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Int. J. Environ. Res. Public Health, Volume 17, Issue 11 (June-1 2020) – 433 articles

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Cover Story (view full-size image) The new dental practice scenery, due to COVID-19, is very complex, and dentists should face up to [...] Read more.
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Open AccessArticle
A WHO Pathfinder Survey of Dental Caries in 6 and 12-Year Old Transylvanian Children and the Possible Correlation with Their Family Background, Oral-Health Behavior, and the Intake of Sweets
Int. J. Environ. Res. Public Health 2020, 17(11), 4180; https://doi.org/10.3390/ijerph17114180 - 11 Jun 2020
Viewed by 478
Abstract
To our knowledge, recent oral health data in Romania is poor, as no comprehensive oral health surveys have been carried out in the last five years. The present cross-sectional oral health survey aimed to assess the dental health status in 6 and 12-year [...] Read more.
To our knowledge, recent oral health data in Romania is poor, as no comprehensive oral health surveys have been carried out in the last five years. The present cross-sectional oral health survey aimed to assess the dental health status in 6 and 12-year old children from Transylvania, in correlation with their family background, oral-health behavior, and the intake of sweets. The study was conducted on 290 children from nine schools in the Transylvanian region of Romania. The study consisted of the clinical examination of children, recording of data in an International Cavity Detection and Assessment System (ICDAS) chart, and a questionnaire referring to the child’s parental education, frequency, and motivation of visits to the dentist, dental care habits, and the intake of sweets. Our results indicated that the most prevalent ICDAS scores recorded in 6-year-old children were “0A” (p = 0.001464), “03” (p = 0.00366), “05” (p = 0.005563), “06” for rural areas. Restorations were statistically more prevalent in the urban population (p = 0.000076). The ICDAS score for 12-year old children was “03” (p = 0.003614) and prevalent in the urban area. The ICDAS score for the rural area was “04” (p = 0.0056). Comparing dental health status with family background demonstrated a strong correlation for the group of 6-year-old children, and a lack of correlation for the 12-year-old children. The number of dental visits corelated with the parents’ backgrounds, and was higher in the urban population. Frequent hygiene habits (toothbrushing) were statistically correlated with lower ICDAS scores: “04” (p = 0.016482), “05” (p = 0.039127), “06” (p = 0.010785). Eating habits in both age groups were associated with statistically significant differences of “03”, “04”, “05”, “06”, “0A” in the ICDAS score. The obtained results provided clarification on the dental health situation in Romania and the potential risk factors of caries among the population, and therefore it could be used as a starter point for future studies to investigate, in depth, the effects of various variables on cavities found in Transylvanian schoolchildren. Full article
(This article belongs to the Special Issue Oral and Dental Health)
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Open AccessArticle
Leveraging Machine Learning Techniques and Engineering of Multi-Nature Features for National Daily Regional Ambulance Demand Prediction
Int. J. Environ. Res. Public Health 2020, 17(11), 4179; https://doi.org/10.3390/ijerph17114179 - 11 Jun 2020
Viewed by 426
Abstract
The accurate prediction of ambulance demand provides great value to emergency service providers and people living within a city. It supports the rational and dynamic allocation of ambulances and hospital staffing, and ensures patients have timely access to such resources. However, this task [...] Read more.
The accurate prediction of ambulance demand provides great value to emergency service providers and people living within a city. It supports the rational and dynamic allocation of ambulances and hospital staffing, and ensures patients have timely access to such resources. However, this task has been challenging due to complex multi-nature dependencies and nonlinear dynamics within ambulance demand, such as spatial characteristics involving the region of the city at which the demand is estimated, short and long-term historical demands, as well as the demographics of a region. Machine learning techniques are thus useful to quantify these characteristics of ambulance demand. However, there is generally a lack of studies that use machine learning tools for a comprehensive modeling of the important demand dependencies to predict ambulance demands. In this paper, an original and novel approach that leverages machine learning tools and extraction of features based on the multi-nature insights of ambulance demands is proposed. We experimentally evaluate the performance of next-day demand prediction across several state-of-the-art machine learning techniques and ambulance demand prediction methods, using real-world ambulatory and demographical datasets obtained from Singapore. We also provide an analysis of this ambulatory dataset and demonstrate the accuracy in modeling dependencies of different natures using various machine learning techniques. Full article
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Open AccessArticle
Longitudinal Study of Metabolic Biomarkers among Conventional and Organic Farmers in Thailand
Int. J. Environ. Res. Public Health 2020, 17(11), 4178; https://doi.org/10.3390/ijerph17114178 - 11 Jun 2020
Viewed by 443
Abstract
The aim of this longitudinal study is to assess how pesticide use may impact metabolic biomarkers by collecting and comparing data from conventional (n = 13) and organic farmers (n = 225) every eight months for four rounds. Farmers were interviewed [...] Read more.
The aim of this longitudinal study is to assess how pesticide use may impact metabolic biomarkers by collecting and comparing data from conventional (n = 13) and organic farmers (n = 225) every eight months for four rounds. Farmers were interviewed about family health history, food consumption behaviors, self-reported health problems, agricultural activities, and history of pesticide use. Systolic and diastolic blood pressure and body mass index (BMI) were measured. Blood samples were collected for total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), blood glucose, and triglycerides. A linear mixed model with random intercepts for subjects was used to compare the metabolic biomarkers between conventional and organic farmers and to examine the impact of the number of pesticide spray days for all four rounds after controlling for covariates. The conventional farmers reported using insecticides, herbicides, and fungicides. The marginal means for chemical farmers were significantly higher than organic farmers for total cholesterol, LDL, HDL, glucose, systolic and diastolic blood pressure, BMI, and waist circumference. Increasing the number of days of spraying either insecticides or fungicides was associated with an increase in HDL, LDL, and cholesterol levels. Increasing the number of herbicide spray days was associated with an increase in systolic and diastolic blood pressure and a decrease in BMI. These findings suggest that pesticide-using conventional farmers may be at higher risk of metabolic disease in the future. Full article
Open AccessArticle
Effect of Wall Texture on Perceptual Spaciousness of Indoor Space
Int. J. Environ. Res. Public Health 2020, 17(11), 4177; https://doi.org/10.3390/ijerph17114177 - 11 Jun 2020
Viewed by 298
Abstract
As the main place of people’s daily activities, indoor space (its size, shape, colors, material and textures, and so on) has important physical, emotional and health-based implications on people’s behavior and quality of life. Material texture is an integral part of architectural environment [...] Read more.
