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Int. J. Environ. Res. Public Health, Volume 16, Issue 23 (December-1 2019)

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Cover Story (view full-size image) Heated tobacco products (HTPs) such as IQOS, glo, and Ploom TECH are alternative tobacco products [...] Read more.
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Open AccessFeature PaperArticle
Effects of Weight Loss on FGF-21 in Human Subjects: An Exploratory Study
Int. J. Environ. Res. Public Health 2019, 16(23), 4877; https://doi.org/10.3390/ijerph16234877 - 03 Dec 2019
Viewed by 443
Abstract
Fibroblast growth factor-21 (FGF-21), is a protein involved in cell growth and differentiation, development, wound repair and metabolism. Research looking at the impact of weight loss on FGF-21 levels is limited. The objective of this exploratory study was to determine changes in serum [...] Read more.
Fibroblast growth factor-21 (FGF-21), is a protein involved in cell growth and differentiation, development, wound repair and metabolism. Research looking at the impact of weight loss on FGF-21 levels is limited. The objective of this exploratory study was to determine changes in serum FGF-21 levels following weight loss induced by either continuous energy restriction or intermittent energy restriction. A sub cohort of participants who completed a 12-month dietary intervention trial following continuous energy restriction, or a week-on week-off energy restriction pattern, were selected for analysis. FGF-21 levels were not altered by weight loss and were not correlated with body weight or BMI at baseline or 12 months. Weight loss after 12 months either through continuous energy restriction or intermittent energy restriction was −5.9 ± 4.5 and −4.9 ± 3.4 kg, respectively. There was no change in FGF-21 levels, 0.3 ± 0.9 and 0.04 ± 0.2 ng/mL (p = 0.2). In conclusion, weight loss in healthy overweight or obesity subjects did not affect FGF-21 levels. Full article
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
Open AccessEditorial
Together in the Fight against Arthropod-Borne Diseases: A One Health Perspective
Int. J. Environ. Res. Public Health 2019, 16(23), 4876; https://doi.org/10.3390/ijerph16234876 - 03 Dec 2019
Viewed by 344
Abstract
Arthropod-borne diseases represent a major risk for humans, livestock, pets and wildlife worldwide [...] Full article
Open AccessArticle
Pythagorean 2-Tuple Linguistic Taxonomy Method for Supplier Selection in Medical Instrument Industries
Int. J. Environ. Res. Public Health 2019, 16(23), 4875; https://doi.org/10.3390/ijerph16234875 - 03 Dec 2019
Viewed by 331
Abstract
Supplier selection in medical instrument industries is a classical multiple attribute group decision making (MAGDM) problem. The Pythagorean 2-tuple linguistic sets (P2TLSs) can reflect uncertain or fuzzy information well and solve the supplier selection in medical instrument industries, and the original Taxonomy is [...] Read more.
Supplier selection in medical instrument industries is a classical multiple attribute group decision making (MAGDM) problem. The Pythagorean 2-tuple linguistic sets (P2TLSs) can reflect uncertain or fuzzy information well and solve the supplier selection in medical instrument industries, and the original Taxonomy is very appropriate for comparing different alternatives with respect to their advantages from studied attributes. In this study, we present an algorithm that combines Pythagorean 2-tuple linguistic numbers (P2TLNs) with the Taxonomy method, where P2TLNs are applied to express the evaluation of decision makers on alternatives. Relying on the Pythagorean 2-tuple linguistic weighted average (P2TLWA) operator or Pythagorean 2-tuple linguistic weighted geometric (P2TLWG) operator to fuse P2TLNs, the new general framework is established for Pythagorean 2-tuple linguistic multiple attribute group decision making (MAGDM) under the classical Taxonomy method. Ultimately, an application case for supplier selection in medical instrument industries is designed to test the novel method’s applicability and practicality and a comparative analysis with three other methods is used to elaborate further. Full article
(This article belongs to the Special Issue Network Analytics in Healthcare Decision Making)
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Open AccessArticle
Nothing Like Living with a Family: A Qualitative Study of Subjective Well-Being and its Determinants among Migrant and Local Elderly in Dongguan, China
Int. J. Environ. Res. Public Health 2019, 16(23), 4874; https://doi.org/10.3390/ijerph16234874 - 03 Dec 2019
Viewed by 314
Abstract
Chinese economic development has led to a significant rise in internal migration over the last 20 years, including large numbers of elderly. When elderly Chinese people migrate, they still register their residency to their place of origin and often do not register with [...] Read more.
Chinese economic development has led to a significant rise in internal migration over the last 20 years, including large numbers of elderly. When elderly Chinese people migrate, they still register their residency to their place of origin and often do not register with the new administrative office at the destination due to the household registration (hukou) system in China. Thus, most of these migrant elderly do not receive full social services, possibly leading to poor subjective well-being. This study aims to qualitatively examine the level of subjective well-being and its determinants among migrants and local elderly in Dongguan City of Guangdong province, one of the most rapid economically developing areas in China. We also present the results of in-depth interviews among 27 elderly, 15 elderly migrants and 12 local elderly living in Dongguan. The results reveal that the overall subjective well-being of the two groups were good. Most migrants believed their well-being had remained stable or even improved over time due to family reunion and a better physical environment. Elderly’s most valuable needs and the main reason of migration is family reunion; however, inadequacy of social support, including community support and government support (e.g., gift during holiday season, free health examination, healthcare expenditure reimbursement), cannot be neglected for maintaining a good level of well-being. The well-being of migrant elderly can be further enhanced by promoting social services and welfare, recreational activities, and enhancing healthcare reimbursement in their new home. Full article
(This article belongs to the Special Issue The Health and Wellbeing of Migrant Populations)
Open AccessArticle
Decoupling Analysis of Water Footprint and Economic Growth: A Case Study of Beijing–Tianjin–Hebei Region from 2004 to 2017
Int. J. Environ. Res. Public Health 2019, 16(23), 4873; https://doi.org/10.3390/ijerph16234873 - 03 Dec 2019
Viewed by 301
Abstract
The Beijing–Tianji–Hebei region (BTHR) is economically developed and densely populated, but its water resources are extremely scarce. A clear understanding of the decoupling relationship between water footprint and economic growth is conducive to facilitating and realizing the coordinated development of water resources and [...] Read more.
