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Background: In the UK, few employers offer general health checks for employees, and opt-in HIV testing is rarely included. There is a need to provide evidence-based guidance and support for employers around health checks and HIV testing in the workplace. An Agile approach was used to develop and evaluate a digital toolkit to facilitate employers’ understanding about workplace health screening. Methods: The [email protected] toolkit development included an online survey (STAGE 1: n = 201), stakeholder consultation (STAGE 2: n = 19), expert peer review (STAGE 3: n = 24), and pilot testing (STAGE 4: n = 20). The toolkit includes employer guidance on workplace health promotion, workplace health screening, and confidential opt-in HIV testing with signposting to resources. Pilot testing included assessment of fidelity (delivery and engagement) and implementation qualities (attitudes, resources, practicality, acceptability, usability and cost). Results: STAGE 1: The vast majority of respondents would consider offering general health checks in the workplace that included confidential opt-in HIV testing, and this view was broadly comparable across organisation types (n = 201; public: 87.8%; private: 89.7%; third: 87.1%). STAGES 2 and 3: Stakeholders highlighted essential content considerations: (1) inclusion of the business case for workplace health initiatives, (2) clear pathways to employer responsibilities, and (3) presenting HIV-related information alongside other areas of health. With regards presentation, stakeholders proposed that the toolkit should be concise, with clear signposting and be hosted on a trusted portal. STAGE 4: Employers were satisfied with the toolkit content, usability and utility. The toolkit had high fidelity with regards to delivery and employer engagement. Assessment of implementation qualities showed high usability and practicality, with low perceived burden for completion and acceptable cost implications. Very few resource challenges were reported, and the toolkit was considered to be appropriate for any type of organisation, irrespective of size or resources. Conclusions: Employers perceived the [email protected] toolkit to be useful, meaningful and appropriate for their needs. This digital resource could be used to support employers to engage with health screening and opt-in HIV testing within the context of workplace health promotion. Full article

Ethiopia’s performance toward the UNAIDS 90-90-90 targets is low. The present study explored interventions to improve delayed HIV care presentation (first 90), poor retention (second 90) and clinical and immunological failure (third 90). We employed a qualitative approach using in-depth interviews with 10 HIV patients, nine health workers, 11 community advocates and five HIV program managers. Ethical approvals were obtained from Australia and Ethiopia. The following were suggested solutions to improve HIV care and treatment to meet the three 90s: (i) strengthening existing programs including collaboration with religious leaders; (ii) implementing new programs such as self-HIV testing, house-to-house HIV testing, community antiretroviral therapy (ART) distribution and teach-test-treat-link strategy; (iii) decentralizing and integrating services such as ART in health post and in private clinics, and integrating HIV care services with mental illness and other non-communicable diseases; and (iv) filling gaps in legislation in issues related with HIV status disclosure and traditional healing practices. In conclusion, the study suggested important solutions for improving delayed HIV care presentation, attrition, and clinical and immunological failure. A program such as the teach-test-treat-link strategy was found to be a cross-cutting intervention to enhance the three 90s. We recommend further nationwide research before implementing the interventions. Full article

Ground and environmental vibrations induced by high dam flood discharge from the Xiangjiaba hydropower station (XHS) has significant adverse effects on nearby building safety and the physical and mental health of surrounding residents. As an effective approach to simulate the flow-induced vibration of hydraulic structures, the hydro-elastic experiment approach has been extensively applied and researched by Chinese scholars, but the relevant systematic research is rarely reported in international journals. Firstly, the hydraulic and structural dynamic similarity conditions that should be satisfied by the hydro-elastic model are briefly reviewed and derived. A hydro-elastic model of the XHS was further constructed using self-developed high-density rubber, and the vibration isolation system (including open trenches and flexible connects) was applied to avoid the external disturbances of pump operation, vehicle vibration and other experiments in the laboratory. Based on the data of model and prototype dynamic tests, a back propagation (BP) neural network was established to map the acceleration of the physical model to the ground in the prototype. In order to reduce the ground vibration, experiments were carried out to meticulously evaluate the ground vibration intensity under more than 600 working conditions, and the optimal operation scheme under different discharge volumes is presented here in detail. According to the prototype test data in 2013, 2014, and 2015, ground vibrations were significantly reduced by applying the presented optimal operation principle which indicates that the presented hydro-elastic approach and the vibration attenuation operation scheme were effective and feasible. Full article