As the main place of people’s daily activities, indoor space (its size, shape, colors, material and textures, and so on) has important physical, emotional and health-based implications on people’s behavior and quality of life. Material texture is an integral part of architectural environment perception and quality evaluation, but the effect of material texture on perceptual spaciousness lacks the support of experimental data. This research examined the effects between different wall textures on the observer’s perception of spaciousness in indoor space, the influence of wall texture changes in different room sizes, and how the associational meaning of texture affects the degree of influence of wall texture on the spaciousness of indoor space. By using VR technology and the magnitude estimation (ME) analysis method, the authors found that the effect of wall texture on perceptual spaciousness varies depending on the wall material, and the textural effect is affected by room size. The perception of spaciousness is influenced by the observer’s associational meaning of material texture, and the influence of associational meaning of material texture varies contingent on the room size. In relatively small rooms, the objective aspect (such as hardness, surface reflectivity, texture direction and texture depth) of the wall texture has a significant impact on perceived space. In contrast, the effects of subjective aspects (such as affinity and ecology) become more pronounced in relatively larger rooms. This research makes up for the lack of material texture research in perceptual spaciousness, and provides a new way for the designer to choose materials for the design of a spatial scale. Full article
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Open AccessReview
Effects of COVID-19 Infection during Pregnancy and Neonatal Prognosis: What Is the Evidence?
Int. J. Environ. Res. Public Health 2020, 17(11), 4176; https://doi.org/10.3390/ijerph17114176 - 11 Jun 2020
Viewed by 808
Abstract
Background: This study’s aims are to assess the current evidence presented in the literature regarding the potential risks of COVID-19 infection among pregnant women and consequent fetal transmission. Methods: a systematic literature review assessing papers published in the most comprehensive databases in the [...] Read more.
Background: This study’s aims are to assess the current evidence presented in the literature regarding the potential risks of COVID-19 infection among pregnant women and consequent fetal transmission. Methods: a systematic literature review assessing papers published in the most comprehensive databases in the field of health intended to answer the question, “What are the effects of COVID-19 infection during pregnancy, and what is the neonatal prognosis?” Results: 49 papers published in 2020 were eligible, presenting low levels of evidence. A total of 755 pregnant women and 598 infants were assessed; more than half of pregnant women had C-sections (379/65%). Only 493 (82%) infants were tested for SARS-CoV-2, nine (2%) of whom tested positive. There is, however, no evidence of vertical transmission based on what has been assessed so far, considering there are knowledge gaps concerning the care provided during and after delivery, as well as a lack of suitable biological samples for testing SARS-CoV-2. Conclusions: We cannot rule out potential worsening of the clinical conditions of pregnant women infected with SARS-CoV-2, whether the infection is associated with comorbidities or not, due to the occurrence of respiratory disorders, cardiac rhythm disturbances, and acid-base imbalance, among others. We recommend relentless monitoring of all pregnant women in addition to testing them before delivery or the first contact with newborns. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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Open AccessArticle
Comparison between Communicated and Calculated Exposure Estimates Obtained through Three Modeling Tools
Int. J. Environ. Res. Public Health 2020, 17(11), 4175; https://doi.org/10.3390/ijerph17114175 - 11 Jun 2020
Viewed by 594
Abstract
This study aims to evaluate the risk assessment approach of the REACH legislation in industrial chemical departments with a focus on the use of three models to calculate exposures, and discuss those factors that can determine a bias between the estimated exposure (and [...] Read more.
This study aims to evaluate the risk assessment approach of the REACH legislation in industrial chemical departments with a focus on the use of three models to calculate exposures, and discuss those factors that can determine a bias between the estimated exposure (and therefore the expected risk) in the extended safety data sheets (e-SDS) and the expected exposure for the actual scenario. To purse this goal, the exposure estimates and risk characterization ratios (RCRs) of registered exposure scenarios (ES; “communicated exposure” and “communicated RCR”) were compared with the exposure estimates and the corresponding RCRs calculated for the actual, observed ES, using recommended tools for the evaluation of exposure assessment and in particular the following tools: (i) the European Centre for Ecotoxicology and Toxicology of Chemicals Targeted Risk Assessment v.3.1 (ECETOC TRA), (ii) STOFFENMANAGER® v.8.0 and (iii) the Advanced REACH Tool (ART). We evaluated 49 scenarios in three companies handling chemicals. Risk characterization ratios (RCRs) were calculated by dividing estimated exposures by derived no-effect levels (DNELs). Although the calculated exposure and RCRs generally were lower than communicated, the correlation between communicated and calculated exposures and RCRs was generally poor, indicating that the generic registered scenarios do not reflect actual working, exposure and risk conditions. Further, some observed scenarios resulted in calculated exposure values and RCR higher than those communicated through chemicals’ e-SDSs; thus ‘false safe’ scenarios (calculated RCRs > 1) were also observed. Overall, the obtained evidences contribute to doubt about whether the risk assessment should be performed using generic (communicated by suppliers) ES with insufficient detail of the specific scenario at all companies. Contrariwise, evidences suggested that it would be safer for downstream users to perform scenario-specific evaluations, by means of proper scaling approach, to achieve more representative estimates of chemical risk. Full article
(This article belongs to the Special Issue Modeling Tools for Occupational Exposure Assessment)
Open AccessArticle
Does Emotion Regulation Predict Gains in Exercise-Induced Fitness? A Prospective Mixed-Effects Study with Elite Helicopter Pilots
Int. J. Environ. Res. Public Health 2020, 17(11), 4174; https://doi.org/10.3390/ijerph17114174 - 11 Jun 2020
Viewed by 510
Abstract
Emotion regulation (ER) is a strong predictor of different aspects of mental health and wellbeing. However, only recently has ER been examined in relation to physical activity and its effects on fitness. In the present study, 26 elite helicopter pilots, serving in the [...] Read more.
Emotion regulation (ER) is a strong predictor of different aspects of mental health and wellbeing. However, only recently has ER been examined in relation to physical activity and its effects on fitness. In the present study, 26 elite helicopter pilots, serving in the Spanish Air Force, were physically trained for 6 months, and their level of fitness (maximum oxygen consumption and time to exhaustion in a treadmill-running test) was assessed before and after that period. Additionally, two indices of emotion regulation (general adaptiveness of ER strategies, as measured by the Emotion Regulation Questionnaire (ERQ), and negative urgency, as measured by the UPPS-P questionnaire) measured at baseline were used as prospective predictors of fitness improvement. After controlling for individual features, baseline fitness, and type of training, better emotion regulation strategies (more cognitive reappraisal plus less expressive suppression) predicted larger fitness gains (p = 0.028). Incidental emotion regulation, as measured by the negative urgency index, failed to predict pre–post-fitness changes (p = 0.734). These results suggest that fostering emotion regulation skills may improve the effectiveness of fitness training programs. Full article
Open AccessArticle
Consolidation of Aedes albopictus Surveillance Program in the Autonomous Community of the Region of Murcia, Spain
Int. J. Environ. Res. Public Health 2020, 17(11), 4173; https://doi.org/10.3390/ijerph17114173 - 11 Jun 2020
Viewed by 377
Abstract
Background: Due to the Spanish legal framework, the national program for vector-borne diseases results from the agreement between national and regional governments, and it is the basis for the development of the regional programs, which should include the regional entomological surveillance program. Aedes [...] Read more.
