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Int. J. Environ. Res. Public Health, Volume 17, Issue 15 (August-1 2020) – 365 articles

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Cover Story (view full-size image) Exposures to chemical and nonchemical stressors during early lifestages impact cognitive ability. [...] Read more.
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Open AccessCommunication
Perceptions of Light Pollution and its Impacts: Results of an Irish Citizen Science Survey
Int. J. Environ. Res. Public Health 2020, 17(15), 5628; https://doi.org/10.3390/ijerph17155628 - 04 Aug 2020
Viewed by 475
Abstract
Background: Light pollution is increasingly an area of concern for health and quality of life research. Somewhat surprisingly, there are relatively few descriptions of perceptions of light pollution in the literature. The current study examined such perceptions in a Irish sample. Methods: A [...] Read more.
Background: Light pollution is increasingly an area of concern for health and quality of life research. Somewhat surprisingly, there are relatively few descriptions of perceptions of light pollution in the literature. The current study examined such perceptions in a Irish sample. Methods: A survey was circulated as part of a citizen science initiative of a national newspaper; the survey included questions regarding night sky brightness and the impact of light at night on sleep and animal behaviour. Complete responses from 462 respondents were analysed. Results: Urban location was, as anticipated, associated with reported brighter night skies, and public lighting was reported as the main source of light at night for urban settings, whilst neighbours’ domestic lighting was the most commonly reported source for rural settings. Respondents from rural settings were more likely to report that light at night impinged on sleep, whilst city dwellers were more likely to report recent changes in wildlife behaviour. Conclusions: Citizen science approaches may be useful in gathering data on public perceptions of light pollution and its impacts. In the current study, this perception was strongly influenced by location, highlighting the importance of assessing experiences and attitudes across a number of geographical settings. Full article
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Open AccessArticle
Factors Associated with Mental Health Results among Workers with Income Losses Exposed to COVID-19 in China
Int. J. Environ. Res. Public Health 2020, 17(15), 5627; https://doi.org/10.3390/ijerph17155627 - 04 Aug 2020
Viewed by 489
Abstract
The outbreak and worldwide spread of COVID-19 has resulted in a high prevalence of mental health problems in China and other countries. This was a cross-sectional study conducted using an online survey and face-to-face interviews to assess mental health problems and the associated [...] Read more.
The outbreak and worldwide spread of COVID-19 has resulted in a high prevalence of mental health problems in China and other countries. This was a cross-sectional study conducted using an online survey and face-to-face interviews to assess mental health problems and the associated factors among Chinese citizens with income losses exposed to COVID-19. The degrees of the depression, anxiety, insomnia, and distress symptoms of our participants were assessed using the Chinese versions of the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the Insomnia Severity Index-7 (ISI-7), and the revised 7-item Impact of Event Scale (IES-7) scales, respectively, which found that the prevalence rates of depression, anxiety, insomnia, and distress caused by COVID-19 were 45.5%, 49.5%, 30.9%, and 68.1%, respectively. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes among workers with income losses during COVID-19. Participants working in Hubei province with heavy income losses, especially pregnant women, were found to have a high risk of developing unfavorable mental health symptoms and may need psychological support or interventions. Full article
(This article belongs to the Special Issue Outbreak of a Novel Coronavirus: A Global Health Threat)
Open AccessReview
Factors Influencing Patient Adherence to Tuberculosis Treatment in Ethiopia: A Literature Review
Int. J. Environ. Res. Public Health 2020, 17(15), 5626; https://doi.org/10.3390/ijerph17155626 - 04 Aug 2020
Viewed by 449
Abstract
Background: Tuberculosis (TB) is a major global public health problem and one of the leading causes of death among infectious diseases. Although TB can be cured with first-line antibiotics treatment of 6 months regimen, non-adherence to the treatment remains the main challenge for [...] Read more.
Background: Tuberculosis (TB) is a major global public health problem and one of the leading causes of death among infectious diseases. Although TB can be cured with first-line antibiotics treatment of 6 months regimen, non-adherence to the treatment remains the main challenge for TB prevention and control. Interventions to promote adherence need to address multiple underlying factors linked to non-adherence, which requires a synthesis of studies to understand these factors in the local context. Our review accordingly examines these factors for TB treatment in Ethiopia. Methods: Articles were searched from PubMed and ScienceDirect databases, as well as manual searches through Google and Google Scholar search engines. Both quantitative and qualitative studies that showed factors associated with or reasons for non-adherence, default or loss to follow up from TB treatment were included. A total of 276 articles were screened, and 29 articles were ultimately included in the review. Findings: The extracted factors were synthesized thematically into seven dimensions of patient-centred, social, economic, health system, therapy, lifestyle, and geographic access factors. More than 20 distinct factors were identified under these headings. Some of these factors may also apply quite widely in other settings, with greater or lesser influence, but some are particularly applicable to the Ethiopian setting. Conclusion: Helping patients to achieve full adherence to TB medication is a complex problem as it is influenced by interplay between many factors. Healthcare managers, providers, and researchers need to consider and address multiple underlying factors when designing adherence interventions. This work provides a reference set of such factors for Ethiopian interventions. Full article
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Open AccessReview
Physical Activity Counseling in Primary Care in Germany—An Integrative Review
Int. J. Environ. Res. Public Health 2020, 17(15), 5625; https://doi.org/10.3390/ijerph17155625 - 04 Aug 2020
Viewed by 422
Abstract
Physical activity counseling in primary health care is regarded as a useful complementary preventive and therapeutic measure and is advocated by leading public health institutions. This integrative review summarizes the available data on physical activity counseling in primary care in Germany. A systematic [...] Read more.
