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Int. J. Environ. Res. Public Health, Volume 17, Issue 20 (October-2 2020) – 347 articles

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Cover Story (view full-size image) WHO’s Health Economic Assessment Tool for walking and cycling (HEAT) provides a simple way to [...] Read more.
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Open AccessArticle
The Effects of Epistemic Trust and Social Trust on Public Acceptance of Genetically Modified Food: An Empirical Study from China
Int. J. Environ. Res. Public Health 2020, 17(20), 7700; https://doi.org/10.3390/ijerph17207700 - 21 Oct 2020
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Abstract
Most studies exploring the public acceptance of genetically modified food (GMF) are based on social trust and the establishment of a causal model. The underlying premise is that social trust indirectly affects public acceptance of GMF through perceived risks and perceived benefits. The [...] Read more.
Most studies exploring the public acceptance of genetically modified food (GMF) are based on social trust and the establishment of a causal model. The underlying premise is that social trust indirectly affects public acceptance of GMF through perceived risks and perceived benefits. The object of social trust is trust in people, organizations, and institutions. Different from the social trust, epistemic trust refers to people’s trust in scientific knowledge behind the technology of concern. It has been shown that epistemic trust, like social trust, is also an important factor that affects the public perception of applicable risks and benefits. Therefore, it is necessary to incorporate epistemic trust into the causal model to derive a more complete explanation of public acceptance. However, such work has not been conducted to date. The causal model proposed in this paper integrated epistemic trust and social trust and divided social trust into trust in public organizations and trust in industrial organizations. A representative questionnaire survey (N = 1091) was conducted with Chinese adults. The model was analyzed by the partial least squares structural equation modeling (PLS-SEM) method. Three major findings were obtained: First, epistemic trust is an important antecedent of perceived risks and perceived benefits and exerts a significant indirect effect on the acceptance of GMF. Secondly, trust in industrial organizations negatively impacts perceived risks, while trust in public organizations positively impacts perceived benefits. Thirdly, contrary to the common opinion, trust in industrial organizations did not exert a significant direct effect on perceived benefits, and trust in public organizations did not demonstrate a significant direct effect on perceived risks. Therefore, trust in industrial organizations and trust in public organizations utilize different influence paths on GMF acceptance. This study enriches the understanding of the influence path of trust with regard to the acceptance of emerging technologies and is of great significance to relevant risk-management practices. Full article
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Open AccessArticle
Nutrient Composition of Foods Marketed to Children or Adolescents Sold in the Spanish Market: Are They Any Better?
Int. J. Environ. Res. Public Health 2020, 17(20), 7699; https://doi.org/10.3390/ijerph17207699 - 21 Oct 2020
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Abstract
Healthy eating is essential for the growth and development of children and adolescents. Eating habits established in childhood continue into adulthood. In Spain, the frequent promotion of foods with low nutritional value is already considered a threat to the health of the population, [...] Read more.
Healthy eating is essential for the growth and development of children and adolescents. Eating habits established in childhood continue into adulthood. In Spain, the frequent promotion of foods with low nutritional value is already considered a threat to the health of the population, particularly to children and adolescents. In this work, we analyse 3209 foods from the Food Database, BADALI. Foods were classified as marketed to children or adolescents according to the advertising on the packaging, television or internet. We found that 17.5% of foods in the database were marketed to this population and 97% of those were considered unhealthy following the Pan American Health Organization Nutrient Profile Model (PAHO-NPM). In the total of foods for children or adolescents, 61.5% were high in fat, 58.5% in free-sugar, 45.4% in saturated fat and 45% in sodium. Foods marketed to them presented higher amounts of carbohydrates and sugar, while lower protein and fibre content than the rest. There was also considerable variability in levels of the other nutrients found in these products, which depended largely on the food group. According to our findings, there is a tendency for products marketed to children or adolescents to be unhealthy and of a poorer nutritional quality than those not targeted at them. Full article
Open AccessArticle
Feasibility of Participatory Theater Workshops to Increase Staff Awareness of and Readiness to Respond to Abuse in Health Care: A Qualitative Study of a Pilot Intervention Using Forum Play among Sri Lankan Health Care Providers
Int. J. Environ. Res. Public Health 2020, 17(20), 7698; https://doi.org/10.3390/ijerph17207698 - 21 Oct 2020
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Abstract
Women globally experience mistreatment by health providers during childbirth. Researchers have identified strategies to counteract this type of abuse in health care, but few have been evaluated. We used a theater technique, Forum Play, in a brief training intervention to increase awareness of [...] Read more.