Background: Due to the Spanish legal framework, the national program for vector-borne diseases results from the agreement between national and regional governments, and it is the basis for the development of the regional programs, which should include the regional entomological surveillance program. Aedes albopictus was recorded for the first time in the Region of Murcia, in 2011. It gave rise to a new epidemiological scenario due to the presence of a competent vector of several arboviruses, which resulted in autochthonous cases of dengue in 2018. Methods: 40 out of 45 municipalities participated in the regional entomological surveillance program, and 266 sampling points were established, with two ovitraps at each site as pseudo-replications. The study period was from April 16th to November 26th, with bi-weekly sample collections: 16 regional samplings were carried out. Results: Regional participation was high, and data loss was low (1.26%). Ae. albopictus was detected in 4.9% of samples and 89.4% of points, located in 39 of the 40 municipalities. The intensity of the presence of Ae. albopictus was estimated by a positivity index, that is, the percentage of positive samples over time. The vector phenology was obtained at a regional level, using the number of eggs as estimation of population density and the positivity values of points and municipalities. Every two weeks, real-time results were provided to the municipalities, which could use them as a vector management tool. Conclusion: The regional entomological surveillance program for Ae. albopictus in the Region of Murcia was consolidated in 2019, with standardized and comparable methods. Almost all the municipalities of the region have observed the presence of Ae. albopictus, although intensity and spatial and temporal cover vary among them. Full article
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Open AccessArticle
The Advertising Policies of Major Social Media Platforms Overlook the Imperative to Restrict the Exposure of Children and Adolescents to the Promotion of Unhealthy Foods and Beverages
Int. J. Environ. Res. Public Health 2020, 17(11), 4172; https://doi.org/10.3390/ijerph17114172 - 11 Jun 2020
Viewed by 1143
Abstract
There have been global calls to action to protect children (aged <18) from exposure to the marketing of unhealthy foods and beverages (‘unhealthy foods’). In this context, the rising popularity of social media, particularly amongst adolescents, represents an important focus area. This study [...] Read more.
There have been global calls to action to protect children (aged <18) from exposure to the marketing of unhealthy foods and beverages (‘unhealthy foods’). In this context, the rising popularity of social media, particularly amongst adolescents, represents an important focus area. This study aimed to examine the advertising policies of major global social media platforms related to the advertising of unhealthy foods, and to identify opportunities for social media platforms to take action. We conducted a desk-based review of the advertising policies of the 16 largest social media platforms globally. We examined their publicly available advertising policies related to food and obesity, as well as in relation to other areas impacting public health. The advertising policies for 12 of the selected social media platforms were located. None of these platforms adopted comprehensive restrictions on the advertising of unhealthy foods, with only two platforms having relevant (but very limited) policies in the area. In comparison, 11 of the 12 social media platforms had policies restricting the advertising of alcohol, tobacco, gambling, and/or weight loss. There is, therefore, an opportunity for major social media platforms to voluntarily restrict the exposure of children to the marketing of unhealthy foods, which can contribute to efforts to improve populations’ diets. Full article
(This article belongs to the Special Issue Child Nutrition Management)
Open AccessArticle
First Occurrence of Eustrongylides spp. (Nematoda: Dioctophymatidae) in a Subalpine Lake in Northwest Italy: New Data on Distribution and Host Range
Int. J. Environ. Res. Public Health 2020, 17(11), 4171; https://doi.org/10.3390/ijerph17114171 - 11 Jun 2020
Viewed by 389
Abstract
The genus Eustrongylides includes nematodes that infect fish species and fish-eating birds inhabiting freshwater ecosystems. Nematodes belonging to the genus Eustrongylides are potentially pathogenic for humans; infection occurs after the consumption of raw or undercooked fish. In the two-year period 2019–2020, a total [...] Read more.
The genus Eustrongylides includes nematodes that infect fish species and fish-eating birds inhabiting freshwater ecosystems. Nematodes belonging to the genus Eustrongylides are potentially pathogenic for humans; infection occurs after the consumption of raw or undercooked fish. In the two-year period 2019–2020, a total of 292 fish belonging to eight species were examined for the occurrence of Eustrongylides spp. from Lake San Michele, a small subalpine lake in northwest Italy. The prevalence of infestation was 18.3% in Lepomis gibbosus, 16.7% in Micropterus salmoides, and 10% in Perca fluviatilis. The other five fish species (Ameiurus melas, Ictalurus punctatus, Squalius cephalus, Carassius carassius, and Scardinius erythrophthalmus) were all negative for parasite presence. There were no significant differences in prevalence between the three fish species (Fisher’s exact test; p = 0.744). The mean intensity of infestation ranged from 1 (M. salmoides and P. fluviatilis) to 1.15 (L. gibbosus), and the mean abundance ranged from 0.1 (P. fluviatilis) to 0.28 (L. gibbosus). There were significant differences in the infestation site between the four muscle quadrants (anterior ventral, anterior dorsal, posterior ventral, and posterior dorsal) and the visceral cavity (Kruskal–Wallis test; p = 0.0008). The study findings advance our knowledge about the distribution and host range of this parasite in Italy. Full article
(This article belongs to the Section Infectious Disease Epidemiology)
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Open AccessArticle
Differences in Body Composition among Patientsafter Hemorrhagic and Ischemic Stroke
Int. J. Environ. Res. Public Health 2020, 17(11), 4170; https://doi.org/10.3390/ijerph17114170 - 11 Jun 2020
Viewed by 340
Abstract
The aim of the study was to assess differences in the body composition of patients after hemorrhagic and ischemic stroke. There were 74 male participants in the study, of which 13 (18%) experienced hemorrhagic stroke, while 61 (82%) were after ischemic stroke. Significantly [...] Read more.
The aim of the study was to assess differences in the body composition of patients after hemorrhagic and ischemic stroke. There were 74 male participants in the study, of which 13 (18%) experienced hemorrhagic stroke, while 61 (82%) were after ischemic stroke. Significantly (p < 0.05) higher values of body composition variables were noted for ischemic compared to hemorrhagic strokes, and concerned: body mass (BM) (kg), basal metabolic rate (BMR) (kJ), fat-free mass (FFM) (kg), total body water (TBW) (kg), muscle mass (MM) (kg), visceral fat level (VFL), bone mass (BoM) (kg), extracellular water(ECW) (kg),intracellular water (ICW) (kg), trunk fat-free mass (TFFM) (kg) and trunk muscle mass (TMM) (kg)in the paretic upper limb; FFM (kg) and MM (kg) in the non-paretic upper limb; FFM (kg) and MM (kg) in the paretic lower limbas well as FFM (kg) and MM (kg) in the non-paretic lower limb without paresis. Only for the variables fat mass (FM) (kg), body mass index (BMI), metabolic age (MA), trunk fat mass (TFM) (kg), and FM (kg) in the paretic upper limb and FM (kg) in the non-paretic upper limb were there no significant differences. Significant differences in body composition of patients after hemorrhagic and ischemic stroke have been demonstrated. Individuals after ischemic stroke had significantly worse body composition. Incorrect body composition is a significant risk factor, especially of ischemic stroke. Full article
(This article belongs to the Special Issue Population Health and Health Services)
Open AccessArticle
Perceived Novelty Support and Psychological Needs Satisfaction in Physical Education
Int. J. Environ. Res. Public Health 2020, 17(11), 4169; https://doi.org/10.3390/ijerph17114169 - 11 Jun 2020
Cited by 1 | Viewed by 523
Abstract
In recent years, novelty has been proposed as a potential fourth basic psychological need. In the present study, the behavior of novelty resulting from support from the Physical Education teacher was evaluated in 723 students with an average age of 13.30 years old. [...] Read more.
