating smoking cessation training programs for healthcare providers called the Providers’ Smoking Cessation Training Evaluation (ProSCiTE). Methods: The 74-item ProSCiTE tool was developed based on a review of the literature and an expert panel review. The tool was validated in a sample of 403 healthcare providers using a cross-sectional study design from July to December 2016. Content validity was assessed by the Scale-Content Validity Index (S-CVI). The construct validity of the ProSCiTE was analyzed using exploratory factor analysis (EFA) to confirm psychometric properties. Internal consistency reliability was determined using Cronbach’s alpha. Results: The content validity showed that the S-CVI ranged from 0.82 to 1.00 for consistency, representativeness, relevancy, and the clarity of each construct, resulting in 67 items for the questionnaire. The construct validity of the ProSCiTE (based on eigenvalues and factor loadings to confirm the four-factor structure (attitude, self-efficacy, behavior, and barriers) with 54.74% total variance) was acceptable (Kaiser-Mayer-Olkin = 0.923; Bartlett’s test of sphericity was significant, p < 0.001). The internal consistency reliability of the four-factor structure was very good, with Cronbach’s alpha values at 0.89, 0.94, 0.95, and 0.90, respectively. Conclusions: This study showed that 67 items of the ProSCiTE demonstrated good content and construct validity, as well as a high internal consistency reliability for the measurement of knowledge, attitudes, self-efficacy, behavior, and barriers to smoking cessation interventions among healthcare providers. Therefore, the ProSCiTE is a valid and reliable research tool with which to evaluate the effectiveness of smoking cessation training programs. Full article
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
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Open AccessArticle
Air Pollution as a Cause of Obesity: Micro-Level Evidence from Chinese Cities
Int. J. Environ. Res. Public Health 2019, 16(21), 4296; https://doi.org/10.3390/ijerph16214296 - 05 Nov 2019
Abstract
Chinese air pollution is obviously increasing, and the government makes efforts to strengthen air pollution treatment. Although adverse health effects gradually emerge, research determining individual vulnerability is limited. This study estimated the relationship between air pollution and obesity. Individual information of 13,414 respondents [...] Read more.
Chinese air pollution is obviously increasing, and the government makes efforts to strengthen air pollution treatment. Although adverse health effects gradually emerge, research determining individual vulnerability is limited. This study estimated the relationship between air pollution and obesity. Individual information of 13,414 respondents from 125 cities is used in the analysis. This study employs ordinary least squares (OLS) and multinomial logit model (m-logit) to estimate the impact of air pollution on obesity. We choose different air pollution and Body Mass Index (BMI) indicators for estimation. Empirical results show Air Quality Index (AQI) is significantly positively associated with the BMI score. As AQI adds one unit, the BMI score increases 0.031 (SE = 0.002; p < 0.001). The influence coefficients of particle size smaller than 2.5 μm (PM2.5), particle size smaller than 10 μm (PM10), carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), and sulfur dioxide (SO2) to the BMI score are 0.034 (SE = 0.002; p < 0.001), 0.023 (SE = 0.001; p < 0.001), 0.52 (SE = 0.095; p < 0.001), 0.045 (SE = 0.004; p < 0.001), 0.021 (SE = 0.002; p < 0.001), 0.008 (SE = 0.003; p = 0.015), respectively. Generally, air pollution has an adverse effect on body weight. CO is the most influential pollutant, and female, middle-aged, and low-education populations are more severely affected. The results confirm that the adverse health effects of air pollution should be considered when making the air pollution policies. Findings also provide justification for health interventions, especially for people with obesity. Full article
(This article belongs to the Special Issue Air Pollution and Cardiopulmonary Health)
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Open AccessArticle
Is Health Literacy of Dialyzed Patients Related to Their Adherence to Dietary and Fluid Intake Recommendations?
Int. J. Environ. Res. Public Health 2019, 16(21), 4295; https://doi.org/10.3390/ijerph16214295 - 05 Nov 2019
Abstract
Non-adherence to dietary and fluid intake recommendations (NADFIR) is an important factor for the effective treatment of dialyzed patients and may be hindered by low health literacy (HL). Therefore, we assessed whether low HL of dialyzed patients is associated with their NADFIR. We [...] Read more.
Non-adherence to dietary and fluid intake recommendations (NADFIR) is an important factor for the effective treatment of dialyzed patients and may be hindered by low health literacy (HL). Therefore, we assessed whether low HL of dialyzed patients is associated with their NADFIR. We performed a multicentric cross-sectional study in 20 dialysis clinics in Slovakia (n = 452; response rate: 70.1%; mean age = 63.6 years; males: 60.7%). We assessed the association between nine domains of HL and non-adherence (high serum potassium, high serum phosphate, relative overhydration, and self-reported NADFIR) using general linear models adjusted for age and gender. Moreover, we assessed the moderation by socioeconomic status (SES). We found higher NADFIR among patients with less sufficient information for health management (high serum phosphate level; odds ratio (OR): 0.77; 95% confidence interval (CI): 0.63–0.94), with a lower ability to actively manage their health (self-reported diet non-adherence; OR: 0.74; 95% CI: 0.62–0.89), and those less able to actively engage with healthcare providers (overhydrated; OR: 0.78; 95% CI: 0.65–0.94). Moreover, SES modified this relation. Low HL affects the adherence of dialyzed patients. This shows a need to support patients with low HL and to train healthcare providers to work with these patients, taking into account their SES. Full article
(This article belongs to the Special Issue Routes to Improve Health Literacy during the Life-Course)
Open AccessArticle
Alcohol Consumption Among Spanish Female Adolescents: Related Factors and National Trends 2006–2014
Int. J. Environ. Res. Public Health 2019, 16(21), 4294; https://doi.org/10.3390/ijerph16214294 - 05 Nov 2019
Abstract
Background: The purpose of this study was: (a) to estimate trends over time in the prevalence of alcohol consumption among female adolescents between 2006 and 2014; (b) to identify the factors associated with the probability of consuming alcohol during this period for Spanish [...] Read more.