Women globally experience mistreatment by health providers during childbirth. Researchers have identified strategies to counteract this type of abuse in health care, but few have been evaluated. We used a theater technique, Forum Play, in a brief training intervention to increase awareness of abuse in health care and promote taking action to reduce or prevent it. The intervention was implemented in four workshops with 50 participating physicians and nurses from three hospitals in Colombo, Sri Lanka. This article reports the views of 23 workshop participants who also took part in four focus group discussions on the acceptability and feasibility of the method. The participants reported that the intervention method stimulated dialogue and critical reflection and increased their awareness of the everyday nature of abuses experienced by patients. Participants appreciated the participatory format of Forum Play, which allowed them to re-enact scenarios they had experienced and rehearse realistic actions to improve patient care in these situations. Structural factors were reported as limitations to the effectiveness of the intervention, including under-developed systems for protecting patient rights and reporting health provider abuses. Nonetheless, the study indicates the acceptability and feasibility of a theater-based training intervention for reducing the mistreatment of patients by health care providers in Sri Lanka. Full article
(This article belongs to the Special Issue Obstetric Violence and Women's Health)
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Open AccessArticle
Association between Dietary Habits, Shift Work, and the Metabolic Syndrome: The Korea Nurses’ Health Study
Int. J. Environ. Res. Public Health 2020, 17(20), 7697; https://doi.org/10.3390/ijerph17207697 - 21 Oct 2020
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Abstract
Metabolic syndrome (MetS) is an important public health problem, and unhealthy dietary habits and shift work are considered major factors that increase the prevalence of MetS. The purpose of this study was to examine whether dietary habits, alcohol drinking, and shift-working were associated [...] Read more.
Metabolic syndrome (MetS) is an important public health problem, and unhealthy dietary habits and shift work are considered major factors that increase the prevalence of MetS. The purpose of this study was to examine whether dietary habits, alcohol drinking, and shift-working were associated with development of MetS in shift-working female nurses. This study analyzed cross-sectional survey data from the Korea Nurses’ Health Study (KNHS). Of the 1638 nurses, 403 participants were selected based on the propensity score matching method (PSM). These participants had either no or more than three MetS determinant factors. Analysis was conducted by using multivariable logistic regression to confirm the factors influencing MetS. The prevalence of MetS in this group (1638 participants) was 5.6% (92 participants). Consumption of over 50% of daily calorie intake after 7 p.m., consumption of carbonated drinks, family history of diabetes, and non-shift work were significant factors influencing MetS. Nurses are one of the at-risk groups for unhealthy dietary habits due to the nature of their work. Therefore, nurse managers should include regular dietary education for nurses and continue their policy efforts to resolve health problems that may arise in connection with nurses’ work. Full article
Open AccessArticle
Neighborhood Social and Built Environment and Disparities in the Risk of Hypertension: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2020, 17(20), 7696; https://doi.org/10.3390/ijerph17207696 - 21 Oct 2020
Viewed by 328
Abstract
Citizens’ participation in urban environmental quality assessment is important when identifying local problems in the sustainable development and environmental planning policy. The principal aim of this study was to analyze whether any social differences exist between the joint effect of built neighborhood quality [...] Read more.
Citizens’ participation in urban environmental quality assessment is important when identifying local problems in the sustainable development and environmental planning policy. The principal aim of this study was to analyze whether any social differences exist between the joint effect of built neighborhood quality and exposure to urban green spaces and the risk of hypertension. The study sample consisted of 580 participants residing in 11 districts in Kaunas city, Lithuania. Using geographic information systems (GIS), individual data on the socioeconomic status (SES) and health were linked to the participants’ perceptions of the environmental quality and exposure to green spaces (NDVI). We used multivariate logistic regression to estimate associations as odds ratios (OR). Those study participants with lower education and those study participants with higher education on low incomes rated their health significantly worse. Low SES persons residing in areas with low exposure to green spaces had a significantly higher risk of hypertension when sex, age, family status, smoking, and income were accounted for (OR 1.83, 95% CI 1.01–3.36). This citizen science study provided evidence that the social environment and the quality of the built environment had a complex effect on disparities in the risk of hypertension. Full article
(This article belongs to the Special Issue Space, Place and Health Outcomes)
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Open AccessArticle
Impact of the “Sling Shot” Supportive Device on Upper-Body Neuromuscular Activity during the Bench Press Exercise
Int. J. Environ. Res. Public Health 2020, 17(20), 7695; https://doi.org/10.3390/ijerph17207695 - 21 Oct 2020
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Abstract
The aim of this study was to compare the muscle activity between the sling shot assisted (SS) and control (CONT) flat barbell bench press for selected external loads of 70%, 85%, 100% one-repetition maximum (1RM). Ten resistance-trained men participated in the study (age [...] Read more.