In recent years, novelty has been proposed as a potential fourth basic psychological need. In the present study, the behavior of novelty resulting from support from the Physical Education teacher was evaluated in 723 students with an average age of 13.30 years old. The first objective was to validate the Support for Basic Psychological Needs-4 (SBPN-4) in Physical Education questionnaire, which included support for the novelty factor. The second objective was to test the mediation model in order to confirm the effect of support for novelty in relation to basic psychological needs and intrinsic motivation. The results obtained show that the Support for Basic Psychological Needs-4 (SBPN-4) questionnaire is a valid and reliable tool. On the other hand, support for novelty predicts satisfaction of basic psychological needs, particularly novelty satisfaction, which in turn predicts intrinsic motivation. These results show how the students are capable of perceiving the teacher’s support for novelty and how this positively influences their intrinsic motivation. Further investigations are required to continue developing our knowledge of the role of novelty as a basic psychological need. Full article
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Open AccessArticle
Application of Functional Data Analysis to Identify Patterns of Malaria Incidence, to Guide Targeted Control Strategies
Int. J. Environ. Res. Public Health 2020, 17(11), 4168; https://doi.org/10.3390/ijerph17114168 - 11 Jun 2020
Viewed by 909
Abstract
We introduce an approach based on functional data analysis to identify patterns of malaria incidence to guide effective targeting of malaria control in a seasonal transmission area. Using functional data method, a smooth function (functional data or curve) was fitted from the time [...] Read more.
We introduce an approach based on functional data analysis to identify patterns of malaria incidence to guide effective targeting of malaria control in a seasonal transmission area. Using functional data method, a smooth function (functional data or curve) was fitted from the time series of observed malaria incidence for each of 575 villages in west-central Senegal from 2008 to 2012. These 575 smooth functions were classified using hierarchical clustering (Ward’s method), and several different dissimilarity measures. Validity indices were used to determine the number of distinct temporal patterns of malaria incidence. Epidemiological indicators characterizing the resulting malaria incidence patterns were determined from the velocity and acceleration of their incidences over time. We identified three distinct patterns of malaria incidence: high-, intermediate-, and low-incidence patterns in respectively 2% (12/575), 17% (97/575), and 81% (466/575) of villages. Epidemiological indicators characterizing the fluctuations in malaria incidence showed that seasonal outbreaks started later, and ended earlier, in the low-incidence pattern. Functional data analysis can be used to identify patterns of malaria incidence, by considering their temporal dynamics. Epidemiological indicators derived from their velocities and accelerations, may guide to target control measures according to patterns. Full article
(This article belongs to the Special Issue Geo-Epidemiology of Malaria)
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Open AccessArticle
Italian Consensus Statement on Patient Engagement in Chronic Care: Process and Outcomes
Int. J. Environ. Res. Public Health 2020, 17(11), 4167; https://doi.org/10.3390/ijerph17114167 - 11 Jun 2020
Viewed by 398
Abstract
Patient engagement has been recognized as a key priority in chronic care. However, scholars agree that guidelines are needed to ensure effective patient engagement strategies. To this end, a Consensus Conference process was promoted with the following methodological steps: (1) extensive literature review [...] Read more.
Patient engagement has been recognized as a key priority in chronic care. However, scholars agree that guidelines are needed to ensure effective patient engagement strategies. To this end, a Consensus Conference process was promoted with the following methodological steps: (1) extensive literature review about patient engagement initiatives in chronic care; (2) a stakeholders survey to collect best practices and (3) workshops with experts. On the basis of the information collected, a consensus statement was drafted, revised, and finalized by a panel of select renowned experts. These experts agreed in defining engagement as an eco-systemic concept involving multiple actors all of which contribute to influence patients’ willingness and ability to engage in chronic care. Moreover, experts recommended, whenever possible, to adopt standardized instruments to assess engagement levels and related unmet needs. Then, experts strongly advised appropriate trainings for healthcare professionals about patient engagement strategies. Furthermore, the importance of promoting healthcare professionals’ wellbeing has been advocated. Family caregivers, as well as patients’ organizations - should be trained and engaged to increase the effectiveness of interventions dedicated to patients. Finally, experts agreed that digital technologies should be considered as a crucial enhancer for patient engagement in chronic care. Full article
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Open AccessArticle
Psychosocial Well-Being of School-Aged Children Born to Bereaved (Shidu) Families: Associations with Mothers’ Quality of Life and Involvement Behaviors
Int. J. Environ. Res. Public Health 2020, 17(11), 4166; https://doi.org/10.3390/ijerph17114166 - 11 Jun 2020
Viewed by 368
Abstract
Parents who lost their only child in the 12 May 2018 Wenchuan earthquake came to be known as the “shidu” (loss of an only child) parents. After the earthquake, they were beneficiaries of free reproductive health services, and most had another [...] Read more.
Parents who lost their only child in the 12 May 2018 Wenchuan earthquake came to be known as the “shidu” (loss of an only child) parents. After the earthquake, they were beneficiaries of free reproductive health services, and most had another child. This study focuses on the psychosocial well-being of those children born to the shidu parents, and explores factors associated with mothers’ quality of life (QoL) and their involvement with their children. A cross-sectional survey was conducted in two primary schools in Wenchuan County. A sample of 192 families was analyzed (147 non-shidu and 45 shidu). The statistical analyses indicated that the children of shidu families had poorer peer relationships than children of non-shidu families. Moreover, shidu mothers’ expectations of their children’s achievements were significantly lower than for non-shidu mothers, but there was no statistically significant difference in the QoL between them. Additionally, a higher home-based involvement of mothers was found to be moderately associated with peer relationship problems of children in shidu families. Therefore, we suggest a future research focus on developing joint activities for parents and children that help to increase emotional communication for the psychosocial development of children in shidu families after disasters in China. Full article
Open AccessArticle
Geographic Inequalities in Breast Cancer in Italy: Trend Analysis of Mortality and Risk Factors
Int. J. Environ. Res. Public Health 2020, 17(11), 4165; https://doi.org/10.3390/ijerph17114165 - 11 Jun 2020
Viewed by 399
Abstract
We calculated time trends of standardised mortality rates and risk factors for breast cancer (BC) from 1990 to 2016 for all women resident in Italy. The age-standardised mortality rate in Italy decreased from 4.2 in 1990 to 3.2 (×100,000) in 2016. While participation [...] Read more.