The Beijing–Tianji–Hebei region (BTHR) is economically developed and densely populated, but its water resources are extremely scarce. A clear understanding of the decoupling relationship between water footprint and economic growth is conducive to facilitating and realizing the coordinated development of water resources and economic growth in this region. This study calculated the water footprint and other related indicators of BTHR from 2004 to 2017, and objectively evaluated the utilization of water resources in the region. Then, logarithmic mean divisia index (LMDI) method was applied to study the driving factors that resulted in the change of water footprint and their respective effects. Finally, Tapio decoupling model was used to research the decoupling relationships between water footprint and economic growth, and between the driving factors of water footprint and economic growth. There are three main results in this research. (1) The water utilization efficiency in BTHR continues to improve, and the water footprint shows a gradually increasing trend during the research period, among which the agricultural water footprint accounts for a relatively high proportion. (2) The change of water footprint can be attributed to efficiency effect, economic effect, and population effect. Furthermore, efficiency effect is the decisive factor of water footprint reduction and economic effect is the main factor of water footprint increase, while population effect plays a weak role in promoting the increase in water footprint. (3) The decoupling status between water footprint and economic growth show a weak decoupling in most years, while the status between water footprint intensity and economic growth always remains strong decoupling. Moreover, population size and economic growth always show an expansive coupling state. In sum, it is advisable for policy makers to improve water utilization efficiency, especially agricultural irrigation efficiency, to raise residents’ awareness of water conservation, and increase the import of water-intensive products, so as to alleviate water shortage and realize the coordinated development of water resources and economic growth in BTHR. Full article
(This article belongs to the Special Issue Water Resources Systems Quality and Quantity Management)
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Open AccessArticle
Impacts of Precipitation and Temperature on Changes in the Terrestrial Ecosystem Pattern in the Yangtze River Economic Belt, China
Int. J. Environ. Res. Public Health 2019, 16(23), 4872; https://doi.org/10.3390/ijerph16234872 - 03 Dec 2019
Viewed by 328
Abstract
The terrestrial ecosystem plays an important role in maintaining an ecological balance, protecting the ecological environment, and promoting the sustainable development of human beings. The impacts of precipitation, temperature, and other natural factors on terrestrial ecosystem pattern change (TEPC) are the basis for [...] Read more.
The terrestrial ecosystem plays an important role in maintaining an ecological balance, protecting the ecological environment, and promoting the sustainable development of human beings. The impacts of precipitation, temperature, and other natural factors on terrestrial ecosystem pattern change (TEPC) are the basis for promoting the healthy development of the terrestrial ecosystem. This paper took the Yangtze River Economic Belt (YREB) as the study area, analyzed the temporal and spatial characteristics of TEPC from 1995 to 2015, and used spatial transfer matrix and terrestrial ecosystem pattern dynamic degree models to analyze the area transformation between different terrestrial ecosystem types. A bivariate spatial autocorrelation model and a panel data regression model were used to study the impacts of precipitation and temperature on TEPC. The results show that: (1) The basic pattern of the terrestrial ecosystem developed in a relatively stable manner from 1995 to 2005 in the YREB, and transformations between the farmland ecosystem, forest ecosystem, and grassland ecosystem were more frequent. The temporal and spatial evolution of precipitation and temperature in the YREB showed significant regional differences. (2) There was a significant negative bivariate global spatial autocorrelation effect of precipitation and temperature on the area change of the forest ecosystem, and a positive effect on the area change of the settlement ecosystem. The local spatial correlation between precipitation or temperature and the terrestrial ecosystem showed significant scattered distribution characteristics. (3) The impacts of precipitation and temperature on TEPC showed significant regional characteristics on the provincial scale. The impact utility in the tail region is basically negative, while both positive and negative effects exist in the central and head regions of the YREB. Moreover, the impact showed significant spatial heterogeneity on the city scale. (4) The Chinese government has promulgated policies and measures for strategic planning, ecological environment protection, and economic support, which could effectively promote ecological and sustainable development of the YREB and promote the coordinated development of the ecology, economy, and society in China. Full article
(This article belongs to the Section Environmental Science and Engineering)
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Open AccessArticle
A Training Program to Enhance Disaster Preparedness of Group Companies in the Tokyo Metropolitan Area
Int. J. Environ. Res. Public Health 2019, 16(23), 4871; https://doi.org/10.3390/ijerph16234871 - 03 Dec 2019
Viewed by 312
Abstract
Many business continuity (BC) plans do not mention food and water for BC personnel. Moreover, the BC relies on the assumption that, during an emergency or crisis, employees’ basic needs and personal hygiene are satisfied. Although no one can engage in BC without [...] Read more.
Many business continuity (BC) plans do not mention food and water for BC personnel. Moreover, the BC relies on the assumption that, during an emergency or crisis, employees’ basic needs and personal hygiene are satisfied. Although no one can engage in BC without these supplies, literature regarding companies’ disaster stocks for their employees is limited. We evaluated the current situation of companies’ stockpiles of food and other supplies and what their employees thought about them after participating in a newly-developed overnight training program that allows the participants to experience situations that they would encounter in a disaster. Thirty-three employees from eight companies in Tokyo participated in the program. Seventy-five percent of the participants’ companies had food stocks for three days as instructed by the Tokyo Metropolitan Government but, after eating four stock meals, 81.3% of the participants thought it would be better if this provision were improved. The stock rate for bedding was 62.5% but less than 30% of companies stocked both blankets and mats, as suggested by the Sphere Standards. There were several people who complained of sleeplessness and a poor physical condition the next morning and this could be an obstacle in the BC. Full article
(This article belongs to the Special Issue The World in Crisis: Current Health Issues)
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Open AccessArticle
Level of Stigma among Spanish Nursing Students toward Mental Illness and Associated Factors: A Mixed-Methods Study
Int. J. Environ. Res. Public Health 2019, 16(23), 4870; https://doi.org/10.3390/ijerph16234870 - 03 Dec 2019
Viewed by 318
Abstract
Mental health problems have been identified by the World Health Organization as a global development priority. Negative attitudes toward mental health patients have been documented in multiple health professionals. The aim of this study was to determine the level of stigma and associated [...] Read more.