Physical activity counseling in primary health care is regarded as a useful complementary preventive and therapeutic measure and is advocated by leading public health institutions. This integrative review summarizes the available data on physical activity counseling in primary care in Germany. A systematic literature search in various databases (peer reviewed and grey literature) was carried out for quantitative and qualitative studies on physical activity counseling and use of “Exercise on Prescription”. The 25 studies included show a very high methodological diversity and, in some cases, considerable risks of bias, with limited comparability across studies. Counseling was provided in all studies by physicians. They report frequent physical activity counseling, which is partly confirmed and partly refuted by patient data. The use of “Exercise on Prescription” is at a very low level. Information on the frequency of physical activity counseling in Germany varies depending on data source and is sometimes contradictory. Our review provides a synthesis of various perspectives on routine physical activity counseling in primary care in Germany. Future studies using standardized and validated instruments in representative samples are needed to further knowledge on counseling and to be able to establish trends in prevalence. Strengthening the topics of physical activity and health and physical activity counseling in medical curriculum is strongly recommended. Full article
(This article belongs to the Section Exercise and Health)
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Open AccessArticle
Synthetic Bone Grafting in Aseptic Loosening of Acetabular Cup: Good Clinical and Radiological Outcomes in Contained Bone Defects at Medium-Term Follow Up
Int. J. Environ. Res. Public Health 2020, 17(15), 5624; https://doi.org/10.3390/ijerph17155624 - 04 Aug 2020
Viewed by 388
Abstract
Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study [...] Read more.
Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study investigated the effectiveness of impaction bone grafting (IBG) of contained acetabular defects (Paprosky 2 and 3a) using a porous ceramic-based hydroxyapatite bone substitute (Engipore, provided by Finceramica Faenza S.p.A., Faenza, Italy) mixed with a low percentage of autologous bone (obtained from reaming when available). We retrospectively assessed 36 patients who underwent acetabular revision using IBG using a porous ceramic-based hydroxyapatite bone substitute with cementless implants with a mean follow-up of 4.4 years. We evaluated, at regular intervals, patients clinically (using the Hip Harris Score and Oxford Score) and radiologically to evaluate the rate of incorporation of the graft, the presence of radiolucent lines or migrations of the cup. Clinical scores significantly improved (WOMAC improved from 49.7–67.30, and the HSS from 56–89). The rate of implants’ survival was 100% at our medium follow-up (4.4 years). We reported five cases of minor migration of the cup, and radiolucent lines were visible in seven patients at the last-follow up. The graft was well-incorporated in all patients. The results presented in this study suggest the HA bone substitute is an effective and safe bone graft when facing hip revision surgery; thus, longer follow-up studies are required. Full article
(This article belongs to the Special Issue The Burden of Orthopedic Surgery)
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Open AccessArticle
Influential Factors Associated with Consecutive Crash Severity: A Two-Level Logistic Modeling Approach
Int. J. Environ. Res. Public Health 2020, 17(15), 5623; https://doi.org/10.3390/ijerph17155623 - 04 Aug 2020
Viewed by 409
Abstract
A consecutive crash series is composed by a primary crash and one or more subsequent secondary crashes that occur immediately within a certain distance. The crash mechanism of a consecutive crash series is distinctive, as it is different from common primary and secondary [...] Read more.
A consecutive crash series is composed by a primary crash and one or more subsequent secondary crashes that occur immediately within a certain distance. The crash mechanism of a consecutive crash series is distinctive, as it is different from common primary and secondary crashes mainly caused by queuing effects and chain-reaction crashes that involve multiple collisions in one crash. It commonly affects a large area of road space and possibly causes congestions and significant delays in evacuation and clearance. This study identified the influential factors determining the severity of primary and secondary crashes in a consecutive crash series. Basic, random-effects, random-parameters, and two-level binary logistic regression models were established based on crash data collected on the freeway network of Guizhou Province, China in 2018, of which 349 were identified as consecutive crashes. According to the model performance metrics, the two-level logistic model outperformed the other three models. On the crash level, double-vehicle primary crash had a negative association with the severity of secondary consecutive crashes, and the involvement of trucks in the secondary consecutive crash had a positive contribution to its crash severity. On a road segment level, speed limit, traffic volume, tunnel, and extreme weather conditions such as rainy and cloudy days had positive effects on consecutive crash severity, while the number of lanes was negatively associated with consecutive crash severity. Policy suggestions are made to alleviate the severity of consecutive crashes by reminding the drivers with real-time potential hazards of severe consecutive crashes and providing educative programs to specific groups of drivers. Full article
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Open AccessArticle
Walkability and Fitness Center Prices, Opening Hours, and Extra Services: The Case of Madrid, Spain
Int. J. Environ. Res. Public Health 2020, 17(15), 5622; https://doi.org/10.3390/ijerph17155622 - 04 Aug 2020
Viewed by 480
Abstract
Walkability has been associated with urban development and political plans, contributing to more connected cities with improvements in communication, shopping, and pedestrian base. Among these services, fitness centers are becoming important elements for communities due to their impact on the health and welfare [...] Read more.
Walkability has been associated with urban development and political plans, contributing to more connected cities with improvements in communication, shopping, and pedestrian base. Among these services, fitness centers are becoming important elements for communities due to their impact on the health and welfare of citizens. The present study aims to examine how an area’s Walk Score® affects fitness center services, specifically membership costs, opening hours, and aquatic services. Data from 193 fitness centers were retrieved, representing all the areas of the municipality of Madrid, Spain, including fitness centers in the 21 city districts. A nonlinear relationship between an area’s Walk Score® and fitness centers’ monthly fees is observed. Only in premium fitness centers, a weak curvilinear model is observed, following a quadratic equation, showing that fitness centers with higher prices are in less walkable areas. Additionally, the association between Walk Score® and a fitness center’s opening hours reveals that fitness centers with wider hours of operation tend to be in moderately to highly walkable locations. Lastly, the existence of a swimming pool is related to a lower Walk Score®. Thus, fitness centers in less walkable areas try to offer additional services as differentiation from competitors, whereas centers in walkable locations use this advantage as a strength. Full article
(This article belongs to the Section Environmental Health)
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Open AccessArticle
Perspectives Emerged from Students and Supervisory Staff Interaction in Drug Use Prevention: A Q Methodology Investigation
Int. J. Environ. Res. Public Health 2020, 17(15), 5621; https://doi.org/10.3390/ijerph17155621 - 04 Aug 2020
Viewed by 374
Abstract
This study aims to identify and describe the patterns of shared perspectives of students and supervisory staff associated with their interaction in drug use prevention. We applied the Q methodology to cluster participants into groups according to the similarities of their Q sorts. [...] Read more.