We calculated time trends of standardised mortality rates and risk factors for breast cancer (BC) from 1990 to 2016 for all women resident in Italy. The age-standardised mortality rate in Italy decreased from 4.2 in 1990 to 3.2 (×100,000) in 2016. While participation in organised screening programmes and age-standardised fertility rates decreased in Italy, screening invitation coverage and mammography uptake, the prevalence of women who breastfed and mean age at birth increased. Although southern regions had favourable prevalence of protective risk factors in the 1990s, fertility rates decreased in southern regions and increased in northern regions, which in 2016 had a higher rate (1.28 vs. 1.32 child per woman) and a smaller increase in women who breastfed (+4% vs. +30%). In 2000, mammography screening uptake was lower in southern than in northern and central regions (28% vs. 52%). However, the increase in mammography uptake was higher in southern (203%) than in northern and central Italy (80%), reducing the gap. Participation in mammographic screening programmes decreased in southern Italy (−10%) but increased in the North (6.6%). Geographic differences in mortality and risk factor prevalence is diminishing, with the South losing all of its historical advantage in breast cancer mortality. Full article
(This article belongs to the Special Issue Breast Cancer Health Disparities and Prevention)
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Open AccessFeature PaperArticle
Fear of COVID-19 Scale—Associations of Its Scores with Health Literacy and Health-Related Behaviors among Medical Students
Int. J. Environ. Res. Public Health 2020, 17(11), 4164; https://doi.org/10.3390/ijerph17114164 - 11 Jun 2020
Viewed by 1167
Abstract
The coronavirus disease 2019 (COVID-19) pandemic causes fear, as its immediate consequences for the public have produced unprecedented challenges for the education and healthcare systems. We aimed to validate the fear of COVID-19 scale (FCoV-19S) and examine the association of its scores with [...] Read more.
The coronavirus disease 2019 (COVID-19) pandemic causes fear, as its immediate consequences for the public have produced unprecedented challenges for the education and healthcare systems. We aimed to validate the fear of COVID-19 scale (FCoV-19S) and examine the association of its scores with health literacy and health-related behaviors among medical students. A cross-sectional study was conducted from 7 to 29 April 2020 on 5423 students at eight universities across Vietnam, including five universities in the North, one university in the Center, two universities in the South. An online survey questionnaire was used to collect data on participants’ characteristics, health literacy, fear of COVID-19 using the FCoV-19S, and health-related behaviors. The results showed that seven items of the FCoV-19S strongly loaded on one component, explained 62.15% of the variance, with good item–scale convergent validity and high internal consistency (Cronbach’s alpha = 0.90). Higher health literacy was associated with lower FCoV-19S scores (coefficient, B, −0.06; 95% confidence interval, 95%CI, −0.08, −0.04; p < 0.001). Older age or last academic years, being men, and being able to pay for medication were associated with lower FCoV-19S scores. Students with higher FCoV-19S scores more likely kept smoking (odds ratio, OR, 1.11; 95% CI, 1.08, 1.14; p < 0.001) or drinking alcohol (OR, 1.04; 95% CI, 1.02, 1.06; p < 0.001) at an unchanged or higher level during the pandemic, as compared to students with lower FCoV-19S scores. In conclusion, the FCoV-19S is valid and reliable in screening for fear of COVID-19. Health literacy was found to protect medical students from fear. Smoking and drinking appeared to have a negative impact on fear of COVID-19. Strategic public health approaches are required to reduce fear and promote healthy lifestyles during the pandemic. Full article
(This article belongs to the Special Issue Global Health Literacy)
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Open AccessArticle
Effect of Height of Fall on Mortality in Patients with Fall Accidents: A Retrospective Cross-Sectional Study
Int. J. Environ. Res. Public Health 2020, 17(11), 4163; https://doi.org/10.3390/ijerph17114163 - 11 Jun 2020
Viewed by 358
Abstract
Background: Accidental falls are a common cause of injury and deaths. Both ground-level falls (GLF) and non-GLF may lead to significant morbidity or mortality. This study aimed to explore the relationship between height of falls and mortality. Method: This is a retrospective study [...] Read more.
Background: Accidental falls are a common cause of injury and deaths. Both ground-level falls (GLF) and non-GLF may lead to significant morbidity or mortality. This study aimed to explore the relationship between height of falls and mortality. Method: This is a retrospective study based on the data from a registered trauma database and included 8699 adult patients who were hospitalized between 1 January 2009 and 31 December 2017 for the treatment of fall-related injuries. Study subjects were divided into three groups of two categories based on the height of fall: GLF (group I: < 1 m) and non-GLF (group II: 1–6 m and group III: > 6 m). The primary outcome was in-hospital mortality. The adjusted odds ratio (AOR) of mortality adjusted for age, sex, and comorbidities with or without an injury severity score (ISS) was calculated using multiple logistic regression. Results: Among the 7001 patients in group I, 1588 in group II, and 110 in group III, patients in the GLF group were older, predominantly female, had less intentional injuries, and had more pre-existing comorbidities than those in the non-GLF group. The patients in the non-GLF group had a significantly lower Glasgow Coma Scale (GCS), a higher injury severity score (ISS), worse physiological responses, and required more procedures performed in the emergency department. The mortality rate for the patients in group I, II, and III were 2.5%, 3.5%, and 5.5%, respectively. After adjustment by age, sex, and comorbidities, group II and group III patients had significantly higher adjusted odds of mortality than group I patients (AOR 2.2, 95% CI 1.64–2.89, p < 0.001 and AOR 2.5, 95% CI 1.84–3.38, p < 0.001, respectively). With additional adjustment by ISS, group II did not have significantly higher adjusted odds of mortality than group I patients (AOR 1.4, 95% CI 0.95–2.22, p = 0.082), but group III patients still had significantly higher adjusted odds of mortality than group I patients (AOR 10.0, 95% CI 2.22–33.33, p = 0.002). Conclusion: This study suggested that patients who sustained GLF and non-GLF were distinct groups of patients, and the height of fall did have an impact on mortality in patients of fall accidents. A significantly higher adjusted odds of mortality was found in the GLF group than in the non-GLF group after adjusting for age, sex, and comorbidities. Full article
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Open AccessArticle
Impact of Molar Furcations on Photodynamic Therapy Outcomes: A 6-Month Split-Mouth Randomized Clinical Trial
Int. J. Environ. Res. Public Health 2020, 17(11), 4162; https://doi.org/10.3390/ijerph17114162 - 11 Jun 2020
Viewed by 613
Abstract
The effectiveness of adjunctive photodynamic treatment (PDT) to non-surgical periodontal therapy has been shown to depend on initial periodontal status. As molar furcation involvement impairs healing response to non-surgical periodontal therapy, the aim of this study was to evaluate the impact of furcation [...] Read more.