Background: The purpose of this study was: (a) to estimate trends over time in the prevalence of alcohol consumption among female adolescents between 2006 and 2014; (b) to identify the factors associated with the probability of consuming alcohol during this period for Spanish female adolescents (14–18 years old). Methods: Spanish nationwide, epidemiological, cross-sectional study on alcohol consumption by adolescent women. We used individualized secondary data retrieved from the 2006 and 2014 Spanish state survey on drug use in secondary education, for a total of 48,676 survey respondents aged 14 to 18 years. Alcohol use was the dependent variable. We also analyzed sociodemographic and educational features, lifestyle habits, perceived health risk for consumption, and perceived availability of substance using logistic regression models. Results: The prevalence of alcohol consumption among female adolescents was 62.35% during the study period. Alcohol consumption increased with age and was more frequent on weekends than on school days. The variables associated with a greater probability of alcohol consumption were tobacco, marijuana (aOR = 2.37; 95% CI: 2.08–2.72), and alcohol consumption by friends (aOR = 7.24; 95% CI: 6.42–8.16). Conclusions: Alcohol consumption by female adolescents in Spain significantly increased from 2006 to 2014. Marijuana and alcohol consumption by friends were associated factors. Full article
(This article belongs to the Special Issue Environmental Factors, Children’s Health and Safety)
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Open AccessArticle
Impact of PM2.5 on Second Birth Intentions of China’s Floating Population in a Low Fertility Context
Int. J. Environ. Res. Public Health 2019, 16(21), 4293; https://doi.org/10.3390/ijerph16214293 - 05 Nov 2019
Abstract
The total fertility rate of the Chinese population has declined dramatically over the last three decades. Research has substantiated the causal link between particulate matter (PM) and adverse health effects. However, the impact of PM on the birth intentions or fertility behavior of [...] Read more.
The total fertility rate of the Chinese population has declined dramatically over the last three decades. Research has substantiated the causal link between particulate matter (PM) and adverse health effects. However, the impact of PM on the birth intentions or fertility behavior of the childbearing population remains understudied. The paper analyzes the impact of PM2.5 concentration (a mixture of extremely small solid particles and liquid droplets found in the air) on the second birth intentions of the Chinese floating population. We used urban migrant population matching data at the prefectural level for the analysis. The unique datasets were derived from the Chinese Floating Population Dynamic Survey in 2014 administered by the National Health Commission, the National Prefecture-level City Matching Data administered by the National Bureau of Statistics of China, and the air pollution index PM2.5 collected by the Green Peace Organization. The results show that PM2.5 concentration has a negative impact on the second birth intentions of the floating population. This impact exhibits marked regional heterogeneity: the desire for a second birth across migrant groups living in south China decreases if PM2.5 concentration goes up, while migrants coming from, and living in, north China show strong intentions to have a second birth despite an increase in PM2.5 concentration in northern cities. The results have direct implications for the Chinese government at various levels to play a vital role in making and implementing environmental policies on the mitigation of smog to effectively safeguard the health of individuals and communities and potentially raise China’s fertility rate. Full article
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Open AccessArticle
Does Information Asymmetry Impact Sub-Regions’ Cooperation of Regional Water Resource Allocation?
Int. J. Environ. Res. Public Health 2019, 16(21), 4292; https://doi.org/10.3390/ijerph16214292 - 05 Nov 2019
Abstract
Water resources allocation is an urgent problem for basin authorities. In order to obtain greater economic benefits from limited water supplies, sub-regions must cooperate with each other. To study the influence of cooperation among sub-regions and the symmetry of cooperation information on the [...] Read more.
Water resources allocation is an urgent problem for basin authorities. In order to obtain greater economic benefits from limited water supplies, sub-regions must cooperate with each other. To study the influence of cooperation among sub-regions and the symmetry of cooperation information on the interests of the basin authority and each sub-region, this study proposes a regional water allocation model in three different situations: (1) non-cooperation; (2) cooperation and information symmetry; (3) cooperation and information asymmetry. The proposed model clearly reflects the Stackelberg game relationship between the basin authority and sub-regions. Finally, the model is applied to the Qujiang River Basin in China, and the decisions of the basin authority and sub-regional managers of the Qujiang River Basin under three different situations are discussed. The results show that regional cooperation benefits both the cooperative regions and the social welfare value of the entire river basin, when compared with non-cooperation. Full article
(This article belongs to the Special Issue Water Resources Systems Quality and Quantity Management)
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Open AccessArticle
Effects of Endurance and Endurance–Strength Training on Endothelial Function in Women with Obesity: A Randomized Trial
Int. J. Environ. Res. Public Health 2019, 16(21), 4291; https://doi.org/10.3390/ijerph16214291 - 05 Nov 2019
Abstract
Some investigations have demonstrated that a combined endurance–strength training is the most effective in the treatment of obesity. The aim of the research was to access how different trainings influence: endothelial function, lipid metabolism, and risk of atherosclerosis in women with obesity. In [...] Read more.
