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Int. J. Environ. Res. Public Health, Volume 16, Issue 6 (March-2 2019) – 187 articles

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Cover Story (view full-size image) In this study, rates of chronic medical conditions in Gulf War (GW) veterans (n = 448) were [...] Read more.
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Open AccessArticle
Factors Associated with Participation of Community-Dwelling Older Adults in a Home-Based Falls Prevention Program
Int. J. Environ. Res. Public Health 2019, 16(6), 1087; https://doi.org/10.3390/ijerph16061087 - 26 Mar 2019
Cited by 1 | Viewed by 1258
Abstract
This observational study was conducted to determine which factors are associated with frequent participation in a home-based exercise program. The effects of frequent participation on health-related outcomes over time are investigated, as well. Community-dwelling adults aged ≥65 years participated in a twelve-week home-based [...] Read more.
This observational study was conducted to determine which factors are associated with frequent participation in a home-based exercise program. The effects of frequent participation on health-related outcomes over time are investigated, as well. Community-dwelling adults aged ≥65 years participated in a twelve-week home-based exercise program. The program consisted of an instruction book with exercises that were performed individually at home. Frequent participation was classified as performing exercises of the instruction book daily or a few days a week during the study period. A logistic regression analysis was performed to determine the association between factors (i.e., demographic and health-related characteristics) and frequent participation. Furthermore, to investigate the effects of frequent participation on health-related outcomes, generalized linear and logistic regression models were built. A total of 238 participants (mean age 81.1 years (SD ± 6.7), 71% female) were included in the study. Frequent participation during the study period was indicated by fifty-two percent of participants. Analyses showed that a higher degree of pain (OR: 1.02, 95% CI: 1.–1.04) was associated with frequent participation. In addition, the effect of frequent participation over time was a significant improvement in current health perceptions (B: 4.46, SE: 1.99). Full article
(This article belongs to the collection Falls in Older Adults: Risk and Prevention)
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Open AccessReview
Fluoride Exposure Induces Inhibition of Sodium/Iodide Symporter (NIS) Contributing to Impaired Iodine Absorption and Iodine Deficiency: Molecular Mechanisms of Inhibition and Implications for Public Health
Int. J. Environ. Res. Public Health 2019, 16(6), 1086; https://doi.org/10.3390/ijerph16061086 - 26 Mar 2019
Cited by 7 | Viewed by 10796
Abstract
The sodium iodide symporter (NIS) is the plasma membrane glycoprotein that mediates active iodide transport in the thyroid and other tissues, such as the salivary, gastric mucosa, rectal mucosa, bronchial mucosa, placenta and mammary glands. In the thyroid, NIS mediates the uptake and [...] Read more.
The sodium iodide symporter (NIS) is the plasma membrane glycoprotein that mediates active iodide transport in the thyroid and other tissues, such as the salivary, gastric mucosa, rectal mucosa, bronchial mucosa, placenta and mammary glands. In the thyroid, NIS mediates the uptake and accumulation of iodine and its activity is crucial for the development of the central nervous system and disease prevention. Since the discovery of NIS in 1996, research has further shown that NIS functionality and iodine transport is dependent on the activity of the sodium potassium activated adenosine 5′-triphosphatase pump (Na+, K+-ATPase). In this article, I review the molecular mechanisms by which F inhibits NIS expression and functionality which in turn contributes to impaired iodide absorption, diminished iodide-concentrating ability and iodine deficiency disorders. I discuss how NIS expression and activity is inhibited by thyroglobulin (Tg), tumour necrosis factor alpha (TNF-α), transforming growth factor beta 1 (TGF-β1), interleukin 6 (IL-6) and Interleukin 1 beta (IL-1β), interferon-γ (IFN-γ), insulin like growth factor 1 (IGF-1) and phosphoinositide 3-kinase (PI3K) and how fluoride upregulates expression and activity of these biomarkers. I further describe the crucial role of prolactin and megalin in regulation of NIS expression and iodine homeostasis and the effect of fluoride in down regulating prolactin and megalin expression. Among many other issues, I discuss the potential conflict between public health policies such as water fluoridation and its contribution to iodine deficiency, neurodevelopmental and pathological disorders. Further studies are warranted to examine these associations. Full article
(This article belongs to the Special Issue The Harmful Effects of Fluoride Exposure)
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Open AccessArticle
Pro-Inflammatory Responses in Human Bronchial Epithelial Cells Induced by Spores and Hyphal Fragments of Common Damp Indoor Molds
Int. J. Environ. Res. Public Health 2019, 16(6), 1085; https://doi.org/10.3390/ijerph16061085 - 26 Mar 2019
Cited by 3 | Viewed by 1071
Abstract
Damp indoor environments contaminated with different mold species may contribute to the development and exacerbation of respiratory illnesses. Human bronchial epithelial BEAS-2B cells were exposed to X-ray treated spores and hyphal fragments from pure cultures of Aspergillus fumigatus, Penicillum chrysogenum, Aspergillus [...] Read more.
Damp indoor environments contaminated with different mold species may contribute to the development and exacerbation of respiratory illnesses. Human bronchial epithelial BEAS-2B cells were exposed to X-ray treated spores and hyphal fragments from pure cultures of Aspergillus fumigatus, Penicillum chrysogenum, Aspergillus versicolor and Stachybotrys chartarum. Hyphal fragments of A. fumigatus and P. chrysogenum induced expression and release of the pro-inflammatory cytokine interleukin (IL)-6 and the chemokine IL-8, while none of the other hyphal preparations had effects. Hyphal fragments from A. fumigatus and P. chrysogenum also increased the expression of IL-1α, IL-1β and tumor necrosis factor (TNF)-α, but these cytokines were not released. X-ray treated spores had little or no inflammatory potential. Attenuating Toll-like receptor (TLR)-2 by blocking antibodies strongly reduced the A. fumigatus and P. chrysogenum hyphae-induced IL-6 and IL-8 release, whereas TLR4 antagonist treatment was without effects. Untreated A. fumigatus spores formed hyphae and triggered expression of pro-inflammatory genes with similarities to the effects of hyphal fragments. In conclusion, while X-ray treated spores induced no pro-inflammatory responses, hyphal fragments of A. fumigatus and P. chrysogenum enhanced a TLR2-dependent expression and release of IL-6 and IL-8. Full article
(This article belongs to the Section Environmental Health)
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Open AccessArticle
Environmental Burden of Childhood Disease in Europe
Int. J. Environ. Res. Public Health 2019, 16(6), 1084; https://doi.org/10.3390/ijerph16061084 - 26 Mar 2019
Cited by 7 | Viewed by 2815
Abstract
Background: Environmental factors determine children’s health. Quantifying the health impacts related to environmental hazards for children is essential to prioritize interventions to improve health in Europe. Objective: This study aimed to assess the burden of childhood disease due to environmental risks [...] Read more.
