Int. J. Environ. Res. Public Health, Volume 17, Issue 2 (January-2 2020) – 296 articles

Effective vascular access (VA) is an essential condition for providing hemodialysis, affecting patients’ health outcomes. We aim to explore how health literacy (HL) as a non-clinical factor is associated with the decision-making process regarding VA type selection. Using data from 20 dialysis centers across Slovakia (n = 542, mean age = 63.6, males = 60.7%), the association of HL with type of VA (arteriovenous fistula (AVF) vs. central venous catheter (CVC)) was analyzed using a logistic regression model adjusted for sociodemographic characteristics and comorbidity. Sociodemographic data and data on nine domains of HL were collected by questionnaire. Data on VA and comorbidity were obtained from a medical records. Patients with a greater ability to engage with healthcare providers (odds ratio (OR): 1.34; 95% confidence interval (CI): 1.00–1.78), those with a better ability to navigate the healthcare system (OR: 1.41; 95% CI: 1.08–1.85), those more able to find good health information (OR: 1.52; 95% CI: 1.15–2.03), and those who understand it well enough to know what to do (OR: 1.52; 95% CI: 1.12–2.06) are more likely to have AVF. Patients’ HL is associated with the type of VA; therefore, it should be considered in the decision-making process regarding the selection of the type of VA, thereby informing strategies for improving patients’ HL and doctor–patient communication. Full article

The purpose of the present study was to describe the anthropometric characteristics, body composition and somatotype of elite male young runners (EYR), and to compare these variables according to the specialty in which they engaged (middle-distance vs. long-distance). This will enable an anthropometric profile chart to be established for them. Ninety EYR aged 17 to 23 years (18.4 ± 2.0) participated in the study. Athletes were divided into two groups according to the event in which they participated: middle-distance runners (MDR, n = 56) and long-distance runners (LDR, n = 34). Sixteen anthropometric variables were recorded for each participant: Weight, height, eight skinfolds, four girths, and two breadths. Body mass index (BMI), body composition and somatotype were calculated. Comparing MDR with the group of LDR, significant differences were found to exist for height, weight, relaxed upper arm girth, flexed and tensed upper arm girth, total upper arm area, upper arm muscle area, and thigh muscle area. No significant differences were observed in the other variables. MDR are taller, heavier and have larger girths than LDR. Coaches and sports scientists can use the data obtained to better control training, as well as for talent identification and athlete selection. Full article

Background: Middle managers have not received enough attention within the healthcare field, and little is known how stressful factors in their work environment coupled with a lack of adequate sleep are related to musculoskeletal pain. The aim of this study was to examine the correlation between stressful factors in the work environment, lack of adequate sleep, and pain/discomfort in three body areas. Methods: Questionnaire was sent electronically to all female nursing unit managers (NUM) in Iceland through the outcome-survey system. The response rate was 80.9%. Results: NUM who had high pain/discomfort in the neck area also had very high pain/discomfort in the shoulder area and pain in the lower back. The results also revealed positive a medium-strong correlation between mental and physical exhaustion at the end of the workday and musculoskeletal pain. Stress in daily work, mental strain at work, and being under time-pressures had hardly any correlation with pain/discomfort in the three body parts. Adequate sleep had a significant negative correlation with all stressful factors in the work environment and all three body parts under review. Conclusion: The results will hopefully lead to a better consideration of stressful factors in the work environment, sleep, and musculoskeletal pain in middle managers. Full article

With the visual turn in online communication, selfies have become common on social media. Although selfies as a way of self-representation provide people with more chances to express themselves, the adverse effects selfies could bring to users’ body image need to be treated seriously. This study tested whether selfie-viewing behaviour on social media was related to facial dissatisfaction and whether appearance comparisons played a mediating role. Moreover, the self-objectification was examined as a moderator between selfie-viewing behaviour and facial dissatisfaction via appearance comparisons. Results showed that more selfie-viewing was associated with higher facial dissatisfaction, and this relationship was mediated by appearance comparisons. The study also found that self-objectification moderated the indirect relation between selfie-viewing and facial dissatisfaction via appearance comparisons. Gender differences were also found to affect the mediation model. Our research provides new insights into the interactions between social media use and perception of body image. Full article