Mental health problems have been identified by the World Health Organization as a global development priority. Negative attitudes toward mental health patients have been documented in multiple health professionals. The aim of this study was to determine the level of stigma and associated factors toward people with mental health problems among students doing their degree in nursing. An explanatory sequential mixed-methods approach. A cross-sectional descriptive observational study was carried out on a sample of 359 students doing their degree in nursing. Students had to be enrolled in any of the four years of study of the degree at the time the questionnaire was done. We explored the perception and experience of students doing their degree in nursing regarding the level of stigma, through in-depth interviews (n = 30). The mean overall Mental Health Stigma Scale (MHSS) score was 30.7 points (SD = 4.52); 29.5% (n = 106) scored low for stigma, 49.9% (n = 179) showed moderate stigma, and 20.6% (n = 74) scored high. The multivariate analysis showed that 4th-year students had an OR of 0.41 (CI95%: 0.20–0.84) for high/moderate stigma and that 3rd-year students had an OR of 0.49 for high/moderate stigma compared with 1st-year students. We also observed that students with family members with mental health problems had an OR of 2.05 (CI95%: 1.19–3.56) for high/moderate stigma compared with students who did not have family members with mental health problems. The following categories emerged: fear and lack of knowledge, breaking the silence, and integration into society. The levels of mental health stigma in our sample of nursing students were moderate. Stigma levels were lower in 3rd- and 4th-year students (i.e., after having received training in mental health), and in students with family members with mental health problems. Full article
(This article belongs to the Special Issue Stigma, Health and Wellbeing)
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Open AccessArticle
Integrating Geospatial Data and Measures of Disability and Wealth to Assess Inequalities in an Eye Health Survey: An Example from the Indian Sunderbans
Int. J. Environ. Res. Public Health 2019, 16(23), 4869; https://doi.org/10.3390/ijerph16234869 - 03 Dec 2019
Viewed by 360
Abstract
The Sunderbans are a group of delta islands that straddle the border between India and Bangladesh. For people living on the Indian side, health services are scarce and the terrain makes access to what is available difficult. In 2018, the international non-governmental organisation [...] Read more.
The Sunderbans are a group of delta islands that straddle the border between India and Bangladesh. For people living on the Indian side, health services are scarce and the terrain makes access to what is available difficult. In 2018, the international non-governmental organisation Sightsavers and their partners conducted a population-based survey of visual impairment and coverage of cataract and spectacle services, supplemented with tools to measure equity in eye health by wealth, disability, and geographical location. Two-stage cluster sampling was undertaken to randomly select 3868 individuals aged 40+ years, of whom 3410 were examined. Results were calculated using standard statistical processes and geospatial approaches were used to visualise the data. The age–sex adjusted prevalence of blindness was 0.8%, with higher prevalence among women (1.1%). Cataract Surgical Coverage for eyes at visual acuity (VA) 3/60 was 86.3%. The study did not find any association between visual impairment and wealth, however there were significant differences by additional (non-visual) disabilities at all levels of visual impairment. Geospatial mapping highlighted blocks where higher prevalence of visual impairment was identified. Integrating additional tools in population-based surveys is critical for measuring eye health inequalities and identifying population groups and locations that are at risk of being left behind. Full article
(This article belongs to the Special Issue Leaving no one behind: Equity and Eye Health)
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Open AccessArticle
Fault Diagnosis of Loader Gearbox Based on an ICA and SVM Algorithm
Int. J. Environ. Res. Public Health 2019, 16(23), 4868; https://doi.org/10.3390/ijerph16234868 - 03 Dec 2019
Viewed by 208
Abstract
When a part of the loader’s gearbox fails, this can lead to equipment failure due to the complex internal structure and the interrelationship between the parts. Therefore, it is imperative to research an efficient strategy for transmission fault diagnosis. In this study, the [...] Read more.
When a part of the loader’s gearbox fails, this can lead to equipment failure due to the complex internal structure and the interrelationship between the parts. Therefore, it is imperative to research an efficient strategy for transmission fault diagnosis. In this study, the non-contact characteristics of noise diagnosis using sound intensity probes were used to collect noise signals generated under gear breaking conditions. The independent component analysis (ICA) technique was applied for feature extraction from the original data and to reduce the correlation between the signals. The correlation coefficient between the independent components and the source data was used as the input parameters of the support vector machine (SVM) classifier. The separation of the independent components was achieved by MATLAB simulation. The misdiagnosis rate was 5% for 40 sets of test data. A 13-point test platform for noise testing of the loader gearbox was built according to Chinese national standards. Source signals under the normal and fault conditions were analyzed separately by ICA and SVM algorithms. In this case, the misdiagnosis rate was 7.5% for the 40 sets of experimental test data. This proved that the proposed method could effectively realize fault classification and recognition. Full article
(This article belongs to the Special Issue Advances in the Field of Human Health and Environment)
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Open AccessArticle
PEN-13: A New Generic 13-Item Questionnaire for Measuring Patient Enablement (German Version)
Int. J. Environ. Res. Public Health 2019, 16(23), 4867; https://doi.org/10.3390/ijerph16234867 - 03 Dec 2019
Viewed by 422
Abstract
Background: The purpose of our study was to develop and psychometrically test a German-language survey instrument that measures patient enablement generically and in greater detail than previous instruments. Methods: A multidisciplinary team developed 13 items to capture individual aspects of patient [...] Read more.
Background: The purpose of our study was to develop and psychometrically test a German-language survey instrument that measures patient enablement generically and in greater detail than previous instruments. Methods: A multidisciplinary team developed 13 items to capture individual aspects of patient enablement (PEN-13). A pre-test with 26 subjects was followed by a random sample survey of N = 1168 subjects. An exploratory factor analysis was conducted in a random split-half sample of the data to explore PEN-13’s factor structure; a confirmatory factor analysis was conducted in the validation sample. The internal consistency of the factors was evaluated using Cronbach’s alpha, PEN-13’s construct validity was checked by means of additional hypothesis testing. Results: The two factors self-management and patient-practitioner interaction, detected in the exploratory analysis, were confirmed with a few modifications in the confirmatory factor analysis, with the comparative fit index (CFI) amounting to 0.903. The Cronbach’s alpha values of those two factors amounted to α = 0.90 and α = 0.82, respectively. The correlations of the PEN-13 score with the ’general self-efficacy’ and ’health literacy’ (HLS-EU-Q16) scores further confirmed its construct validity; the respective correlation coefficients amounted to 0.57 and 0.60. Conclusion: The German version of the survey instrument Patient Enablement Scale—13 items (PEN-13) shows acceptable psychometric properties. Practical implications: PEN-13 seems particularly suitable for health services research purposes. We recommend checking the results in another sample as well as evaluating its responsiveness to enablement-enhancing interventions. Full article
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Open AccessArticle
Suicide Overall and Suicide by Pesticide Rates among South Korean Workers: A 15-Year Population-Based Study
Int. J. Environ. Res. Public Health 2019, 16(23), 4866; https://doi.org/10.3390/ijerph16234866 - 03 Dec 2019
Viewed by 393
Abstract
Suicide is a major public health concern in South Korea, and self-poisoning by pesticides is one of the common methods of suicide. Pesticide ban policies have been successful for suicide prevention; however, no studies have shown their effect according to occupational groups. The [...] Read more.