This study aims to identify and describe the patterns of shared perspectives of students and supervisory staff associated with their interaction in drug use prevention. We applied the Q methodology to cluster participants into groups according to the similarities of their Q sorts. A total of 31 pairs of students and their supervisory staff participated in the study to rank the designed Q statements. The Q factor analysis for supervisory staff revealed a five-factor solution that accounted for 58% of the total variance. Another five-factor solution for the students explained 49% of the total variance. One similarity between the groups was the need to enhance the involvement of significant others to help the students quit drugs. A major identified difference between the groups was that whereas the students highlighted the importance of health consequences of drug use in helping them stop use, the supervisory staff did not. The elucidation of similarities and differences between supervisory staff and students could offer more insightful strategies of preventing the drug use. Full article
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Open AccessArticle
Objective Analysis of Movement in Subjects with ADHD. Multidisciplinary Control Tool for Students in the Classroom
Int. J. Environ. Res. Public Health 2020, 17(15), 5620; https://doi.org/10.3390/ijerph17155620 - 04 Aug 2020
Viewed by 440
Abstract
The term Attention Deficit Hyperactivity Disorder (ADHD) has a long history of problems behind it. The origin of all these problems lies in the lack of agreement in the assessment procedures and evaluation instruments. The diagnosis is clinical and is determined by the [...] Read more.
The term Attention Deficit Hyperactivity Disorder (ADHD) has a long history of problems behind it. The origin of all these problems lies in the lack of agreement in the assessment procedures and evaluation instruments. The diagnosis is clinical and is determined by the observation and information provided by parents and teachers. So, this is highly subjective and leads to disparate results. Therefore, on the one hand the inaccuracy of the diagnosis of ADHD, which has been based on subjective criteria, together with the fact that hyperactivity is one of the main symptoms of this disorder, implies that several studies (with limitations) have been carried out to record objective measures of movement in subjects in at least the last ten years. In order to solve some of this derived problems and limitations of previous studies, a computer program has been developed to objectively record the amount of movement of subjects. The main objective of this study is threefold: first to register the amount of movement of both experimental group and control group, then to compare them with the movement registered by observers and finally to determine the validity of the software developed as a tool to support the diagnosis of ADHD. Results show that there are significant differences in the amount of objective movement between a clinical group of subjects with ADHD and a control group, obtaining a higher average of movement the experimental group. In addition, results also demonstrate that the developed software is a valid tool for the evaluation of movement that solves the limitations of previous studies. The proposed tool is developed from different aspects to give it a multidisciplinary character. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of ADHD in Adolescents)
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Open AccessArticle
Investigating Connections between Need for Cognitive Closure and Climate Change Concern in College Students
Int. J. Environ. Res. Public Health 2020, 17(15), 5619; https://doi.org/10.3390/ijerph17155619 - 04 Aug 2020
Viewed by 470
Abstract
Understanding how people’s worldviews and individual personality differences affect their thinking about anthropogenic climate change is critical to communication efforts regarding this issue. This study surveyed University of Georgia students to investigate the role that need for cognitive closure plays in level of [...] Read more.
Understanding how people’s worldviews and individual personality differences affect their thinking about anthropogenic climate change is critical to communication efforts regarding this issue. This study surveyed University of Georgia students to investigate the role that need for cognitive closure plays in level of climate change worry. The relationship between these two was found to involve suppression—a subset of mediation—by the social dimension of political conservatism. Political conservatism was also found to play a mediating role in the relationship between need for cognitive closure and support for governmental and personal climate solutions. However, social conservatism played this mediator role in women, and functioned as a suppressor for men. These findings help inform audience segmentation and creation of climate-related messages based on audience worldview and personality. Full article
(This article belongs to the Special Issue The Psychological Impacts of Global Climate Change)
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Open AccessArticle
Effectiveness of Using Voice Assistants in Learning: A Study at the Time of COVID-19
Int. J. Environ. Res. Public Health 2020, 17(15), 5618; https://doi.org/10.3390/ijerph17155618 - 04 Aug 2020
Viewed by 405
Abstract
The use of advanced learning technologies in a learning management system (LMS) can greatly assist learning processes, especially when used in university environments, as they promote the development of Self-Regulated learning, which increases academic performance and student satisfaction towards personal learning. One of [...] Read more.
The use of advanced learning technologies in a learning management system (LMS) can greatly assist learning processes, especially when used in university environments, as they promote the development of Self-Regulated learning, which increases academic performance and student satisfaction towards personal learning. One of the most innovative resources that an LMS may have is an Intelligent Personal Assistant (IPA). We worked with a sample of 109 third-grade students following Health Sciences degrees. The aims were: (1) to verify whether there will be significant differences in student access to the LMS, depending on use versus non-use of an IPA. (2) To verify whether there will be significant differences in student learning outcomes depending on use versus non-use of an IPA. (3) To verify whether there will be significant differences for student satisfaction with teaching during the COVID-19 pandemic, depending on use versus non-use of an IPA. (4) To analyze student perceptions of the usefulness of an IPA in the LMS. We found greater functionality in access to the LMS and satisfaction with teaching, especially during the health crisis, in the group of students who had used an IPA. However, both the expansion of available information and the usability of the features embedded in an IPA are still challenging issues. Full article
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Open AccessArticle
Changes in the Static Balance of Older Women Participating in Regular Nordic Walking Sessions and Nordic Walking Combined with Cognitive Training
Int. J. Environ. Res. Public Health 2020, 17(15), 5617; https://doi.org/10.3390/ijerph17155617 - 04 Aug 2020
Viewed by 369
Abstract
Regular Nordic walking (NW) improves physical fitness, including the ability to maintain balance, in older adults. However, little is known about whether complementing the exercise programme with cognitive training (CT) contributes to increased effects. The aim of the study was to determine and [...] Read more.
