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Int. J. Environ. Res. Public Health, Volume 17, Issue 18 (September-2 2020) – 445 articles

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Open AccessBrief Report
Association between Sexual Habits and Sexually Transmitted Infections at a Specialised Centre in Granada (Spain)
Int. J. Environ. Res. Public Health 2020, 17(18), 6881; https://doi.org/10.3390/ijerph17186881 (registering DOI) - 21 Sep 2020
Abstract
Sexually transmitted infections are an important public health issue. The purpose of this study is to analyse the association between different sexual habits and the prevalence of sexually transmitted infections in the population of Granada who consult with a specialised centre. An observational, [...] Read more.
Sexually transmitted infections are an important public health issue. The purpose of this study is to analyse the association between different sexual habits and the prevalence of sexually transmitted infections in the population of Granada who consult with a specialised centre. An observational, cross-sectional study was conducted based on the medical records of 678 people from the Sexually Transmitted Diseases and Sexual Orientation Centre of Granada, who were diagnosed positively or negatively with a sexually transmitted infection, during the 2000−2014 period. Sociodemographic and clinical data, as well as data on frequency and type of sexual habits, frequency of condom use and sexually transmitted infection positive or negative diagnosis were collected. Univariate and bivariate analyses were conducted. The most popular sexual habits were vaginal intercourse, oral sex (mouth–vagina and mouth–penis) and the least popular were anus–mouth and anal sex. The use of condom is frequent in vaginal and anal sex and less frequent in oral sex. Sexually transmitted infection is associated with mouth–penis (p = 0.004) and mouth–vagina (p = 0.023) oral sex and anal sex (p = 0.031). It is observed that there is a relationship between the presence of STIs and oral sex practices, people having such practices being the ones who use condoms less frequently. There is also a relationship between anal sex and the prevalence of STIs, although in such sexual practice the use of condom does prevail. Full article
(This article belongs to the Special Issue Policies and Strategies in Sexual and Reproductive Health)
Open AccessReview
Theoretical Boundary Conditions of Partner Buffering in Romantic Relationships
Int. J. Environ. Res. Public Health 2020, 17(18), 6880; https://doi.org/10.3390/ijerph17186880 (registering DOI) - 21 Sep 2020
Abstract
Attachment insecurity is consequential for both personal and relationship wellbeing. Some research has documented that partner buffering can downregulate insecure individuals’ immediate feelings of distress, allowing them to feel more secure at least temporarily. The benefits of partner buffering, however, may be limited [...] Read more.
Attachment insecurity is consequential for both personal and relationship wellbeing. Some research has documented that partner buffering can downregulate insecure individuals’ immediate feelings of distress, allowing them to feel more secure at least temporarily. The benefits of partner buffering, however, may be limited by several contextual factors. In this article, we identify boundary conditions that may curb or amplify the benefits of partner buffering for both targets (those who receive buffering) and agents (those who enact buffering). We suggest that motivation, ability, and timing may all affect partner buffering outcomes for targets and agents. If partner buffering is delivered in an adaptive way that does not reinforce the target’s insecure tendencies, it may help insecure targets learn that they can trust and depend on their partners (agents), which may facilitate greater security in targets. We recommend that future research consider these contextual factors and examine partner buffering as an inherently dyadic relationship process capable of enhancing attachment security. Full article
(This article belongs to the Special Issue Advances in Fostering Attachment Security)
Open AccessArticle
Feeling Connected after Experiencing Digital Nature: A Survey Study
Int. J. Environ. Res. Public Health 2020, 17(18), 6879; https://doi.org/10.3390/ijerph17186879 (registering DOI) - 21 Sep 2020
Abstract
Digital nature can provide a substitute for real nature for those who have limited access to green space, or are confined to their homes, for example during the worldwide COVID-19 lockdown. In a large-scale online survey, respondents (N = 1203) watched videos [...] Read more.
Digital nature can provide a substitute for real nature for those who have limited access to green space, or are confined to their homes, for example during the worldwide COVID-19 lockdown. In a large-scale online survey, respondents (N = 1203) watched videos of digital nature, varying in terms of type of nature (wild versus tended nature) and spaciousness. Results show a significant increase of feelings of connectedness to the community after watching digital nature. Furthermore, tended nature scenes elicited more social aspirations than wild nature scenes. A multiple regression model further shows that living further away from nature was a significant predictor for loneliness scores, while number of nature interactions during a week was not. Results of this study confirm the importance of nature interaction for mental and social wellbeing for the general population and stress the potential of digital nature as a complementary strategy. These findings are of particular relevance to those who lack access to nature due to old age and related mobility constraints or a lockdown. Full article
(This article belongs to the Section Digital Health)
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Open AccessArticle
Physical Activity Change during COVID-19 Confinement
Int. J. Environ. Res. Public Health 2020, 17(18), 6878; https://doi.org/10.3390/ijerph17186878 (registering DOI) - 21 Sep 2020
Abstract
Background: The lockdown and social distancing caused by COVID-19 may influence common health behavior. The unprecedent worldwide confinement, in which Spain has been one of the most affected—with severe rules governing confinement—may have changed physical activity (PA) and sedentary habits due to prolonged [...] Read more.
Background: The lockdown and social distancing caused by COVID-19 may influence common health behavior. The unprecedent worldwide confinement, in which Spain has been one of the most affected—with severe rules governing confinement—may have changed physical activity (PA) and sedentary habits due to prolonged stays at home. Purpose: The aim of this study is to evaluate how self-reported PA and sedentary time (ST) have changed during confinement in the Spanish population. Methods: 3800 healthy adults (age 18–64 years) residing in Spain answered the international physical activity questionnaire short (IPAQ-S) twice between 23 March and 1 April (confinement). Data analysis was carried out taking into consideration meeting general PA recommendations before confinement, age and gender. Results: Self-reported PA decreased significantly during confinement in our sample. Vigorous physical activities (VPA) and walking time decreased by 16.8% (p < 0.001) and 58.2% (p < 0.001), respectively, whereas ST increased by 23.8% (p < 0.001). The percent of people fulfilling the 75 min/week of VPA recommendation decreased by 10.7% (p < 0.001) while the percent of people who reached 150 min/week of moderate activity barely changed (1.4%). The group that performed the most VPA before confinement showed the greatest decrease (30.5%, p < 0.001). Men reduced time in VPA more than women (21% vs 9%, respectively) who even increased time in moderate PA by 11% (p < 0.05) and reported less increase in ST than men (35% vs 25.3%, respectively). Conclusion: The Spanish adult population, especially young people, students and very active men, decreased daily self-reported PA and increased ST during COVID-19 confinement. Full article
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
Open AccessComment
Prevalence Studies on CKDu Need Stringent Reporting on Outcomes to Enhance Comparability
Int. J. Environ. Res. Public Health 2020, 17(18), 6877; https://doi.org/10.3390/ijerph17186877 (registering DOI) - 21 Sep 2020
Abstract
Prevalence studies on Chronic Kidney Disease of unknown etiology (CKDu) need stringent reporting on outcomes following existing guidelines. Only by doing so, the much-needed comparisons between occupations, regions and climates for the elucidation of the etiology/etiologies of CKDu, and subsequently for its prevention, [...] Read more.