The aim of this study was to compare the muscle activity between the sling shot assisted (SS) and control (CONT) flat barbell bench press for selected external loads of 70%, 85%, 100% one-repetition maximum (1RM). Ten resistance-trained men participated in the study (age = 22.2 ± 1.9 years, body mass = 88.7 ± 11.2 kg, body height = 179.5 ± 4.1, 1RM in the bench press = 127.25 ± 25.86 kg, and strength training experience = 6 ± 2.5 years). Evaluation of peak muscle activity of the dominant body side was carried out using surface electromyography (sEMG) recorded for the triceps brachii, pectoralis major, and anterior deltoid during each attempt. The three-way repeated measure ANOVA revealed statistically significant main interaction for condition x muscle group (p < 0.01; η2 = 0.569); load x muscle group (p < 0.01; η2 = 0.709); and condition x load (p < 0.01; η2 = 0.418). A main effect was also observed for condition (p < 0.01; η2 = 0.968); load (p < 0.01; η2 = 0.976); and muscle group (p < 0.01; η2 = 0.977). The post hoc analysis for the main effect of the condition indicated statistically significant decrease in %MVIC for the SS compared to CONT condition (74.9 vs. 88.9%MVIC; p < 0.01; ES = 0.39). The results of this study showed that using the SS significantly affects the muscle activity pattern of the flat bench press and results in its acute decrease in comparison to an equal load under CONT conditions. The SS device may be an effective tool both in rehabilitation and strength training protocols by increasing stability with a reduction of muscular activity of the prime movers. Full article
(This article belongs to the Special Issue Resistance Exercise/Training to Improve Physical Fitness and Health)
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Open AccessArticle
Optimized Pretreatment of Non-Thermal Plasma for Advanced Sewage Oxidation
Int. J. Environ. Res. Public Health 2020, 17(20), 7694; https://doi.org/10.3390/ijerph17207694 - 21 Oct 2020
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Abstract
This study investigates how the non-thermal plasma (NTP) process leads to advanced oxidation of sewage using response surface methodology. For environmentally viable and efficient operation of the NTP process, temperature and contact time were selected as two important independent variables. Their impacts on [...] Read more.
This study investigates how the non-thermal plasma (NTP) process leads to advanced oxidation of sewage using response surface methodology. For environmentally viable and efficient operation of the NTP process, temperature and contact time were selected as two important independent variables. Their impacts on the performance were tested following an experimental design to figure out optimal operating conditions. Based on obtained treatment efficiency, statistically optimized conditions were derived by using an approach adapting the central composite design. Results show that coupling 40 °C of temperature and 4 h of contact time demonstrate optimal performance for total chemical oxygen demand (TCOD, 59%) and total suspended solids (85%), respectively. This implies that NTP may present efficient particulate destruction leading to organic solids dissolution. Statistical analysis reveals that the contact time shows more significant dependency than the temperature on the advanced oxidation of TCOD, possibly due to dissolved organic material. For total nitrogen removal, on the contrary, the optimal efficiency was strongly related to the higher temperature (~68 °C). This work provides an inroad to considering how NTP can optimally contribute to better oxidation of multiple pollutants. Full article
(This article belongs to the collection Municipal Wastewater Treatment and Sludge Treatment and Disposal)
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Open AccessArticle
Adsorption Media for the Removal of Soluble Phosphorus from Subsurface Drainage Water
Int. J. Environ. Res. Public Health 2020, 17(20), 7693; https://doi.org/10.3390/ijerph17207693 - 21 Oct 2020
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Abstract
Phosphorus (P) is a valuable, nonrenewable resource in agriculture promoting crop growth. P losses through surface runoff and subsurface drainage discharge beneath the root zone is a loss of investment. P entering surface water contributes to eutrophication of freshwater environments, impacting tourism, human [...] Read more.