Health literacy has been identified as an important and changeable intermediary determinant of health equity. Vocational education and training (VET) schools are a relevant setting for health behavior interventions seeking to diminish health inequities because many VET students come from low socio-economic status backgrounds. This study examines VET students’ health literacy and its association with health behavior based on a cross-sectional survey among 6119 students from 58 VET schools in Denmark in 2019. Two scales from the Health Literacy Questionnaire was used to assess domains of health literacy. Data were analyzed using Anova and logistic regression. The study population consisted of 43.4% female, and mean age was 24.2 years (range 15.8–64.0). The health literacy domain ‘Actively managing my health’ mean was 2.51, SD 0.66, and ‘Appraisal of health information’ mean was 2.37, SD 0.65. For both domains, being female, older age, attending the VET educational program Care-health-pedagogy, and higher self-rated health were associated with higher scale scores. In the adjusted analyses, lower scale scores were associated with less frequent breakfast, daily smoking, high-risk alcohol behavior and moderate-to-low physical activity. Our results show that low health literacy is associated with unhealthy behaviors in this population. Our results support and inform health literacy research and practice in educational institutions and services. Full article

We live in a rapidly changing business environment where change has become the norm for organizations to maintain competitiveness. Although both scholars and practitioners agree that organizational change communication is important to help employees adjust to change, little is known about how negative informal information before the change affects employees’ reaction to the change and occurrence of possible within-person dynamics of resistance intention over time. Based on the construal-level theory, we used SPSS 22, AMOS 20, and HLM 6.0 as tools to explore how negative informal information affects individual performance. We used a multilevel approach to probe within-person processes among 215 MBA students in China. The results show that (1) negative informal information provided before the organizational change is positively related to the resistance intention, (2) resistance intention decreases significantly over time, and (3) negative informal information is negatively related to individual performance during the organizational change. The results from this study extend the literature on informal communication before the change and provide a dynamic perspective on the occurrence of possible within-person dynamics of resistance intention over time. Full article

Children and adolescents are not meeting the required federal physical activity (PA) guidelines established by the United States Department of Health and Human Services. It is critical that a regular pattern of PA is established in their youth to ensure ongoing PA into adulthood. However, many programs implemented during adolescence have shown limited effects, stressing the need for more innovative approaches to generate more interest and maintenance of PA behavior in this age group. Active video games (AVGs) or exergaming may prove to be an innovate process to improve PA in children and adolescents. A literature review was conducted to explore if active video games or exergaming could be an effective intervention to improve physical activity in adolescents. Active video games, also called “exergames”, are a category of video games that require movement or physical exertion to play the game. The methodology consisted of searching Academic Search Premier, CINAHL, The Cochrane Library, ERIC, PubMed, and Web of Science databases. Inclusion criteria involved only youth aged 12 to 19 years, randomized controlled trials (RCTs), and studies within the last 12 years. The following search terms were used: exergaming or active video games; physical activity or exercise; adolescents or youth; RCT or randomized clinical trial. The outcome indicates that exergaming or active video games can be an effective tool to improve PA in adolescents that will be more acceptable and sustainable than many conventional approaches. Full article

Active commuting (AC) has been proposed as a great opportunity to increase physical activity level (PA) in children and adolescents. The aim of the present study is to determine the associations between AC (walk and cycle commuting) and non-AC (motor vehicle commuting) with PA levels, and with AC and sedentarism in Spanish children and adolescents. A representative Spanish sample of 424 children and adolescents (38% females) was involved in the ANIBES (Anthropometry, Dietary Intake and Lifestyle in Spain) Study in 2013. Data on the levels of AC, non-AC, PA, and sedentarism were obtained using the International Physical Activity Questionnaire for adolescents. Stepwise backward univariate generalized linear and linear regression models were performed. In girls, walking was associated with playground PA, moderate PA, and moderate to vigorous PA (MVPA) (β = 0.007, p < 0.05; both β = 0.007, p < 0.01), respectively. In boys, walking was associated with all PA levels (p < 0.05); while cycling was related to moderate PA and MVPA (both β = 0.007, p < 0.05). A negative significant association was observed between AC and time spent studying without Internet use in boys (β = −0.184, p < 0.05). Commuting by walking contributes to increased daily PA in both sexes, whereas cycling was only related to moderate PA and MVPA in boys. Sedentary behaviors are not related to AC, but studying without Internet use was negatively associated with AC in boys. Full article