Prevalence studies on Chronic Kidney Disease of unknown etiology (CKDu) need stringent reporting on outcomes following existing guidelines. Only by doing so, the much-needed comparisons between occupations, regions and climates for the elucidation of the etiology/etiologies of CKDu, and subsequently for its prevention, are possible. We, here, comment on methodological issues in a recently published study on rice farmers from West Java, Indonesia. Full article
Open AccessArticle
Factors Associated with Latent Tuberculosis Infection among the Hospital Employees in a Tertiary Hospital of Northeastern Thailand
Int. J. Environ. Res. Public Health 2020, 17(18), 6876; https://doi.org/10.3390/ijerph17186876 (registering DOI) - 21 Sep 2020
Abstract
Latent tuberculosis infection (LTBI) can develop into tuberculosis (TB). The WHO requires the discovery and management of LTBI among high-risk groups. Health care workers (HCWs) constitute a high-risk group. Factors associated with LTBI among HCWs in Thailand need further study. The current study [...] Read more.
Latent tuberculosis infection (LTBI) can develop into tuberculosis (TB). The WHO requires the discovery and management of LTBI among high-risk groups. Health care workers (HCWs) constitute a high-risk group. Factors associated with LTBI among HCWs in Thailand need further study. The current study aimed to explore the factors related to LTBI among Thai HCWs. A hospital-based, matched, case-control study was conducted. All cases and controls were HCWs at a tertiary hospital in northeastern Thailand. Between 2017 and 2019, a total of 85 cases of interferon-γ release assays (IGRAs)-proven LTBI, and 170 control subjects were selected from a hospital (two controls per case). The two recruited controls were individually matched with LTBI cases by sex and age (±5 years). Secondary data were obtained from the occupational health and safety office. Case HCWs had a higher proportion of significant factors than control HCWs (i.e., working closely with pulmonary TB—94.1% vs. 88.8%, and working in the area of aerosol-generating procedures (AGPs) 81.2% vs. 69.4%). The bivariate conditional logistic regression showed that the occurrence of LTBI in HCWs was statistically significant (p-value < 0.05), particularly with respect to: workplaces of AGPs (crude OR = 1.90, 95% CI: 1.01–3.58, p = 0.041); among HCWs performing AGP (crude OR = 2.04, 95% CI: 1.20, 3.48, p = 0.007); and, absent Bacille Calmette-Guérin (BCG) scar (crude OR = 2.59, 95% CI: 1.50–4.47, p = 0.001). Based on the multivariable conditional logistics analysis, HCWs who performed AGPs while contacting TB cases had a statistically significant association with LTBI (adjusted OR = 1.82, 95% CI: 1.04–3.20, p = 0.035). HCWs who reported the absence of a BCG scar had a statistically significant association with LTBI (adjusted OR = 2.49, 95% CI: 1.65–5.36, p = 0.001), whereas other factors including close contact with TB (adjusted OR = 2.44, 95% CI: 0.74, 8.09, p = 0.123) were not significantly associated with LTBI. In conclusion, HCWs who performed AGP and were absent a BCG scar had a significant association with LTBI, while other factors played a less critical role. Full article
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Open AccessProtocol
Go Zika Go: A Feasibility Protocol of a Modified Ride-on Car Intervention for Children with Congenital Zika Syndrome in Brazil
Int. J. Environ. Res. Public Health 2020, 17(18), 6875; https://doi.org/10.3390/ijerph17186875 (registering DOI) - 21 Sep 2020
Abstract
Children with congenital Zika syndrome (CZS) present severe motor disability and can benefit from early powered mobility. The Go Zika Go project uses modified ride-on toy cars, which may advance the body functions, activities, and participation of children. This paper describes the study [...] Read more.
Children with congenital Zika syndrome (CZS) present severe motor disability and can benefit from early powered mobility. The Go Zika Go project uses modified ride-on toy cars, which may advance the body functions, activities, and participation of children. This paper describes the study protocol aiming to assess the feasibility of a modified ride-on car intervention for children with CZS in Brazil. A mixed-methods design with a multiple 1-week baseline, 3-month intervention, and 1-month follow-up will be implemented. Modified ride-on car training sessions will be conducted three times a week at the participants’ home or in the clinic. The primary outcome will be a narrative description of study feasibility (photovoice method, focus groups, parent feasibility questionnaire and assessment of learning powered mobility). Secondary outcomes will be switch activation, driving sessions journal, social-cognitive interactions, mobility (pediatric evaluation of disability inventory computer adaptive test), goal attainment scaling (GAS), and participation (young children’s participation and environment measure). Go Zika Go is expected to be viable and to improve function, activity, and participation of children with CZS, providing a low-cost, evidence-based rehabilitation option that will be relevant to early child development in a global perspective. Full article
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Open AccessReview
In Search of Concrete Outcomes—A Systematic Review on the Effectiveness of Educational Interventions on Reducing Acute Occupational Injuries
Int. J. Environ. Res. Public Health 2020, 17(18), 6874; https://doi.org/10.3390/ijerph17186874 - 20 Sep 2020
Abstract
Education is a common strategy used to prevent occupational injuries. However, its effectiveness is often measured using surrogate measures instead of true injury outcomes. To evaluate the effectiveness of workplace educational interventions, we selectively analyzed studies that reported injury outcomes (PROSPERO ID: CRD42019140631). [...] Read more.