Background: Environmental factors determine children’s health. Quantifying the health impacts related to environmental hazards for children is essential to prioritize interventions to improve health in Europe. Objective: This study aimed to assess the burden of childhood disease due to environmental risks across the European Union. Methods: We conducted an environmental burden of childhood disease assessment in the 28 countries of the EU (EU28) for seven environmental risk factors (particulate matter less than 10 micrometer of diameter (PM10) and less than 2.5 micrometer of diameter (PM2.5), ozone, secondhand smoke, dampness, lead, and formaldehyde). The primary outcome was disability-adjusted life years (DALYs), assessed from exposure data provided by the World Health Organization, Global Burden of Disease project, scientific literature, and epidemiological risk estimates. Results: The seven studied environmental risk factors for children in the EU28 were responsible for around 211,000 DALYs annually. Particulate matter (PM10 and PM2.5) was the main environmental risk factor, producing 59% of total DALYs (125,000 DALYs), followed by secondhand smoke with 20% of all DALYs (42,500 DALYs), ozone 11% (24,000 DALYs), dampness 6% (13,000 DALYs), lead 3% (6200 DALYs), and formaldehyde 0.2% (423 DALYs). Conclusions: Environmental exposures included in this study were estimated to produce 211,000 DALYs each year in children in the EU28, representing 2.6% of all DALYs in children. Among the included environmental risk factors, air pollution (particulate matter and ozone) was estimated to produce the highest burden of disease in children in Europe, half of which was due to the effects of PM10 on infant mortality. Effective policies to reduce environmental pollutants across Europe are needed. Full article
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Open AccessArticle
Sleep Disturbance in Adjustment Disorder and Depressive Episode
Int. J. Environ. Res. Public Health 2019, 16(6), 1083; https://doi.org/10.3390/ijerph16061083 - 26 Mar 2019
Viewed by 880
Abstract
Background: In this paper, we aimed to examine the patterns of sleep disturbance in adjustment disorder (AD) and depressive episode (DE), to examine the variables associated with sleep disturbance in AD and DE and associated impairment in functioning. Methods: This is a multi-centre [...] Read more.
Background: In this paper, we aimed to examine the patterns of sleep disturbance in adjustment disorder (AD) and depressive episode (DE), to examine the variables associated with sleep disturbance in AD and DE and associated impairment in functioning. Methods: This is a multi-centre case-control study of 370 patients: 185 patients with AD and 185 patients with a diagnosis of DE, recruited from the liaison psychiatry services of three Dublin hospitals. We examined the participants’ sleep pathology using the sleep disturbance items on the Schedule for Clinical Assessment in Neuropsychiatry, and the Inventory of Depressive Symptoms—Clinician-rated-30. Results: Patients with a diagnosis of AD were less likely to report disturbed sleep than those with a diagnosis of DE (p = 0.002). On multivariate analysis, sleep disturbance was significantly associated with greater severity of certain depressive symptoms: decreased appetite (p < 0.001) and psychomotor agitation (p = 0.009). Decreased appetite, younger age and single marital status were significantly associated with sleep disturbance in male patients, and decreased appetite and psychomotor agitation were significantly associated with sleep disturbance in female participants. Conclusions: This is the largest study to date which has examined sleep disturbance in adjustment disorder. Disturbance of sleep is a significant symptom in AD and may represent a potential target for treatment. With further research, patterns of sleep disturbance may be useful in differentiating AD from DE. Full article
(This article belongs to the Special Issue Adjustment Disorder in Liaison Psychiatry)
Open AccessArticle
Development of A Safety Climate Scale for Geological Prospecting Projects in China
Int. J. Environ. Res. Public Health 2019, 16(6), 1082; https://doi.org/10.3390/ijerph16061082 - 26 Mar 2019
Viewed by 922
Abstract
The geological prospecting industry has developed rapidly in China over the past few years. It has made outstanding contributions to the discovery of new mineral resources, new energy sources, and the excavation and utilization of resources. However, geological prospecting projects do not have [...] Read more.
The geological prospecting industry has developed rapidly in China over the past few years. It has made outstanding contributions to the discovery of new mineral resources, new energy sources, and the excavation and utilization of resources. However, geological prospecting projects do not have effective safety management measures at present. Moreover, the geological prospecting project has its own traits and features that differ from other industries, leading to the fact that safety management measures in other industries cannot be used in geological prospecting projects. Therefore, development of an effective safety management measuring tool is urgent and necessary. In recent years, safety climate has drawn great attention from scholars, and research results have been successfully applied in construction, coal mining and other industries. Based on the extensive literature review on safety climate as well as its organizational structure and employees’ individual behavior characteristics, this paper first extracted the factor structure of the safety climate and then developed a safety climate scale for geological prospecting projects. This paper used the methods of exploratory factor analysis and reliability analysis to ensure the developed safety climate scale was valid and reliable. The safety climate scale developed has four dimensions, i.e., project leader’s safety commitment, safety institutions, risk response, and employee’s safety attitude, containing a total of 17 measurable items. This study contributes to the current literature by exploring the factor structure of the safety climate for geological prospecting projects, and further provides a scientific basis for improvements in the geological prospecting industry. Meanwhile, the findings not only provide technical support for investigating and analyzing the safety management levels of the geological prospecting industry, but also contribute to the benchmarking standards among different enterprises and projects. Full article
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Open AccessArticle
Fine Particulate Matter and Respiratory Healthcare Encounters among Survivors of Childhood Cancers
Int. J. Environ. Res. Public Health 2019, 16(6), 1081; https://doi.org/10.3390/ijerph16061081 - 26 Mar 2019
Cited by 4 | Viewed by 1505
Abstract
Some chemotherapies that treat childhood cancers have pulmonary-toxic properties that increase risk for adverse respiratory-health outcomes. PM2.5 causes similar outcomes but its effect among pulmonary compromised cancer survivors is unknown. This case-crossover study identified the PM2.5-associated odds for primary-respiratory hospitalizations [...] Read more.