Phosphorus (P) is a valuable, nonrenewable resource in agriculture promoting crop growth. P losses through surface runoff and subsurface drainage discharge beneath the root zone is a loss of investment. P entering surface water contributes to eutrophication of freshwater environments, impacting tourism, human health, environmental safety, and property values. Soluble P (SP) from subsurface drainage is nearly all bioavailable and is a significant contributor to freshwater eutrophication. The research objective was to select phosphorus sorbing media (PSM) best suited for removing SP from subsurface drainage discharge. From the preliminary research and literature, PSM with this potential were steel furnace slag (SFS) and a nano-engineered media (NEM). The PSM were evaluated using typical subsurface drainage P concentrations in column experiments, then with an economic analysis for a study site in Michigan. Both the SFS and generalized NEM (GNEM) removed soluble reactive phosphorus from 0.50 to below 0.05 mg/L in laboratory column experiments. The most cost-effective option from the study site was the use of the SFS, then disposing it each year, costing $906/hectare/year for the case study. GNEM that was regenerated onsite had a very similar cost. The most expensive option was the use of GNEM to remove P, including regeneration at the manufacturer, costing $1641/hectare/year. This study suggests that both SFS and NEM are both suited for treating drainage discharge. The use of SFS was more economical for the study site, but each site needs to be individually considered. Full article
(This article belongs to the Special Issue Advanced Technologies to Manage Nutrients in Wastes)
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Open AccessArticle
Investigation of the Association between Drinking Water Habits and the Occurrence of Women Breast Cancer
Int. J. Environ. Res. Public Health 2020, 17(20), 7692; https://doi.org/10.3390/ijerph17207692 - 21 Oct 2020
Viewed by 369
Abstract
Risk and protective factors for breast cancer (BC) include lifestyle, diet, reproduction, and others. Increased risk for colon cancer was linked with low water intake. The link between water consumption and BC was scarcely studied. We investigated the association between water and fluid [...] Read more.
Risk and protective factors for breast cancer (BC) include lifestyle, diet, reproduction, and others. Increased risk for colon cancer was linked with low water intake. The link between water consumption and BC was scarcely studied. We investigated the association between water and fluid consumption and the occurrence of BC in a retrospective case–control study in the Shaare Zedek Medical Center, Jerusalem, in 206 women aged 25–65 years (106 with newly diagnosed BC, and 100 controls). A food frequency questionnaire (FFQ), consumption of water, foods, and beverages, lifestyle, and other risk and protective factors were recorded. The age of women in both groups was comparable ((M ± SD) 52.7 ± 9.8 and 50.6 ± 11.4 years, respectively (p = 0.29)). Women with BC consumed 20.2% less water (M ± SD = 5.28 ± 4.2 and 6.62 ± 4.5 cups/day, respectively, p = 0.02) and 14% less total fluids than controls (M ± SD = 2095 ± 937 mL/day and 2431 ± 1087 mL/day, respectively, p = 0.018). Multiple stepwise logistic regression showed that the differences remained significant both for daily water consumption (p = 0.031, CI = 0.462–0.964) and for total daily liquid intake (p = 0.029, CI = 0.938–0.997). Low water and liquids intake as a risk factor for BC may be related to the younger age of our subjects. The effect of age on the potential role of water intake in decreasing BC risk should be investigated. Full article
(This article belongs to the Special Issue Women's Health throughout Life Stages)
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Open AccessArticle
Relation between Mother’s Taekyo, Prenatal and Postpartum Depression, and Infant’s Temperament and Colic: A Longitudinal Prospective Approach
Int. J. Environ. Res. Public Health 2020, 17(20), 7691; https://doi.org/10.3390/ijerph17207691 - 21 Oct 2020
Viewed by 365
Abstract
This longitudinal cohort correlational study aimed to confirm the relation among taekyo or traditional prenatal practice, prenatal depression, postpartum depression, maternal–fetal interaction, and infant temperament and colic using a prospective design. We recruited 212 women 16–20 weeks pregnant from July 2017 to September [...] Read more.