Education is a common strategy used to prevent occupational injuries. However, its effectiveness is often measured using surrogate measures instead of true injury outcomes. To evaluate the effectiveness of workplace educational interventions, we selectively analyzed studies that reported injury outcomes (PROSPERO ID: CRD42019140631). We searched databases for peer-reviewed journal articles and sources of grey literature such as abstracts, registered trials, and theses published between 2000 and 2019. Studies on educational interventions that reported fatal or non-fatal occupational injury outcomes were selected. Two reviewers independently and in duplicate screened the studies, extracted data, and assessed risk of bias. Heterogeneity in the data precluded meta-analysis, and the results were reviewed narratively. In total, 35 studies were included. Of which, 17 found a significant reduction in injuries, most of which featured a multifaceted approach or non-didactic education. The remaining studies either described equivocal results or did not report statistical significance. Overall, interventions in the manufacturing industry were more effective than those in the construction sector. Risk of bias among included studies was moderate to high. In conclusion, educational interventions could be an effective part of multifaceted injury prevention programs. However, over-reliance on didactic education alone is not advised. Full article
(This article belongs to the Special Issue Non-Technical Perspectives for Improving Safety in the Workplace)
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Open AccessArticle
Predicting Daily Sheltering Arrangements among Youth Experiencing Homelessness Using Diary Measurements Collected by Ecological Momentary Assessment
Int. J. Environ. Res. Public Health 2020, 17(18), 6873; https://doi.org/10.3390/ijerph17186873 - 20 Sep 2020
Abstract
Youths experiencing homelessness (YEH) often cycle between various sheltering locations including spending nights on the streets, in shelters and with others. Few studies have explored the patterns of daily sheltering over time. A total of 66 participants completed 724 ecological momentary assessments that [...] Read more.
Youths experiencing homelessness (YEH) often cycle between various sheltering locations including spending nights on the streets, in shelters and with others. Few studies have explored the patterns of daily sheltering over time. A total of 66 participants completed 724 ecological momentary assessments that assessed daily sleeping arrangements. Analyses applied a hypothesis-generating machine learning algorithm (component-wise gradient boosting) to build interpretable models that would select only the best predictors of daily sheltering from a large set of 92 variables while accounting for the correlated nature of the data. Sheltering was examined as a three-category outcome comparing nights spent literally homeless, unstably housed or at a shelter. The final model retained 15 predictors. These predictors included (among others) specific stressors (e.g., not having a place to stay, parenting and hunger), discrimination (by a friend or nonspecified other; due to race or homelessness), being arrested and synthetic cannabinoids use (a.k.a., “kush”). The final model demonstrated success in classifying the categorical outcome. These results have implications for developing just-in-time adaptive interventions for improving the lives of YEH. Full article
Open AccessArticle
Gender Influence on Students, Parents, and Teachers’ Perceptions of What Children and Adolescents in Germany Need to Cycle to School: A Concept Mapping Study
Int. J. Environ. Res. Public Health 2020, 17(18), 6872; https://doi.org/10.3390/ijerph17186872 - 20 Sep 2020
Abstract
Active commuting to school is highly recommended for several reasons, and in the decision-making process for doing so, a child interacts with parents and teachers. Until now, these three interactors’ gender-specific perspectives on children and adolescents’ need for cycling to school have been [...] Read more.
Active commuting to school is highly recommended for several reasons, and in the decision-making process for doing so, a child interacts with parents and teachers. Until now, these three interactors’ gender-specific perspectives on children and adolescents’ need for cycling to school have been unavailable. Thus, our concept mapping study analyzed the needs of 12- to 15-year-olds in Germany for cycling to and from school daily, as perceived by students, parents, and teachers stratified by gender. From November 2019 to February 2020, 136 students, 58 parents, and 29 teachers participated. Although 87.8% of girls and 100% of boys owned a bicycle, only 44.4% of girls and 72.9% of boys cycled to school. On average, girls cycled to school on 1.6 ± 2.0 days a week and boys on 2.7 ± 2.0 days a week. A “bicycle and related equipment,” the “way to school,” and “personal factors” were reported needs, perceived by students and teachers of both genders and by mothers. Girls reported the additional gender-specific need for “social behavior in road traffic,” mothers and female teachers reported “role of parents,” and female teachers reported a “sense of safety.” This study’s findings could inspire the development of school-based bicycle interventions. Full article
(This article belongs to the Special Issue Active Commuting and Active Transportation)
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Open AccessArticle
Gender, Physical Self-Perception and Overall Physical Fitness in Secondary School Students: A Multiple Mediation Model
Int. J. Environ. Res. Public Health 2020, 17(18), 6871; https://doi.org/10.3390/ijerph17186871 - 20 Sep 2020
Abstract
Background: Physical self-perception is often related with better physical fitness perception in adolescents. Moreover, it is an important social cognitive perspective to provide suitable mental health in this population. However, this relationship is unequal between boys and girls. The physical fitness is a [...] Read more.
Background: Physical self-perception is often related with better physical fitness perception in adolescents. Moreover, it is an important social cognitive perspective to provide suitable mental health in this population. However, this relationship is unequal between boys and girls. The physical fitness is a marker of health in young population. The aims of the present study were the following: (1) to compare physical self-perception and self-reported overall physical fitness (OPF) between boys and girls (gender) and body mass index (BMI) status, and (2) to determine the mediating role of all physical self-perception subscales (except physical condition) and BMI status in the link between gender and OPF in adolescent students. Methods: This cross-sectional study consisted of 85 adolescent students of secondary school between 12 and 17 years of age; 41 were boys (Mage = 14.6, SD = 1.7) and 44 were girls (Mage = 14.4, SD = 1.6). Adolescent participants completed all clinical characteristics by body composition measures (age, body weight, body height, and BMI). Physical self-perception was assessed by the physical self-perception profile (PSPP) whereas the international fitness scale (IFIS) was used to predict the self-reported OPF of adolescents in the present study. Results: Gender (boys and girls) differed significantly in all PSPP subscales and OPF, whereas the BMI status (underweight = 19 students, normal weight = 53 students, overweight/obese = 13 students) showed significant differences in all clinical characteristics, physical condition (PSPP), and OPF. A multiple mediation analysis was performed using bias corrected bootstrap. This multiple mediation analysis revealed that all PSPP subscales were significant mediators between gender and OPF: attractive body (p = 0.013), sport competence (p = 0.009), physical strength (p = 0.002), and self-confidence (p = 0.002). The total direct effect of gender on OPF was significant (p = 0.002). Moreover, the multiple mediation estimated a completely standardized indirect of X on Y for attractive body (effect = 0.109), sport competence (effect = 0.066), physical strength (effect = 0.130), and self-confidence (effect = 0.193). Conclusions: These findings contribute to understanding the link between gender and OPF in adolescent students and the mediation of physical self-perception and OPF in this relationship. In addition, strategies focused to improve self-confidence and physical self-perception are necessary in female adolescent students, because boys showed better physical self-perception in all PSPP subscales. Girls are a risk group because they report low physical self-confidence with their respective insecurity feelings and psychological disorders. Thus, personal physical self-perception must be considered as an important social cognitive perspective to provide suitable mental health in children and adolescents. Full article
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Open AccessArticle
Increased Mortality Risk in People with Type 2 Diabetes Mellitus in Lithuania
Int. J. Environ. Res. Public Health 2020, 17(18), 6870; https://doi.org/10.3390/ijerph17186870 - 20 Sep 2020
Abstract
This retrospective cohort study aimed to analyze overall and cause-specific mortality risk in people with type 2 diabetes mellitus (T2DM) in Lithuania. Information on the diagnosis of T2DM and glucose-lowering medication was obtained from the National Health Insurance Fund database, causes of death–from [...] Read more.