Some investigations have demonstrated that a combined endurance–strength training is the most effective in the treatment of obesity. The aim of the research was to access how different trainings influence: endothelial function, lipid metabolism, and risk of atherosclerosis in women with obesity. In a randomized trial, 39 obese women aged 28–62 completed endurance (n = 22, 60-80% HRmax) or combined training (n = 17, 20 minutes of strength exercises, 50–60% 1RM and 25 minutes of endurance training, 60-80% HRmax). Before and after the intervention vascular endothelial function (endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF), thiobarbituric acid reactive substances (TBARS), blood total antioxidant capacity (TAC)), total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides and C-reactive protein (CRP)as well as visceral adiposity index (VAI), total-body skeletal muscle mass and atherogenic index of plasma (AIP) were determined. After the trainings, in both groups total cholesterol and total-body skeletal muscle mass increased (p < 0.05). In the group undergoing combined training, lower (p < 0.05) VAI, AIP, CRP and LDL-C were noted. In the group undergoing endurance training TBARS concentration decreased (p < 0.01), while the HDL-C (p < 0.01) concentration as well as eNOS (p < 0.05) activity increased. No significant differences between groups were found, either before or after the programs. Both training programs led to the improvement of lipid metabolism, but only endurance training alone favorably changed indicators of endothelial functions in women with obesity. Full article
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Open AccessArticle
Public Awareness of Tuberculosis in Southeast China: A Population-Based Study
Int. J. Environ. Res. Public Health 2019, 16(21), 4290; https://doi.org/10.3390/ijerph16214290 - 05 Nov 2019
Abstract
Few provinces in China have recently conducted population-based surveys on tuberculosis (TB) awareness at the provincial level. Hence, we conducted a population-based, cross-sectional study to evaluate the level of awareness of TB knowledge among residents of Zhejiang Province, China from October 2018 to [...] Read more.
Few provinces in China have recently conducted population-based surveys on tuberculosis (TB) awareness at the provincial level. Hence, we conducted a population-based, cross-sectional study to evaluate the level of awareness of TB knowledge among residents of Zhejiang Province, China from October 2018 to December 2018. A total of 7174 individuals were randomly selected to participate in this survey. The rate of awareness of key information on TB was found to be 48.0%. The study’s participants exhibited a good understanding of the transmission route (80.8%), curable outcome (78.3%), and designated treatment sites (67.0%) of TB. The rate of awareness of suspicious TB symptoms (36.1%) and the relief policy on diagnosis and first-line therapeutic drugs (38.0%) were found to be relatively low among the respondents. People living in rural areas, those who were less educated, and students all showed a low level of awareness of key knowledge about TB. In conclusion, residents in Zhejiang Province generally lacked key information about TB, which is not conducive to the early detection and treatment of TB. Corresponding efforts should be made for different groups of people to achieve favorable effects on the prevention and control of TB. Full article
(This article belongs to the Section Infectious Disease Epidemiology)
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Open AccessArticle
Prediction of Human Brucellosis in China Based on Temperature and NDVI
Int. J. Environ. Res. Public Health 2019, 16(21), 4289; https://doi.org/10.3390/ijerph16214289 - 05 Nov 2019
Abstract
Brucellosis occurs periodically and causes great economic and health burdens. Brucellosis prediction plays an important role in its prevention and treatment. This paper establishes relationships between human brucellosis (HB) and land surface temperature (LST), and the normalized difference vegetation index (NDVI). A seasonal [...] Read more.
Brucellosis occurs periodically and causes great economic and health burdens. Brucellosis prediction plays an important role in its prevention and treatment. This paper establishes relationships between human brucellosis (HB) and land surface temperature (LST), and the normalized difference vegetation index (NDVI). A seasonal autoregressive integrated moving average with exogenous variables (SARIMAX) model is constructed to predict trends in brucellosis rates. The fitted results (Akaike Information Criterion (AIC) = 807.58, Schwarz Bayes Criterion (SBC) = 819.28) showed obvious periodicity and a rate of increase of 138.68% from January 2011 to May 2016. We found a significant effect between HB and NDVI. At the same time, the prediction part showed that the highest monthly incidence per year has a decreasing trend after 2015. This may be because of the brucellosis prevention and control measures taken by the Chinese Government. The proposed model allows the early detection of brucellosis outbreaks, allowing more effective prevention and control. Full article
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Open AccessArticle
Effectiveness of the e-NurSus Children Intervention in the Training of Nursing Students
Int. J. Environ. Res. Public Health 2019, 16(21), 4288; https://doi.org/10.3390/ijerph16214288 - 05 Nov 2019
Abstract
The paediatric population is the most vulnerable to exposure to environmental risk factors. Institutions of higher education have to equip nursing students with the attitudes, knowledge, and skills to respond to this using blended learning. The aim of this study was to evaluate [...] Read more.