Suicide is a major public health concern in South Korea, and self-poisoning by pesticides is one of the common methods of suicide. Pesticide ban policies have been successful for suicide prevention; however, no studies have shown their effect according to occupational groups. The present study analyzed suicide and suicide by pesticide rates among South Korean workers aged 15–64 in 2003–2017, their associations with occupational groups, and the impact of three major economic indices on these factors. Workers in the agriculture, forestry, and fishery industries had relative risks of 5.62 (95% CI: 5.54–5.69) for suicide overall and 25.49 (95% CI: 24.46–26.57) for suicide by pesticide. The real gross domestic product had a positive association with suicide overall only in the last five-year period investigated in this study, and the unemployment rate consistently had a positive association. The economic status and policy for suicide prevention affected suicide and suicide by pesticide rates differently among occupational groups and different time periods. Policy addressing suicidal risk for different occupational groups should be of concern in South Korea. Full article
(This article belongs to the Special Issue Suicidal Behavior as a Complex Dynamical System)
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Open AccessArticle
Public Health Insurance, Non-Farm Labor Supply, and Farmers’ Income: Evidence from New Rural Cooperative Medical Scheme
Int. J. Environ. Res. Public Health 2019, 16(23), 4865; https://doi.org/10.3390/ijerph16234865 - 03 Dec 2019
Viewed by 326
Abstract
The major source of income of Chinese farmers is non-farm income, especially wages and salaries. Based on the economics theory of health and healthcare, their non-farm labor supply behavior could be affected by health insurance policies. The work presented in this paper focuses [...] Read more.
The major source of income of Chinese farmers is non-farm income, especially wages and salaries. Based on the economics theory of health and healthcare, their non-farm labor supply behavior could be affected by health insurance policies. The work presented in this paper focuses on the impact of the New Rural Cooperative Medical Scheme (NRCMS) on farmers’ non-farm labor supply behavior in China. A four-part model regression approach was used to examine the relationship. Our dataset comprised of 8273 people, aged 45 or above, from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011 and 2013. The empirical results showed that NRCMS significantly reduced non-farm labor force participation and employment. Compared to non-participants of the NRCMS, the non-farmer labor time of these participants reduced, but the supplementary medical insurance and immediate reimbursement of the NRCMS increased the participants’ non-farm labor time. Our results have contributed to the reform of China’s public health insurance and farms’ income growth, and it would be necessary to actively promote immediate reimbursement, gradually simplify reimbursement procedures for medical treatment in non-registered places, and eliminate the non-portability of NRCMS. Full article
(This article belongs to the Special Issue Health, Ageing and the Labour Market)
Open AccessReview
Chloracne and Hyperpigmentation Caused by Exposure to Hazardous Aryl Hydrocarbon Receptor Ligands
Int. J. Environ. Res. Public Health 2019, 16(23), 4864; https://doi.org/10.3390/ijerph16234864 - 03 Dec 2019
Viewed by 325
Abstract
Dioxins and dioxin-like compounds are environmental pollutants that are hazardous to human skin. They can be present in contaminated soil, water, and air particles (such as ambient PM2.5). Exposure to a high concentration of dioxins induces chloracne and hyperpigmentation. These chemicals [...] Read more.
Dioxins and dioxin-like compounds are environmental pollutants that are hazardous to human skin. They can be present in contaminated soil, water, and air particles (such as ambient PM2.5). Exposure to a high concentration of dioxins induces chloracne and hyperpigmentation. These chemicals exert their toxic effects by activating the aryl hydrocarbon receptor (AHR) which is abundantly expressed in skin cells, such as keratinocytes, sebocytes, and melanocytes. Ligation of AHR by dioxins induces exaggerated acceleration of epidermal terminal differentiation (keratinization) and converts sebocytes toward keratinocyte differentiation, which results in chloracne formation. AHR activation potently upregulates melanogenesis in melanocytes by upregulating the expression of melanogenic enzymes, which results in hyperpigmentation. Because AHR-mediated oxidative stress contributes to these hazardous effects, antioxidative agents may be potentially therapeutic for chloracne and hyperpigmentation. Full article
(This article belongs to the Special Issue Environment, Endocrine Disruptors and Cutaneous Effects)
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Open AccessArticle
Lack of Association between Cytokine Genetic Polymorphisms in Takayasu’s Arteritis in Mexican Patients
Int. J. Environ. Res. Public Health 2019, 16(23), 4863; https://doi.org/10.3390/ijerph16234863 - 03 Dec 2019
Viewed by 327
Abstract
Aim: To investigate the relation between polymorphisms in the interleukin 10 (IL)-10, tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β and interferon (IFN)-γ genes and Takayasu’s arteritis in the Mexican population. Methods: [...] Read more.