The study designs a comprehensive evaluation system for the prevention and control of occupational hazards, calculates its weight coefficient, and provides a potential strategic and effective tool for the scientific evaluation of occupational hazards in the iron and steel enterprises. The system was established through induction and analysis of relevant literature, personal interview, theoretical analysis, Delphi expert consultation, and special group discussions. Using an improved analytical hierarchy process fuzzy comprehensive evaluation model and on the basis of the improved Delphi expert investigation, the weight of the operability comprehensive evaluation index system is constructed. A three-level index system is established on the basis of harmful factors of occupational activities, health status of employees, protection facilities of occupational hazards, occupational health management, and so on. The index system structure is 4-20-95, and the weight coefficients of the four dimensions are 0.2516, 0.2428, 0.2550, and 0.2506. The recovery rate of the questionnaire was 82.5%, 100.0%, and 100.0%. The effective rates were 75.0%, 100.0%, and 100.0%. Conversely, the expert authority coefficients of the four dimensions are 0.875, 0.769, 0.832 and 0.800. Results show that the consistency factors of the four dimensions are statistically significant. Cronbach’s α coefficient, standardized Cronbach’s α coefficient, and split-half reliability of the comprehensive evaluation index system are 0.959, 0.950, and 0.810, respectively. After factor analysis, four common factors were extracted on the basis of expert opinions, and the cumulative variance was 63.1%. The comprehensive evaluation system for the prevention and control of occupational hazards in the iron and steel enterprises proposed by the study is relatively complete and reasonable. Full article

Multicomponent physical exercise is effective in curbing the effect of hospitalization in older adults. However, it is not well established which characteristics of the exercise interventions would optimize intervention sustainability and efficacy. This study compared the effects of two group-based multicomponent exercise interventions of different lengths in older adults after hospitalization. Fifty-five participants were randomly assigned to a short-term group-based branch (SGB, n = 27) or to a long-term group-based branch (LGB, n = 28). The SGB participated in a six-week multicomponent group-based exercise-training program followed by 18 weeks of home-based exercise. The LGB completed 12 weeks of each phase. Physical function, physical activity, quality of life, anthropometrics, and nutritional status were assessed at baseline, after 12 weeks, and after 24 weeks of intervention. Both groups improved physical function and nutritional status and increased physical activity after 12 weeks of intervention (paired student’s t-test, p < 0.01), and maintained the positive effects during the following 12 weeks. No group-by-time interaction was observed in any of the studied variables using mixed-model ANOVA. Based on these findings, we determined that 6 weeks of a group-based exercise intervention caused similar functional and nutritional benefits to a longer group-based intervention of 12 weeks when both are continued at home until 24 weeks. Full article

We aimed to assess the risk of oral cancer incidence in a high-risk population, establish a predictive model for oral cancer among these high-risk individuals, and assess the predictive ability of the constructed model. Individuals aged ≥30 years who had a habit of smoking or betel nut chewing and had undergone oral cancer screening in 2010 or 2011 were selected as study subjects. The incidence of oral cancer among the subjects at the end of 2014 was determined. The annual oral cancer incidence among individuals with a positive screening result was 624 per 100,000 persons, which was 6.5 times that of the annual oral cancer incidence among all individuals screened. Male sex, aged 45–64 years, divorce, low educational level, presence of diabetes, presence of other cancers, high comorbidity severity, a habit of smoking or betel nut chewing, and low monthly salary were high-risk factors for oral cancer incidence (p < 0.05). The area under the curve of the predictive model for oral cancer incidence was 0.73, which indicated a good predictive ability. Therefore, the oral cancer screening policy for the high-risk population with a habit of smoking and/or betel nut chewing is beneficial for the early diagnosis of oral cancer. Full article

Greenhouse farming is an agricultural management system that has demonstrated its efficiency in intensifying food production. These systems constitute a feasible alternative for ensuring food supply, which is one of the greatest challenges faced by humankind in the twenty-first century. Technology has been able to meet the challenges related to greenhouse farming in both contributing to overcoming its limitations, correcting adverse impacts and ensuring system sustainability. The objective of this article is to analyse the global research trends in greenhouse technology over the last two decades, in order to identify the main driving agents, the most outstanding research lines and possible gaps in the literature. Different methodologies have been used for the analysis; both quantitative and qualitative. The principal results show that there are different relevant lines of research related to different aspects of greenhouse farming: the use of water for irrigation, the design of the optimum structure of the greenhouse, conserving the soil in the best growing conditions, energy consumption of the system as a whole, climate control within the facility and pest control. The research is characterized by the being composed largely of ad hoc studies, which hinders the international collaboration between researchers and institutions. The research approach has shifted from being focused on increasing production and cost savings to aspects related to resource conservation and sustainability. Full article