This longitudinal cohort correlational study aimed to confirm the relation among taekyo or traditional prenatal practice, prenatal depression, postpartum depression, maternal–fetal interaction, and infant temperament and colic using a prospective design. We recruited 212 women 16–20 weeks pregnant from July 2017 to September 2018; they were followed up until six months postpartum. Data from 97 participants were used in the final analysis. We used the Edinburgh Postnatal Depression Scale, Cranley’s Maternal–Fetal Attachment Scale, and What My Baby Is Like as measurement tools. We observed a significant correlation between prenatal maternal depression in the first to third trimesters and 6–8 weeks and six months postpartum. In addition, infant temperament at six months old showed a significant negative correlation with prenatal and postpartum depression: the higher the prenatal and postpartum depression level, the more difficult the infant’s temperament. Taekyo practice was significantly related to maternal–fetal attachment (r = 0.45−0.68, p < 0.001). Difficult infants showed more colic episodes than any other type of infant (χ2 = 18.18, p < 0.001). Prenatal and postnatal maternal depression affected infants’ temperament and colic episodes. The management of mothers’ mental health before and after pregnancy is important for infants’ and mothers’ health. Full article
(This article belongs to the Special Issue Prenatal Stress, Health Behaviors and Child Development)
Open AccessArticle
Citation Network Analysis of the Novel Coronavirus Disease 2019 (COVID-19)
Int. J. Environ. Res. Public Health 2020, 17(20), 7690; https://doi.org/10.3390/ijerph17207690 - 21 Oct 2020
Viewed by 350
Abstract
Background: The first outbreaks of the new coronavirus disease, named COVID-19, occurred at the end of December 2019. This disease spread quickly around the world, with the United States, Brazil and Mexico being the countries the most severely affected. This study aims to [...] Read more.
Background: The first outbreaks of the new coronavirus disease, named COVID-19, occurred at the end of December 2019. This disease spread quickly around the world, with the United States, Brazil and Mexico being the countries the most severely affected. This study aims to analyze the relationship between different publications and their authors through citation networks, as well as to identify the research areas and determine which publication has been the most cited. Methods: The search for publications was carried out through the Web of Science database using terms such as “COVID-19” and “SARS-CoV-2” for the period between January and July 2020. The Citation Network Explorer software was used for publication analysis. Results: A total of 14,335 publications were found with 42,374 citations generated in the network, with June being the month with the largest number of publications. The most cited publication was “Clinical Characteristics of Coronavirus Disease 2019 in China” by Guan et al., published in April 2020. Nine groups comprising different research areas in this field, including clinical course, psychology, treatment and epidemiology, were found using the clustering functionality. Conclusions: The citation network offers an objective and comprehensive analysis of the main papers on COVID-19 and SARS-CoV-2. Full article
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Open AccessArticle
Relationship between Firefighter Physical Fitness and Special Ability Performance: Predictive Research Based on Machine Learning Algorithms
Int. J. Environ. Res. Public Health 2020, 17(20), 7689; https://doi.org/10.3390/ijerph17207689 - 21 Oct 2020
Viewed by 355
Abstract
Firefighters require a high level of physical fitness to meet the demands of their job. The correlations and contributions of individual physical health parameters to the tasks of firefighting would enable firefighters to focus on the effects of specific physical conditions during their [...] Read more.
Firefighters require a high level of physical fitness to meet the demands of their job. The correlations and contributions of individual physical health parameters to the tasks of firefighting would enable firefighters to focus on the effects of specific physical conditions during their physical training programs. Therefore, the purpose of the present study was to identify the relationships between various physical health parameters (weight, maximum oxygen uptake, body fat percentage, upper body muscular power and lower body muscular power) and performance on simulated firefighting ability tasks, which included a set of seven tasks (rope climb, run 200 m round trip with load, 60 m carrying a ladder, climb stairs with load, evacuation of 400 m with supplies, run 5 km with an air respirator, run 100 m with the water hose). Through use of a partial least-squares regression (PLSR) algorithm to analyze the linear correlation, we revealed the change in various training performances of specific ability tests with physical fitness parameters. The present study demonstrated significant relationships among physical health parameters and performance on simulated firefighting ability tasks, which also represent that those parameters contributed significantly to the model’s predictive power and were suitable predictors of the simulated firefighting tasks score. Full article
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Open AccessArticle
Framework for Participatory Quantitative Health Impact Assessment in Low- and Middle-Income Countries
Int. J. Environ. Res. Public Health 2020, 17(20), 7688; https://doi.org/10.3390/ijerph17207688 - 21 Oct 2020
Viewed by 374
Abstract
Background: Conducting health impact assessments (HIAs) is a growing practice in various organizations and countries, yet scholarly interest in HIAs has primarily focused on the synergies between exposure and health outcomes. This limits our understanding of what factors influence HIAs and the uptake [...] Read more.