Regular Nordic walking (NW) improves physical fitness, including the ability to maintain balance, in older adults. However, little is known about whether complementing the exercise programme with cognitive training (CT) contributes to increased effects. The aim of the study was to determine and compare the effect of regular NW and NW combined with CT on the ability to maintain static balance in older adults. The study examined 61 women aged 64 to 93 years living in adult day care centres. Twenty people participated in a three-month programme combining NW and CT (group NW + CT), 20 people participated only in NW classes (group NW), and 21 people were a control group (group C). The Romberg balance test, Fullerton Functional Fitness Test, and Attention and Perceptivity Test were used. After the programme, an increase in the time of maintaining the balance (with eyes open on the left and right legs) was observed in groups NW + CT and NW, with no such changes found in group C. This increase was greater in group NW + CT. Increased agility and strength of the hand were predictors of improving the ability to maintain balance. Regular NW improved the ability to maintain balance with eyes open in female residents of adult day care centres. Full article
(This article belongs to the Section Women's Health)
Open AccessArticle
A Look Behind the Scenes at COVID-19: National Strategies of Infection Control and Their Impact on Mortality
Int. J. Environ. Res. Public Health 2020, 17(15), 5616; https://doi.org/10.3390/ijerph17155616 - 04 Aug 2020
Viewed by 472
Abstract
(1) Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began spreading across the globe in December and, as of 9 July 2020, had inflicted more than 550,000 deaths. Public health measures implemented to control the outbreak caused socio-economic havoc in many countries. [...] Read more.
(1) Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began spreading across the globe in December and, as of 9 July 2020, had inflicted more than 550,000 deaths. Public health measures implemented to control the outbreak caused socio-economic havoc in many countries. The pandemic highlighted the quality of health care systems, responses of policymakers in harmony with the population, and socio-economic resilience factors. We suggest that different national strategies had an impact on mortality and case count. (2) Methods: We collected fatality data for 17 countries until 2 June 2020 from public data and associated these with implemented containment measures. (3) Results: The outcomes present the effectiveness of control mechanisms in mitigating the virus for selected countries and the UAE as a special case. Pre-existing conditions defined the needed public health strategies and fatality numbers. Other pre-existing conditions, such as temperature, humidity, median age, and low serum 25-hydroxyvitamin D (25(OH)D) concentrations played minor roles and may have had no direct impact on fatality rates. (4) Conclusions: Prevention, fast containment, adequate public health strategies, and importance of indoor environments were determining factors in mitigating the pandemic. Development of public health strategies adapted to pre-existing conditions for each country and community compliance with implemented policies ensure the successful control of pandemics. Full article
(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)
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Open AccessArticle
Parental Support, Beliefs about Mental Illness, and Mental Help-Seeking among Young Adults in Saudi Arabia
Int. J. Environ. Res. Public Health 2020, 17(15), 5615; https://doi.org/10.3390/ijerph17155615 - 04 Aug 2020
Viewed by 363
Abstract
Mental illness is not uncommon among young adults, but negative attitudes towards mental disorders and lack of parental support might be associated with hesitancy in seeking professional help. This study aimed to examine the relationships of parental support, beliefs about mental illness, and [...] Read more.
Mental illness is not uncommon among young adults, but negative attitudes towards mental disorders and lack of parental support might be associated with hesitancy in seeking professional help. This study aimed to examine the relationships of parental support, beliefs about mental illness, and mental help-seeking among young adults in Saudi Arabia. This quantitative cross-sectional study included a convenience sample of 236 young adults (ages 18–25) with the majority of the total (86.4%) being female. Data were collected via three self-administered questionnaires: The Perceived Parental Support Scale, Beliefs toward Mental Illness scale, and Mental Help Seeking Attitude Scale. Results indicated that the participants had a moderately negative attitude toward mental illness, a moderately positive attitude toward parental support, and a highly positive attitude toward mental help-seeking. No significant relationships were found among the study variables. The study highlights that despite young adults’ positive attitude toward mental help-seeking and parental support, they have negative views toward people with mental illnesses. Educational programs in schools and media are needed to improve attitudes and enhance readiness to interact with people with mental illness. Full article
(This article belongs to the Special Issue Stigma, Health and Wellbeing)
Open AccessFeature PaperArticle
Conceptualizing Pathways of Sustainable Development in the Union for the Mediterranean Countries with an Empirical Intersection of Energy Consumption and Economic Growth
Int. J. Environ. Res. Public Health 2020, 17(15), 5614; https://doi.org/10.3390/ijerph17155614 - 04 Aug 2020
Viewed by 552
Abstract
The availability of sufficient and trustworthy energy services at the reasonable cost in a securely and environmentally friendly manner, and conventionality with economic and social development requirements, is an important factor of sustainable development (SD). Energy plays a significant role in eliminating poverty [...] Read more.
The availability of sufficient and trustworthy energy services at the reasonable cost in a securely and environmentally friendly manner, and conventionality with economic and social development requirements, is an important factor of sustainable development (SD). Energy plays a significant role in eliminating poverty and increasing living standards. However, most of the present energy forms of energy supply and consumption are unsustainable. This paper analyzes the association between economic growth (EG), energy consumption (EC), and sustainable development (SD) among other economic factors. The sample of 14 developed and developing member states of the Union for the Mediterranean (UFM) was selected. To deal with the endogeneity issue, the system- generalized method of moment (GMM) model was employed. Moreover, panel co-integration, Granger causality tests, and robustness tests were employed to examine the long-run and short-run causality among variables of interest. The results confirmed the short-run dynamic association from sustainable development (SD) to energy consumption (EC), and economic growth (EG) to sustainable development (SD). Moreover, the results validated the presence of long-run equilibrium association in the equations of EC and sustainable development (SD). The findings of this study will be supportive for the policymakers to formulate sustainable energy policies to stimulate the economic growth (EG) in the way of sustainable development (SD) in the UFM countries. Full article
(This article belongs to the Special Issue Energy Use and Environmental and Public Health)
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Open AccessArticle
Predicting Errors, Violations, and Safety Participation Behavior at Nuclear Power Plants
Int. J. Environ. Res. Public Health 2020, 17(15), 5613; https://doi.org/10.3390/ijerph17155613 - 04 Aug 2020
Viewed by 370
Abstract
Commissioning workers at nuclear power plants have long been ignored in previous studies, although their performance is closely related to the overall safety of plants. This study aimed to explain and predict three types of behavior, i.e., errors, violations, and safety participation, of [...] Read more.