Intellectual capital (IC) and corporate social responsibility (CSR) provide a strong link between the enterprise and stakeholders. These strategic approaches are responsible in value formation for better financial performance. This study investigates the mediating effects of corporate financial performance on the relationship between IC components (ICs) and CSR of firms from the food industry in Asia. We analyzed 308 firm-year observations of 44 listed firms from 2011 to 2017. The results of this study provided mixed findings regarding the effects of ICs and CSR. In addition, results vary from the disaggregated effects of each IC component on environmental, social, and governance pillars. The results also indicate that the combination of accounting and market-based estimates of financial performance was found to be significant mediating factor to explain the phenomenon which varies per ICs and dimensions of CSR. Lastly, the implications for sustainable business practices and investments in knowledge-based resources in the food industry are elaborated. Full article

Although immunization against varicella using vaccines has been proven to be significant and effective in the past decades, varicella remains a major public health concern for many developing countries. Varicella vaccination has not been introduced into routine immunization programs in China, and varicella outbreaks have continued to occur. Taking the city of Chongqing, which has a high prevalence of varicella, as an example, this study explored the spatiotemporal epidemiology of varicella. Based on the reported data of varicella cases from 1 January 2014 to 31 December 2018 in Chongqing, hot spots and space-time clusters of varicella were identified using spatial autocorrelation analysis and scan statistics. Within this period, a total of 112,273 varicella cases were reported in Chongqing (average annual incidence: 73.44 per 100,000), including one death. The incidence of varicella showed an increasing trend with significant seasonal peaks, which occurred during April to July and October to January of the following year. The total ratio of male to female patients affected was 1.10:1. Children under the age of 15 and students accounted for the majority of the patient population. The hotspots detected through local spatial autocorrelation analysis, and the most likely clusters identified by scan analysis, were primarily in the main urban districts of Chongqing. The secondary clusters were mostly detected in northeast and southwest Chongqing. There were obvious spatial dependence and spatiotemporal clustering characteristics of varicella in Chongqing from 2014 to 2018. High-risk districts, populations, and peak periods were found in this study, which could be helpful in implementing varicella prevention and control programs, and in adjusting vaccination strategies for the varicella vaccine based on actual conditions. Full article

An emerging strategy to combat homelessness is the development of “tiny homes”. However, the advent of tiny homes as a new form of housing intervention raises a number of questions about their intentions, efficacy, and policy feasibility. This paper seeks to understand the strategies used by stakeholders to plan, design, and implement a tiny home community to meet the needs of those experiencing homelessness, and to understand where these plans were effective and where challenges arose in meeting the intended project goals. Utilizing the recent development of Tallahassee’s “The Dwellings” project as a case study, we examine how the community was planned, resident experiences, and constraints to implementing a tiny home development. We use qualitative methods that include interviews with stakeholders who were integral to the planning and development process. Our findings highlight how funding constraints and NIMBYism (Not in My Backyard-ism) stymied stakeholder efforts to achieve equity and affordability at The Dwellings, resulting in the inability to achieve project aims of developing housing that serves the homeless population. We conclude by offering some observations and lessons learned for future research on tiny homes as a solution to ameliorate homelessness. Full article

Occupational stress and high workload are being increasingly recognized as significant contributors to the diseases and disorders constituting major components of the global burden of disease. A more detailed definition of burn-out was recently included by the World Health Organization (WHO) in the eleventh revision of the International Classification of Diseases (ICD-11) which reflects a growing acknowledgment of the role of professional work in mental health. One of the symptoms of obsessive-compulsive personality disorder/anankastic personality disorder (OCPD/APD) is an undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships. This compulsive overworking is closely related to the concept of work addiction, and OCPD/APD was suggested to be its major risk factor. OCPD/APD is the most prevalent personality disorder and one that appears to produce the highest direct and indirect medical costs. At the same time, it is vastly understudied. In recent years, it has been repeatedly emphasized that it requires consistent conceptualization and clarification of its overlapping with similar conditions. Even though the limited existing studies suggest its strong relationship with burn-out and depression among employed individuals, there has been no systematic effort to investigate its role in the consequences of occupational stress and high workload. This paper identifies several substantial gaps in the current understanding of the relationships between work addiction, OCPD/APD, burn-out, and the global burden of disease within the context of the WHO’s plan of developing evidence-based guidelines on mental wellbeing in the workplace. Full article