The effectiveness of adjunctive photodynamic treatment (PDT) to non-surgical periodontal therapy has been shown to depend on initial periodontal status. As molar furcation involvement impairs healing response to non-surgical periodontal therapy, the aim of this study was to evaluate the impact of furcation involvement on PDT outcomes. Thirty-six patients suffering from severe chronic periodontitis were included in a 6-month split-mouth randomized clinical trial. PDT applications used the toluidine blue O and a light-emitting diode (LED) with a red spectrum. Repeated PDT applications were performed in addition to non-surgical periodontal treatment at baseline and at 3-months. Pocket probing depth (PPD), plaque index, bleeding on probing, and clinical attachment level were recorded at baseline, and again at 3- and 6-months. Furcation sites of molars were compared to other sites of molars and non-molars. Multilevel analysis showed no PDT effect in molar furcation sites while an additional significant reduction (odds ratio = 0.67) of pockets with PPD > 5 mm in other sites at 3-months was measured. PPD reduction appeared delayed in molar furcation sites treated with PDT. There is no additional apparent benefit to use PDT in molar furcation sites for the reduction of pockets with PPD > 5 mm contrary to other sites. Full article
(This article belongs to the Special Issue Influence of Risk Factors on Periodontitis and Periodontal Treatment)
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Open AccessArticle
A Questionnaire Survey of Management of Patients with Aneurysmal Subarachnoid Haemorrhage in Poland
Int. J. Environ. Res. Public Health 2020, 17(11), 4161; https://doi.org/10.3390/ijerph17114161 - 11 Jun 2020
Viewed by 385
Abstract
Background: Aneurysmal subarachnoid haemorrhage (aSAH) remains a potentially devastating threat to the brain with a serious impact on mortality and morbidity. We attempted to investigate correspondence between the current guidelines for aSAH management and real clinical practice in Poland. Methods: A web-based questionnaire [...] Read more.
Background: Aneurysmal subarachnoid haemorrhage (aSAH) remains a potentially devastating threat to the brain with a serious impact on mortality and morbidity. We attempted to investigate correspondence between the current guidelines for aSAH management and real clinical practice in Poland. Methods: A web-based questionnaire was performed between 03.2019 and 06.2019. Centres performing neuro-interventional radiology procedures and neuro-critical care were included (n = 29). One response from each hospital was recorded. Results: In three (10.4%) centres, there was no clear protocol for an interventional treatment plan. Endovascular embolisation was predominantly used in 11 (37.9%) hospitals, and microsurgical clipping, in 10 (34.5%). A written protocol for standard anaesthetic management was established only in six (20.7%) centres for coiling and in five (17.2%) for microsurgical clipping. The diagnosis of cerebral vasospasm was based on transcranial Doppler as the first-choice method in seven (24.1%) units. “3-H therapy” was applied by 15 (51.8%) respondents, and “2-H therapy”, by four (13.8%) respondents. In only eight (27.6%) centres were all patients with aSAH being admitted to the ICU. Conclusion: Many discrepancies exist between the available guidelines and clinical practice in aSAH treatment in Poland. Peri-procedural management is poorly standardised. Means must be undertaken to improve patient-oriented treatment and care. Full article
Open AccessReview
Nigella sativa and Its Active Compound, Thymoquinone, Accelerate Wound Healing in an In Vivo Animal Model: A Comprehensive Review
Int. J. Environ. Res. Public Health 2020, 17(11), 4160; https://doi.org/10.3390/ijerph17114160 - 11 Jun 2020
Viewed by 451
Abstract
Nigella sativa (NS) has been reported to have a therapeutic effect towards skin wound healing via its anti-inflammatory, tissue growth stimulation, and antioxidative properties. This review examines all the available studies on the association of Nigella sativa (NS) and skin wound healing. The [...] Read more.
Nigella sativa (NS) has been reported to have a therapeutic effect towards skin wound healing via its anti-inflammatory, tissue growth stimulation, and antioxidative properties. This review examines all the available studies on the association of Nigella sativa (NS) and skin wound healing. The search was performed in Medline via EBSCOhost and Scopus databases to retrieve the related papers released between 1970 and March 2020. The principal inclusion criteria were original article issued in English that stated wound healing criteria of in vivo skin model with topically applied NS. The search discovered 10 related articles that fulfilled the required inclusion criteria. Studies included comprise different types of wounds, namely excisional, burn, and diabetic wounds. Seven studies unravelled positive results associated with NS on skin wound healing. Thymoquinone has anti-inflammatory, antioxidant, and antibacterial properties, which mainly contributed to wound healing process. Full article
(This article belongs to the Section Health Care Sciences & Services)
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Open AccessArticle
Exercise Addiction and Its Relationship with Health Outcomes in Indoor Cycling Practitioners in Fitness Centers
Int. J. Environ. Res. Public Health 2020, 17(11), 4159; https://doi.org/10.3390/ijerph17114159 - 11 Jun 2020
Viewed by 416
Abstract
We studied the prevalence and possible association between exercise addiction and health in indoor cycling practitioners. In 1014 (492 women) adult indoor cyclists and 926 (597 women) controls with low levels of physical activity according to the short form of the International Physical [...] Read more.
We studied the prevalence and possible association between exercise addiction and health in indoor cycling practitioners. In 1014 (492 women) adult indoor cyclists and 926 (597 women) controls with low levels of physical activity according to the short form of the International Physical Activity Questionnaire, we examined the risk of exercise addiction according to the Exercise Addiction Inventory and several health outcomes through a web-based experiment. The prevalence of a high risk of exercise addiction in cyclists was 13.3%, and it was higher in men than in women (16.5% vs. 10.0%, p = 0.002). Women cyclists with a high risk of exercise addiction had higher levels of physical activity (p < 0.001; effect size = −0.62, 95% CI: (−0.91, −0.32)) and anxiety symptom severity (p = 0.001; Effect Size (ES) = −0.59 (−0.89, −0.30)) than those with a low risk. For both sexes, cyclists with a low risk of exercise addiction had better social function, emotional role, and anxiety symptom severity compared with the controls (all p < 0.002; ES ranged from 0.25 to 0.47). Higher anxiety symptom severity and cardiorespiratory fitness were the main determinants of exercise addiction in cyclists (both p < 0.001). Our data suggest the importance of considering exercise addiction in indoor cyclists. Full article
(This article belongs to the Special Issue Sports and Health)
Open AccessArticle
A Sediment Diagenesis Model of Seasonal Nitrate and Ammonium Flux Spatial Variation Contributing to Eutrophication at Taihu, China
Int. J. Environ. Res. Public Health 2020, 17(11), 4158; https://doi.org/10.3390/ijerph17114158 - 11 Jun 2020
Viewed by 480
Abstract
Algal blooms have thrived on the third-largest shallow lake in China, Taihu over the past decade. Due to the recycling of nutrients such as nitrate and ammonium, this problem has been difficult to eradicate. Sediment flux, a product of diagenesis, explains the recycling [...] Read more.