Mechanistic understanding of how activated sludge (AS) solids density influences wastewater treatment processing is limited. Because microbial groups often generate and store intracellular inclusions during certain metabolic processes, it is hypothesized that some microorganisms, like polyphosphate-accumulating organisms (PAOs), would have higher biomass densities. The present study developed a density-based separation approach and applied it to suspended growth AS in two full-scale domestic water resource recovery facilities (WRRFs). Incorporating quantitative real-time PCR (qPCR) and fluorescence in situ hybridization (FISH) analyses, the research demonstrated the effectiveness of density-based separation in enriching key microbial functional groups, including ammonia-oxidizing bacteria (AOB), nitrite-oxidizing bacteria (NOB) and PAOs, by up to 90-fold in target biomass fractions. It was observed that WRRF process functionalities have significant influence on density-based enrichment, such that maximum enrichments were achieved in the sludge fraction denser than 1.036 g/cm³ for the enhanced biological phosphorus removal (EBPR) facility and in the sludge fraction lighter than 1.030 g/cm³ for the non-EBPR facility. Our results provide important information on the relationship between biomass density and enrichment of microbial functional groups in AS, contributing to future designs of enhanced biological treatment processes for improved AS settleability and performance. Full article

Telemedicine is an innovative approach that helps alleviate the health disparity in developing countries and improve health service accessibility, affordability, and quality. Few studies have focused on the social and organizational issues involved in telemedicine, despite in-depth studies of and significant improvements in these technologies. This paper used evolutionary game theory to analyze behavioral strategies and their dynamic evolution in the implementation and operation of telemedicine. Further, numerical simulation was carried out to develop management strategies for promoting telemedicine as a new way of delivering health services. The results showed that: (1) When the benefits are greater than the costs, the higher medical institutions (HMIs), primary medical institutions (PMIs), and patients positively promote telemedicine with benign interactions; (2) when the costs are greater than the benefits, the stability strategy of HMIs, PMIs, and patients is, respectively, ‘no efforts’, ‘no efforts’, and ‘non-acceptance’; and (3) promotion of telemedicine is influenced by the initial probability of the ‘HMI efforts’, ‘PMI efforts’, and ‘patients’ acceptance’ strategy chosen by the three stakeholders, telemedicine costs, and the reimbursement ratio of such costs. Based on theoretical analysis, in order to verify the theoretical model, this paper introduces the case study of a telemedicine system integrated with health resources at provincial, municipal, county, and township level in Guizhou. The findings of the case study were consistent with the theoretical analysis. Therefore, the central Chinese government and local governments should pay attention to the running cost of MIs and provide financial support when the costs are greater than the benefits. At the same time, the government should raise awareness of telemedicine and increase participation by all three stakeholders. Lastly, in order to promote telemedicine effectively, it is recommended that telemedicine services are incorporated within the scope of medical insurance and the optimal reimbursement ratio is used. Full article

With the economic growth, continuous global environment deterioration, and increasingly serious water resources shortage, droughts have become more and more serious and produced great impacts on both the regional ecology and sustainable economic development. This paper has established the “green, blue, yellow, orange, and red lights” as the early warning grades for agricultural droughts. By using the two influencing factors, namely precipitation and soil moisture, this paper has established the drought assessment index evaluation model using weighted coupling method. It has carried out the analogue simulation of the early drought warning based on the Jinghui Channel’s 2013 water source situations. The soil moisture in January and February is relatively ideal, and the actual early drought warning is expressed by the “green light”. The soil moisture deficit is comparatively serious in March, but the situation concerning water inflow is ideal with the “green light”. Actually, the early warning signal is basically consistent with the soil moisture drought degree between April and August. The actual early warning is expressed by the “green light” as well, but the soil moisture is not so ideal, however, this is the seeding time of the winter wheat so the lack of soil moisture has no impact on the crops output. In November and December, the winter wheat is at the growth and development stage and does not need much moisture. At this stage, the soil moisture is relatively poor. By integrating the time effects into the early drought warning system, this paper provides administrators of irrigation areas with a scientific decision-making based on the drought control measures. Full article

Internet addiction and Internet gaming disorders are increasingly prevalent. Whilst there has been much focus on the use of conventional psychological approaches in the treatment of individuals with these addictive disorders, there has also been ongoing research exploring the potential of cognitive bias modification amongst individuals with Internet and gaming addiction. Some studies have documented the presence of cognitive biases and the effectiveness of bias modification for Internet addiction and gaming disorders. However, there have not been any reviews that have synthesized the findings related to cognitive biases for Internet addiction and Internet gaming disorders. It is important for us to undertake a scoping review as an attempt to map out the literature for cognitive biases in Internet addiction and gaming disorders. A scoping review was undertaken, and articles were identified using a search through the following databases: PubMed, MEDLINE, and PsycINFO. Six articles were identified. There were differences in the methods of ascertaining whether an individual has an underlying Internet or gaming addiction, as several different instruments have been used. With regards to the characteristics of the cognitive bias assessment task utilized, the most common task used was that of the Stroop task. Of the six identified studies, five have provided evidence documenting the presence of cognitive biases in these disorders. Only one study has examined cognitive bias modification and provided support for its effectiveness. Whilst several studies have provided preliminary findings documenting the presence of cognitive biases in these disorders, there remains a need for further research evaluating the effectiveness of bias modification, as well as the standardization of the diagnostic tools and the task paradigms used in the assessment. Full article