Background: Conducting health impact assessments (HIAs) is a growing practice in various organizations and countries, yet scholarly interest in HIAs has primarily focused on the synergies between exposure and health outcomes. This limits our understanding of what factors influence HIAs and the uptake of their outcomes. This paper presents a framework for conducting participatory quantitative HIA (PQHIA) in low- and middle-income countries (LMICs), including integrating the outcomes back into society after an HIA is conducted. The study responds to the question: what are the different components of a participatory quantitative model that can influence HIA implementation in LMICs? Methods: To build the framework, we used a case study from a PQHIA fieldwork model developed in Port Louis (Mauritius). To explore thinking on the participatory components of the framework, we extract and analyze data from ethnographic material including fieldnotes, interviews, focus group discussions and feedback exercises with 14 stakeholders from the same case study. We confirm the validity of the ethnographic data using five quality criteria: credibility, transferability, dependability, confirmability, and authenticity. We build the PQHIA framework connecting the main HIA steps with factors influencing HIAs. Results: The final framework depicts the five standard HIA stages and summarizes participatory activities and outcomes. It also reflects key factors influencing PQHIA practice and uptake of HIA outcomes: costs for participation, HIA knowledge and interest of stakeholders, social responsibility of policymakers, existing policies, data availability, citizen participation, multi-level stakeholder engagement and multisectoral coordination. The framework suggests that factors necessary to complete a participatory HIA are the same needed to re-integrate HIA results back into the society. There are three different areas that can act as facilitators to PQHIAs: good governance, evidence-based policy making, and access to resources. Conclusions: The framework has several implications for research and practice. It underlines the importance of applying participatory approaches critically while providing a blueprint for methods to engage local stakeholders. Participatory approaches in quantitative HIAs are complex and demand a nuanced understanding of the context. Therefore, the political and cultural contexts in which HIA is conducted will define how the framework is applied. Finally, the framework underlines that participation in HIA does not need to be expensive or time consuming for the assessor or the participant. Yet, participatory quantitative models need to be contextually developed and integrated if they are to provide health benefits and be beneficial for the participants. This integration can be facilitated by investing in opportunities that fuel good governance and evidence-based policy making. Full article
(This article belongs to the Special Issue Health Impacts of the Built Environment and Transport Planning)
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Open AccessArticle
The Influence of Transformational Teacher Leadership on Academic Motivation and Resilience, Burnout and Academic Performance
Int. J. Environ. Res. Public Health 2020, 17(20), 7687; https://doi.org/10.3390/ijerph17207687 - 21 Oct 2020
Viewed by 319
Abstract
Currently, the university failure rate is around 33% of students starting their studies. Among the main reasons are demanding academic situations and the use of inappropriate coping strategies. Therefore, the aim of this study was to analyze the influence of teacher leadership on [...] Read more.
Currently, the university failure rate is around 33% of students starting their studies. Among the main reasons are demanding academic situations and the use of inappropriate coping strategies. Therefore, the aim of this study was to analyze the influence of teacher leadership on academic resilience and motivation, burnout, and academic performance. This study involved 3354 university students. A structural equation model was made to analyze the predictive relationships between the study’s variables. The results showed that teacher leadership positively predicted academic resilience and motivation; academic resilience negatively predicted burnout and positively predicted academic performance; likewise, academic motivation negatively predicted burnout and positively predicted academic performance; finally, burnout negatively predicted academic resilience. Full article
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Open AccessArticle
Correlation of Pre-Hypertension with Carotid Artery Damage in Middle-Aged and Older Adults
Int. J. Environ. Res. Public Health 2020, 17(20), 7686; https://doi.org/10.3390/ijerph17207686 - 21 Oct 2020
Viewed by 347
Abstract
The intima–media thickness (IMT), luminal diameters (LDs), flow velocities (FVs), compliance, and β-stiffness of the carotid artery (CA) are considered as independent risk factors for cardiovascular diseases (CVDs). Pre-hypertension (PHT) is also an independent CVD risk factor. This study investigated the association between [...] Read more.