The paediatric population is the most vulnerable to exposure to environmental risk factors. Institutions of higher education have to equip nursing students with the attitudes, knowledge, and skills to respond to this using blended learning. The aim of this study was to evaluate the effect of e-NurSus Children intervention on student nurses’ attitudes, knowledge, and skills. A quasi-experimental study of time series was designed using pre and post educational intervention evaluation in 2018. The participants were nursing students (N = 267) from Spain (n = 110) and the United Kingdom (n = 157). Three instruments were used: the Sustainability Attitudes in Nursing Survey, the Children’s Environmental Health Knowledge Questionnaire, and the Children’s Environmental Health Skills Questionnaire. The attitudes (15.81%), knowledge (39.02%), and skills (29.98%) of nursing students improved following the e-NurSus Children intervention. It is necessary to include topics on children’s environmental health in nurse education as students are aware of this issue but do not have the knowledge or skills required to manage problems or illness caused by the environment. The e-NurSus Children intervention is an effective tool to address this educational gap. Full article
(This article belongs to the Section Children's Health)
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Open AccessArticle
The Effectiveness of Cigarette Pack Health Warning Labels with Religious Messages in an Urban Setting in Indonesia: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2019, 16(21), 4287; https://doi.org/10.3390/ijerph16214287 - 05 Nov 2019
Abstract
This study sought to assess the effectiveness of religious cigarette health warning labels (HWLs) in Indonesia, a country with a high public health burden from tobacco use. The study tested different religious and nonreligious messages related to suicide, secondhand smoke (SHS) and gangrene. [...] Read more.
This study sought to assess the effectiveness of religious cigarette health warning labels (HWLs) in Indonesia, a country with a high public health burden from tobacco use. The study tested different religious and nonreligious messages related to suicide, secondhand smoke (SHS) and gangrene. Participants were smokers and non-smokers from Surabaya, Indonesia (n = 817). Participants rated each HWL for its effectiveness on a scale of 1 to 10 (1 = “not at all”, 10 = “extremely”) with respect to 10 items. Nonreligious HWLs were marginally superior for SHS and suicide while religious HWLs were marginally superior for gangrene. Given the close rating scores between religious and nonreligious HWLs, they were functionally equal in effectiveness. With proper assessment of potential unintended consequences, the implementation of religious HWLs could be considered for a proportion of HWLs. Full article
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Open AccessArticle
Chinese Consumers’ Preferences for Attributes of Fresh Milk: A Best–Worst Approach
Int. J. Environ. Res. Public Health 2019, 16(21), 4286; https://doi.org/10.3390/ijerph16214286 - 05 Nov 2019
Abstract
Fresh milk represents a major type of dairy product in China, while it remains at a low level in terms of consumption. Consumers’ preferences are a crucial factor determining consumers’ attitudes and behavior towards fresh milk consumption. However, little is known about what [...] Read more.
Fresh milk represents a major type of dairy product in China, while it remains at a low level in terms of consumption. Consumers’ preferences are a crucial factor determining consumers’ attitudes and behavior towards fresh milk consumption. However, little is known about what drives consumers’ preferences for fresh milk. This study intends to fill this gap based on a survey with a sample of 1248 respondents in ten cities in China. The best–worst scaling (BWS) method was employed to measure the importance of different attributes that consumers consider when selecting fresh milk. The BWS result indicates that safety certification, shelf-life, and nutrition were ranked as the most important attributes of fresh milk, whereas origin, purchasing location, and package were found to be the least preferred attributes. Furthermore, the study also explored heterogeneities by dividing all samples into a developed area and a less developed area, and a latent class model (LCM) was then applied to classify consumers based on their preferences and demographics in these two areas, respectively. In developed areas, consumers were divided into “Safety First” and “Taste Sensitive”, and Gender and Age were significant determinants of class membership. In less developed areas, consumers were classified as “Quality Sensitive” and “Brand Sensitive”, while Education, Pregnancy, and Health condition were significant determinants of class membership. The findings might be useful for the government in terms of encouraging dairy companies to implement safety management certification, and suggest that companies should design differentiated strategies in different areas. Full article
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Open AccessArticle
Companion Dog Foster Caregiver Program for Older Veterans at the VA Maryland Health Care System: A Feasibility Study
Int. J. Environ. Res. Public Health 2019, 16(21), 4285; https://doi.org/10.3390/ijerph16214285 - 04 Nov 2019
Abstract
Veterans experience mental health conditions at a disproportionate rate compared to their civilian counterparts, and approximately 60% of older veterans who receive their care through the United States Department of Veterans Affairs (VA) do not meet physical activity (PA) recommendations. We tested the [...] Read more.
Veterans experience mental health conditions at a disproportionate rate compared to their civilian counterparts, and approximately 60% of older veterans who receive their care through the United States Department of Veterans Affairs (VA) do not meet physical activity (PA) recommendations. We tested the Veterans as Foster Ambassadors program at the VA Maryland Health Care System to examine whether fostering a companion dog would improve PA and function, heart rate variability (HRV), balance, and quality of life (QOL) in older veterans. Participants wore an accelerometer for ≥10 days during each phase (30 day baseline vs. 60 day foster period) to measure daily PA (n = 4). Six-minute walk (6MW) and balance testing (n = 4) and 24 h heart rate (HR) and HRV (n = 2) were determined at baseline and during the foster period. Compared to baseline, there were significant increases in (a) distance during the 6MW, (b) daily steps, and (c) time spent in moderate activity during the foster period. 24 h HR decreased and time- and frequency-domain measures of HRV significantly increased in a veteran with post-traumatic stress disorder during the foster period compared to baseline. All veterans offered positive feedback about the program and indicated that it was beneficial to them. The results from this pilot study provide evidence that fostering a companion dog can improve PA, health, and QOL in older veterans. Future research conducted with a larger sample size to validate the results is warranted. Full article
(This article belongs to the Special Issue The Psycho-Social Impact of Human-Animal Interactions)
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Open AccessArticle
Newly Qualified Nurses’ Perception of Their Competency Achievement on Leaving University: A Qualitative Study
Int. J. Environ. Res. Public Health 2019, 16(21), 4284; https://doi.org/10.3390/ijerph16214284 - 04 Nov 2019
Abstract
Background: After implementing the Tuning Educational Structures in Europe Project, numerous efforts have been made to define, establish, and evaluate nursing competences. The European Federation of Nurses Association played a key role in enacting the nursing competences included in Directive 2013/55/EU. Nevertheless, [...] Read more.