Comprehensive epidemiological data on prevalence, trends, and determinants of the use of unskilled birth attendants (traditional birth attendants (TBAs) and other unskilled birth attendants) are essential to policy decision-makers and health practitioners, to guide efforts and resource allocation. This study investigated the prevalence, trends, and drivers of the utilization of unskilled birth attendants during democratic governance in Nigeria from 1999 to 2018. The study used the Nigeria Demographic and Health Surveys data for the years 1999 (n = 3552), 2003 (n = 6029), 2008 (n = 28,647), 2013 (n = 31,482), and 2018 (34,193). Multivariate multinomial logistic regression was used to investigate the association between socioeconomic, demographic, health-service, and community-level factors with the utilization of TBAs and other unskilled birth attendants in Nigeria. Between 1999 and 2018, the study showed that the prevalence of TBA-assisted delivery remained unchanged (20.7%; 95% CI: 18.0–23.7% in 1999 and 20.5%; 95% CI: 18.9–22.1% in 2018). The prevalence of other-unskilled-birth-attendant use declined significantly from 45.5% (95% CI: 41.1–49.7%) in 2003 to 36.2% (95% CI: 34.5–38.0%) in 2018. Higher parental education, maternal employment, belonging to rich households, higher maternal age (35–49 years), frequent antenatal care (ANC) (≥4) visits, the proximity of health facilities, and female autonomy in households were associated with lower odds of unskilled birth attendants’ utilization. Rural residence, geopolitical region, lower maternal age (15–24 years), and higher birth interval (≥2 years) were associated with higher odds of unskilled-birth-attendant-assisted deliveries. Reducing births assisted by unskilled birth attendants in Nigeria would require prioritized and scaled-up maternal health efforts that target all women, especially those from low socioeconomic backgrounds, those who do not attend antenatal care, and/or those who reside in rural areas. Full article

This study examines the associations between medication adherence and burden, and health-related quality of life (HRQOL) in predialysis chronic kidney disease (CKD). A prospective study targeting adults with advanced CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m²) and not receiving renal replacement therapy was conducted in Tasmania, Australia. The actual medication burden was assessed using the 65-item Medication Regimen Complexity Index, whereas perceived burden was self-reported using a brief validated questionnaire. Medication adherence was assessed using a four-item Morisky-Green-Levine Scale (MGLS) and the Tool for Adherence Behaviour Screening (TABS). The Kidney Disease and Quality of Life Short-Form was used to assess HRQOL. Of 464 eligible adults, 101 participated in the baseline interview and 63 completed a follow-up interview at around 14 months. Participants were predominantly men (67%), with a mean age of 72 (SD 11) years and eGFR of 21 (SD 6) mL/min/1.73 m². Overall, 43% and 60% of participants reported medication nonadherence based on MGLS and TABS, respectively. Higher perceived medication burden and desire for decision-making were associated with nonadherent behaviour. Poorer HRQOL was associated with higher regimen complexity, whereas nonadherence was associated with a decline in physical HRQOL over time. Medication nonadherence, driven by perceived medication burden, was prevalent in this cohort, and was associated with a decline in physical HRQOL over time. Full article

This study investigated the feasibility of using sodium hexametaphosphate (SHMP)- amended calcium (Ca) bentonite in backfills for slurry trench cutoff walls for the containment of lead (Pb) contamination in groundwater. Backfills composed of 80 wt% sand and 20 wt% either Ca-bentonite or SHMP-amended Ca-bentonite were tested for hydraulic conductivity and sorption properties by conducting laboratory flexible-wall hydraulic conductivity tests and batch isothermal sorption experiments, respectively. The results showed that the SHMP amendment causes a one order of magnitude decrease in hydraulic conductivity of the backfill using tap water (1.9 to 3.0 × 10⁻¹⁰ m/s). Testing using 1000 mg/L Pb solution resulted insignificant variation in hydraulic conductivity of the amended backfill. Moreover, SHMP-amendment induced favorable conditions for increased sorption capacity of the backfill, with 1.5 times higher retardation factor relative to the unamended backfill. The Pb transport modeling through an hypothetical 1-m-thick slurry wall composed of amended backfill revealed 12 to 24 times of longer breakthrough time for Pb migration as compared to results obtained for the same thickness slurry wall with unamended backfill, which is attributed to decrease in seepage velocity combined with increase in retardation factor of the backfill with SHMP amendment. Overall, SHMP is shown to be a promising Ca-bentontie modifier for use in backfill for slurry trench cutoff wall for effective containment of Pb-contaminated groundwater. Full article