Commissioning workers at nuclear power plants have long been ignored in previous studies, although their performance is closely related to the overall safety of plants. This study aimed to explain and predict three types of behavior, i.e., errors, violations, and safety participation, of commissioning workers, under the general framework of the theory of planned behavior (TPB) and by considering organization and planning factors. The validity of the model was evaluated with a sample of 167 commissioning workers who completed a self-reported questionnaire. The results showed that perceived behavioral control, along with organization and planning, significantly affected all types of behavior. It was also found that violations and errors were a direct result of attitude. Besides, errors were predicted by subjective norm; unexpectedly, this occurred in a positive way. These findings revealed the underlying mechanisms for the development of errors, violations, and safety participation among commissioning workers and provided practical implications for safety improvement at the commissioning workplace. Full article
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Open AccessArticle
Design and Validation of the Adaptation to Change Questionnaire: New Realities in Times of COVID-19
Int. J. Environ. Res. Public Health 2020, 17(15), 5612; https://doi.org/10.3390/ijerph17155612 - 04 Aug 2020
Viewed by 835
Abstract
Emotional and cognitive-behavioral factors influence people’s adaptability to change. Based on this premise, the objective of this study was to develop, evaluate and validate the Adaptation to Change Questionnaire (ADAPTA-10) for identifying those who show poor adaptability to adverse situations, such as those [...] Read more.
Emotional and cognitive-behavioral factors influence people’s adaptability to change. Based on this premise, the objective of this study was to develop, evaluate and validate the Adaptation to Change Questionnaire (ADAPTA-10) for identifying those who show poor adaptability to adverse situations, such as those caused by COVID-19. This study was carried out in a sample of 1160 adults and produced a 10-item instrument with good reliability and validity indices. It is an effective tool useful in research and in clinical practice. Calculation tables are provided for the general Spanish population and by sex to evaluate adaptability to change. The two-dimensional structure proposed in the original model was confirmed. This instrument will enable the needs for adaptation to the new reality associated with COVID-19 to be detected and also other situations in which the subject becomes immersed which demand adaptation strategies in the new situation lived in. Full article
(This article belongs to the Special Issue Mental Health in the Time of COVID-19)
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Open AccessArticle
Tool for Observing Play Outdoors (TOPO): A New Typology for Capturing Children’s Play Behaviors in Outdoor Environments
Int. J. Environ. Res. Public Health 2020, 17(15), 5611; https://doi.org/10.3390/ijerph17155611 - 04 Aug 2020
Viewed by 357
Abstract
Engagement in play has been definitively linked to the healthy development of children across physical, social, cognitive, and emotional domains. The enriched nature of high-quality outdoor play environments can afford a greater diversity of opportunities for play than indoor settings. To more effectively [...] Read more.
Engagement in play has been definitively linked to the healthy development of children across physical, social, cognitive, and emotional domains. The enriched nature of high-quality outdoor play environments can afford a greater diversity of opportunities for play than indoor settings. To more effectively design outdoor play settings, we must better understand how the physical environment supports, or hinders, the different types of play which suit children’s needs and interests. However, play typologies or observation tools available to date do not adequately capture the unique characteristics of outdoor play. This paper outlines the development and testing of the Tool for Observing Play Outdoors (TOPO), a new typology of outdoor play, as well as a systematic field observational protocol which can be used to effectively depict children’s behaviors in outdoor spaces, as well as evaluate the play environment itself. The tool can be deployed in either a collapsed or expanded form to serve the needs of a wide range of studies and environments. This new tool represents a significant advance in the ability to fully and effectively study and plan outdoor play environments to provide more diverse, high-quality play settings that will support the healthy development of children across the spectrum. Full article
(This article belongs to the Special Issue The Environment and Children’s Health)
Open AccessArticle
Spatial Effect of Industrial Energy Consumption Structure and Transportation on Haze Pollution in Beijing-Tianjin-Hebei Region
Int. J. Environ. Res. Public Health 2020, 17(15), 5610; https://doi.org/10.3390/ijerph17155610 - 04 Aug 2020
Viewed by 361
Abstract
Haze pollution has a serious impact on China’s economic development and people’s livelihood. We used data on PM2.5 concentration, industrial energy consumption structure, economic development and transportation in Beijing-Tianjin-Hebei and surrounding cities from 2000 to 2017, and analyzed the spatial effect of [...] Read more.
Haze pollution has a serious impact on China’s economic development and people’s livelihood. We used data on PM2.5 concentration, industrial energy consumption structure, economic development and transportation in Beijing-Tianjin-Hebei and surrounding cities from 2000 to 2017, and analyzed the spatial effect of industrial energy consumption structure and traffic factors on haze pollution by using spatial autoregressive model (SAR) and spatial error model (SEM). The results indicated that: (1) The global spatial correlation analysis showed that haze pollution had a significant positive spatial correlation, and the local spatial correlation analysis showed that the high-high clusters of PM2.5 were located in the south and middle of the region; (2) The change of industrial energy consumption structure was highly correlated with haze pollution, namely, the increase of industrial energy consumption led to the deterioration of environmental quality; (3) The change of economic development was highly correlated with haze pollution. There was no clear EKC relationship between haze pollution and economic development in Beijing-Tianjin-Hebei region and surrounding cities. However, the relationship was similar to inverted U-shaped curve; (4) The change of traffic jam was highly correlated with haze pollution, namely, the increase of fuel consumption per unit road area led to the deterioration of environmental quality. Based on the above results, from the perspective of space, the long-term measures for haze control in Beijing-Tianjin-Hebei and surrounding cities can be explored from the aspects of energy conservation and emission reduction, industrial transfer, vehicle emission control, traffic restrictions and purchase restrictions. Full article
(This article belongs to the Special Issue Spatial Modeling of Air Pollutant Variability)
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Open AccessReview
Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review
Int. J. Environ. Res. Public Health 2020, 17(15), 5609; https://doi.org/10.3390/ijerph17155609 - 04 Aug 2020
Viewed by 385
Abstract
Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions [...] Read more.
Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve. The review was performed according to PRISMA. We used six databases to search for studies published from 2002 to 2019. Out of 5732 studies, 39 measuring one or more defined outcomes were included. Hospital length of stay (LOS) was measured in 23 studies, 16 of which reported a reduction, turnover time (TOT) decreased in six out of eight studies, while the turnaround time (TAT) and on-time starts (OTS) improved in all five and seven studies, respectively. Moreover, eight out of nine studies reported an earlier discharge time, and the boarding time decreased in all four cases. Meanwhile, the readmission rate did not increase in all nine studies. Lastly, staff and patient satisfaction improved in all eight studies. Our findings show that by focusing on reducing non-value-added activities, LH contributed to improving patient flow and efficiency within inpatient care. Full article
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Open AccessArticle
Acute Effects of ACL Injury-Prevention Warm-Up and Soccer-Specific Fatigue Protocol on Dynamic Knee Valgus in Youth Male Soccer Players
Int. J. Environ. Res. Public Health 2020, 17(15), 5608; https://doi.org/10.3390/ijerph17155608 - 04 Aug 2020
Viewed by 475
Abstract
Childhood anterior cruciate ligament (ACL) injuries—which can pose a major risk to a child’s sporting career—have been on the rise in the last few decades. Dynamic knee valgus (DKV) has been linked to an increased risk of ACL injury. Therefore, the aim of [...] Read more.
Childhood anterior cruciate ligament (ACL) injuries—which can pose a major risk to a child’s sporting career—have been on the rise in the last few decades. Dynamic knee valgus (DKV) has been linked to an increased risk of ACL injury. Therefore, the aim of this study was to analyze the acute effects of an ACL injury prevention protocol (ACL-IPP) and a soccer-specific fatigue protocol (SSFP) on DKV in youth male soccer players. The research hypothesis was that DKV would be reduced by the ACL-IPP and increased by the SSFP. Eighteen youth male soccer players were divided according to baseline DKV. Those with moderate or large DKV performed a neuromuscular training protocol based on activation of the abductor and external rotator hip muscles. Those with little or no DKV performed a soccer-specific fatigue protocol. DKV was assessed using the single-leg squat pre- and post-protocols in both legs. The ACL-IPP significantly decreased DKV during single-leg squat (p < 0.01, effect size = 1.39), while the SSFP significantly increased baseline DKV in the dominant leg during single-leg squat (p = 0.012; effect size = 1.74). In conclusion, the ACL-IPP appears to acutely reduce the DKV in youth male soccer players, and the SSFP seems to acutely increase the DKV in those players who showed a light or no DKV in a non-fatigue situation. By using the SSFP, it may be possible to determine which players would benefit from injury prevention programs due to increased DKV during game scenarios, while hip abductor and external rotator neuromuscular training may be beneficial for players who have moderate and severe DKV during single-leg squat under non-fatigued scenarios. Full article
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Open AccessReview
Intimate Partner Violence: A Bibliometric Review of Literature
Int. J. Environ. Res. Public Health 2020, 17(15), 5607; https://doi.org/10.3390/ijerph17155607 - 04 Aug 2020
Viewed by 357
Abstract
Intimate partner violence (IPV) is a worldwide public health problem. Here, a bibliometric analysis is performed to evaluate the publications in the Intimate Partner Violence (IPV) field from 2000 to 2019 based on the Science Citation Index (SCI) Expanded and the Social Sciences [...] Read more.
Intimate partner violence (IPV) is a worldwide public health problem. Here, a bibliometric analysis is performed to evaluate the publications in the Intimate Partner Violence (IPV) field from 2000 to 2019 based on the Science Citation Index (SCI) Expanded and the Social Sciences Citation Index (SSCI) databases. This work presents a detailed overview of IPV from aspects of types of articles, citations, h-indices, languages, years, journals, institutions, countries, and author keywords. The results show that the USA takes the leading position in this research field, followed by Canada and the U.K. The University of North Carolina has the most publications and Harvard University has the first place in terms of h-index. The London School of Hygiene and Tropical Medicine leads the list of average citations per paper. The Journal of Interpersonal Violence, Journal of Family Violence and Violence Against Women are the top three most productive journals in this field, and Psychology is the most frequently used subject category. Keywords analysis indicates that, in recent years, most research focuses on the research fields of “child abuse”, “pregnancy”, “HIV”, “dating violence”, “gender-based violence” and “adolescents”. Full article
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Open AccessArticle
Occurrence and Antimicrobial Resistance Traits of Escherichia coli from Wild Birds and Rodents in Singapore
Int. J. Environ. Res. Public Health 2020, 17(15), 5606; https://doi.org/10.3390/ijerph17155606 - 03 Aug 2020
Viewed by 487
Abstract
Antimicrobial resistance (AMR) in Escherichia coli (E. coli) poses a public health concern worldwide. Wild birds and rodents, due to their mobility, are potential vehicles for transmission of AMR bacteria to humans. Ninety-six wild birds’ faecal samples and 135 rodents’ droppings [...] Read more.
Antimicrobial resistance (AMR) in Escherichia coli (E. coli) poses a public health concern worldwide. Wild birds and rodents, due to their mobility, are potential vehicles for transmission of AMR bacteria to humans. Ninety-six wild birds’ faecal samples and 135 rodents’ droppings samples were collected and analysed in 2017. Forty-six E. coli isolates from wild birds and rodents were subjected to AMR phenotypic and genotypic characterisation. The proportion of E. coli isolates resistant to at least one of the antimicrobials tested from wild birds (80.8%) was significantly higher than that of isolates from rodents (40.0%). The proportion of E. coli isolates resistant to each antimicrobial class for wild birds was 3.8% to 73.1% and that for rodents was 5.0% to 35.0%. Six out of 26 E. coli isolates from wild birds (23.1%) and two out of 20 (10.0%) isolates from rodents were multi-drug resistant (MDR) strains. These MDR E. coli isolates were detected with various antimicrobial resistance genes such as blaTEM-1B and qnrS1 and could be considered as part of the environmental resistome. Findings in this study suggested that wild birds and rodents could play a role in disseminating antimicrobial resistant E. coli, and this underscores the necessity of environment management and close monitoring on AMR bacteria in wild birds and rodents to prevent spreading of resistant organisms to other wildlife animals and humans. Full article
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Open AccessArticle
Schoolteachers’ Knowledge of Attention-Deficit/Hyperactivity Disorder—Current Status and Effectiveness of Knowledge Improvement Program: A Randomized Controlled Trial
Int. J. Environ. Res. Public Health 2020, 17(15), 5605; https://doi.org/10.3390/ijerph17155605 - 03 Aug 2020
Viewed by 476
Abstract
Background: Adequately knowledgeable schoolteachers can play an essential role in early detection and proper treatment of children with attention-deficit/hyperactivity disorder (ADHD) at school. Objectives: To assess the schoolteachers’ knowledge of ADHD and to evaluate the effectiveness of the ADHD knowledge improvement program. Methods: [...] Read more.