Aim: To investigate the relation between polymorphisms in the interleukin 10 (IL)-10, tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β and interferon (IFN)-γ genes and Takayasu’s arteritis in the Mexican population. Methods: A case-control study was performed to investigate the associations of IL-10, TNF-α, TGF-β and IFN-γ polymorphisms in a sample of 52 Takayasu’s arteritis patients, diagnosed according to the criteria of the American College of Rheumatology and EULAR PRINTO criteria when the patients were under 18 years of age; 60 clinically healthy unrelated Mexican individuals by the 5′ exonuclease TaqMan polymerase chain reaction. Polymorphic haplotypes were constructed after linkage disequilibrium analysis. Results: Significant differences were not found in the distribution for genotype and allele frequencies of the polymorphisms studied between healthy controls and Takayasu´s arteritis patients. Likewise, significant associations were not detected in the haplotype analysis with the different genes studied. Conclusions: These findings suggest that the polymorphisms in IL-10, TNF-α, TGF-β and IFN-γ might not contribute to the susceptibility of Takayasu´s arteritis in the Mexican population. Full article
Open AccessBrief Report
Use of Heated Tobacco Products within Indoor Spaces: Findings from the 2018 ITC Japan Survey
Int. J. Environ. Res. Public Health 2019, 16(23), 4862; https://doi.org/10.3390/ijerph16234862 - 03 Dec 2019
Viewed by 411
Abstract
Although heated tobacco products (HTPs) have become increasingly popular in Japan, little is known about whether these emerging tobacco products are being used within indoor public spaces. Nationally representative data were obtained prior to implementation of a comprehensive smoke-free law in Japan as [...] Read more.
Although heated tobacco products (HTPs) have become increasingly popular in Japan, little is known about whether these emerging tobacco products are being used within indoor public spaces. Nationally representative data were obtained prior to implementation of a comprehensive smoke-free law in Japan as part of Wave 1 of the International Tobacco Control Japan Survey (February–March 2018). We estimated the weighted prevalence of HTP use within indoor public spaces among tobacco users and compared these to estimates for combustible cigarettes (CCs). Overall, 15.6% of current tobacco users in Japan declared that they used HTPs within indoor public spaces. Any HTP use within indoor public spaces was significantly lower than any CC use (80.1% vs. 96.7%). Dual HTP + CC users reported using CCs more frequently than using HTPs within indoor public spaces (97.7% vs. 76.0%). In conclusion, HTP use is less common than CC use within indoor public spaces. Findings of this study can inform the development of targeted smoke-free policies to benefit public health. Full article
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Open AccessReview
Using a Developmental-Relational Approach to Understand the Impact of Interpersonal Violence in Women Who Struggle with Substance Use
Int. J. Environ. Res. Public Health 2019, 16(23), 4861; https://doi.org/10.3390/ijerph16234861 - 03 Dec 2019
Viewed by 329
Abstract
Substance use among women is a major public health concern. This review article takes a developmental-relational approach to examine processes through which early relational trauma and violence in relationships may lead to substance use. We examine how early exposure to violence in relationships [...] Read more.
Substance use among women is a major public health concern. This review article takes a developmental-relational approach to examine processes through which early relational trauma and violence in relationships may lead to substance use. We examine how early exposure to violence in relationships can impact neurological development, specifically through interference with physiological mechanisms (e.g., the hypothalamic-pituitary-adrenal axis), brain structure and functioning (e.g., the hippocampus and prefrontal cortex), and neuropsychological development (e.g., executive functioning and emotion regulation) across the lifespan. Further, we discuss the impact of exposure to violence on the development of relational capacity, including attachment, internal working models, and subsequent interpersonal relationships across the lifespan, and how these developmental pathways can lead to continued problematic substance use in women. Full article
(This article belongs to the Special Issue Sex, Gender and Substance Use)
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Open AccessArticle
No More Bricks in the Wall: Adopting Healthy Lifestyles through Physical Education Classes
Int. J. Environ. Res. Public Health 2019, 16(23), 4860; https://doi.org/10.3390/ijerph16234860 - 03 Dec 2019
Viewed by 368
Abstract
Despite the multiple benefits associated with practicing physical activity regularly, less than 20% of the population do it on a daily basis. Physical education classes could contribute, during childhood and adolescence, to consolidating adherence to healthy lifestyle habits. The present study involved 606 [...] Read more.
Despite the multiple benefits associated with practicing physical activity regularly, less than 20% of the population do it on a daily basis. Physical education classes could contribute, during childhood and adolescence, to consolidating adherence to healthy lifestyle habits. The present study involved 606 secondary school students between the ages of 13 and 19. We analysed the relationships between the perception of psychological control and support for autonomy, the satisfaction and frustration of psychological needs, mind-wandering and mindfulness, positive and negative emotions, motivation towards physical education classes, physical activity and the intention to be physically active—all through a structural equation model, which presented acceptable goodness-of-fit indices. The results showed that students who feel more autonomous see that their psychological needs are met and feel emotionally positive; this will result in the development of autonomous motivation towards physical education classes and physical activity that, in turn, could lead to a greater intention to be physically active. Full article
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Open AccessBenchmark
Mosquitoes, Infectious Diseases, and Cancer: A Connection to Study?
Int. J. Environ. Res. Public Health 2019, 16(23), 4859; https://doi.org/10.3390/ijerph16234859 - 03 Dec 2019
Cited by 1 | Viewed by 255
Abstract
Mosquitoes (Diptera: Culicidae) are vectors of pathogens and parasites of great medical and veterinary relevance. The possible association between mosquitoes, infectious diseases, and cancer has been investigated. Despite its potential importance, there is a severe lack of research data on the topic. Herein, [...] Read more.
Mosquitoes (Diptera: Culicidae) are vectors of pathogens and parasites of great medical and veterinary relevance. The possible association between mosquitoes, infectious diseases, and cancer has been investigated. Despite its potential importance, there is a severe lack of research data on the topic. Herein, current knowledge, tenuous links, and related challenges on the topic were examined, grouping information under four major hypotheses. The first hypothesis is that the infection of mosquito-vectored parasites, with special reference to Plasmodium spp., may lead to cancer. The International Agency for Research on Cancer stated that being infected by Plasmodium falciparum malaria in holoendemic areas is probably carcinogenic to humans (group 2A), considering that P. falciparum infection is able to reactivate the Epstein–Barr virus, leading to endemic Burkitt lymphoma. Also, malaria was recently associated with a cancer incidence increase in the United States. The second hypothesis is that cancer may be spread directly through mosquito bites: Aedes mosquitoes transfer viable tumor cells among vertebrate hosts, even if no plausible mechanisms for these cells to develop cancer into the new host are known. As the third hypothesis, mosquito bites may lead to hypersensitivity, resulting in cancer. Hypersensitivity stimulated by mosquito bites links allergy, oncogenesis, and the Epstein–Barr virus, causing Burkitt lymphoma. One may argue that pathogens transmitted by mosquitoes, such as viruses, may be carcinogenic. However, no detailed research evidences are available to substantiate this last hypothesis. However, despite the intriguing hypotheses outlined above, there is a severe lack of data showing cancer development in organisms exposed to mosquitoes transmitting parasites or pathogens. According to One Health criteria, this benchmark is aimed to outline major questions on this public health issue, stressing the need of multidisciplinary research and discussion. Full article
Open AccessArticle
Validation of Submaximal Step Tests and the 6-Min Walk Test for Predicting Maximal Oxygen Consumption in Young and Healthy Participants
Int. J. Environ. Res. Public Health 2019, 16(23), 4858; https://doi.org/10.3390/ijerph16234858 - 03 Dec 2019
Viewed by 328
Abstract
Background: This study aimed to test the validity of three different submaximal tests (i.e., 3-min step test with 20.3-cm step box height (3MST20), 3-min step test with 30-cm step box height (3MST30), and 6-min walk test (6MWT)) in [...] Read more.