Algal blooms have thrived on the third-largest shallow lake in China, Taihu over the past decade. Due to the recycling of nutrients such as nitrate and ammonium, this problem has been difficult to eradicate. Sediment flux, a product of diagenesis, explains the recycling of nutrients. The objective was to simulate the seasonal spatial variations of nitrate and ammonium flux. In this paper, sediment diagenesis modeling was applied to Taihu with Environmental Fluid Dynamics Code (EFDC). Latin hypercube sampling was used to create an input file from twelve (12) nitrogen related parameters of sediment diagenesis and incorporated into the EFDC. The results were analyzed under four seasons: summer, autumn, winter, and spring. The concentration of NH4–N in the sediment–water column increased from 2.744903 to 22.38613 (g/m3). In summer, there was an accumulation of ammonium in the water column. In autumn and winter, the sediment was progressively oxidized. In spring, low-oxygen conditions intensify denitrification. This allows algal blooms to continue to thrive, creating a threat to water quality sustainability. The sediment diagenesis model, coupled with water quality measured data, showed an average relative error for Total Nitrogen (TN) of 38.137%, making the model suitable. Future studies should simulate phosphate flux and measure sediment fluxes on the lake. Full article
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Open AccessArticle
Adaptation and Validation of the Scale of Types of Users in Gamification with the Spanish Adolescent Population
Int. J. Environ. Res. Public Health 2020, 17(11), 4157; https://doi.org/10.3390/ijerph17114157 - 10 Jun 2020
Viewed by 480
Abstract
The video game has been one of the phenomena with the greatest impact on the entire social fabric, and especially among young people. Therefore, it is essential to understand the interaction between the players and the video game itself. However, few instruments have [...] Read more.
The video game has been one of the phenomena with the greatest impact on the entire social fabric, and especially among young people. Therefore, it is essential to understand the interaction between the players and the video game itself. However, few instruments have been designed to assess the types of players in the adolescent population. Therefore, the purpose of this study was to validate the Gamification User Types Hexad Scale for the Spanish adolescent population. The sample of participants consisted of 1345 adolescents between the ages of 13 and 18. To evaluate the psychometric properties of the scale, a confirmatory factor analysis and a multi-group analysis of invariance by sex were performed. The results provide evidence of a valid and reliable six-factor instrument to measure the types of players in the Spanish adolescent population, regardless of their sex. Full article
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Open AccessArticle
Process Evaluation of a Clustered Randomized Control Trial of a Comprehensive Intervention to Reduce the Risk of Cardiovascular Events in Primary Health Care in Rural China
Int. J. Environ. Res. Public Health 2020, 17(11), 4156; https://doi.org/10.3390/ijerph17114156 - 10 Jun 2020
Viewed by 502
Abstract
Background: Cardiovascular disease (CVD) is a major public health challenge in China. This study aims to understand the processes of implementing a comprehensive intervention to reduce CVD events in areas of drug therapy, lifestyle changes, and adherence support in a clustered randomized controlled [...] Read more.
Background: Cardiovascular disease (CVD) is a major public health challenge in China. This study aims to understand the processes of implementing a comprehensive intervention to reduce CVD events in areas of drug therapy, lifestyle changes, and adherence support in a clustered randomized controlled trial (cRCT). This trial consisted of 67 clusters spanning over 3 years in Zhejiang Province, China. Method: A qualitative process evaluation was nested within the cRCT conducted in 9 township hospitals with 27 healthcare providers, 18 semi-structured interviews, and 23 observational studies of clinical practices within the intervention arm. Results: Effective and repeated trainings using an interactive approach were crucial to improve the prescribing behaviour of family doctors and their patient communication skills. However, the awareness of patients remained limited, thus compromising their use of CVD preventive drugs and adoption of healthy lifestyles. Health system factors further constrained providers’ and patients’ responses to the intervention. Financial barrier was a major concern because of the low coverage of health insurance. Other barriers included limited doctor–patient trust and suboptimal staff motivation. Conclusion: Our study suggests the feasibility of implementing a comprehensive CVD risk reduction strategy in China’s rural primary care facilities. However, health system barriers need to be addressed to ensure the success and sustainability of the intervention. Full article
(This article belongs to the Section Global Health)
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Open AccessArticle
Inclusion of Health in Impact Assessment: A Review of Current Practice in Sub-Saharan Africa
Int. J. Environ. Res. Public Health 2020, 17(11), 4155; https://doi.org/10.3390/ijerph17114155 - 10 Jun 2020
Viewed by 545
Abstract
Natural resource extraction projects, including those in the mining sector, have various effects on human health and wellbeing, with communities in resource-rich areas in sub-Saharan Africa (SSA) being particularly vulnerable. While impact assessments (IA) can predict and mitigate negative effects, it is unclear [...] Read more.
Natural resource extraction projects, including those in the mining sector, have various effects on human health and wellbeing, with communities in resource-rich areas in sub-Saharan Africa (SSA) being particularly vulnerable. While impact assessments (IA) can predict and mitigate negative effects, it is unclear whether and to what extent health aspects are included in current IA practice in SSA. For collecting IA reports, we contacted 569 mining projects and 35 ministries regulating the mining sector. The reports obtained were complemented by reports identified in prior research. The examination of the final sample of 44 IA reports revealed a heavy focus on environmental health determinants and included health outcomes were often limited to a few aspects, such as HIV, malaria and injuries. The miniscule yield of reports (1.6% of contacted projects) and the low response rate by the contacted mining companies (18%) might indicate a lack of transparency in the IA process of the mining sector in SSA. To address the shortcomings identified, policies regulating IA practice should strengthen the requirements for public disclosure of IA reports and promote a more comprehensive inclusion of health in IA, be it through stand-alone health impact assessment or more rigorous integration of health in other forms of IA. Full article
(This article belongs to the Special Issue Health Impact Assessment)
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Open AccessArticle
Food Co-Operatives: A Potential Community-Based Strategy to Improve Fruit and Vegetable Intake in Australia
Int. J. Environ. Res. Public Health 2020, 17(11), 4154; https://doi.org/10.3390/ijerph17114154 - 10 Jun 2020
Viewed by 599
Abstract
Only 5% of Australian children and adults eat enough fruit and vegetables. Two common barriers are high cost and limited access. Food co-operatives (‘co-ops’) may have the potential to reduce these barriers. We conducted a scoping analysis of food co-ops in the Sydney [...] Read more.