Some chemotherapies that treat childhood cancers have pulmonary-toxic properties that increase risk for adverse respiratory-health outcomes. PM2.5 causes similar outcomes but its effect among pulmonary compromised cancer survivors is unknown. This case-crossover study identified the PM2.5-associated odds for primary-respiratory hospitalizations and emergency department visits among childhood cancer survivors in Utah. We compared risk among chemotherapy-treated survivors to a cancer-free sample. We calculated 3-day-average PM2.5 by ZIP code and county for event and control days. Conditional logistic regression estimated odds ratios. Models were stratified by cause of admission (infection, respiratory disease, asthma), previous chemotherapy, National Ambient Air Quality Standard (NAAQS), and other variables. Results are presented per 10 µg/m3 of PM2.5. 90% of events occurred at 3-day PM2.5 averages <35.4 µg/m3, the NAAQS 24-h standard. For survivors, PM2.5 was associated with respiratory hospitalizations (OR = 1.84, 95% CI = 1.13–3.00) and hospitalizations from respiratory infection (OR = 2.09, 95% CI = 1.06–4.14). Among chemotherapy-treated survivors, the PM2.5-associated odds of respiratory hospitalization (OR = 2.03, 95% CI = 1.14–3.61) were significantly higher than the cancer-free sample (OR = 0.84, 95% CI = 0.57–1.25). This is the first study to report significant associations between PM2.5 and respiratory healthcare encounters in childhood cancer survivors. Chemotherapy-treated survivors displayed the highest odds of hospitalization due to PM2.5 exposure and their risk is significantly higher than a cancer-free sample. Full article
(This article belongs to the Section Children's Health)
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Open AccessArticle
Lack of Knowledge about Sexually Transmitted Diseases (STDs): Implications for STDs Prevention and Care among Dermatology Patients in an Urban City in Vietnam
Int. J. Environ. Res. Public Health 2019, 16(6), 1080; https://doi.org/10.3390/ijerph16061080 - 26 Mar 2019
Cited by 5 | Viewed by 1423
Abstract
Sexually transmitted diseases (STDs) are a substantial global burden of diseases, especially in developing countries. Lack of awareness of STDs may lead to a delay in treatment. This study aimed to assess knowledge about STDs and the associated factors among dermatological patients. A [...] Read more.
Sexually transmitted diseases (STDs) are a substantial global burden of diseases, especially in developing countries. Lack of awareness of STDs may lead to a delay in treatment. This study aimed to assess knowledge about STDs and the associated factors among dermatological patients. A cross-sectional study was conducted among 622 patients at Vietnam National Hospital of Dermatology and Venereology (NHD). Structured questionnaires were used to investigate the knowledge about STDs. A multivariate Tobit regression was employed to determine factors associated with knowledge about STDs. The percentage of patients knowing that syphilis was an STD was highest (57.8%), followed by herpes warts (57.7%) and HIV/AIDS (57.4%). By contrast, 26.6% and 17.2% of patients knew that chlamydia and hepatitis C were STDs. The most commonly stated symptom of STDs was purulent genital (53.5%). Nearly two-thirds of participants were aware of the curability of STDs, and 34.7% knew about vaccines for STDs. Living with partners, young age, and acquired knowledge of STDs via the Internet, social networks, and health staff were positively related to having better knowledge about STDs. Based on the results of this study, peer education, informal conversations within clusters, mass community campaigns through the Internet and social networks, and the use of online health care providers should be promoted in order to improve awareness of STDs. Full article
Open AccessArticle
Evaluation of Implementing a Home-Based Fall Prevention Program among Community-Dwelling Older Adults
Int. J. Environ. Res. Public Health 2019, 16(6), 1079; https://doi.org/10.3390/ijerph16061079 - 26 Mar 2019
Cited by 3 | Viewed by 1541
Abstract
We aimed to describe and evaluate the implementation of a home-based exercise program among community-dwelling adults aged ≥65 years. In an observational study, the twelve-week program was implemented in a community setting. The implementation plan consisted of dialogues with healthcare professionals and older [...] Read more.
We aimed to describe and evaluate the implementation of a home-based exercise program among community-dwelling adults aged ≥65 years. In an observational study, the twelve-week program was implemented in a community setting. The implementation plan consisted of dialogues with healthcare professionals and older adults, development of an implementation protocol, recruitment of participants, program implementation, and implementation evaluation. The dialogues consisted of a Delphi survey among healthcare professionals, and of individual and group meetings among older adults. The implementation of the program was evaluated using the framework model RE-AIM. In the dialogues with healthcare professionals and older adults, it was found that negative consequences of a fall and positive effects of preventing a fall should be emphasized to older adults, in order to get them engaged in fall prevention activities. A total of 450 older adults enrolled in the study, of which 238 started the program. The process evaluation showed that the majority of older adults were recruited by a community nurse. Also, a good collaboration between the research team and the local primary healthcare providers was accomplished, which was important in the recruitment. Future fall prevention studies may use this information in order to translate an intervention in a research project into a community-based program. Full article
(This article belongs to the collection Falls in Older Adults: Risk and Prevention)
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Open AccessArticle
Association of Consecutive Influenza Vaccinations and Pneumonia: A Population-Based Case-Control Study
Int. J. Environ. Res. Public Health 2019, 16(6), 1078; https://doi.org/10.3390/ijerph16061078 - 26 Mar 2019
Viewed by 1301
Abstract
The purpose of this study was to investigate whether individuals receiving influenza vaccines have a lower risk of pneumonia. A nationwide population-based case-control study was conducted using data from the National Health Insurance Research Database in Taiwan. We enrolled 7565 patients each in [...] Read more.
The purpose of this study was to investigate whether individuals receiving influenza vaccines have a lower risk of pneumonia. A nationwide population-based case-control study was conducted using data from the National Health Insurance Research Database in Taiwan. We enrolled 7565 patients each in pneumonia and non-pneumonia groups after diagnosis of patients with chronic pulmonary disease, and these patients were individually age and sex matched in a 1:1 ratio. Using conditional logistic regression analysis, adjusted odds ratios (aORs) were estimated in patients who received influenza vaccination and those who had not previously had pneumonia. Moreover, we also analyzed the interval between vaccination and the onset of pneumonia and the number of vaccinations received by patients. This was compared with patients who never received influenza vaccination. Patients who had received influenza vaccination and had been vaccinated for two consecutive years (aOR = 0.85, confidence interval (CI) = 0.79–0.93 and aOR = 0.75, CI = 0.67–0.85, respectively) showed lower rates of pneumonia occurrence by 15–25%. In conclusion, influenza vaccination significantly reduces the occurrence of pneumonia, especially in individuals who receive vaccination in consecutive years. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
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Open AccessArticle
Bibliometric Analysis of Algal-Bacterial Symbiosis in Wastewater Treatment
Int. J. Environ. Res. Public Health 2019, 16(6), 1077; https://doi.org/10.3390/ijerph16061077 - 26 Mar 2019
Cited by 4 | Viewed by 1262
Abstract
In recent years, the algae-bacteria symbiotic system has played a significant role in the sustainable development of wastewater treatment. With the continuous expansion of research outputs, publications related to wastewater treatment via algal-bacterial consortia appear to be on the rise. Based on SCI-EXPANDED [...] Read more.