Shift work is considered a risk factor for some health problems. This study aimed to determine whether night shift work is a significant factor for breast cancer risk. The case–control study was conducted from 2015–2019 in the Łódź region. The case group included 494 women diagnosed with malignant breast cancer; the control group included 515 healthy women. The research tool was an anonymous questionnaire. In the case group, the percentage of women working shift work was 51.9%, whereas in the control group, it was 34.1% (OR = 2.08 (95% CI: 1.61; 2.69)). A more insightful examination of shift work showed that only night work has a significant impact on breast cancer (OR = 2.61 (95% CI: 1.94; 3.53)). Even after considering the effect of other possible cancer factors (like high BMI, smoking, early menstruation, late menopause, pregnancy history, age, place of living, education), the odds of developing cancer were twice as high in the group of shift workers (OR = 2.20 (95% CI: 1.57; 3.08)). Considering a significantly higher risk of cancer among people working at night and a high percentage of such employees in Poland, the government should consider special action in the prophylactic treatment of cancers. Full article

The objective of the present study was to validate and adapt the Acceptance and Action Questionnaire-Stigma (AAQ-S) to the Spanish context. Method: The study included the participation of 1212 subjects, with an average age of 17.12 years old. Results: The confirmatory factorial analysis revealed a number of adequate fit indices for the new version of the scale χ²/df = 3.24; Comparative Fit Index = 0.96; Incremental Fit Index = 0.96; Root Mean Square Error of Approximation = 0.060; Standardized Root Mean Square Residual = 0.035, in which the factorial structures displayed gender invariance. The two factors comprise the scale both exhibited high internal consistency (+0.90) and temporal stability. Conclusion: The Spanish version of the AAQ-S proved to be a robust and adequate psychometric instrument. In this sense, future lines of research focused on determining the role of psychological flexibility in stigma and the processes of change at the base of interventions could benefit substantially from the use of AAQ-S. Full article

We aimed to describe the epidemiology, multi-drug resistance and seasonal distribution of bacteria cultured within 12 months following lower limb orthopaedic surgery in tropical and subtropical Australian hospitals between 2010 and 2017. We collected data from four tropical and two subtropical hospitals. Categorical variables were examined using the Pearson Chi-squared test or Fisher’s Exact test, and continuous variables with the Student t-test or Mann–Whitney U test. A Poisson regression model was used to examine the relationship between season, weather and the incidence of Staphylococcus and nonfermentative species. We found that at tropical sites, nonfermenters (Pseudomonas aeruginosa and Acinetobacter baumannii) were more common (28.7% vs. 21.6%, p = 0.018), and patients were more likely to culture multi-drug-resistant (MDR) nonfermenters (11.4% vs. 1.3%, p = 0.009) and MDR Staphylococcus aureus (35.9% vs. 24.6%, p = 0.006). At tropical sites, patients were more likely to be younger (65.9 years vs. 72.0, p = < 0.001), male (57.7% vs. 47.8%, p = 0.005), having knee surgery (45.3% vs. 34.5%, p = 0.002) and undergoing primary procedures (85.0% vs. 73.0%, p = < 0.001). Species were similar between seasons in both tropical and subtropical hospitals. Overall, we found that following lower limb orthopaedic surgery in tropical compared with subtropical Australia, patients were more likely to culture nonfermenters and some MDR species. Full article