Objectives: The aim of this study was to understand the willingness for downward referral among older adults who were hospitalized in the year before the survey and to explore its influencing factors. Methods: The sample was randomly selected by the multi-stage sampling method. A structural questionnaire was used to collect data from participants age 60 and above in Shandong, China, during August 2017. Data were analyzed by using descriptive statistics, one-way ANOVA, chi-square test, and multinomial logistic regression. Results: Of 1198 participants who were hospitalized in the year before the survey, 28.7% self-initiated downward referral, and 33.9% were willing to accept downward referral after a doctor’s advice. Multinomial logistic regression results showed that self-rated health, treatment effect in primary medical institutions, preference for outpatient service, choice of inpatient service, general understanding of essential medicines, the cost of essential medicines after zero-markup policy, and satisfaction with essential medicines’ reimbursement policy significantly correlated with older adults’ willingness for downward referral. Conclusions: The proportion of older adults who self-initiated downward referral was less than one-third. Doctors’ advice plays an important role in willingness for downward referral. More attention should be paid to improving the treatment effect of primary medical institutions, increasing the benefits of zero-markup policy, and ensuring a high reimbursement for the downward referral to work alongside doctors’ advice. Full article

Restless legs syndrome is a relatively common neurologic disorder considerably more prevalent in women than in men. It is characterized by an inactivity-induced, mostly nocturnal, uncomfortable sensation in the legs and an urge to move them to make the disagreeable sensation disappear. Some known genes contribute to this disorder and the same genes contribute to an overlapping condition—periodic leg movements that occur during sleep and result in insomnia. Dopamine and glutamate transmission in the central nervous system are involved in the pathophysiology, and an iron deficiency has been shown in region-specific areas of the brain. A review of the literature shows that pregnant women are at particular risk and that increased parity is a predisposing factor. Paradoxically, menopause increases the prevalence and severity of symptoms. This implies a complex role for reproductive hormones. It suggests that changes rather than absolute levels of estrogen may be responsible for the initiation of symptoms. Both iron (at relatively low levels in women) and estrogen (at relatively high oscillating levels in women) influence dopamine and glutamate transmission, which may help to explain women’s vulnerability to this condition. The syndrome is comorbid with several disorders (such as migraine, depression, and anxiety) to which women are particularly prone. This implies that the comorbid condition or its treatment, or both, contribute to the much higher prevalence in women than in men of restless legs syndrome. Full article

Background and objectives: Presenteeism is a relatively new phenomenon that people, despite complaints and ill health that should prompt them to rest and take sick leave, go to work in any case. The highest sickness presence is largely to be found in the care and welfare and educational sectors. The aim of the study is to investigate the relations between different factors and sickness presence among health care professionals. Materials and Methods: A cross-sectional study was conducted at the largest hospital in Slovenia involving 5865 health care professionals employed at the University Medical Centre Ljubljana in the period between 1 January 2010 and 31 December 2010. Logistic regression methods were used to assess the associations between risk factors and their interactions and sickness presence. Results: Besides high odds for sickness presence in multivariate modelling for acute (OR = 359.7; 95%CI = 89.1–1452.8) and chronic disease (OR = 722.5; 95%CI = 178.5–2924.5) the highest odds were calculated for poor self-related health (OR = 3.0; 95%CI = 1.9–4.8), no possibility of replacement (OR = 1.9; 95%CI = 1.5–2.3), sickness absence > two times a year (OR = 1.6; 95%CI = 1.2–2.1), disabled workers (OR = 1.6; 95%CI = 1.0–2.5), and lower salary when on sick leave (OR = 1.5; 95%CI = 120–1.9). Risk factors interactions were not found to be associated with sickness presence among health care workers. Conclusions: The pre-requisite for higher sickness presence is workers’ bad health. The results indicate that sickness presence was associated with psycho social risk factors at work and their economic consequences. Continued sickness presence might have negative rather than positive consequences on work and health care professionals’ health in the future. Sickness presence needs to be taken into account for health care organizers. Full article

Commensal Escherichia coli, naturally occurring in the intestinal tract, can be the origin of extraintestinal pathogenic E. coli (ExPEC) strains. ExPEC causes high mortality and significant economic losses in the swine industry in several countries and poses a serious threat to public health worldwide. The aim of this study was to analyze the extended phylogenetic structure and extraintestinal virulence potential in two groups of commensal E. coli isolates from post-weaning piglets and sows. The phylogenetic assignment to eight groups was determined using the revised Clermont phylogenetic typing method in quadruplex PCR. Identification of extraintestinal virulence genes (VGs) and adhesin operon genes was performed using multiplex or simplex PCR. The revised phylogenetic assignment allowed us to distinguish E. coli with significantly higher (groups C and F) or lower (group E) virulence potential in isolates from piglets. The majority of the tested VGs occurred more frequently in isolates from piglets than from sows, with statistically significant differences for seven genes: fimH, papAH, iutA, iroN, ompT, traT, and iss. Complete operons for type I and P fimbriae significantly prevailed among E. coli from piglets. This study provides insight into the extended phylogenetic structure of porcine commensal E. coli and showed that these strains, particularly from piglets, constitute a considerable reservoir of extraintestinal VGs and may increase the potential risk of extraintestinal infections. Full article