Background: After implementing the Tuning Educational Structures in Europe Project, numerous efforts have been made to define, establish, and evaluate nursing competences. The European Federation of Nurses Association played a key role in enacting the nursing competences included in Directive 2013/55/EU. Nevertheless, assessing competences remains elusive, and there is little research into nurses’ perceptions of the competency training provided by their universities. The purpose of the study was to explore the perceptions and experiences of newly qualified nurses about the competences they acquired during their university education. Methods: A qualitative research study was developed in a Spanish university. Twelve semi-structured interviews with newly qualified nurses were conducted, and two focus groups made up of twelve students were carried out in order to triangulate the results. Participants were recruited through email contact. Interviews focused on clinical training, theoretical content, and the reality of healthcare. Data was analyzed thematically. Results: Two main themes emerged: (1) improving theoretical content and (2) rethinking practical lessons and clinical training. A lack of knowledge about mental health, pharmacology, or critical care has been found; in addition, it was highlighted, among others, the need to improve communication skills in difficult and conflictive situations. Conclusions: Considering the participants’ perception of deficiency in some aspects of most of the competences established by the European Federation of Nurses Association, further research has been suggested to include other stakeholders’ views. Full article
Open AccessArticle
The Effect of Brain Breaks on Physical Activity Behaviour among Primary School Children: A Transtheoretical Perspective
Int. J. Environ. Res. Public Health 2019, 16(21), 4283; https://doi.org/10.3390/ijerph16214283 - 04 Nov 2019
Abstract
Brain Breaks Physical Activity Solutions (BBPAS) is a web-based structured physical activity (PA) video that is specifically designed for school settings and can stimulate a student’s health and learning. The purpose of this study is to measure the effect of BBPAS on the [...] Read more.
Brain Breaks Physical Activity Solutions (BBPAS) is a web-based structured physical activity (PA) video that is specifically designed for school settings and can stimulate a student’s health and learning. The purpose of this study is to measure the effect of BBPAS on the stages of change, decisional balance, processes of change, self-efficacy and leisure-time exercise among Malay ethnic primary school children. A validated Malay version of three of the five constructs was derived with sound validity and was used in the present study. A total of 159 male and 163 female children aged 10 to 11 years old, mean (SD) = 10.53 (0.50), were recruited from two schools in Kelantan, Malaysia. Purposive sampling was used to divide the children into intervention (n = 177) and control (n = 145) groups. Children in the intervention group underwent BBPAS activity for an accumulated 30 min per week, while children in the control group were not involved in the BBPAS intervention. Mixed factorial analysis of variance (ANOVA) was used to examine the effect of BBPAS on the study variables. A mixed ANOVA showed significant changes (time effect) on cognitive process, F(1, 320) = 5.768, p-value = 0.017; behavioural process, F(1, 313) = 5.736, p-value = 0.017; and internal feeling, F(1, 312) = 6.050, p-value = 0.014. There was also a significant difference between groups on cons, F(1, 316) = 7.504, p-value = 0.007. A significant interaction effect was observed for stages of change, F(1, 319) = 7.861, p-value = 0.005; pros, F(1, 316) = 31.311, p-value = 0.001; internal feeling, F(1, 312) = 4.692, p-value = 0.031; and behavioural process, F(1, 313) = 7.312, p-value = 0.007. In conclusion, BBPAS was successful in improving four of the five constructs, and thus, should be recommended to be used in schools throughout Malaysia. Full article
(This article belongs to the Section Children's Health)
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Open AccessArticle
Loneliness and Life Satisfaction Explained by Public-Space Use and Mobility Patterns
Int. J. Environ. Res. Public Health 2019, 16(21), 4282; https://doi.org/10.3390/ijerph16214282 - 04 Nov 2019
Abstract
Previous research has shown that personal, neighborhood, and mobility characteristics could influence life satisfaction and loneliness of people and that exposure to public spaces, such as green spaces, may also affect the extent to which people feel lonely or satisfied with life. However, [...] Read more.
Previous research has shown that personal, neighborhood, and mobility characteristics could influence life satisfaction and loneliness of people and that exposure to public spaces, such as green spaces, may also affect the extent to which people feel lonely or satisfied with life. However, previous studies mainly focused on one of these effects, resulting in a lack of knowledge about the simultaneous effects of these characteristics on loneliness and life satisfaction. This study therefore aims to gain insights into how public-space use mediates the relations between personal, neighborhood, and mobility characteristics on the one hand and loneliness and life satisfaction on the other hand. Relationships were analyzed using a path analysis approach, based on a sample of 200 residents of three neighborhoods of the Dutch city ‘s-Hertogenbosch. The results showed that the influence of frequency of public-space use on life satisfaction and loneliness is limited. The effects of personal, neighborhood, and mobility characteristics on frequency of use of public space and on loneliness and life satisfaction were found to be significant. Age and activities of daily living (ADL) are significantly related to each other, and ADL was found to influence recreational and passive space use and loneliness and life satisfaction. Policymakers should, therefore, mainly focus on creating neighborhoods that are highly walkable and accessible, where green spaces and public-transport facilities are present, to promote physical activity among all residents. Full article
(This article belongs to the Special Issue Daily Travel and Wellbeing among the Elderly)
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Open AccessArticle
Green Exercise: How Are Characteristics of Urban Green Spaces Associated with Adolescents’ Physical Activity and Health?