In recent years, the algae-bacteria symbiotic system has played a significant role in the sustainable development of wastewater treatment. With the continuous expansion of research outputs, publications related to wastewater treatment via algal-bacterial consortia appear to be on the rise. Based on SCI-EXPANDED database, this study investigated the research activities and tendencies of algae-bacteria symbiotic wastewater treatment technology by bibliometric method from 1998 to 2017. The results indicated that environmental sciences and ecology was the most productive subject categories, followed by engineering. Bioresource Technology was the most prominent journal in this field with considerable academic influence. China (146), USA (139) and Spain (76) had the largest amount of publications. Among them, USA was in a leading position in international cooperation, with the highest h-index (67) in 79 countries/territories. The cooperation between China and USA was the closest. The cooperative publishing rate of the Chinese Academy of Sciences was 83.33%, but most of them were in cooperation with domestic institutions, while international cooperation was relatively limited. Methane production, biofuel production, and extracellular polymeric substance were future focal frontiers of research, and this field had gradually become a multi-perspective and inter-disciplinary approach combining biological, environmental and energy technologies. Full article
(This article belongs to the Special Issue Environmental and Occupational Exposure to Microbial Contaminants)
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Open AccessArticle
Continuous Rural-Urban Coding for Cancer Disparity Studies: Is It Appropriate for Statistical Analysis?
Int. J. Environ. Res. Public Health 2019, 16(6), 1076; https://doi.org/10.3390/ijerph16061076 - 26 Mar 2019
Cited by 3 | Viewed by 1340
Abstract
Background: The dichotomization or categorization of rural-urban codes, as nominal variables, is a prevailing paradigm in cancer disparity studies. The paradigm represents continuous rural-urban transition as discrete groups, which results in a loss of ordering information and landscape continuum, and thus may [...] Read more.
Background: The dichotomization or categorization of rural-urban codes, as nominal variables, is a prevailing paradigm in cancer disparity studies. The paradigm represents continuous rural-urban transition as discrete groups, which results in a loss of ordering information and landscape continuum, and thus may contribute to mixed findings in the literature. Few studies have examined the validity of using rural-urban codes as continuous variables in the same analysis. Methods: We geocoded cancer cases in north central Florida between 2005 and 2010 collected by Florida Cancer Data System. Using a linear hierarchical model, we regressed the occurrence of late stage cancer (including breast, colorectal, hematological, lung, and prostate cancer) on the rural-urban codes as continuous variables. To validate, the results were compared to those from using a truly continuous rurality data of the same study region. Results: In term of associations with late-stage cancer risk, the regression analysis showed that the use of rural-urban codes as continuous variables produces consistent outcomes with those from the truly continuous rurality for all types of cancer. Particularly, the rural-urban codes at the census tract level yield the closest estimation and are recommended to use when the continuous rurality data is not available. Conclusions: Methodologically, it is valid to treat rural-urban codes directly as continuous variables in cancer studies, in addition to converting them into categories. This proposed continuous-variable method offers researchers more flexibility in their choice of analytic methods and preserves the information in the ordering. It can better inform how cancer risk varies, degree by degree, over a finer spectrum of rural-urban landscape. Full article
(This article belongs to the Special Issue Rural Health Disparities)
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Open AccessTechnical Note
Erosion Failure of a Soil Slope by Heavy Rain: Laboratory Investigation and Modified GA Model of Soil Slope Failure
Int. J. Environ. Res. Public Health 2019, 16(6), 1075; https://doi.org/10.3390/ijerph16061075 - 26 Mar 2019
Cited by 3 | Viewed by 1339
Abstract
Rainfall has been identified as one of the main causes for slope failures in areas where high annual rainfall is experienced. The slope angle is important for its stability during rainfall. This paper aimed to determine the impact of the angle of soil [...] Read more.
Rainfall has been identified as one of the main causes for slope failures in areas where high annual rainfall is experienced. The slope angle is important for its stability during rainfall. This paper aimed to determine the impact of the angle of soil slope on the migration of wetting front in rainfall. The results proved that under the same rainfall condition, more runoff was generated with the increase of slope angle, which resulted in more serious erosion of the soil and the ascent of wetting front. A modified Green-Ampt (GA) model of wetting front was also proposed considering the seepage in the saturated zone and the slope angle. These findings will provide insights into the rainfall-induced failure of soil slopes in terms of angle. Full article
(This article belongs to the Special Issue Advances in Hazard, Risk and Disaster Management)
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Open AccessArticle
New Health Care Reform and Impoverishment among Chronic Households in China: A Random-Intercept Approach
Int. J. Environ. Res. Public Health 2019, 16(6), 1074; https://doi.org/10.3390/ijerph16061074 - 26 Mar 2019
Viewed by 1395
Abstract
High out-of-pocket (OOP) payments for chronic disease care often contribute directly to household poverty. Although previous studies have explored the determinants of impoverishment in China, few published studies have compared levels of impoverishment before and after the New Health Care Reform (NHCR) in [...] Read more.
High out-of-pocket (OOP) payments for chronic disease care often contribute directly to household poverty. Although previous studies have explored the determinants of impoverishment in China, few published studies have compared levels of impoverishment before and after the New Health Care Reform (NHCR) in households with members with chronic diseases (hereafter referred to as chronic households). Our study explored this using data from the fourth and fifth National Health Service Surveys conducted in Shaanxi Province. In total, 1938 households in 2008 and 7700 households in 2013 were included in the analysis. Rates of impoverishment were measured using a method proposed by the World Health Organization. Multilevel logistic modeling was used to explore the influence of the NHCR on household impoverishment. Our study found that the influence of NHCR on impoverishment varied by residential location. After the reform, in rural areas, there was a significant decline in impoverishment, although the impoverishment rate remained high. There was little change in urban areas. In addition, impoverishment in the poorest households did not decline after the NHCR. Our findings are important for policy makers in particular for evaluating reform effectiveness, informing directions for health policy improvement, and highlighting achievements in the efforts to alleviate the economic burden of households that have members with chronic diseases. Full article
(This article belongs to the Special Issue Global Public Health and Epidemiology)
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Open AccessArticle
Comparing the Effects of Road, Railway, and Aircraft Noise on Sleep: Exposure–Response Relationships from Pooled Data of Three Laboratory Studies
Int. J. Environ. Res. Public Health 2019, 16(6), 1073; https://doi.org/10.3390/ijerph16061073 - 26 Mar 2019
Cited by 5 | Viewed by 1366
Abstract
Objectives: Air, road, and railway traffic, the three major sources of traffic noise, have been reported to differently impact on annoyance. However, these findings may not be transferable to physiological reactions during sleep which are considered to decrease nighttime recovery and might mediate [...] Read more.