The intima–media thickness (IMT), luminal diameters (LDs), flow velocities (FVs), compliance, and β-stiffness of the carotid artery (CA) are considered as independent risk factors for cardiovascular diseases (CVDs). Pre-hypertension (PHT) is also an independent CVD risk factor. This study investigated the association between CA damage (CAD) and PHT. A total of 544 adults participated; their blood pressures (BPs) and CA characteristics were measured using a mercury-free sphygmomanometer and ultrasound. Analysis of covariance (ANCOVA) was performed to assess the differences in the CA characteristics according to the BPs, multinomial logistic regression to evaluate the risk of CAD associated with PHT. In ANCOVA, the CA characteristics of PHT were significantly different from normotensive. The odds ratios (ORs) of IMTmax, LDmax, LDmin, peak-systolic FV (PFV), end-diastolic FV (EFV), PFV/LDmin, EFV/LDmax, compliance, and β-stiffness of PHT were 4.20, 2.70, 3.52, 2.41, 3.06, 3.55, 3.29, 2.02, and 1.84 times higher than those of the normotensive, respectively, in Model 2. In Model 3 adjusted for age, the ORs of LDmax, LDmin, EFV, PFV/LDmin, and EFV/LDmax of PHT were 2.10, 2.55, 1.96, 2.20, and 2.04 times higher than those of the normotensive, respectively. Therefore, the present study revealed that CAD is closely correlated with pre-hypertensive status in adults. Full article
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Open AccessArticle
How Can the Lived Environment Support Healthy Ageing? A Spatial Indicators Framework for the Assessment of Age-Friendly Communities
Int. J. Environ. Res. Public Health 2020, 17(20), 7685; https://doi.org/10.3390/ijerph17207685 - 21 Oct 2020
Viewed by 430
Abstract
The Age-Friendly Cities and Communities Guide was released by the World Health Organization over a decade ago with the aim of creating environments that support healthy ageing. The comprehensive framework includes the domains of outdoor spaces and buildings, transportation, housing, social participation, respect [...] Read more.
The Age-Friendly Cities and Communities Guide was released by the World Health Organization over a decade ago with the aim of creating environments that support healthy ageing. The comprehensive framework includes the domains of outdoor spaces and buildings, transportation, housing, social participation, respect and inclusion, civic participation and employment, communication and information, and community and health services. A major critique of the age-friendly community movement has argued for a more clearly defined scope of actions, the need to measure or quantify results and increase the connections to policy and funding levers. This paper provides a quantifiable spatial indicators framework to assess local lived environments according to each Age-Friendly Cities and Communities (AFC) domain. The selection of these AFC spatial indicators can be applied within local neighbourhoods, census tracts, suburbs, municipalities, or cities with minimal resource requirements other than applied spatial analysis, which addresses past critiques of the Age-Friendly Community movement. The framework has great potential for applications within local, national, and international policy and planning contexts in the future. Full article
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Open AccessArticle
Speech and Language Skills of Low-Risk Preterm and Full-Term Late Talkers: The Role of Child Factors and Parent Input
Int. J. Environ. Res. Public Health 2020, 17(20), 7684; https://doi.org/10.3390/ijerph17207684 - 21 Oct 2020
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Abstract
Among children in the third year of life, late talkers comprise from 9% to 20%. This range seems to increase when addressing preterm children. This study examined video-recorded child spontaneous speech during parent–child book sharing as well as linguistic skills reported through the [...] Read more.
Among children in the third year of life, late talkers comprise from 9% to 20%. This range seems to increase when addressing preterm children. This study examined video-recorded child spontaneous speech during parent–child book sharing as well as linguistic skills reported through the MacArthur Bates Communicative Development Inventories (MB-CDI) Short Form in 61 late talkers aged 30 months old (26 low-risk preterm, 8 females; 35 full-term, 12 females). Differences between low-risk preterm and full-term late talkers in child language measures and parental speech input were tested, as were the roles of child and parent factors on child language. Low-risk preterm and full-term late talkers showed similar speech and language skills. Similarly, no differences were found in measures of parental speech between groups. Child cognitive score, chronological age, and low-risk preterm status were positively associated with lexical diversity, rate, and composition of child speech production, whereas family history for language and/or learning disorders as well as parent measures of lexical diversity, rate, and grammatical complexity were negatively associated with the above child variables. In addition, child cognitive score and low-risk preterm status were positively associated with the MB-CDI measures of word and sentence production. Findings are discussed in terms of the need of good practices when following up on low-risk preterm children and of interventions targeting parents’ input to preterm and full-term late talkers. Full article
(This article belongs to the Special Issue Preterm Birth: Research, Intervention and Developmental Outcomes)
Open AccessArticle
Public Medical Insurance and Healthcare Utilization and Expenditures of Older with Chronic Diseases in Rural China: Evidence from NRCMS
Int. J. Environ. Res. Public Health 2020, 17(20), 7683; https://doi.org/10.3390/ijerph17207683 - 21 Oct 2020
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Abstract
China’s rural older are the threat from chronic diseases, making it important to evaluate the effect of public health insurance on the health care utilization and expenditures with chronic diseases. In 2003, China initiated a public health insurance, which was called the New [...] Read more.