This retrospective cohort study aimed to analyze overall and cause-specific mortality risk in people with type 2 diabetes mellitus (T2DM) in Lithuania. Information on the diagnosis of T2DM and glucose-lowering medication was obtained from the National Health Insurance Fund database, causes of death–from death certificates. Sex, age, and calendar period-standardized mortality ratios (SMRs) were calculated. In addition, 89,512 patients were followed-up between 2010 and 2017, contributing to the observation period of 592,321 person-years. Overall mortality risk was increased for both sexes (overall SMR = 1.35, 95% confidence interval (CI) 1.34–1.37). Greatest mortality risk was in the age group of 40–49 years at diabetes diagnosis (SMR = 1.68, 95% CI 1.60–1.76) and among those who had died before the age of 50 (SMR = 22.04, 95% CI 18.82–25.81). Patients treated with insulin only had the highest SMR (2.43, 95% CI 2.32–2.55). Mortality risk increased with increasing diabetes duration and was higher in women in all these groups. The highest cause-specific SMRs were infection-related causes (SMR = 1.44), particularly septicemia (SMR = 1.78), diseases of the circulatory system (SMR = 1.42), especially ischemic heart (SMR = 1.46) and cerebrovascular diseases (SMR = 1.38), as well as diseases of the digestive system (SMR = 1.35). Cancer mortality risk was elevated for women (SMR = 1.13), but not for men (SMR = 0.93). In conclusion, people with T2DM had an excess mortality risk, which was higher in women compared to men, younger people, in those who were diagnosed with T2DM at a younger age, had longer diabetes duration, and who required treatment with insulin. Full article
(This article belongs to the Special Issue The Burden of Diabetes on Health Services)
Open AccessArticle
The Experience of Do-Not-Resuscitate Orders and End-of-Life Care Discussions among Physicians
Int. J. Environ. Res. Public Health 2020, 17(18), 6869; https://doi.org/10.3390/ijerph17186869 - 20 Sep 2020
Abstract
Physicians have a responsibility to discuss do-not-resuscitate (DNR) decisions and end-of-life (EOL) care with patients and family members. The aim of this study was to explore the DNR and EOL care discussion experience among physicians in Taiwan. A qualitative study was conducted with [...] Read more.
Physicians have a responsibility to discuss do-not-resuscitate (DNR) decisions and end-of-life (EOL) care with patients and family members. The aim of this study was to explore the DNR and EOL care discussion experience among physicians in Taiwan. A qualitative study was conducted with 16 physicians recruited from the departments of hospice care, surgery, internal medicine, emergency, and the intensive care unit. The interview guidelines included their DNR experience and process and EOL care discussions, as well as their concerns, difficulties, or worries in discussions. Thematic analysis was used to analyze data. Four themes were identified. First, family members had multiple roles in the decision process. Second, the characteristics of the units, including time urgency and relationships with patients and family members, influenced physicians’ work. Third, the process included preparation, exploration, information delivery, barrier solution, and execution. Fourth, physicians shared reflections on their ability and the conflicts between law, medical professionals, and the best interests of patients. Physicians must consider not only patients’ but also family members’ opinions and surmount several barriers in decision-making. They also experienced negative and positive impacts from these discussions. Full article
(This article belongs to the Section Health Care Sciences & Services)
Open AccessArticle
Estimation on Fixed-Bed Column Parameters of Breakthrough Behaviors for Gold Recovery by Adsorption onto Modified/Functionalized Amberlite XAD7
Int. J. Environ. Res. Public Health 2020, 17(18), 6868; https://doi.org/10.3390/ijerph17186868 - 20 Sep 2020
Abstract
The objective of this paper was to evaluate the potential of a new adsorbent material to recover Au (III) from real wastewater, in a column with a fixed bed in a dynamic regime. The material was obtained through functionalization, by impregnation of the [...] Read more.
The objective of this paper was to evaluate the potential of a new adsorbent material to recover Au (III) from real wastewater, in a column with a fixed bed in a dynamic regime. The material was obtained through functionalization, by impregnation of the commercial resin, Amberlite XAD 7 type, with L-glutamic acid, which has active groups –NH2 and –COOH. The goal of the experiments was to follow the correlation of fixed-bed column specific adsorption parameters (the effluent volume, the amounts of adsorbent, heights of the adsorbent layer in column) with the time necessary to cross the column. The experimental data obtained were modeled, using the Bohart–Adams, Yoon–Nelson Thomas and Clark models, to establish the mechanism of the Au (III) recovery process, in a dynamic regime. Also, we established the number of cycles for adsorption–desorption for which the new material can be used. We used 5% HNO3 (5%) as desorption agent in five adsorption–desorption cycles, until the process was no longer efficient. The degree of desorption varied between 84% and 34% from cycle 1 to cycle 5. Full article
(This article belongs to the collection Environmental Chemistry and Technology)
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Open AccessArticle
How Older People Experience the Age-Friendliness of Their City: Development of the Age-Friendly Cities and Communities Questionnaire
Int. J. Environ. Res. Public Health 2020, 17(18), 6867; https://doi.org/10.3390/ijerph17186867 - 20 Sep 2020
Abstract
The World Health Organization engages cities and communities all over the world in becoming age-friendly. There is a need for assessing the age-friendliness of cities and communities by means of a transparently constructed and validated tool which measures the construct as a whole. [...] Read more.