Based on the panel data of 106 cities in the Yangtze River Economic Belt of China from 2007 to 2016, this paper explores the impact of city centrality on the green innovation efficiency and proves the mediation effect of migrants by using spatial econometric model. The results show that there are more and more innovation contacts between cities, and the innovation network is becoming more and more dense. The core cities of the downstream innovation network are mainly Yangzhou, Zhenjiang, Wuxi, Changzhou, Suzhou and Hangzhou; the core cities in the midstream are mainly Wuhan, Changsha and Yichun; the core cities in the upstream are Chengdu and Bazhong. There is an inverted U-shaped relationship between city centrality and green innovation efficiency. In addition, the influence curve of city centrality on the green innovation efficiency of surrounding cities is also inverted U-shaped. Cities with high city centrality attract a large number of migrants that come from cities with lower centrality to improve the green innovation efficiency, but the green innovation efficiency of cities with low city centrality will decline due to lack of talents. Full article

Background: The hospitalization of patients treated in the intensive care unit (ICU) in 5–15% of cases is associated with the occurrence of a complication in the form of ventilator-associated pneumonia (VAP). Purpose: Retrospective assessment of risk factors of VAP in patients treated at ICUs in the University Hospital in Krakow. Methods: The research involved the medical documentation of 1872 patients treated at the ICU of the University Hospital in Krakow between 2014 and 2017. The patients were mechanically ventilated for at least 48 h. The obtained data were presented by qualitative and quantitative analysis (%). The qualitative variables were compared using the Chi² test. Statistically significant was the p < 0.05 value. Results: VAP was demonstrated in 23% of all patients treated in ICU during the analyzed period, and this infection occurred in 13% of men and 10% of women. Pneumonia associated with ventilation was found primarily in patients staying in the ward for over 15 days and subjected to intratracheal intubation (17%). A statistically significant was found between VAP and co-morbidities, e.g., chronic obstructive pulmonary disease, diabetes, alcoholism, obesity, the occurrence of VAP and multi-organ trauma, hemorrhage/hemorrhagic shock, and fractures as the reasons for admitting ICU patients. Conclusions: Patients with comorbidities such as chronic obstructive pulmonary disease, obesity, diabetes, and alcoholism are a high-risk group for VAP. Particular attention should be paid to patients admitted to the ICU with multi-organ trauma, fractures, and hemorrhage/hemorrhagic shock as patients predisposed to VAP. There is a need for further research into risk factors for non-modifiable VAP such as comorbidities and reasons for ICU admission in order to allow closer monitoring of these patients for VAP. Full article

The South African mining industry is one of the largest producers of platinum (Pt) in the world. Workers in this industry are exposed to significant amounts of dust, and this dust consists of particles sizes that can penetrate deep inside the respiratory region. A cross-sectional study was conducted to evaluate dust exposure risk at two Pt mine waste rock crusher plants (Facility A and B) in Limpopo, South Africa. Workers’ demographic and occupational information was collected through a structured questionnaire, a walk-through observation on facilities’ processes, and static dust sampling for the collection of inhalable and respirable dust particles using the National Institute for Occupational Safety and Health (NIOH) 7602 and the Methods for Determination of Hazardous Substance (MDHS) 14/4 as guidelines. Only 79% of Pt mine workers, used their respiratory protective equipment (RPE), sixty-five percent were exposed to work shifts exceeding the recommended eight hours and 8.8% had been employed for more than ten years. The mean time-weighted average (TWA) dust concentrations between Facility A and B showed a significant difference (p < 0.026). The Pt mine’s inhalable concentrations (range 0.03–2.2 mg/m³) were higher than the respirable concentrations (range 0.02–0.7 mg/m³), however were all below the respective international and local occupational exposure limits (OELs). The Pt mine’s respirable crystalline silica (SiO₂) quartz levels were all found below the detectable limit (<0.01 mg/m³). The Pt miners had increased health risks due to accumulated low levels of dust exposure and lack of usage of RPE. It is recommended that an improved dust control program be put in place which includes, but is not limited to, stockpile enclosures, tire stops with water sprays, and education on the importance of RPE usage. Full article

A few decades ago, robotics started to be implemented in the medical field, especially in the rehabilitation of patients with different neurological diseases that have led to neuromuscular disorders. The main concern regarding medical robots is their safety assurance in the medical environment. The goal of this paper is to assess the risk of a medical robotic system for elbow and wrist rehabilitation in terms of robot and patient safety. The approached risk assessment follows the ISO12100:2010 risk management chart in order to determine, identify, estimate, and evaluate the possible risk that can occur during the use of the robotic system. The result of the risk assessment process is further analyzed using a fuzzy logic system in order to determine the safety degree conferred during the use of the robotic system. The innovative process concerning the risk assessment allows the achievement of a reliable medical robotic system both for the patient and the clinicians as well. The clinical trials performed on a group of 18 patients validated the functionality and the safe behavior of the robotic system. Full article