Background: Adequately knowledgeable schoolteachers can play an essential role in early detection and proper treatment of children with attention-deficit/hyperactivity disorder (ADHD) at school. Objectives: To assess the schoolteachers’ knowledge of ADHD and to evaluate the effectiveness of the ADHD knowledge improvement program. Methods: A randomized controlled trial study design was followed on 100 primary school teachers from Abha City, Saudi Arabia. Teachers were randomly selected and allocated into trial and control groups. A self-administered questionnaire was used to evaluate teachers’ knowledge about ADHD. After the baseline assessment, participants in the trial group received a two-day ADHD knowledge improvement program. Teachers’ knowledge about ADHD was reassessed using the same questionnaire immediately after finishing the intervention program and after three months in both groups. Results: Only 16% and 22% of trial and control groups, respectively, showed adequate baseline knowledge about ADHD. Teachers’ main sources of information about ADHD were the internet (67%), friends (47%), TV (34%), and reading books (23%). Knowledge of teachers in the trial group significantly improved immediately after the intervention. After three months, these knowledge benefits slightly declined but remained more adequate than those of teachers in the control group. The logistic regression model revealed that being a participant in the trial group and of higher qualification were associated with significant improvement in teachers’ retained knowledge on ADHD (p < 0.001 and p = 0.050, respectively). Conclusions: The majority of male primary school teachers in Abha City, Saudi Arabia, have inadequate knowledge about ADHD. Applying a knowledge improvement program can substantially improve their knowledge of ADHD. Consideration should be given to the integration of ADHD knowledge improvement program into teachers’ educational programs. Full article
(This article belongs to the Section Global Health)
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Open AccessArticle
Measurement Invariance of the Burnout Assessment Tool (BAT) Across Seven Cross-National Representative Samples
Int. J. Environ. Res. Public Health 2020, 17(15), 5604; https://doi.org/10.3390/ijerph17155604 - 03 Aug 2020
Viewed by 767
Abstract
The aim of this study was to investigate the measurement invariance of the Burnout Assessment Tool (BAT) across seven cross-national representative samples. In this study, burnout was modeled as a second-order factor in line with the conceptual definition as a syndrome. The combined [...] Read more.
The aim of this study was to investigate the measurement invariance of the Burnout Assessment Tool (BAT) across seven cross-national representative samples. In this study, burnout was modeled as a second-order factor in line with the conceptual definition as a syndrome. The combined sample consisted of 10,138 participants from countries in Europe and Japan. The data were treated as ordered categorical in nature and a series of models were tested to find evidence for invariance. Specifically, theta parameterization was used in conjunction with the weighted least squares (mean- and variance adjusted) estimation method. The results showed supportive evidence that BAT-assessed burnout was invariant across the samples, so that cross-country comparison would be justifiable. Comparison of effect sizes of the latent means between countries showed that Japan had a significantly higher score on overall burnout and all the first-order factors compared to the European countries. The European countries all scored similarly on overall burnout with no significant difference but for some minor differences in first-order factors between some of the European countries. All in all, the analyses of the data provided evidence that the BAT is invariant across the countries for meaningful comparisons of burnout scores. Full article
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Open AccessArticle
How Does COVID-19 Pandemic Influence the Sense of Belonging and Decision-Making Process of Nursing Students: The Study of Nursing Students’ Experiences
Int. J. Environ. Res. Public Health 2020, 17(15), 5603; https://doi.org/10.3390/ijerph17155603 - 03 Aug 2020
Viewed by 450
Abstract
Financial consideration, internal and external influence, personal goal, and educational achievement always influence the decision-making process and behavior of individuals. Using nursing students as the population, the researcher employed the Social Cognitive Career Theory as the theoretical framework to examine the nursing human [...] Read more.
Financial consideration, internal and external influence, personal goal, and educational achievement always influence the decision-making process and behavior of individuals. Using nursing students as the population, the researcher employed the Social Cognitive Career Theory as the theoretical framework to examine the nursing human resources shortages and how would the COVID-19 pandemic influence the experiences, sense of belonging, and career decision-making process of 58 nursing students in South Korea. The researcher categorized the sharing into two groups, which were before the influence of the COVID-19 pandemic, and the changes during the COVID-19 pandemic. The results indicated that financial consideration was the significant reason why South Korean nursing students decided to study nursing regardless of the COVID-19 pandemic. More importantly, almost all participants decided to leave the nursing profession due to the COVID-19 pandemic and the consideration between financial factor and personal sacrifice. The outcomes of this study provided a blueprint for human resources professionals, government leaders, policymakers, school leaders, and hospital managers to reform their current curriculum and human resources planning to overcome the potential human resources gaps in the soon future due to the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Survey about Psychological Health)
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Open AccessArticle
Assessment of Deoxynivalenol in Wheat, Corn and Its Products and Estimation of Dietary Intake
Int. J. Environ. Res. Public Health 2020, 17(15), 5602; https://doi.org/10.3390/ijerph17155602 - 03 Aug 2020
Viewed by 419
Abstract
The main goal of the present research was to explore the seasonal variation of deoxynivalenol (DON) in wheat, corn, and their products, collected during 2018–2019. Samples of 449 of wheat and products and 270 samples of corn and their products were examined using [...] Read more.