The World Health Organization engages cities and communities all over the world in becoming age-friendly. There is a need for assessing the age-friendliness of cities and communities by means of a transparently constructed and validated tool which measures the construct as a whole. The aim of this study was to develop a questionnaire measuring age-friendliness, providing full transparency and reproducibility. The development and validation of the Age Friendly Cities and Communities Questionnaire (AFCCQ) followed the criteria of the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN). Four phases were followed: (1) development of the conceptual model, themes and items; (2) initial (qualitative) validation; (3) psychometric validation, and (4) translating the instrument using the forward-backward translation method. This rigorous process of development and validation resulted in a valid, psychometrically sound, comprehensive 23-item questionnaire. This questionnaire can be used to measure older people’s experiences regarding the eight domains of the WHO Age-Friendly Cities model, and an additional financial domain. The AFCCQ allows practitioners and researchers to capture the age-friendliness of a city or community in a numerical fashion, which helps monitor the age-friendliness and the potential impact of policies or social programmes. The AFCCQ was created in Dutch and translated into British-English. Full article
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Open AccessArticle
Movement Behaviors and Perceived Loneliness and Sadness within Alaskan Adolescents
Int. J. Environ. Res. Public Health 2020, 17(18), 6866; https://doi.org/10.3390/ijerph17186866 - 20 Sep 2020
Abstract
Physical activity, screen use, and sleep are behaviors that integrate across the whole day. However, the accumulative influence of meeting recommendations for these 24-h movement behaviors on the mental health of Alaskan adolescents has not been examined. The purpose of this study was [...] Read more.
Physical activity, screen use, and sleep are behaviors that integrate across the whole day. However, the accumulative influence of meeting recommendations for these 24-h movement behaviors on the mental health of Alaskan adolescents has not been examined. The purpose of this study was to examine the associations between movement behaviors, loneliness, and sadness within Alaskan adolescents. Data were obtained from the 2019 Alaska Youth Risk Behavior Survey (YRBS). The number of adolescents participating in the 2019 Alaska YRBS was 1897. Associations between meeting recommendations for movement behaviors with loneliness and sadness were examined using weighted logistic regression models, adjusted for age, sex, race/ethnicity, and body mass index (BMI). Approximately 5.0% of the sample met recommendations for all three movement behaviors. Meeting 2 or 3 movement behavior recommendations was associated with lower odds of loneliness (odds ratio (OR) range = 0.23 to 0.44, p < 0.01). Additionally, meeting 1 to 3 movement behavior recommendations was associated with lower odds of sadness (OR range = 0.29 to 0.52, p < 0.05). Joint association analyses determined that these relationships were primarily driven by meeting the sleep recommendation for loneliness and meeting the screen use recommendation for sadness. The results support use of multiple movement-based behavior programming to attenuate feelings of loneliness and sadness within Alaskan adolescents. Full article
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Open AccessArticle
The Protective Association of Trait and Ability Emotional Intelligence with Adolescent Tobacco Use
Int. J. Environ. Res. Public Health 2020, 17(18), 6865; https://doi.org/10.3390/ijerph17186865 - 20 Sep 2020
Abstract
The present study is one of the first to analyze the predictive capacity of both trait and ability Emotional Intelligence (EI) based on the Mayer and Salovey model, in relation to tobacco use in a sample of Spanish adolescents. In this study, 799 [...] Read more.
The present study is one of the first to analyze the predictive capacity of both trait and ability Emotional Intelligence (EI) based on the Mayer and Salovey model, in relation to tobacco use in a sample of Spanish adolescents. In this study, 799 students between the ages of 12 and 16 participated. A self-report on trait EI, an EI peak performance test, and questions about habits relating to tobacco use were administered. This cross-sectional study developed a quantitative and correlation-type methodology. The main results of the regression analyses, once the sex and age of the participants were controlled, revealed negative associations between the factors of clarity and emotional repair of the trait EI with respect to the variables of tobacco use, and a positive association was found for them and emotional attention. By comparison, with respect to ability EI, emotional perception and understanding were inversely related to adolescent tobacco use. These results underscore the importance of EI skills as protective factors against early initiation and subsequent tobacco abuse. Full article
Open AccessArticle
Are the Parents’ and Their Children’s Physical Activity and Mode of Commuting Associated? Analysis by Gender and Age Group
Int. J. Environ. Res. Public Health 2020, 17(18), 6864; https://doi.org/10.3390/ijerph17186864 - 20 Sep 2020
Abstract
Background: Some studies have reported a positive parent–child association between physical activity (PA), but few have examined the difference in these associations concerning both genders. The objective of this study was to establish the association between moderate to vigorous physical activity (MVPA) and [...] Read more.
Background: Some studies have reported a positive parent–child association between physical activity (PA), but few have examined the difference in these associations concerning both genders. The objective of this study was to establish the association between moderate to vigorous physical activity (MVPA) and mode of commuting (MC) of the parents with their children by gender and age group. Methods: This cross-sectional study included 686 mothers and fathers (43.4 ± 6.5 years old) and their children (children 9.7 ± 1.7 y. and adolescents 14.0 ± 1.7 y.). Each participant completed a questionnaire on PA and MC. Chi-square test, odds ratio for categorical variables, and lineal regressions for continuous variables were used to examine the parent–child associations. Results: An inverse association was found between fathers–children in the weekend MVPA in children and between mothers–adolescents in out-of-school and weekend MVPA. An inverse association was found in MVPA between mothers-girls, and the different parents’ MC to work was positively associated with the MC to school in children and adolescents except for the association AC parents–adolescents. The AC was mainly associated between mothers and girls and boys. Conclusions: A weak association in parent–child MVPA but a strong association in MC between parent–child was found. Full article
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Open AccessReview
A Historical Analysis of Randomized Controlled Trials in Rotator Cuff Tears
Int. J. Environ. Res. Public Health 2020, 17(18), 6863; https://doi.org/10.3390/ijerph17186863 - 20 Sep 2020
Abstract
Background and objectives: Our research aimed to evaluate the quality of reporting of randomized controlled trials (RCTs) linked to rotator cuff (RC) tears. The present study analyzed factors connected to the quality of the RCTs and trends in the quality of reporting through [...] Read more.