Background: The Standardised Nordic Questionnaire (SNQ) is an instrument to analyse the musculoskeletal symptoms in an ergonomic or occupational health context. We aimed to cross-culturally adapt and evaluate the psychometric properties of the SNQ among Spanish musicians. Methods: Cross-cultural adaptation and psychometric validation (reliability, validity, and feasibility) was performed. Reliability was analysed by test-retest reliability (Cohen’s Kappa) and internal consistency (Kuder–Richardson). Content and face validity were measured by the Expert Committee and the opinion of participants. Construct validity (Mann–Whitney U test) was measured by comparing with questionnaires used to assess pain and disability in neck, shoulders, upper back, and low back regions. Feasibility was calculated with the average response time. Results: A total of 312 Spanish musicians were included. The Spanish version of SNQ achieved good semantic, conceptual, idiomatic, and content equivalence. For most of the variables, test-retest reliability was good to very good (k = 0.60–0.81). The internal consistency showed good to acceptable (Kuder–Richardson 20 (KR20) = 0.737–0.873). Participants with versus without musculoskeletal problems in a related region showed significantly higher disability/pain, indicating a good construct validity. About the feasibility, the average response time of the questionnaire was 6 min (±2). Conclusions: The results show that the Spanish SNQ is reliable, valid, and feasible screening tool to assess musculoskeletal problems among musicians. Full article

Organic UV filters are a kind of emerging pollutants, which have been widely used in personal care products (PCPs). This study evaluated the effects of benzophenone-4 (BP-4), 4-aminobenzoic acid (PABA), and 2-phenylbenzimidazole-5-sulfonic acid (PBSA) on the selected indices of antioxidative responses in zebrafish (Danio rerio) liver. Zebrafish were exposed to two different doses (i.e., 0.5 and 5 mg L⁻¹) of semi-static water with three individual compounds. Liver samples were collected on 7 and 14 days to analyze biochemical indicators, including superoxide dismutase (SOD), glutathione S-transferase (GST), reduced glutathione (GSH), and malondialdehyde (MDA). Oxidative stress occurred in zebrafish liver with significantly changed indicators during the whole exposure period. Different experimental groups could induce or inhibit the activity of antioxidant enzymes with varying degrees. With a prolonged exposure time and increased exposure dose, the hepatic lipid peroxidation was also obviously observed. Moreover, the toxicity order of three organic UV filters was analyzed using the integrated biomarker response (IBR) index and the results indicate that exposure to PABA for 7 days at 0.5 mg L⁻¹ and PBSA for 7 days at 5 mg L⁻¹ induced the most severe oxidative stress in the liver of zebrafish. Full article

Approximately 50% of preschoolers do not meet physical activity recommendations and children who reside in low-income rural communities may be further at risk for higher levels of sedentary behavior. Outdoor play is essential for preschool children; however, literature is unclear as to which types of interventions elicit moderate-to-vigorous physical activity (MVPA) for all preschoolers. The aim of this study was to determine which type of intervention, physical activity or fundamental motor skill focus, elicits MVPA during outdoor play. Ninety-eight preschool children (M age = 4.48 years) from one Head Start center participated in an outdoor play intervention two days per week for 7 weeks. Classes were randomly assigned to one of four groups: fundamental motor skill focus (FMS), physical activity focus (PA), FMS and PA (FMS + PA), and control. An accelerometer worn on the hip measured MVPA. Results showed that age, sex and group assignment contributed to MVPA at the beginning of the intervention and age, sex, group assignment and MVPA during the beginning of the intervention contributed to MVPA at the end of the intervention. Overall, the FMS + PA group elicited MVPA from males and females of all ages. Interventions that combine both FMS and PA may reduce physical activity disparities in preschool children. Full article