Int. J. Environ. Res. Public Health 2019, 16(21), 4281; https://doi.org/10.3390/ijerph16214281 - 04 Nov 2019
Abstract
This study investigates associations between characteristics of urban green spaces (UGSs) and adolescents’ self-reported green exercise (GE), general health, and body mass index (BMI). Data were collected through face-to-face personal interviews with 384 adolescents ages 13–19 between 1 March and 31 May, 2018 [...] Read more.
This study investigates associations between characteristics of urban green spaces (UGSs) and adolescents’ self-reported green exercise (GE), general health, and body mass index (BMI). Data were collected through face-to-face personal interviews with 384 adolescents ages 13–19 between 1 March and 31 May, 2018 in UGSs in Aydın, Turkey. Multivariate regression analyses were conducted to examine associations controlling for confounding factors. Stratified analyses were also conducted to determine differences between boys and girls. Positive associations with the duration of GE included many trees, lawns, soccer fields and basketball courts, play equipment, and self-reported general health. Whereas increased BMI was associated with increased benches/ seating, lawns and exercise trails were positively associated with self-reported general health. Negative relationships with increased BMI included many trees, open areas, and outdoor fitness equipment. Increased distance from UGSs was negatively associated with the frequency of GE. In stratified analyses, positive associations between boys’ duration of GE and self-reported general health were found. Whereas soccer fields and basketball courts were associated with girls’ frequency of GE, exercise trails and play equipment were correlated with girls’ self-reported general health. Negative associations with the boys’ frequency of GE included increased BMI and screen time. Whereas increased distance from UGSs was negatively associated with girls’ frequency of GE, many trees, lawns, exercise trails, play equipment, open areas, flowerbeds, and outdoor fitness equipment were negatively correlated with girls’ increased BMI. Findings suggest that adolescents’ GE and health could be promoted with many trees, lawns, flowerbeds, open areas, play and outdoor fitness equipment, exercise trails, and soccer fields and basketball courts. Findings of this study should be tested with longitudinal or intervention studies in future research. Full article
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Open AccessReview
Aberrant Epigenomic Modulation of Glucocorticoid Receptor Gene (NR3C1) in Early Life Stress and Major Depressive Disorder Correlation: Systematic Review and Quantitative Evidence Synthesis
Int. J. Environ. Res. Public Health 2019, 16(21), 4280; https://doi.org/10.3390/ijerph16214280 - 04 Nov 2019
Abstract
Early life stress (ELS) induced by psychological trauma, child maltreatment, maternal separation, and domestic violence predisposes to psycho-behavioral pathologies during adulthood, namely major depressive disorder (MDD), anxiety, and bipolar affective disorder. While environmental data are available in illustrating this association, data remain to [...] Read more.
Early life stress (ELS) induced by psychological trauma, child maltreatment, maternal separation, and domestic violence predisposes to psycho-behavioral pathologies during adulthood, namely major depressive disorder (MDD), anxiety, and bipolar affective disorder. While environmental data are available in illustrating this association, data remain to be established on the epigenomic underpinning of the nexus between ELS and MDD predisposition. Specifically, despite the observed aberrant epigenomic modulation of the NR3C1, a glucocorticoid receptor gene, in early social adversity and social threats in animal and human models, reliable scientific data for intervention mapping in reducing social adversity and improving human health is required. We sought to synthesize the findings of studies evaluating (a) epigenomic modulations, mainly DNA methylation resulting in MDD following ELS, (b) epigenomic modifications associated with ELS, and (c) epigenomic alterations associated with MDD. A systematic review and quantitative evidence synthesis (QES) were utilized with the random effect meta-analytic procedure. The search strategy involved both the PubMed and hand search of relevant references. Of the 1534 studies identified through electronic search, 592 studies were screened, 11 met the eligibility criteria for inclusion in the QES, and 5 examined ELS and MDD; 4 studies assessed epigenomic modulation and ELS, while 2 studies examined epigenomic modulations and MDD. The dense DNA methylation of the 1F exon of the NR3C1, implying the hypermethylated region of the glucocorticoid receptor gene, was observed in the nexus between ELS and MDD, common effect size (CES) = 14.96, 95%CI, 10.06–19.85. With respect to epigenomic modulation associated with child ELS, hypermethylation was observed, CES = 23.2%, 95%CI, 8.00–38.48. In addition, marginal epigenomic alteration was indicated in MDD, where hypermethylation was associated with increased risk of MDD, CES = 2.12%, 95%CI, −0.63–4.86. Substantial evidence supports the implication of NR3C1 and environmental interaction, mainly DNA methylation, in the predisposition to MDD following ELS. This QES further supports aberrant epigenomic modulation identified in ELS as well as major depressive episodes involving dysfunctional glucocorticoid-mediated negative feedback as a result of allostatic overload. These findings recommend prospective investigation of social adversity and its predisposition to the MDD epidemic via aberrant epigenomic modulation. Such data will facilitate early intervention mapping in reducing MDD in the United States population. Full article
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Open AccessArticle
Physiological and Psychological Effects of Viewing Urban Parks in Different Seasons in Adults
Int. J. Environ. Res. Public Health 2019, 16(21), 4279; https://doi.org/10.3390/ijerph16214279 - 04 Nov 2019
Abstract
Although the health benefits of urban parks have gained significant attention, the effects of viewing park landscape on older adult residents have not commanded much research. This study aimed to investigate the physiological and psychological effects of viewing cherry blossoms in spring and [...] Read more.