Objectives: Air, road, and railway traffic, the three major sources of traffic noise, have been reported to differently impact on annoyance. However, these findings may not be transferable to physiological reactions during sleep which are considered to decrease nighttime recovery and might mediate long-term negative health effects. Studies on awakenings from sleep indicate that railway noise, while having the least impact on annoyance, may have the most disturbing properties on sleep compared to aircraft noise. This study presents a comparison between the three major traffic modes and their probability to cause awakenings. In combining acoustical and polysomnographical data from three laboratory studies sample size and generalizability of the findings were increased. Methods: Data from three laboratory studies were pooled, conducted at two sites in Germany (German Aerospace Center, Cologne, and Leibniz Research Centre for Working Environment and Human Factors, Dortmund). In total, the impact of 109,836 noise events on polysomnographically assessed awakenings was analyzed in 237 subjects using a random intercept logistic regression model. Results: The best model fit according to the Akaike Information Criterion (AIC) included different acoustical and sleep parameters. After adjusting for these moderators results showed that the probability to wake up from equal maximum A-weighted sound pressure levels (SPL) increased in the order aircraft < road < railway noise, the awakening probability from road and railway noise being not significantly different (p = 0.988). At 70 dB SPL, it was more than 7% less probable to wake up due to aircraft noise than due to railway noise. Conclusions: The three major traffic noise sources differ in their impact on sleep. The order with which their impact increased was inversed compared to the order that was found in annoyance surveys. It is thus important to choose the correct concept for noise legislation, i.e., physiological sleep metrics in addition to noise annoyance for nighttime noise protection. Full article
(This article belongs to the Special Issue Noise and Sleep)
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Open AccessArticle
Does Sleep Mediate the Association between School Pressure, Physical Activity, Screen Time, and Psychological Symptoms in Early Adolescents? A 12-Country Study
Int. J. Environ. Res. Public Health 2019, 16(6), 1072; https://doi.org/10.3390/ijerph16061072 - 25 Mar 2019
Cited by 3 | Viewed by 2041
Abstract
This study examines the mediating role of sleep duration and sleep onset difficulties in the association of school pressure, physical activity, and screen time with psychological symptoms in early adolescents. Data were retrieved from 49,403 children (13.7 ± 1.6 years old, 48.1% boys) [...] Read more.
This study examines the mediating role of sleep duration and sleep onset difficulties in the association of school pressure, physical activity, and screen time with psychological symptoms in early adolescents. Data were retrieved from 49,403 children (13.7 ± 1.6 years old, 48.1% boys) from 12 countries participating in the World Health Organization (WHO) “Health Behaviour in School-aged Children” 2013/2014 study. A validated self-report questionnaire assessed psychological symptoms (feeling low, irritability or bad temper, feeling nervous), school pressure, physical activity (number of days/week 60 min moderate-to-vigorous), screen time, sleep duration on week- and weekend days, and perceived difficulties in getting asleep. Multilevel mediation analyses were conducted. School pressure and screen time were positively associated with psychological symptoms, whereas physical activity was negatively associated. With the exception of sleep duration in the association between physical activity and psychological symptoms, all associations were significantly mediated by sleep duration on week- and weekend days and sleep onset difficulties. Percentages mediated ranged from 0.66% to 34.13%. This study partly explains how school pressure, physical activity, and screen time are related to adolescents’ psychological symptoms. Future interventions improving adolescents’ mental well-being could target schoolwork, physical activity, and screen time, as these behaviours are directly and indirectly (through sleep) related to psychological symptoms. Full article
(This article belongs to the collection Sedentary Behaviour and Health)
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Open AccessArticle
Association between Take-Out Food Consumption and Obesity among Chinese University Students: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2019, 16(6), 1071; https://doi.org/10.3390/ijerph16061071 - 25 Mar 2019
Cited by 3 | Viewed by 1499
Abstract
Background: The frequency of take-out food consumption has increased rapidly among Chinese college students, which has contributed to high obesity prevalence. However, the relationships between take-out food consumption, body mass index (BMI), and other individual factors influencing eating behavior among college students are [...] Read more.
Background: The frequency of take-out food consumption has increased rapidly among Chinese college students, which has contributed to high obesity prevalence. However, the relationships between take-out food consumption, body mass index (BMI), and other individual factors influencing eating behavior among college students are still unclear. This study explored the association of take-out food consumption with gender, BMI, physical activity, preference for high-fat and high-sugar (HFHS) food, major category, and degree level among Chinese college students. Methods: Cross-sectional data were collected from 1220 college students in Beijing, China, regarding information about take-out food consumption, physical activity, and preference for HFHS food using a self-reported questionnaire. The logistic linear regression model was used to analyze the association between take-out food consumption and personal and lifestyle characteristics. Results: Out of 1220 college students, 11.6% of college students were overweight or obese. Among the personal and lifestyle characteristics, high frequency of take-out food consumption was significantly associated with a non-medical major, high preference for HFHS food, degree level, and higher BMI, but not physical activity. Conclusion: Among Chinese college students, consumption of take-out food may be affected by major category, preference for HFHS food, degree level, and BMI. This could provide guidance on restrictions of high take-out food consumption, which contributes to high obesity prevalence and high risk for metabolic diseases. Full article
Open AccessArticle
The Policy Effect of the General Data Protection Regulation (GDPR) on the Digital Public Health Sector in the European Union: An Empirical Investigation
Int. J. Environ. Res. Public Health 2019, 16(6), 1070; https://doi.org/10.3390/ijerph16061070 - 25 Mar 2019
Cited by 2 | Viewed by 1744
Abstract
The rapid development of digital health poses a critical challenge to the personal health data protection of patients. The European Union General Data Protection Regulation (EU GDPR) works in this context; it was passed in April 2016 and came into force in May [...] Read more.
The rapid development of digital health poses a critical challenge to the personal health data protection of patients. The European Union General Data Protection Regulation (EU GDPR) works in this context; it was passed in April 2016 and came into force in May 2018 across the European Union. This study is the first attempt to test the effectiveness of this legal reform for personal health data protection. Using the difference-in-difference (DID) approach, this study empirically examines the policy influence of the GDPR on the financial performance of hospitals across the European Union. Results show that hospitals with the digital health service suffered from financial distress after the GDPR was published in 2016. This reveals that during the transition period (2016–2018), hospitals across the European Union indeed made costly adjustments to meet the requirements of personal health data protection introduced by this new regulation, and thus inevitably suffered a policy shock to their financial performance in the short term. The implementation of GDPR may have achieved preliminary success. Full article
(This article belongs to the Special Issue Global Health Economics)
Open AccessArticle
Statistical Evaluation of Radiofrequency Exposure during Magnetic Resonant Imaging: Application of Whole-Body Individual Human Model and Body Motion in the Coil
Int. J. Environ. Res. Public Health 2019, 16(6), 1069; https://doi.org/10.3390/ijerph16061069 - 25 Mar 2019
Cited by 2 | Viewed by 1003
Abstract
The accurate estimation of patient’s exposure to the radiofrequency (RF) electromagnetic field of magnetic resonance imaging (MRI) significantly depends on a precise individual anatomical model. In the study, we investigated the applicability of an efficient whole-body individual modelling method for the assessment of [...] Read more.