Background: This study aimed to test the validity of three different submaximal tests (i.e., 3-min step test with 20.3-cm step box height (3MST20), 3-min step test with 30-cm step box height (3MST30), and 6-min walk test (6MWT)) in estimating maximal oxygen consumption (VO2max) in young and healthy individuals. Methods: The 3MST20, 3MST30, 6MWT, as well as the cardiopulmonary exercise test (CPET) were performed in 73 participants (37 men and 36 women; mean age: 30.8 ± 9.3 years). All participants visited the clinic three times in a random order for anthropometric measurements, three submaximal tests, and the VO2max test. Multiple linear regression analyses were conducted to construct the VO2max prediction equations for each submaximal test. Results: The prediction equations developed based on multiple regression analyses for each submaximal tests were as follows: 3MST20: VO2max = 86.0 − 10.9 × sex (male = 1, female = 2) − 0.4 × age − 0.1 × weight − 0.1 × heart rate recovery at 30 s (HRR30s); 3MST30: VO2max = 84.5 − 10.2 × sex (male = 1, female = 2) − 0.4 × age − 0.1 × weight − 0.1 × HRR30s; and 6MWT: VO2max = 61.1 − 11.1 × sex (male = 1, female = 2) − 0.4 × age − 0.2 × weight − 0.2 × (distance walked·10−1). The estimated VO2max values based on formulated equations were 37.0 ± 7.9, 37.3 ± 7.6, and 36.9 ± 7.9 mL∙kg−1∙min−1 derived from the 3MST20, 3MST30, and 6MWT, respectively. These estimated VO2max values were not significantly different from the measured VO2max value, 37.3 mL∙kg−1∙min−1. The estimated VO2max based on the 3MST20, 3MST30, and 6MWT results explained 73.4%, 72.2%, and 74.4% of the variances in the measured VO2max (p < 0.001), respectively. Conclusions: The 3MST20, 3MST30, and 6MWT were valid in estimating VO2max in relatively young and healthy Asian individuals. Full article
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Open AccessCommunication
Detectable Levels of Bacterial Pathogens in the Rivers of the Lake Chaohu Basin, China
Int. J. Environ. Res. Public Health 2019, 16(23), 4857; https://doi.org/10.3390/ijerph16234857 - 03 Dec 2019
Viewed by 319
Abstract
Bacterial pathogens are one of the causes of human diseases and have a serious impact on environmental health. In this study, we investigated the bacterial pathogen community in 88 sites at rivers around Lake Chaohu Basin, China, using Illumina miseq sequencing. The results [...] Read more.
Bacterial pathogens are one of the causes of human diseases and have a serious impact on environmental health. In this study, we investigated the bacterial pathogen community in 88 sites at rivers around Lake Chaohu Basin, China, using Illumina miseq sequencing. The results showed that three opportunistic pathogens: Acinetobacter, Massilia, and Brevundimonas, were the three abundant bacterial genera in all samples, and had a relative abundance of 0.33 to 49.28% (average 8.80%), 0.06 to 25.4% (average 4.6%), 0.01 to 12.82% (average 2.6%) of all bacterial sequences, respectively. Our results indicated that a high abundance of opportunistic pathogens was observed in the rivers of the Lake Chaohu Basin, and that effective treatment and monitoring of sewage entering into rivers should be further strengthened. Full article
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Open AccessArticle
Changing Incidence and Stage Distribution of Prostate Cancer in a Lithuanian Population—Evidence from National PSA-Based Screening Program
Int. J. Environ. Res. Public Health 2019, 16(23), 4856; https://doi.org/10.3390/ijerph16234856 - 03 Dec 2019
Viewed by 375
Abstract
Background: The aim of this study was to examine the impact of screening introduction on prostate cancer incidence changes, and changes in stage distribution in Lithuania between 1998–2016. Methods: Age-standardized incidence as well as stage-specific incidence rates were calculated. Joinpoint regression was used [...] Read more.
Background: The aim of this study was to examine the impact of screening introduction on prostate cancer incidence changes, and changes in stage distribution in Lithuania between 1998–2016. Methods: Age-standardized incidence as well as stage-specific incidence rates were calculated. Joinpoint regression was used to estimate the annual percentage change in the incidence changes by determined stage: Localized, advanced, distant and unknown. Results: Over the study period, a total number of 48,815 new prostate cancer cases was identified. Age-standardized incidence rose from 51.9 per 100,000 in 1998 to 279.3 per 100,000 in 2007 (by 20.3% per year) and then decreased thereafter by 3.8% annually. Highest incidence rates after introduction of prostate specific antigene (PSA)-based screening was found for localized disease, followed by advanced. Incidence of localized disease rose by 38.2% per year until 2007 reaching the highest rate of 284.6 per 100,000, with a subsequent decrease of 5.5% every year thereafter. Advanced stage of disease experienced rise till 2007, and continuous decrease by 11.1% every year thereafter. Incidence of disease with distant metastasis was lowest, and rose till 2003, thereafter incidence significantly decreased by 8.1% every year. Conclusions: To our knowledge, this is the first report of stage migration effect in Lithuania, following the introduction of nationwide PSA-based screening. Prostate cancer screening substantially increased the overall incidence and incidence of localized cancer. Full article
(This article belongs to the Section Public Health Statistics and Risk Assessment)
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Open AccessArticle
Inter-Individual Variability in Metabolic Syndrome Severity Score and VO2max Changes Following Personalized, Community-Based Exercise Programming
Int. J. Environ. Res. Public Health 2019, 16(23), 4855; https://doi.org/10.3390/ijerph16234855 - 03 Dec 2019
Viewed by 421
Abstract
This study sought to examine the effectiveness of a personalized, community-based exercise program at reducing MetS severity and consequently Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) risk. One-hundred and fifty physically inactive participants (aged 18–83 years) were randomized to a non-exercise [...] Read more.