Although the health benefits of urban parks have gained significant attention, the effects of viewing park landscape on older adult residents have not commanded much research. This study aimed to investigate the physiological and psychological effects of viewing cherry blossoms in spring and fresh greenery in early summer at urban parks. The experiments were conducted in two viewing spots in the same park in Japan during different seasons, and included 12 participants in both spring (mean age, 66.4 ± 10.5 years) and summer (mean age, 65.75 ± 10.1 years). Participants sat and viewed an urban park and city landscape for 11–15 min. Blood pressure was measured before and after the seated viewing while heart rate was measured continuously. Then, they evaluated the psychological responses using the Profile of Mood States and State-Trait Anxiety Inventory. Viewing cherry blossoms and fresh greenery in urban parks led to lower blood pressure in spring and early summer than viewing city areas in spring and early summer. Moreover, the score of vigor–activity was significantly higher; tension–anxiety was significantly lower in spring; and the state-anxiety level was significantly lower in early summer. The results of this study suggest that viewing urban parks results in physiological and psychological relaxation. Full article
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Open AccessArticle
Increased Dementia Mortality in West Virginia Counties with Mountaintop Removal Mining?
Int. J. Environ. Res. Public Health 2019, 16(21), 4278; https://doi.org/10.3390/ijerph16214278 - 04 Nov 2019
Abstract
Atmospheric particulate matter (PM) is elevated in areas of mountaintop removal mining (MTM), a practice that has been ongoing in some counties of West Virginia (WV) USA since the 1970s. PM inhalation has been linked to central nervous system pathophysiology, including cognitive decline [...] Read more.
Atmospheric particulate matter (PM) is elevated in areas of mountaintop removal mining (MTM), a practice that has been ongoing in some counties of West Virginia (WV) USA since the 1970s. PM inhalation has been linked to central nervous system pathophysiology, including cognitive decline and dementia. Here we compared county dementia mortality statistics in MTM vs. non-MTM WV counties over a period spanning 2001–2015. We found significantly elevated age-adjusted vascular or unspecified dementia mortality/100,000 population in WV MTM counties where, after adjusting for socioeconomic variables, dementia mortality was 15.60 (±3.14 Standard Error of the Mean (S.E.M.)) times higher than that of non-MTM counties. Further analyses with satellite imaging data revealed a highly significant positive correlation between the number of distinct mining sites vs. both mean and cumulative vascular and unspecified dementia mortality over the 15 year period. This was in contrast to finding only a weak relationship between dementia mortality rates and the overall square kilometers mined. No effect of living in an MTM county was found for the rate of Alzheimer’s type dementia and possible reasons for this are considered. Based on these results, and the current literature, we hypothesize that inhalation of PM associated with MTM contributes to dementia mortality of the vascular or unspecified types. However, limitations inherent in ecological-type studies such as this, preclude definitive extrapolation to individuals in MTM-counties at this time. We hope these findings will inspire follow-up cohort and case-controlled type studies to determine if specific causative factors associated with living near MTM can be identified. Given the need for caregiving and medical support, increased dementia mortality of the magnitude seen here could, unfortunately, place great demands upon MTM county public health resources in the future. Full article
(This article belongs to the Special Issue Ultrafine Particles Exposure and Health)
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Open AccessArticle
Prevalence of Respiratory Health Symptoms among Landfill Waste Recyclers in the City of Johannesburg, South Africa
Int. J. Environ. Res. Public Health 2019, 16(21), 4277; https://doi.org/10.3390/ijerph16214277 - 04 Nov 2019
Abstract
In developing countries, waste sorting and recycling have become a source of income for poorer communities. However, it can potentially pose significant health risks. This study aimed to determine the prevalence of acute respiratory symptoms and associated risk factors for respiratory health outcomes [...] Read more.
In developing countries, waste sorting and recycling have become a source of income for poorer communities. However, it can potentially pose significant health risks. This study aimed to determine the prevalence of acute respiratory symptoms and associated risk factors for respiratory health outcomes among waste recyclers. A cross-sectional study was conducted among 361 waste recyclers at two randomly selected landfill sites in Johannesburg. Convenience sampling was used to sample the waste recyclers. The prevalence of respiratory symptoms in the population was 58.5%. A persistent cough was the most common symptom reported (46.8%), followed by breathlessness (19.6%) and rapid breathing (15.8%). Approximately 66.4% of waste recyclers reported exposure to chemicals and 96.6% reported exposure to airborne dust. A multivariable logistic regression analysis showed that exposure to waste containing chemical residues (OR 1.80, 95% CI 1.01–3.22 p = 0.044) increased the odds of respiratory symptoms. There was a significant difference in respiratory symptoms in landfill sites 1 and 2 (OR 2.77, 95% CI 1.03–7.42 p = 0.042). Occupational health and safety awareness is important to minimize hazards faced by informal workers. In addition, providing waste recyclers with the correct protective clothing, such as respiratory masks, and training on basic hygiene practices, could reduce the risks associated with waste sorting. Full article
(This article belongs to the Special Issue Occupational Respiratory Health)
Open AccessArticle
Spatio-Temporal Variation Characteristics of PM2.5 in the Beijing–Tianjin–Hebei Region, China, from 2013 to 2018
Int. J. Environ. Res. Public Health 2019, 16(21), 4276; https://doi.org/10.3390/ijerph16214276 - 04 Nov 2019
Abstract
Air pollution, including particulate matter (PM2.5) pollution, is extremely harmful to the environment as well as human health. The Beijing–Tianjin–Hebei (BTH) Region has experienced heavy PM2.5 pollution within China. In this study, a six-year time series (January 2013–December 2018) of [...] Read more.