The accurate estimation of patient’s exposure to the radiofrequency (RF) electromagnetic field of magnetic resonance imaging (MRI) significantly depends on a precise individual anatomical model. In the study, we investigated the applicability of an efficient whole-body individual modelling method for the assessment of MRI RF exposure. The individual modelling method included a deformable human model and tissue simplification techniques. Besides its remarkable efficiency, this approach utilized only a low specific absorption rate (SAR) sequence or even no MRI scan to generate the whole-body individual model. Therefore, it substantially reduced the risk of RF exposure. The dosimetric difference of the individual modelling method was evaluated using the manually segmented human models. In addition, stochastic dosimetry using a surrogate model by polynomial chaos presented SAR variability due to body misalignment and tilt in the coil, which were frequently occurred in the practical scan. In conclusion, the dosimetric equivalence of the individual models was validated by both deterministic and stochastic dosimetry. The proposed individual modelling method allowed the physicians to quantify the patient-specific SAR while the statistical results enabled them to comprehensively weigh over the exposure risk and get the benefit of imaging enhancement by using the high-intensity scanners or the high-SAR sequences. Full article
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Open AccessArticle
Impact of Gender and Age on Rapid Eye Movement-Related Obstructive Sleep Apnea: A Clinical Study of 3234 Japanese OSA Patients
Int. J. Environ. Res. Public Health 2019, 16(6), 1068; https://doi.org/10.3390/ijerph16061068 - 25 Mar 2019
Cited by 5 | Viewed by 1008
Abstract
Rapid eye movement (REM)-related obstructive sleep apnea (OSA) is characterized by apnea and hypopnea events due to airway collapse occurring predominantly or exclusively during REM sleep. Previous studies have reported that REM-related OSA occurs more commonly in women and younger individuals. However, external [...] Read more.
Rapid eye movement (REM)-related obstructive sleep apnea (OSA) is characterized by apnea and hypopnea events due to airway collapse occurring predominantly or exclusively during REM sleep. Previous studies have reported that REM-related OSA occurs more commonly in women and younger individuals. However, external validity of this tendency has not been confirmed in a large clinical sample. The objective of this study was to evaluate the effect of gender and age on REM-related OSA after adjustment for several covariates based on their established clinical relationships to gender difference in OSA. A total of 3234 Japanese patients with OSA were enrolled in this study. We confirmed that female sex is an important risk factor for REM-related OSA, as reported by previous studies. Moreover, we showed that women aged over 50 years were at a greater risk than those aged under 50 years. These results suggest that hormonal changes in women might play an important role in REM-related OSA and might reflect its unknown pathophysiological characteristics. Full article
(This article belongs to the Special Issue Sleep Apnea Syndrome)
Open AccessArticle
Cleaning Staff’s Attitudes about Hand Hygiene in a Metropolitan Hospital in Australia: A Qualitative Study
Int. J. Environ. Res. Public Health 2019, 16(6), 1067; https://doi.org/10.3390/ijerph16061067 - 25 Mar 2019
Cited by 2 | Viewed by 1834
Abstract
Background: In 2009, the National Hand Hygiene Initiative (NHHI) was implemented in hospitals across Australia with the aim of improving hand hygiene practices and reducing healthcare-associated infections. Audits conducted post-implementation showed the lowest rates of compliance with hand hygiene practices are among operational [...] Read more.
Background: In 2009, the National Hand Hygiene Initiative (NHHI) was implemented in hospitals across Australia with the aim of improving hand hygiene practices and reducing healthcare-associated infections. Audits conducted post-implementation showed the lowest rates of compliance with hand hygiene practices are among operational staff including hospital cleaners. There is limited information about hand hygiene issues in hospital cleaners to inform development of evidence-based interventions to improve hand hygiene compliance in this group. Aim: This qualitative study was undertaken to explore the attitudes of hospital cleaning staff regarding hand hygiene and the National Hand Hygiene Initiative. Methodology: Focus groups were conducted with 12 cleaning staff at a large Australian hospital implementing the National Hand Hygiene Initiative. Findings: Hospital cleaners recognise the importance of hand hygiene in preventing healthcare-associated infections. Cleaners cite peer support, leadership, and the recognition and reward of those excelling in hand hygiene as strong motivators. Barriers to optimal hand hygiene practice include the presence of multiple conflicting guidelines, hand hygiene “overload” and a lack of contextualised education programs. This exploratory qualitative study reveals three themes about attitudes of hospital cleaning staff towards hand hygiene. These themes are: (1) “The culture of hand hygiene: It’s drummed into us”; (2) “Reminders and promotion for hand hygiene: We just need a big ‘Please wash your hands’ sign”; and (3) “The personal value of hand hygiene: Like he said, it’s second nature to us”. Conclusion: Hand-hygiene messages and training need to be more consistent and contextualised to achieve improvements in hand hygiene practices in hospital cleaning staff in Australia. Full article
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Open AccessArticle
Seasonal Characteristics of the Chemical Composition of Fine Particles in Residences of Nanjing, China
Int. J. Environ. Res. Public Health 2019, 16(6), 1066; https://doi.org/10.3390/ijerph16061066 - 25 Mar 2019
Cited by 2 | Viewed by 1005
Abstract
Indoor fine particulate matter (PM2.5) and its chemical composition is important for human exposure as people spend most of their time indoors. However, few studies have investigated the multiseasonal characteristics of indoor PM2.5 and its chemical composition in China. In [...] Read more.
Indoor fine particulate matter (PM2.5) and its chemical composition is important for human exposure as people spend most of their time indoors. However, few studies have investigated the multiseasonal characteristics of indoor PM2.5 and its chemical composition in China. In this study, the chemical composition of PM2.5 samples in residences was analyzed over four seasons in Nanjing, China. Indoor water-soluble ions exhibited similar seasonal variations (winter > autumn > summer > spring) to those from outdoors (winter > autumn > spring > summer) except in summer. Whereas, indoor metallic elements exhibited a different seasonal pattern from that of outdoors. The highest concentrations of indoor metallic elements were observed in summer when the outdoor concentrations were low. The different seasonal variations of the chemical composition between indoor and outdoor PM2.5 indicated that people should consider both indoor and outdoor sources to reduce their exposure to air pollutants in different seasons. The carcinogenic risks for metallic elements were within the acceptable levels, while manganese (Mn) was found to have potential noncarcinogenic risk to humans. More attention should be paid to the pollution of Mn in the study area in the future. Moreover, the cumulative effect of noncarcinogenic PM2.5-bound elements should not be ignored. Full article
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Open AccessArticle
Impact of OM-85 Given during Two Consecutive Years to Children with a History of Recurrent Respiratory Tract Infections: A Retrospective Study
Int. J. Environ. Res. Public Health 2019, 16(6), 1065; https://doi.org/10.3390/ijerph16061065 - 25 Mar 2019
Cited by 8 | Viewed by 1355
Abstract
In otherwise healthy infants and young children, respiratory tract infections (RTIs) are extremely common. Clinical data have shown that OM-85 could prevent respiratory recurrences in children. However, further studies are needed to explore the true importance of OM-85 in clinical practice. In addition, [...] Read more.