Presently, a growing popularity of electronic cigarettes may be observed. Used as a means of obtaining nicotine they allow to substitute traditional cigarettes. The origins of substance use disorders are conditioned by dopaminergic signaling which influences motivational processes being elementary factors conditioning the process of learning and exhibiting goal-directed behaviors. The study concentrated on analysis of three polymorphisms located in the dopamine receptor 2 (DRD2) gene—rs1076560, rs1799732 and rs1079597 using the PCR method, personality traits determined with the Big Five Questionnaire, and anxiety measured with the State Trait Anxiety Inventory. The study was conducted on a group of 394 volunteers, consisting e-cigarette users (n = 144) and controls (n = 250). Compared to the controls the case group subjects achieved significantly higher scores in regard to the STAI state and the trait scale, as well as the NEO-FFI Neuroticism and Openness scale. Likewise, in the case of the STAI state for DRD2 rs1076560 significant differences were found. Furthermore, while comparing the groups (e-cigarette users vs. controls) we noticed interactions for the NEO FFI Neuroticism and DRD2 rs1076560. The same was observed in the case of interactions significance while comparing groups (e-cigarette users vs. controls) for the STAI trait/scale and DRD2 rs1799732. Findings from this study demonstrate that psychological factors and genetic determinants should be analyzed simultaneously and comprehensively while considering groups of addicted patients. Since the use, and rapid increase in popularity, of electronic cigarettes has implications for public health, e-cigarette users should be studied holistically, especially younger groups of addicted and experimenting users. Full article

Alpine ski racing is a sport with a high risk of injuries. In order to contribute to the longitudinal career development of young athletes, prevention measures should be elaborated. Therefore, the aim of the present study was to investigate prospectively the role of biological maturity status, and changes in anthropometric characteristics and physical fitness parameters over one season in elite youth ski racers younger than 15 years. Eighty-nine elite youth ski racers (39 females, 50 males), aged 10–14 years (mean age: 12.1 ± 1.3), were investigated. Anthropometric characteristics and physical fitness parameters were assessed prior and after the winter season; traumatic and overuse injuries were recorded over the 32 weeks. Binary logistic regression analyses (R² = 0.202–0.188) revealed that the biological maturity (Wald = 4.818; p = 0.028), and changes over the season in the jump agility test (Wald = 4.692; p = 0.03), in body height (Wald = 6.229; p = 0.013), and in leg length (Wald = 4.321; p = 0.038) represented significant injury risk factors. Athletes who could improve their jump agility performance more, had smaller changes in the anthropometric characteristics and who were closer to their peak height velocity were at a lower injury risk. In the context of injury prevention, regular neuromuscular training should be incorporated, and phases of rapid growth have to be considered. Full article

The relocation of chemical enterprises along the Yangtze River a necessary means of ecological protection in the Yangtze River Basin. Vulnerability assessment provides a new idea for the study of livelihood ability and compensation standard of employees after relocation. Based on the framework of “Exposure-Sensitivity-Adaptability” proposed by the Intergovernmental Panel on Climate Change (IPCC) and the survey data of 410 employees of relocation enterprises in the Hubei Province of the Yangtze River Basin, this study firstly constructs a livelihood vulnerability evaluation index system and evaluation model, and analyzes whether the employees of relocation enterprises have the ability to cope with the risk impact brought by the Yangtze River Ecological Restoration policy. Then, we use multiple linear regression model to explore the relationship between the group’s exposure, sensitivity, adaptability and livelihood vulnerability. Finally, we design a new compensation standard calculation method for special groups from the perspective of social cost, to alleviate their livelihood vulnerability and provide a theoretical basis and decision support for the government and enterprises to formulate and implement relevant resettlement standards. The results show that: (1) employees of all ages show a certain degree of vulnerability in their livelihood; (2) there are differences in livelihood vulnerability between male and female employees; (3) compared with other positions, the livelihood vulnerability of producers is relatively high, and the vulnerability index is unevenly distributed and internally differentiated; (4) a low family burden ratio, high education, convenient living conditions and complex social network can effectively reduce the vulnerability of employees’ livelihood; (5) the key obstacle factors affecting the sustainable livelihood of families are living convenience, adaptability to relocation, policy understanding, children’s burden ratio, education, and annual income per capita; (6) the alternative opportunity cost method can be used as the basis to determine the compensation standard of the relocated employees, which can better reflect the compensation effect of the opportunity cost in the existing definition of international compensation mechanisms and realize the leap from concept to action. Full article