Background and objectives: Our research aimed to evaluate the quality of reporting of randomized controlled trials (RCTs) linked to rotator cuff (RC) tears. The present study analyzed factors connected to the quality of the RCTs and trends in the quality of reporting through time. Materials and Methods: The online databases used to search all RCTs on the topic of RC surgery completed until March 2020 were PubMed and Ovid (MEDLINE). The quality of reporting was evaluated using the modified Coleman methodology score (MCMS) and the consolidated standards of reporting trials (CONSORT). Results: The online search found 957 articles. Finally, 183 studies were included in the quantitative synthesis. A total of 97 (53%) of 183 studies had a level of evidence I and 86 (47%) of 183 studies had a level of evidence II, according to the Oxford Center of Evidence Based Medicine (EBM). A statistically significant difference in MCMS between articles written before 2010 and articles written after 2010 was found. Articles written after 2010 had, on average, the highest Coleman score. The average number of CONSORT checklist items for each article across all analyzed RCTs was 21.67. The 37 studies completed up to 2010 averaged a number of checklist items of 19.97 and the studies completed between 2011 and 2019 averaged a number of checklist items of 22.10. A statistically significant difference in the number of checklist items between articles written before 2010 and articles written after 2010 was found. Articles written after 2010 had on average more checklist items. However, low correlation (0.26) between the number of checklist items for each article and the respective Coleman score was found. On the other hand, articles with the CONSORT diagram had a significantly high Coleman score. Conclusions: An improvement in the quantity and quality of RCTs relating to RC surgery over the analyzed period was found. Full article
(This article belongs to the Special Issue Quality of Life in Orthopedic Diseases)
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Open AccessArticle
Does Coastal Local Government Competition Increase Coastal Water Pollution? Evidence from China
Int. J. Environ. Res. Public Health 2020, 17(18), 6862; https://doi.org/10.3390/ijerph17186862 - 20 Sep 2020
Abstract
China has formulated many policies and regulations for the management of the coastal water environment. However, the coastal water environment has not been significantly improved. The perspective of local government competition can provide an explanation for this phenomenon. This study uses panel data [...] Read more.
China has formulated many policies and regulations for the management of the coastal water environment. However, the coastal water environment has not been significantly improved. The perspective of local government competition can provide an explanation for this phenomenon. This study uses panel data comprising 48 coastal cities in China from 2004 to 2017 as bases explore the impact of coastal local government competition on coastal water pollution by using a two-way fixed-effects panel regression model. Results show that coastal local government competition increased coastal water pollution. However, a sub-sample estimation based on fiscal pressure shows that coastal local government competition only increased the coastal water pollution of the high fiscal pressure group, and its impact on the coastal water pollution in the low financial pressure group failed to pass the significance test. In addition, sub-sample estimation based on different periods shows that the impact of coastal local government competition on coastal water pollution was not significant before 2008, but showed a significant positive impact after 2008. Full article
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Open AccessArticle
Vancomycin for Dialytic Therapy in Critically Ill Patients: Analysis of Its Reduction and the Factors Associated with Subtherapeutic Concentrations
Int. J. Environ. Res. Public Health 2020, 17(18), 6861; https://doi.org/10.3390/ijerph17186861 - 19 Sep 2020
Abstract
This study aimed to evaluate the reduction in vancomycin through intermittent haemodialysis (IHD) and prolonged haemodialysis (PHD) in acute kidney injury (AKI) patients with sepsis and to identify the variables associated with subtherapeutic concentrations. A prospective study was performed in patients admitted at [...] Read more.
This study aimed to evaluate the reduction in vancomycin through intermittent haemodialysis (IHD) and prolonged haemodialysis (PHD) in acute kidney injury (AKI) patients with sepsis and to identify the variables associated with subtherapeutic concentrations. A prospective study was performed in patients admitted at an intensive care unit (ICU) of a Brazilian hospital. Blood samples were collected at the start of dialytic therapy, after 2 and 4 h of treatment and at the end of therapy to determine the serum concentration of vancomycin and thus perform pharmacokinetic evaluation and PK/PD modelling. Twenty-seven patients treated with IHD, 17 treated with PHD for 6 h and 11 treated with PHD for 10 h were included. The reduction in serum concentrations of vancomycin after 2 h of therapy was 26.65 ± 12.64% and at the end of dialysis was 45.78 ± 12.79%, higher in the 10-h PHD group, 57.70% (40, 48–64, 30%) (p = 0.037). The ratio of the area under the curve to minimal inhibitory concentration (AUC/MIC) at 24 h in the PHD group was significantly smaller than at 10 h (p = 0.047). In the logistic regression, PHD was a risk factor for an AUC/MIC ratio less than 400 (OR = 11.59, p = 0.033), while a higher serum concentration of vancomycin at T0 was a protective factor (OR = 0.791, p = 0.009). In conclusion, subtherapeutic concentrations of vancomycin in acute kidney injury (AKI) patients in dialysis were elevated and may be related to a higher risk of bacterial resistance and mortality, besides pointing out the necessity of additional doses of vancomycin during dialytic therapy, mainly in PHD. Full article
(This article belongs to the Section Infectious Disease Epidemiology)
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Open AccessArticle
Physical Activity in the Daily Life of Adolescents: Factors Affecting Healthy Choices from a Discrete Choice Experiment
Int. J. Environ. Res. Public Health 2020, 17(18), 6860; https://doi.org/10.3390/ijerph17186860 - 19 Sep 2020
Abstract
Physical activity improves peoples’ well-being and can help in preventing weight gain, obesity, and related non-communicable diseases. Promoting healthy behaviors in the daily travels and transport choices of adolescents is very important in early establishing healthy habits that imply routine physical activity. For [...] Read more.
Physical activity improves peoples’ well-being and can help in preventing weight gain, obesity, and related non-communicable diseases. Promoting healthy behaviors in the daily travels and transport choices of adolescents is very important in early establishing healthy habits that imply routine physical activity. For designing and developing effective strategies, it is relevant to study adolescents’ preferences for physical activity and what factors in the social and environmental contexts affect their preferences. The paper investigates these aspects by means of a discrete choice experiment, using data from more than 4300 16–17 year-old adolescents in Italy. The results show that adolescents generally prefer walking for long time alone. However, females prefer cycling, while adolescents from lower educated families prefer motorized means of transport. Environmental factors affect the adolescents’ preferences: living nearby a green area is associated with more active and healthier choices in their short daily travels. Conversely, adolescents living closer to an industrial or high traffic area prefer to use motorized vehicles. Such findings have been discussed and policy implications presented, in order to support policymakers in designing cross-sectoral policies to promote healthy choices related to physical activity in adolescence. Full article
(This article belongs to the Special Issue Management and Promotion of Healthy Habits and Active Life)
Open AccessArticle
Transition Trajectories: Contexts, Difficulties and Consequences Reported by Young Transgender and Non-Binary Spaniards
Int. J. Environ. Res. Public Health 2020, 17(18), 6859; https://doi.org/10.3390/ijerph17186859 (registering DOI) - 19 Sep 2020
Abstract
The transition process can have a significant impact on young transgender and non-binary individuals (TNBI), especially regarding their mental health. As such, this study aimed to explore the encountered difficulties and expectations of 225 young adults, between 14 and 25 years old, who [...] Read more.