The main goal of the present research was to explore the seasonal variation of deoxynivalenol (DON) in wheat, corn, and their products, collected during 2018–2019. Samples of 449 of wheat and products and 270 samples of corn and their products were examined using reverse-phase liquid chromatography with a UV detector. The findings of the present work showed that 104 (44.8%) samples of wheat and products from the summer season, and 91 (41.9%) samples from winter season were contaminated with DON (concentration limit of detections (LOD) to 2145 µg/kg and LOD to 2050 µg/kg), from summer and winter seasons, respectively. In corn and products, 87 (61.2%) samples from summer and 57 (44.5%) samples from winter season were polluted with DON with levels ranging from LOD to 2967 µg/kg and LOD to 2490 µg/kg, from the summer and winter season, respectively. The highest dietary intake of DON was determined in wheat flour 8.84 µg/kg body weight/day from the summer season, and 7.21 µg/kg body weight/day from the winter season. The findings of the work argued the need to implement stringent guidelines and create awareness among farmers, stakeholders, and traders of the harmful effect of DON. It is mostly observed that cereal crops are transported and stockpiled in jute bags, which may absorb moisture from the environment and produce favorable conditions for fungal growth. Therefore, these crops must store in polyethylene bags during transportation and storage, and moisture should be controlled. It is highly desirable to use those varieties that are more resistant to fungi attack. Humidity and moisture levels need to be controlled during storage and transportation. Full article
(This article belongs to the Special Issue Food Contaminants and Their Risk Assessment)
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Open AccessReview
Mechanical Debridement with Antibiotics in the Treatment of Chronic Periodontitis: Effect on Systemic Biomarkers―A Systematic Review
Int. J. Environ. Res. Public Health 2020, 17(15), 5601; https://doi.org/10.3390/ijerph17155601 - 03 Aug 2020
Viewed by 414
Abstract
In this systematic review, we assessed the effectiveness of systemic antibiotics as an adjunctive therapy to mechanical debridement in improving inflammatory systemic biomarkers, as compared to mechanical debridement alone, among adults with chronic periodontitis. We searched relevant electronic databases for eligible randomized controlled [...] Read more.
In this systematic review, we assessed the effectiveness of systemic antibiotics as an adjunctive therapy to mechanical debridement in improving inflammatory systemic biomarkers, as compared to mechanical debridement alone, among adults with chronic periodontitis. We searched relevant electronic databases for eligible randomized controlled trials. Two review authors independently screened, extracted data, and assessed risk of bias. We conducted meta-analysis, assessed heterogeneity, and assessed certainty of evidence using GRADEPro software. We included 19 studies (n = 1350 participants), representing 18 randomized controlled trials and found very little or no impact of antibiotics on inflammatory biomarkers. A meta-analysis of eight studies demonstrated a mean reduction of 0.26 mm in the periodontal pockets at three months (mean difference [MD] −0.26, 95%CI: −0.36 to −0.17, n = 372 participants, moderate certainty of evidence) in favor of the antibiotics. However, results from five studies reporting clinical attachment level (mm) yielded little or no difference at three months (MD −0.16, 95% CI: −0.35 to 0.03, n = 217 participants) between antibiotic and placebo groups. There is little or no evidence that adjunctive systemic antibiotics therapy improves inflammatory systemic biomarkers, compared to mechanical debridement alone, among adults with chronic periodontitis. Full article
(This article belongs to the Section Oral Health)
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Open AccessArticle
Effects of Ramadan Intermittent Fasting on Gut Hormones and Body Composition in Males with Obesity
Int. J. Environ. Res. Public Health 2020, 17(15), 5600; https://doi.org/10.3390/ijerph17155600 - 03 Aug 2020
Viewed by 424
Abstract
We studied the effects of Ramadan intermittent fasting (RIF) on gut hormones (leptin, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), cholecystokinin (CCK), and ghrelin) in males with obesity. Thirty sedentary males were randomly allocated to either an experimental group (EG, n = 15) or [...] Read more.
We studied the effects of Ramadan intermittent fasting (RIF) on gut hormones (leptin, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), cholecystokinin (CCK), and ghrelin) in males with obesity. Thirty sedentary males were randomly allocated to either an experimental group (EG, n = 15) or a control group (CG, n = 15). The EG group completed their Ramadan fasting rituals (30 days), whereas the CG continued with their normal daily habits. Blood samples were collected at four time points: 24 h before the start of Ramadan (T0), on the 15th day of Ramadan (T1), the day after the end of Ramadan (T2) and 21 days after Ramadan (T3). There were significant pre-to-post improvements for leptin (p = 0.01, d = 1.52), GLP-1 (p = 0.022, d = 0.75), PYY (p = 0.031, d = 0.69) and CCK (p = 0.027, d = 0.81) in the EG, with no interaction effect for ghrelin (p = 0.74; d = 0.008). No significant changes (p > 0.05) occurred in plasma volume variations (ΔPV) after RIF in both EG (−0.03 ± 0.01%) and CG (0.06 ± 0.07%). RIF represents an effective strategy to modify appetite-regulating hormones, leading to improved body composition indices and reduced obesity. Full article
(This article belongs to the Special Issue Nutrition Styles and Obesity)
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Open AccessFeature PaperArticle
An Anti-Stigma Course for Occupational Therapy Students in Taiwan: Development and Pilot Testing
Int. J. Environ. Res. Public Health 2020, 17(15), 5599; https://doi.org/10.3390/ijerph17155599 - 03 Aug 2020
Viewed by 412
Abstract
Attitudes of healthcare professionals towards people with disorders/disabilities are important for the development of therapeutic relationships, as well as to the evaluation and intervention processes. Therefore, it is critical to be aware and reduce stigmatizing attitudes in future healthcare professionals. An 18-week anti-stigma [...] Read more.
Attitudes of healthcare professionals towards people with disorders/disabilities are important for the development of therapeutic relationships, as well as to the evaluation and intervention processes. Therefore, it is critical to be aware and reduce stigmatizing attitudes in future healthcare professionals. An 18-week anti-stigma course was developed for occupational therapy students based on literature review and focus group interview. The course consisted of three components, including social contact, roleplaying, and critical reflection strategies. A quasi-experimental design was implemented to evaluate participants at three time points (i.e., pre-test, post-test, and one year after completion) using the Social Distance Scale and several questionnaires (i.e., stigmatising attitudes towards mental illness, physical disabilities, and children with emotional behavioural disorders). A total of 16 students completed the course and had significantly decreased social distance and stigmatising attitudes towards mental illness and emotional behavioural disorders in the post-test. These decreases remained one year later. The results support the provision of an anti-stigma course for occupational therapy students to reduce stigmatising attitudes. Future research should extend the anti-stigma course to occupational therapy students at other universities to increase both the sample size and overall generalisability. Full article
(This article belongs to the Special Issue Stigma, Health and Wellbeing)
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