In otherwise healthy infants and young children, respiratory tract infections (RTIs) are extremely common. Clinical data have shown that OM-85 could prevent respiratory recurrences in children. However, further studies are needed to explore the true importance of OM-85 in clinical practice. In addition, an unsolved problem is the efficacy of OM-85 when it is administered for two consecutive years. Moreover, another open question is the safety of OM-85 when co-administered with the influenza vaccine. In order to solve these unanswered issues, 200 children aged three to six years with a history of recurrent RTIs, defined as at least six documented episodes of acute RTI in a single year, who had received OM-85 (Broncho-Vaxom®; OM Pharma, a Vifor Pharma Group Company, Geneva, Switzerland) for two consecutive years (3.5 mg once a day for 10 days for 3 months of each year) were selected and matched based on age, sex, and period of evaluation with children with recurrent RTIs who did not receive OM-85. In the group of children treated with OM-85, the number of patients who did not experience any new episode of RTI, as well as the number of RTIs, wheezing episodes, medical visits, and prescribed antibiotic courses, were significantly lower than that in the group not treated with OM-85. The results were similar in the first and second year of OM-85 administration. A minority of patients showed mild adverse events, and the safety profile was overall good, including in the 49 children who received the influenza vaccination within one month from the beginning of the first cycle of OM-85. Our data suggest that OM-85 can effectively and safely reduce the risk of new infective episodes in children with recurrent RTIs and that a second yearly course of lysate administration can be useful to maintain protection, particularly when the diagnosis of recurrent RTIs is made in younger children for whom it is likely that definitive maturation of the immune system still requires a long time. Full article
(This article belongs to the Special Issue Global Community Child Health)
Open AccessReview
The State of Public Health Lead Policies: Implications for Urban Health Inequities and Recommendations for Health Equity
Int. J. Environ. Res. Public Health 2019, 16(6), 1064; https://doi.org/10.3390/ijerph16061064 - 24 Mar 2019
Cited by 1 | Viewed by 1404
Abstract
Although lead has been removed from paint and gasoline sold in the U.S., lead exposures persist, with communities of color and residents in urban and low-income areas at greatest risk for exposure. The persistence of and inequities in lead exposures raise questions about [...] Read more.
Although lead has been removed from paint and gasoline sold in the U.S., lead exposures persist, with communities of color and residents in urban and low-income areas at greatest risk for exposure. The persistence of and inequities in lead exposures raise questions about the scope and implementation of policies that address lead as a public health concern. To understand the multi-level nature of lead policies, this paper and case study reviews lead policies at the national level, for the state of California, and for Santa Ana, CA, a dense urban city in Southern California. Through a community-academic partnership process, this analysis examines lead exposure pathways represented, the level of intervention (e.g., prevention, remediation), and whether policies address health inequities. Results indicate that most national and state policies focus on establishing hazardous lead exposure levels in settings and consumer products, disclosing lead hazards, and remediating lead paint. Several policies focus on mitigating exposures rather than primary prevention. The persistence of lead exposures indicates the need to identify sustainable solutions to prevent lead exposures in the first place. We close with recommendations to reduce lead exposures across the life course, consider multiple lead exposure pathways, and reduce and eliminate health inequities related to lead. Full article
(This article belongs to the Special Issue Health Disparities in Urban Areas)
Open AccessArticle
‘It’s Important to Make Changes.’ Insights about Motivators and Enablers of Healthy Lifestyle Modification from Young Aboriginal Men in Western Australia
Int. J. Environ. Res. Public Health 2019, 16(6), 1063; https://doi.org/10.3390/ijerph16061063 - 24 Mar 2019
Cited by 2 | Viewed by 1790
Abstract
Lifestyle modification can improve the health of people with or at risk of non-communicable diseases; however, initiating and maintaining positive health behaviours including healthy eating and physical activity is challenging. Young remote Aboriginal people who had successfully made significant healthy lifestyle changes were [...] Read more.
Lifestyle modification can improve the health of people with or at risk of non-communicable diseases; however, initiating and maintaining positive health behaviours including healthy eating and physical activity is challenging. Young remote Aboriginal people who had successfully made significant healthy lifestyle changes were sought out to explore how they achieved this success. Four Aboriginal men aged 20–35 years were identified and consented to participate. Their perceptions of motivation for change, strategies, and facilitators and barriers were explored through in-depth interviews. Themes developed from the interviews included self-efficacy, self-reliance, and increased knowledge and altered health beliefs underpinning change. Participants with diabetes were highly motivated to avoid diabetes complications and had a strong belief that their actions could achieve this. In a setting with high levels of disadvantage, participants had relatively favourable socioeconomic circumstances with solid social supports. These findings highlight that lifestyle modification programs that foster internal motivation, enhance key health knowledge, and modify health beliefs and risk perception are needed. Increasing diabetes awareness among at-risk young people is important, emphasising the largely preventable and potentially reversible nature of the condition. Broad health improvements and individual changes will be facilitated by equitable socioeconomic circumstances and environments that support health. Full article
(This article belongs to the Special Issue Rural and Remote Health)
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Open AccessArticle
LPG Cars in a Car Park Environment—How to Make It Safe
Int. J. Environ. Res. Public Health 2019, 16(6), 1062; https://doi.org/10.3390/ijerph16061062 - 24 Mar 2019
Viewed by 969
Abstract
Alternative and innovative fuel types are being introduced to power cars. These include liquified petroleum gas (LPG) gas and hydrogen energy sources. However, they also introduce new hazards, requiring revised thinking with respect to safety within car parking environments. One of the most [...] Read more.