The transition process can have a significant impact on young transgender and non-binary individuals (TNBI), especially regarding their mental health. As such, this study aimed to explore the encountered difficulties and expectations of 225 young adults, between 14 and 25 years old, who identify themselves as TNBI. Four different aspects were analyzed: difficulties related to the transition process; main current difficulties; if the current difficulties are due to the participants’ sexual orientation or gender identity; and if participants feel the need of changing something in their lives. Several obstacles either before, during or after the transition process were identified; and these obstacles have serious consequences in TBNI’s mental health. Questions regarding legislation, discrimination, transphobia, lack of social support, the pathologization of transgenderism, low self-esteem, anxiety symptomatology, among others, were pointed out by the participants. The narratives collected and analyzed in the present study appear as important inputs to the literature, which can be translated into the basis of further investigations and the improvement of professional practices in the health field. Full article
(This article belongs to the Special Issue Current Research Trends in Transgender Health)
Open AccessArticle
Association between Perceived Neighborhood Built Environment and Walking and Cycling for Transport among Inhabitants from Latin America: The ELANS Study
Int. J. Environ. Res. Public Health 2020, 17(18), 6858; https://doi.org/10.3390/ijerph17186858 - 19 Sep 2020
Abstract
Purpose: This study aimed to examine the associations of the perceived neighborhood built environment with walking and cycling for transport in inhabitants from Latin American countries. Methods: This cross-sectional study involved 9218 participants (15–65 years) from the Latin American Study of Nutrition and [...] Read more.
Purpose: This study aimed to examine the associations of the perceived neighborhood built environment with walking and cycling for transport in inhabitants from Latin American countries. Methods: This cross-sectional study involved 9218 participants (15–65 years) from the Latin American Study of Nutrition and Health, which included a nationally representative sample of eight countries. All participants completed the International Physical Activity Questionnaire-Long Form for measure walking and cycling for transport and the Neighborhood Environment Walkability Scale-Abbreviated. Furthermore, perceived proximity from home to public open spaces and shopping centers was assessed. Results: Perceived land use mix-access (OR: 1.32; 95%CI: 1.16,1.50) and the existence of many alternative routes in the neighbourhood (1.09 1.01,1.17) were associated with higher odds of reporting any walking for transport (≥10 min/week). Perceived slow speed of traffic (1.88 1.82,1.93) and few drivers exceeding the speed limits (1.92; 1.86,1.98) were also related to higher odds of reporting any walking for transport. The odds of reporting any cycling for transport (≥10 min/week) were higher in participants perceiving more walking/cycling facilities (1.87 1.76,1.99), and better aesthetics (1.22 1.09,1.38). Conclusions: Dissimilar perceived neighborhood built environment characteristics were associated with walking and cycling for transport among inhabitants from Latin America. Full article
(This article belongs to the Special Issue Active Commuting and Active Transportation)
Open AccessArticle
Farm to Early Care and Education Programming: A Descriptive Study of Challenges and Opportunities to Promote Healthful Foods to Young Children
Int. J. Environ. Res. Public Health 2020, 17(18), 6857; https://doi.org/10.3390/ijerph17186857 - 19 Sep 2020
Abstract
Interest in farm to early care and education (ECE) programming, which consists of gardening, nutrition education, and local food procurement, has been growing in the United States, as it may be a promising technique for promoting healthful foods to young children. However, there [...] Read more.
Interest in farm to early care and education (ECE) programming, which consists of gardening, nutrition education, and local food procurement, has been growing in the United States, as it may be a promising technique for promoting healthful foods to young children. However, there is limited information about current farm to ECE efforts in specific states, including Colorado, to support funding and resource needs. An online survey was distributed to licensed Colorado ECE providers in two phases to understand current participation in the farm to ECE as well as provider perspectives on benefits and barriers to programming. A total of 250 surveys were completed. Approximately 60% of ECE facilities participated in gardening and nutrition education with providers almost unanimously agreeing on the child-centric benefits of programming. Fewer facilities (37%) participated in local food procurement likely due to significant time, cost, and knowledge barriers. To increase participation in farm to ECE as a technique for promoting healthful foods to young children, future efforts should focus on innovative solutions to reduce ECE-specific barriers. Full article
Open AccessArticle
Social and Demographic Patterns of Health-Related Internet Use Among Adults in the United States: A Secondary Data Analysis of the Health Information National Trends Survey
Int. J. Environ. Res. Public Health 2020, 17(18), 6856; https://doi.org/10.3390/ijerph17186856 - 19 Sep 2020
Abstract
National surveys of U.S. adults have observed significant increases in health-related internet use (HRIU), but there are documented disparities. The study aims to identify social and demographic patterns of health-related internet use among U.S. adults. Using data from the Health Information National Trends [...] Read more.
National surveys of U.S. adults have observed significant increases in health-related internet use (HRIU), but there are documented disparities. The study aims to identify social and demographic patterns of health-related internet use among U.S. adults. Using data from the Health Information National Trends Survey (HINTS) 4 cycle 3 and HINTS 5 cycle 1, we examined HRIU across healthcare, health information seeking, and participation on social media. Primary predictors were gender, race/ethnicity, age, education, income, and nativity with adjustments for smoking and survey year. We used multivariable logistic regression with survey weights to identify independent predictors of HRIU. Of the 4817 respondents, 43% had used the internet to find a doctor; 80% had looked online for health information. Only 20% had used social media for a health issue; 7% participated in an online health support group. In multivariable models, older and low SES participants were significantly less likely to use the internet to look for a provider, use the internet to look for health information for themselves or someone else, and less likely to use social media for health issues. Use of the internet for health-related purposes is vast but varies significantly by demographics and intended use. Full article
(This article belongs to the Special Issue Digital Intervention and Self-Management)
Open AccessArticle
Antithrombotic Preventive Medication Prescription Redemption and Socioeconomic Status in Hungary in 2016: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2020, 17(18), 6855; https://doi.org/10.3390/ijerph17186855 - 19 Sep 2020
Abstract
This work was designed to investigate antithrombotic drug utilization and its link with the socioeconomic characteristics of specific population groups in Hungary by a comparative analysis of data for prescriptions by general practitioners and the redeemed prescriptions for antithrombotic drugs. Risk analysis capabilities [...] Read more.