The expansion of urban areas due to population increase and economic expansion creates demand and depletes natural resources, thereby causing land use changes in the main cities. This study focuses on land cover datasets to characterize impervious surface (urban area) expansion in select cities from 1993 to 2017, using supervised classification maximum likelihood techniques and by quantifying impervious surfaces. The results indicate an increasing trend in the impervious surface area by 35% in Bishkek, 75% in Osh, and 15% in Jalal-Abad. The overall accuracy (OA) for the image classification of two different datasets for the three cities was between 82% and 93%, and the kappa coefficients (KCs) were approximately 77% and 91%. The Landsat images with other supplementary data showed positive urban growth in all of the cities. The GDP, industrial growth, and urban population growth were driving factors of impervious surface sprawl in these cities from 1993 to 2017.Landscape Expansion Index (LEI) results also provided good evidence for the change of impervious surfaces during the study period. The results emphasize the idea of applying future planning and sustainable urban development procedures for sustainable use of natural resources and their management, which will increase life quality in urban areas and environments. Full article

Young judo athletes are bio-banding based on age and body mass and compete in weight classes. The purposes of this study were to investigate the influences of maturation on physical performance in young judokas through controlling the chronological age and body mass, and to examine the mediating role of anthropometric variables. Sixty-seven judokas, aged 11.0–14.7, were measured for 11 anthropometric and seven physical performance variables. Pearson partial correlations were conducted to verify the relationship between the maturational indicator and the dependent variables. Mediation analyses were performed to identify the extent to which anthropometric variables mediate the relationship. The maturation effect remained on the aerobic capacity and handgrip strength (p < 0.05). Fat mass (b = 80.335, 95%CI 11.580–204.270) and fat-free mass (b = 108.256, 95%CI 39.508–207.606) totally mediated the effect on aerobic capacity. Fat mass (b = 0.023, 95%CI 0.004–0.057), fat-free mass (b = 0.029, 95%CI 0.011–0.058), stature (b = 0.031, 95%CI 0.008–0.061), arm span (b = 0.021, 95%CI 0.003–0.044), and inferior members length (b = 0.022, 95%CI 0.005–0.049) totally mediated the effect on handgrip strength. The effect of biological maturation is noticeable even after age and body mass control, being mediated by anthropometric variables related to body composition and size. Full article

Pollutant analysis and pollution source tracing are critical issues in air quality management, in which correlation analysis is important for pollutant relation modeling. A dynamic correlation analysis method was proposed to meet the real-time requirement in atmospheric management. Firstly, the spatio-temporal analysis framework was designed, in which the process of data monitoring, correlation calculation, and result presentation were defined. Secondly, the core correlation calculation method was improved with an adaptive data truncation and grey relational analysis. Thirdly, based on the general framework and correlation calculation, the whole algorithm was proposed for various analysis tasks in time and space, providing the data basis for ranking and decision on pollutant effects. Finally, experiments were conducted with the practical data monitored in an industrial park of Hebei Province, China. The different pollutants in multiple monitoring stations were analyzed crosswise. The dynamic features of the results were obtained to present the variational correlation degrees from the proposed and contrast methods. The results proved that the proposed dynamic correlation analysis could quickly acquire atmospheric pollution information. Moreover, it can help to deduce the influence relation of pollutants in multiple locations. Full article

To identify whether the iron (Fe) mining area in the Jiulongjiang River basin (JRB) has an influence on the mercury in the forest soil, the spatial distribution patterns of mercury’s behavior on different controlling factors were analyzed, and a potential ecological risk assessment was done. A total of 107 soil samples were collected from two forest soil profiles, one profile near the Fe mining area and the other far from it. The soil near the mining area had a moderate potential ecological risk with high Fe content rich in the upper layer of soil (<70 cm), whereas soil collected far from the mining area had a low potential ecological risk. These results indicated that the rise of iron content in the soil near the mining area was beneficial to the enrichment of mercury, probably causing damage to the forest ecosystem. Both soil organic carbon (SOC) and Fe content have strong positive correlations with THg content, controlling the mercury behavior in the upper layer (<70 cm) and a lower layer (>70 cm) of soil, respectively. The high Fe content in the upper layer of soil will compete for the adsorption of mercury by SOC, leading to the poor correlation between SOC and THg. Full article

Children’s ability to adjust to the social rules and expectations in the educational environment is of major concern to researchers and practitioners alike. Accordingly, the main purpose of the present study was to examine predictors of children’s social functioning in kindergarten with a specific focus on (a) maternal factors and (b) children’s social cognition. Using a multi-method (self-reports and direct assessments), multi-informant (child, mother, teacher) design, we collected data from 301 kindergarten children and their mothers tapping the mother’s social cognition (general and child-related) and parenting style, and children’s social cognition (social information processing) and functioning in kindergarten. We found direct associations between the mother and child’s social cognition, between the mother’s authoritarian parenting style and her child’s less competent social cognition and behavior, and between the child’s social cognition and social functioning. Finally, as hypothesized, we found a number of interesting mediated effects. Most notably, we found that the association between the mother’s social cognition (her tendency to attribute hostile intent to unknown others) and the child’s social cognition (his/her tendency to generate less competent responses) is fully mediated by the mother’s higher levels of authoritarian parenting style. The important theoretical and clinical implications of our findings are discussed. Full article