Only 5% of Australian children and adults eat enough fruit and vegetables. Two common barriers are high cost and limited access. Food co-operatives (‘co-ops’) may have the potential to reduce these barriers. We conducted a scoping analysis of food co-ops in the Sydney region to describe their characteristics and objectives. We also conducted a survey of members and non-members of co-ops to assess their fruit and vegetable intake using validated questions. Fifteen food co-ops were identified in the Sydney region and the most common objective was to provide cheap affordable produce. Most co-ops (61%) were in areas of high socio-economic status (SES). Members of food co-ops had a higher vegetable intake than non-members [mean difference (MD) = 0.54 serves/daily; 95% confidence interval (CI) of 0.15 to 0.93] and were also more likely to meet the recommendations for fruit and vegetable intake [odds ratio (OR) = 4.77 (95% CI = 1.15, 19.86)]. Implications of this study are that if food co-ops can be implemented on a wider scale, they hold potential for improving fruit and vegetable intakes. Full article
Open AccessArticle
In the past, the seeds I planted often didn’t grow.” A Mixed-Methods Feasibility Assessment of Integrating Agriculture and Nutrition Behaviour Change Interventions with Cash Transfers in Rural Bangladesh
Int. J. Environ. Res. Public Health 2020, 17(11), 4153; https://doi.org/10.3390/ijerph17114153 - 10 Jun 2020
Viewed by 445
Abstract
Combining agriculture with behaviour change communication and other nutrition-sensitive interventions could improve feeding practices to reduce maternal and child undernutrition. Such integrated intervention requires rigorous design and an appropriate implementation strategy to generate an impact. We assessed feasibility and acceptability of an intervention [...] Read more.
Combining agriculture with behaviour change communication and other nutrition-sensitive interventions could improve feeding practices to reduce maternal and child undernutrition. Such integrated intervention requires rigorous design and an appropriate implementation strategy to generate an impact. We assessed feasibility and acceptability of an intervention package that combines nutrition counselling, counselling and support for home-gardening, and unconditional cash transfers delivered to women on a mobile platform for improving maternal and child nutrition behaviours among low-income families in rural Bangladesh. We used mixed-methods including in-depth interviews with women (20), key-informant interviews with project workers (6), and a cross sectional survey of women (60). Women well-accepted the intervention and reported to be benefited by acquiring new skills and information on home gardening and nutrition. They established homestead gardens of seasonal vegetables successfully and were able to find a solution for major challenges. All women received the cash transfer. Ninety-one percent of women spent the cash for buying foods, 20% spent it on purchasing seeds or fertilizers and 57% used it for medical and livelihood purchases. Project staff and mobile banking agent reported no difficulty in cash transfer. Combining nutrition-specific and -sensitive interventions is a feasible and acceptable approach. Using mobile technologies can provide additional benefits for the intervention to reach the disadvantage families in rural settings. Full article
(This article belongs to the Section Global Health)
Open AccessArticle
Convolution- and Attention-Based Neural Network for Automated Sleep Stage Classification
Int. J. Environ. Res. Public Health 2020, 17(11), 4152; https://doi.org/10.3390/ijerph17114152 - 10 Jun 2020
Viewed by 567
Abstract
Analyzing polysomnography (PSG) is an effective method for evaluating sleep health; however, the sleep stage scoring required for PSG analysis is a time-consuming effort for an experienced medical expert. When scoring sleep epochs, experts pay attention to find specific signal characteristics (e.g., K-complexes [...] Read more.
Analyzing polysomnography (PSG) is an effective method for evaluating sleep health; however, the sleep stage scoring required for PSG analysis is a time-consuming effort for an experienced medical expert. When scoring sleep epochs, experts pay attention to find specific signal characteristics (e.g., K-complexes and spindles), and sometimes need to integrate information from preceding and subsequent epochs in order to make a decision. To imitate this process and to build a more interpretable deep learning model, we propose a neural network based on a convolutional network (CNN) and attention mechanism to perform automatic sleep staging. The CNN learns local signal characteristics, and the attention mechanism excels in learning inter- and intra-epoch features. In experiments on the public sleep-edf and sleep-edfx databases with different training and testing set partitioning methods, our model achieved overall accuracies of 93.7% and 82.8%, and macro-average F1-scores of 84.5 and 77.8, respectively, outperforming recently reported machine learning-based methods. Full article
(This article belongs to the Special Issue Application of Deep Learning for Neural Systems)
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Open AccessArticle
COVID-19 Pandemic in the Italian Population: Validation of a Post-Traumatic Stress Disorder Questionnaire and Prevalence of PTSD Symptomatology
Int. J. Environ. Res. Public Health 2020, 17(11), 4151; https://doi.org/10.3390/ijerph17114151 - 10 Jun 2020
Viewed by 1080
Abstract
Since December 2019, the COVID-19 pandemic has attracted worldwide attention for its rapid and exponential diffusion. The long-term psychological impact, of both the spread of the virus and the restrictive policies adopted to counteract it, remains uncertain. However, recent studies reported a high [...] Read more.
Since December 2019, the COVID-19 pandemic has attracted worldwide attention for its rapid and exponential diffusion. The long-term psychological impact, of both the spread of the virus and the restrictive policies adopted to counteract it, remains uncertain. However, recent studies reported a high level of psychological distress and Post-Traumatic Stress Disorder (PTSD) symptoms. The purpose of this study is to assess the psychometric properties of a new questionnaire, to evaluate PTSD risk related to the COVID-19 emergency. A total of Italian people completed a web-based cross-sectional survey broadcasted through different social-media. Demographic data and some psychological dimensions, such as general distress and sleep disturbance, were collected. A new self-report questionnaire (COVID-19-PTSD), consisting of 19 items, was developed starting from the PTSD Check List for DSM-5 (PCL-5) questionnaire, and it was administered in order to analyze its psychometric properties. The results highlighted the adequate psychometric properties of the COVID-19-PTSD questionnaire. The confirmatory factor analysis indicated that a seven-factor model (Intrusion, Avoidance, Negative Affect, Anhedonia, Dysphoric arousal, Anxious arousal and Externalizing behavior) best fits the data. Significant correlations were found among COVID-19-PTSD scores, general distress and sleep disturbance. A high percentage of PTSD symptomatology (29.5%) was found in the Italian population. COVID-19-PTSD appears to be effective in evaluating the specific stress symptoms related to the COVID-19 pandemic in the Italian population. These results are relevant from a clinical point of view because they suggest that the COVID-19 pandemic could be considered as a traumatic event. Psychological interventions to counteract short- and long-term psychopathological effects, consequent to the COVID-19 pandemic, appear to be necessary. Full article
(This article belongs to the Special Issue COVID-19: Prognosis, Outcomes and Long-Term Sequelae)
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