This work was designed to investigate antithrombotic drug utilization and its link with the socioeconomic characteristics of specific population groups in Hungary by a comparative analysis of data for prescriptions by general practitioners and the redeemed prescriptions for antithrombotic drugs. Risk analysis capabilities were applied to estimate the relationships between socioeconomic status, which was characterized by quintiles of a multidimensional composite indicator (deprivation index), and mortality due to thromboembolic diseases as well as antithrombotic medications for the year 2016 at the district level in Hungary. According to our findings, although deprivation is a significant determinant of mortality due to thromboembolic diseases, clusters can be identified that represent exemptions to this rule: an eastern part of Hungary, consisting of two highly deprived counties, had significantly lower mortality than the country average; by contrast, the least-deprived northwestern part of the country, consisting of five counties, had significantly higher mortality than the country average. The fact that low socioeconomic status in general and poor adherence to antithrombotic drugs irrespective of socioeconomic status were associated with increased mortality indicates the importance of more efficient control of preventive medication and access to healthcare in all districts of the country to reduce mortality due to thromboembolic diseases. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Open AccessArticle
Parents’ Perspectives on the Health Education Provided by Clinicians in Portuguese Pediatric Hospitals and Primary Care for Children Aged 1 to 10 Years
Int. J. Environ. Res. Public Health 2020, 17(18), 6854; https://doi.org/10.3390/ijerph17186854 - 19 Sep 2020
Abstract
This study aimed to analyze parents’ perspectives of the health education practice provided by health professionals to children and parents. This is a descriptive research with a qualitative approach, based on the conceptual framework of health education provided by health professionals to children/young [...] Read more.
This study aimed to analyze parents’ perspectives of the health education practice provided by health professionals to children and parents. This is a descriptive research with a qualitative approach, based on the conceptual framework of health education provided by health professionals to children/young people and families. The selection took place by non-probabilistic sampling of convenience, and was developed with parents/users of health units for pediatric hospitalization and primary health care in northern Portugal. Data were collected using semi-structured interviews with 20 parents from March to April 2019, and were analyzed using the content analysis technique. Health education was understood to enhance health, and the evaluation was carried out according to planning and partnership. The most frequent topics were food, the national vaccination plan, and accident prevention. The evaluation shown is very positive, pointing to the nurse as the professional of choice for this practice and thus contributing to the visibility of nursing. We can state that the perspectives of parents about the health education carried out by health professionals show a practice that values health; is adaptable to the complexity of the binomial child and parents; is capable of influencing health determinants with sustainability, efficacy, and effectiveness; and gives visibility to nurses’ positions as health educators. Full article
Open AccessArticle
Infectious or Recovered? Optimizing the Infectious Disease Detection Process for Epidemic Control and Prevention Based on Social Media
Int. J. Environ. Res. Public Health 2020, 17(18), 6853; https://doi.org/10.3390/ijerph17186853 - 19 Sep 2020
Abstract
Detecting the period of a disease is of great importance to building information management capacity in disease control and prevention. This paper aims to optimize the disease surveillance process by further identifying the infectious or recovered period of flu cases through social media. [...] Read more.
Detecting the period of a disease is of great importance to building information management capacity in disease control and prevention. This paper aims to optimize the disease surveillance process by further identifying the infectious or recovered period of flu cases through social media. Specifically, this paper explores the potential of using public sentiment to detect flu periods at word level. At text level, we constructed a deep learning method to classify the flu period and improve the classification result with sentiment polarity. Three important findings are revealed. Firstly, bloggers in different periods express significantly different sentiments. Blogger sentiments in the recovered period are more positive than in the infectious period when measured by the interclass distance. Secondly, the optimized disease detection process can substantially improve the classification accuracy of flu periods from 0.876 to 0.926. Thirdly, our experimental results confirm that sentiment classification plays a crucial role in accuracy improvement. Precise identification of disease periods enhances the channels for the disease surveillance processes. Therefore, a disease outbreak can be predicted credibly when a larger population is monitored. The research method proposed in our work also provides decision making reference for proactive and effective epidemic control and prevention in real time. Full article
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Open AccessArticle
Promoting Health-Related Cardiorespiratory Fitness in Physical Education: The Role of Class Intensity and Habitual Physical Activity
Int. J. Environ. Res. Public Health 2020, 17(18), 6852; https://doi.org/10.3390/ijerph17186852 - 19 Sep 2020
Abstract
Physical education (PE) has the potential to promote health-related fitness, however, its contribution is still not clear. The aim of this study was to assess whether students’ health-related cardiorespiratory fitness (CRF) improved from the beginning to the end of the school year, and [...] Read more.
Physical education (PE) has the potential to promote health-related fitness, however, its contribution is still not clear. The aim of this study was to assess whether students’ health-related cardiorespiratory fitness (CRF) improved from the beginning to the end of the school year, and to examine the role of PE class intensity and habitual physical activity (PA) in promoting students’ CRF. This observational study employed a longitudinal design. Participants were 212 7th and 8th grade students (105 boys), mean age 12.9 years old, followed during one school year, from September 2017 to June 2018. The Progressive Aerobic Cardiovascular Endurance Run (PACER) was used to assess CRF at baseline and follow-up. PA was measured using accelerometers. PE class intensity was assessed using the System for Observing Fitness Instruction Time. Findings indicated that from the beginning to the end of the school year, a greater percentage of participants were in the CRF healthy fitness zone (73.1% to 79.7%, p = 0.022). Among boys, participating in organized sports (B = 4.61, 95% confidence interval [CI]: 0.33, 8.88) and the percentage of PE time being very active (B = 0.90, 95% CI: 0.44, 1.35) were positively associated with the change in PACER laps. Among girls, daily vigorous PA (B = 0.38, 95% CI: 0.15, 0.60) and participating in organized sports (B = 4.10, 95% CI: 0.93, 7.27) were also positively associated with PACER change, while being overweight or obese (B = −5.11, 95% CI: −8.28, −1.93) was negatively associated. In conclusion, PE was demonstrated to have a positive role in the promotion of CRF, especially among boys, while for girls, habitual PA seems to have a greater contribution. Nevertheless, results and conclusions should be considered carefully, taking into account study limitations, such as the non-direct measures of PE class intensity, CRF, and school setting. Full article
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