Current energy efficiency indicators (such as energy intensity) do not properly reflect the inherent relationship between “energy-environment-health”. Therefore, this study introduces the indicator of energy intensity of human well-being (EIWB) to depict the efficiency problem between energy consumption and residents’ health. In this paper, panel data of 30 provinces in mainland China from 2005 to 2016 is used to calculate the EIWB of each province and analyze its spatial distribution. Moreover, the effect of influencing factors on EIWB is investigated by using the spatial Durbin model. The results show that: (1) The EIWB presents a spatial agglomeration. The provinces with high EIWB mostly cluster in the northern China. (2) Industrial structure and energy structure have positive effects on EIWB in local area through increasing energy consumption and damaging residents’ health. (3) The effect of urbanization and income on local EIWB is significantly positive because it will promote energy consumption. (4) Industrial structure, health expenditure, foreign direct investment and technological progress have spatial spillover effects due to its significant impact on residents’ health in neighboring areas. Based on conclusions, the corresponding policy recommendations are proposed. Full article

Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan–Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population. Full article

As the prevalence of Lyme disease increases across Canada, it is imperative that the educational needs of at-risk groups be identified. The current study compared the level of knowledge and the knowledge needs about Lyme disease among individuals that spend time outdoors for work and for recreational purposes. Between December 2018 and February 2019, a survey was distributed to outdoor organizations across New Brunswick, Canada. Within the current sample of 137 individuals, 36% spent time outdoors for their occupation and 64% for recreational activities. Results showed no significant difference between these groups with regard to their level of knowledge, perceived efficacy and performance of various methods of prevention, and educational needs. Overall, the entire sample reported a low level of knowledge about Lyme disease. Participants perceived each prevention behavior to be at least somewhat effective, and behaviors perceived to be more effective were more likely to be carried out, but the performance of the behaviors varied. The most frequently performed behaviors included wearing long pants and protective footwear. Participants identified several aspects of Lyme disease about which they would like to have more information. The findings call attention to the specific needs of at-risk groups that must be considered when developing educational interventions. Full article

Vibration rolling (VR) has emerged as a self-myofascial release (SMR) tool to aid exercise performance when warming up. However, the benefits of VR on exercise performance when combined with dynamic muscle contraction are unclear. The purpose of this study was to investigate the immediate effects of the combination of VR with dynamic muscle contraction (DVR), VR, and static stretching (SS) during warm-up on range of motion (ROM), proprioception, muscle strength of the ankle, and agility in young adults. In this crossover design study, 20 recreationally active adults without musculoskeletal disorders completed three test sessions in a randomized order, with 48 h of rest between each session. Participants completed one warm-up intervention and its measurements on the same day; different warm-up interventions and measurements were performed on each of the three days. The measurements included ankle dorsiflexion and plantarflexion ROM, ankle joint proprioception, muscle strength, and agility. After DVR and VR intervention, ankle dorsiflexion ROM (both DVR and VR, p < 0.001), plantarflexion ROM (both DVR and VR, p < 0.001), plantar flexor muscle strength (DVR, p = 0.007; VR, p < 0.001), and agility (DVR, p = 0.016; VR, p = 0.007) significantly improved; after SS intervention, ankle dorsiflexion and plantar flexion ROM (dorsiflexion, p < 0.001; plantar flexion, p = 0.009) significantly improved, but muscle strength and agility were not enhanced. Compared with SS, DVR and VR significantly improved ankle plantar flexor muscle strength (p = 0.008 and p = 0.001, respectively). Furthermore, DVR significantly improved ankle dorsiflexion compared with VR (p < 0.001) and SS (p < 0.001). In conclusion, either DVR, VR, or SS increased ankle ROM, but only DVR and VR increased muscle strength and agility. In addition, DVR produced considerable increases in ankle dorsiflexion. These findings may have implications for warm-up prescription and implementation in both rehabilitative and athletic practice settings. Full article

Background: Adverse safety events in healthcare are of great concern, and despite an increasing focus on the prevention of error and harm mitigation, the epidemiology of safety events remains incomplete. Methods: We performed an analysis of all reported safety events in an academic medical center using a voluntary incident reporting surveillance system for patient safety. Safety events were classified as: serious (reached the patient and resulted in moderate to severe harm or death); precursor (reached the patient and resulted in minimal or no detectable harm); and near miss (did not reach the patient). Results: During a three-year period, there were 31,817 events reported. Most of the safety events were precursor safety events (reached the patient and resulted in minimal harm or no detectable harm), corresponding to 77.3%. Near misses accounted for 10.8%, and unsafe conditions for 11.8%. The number of reported serious safety events was low, accounting for only 0.1% of all safety events. Conclusions: The reports analysis of these events should lead to a better understanding of risks in patient care and ways to mitigate it. Full article