Although nurses work in stressful environments, stressors in such environments have yet to be clearly assessed. This study aimed to develop a Nurses’ Occupational Stressor Scale (NOSS) with high reliability and validity. Candidate questions for the NOSS were generated by expert consensus following focus group feedback, and were used to survey in 2013. A shorter version was then developed after examination for validity and reproducibility in 2014. The accuracy of the short version of the NOSS for predicting nurses’ stress levels was evaluated based on receiver operating characteristic curves to compare existing instruments for measuring stress outcomes, namely personal burnout, client-related burnout, job dissatisfaction, and intention to leave. Examination for validity and reproducibility yielded a shorter version of NOSS with only 21 items was considered sufficient for measuring stressors in nurses’ work environments. Nine subscales were included: (1) work demands, (2) work–family conflict, (3) insufficient support from coworkers or caregivers, (4) workplace violence and bullying, (5) organizational issues, (6) occupational hazards, (7) difficulty taking leave, (8) powerlessness, and (9) unmet basic physiological needs. The 21-item NOSS proved to have high concurrent and construct validity. The correlation coefficients of the subscales for test-retest reliability ranged from 0.71 to 0.83. The internal consistency (Cronbach’s α) coefficients ranged from 0.35 to 0.77. The NOSS exhibited accurate prediction of personal burnout, client-related burnout, job dissatisfaction, and intention to leave. Full article

In this study, the characteristics and distribution of the organic phosphorus (Po) fractions in the surface sediments of seven inflow rivers around Hongze Lake in China were analyzed with a soil Po fraction method, as used by Ivanoff. The relationships between the Po fractions and physiochemical features of sediments were also discussed. The results showed that, the sediments of the rivers had been moderately pollution with certain ecological risk effects except the Waste Yellow River. The relative contribution order of the Po fractions in the sediments was residual Po > HCl-Po > fulvic acid-Po > humic acid-Po > labile organic phosphorus (LOP). Moderately labile organic phosphorus (MLOP) was the main part of the Po forms in the whole sediments. The risk of phosphorus released from river sediments was the highest in the western region, followed by the southwestern region, and finally the northwestern region. There were significant correlations between Po forms and total phosphorus (TP), inorganic phosphorus (Pi), and Po. Non labile organic phosphorus (NLOP) had the strongest correlation with TP. The distribution of Po forms in each region was different due to the impact of human activities, industrial and agricultural production and the land types; the heaver polluted sediments with higher Po fractions. It is suggested that most of the sediments of the inflow rivers in the regions have certain ecological risk effects and P of them have an important contributions on the eutrophication of Hongze Lake. Po forms can provide a reliable theoretical basis for dealing with the change of water quality and should be paid more attention in the lake eutrophication investigation. There was reciprocal transformation between different Po forms, especially non-bioavailable fraction can change into bio-available ones. The results can provide a basis for the earth cycle of phosphorus and a new perspective of eutrophication control of shallow lakes. Full article

With increasing girls’ enrolment in schools, school preparedness to ensure a menstrual friendly environment is crucial. The study aimed to conduct a systematic review regarding the existing evidence on menstrual hygiene management (MHM) across schools in India. It further aimed to highlight the actions that have been taken by the government to improve the MHM situation in India. We conducted the systematic literature search using PubMed, EMBASE, and Web of Science for searching the peer-reviewed articles and Google Scholar for anecdotal reports published from inception until 30 October 2019. Of 1125 publications retrieved through the search, 183 papers were included in this review, using a priori created data-extraction form. Meta-analysis was used to estimate the pooled prevalence (PP) of MHM practices in schools. Less than half of the girls were aware of menstruation before menarche (PP 0.45, 0.39 to 0.51, I² = 100.0%, n = 122). Teachers were a less common source of information about menstruation to girls (PP 0.07, 0.05 to 0.08, I² = 100.0%, n = 86). Separate toilets for girls were present in around half of the schools (PP 0.56, 0.42 to 0.75, I² 100.0%, n = 11). MHM in schools should be strengthened with convergence between various departments for explicit implementation of guidelines. Full article

Aspects of human evolutionary biology and prehistory are discussed in relation to vitamin D. The evolution of hairlessness, combined with the need for efficient eccrine sweat production for cooling, provided evolutionary pressure to protect the skin from ultraviolet damage by developing cutaneous pigmentation. There was a subsequent loss of pigmentation as humans journeyed to northern latitudes. Their increasing mastery of technology outstripped evolution’s finite pace as further dispersal occurred around the globe. A timeline for the development of clothing to provide warmth, and the consequent shielding from ultraviolet light, which diminished vitamin D synthesis, can be inferred by an examination of mutations in the human louse. Full article