This study sought to examine the effectiveness of a personalized, community-based exercise program at reducing MetS severity and consequently Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) risk. One-hundred and fifty physically inactive participants (aged 18–83 years) were randomized to a non-exercise control group (n = 75; instructed to continue their usual lifestyle habits) or treatment group (n = 75). Participants randomized to the treatment group completed a 12 week personalized exercise training program based on the American Council on Exercise (ACE) Integrated Fitness Training (IFT) model guidelines. Z-scores were derived from levels of metabolic syndrome risk factors to determine the severity of MetS (MetS z-score). After 12 weeks, the treatment group showed a significant favorable change in MetS z-score, whereas the control group demonstrated increased severity of the syndrome (between-group difference, p < 0.05). The proportion of MetS z-score responders (Δ > −0.48) was greater following the exercise intervention (71%, 50/70) compared to control (10%, 7/72) (between group difference, p < 0.001). The inter-individual variability in VO2max change also showed a similar trend. These findings provide critical translational evidence demonstrating that personalized exercise programming based upon the ACE IFT model guidelines can be successfully implemented within the community setting to reduce T2DM and CVD risk. Full article
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Open AccessArticle
Access to Services in Rural Areas from the Point of View of Older Population—A Case Study in Finland
Int. J. Environ. Res. Public Health 2019, 16(23), 4854; https://doi.org/10.3390/ijerph16234854 - 02 Dec 2019
Viewed by 463
Abstract
Independence and having control over one’s own life are important factors for residential satisfaction. In rural areas, the mobility of people is based on owning a private car, due to the lack of public transport. Furthermore, planning in rural municipalities is highly car [...] Read more.
Independence and having control over one’s own life are important factors for residential satisfaction. In rural areas, the mobility of people is based on owning a private car, due to the lack of public transport. Furthermore, planning in rural municipalities is highly car oriented. Small municipalities with shrinking and aging populations have many challenges to ensure access to services for their residents. This paper focuses on a case study of a small municipality with less than 2000 inhabitants. The objective of the study was to enhance sustainable change in shrinking rural areas and maintain them as good places to live even in the future. Access to local services and social activities is a major challenge for older people, who no longer have the possibility to use their own car. The problem with relocation is the lack of suitable apartments for older people. A dense and walkable municipal centre with accessible apartments may help municipalities provide for their older populations. Moreover, in Finland, second homeowners are an important resource for small municipalities. Spaces for social intercourse between residents and between permanent residents and second homeowners may enhance vitality and community building in these municipalities. Full article
(This article belongs to the Special Issue Daily Travel and Wellbeing among the Elderly)
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Open AccessArticle
Effect of Training Load on Post-Exercise Cardiac Troponin T Elevations in Young Soccer Players
Int. J. Environ. Res. Public Health 2019, 16(23), 4853; https://doi.org/10.3390/ijerph16234853 - 02 Dec 2019
Viewed by 436
Abstract
Training load (TL) metrics are usually assessed to estimate the individual, physiological and psychological, acute, and adaptive responses to training. Cardiac troponins (cTn) reflect myocardial damage and are routinely analyzed for the clinical diagnosis of myocardial injury. The association between TL and post-exercise [...] Read more.
Training load (TL) metrics are usually assessed to estimate the individual, physiological and psychological, acute, and adaptive responses to training. Cardiac troponins (cTn) reflect myocardial damage and are routinely analyzed for the clinical diagnosis of myocardial injury. The association between TL and post-exercise cTn elevations is scarcely investigated in young athletes, especially after playing common team sports such as soccer. The objective of this study was to assess the relationship between TL measurements during a small-sided soccer game and the subsequent increase in cTn in young players. Twenty male soccer players (age 11.9 ± 2 years, height 151 ± 13 cm, weight 43 ± 13 kg) were monitored during a 5 × 5 small-sided game and had blood samples drawn before, immediately after, and 3 h after exercise for a posterior analysis of high-sensitivity cardiac troponin T (hs-cTnT). Internal, external, and mixed metrics of TL were obtained from the rating of perceived exertion (RPE), heart rate (HR), and GPS player tracking. The results show that the concentration of hs-cTnT peaked at 3 h post-exercise in all participants. The magnitude of hs-cTnT elevation was mainly explained by the exercise duration in the maximal heart rate zone (Maximum Probability of Effect (MPE) = 92.5%), time in the high-speed zone (MPE = 90.4 %), and distance in the high-speed zone (MPE = 90.45%). Our results support the idea that common metrics of TL in soccer, easily obtained using player tracking systems, are strongly associated with the release of hs-cTnT in children and adolescents. Full article
(This article belongs to the Special Issue Health, Exercise and Sports Performance)
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Open AccessArticle
Building Healthy Eating Knowledge and Behavior: An Evaluation of Nutrition Education in a Skill Training Course for Construction Apprentices
Int. J. Environ. Res. Public Health 2019, 16(23), 4852; https://doi.org/10.3390/ijerph16234852 - 02 Dec 2019
Viewed by 381
Abstract
Background: Prior research has found poor health among construction workers is related to poor nutrition and low fruit and vegetable consumption. Promoting nutrition knowledge can improve dietary behaviors, but nutrition education among construction workers is limited. We evaluated the effectiveness of nutrition education [...] Read more.