Hispanic women have a higher prevalence of weight associated complications in pregnancy. This ethnic disparity is likely related to behavior patterns, social circumstances, environmental exposures, and access to healthcare, rather than biologic differences. The objective was to determine associations between sociodemographic characteristics, health behaviors, and psychosocial stressors and gestational weight gain (GWG) in low-income Hispanic women. During pregnancy, information on sociodemographic characteristics, health behaviors, and psychosocial stressors were collected. Linear regression estimated mean differences in GWG by selected predictors. Multinomial logistic regression estimated odds of inadequate and excessive GWG by selected predictors. Five-hundred and eight women were included, 38% had inadequate and 28% had excessive GWG; 57% with a normal pre-pregnancy BMI had inadequate GWG. Compared to women with normal BMI, women with overweight or obesity were more likely to have excessive GWG (aRRR = 1.88, 95% CI: 1.04, 3.40 and aRRR = 1.98, 95% CI: 1.08, 3.62, respectively). Mean total GWG was higher among women who were nulliparous (ß = 1.34 kg, 95% CI: 0.38, 2.29) and those who engaged in ≥3 h of screen time daily (ß = 0.98 kg, 95% CI: 0.02, 1.94), and lower among women who were physically active during pregnancy (ß = −1.00 kg, 95% CI: −1.99, −0.03). Eating breakfast daily was associated with lower risk of inadequate GWG (aRRR = 0.47, 95% CI: 0.26, 0.83). Depressive symptoms and poor adherence to dietary recommendations were prevalent, but none of the psychosocial or dietary variables were associated with GWG. In this cohort of primarily immigrant, low-income, Hispanic women, there were high rates of poor adherence to diet and physical activity recommendations, and a majority of women did not meet GWG guidelines. Modifiable health behaviors were associated with GWG, and their promotion should be included in prenatal care. Full article

Although symptom burden and symptom profile severity are independent predictors of post-concussion symptom duration, few studies have examined their effects on prolonged recovery simultaneously. This study examined differences in symptom burden and symptom profile scores between concussed children with prolonged recovery and those with typical recovery. We conducted a retrospective case-control study of concussed children aged 10–18 years. Prolonged recovery was defined as symptom duration beyond 28 days post-injury. Symptom burden was measured as total symptom score (TSS) at injury. Symptom profiles included: (1) vestibular, (2) ocular, (3) cognitive/fatigue, (4) migraine, and (5) anxiety. A total of 4380 unique concussions sustained by 3777 patients were included; 80.3% white, 60.0% male, and 44.0% aged 13–15 years. The prolonged recovery group had a significantly higher TSS and greater number of symptoms than the typical recovery group (p < 0.001 and p < 0.001, respectively). The prolonged recovery group had significantly higher scores on all five symptom profiles, including vestibular (p < 0.001), ocular (p < 0.001), cognitive/fatigue (p < 0.001), migraine (p < 0.001) and anxiety (p < 0.001), than the typical recovery group, even after adjusting for number of symptoms and other covariates. Further studies using prospective cohort designs are needed to better understand the influence of symptom burden and profiles on pediatric concussion recovery. Full article

This study aimed to analyze the modulating effect of competition seriousness and competition level in the testosterone and cortisol responses in professional soccer player. Ninety five (95) soccer players were included in this study (professional, n = 39; semiprofessional, n = 27; amateur, n = 29) before and after training, friendly game and official games. Repeated measures ANOVA showed higher testosterone levels (F_(1,89) = 134, p < 0.0001, η²_p = 0.75) in professional soccer players, when compared with semiprofessional (p < 0.0001) or amateur athletes (p < 0.0001). After winning a competition game an increase in testosterone levels was observed in professionals (t = −3.456, p < 0.001), semiprofessionals (t = −4.400, p < 0.0001), and amateurs (t = −2.835, p < 0.009). In contrast, this momentary hormonal fluctuation was not observed after winning a friendly game or during a regular training day. Additionally, statistical analysis indicated that cortisol levels were lower in professional (t = −3.456, p < 0.001) and semiprofessional athletes (t = −4.400, p < 0.0001) than in amateurs (t = −2.835, p < 0.009). In soccer players a rise in testosterone was only observable when the team was faced with an actual challenge but did not support a different response between categories. Thus, the desire to achieve a goal (and keep the social status) may be one of the key reasons why testosterone levels rise promptly. Conversely, testosterone did not change after friendly games, which suggests these situations are not real goals and the players do not perceive an actual threat (in terms of dominance) more than the preparation for their next competitive game. Full article