Alternative and innovative fuel types are being introduced to power cars. These include liquified petroleum gas (LPG) gas and hydrogen energy sources. However, they also introduce new hazards, requiring revised thinking with respect to safety within car parking environments. One of the most significant dangers is accidental gas release from a car’s system, especially in underground car parks. Jet fan systems are widely used for ventilation of such enclosures, but currently their design is most often based on computational fluid dynamics (CFD) according to computer simulations that may not be relevant for such new fuels. This paper presents the results of full-scale tests which demonstrate the operational factors of jet fan ventilation systems, and assesses the conditions which can occur in a car park when a small volume of LPG is released. On the basis of measurements undertaken, Fire Dynamics Simulator (FDS) software was validated against the air velocity flows and LPG gas dispersion patterns. Finally, the simulations were used to demonstrate the effectiveness of systems in an actual car park, in the case of an accidental LPG car tank release. Full article
(This article belongs to the Section Environmental Science and Engineering)
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Open AccessArticle
Do Healthy City Performance Awards Lead to Health in All Policies? A Case of Taiwan
Int. J. Environ. Res. Public Health 2019, 16(6), 1061; https://doi.org/10.3390/ijerph16061061 - 24 Mar 2019
Cited by 3 | Viewed by 1155
Abstract
The Healthy Cities (HC) Project, which was introduced by the World Health Organization (WHO) in 1986, has been recognized as the best setting approach for health promotion. However, very few studies have addressed how to use HC approaches to establish public policies in [...] Read more.
The Healthy Cities (HC) Project, which was introduced by the World Health Organization (WHO) in 1986, has been recognized as the best setting approach for health promotion. However, very few studies have addressed how to use HC approaches to establish public policies in non-health departments in cities. This paper describes the strategies for the HC Performance Awards used in Taiwan to draw attention from different departments and to sustain intersectoral collaboration for the purpose of establishing Health in All Policies (HiAP). The methods include: (1) setting up the Taiwan Healthy City Alliance; (2) establishing HC Innovation Performance Awards; (3) reviewing the award applications according to seven criteria; and (4) analyzing the topic content of the award applications. We collected 961 HC award applications during 2013–2016 to analyze their content. The results showed that the number of applications increased nearly every year while significantly more non-health departments applied for the awards compared to health departments (73.3% vs. 26.7%). The award rates of non-health departments have also increased twice from 13.9% in 2013 to 25.8% in 2016. By examining the topics of the award winners, we concluded that “HC Innovation Performance Awards” indeed provide a role and opportunity for political involvement, intersectoral collaboration, co-opetition and capacity building that is necessary for establishing health in all policies. Full article
(This article belongs to the Special Issue Healthy Cities)
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Open AccessReview
Waste Mismanagement in Developing Countries: A Review of Global Issues
Int. J. Environ. Res. Public Health 2019, 16(6), 1060; https://doi.org/10.3390/ijerph16061060 - 24 Mar 2019
Cited by 32 | Viewed by 3655
Abstract
Environmental contamination due to solid waste mismanagement is a global issue. Open dumping and open burning are the main implemented waste treatment and final disposal systems, mainly visible in low-income countries. This paper reviews the main impacts due to waste mismanagement in developing [...] Read more.
Environmental contamination due to solid waste mismanagement is a global issue. Open dumping and open burning are the main implemented waste treatment and final disposal systems, mainly visible in low-income countries. This paper reviews the main impacts due to waste mismanagement in developing countries, focusing on environmental contamination and social issues. The activity of the informal sector in developing cities was also reviewed, focusing on the main health risks due to waste scavenging. Results reported that the environmental impacts are pervasive worldwide: marine litter, air, soil and water contamination, and the direct interaction of waste pickers with hazardous waste are the most important issues. Many reviews were published in the scientific literature about specific waste streams, in order to quantify its effect on the environment. This narrative literature review assessed global issues due to different waste fractions showing how several sources of pollution are affecting the environment, population health, and sustainable development. The results and case studies presented can be of reference for scholars and stakeholders for quantifying the comprehensive impacts and for planning integrated solid waste collection and treatment systems, for improving sustainability at a global level. Full article
(This article belongs to the Special Issue Hazardous Waste and Human Health)
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Open AccessComment
No Established Link between Repeated Transient Chokes and Chronic Traumatic Encephalopathy Related Effects. Comment on Lim, L.J.H. et al. Dangers of Mixed Martial Arts in the Development of Chronic Traumatic Encephalopathy. Int. J. Environ. Res. Public Health 2019, 16, 254
Int. J. Environ. Res. Public Health 2019, 16(6), 1059; https://doi.org/10.3390/ijerph16061059 - 23 Mar 2019
Cited by 3 | Viewed by 993
Abstract
This letter to the editor is in response to “Dangers of Mixed Martial Arts in the Development of Chronic Traumatic Encephalopathy” by authors Lim, Ho, and Ho, which was published in the International Journal of Environmental Research and Public Health (2019; 16: 254). [...] Read more.
This letter to the editor is in response to “Dangers of Mixed Martial Arts in the Development of Chronic Traumatic Encephalopathy” by authors Lim, Ho, and Ho, which was published in the International Journal of Environmental Research and Public Health (2019; 16: 254). This communication clarifies some potentially misleading word choices by the authors and addresses the insinuated, but not established, link between repeated transient choking episodes during martial arts training and a gradual decline in neuropsychiatric testing in the patient presented in the report. Full article
Open AccessArticle
The Spatial and Heterogeneity Impacts of Population Urbanization on Fine Particulate (PM2.5) in the Yangtze River Economic Belt, China
Int. J. Environ. Res. Public Health 2019, 16(6), 1058; https://doi.org/10.3390/ijerph16061058 - 23 Mar 2019
Cited by 2 | Viewed by 1096
Abstract
This paper addresses the effect of population urbanization on Fine Particulate (PM2.5) in the Yangtze River Economic Belt in China from 2006 to 2016 by employing PM2.5 remote sensing data and using the Stochastic Impacts by Regression on Population, Affluence and [...] Read more.
This paper addresses the effect of population urbanization on Fine Particulate (PM2.5) in the Yangtze River Economic Belt in China from 2006 to 2016 by employing PM2.5 remote sensing data and using the Stochastic Impacts by Regression on Population, Affluence and Technology (STIRPAT) model. The study contributes to the growing empirical literature by addressing heterogeneity, spillover, and dynamic effects in the dynamic spatial panel modeling process simultaneously. The empirical results show that population urbanization has a significant impact on PM2.5 with a positive spillover effect and a dynamic effect being detected and controlled. The heterogeneity effects of population urbanization on PM2.5 due to geographical positions show evidence of an obvious inverted U-shaped curve relationship in the upstream area and an increasing function curve in the midstream and downstream areas. The heterogeneity effects due to population urbanization levels show that an inverted N-shape curve relationship exists in low and medium urbanization level areas, while a U-shape curve relationship exists in high urbanization level areas. It is hoped that this study will inform the local governments about the heterogeneity of population urbanization and spillover effects of air pollution when addressing air pollution control. Full article
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