Background: Prior research has found poor health among construction workers is related to poor nutrition and low fruit and vegetable consumption. Promoting nutrition knowledge can improve dietary behaviors, but nutrition education among construction workers is limited. We evaluated the effectiveness of nutrition education on fruit and vegetable consumption among construction apprentices. In this pilot evaluative study, 36 construction apprentices enrolled in skill training programs received two 1.5-hour nutrition classes. Twelve questions addressing healthy eating knowledge and behavior were administered at baseline, after intervention, and at three months follow-up. After intervention, daily fruit consumption improved from baseline (mean (s.d.) =1.42 (0.55)) to post intervention (mean (s.d.) =1.72 (0.70)) (p < 0.05) and to three months follow-up (mean(s.d.) =1.94 (0.83)) (p > 0.05). After intervention, daily vegetable consumption improved from baseline (mean (s.d.) =1.67 (0.59)) to post intervention (mean (s.d.) =1.97 (0.74)) (p < 0.05) and to three months follow-up (mean (s.d.) = 2.19 (0.82)) (p > 0.05). Younger construction apprentices showed better healthy eating knowledge at post intervention and three months follow-up (p > 0.05). Working in normal hours showed better healthy eating knowledge at post intervention but not at three months follow up (p > 0.05). Both age groups and working hours did not show significant differences on healthy eating behaviour. Nutrition education implemented as a three-hour session within skill courses may possibly promote fruit and vegetable consumption among construction apprentices. Further research with control group is required to support the findings in this study. Full article
Open AccessArticle
Toward Prevention of Doping in Youth Sport: Cross-Sectional Analysis of Correlates of Doping Tendency in Swimming
Int. J. Environ. Res. Public Health 2019, 16(23), 4851; https://doi.org/10.3390/ijerph16234851 - 02 Dec 2019
Viewed by 385
Abstract
Doping is recognized as one of the most important problems in sports, but a limited number of studies have investigated doping problems in youth athletes. This study aimed to evaluate doping tendency (potential doping behavior (PDB)) and correlates of PDB in youth age [...] Read more.
Doping is recognized as one of the most important problems in sports, but a limited number of studies have investigated doping problems in youth athletes. This study aimed to evaluate doping tendency (potential doping behavior (PDB)) and correlates of PDB in youth age swimmers. The participants were 241 competitive swimmers (131 females; 15.3 ± 1.1 years of age, all under 18 years old). Variables included predictors and PDB (criterion). Predictors consisted of sociodemographic factors (gender and age), sport-related variables (i.e., experience in swimming and sport achievement), variables explaining coaching strategy and training methodology, consumption of dietary supplements (DS), knowledge about doping, and knowledge about sports nutrition and DS (KSN). In addition to the descriptive statistics and differences between genders, a multinomial regression using PDB as the criterion (negative-, neutral-, or positive-PDB, with a negative-PDB as the reference value) was calculated to define associations between predictors and criterion. With only 71% of swimmers who declared negative-PDB results indicated an alarming figure. Boys with better KSN were more negatively oriented toward positive-PDB (OR: 0.77, 95%CI: 0.60–0.95). In girls, lower competitive achievement was evidenced as a risk factor for neutral-PDB (OR: 0.39, 95%CI: 0.24–0.63). Also, higher neutral-PDB (OR: 0.88, 95%CI: 0.81–0.96) and positive-PDB (OR: 0.90, 95%CI: 0.83–0.99) were identified in girls who began with intensive training in younger age. Because of the alarming figures of PDB, there is an evident need for the development of systematic antidoping educational programs in youth swimming. In doing so, focus should be placed on girls who began intensive training at an earlier age and those who did not achieve high competitive results. Full article
(This article belongs to the Special Issue Effect of Sport Activity on Health Promotion 2019)
Open AccessCorrection
Correction: A Fuzzy Model of Risk Assessment for Environmental Start-Up Projects in the Air Transport Sector. Int. J. Environ. Res. Public Health 2019, 16, 3573
Int. J. Environ. Res. Public Health 2019, 16(23), 4850; https://doi.org/10.3390/ijerph16234850 (registering DOI) - 02 Dec 2019
Viewed by 383
Abstract
The authors wish to make the following correction to their paper [...] Full article
(This article belongs to the Special Issue Environmental Issues in Aerospace and their Impact on Public Health)
Open AccessReview
Key Risk Factors Affecting Farmers’ Mental Health: A Systematic Review
Int. J. Environ. Res. Public Health 2019, 16(23), 4849; https://doi.org/10.3390/ijerph16234849 - 02 Dec 2019
Viewed by 466
Abstract
Recently, concern has increased globally over farmers’ mental health issues. We present a systematic review of the outcomes, locations, study designs, and methods of current studies on farmers’ mental health. In particular, this review aims to fill an important gap in understanding of [...] Read more.
Recently, concern has increased globally over farmers’ mental health issues. We present a systematic review of the outcomes, locations, study designs, and methods of current studies on farmers’ mental health. In particular, this review aims to fill an important gap in understanding of the potential key risk factors affecting farmers’ mental health around the world. 167 articles on farmer mental health were included in a final systematic review using a standardized electronic literature search strategy and PRISMA guidelines. The four most-cited influences on farmers’ mental health in the reviewed literature respectively were pesticide exposure, financial difficulties, climate variabilities/drought, and poor physical health/past injuries. The majority of studies were from developed countries, most specifically from the United States, Australia, and the United Kingdom. Comparative studies on the mental health of farmers and other occupational workers showed mixed results, with a larger portion identifying that psychological health disturbances were more common in farmers and farm-workers. Knowledge of farmer psychological disorder risk factors and its impacts are essential for reducing the burden of mental illness. Further research will be required on climate change impacts, developing country farmers’ mental health, and information on how to reduce help-seeking barriers amongst farmers. Full article
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Open AccessReview
The Sustainability Challenge of Food and Environmental Nanotechnology: Current Status and Imminent Perceptions
Int. J. Environ. Res. Public Health 2019, 16(23), 4848; https://doi.org/10.3390/ijerph16234848 - 02 Dec 2019
Viewed by 406
Abstract
Nanotechnology is a connection among various branches of science with potential applications that extend over a variety of scientific disciplines, particularly in the food science and technology fields. For nanomaterial applications in food processing, such as antimicrobials on food contact surfaces along with [...] Read more.
Nanotechnology is a connection among various branches of science with potential applications that extend over a variety of scientific disciplines, particularly in the food science and technology fields. For nanomaterial applications in food processing, such as antimicrobials on food contact surfaces along with the improvement of biosensors, electrospun nanofibers are the most intensively studied ones. As in the case of every developing skill, an assessment from a sustainability point of view is necessary to address the balance between its benefits to civilization and the unwanted effects on human health and the environment. The current review aimed to provide an update regarding the sustainability of current nanotechnology applications in food science technology, environment, and public health together with a risk assessment and toxicity evaluation. Full article
(This article belongs to the Special Issue Nanotechnology to the Benefit of Environment and Public Health)
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