Air pollution, including particulate matter (PM2.5) pollution, is extremely harmful to the environment as well as human health. The Beijing–Tianjin–Hebei (BTH) Region has experienced heavy PM2.5 pollution within China. In this study, a six-year time series (January 2013–December 2018) of PM2.5 mass concentration data from 102 air quality monitoring stations were studied to understand the spatio-temporal variation characteristics of the BTH region. The average annual PM2.5 mass concentration in the BTH region decreased from 98.9 μg/m3 in 2013 to 64.9 μg/m3 in 2017. Therefore, China has achieved its Air Pollution Prevention and Control Plan goal of reducing the concentration of fine particulate matter in the BTH region by 25% by 2017. The PM2.5 pollution in BTH plain areas showed a more significant change than mountains areas, with the highest PM2.5 mass concentration in winter and the lowest in summer. The results of spatial autocorrelation and cluster analyses showed that the PM2.5 mass concentration in the BTH region from 2013–2018 showed a significant spatial agglomeration, and that spatial distribution characteristics were high in the south and low in the north. Changes in PM2.5 mass concentration in the BTH region were affected by both socio-economic factors and meteorological factors. Our results can provide a point of reference for making PM2.5 pollution control decisions. Full article
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Open AccessProtocol
A Cluster Randomised Controlled Trial of an Intervention to Increase Physical Activity of Preschool-Aged Children Attending Early Childhood Education and Care: Study Protocol for the ‘Everybody Energise’ Trial
Int. J. Environ. Res. Public Health 2019, 16(21), 4275; https://doi.org/10.3390/ijerph16214275 - 04 Nov 2019
Abstract
The use of ‘Energisers,’ short bouts of moderate-to-vigorous physical activity (MVPA), have been shown to significantly increase children’s physical activity within the school setting but not within Early Childhood Education and Care (ECEC) centres. The aim of this study is to assess the [...] Read more.
The use of ‘Energisers,’ short bouts of moderate-to-vigorous physical activity (MVPA), have been shown to significantly increase children’s physical activity within the school setting but not within Early Childhood Education and Care (ECEC) centres. The aim of this study is to assess the efficacy of an intervention involving the provision of educator-led daily Energisers to increase the time children spend in MVPA while attending ECEC. Fourteen ECEC centres in the Hunter region of New South Wales, Australia, will be randomised to either an intervention or control group. The intervention group will be supported by the research team to implement three brief (5-min) educator-led Energisers each day for children aged three to six years between the hours of 9:00 a.m. to 3.00 p.m. Control ECEC centres will continue to provide ‘normal practice’ to children. The primary trial outcome is child minutes of MVPA whilst in ECEC, assessed objectively via accelerometery over three days. Outcome assessment will occur at baseline and 6 months post-baseline. Linear mixed models under an intention-to-treat framework will be used to compare differences between groups in MVPA at follow-up. This will be the first cluster randomised controlled trial to test the efficacy of Energisers in isolation on increasing the time children spend in MVPA. Full article
Open AccessArticle
Putting Suicide Policy through the Wringer: Perspectives of Military Members Who Attempted to Kill Themselves
Int. J. Environ. Res. Public Health 2019, 16(21), 4274; https://doi.org/10.3390/ijerph16214274 - 04 Nov 2019
Abstract
In response to the Air Force Surgeon General, Lieutenant General Mark Ediger’s call for medical services to be guided by service members’ values, preferences, and experiences within the medical system, we conducted an interpretive phenomenological analysis of transcripts in which service members shared [...] Read more.
In response to the Air Force Surgeon General, Lieutenant General Mark Ediger’s call for medical services to be guided by service members’ values, preferences, and experiences within the medical system, we conducted an interpretive phenomenological analysis of transcripts in which service members shared their experiences of military mental health policy and practices after being identified as suicidal. Themes of their experiences underscore nuances as it relates to intersectionality of policy when faced with unique military contextual factors and power differentials; both of which were missing in available research literature. Their experiences also illuminate further the innate “Catch 22” which happens when accessing help. Catch 22 basically means if you know you need help than you are rational; but if you actually seek help, then you are crazy and not trustworthy to do your job. Themes presented center on the lack of confidentiality of Service Members in the Workplace, effects of Unit Members’ Surveillance and Command Directed Evaluations, and experiences of Military Mental Health Services. Critical discussions of policy and taken for granted assumptions that often drive narrow responses to suicide, treatment, prevention, and stigma are presented. Particular attention is given to the lived experiences of service members when placed under the demands of circumstances created by policy that may inadvertently lead in some cases to further suffering. The paper closes with recommendations from participants and the authors for policy makers and future directions in research. Full article
(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)
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