China’s rural older are the threat from chronic diseases, making it important to evaluate the effect of public health insurance on the health care utilization and expenditures with chronic diseases. In 2003, China initiated a public health insurance, which was called the New Rural Cooperative Medical System (NRCMS). NRCMS is a voluntary program, targeting rural residents with government subsidies and individual contribution. Using the two-stage residual inclusion approach (2SRI), we analyzed the impact of NRCMS on health-care service utilization and expenditure of rural older with chronic diseases by using the 2011 and 2013 China Health and Retirement Survey (CHARLS) data. The results showed NRCMS did not play an effective role on improving the medical services utilization of rural older with chronic diseases. Although NRCMS immediate reimbursement significantly reduced the outpatient service fee, the actual outpatient reimbursement is the opposite. In addition, NRCMS did not significantly decrease their hospitalization expense. Policy makers should pay attention to health management about chronic diseases in rural China, and some measures should be taken to deepen the medical security system reform and improve the public health service system. Full article
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
Open AccessArticle
Risk Assessment on Continued Public Health Threats: Evidence from China’s Stock Market
Int. J. Environ. Res. Public Health 2020, 17(20), 7682; https://doi.org/10.3390/ijerph17207682 - 21 Oct 2020
Viewed by 389
Abstract
Given the disturbing effects of the coronavirus disease 2019 (COVID-19) outbreak, we are motivated to examine whether the continued increase of the provincial public health threats affects the firms’ accumulative abnormal return. Using the 178,805 firm-day observations from Chinese listed firms from 10 [...] Read more.
Given the disturbing effects of the coronavirus disease 2019 (COVID-19) outbreak, we are motivated to examine whether the continued increase of the provincial public health threats affects the firms’ accumulative abnormal return. Using the 178,805 firm-day observations from Chinese listed firms from 10 January to 31 March 2020, we find that the accumulative abnormal return is significantly lower among firms located in the provinces where face the continued increase of new confirmed COVID-19 cases. The relations remain constant after several robustness tests. These findings suggest that investors concern about the potential risk when firms are located in the provinces with higher threats to public health. We also find that the negative effect of increasing public health threats on abnormal return is weaker for firms surrounded by a provincial environment with stronger information accessibility and economic growth. Overall, this study extends the literature by presenting systematic evidence on the effect of the continued increase of provincial public health threats on the market reaction in Chinese listed firms. Full article
(This article belongs to the Section Public Health Statistics and Risk Assessment)
Open AccessArticle
Methodology of Specialist Physicians Training: From Traditional to e-Learning
Int. J. Environ. Res. Public Health 2020, 17(20), 7681; https://doi.org/10.3390/ijerph17207681 - 21 Oct 2020
Viewed by 327
Abstract
Different studies show that mixed methodology can be effective in medical training. However, there are no conclusive studies in specialist training on advanced life support (ALS). The main objective of this research is to determine if, with mixed didactic methodology, which includes e-learning, [...] Read more.
Different studies show that mixed methodology can be effective in medical training. However, there are no conclusive studies in specialist training on advanced life support (ALS). The main objective of this research is to determine if, with mixed didactic methodology, which includes e-learning, similar results are produced to face-to-face training. The method used was quasi-experimental with a focus on efficiency and evaluation at seven months, in which 114 specialist doctors participated and where the analysis of the sociodemographic and pre-test variables points to the homogeneity of the groups. The intervention consisted of e-learning training plus face-to-face workshops versus standard. The results were the performance in knowledge and technical skills in cardiac arrest scenarios, the perceived quality, and the perception of the training. There were no significant differences in immediate or deferred performance. In the degree of satisfaction, a significant difference was obtained in favour of the face-to-face group. The perception in the training itself presented similar results. The main limitations consisted of sample volume, dropping out of the deferred tests, and not evaluating the transfer or the impact. Finally, mixed methodology including e-learning in ALS courses reduced the duration of the face-to-face sessions and allowed a similar performance. Full article
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Open AccessArticle
Impacts of Environmental Regulation on the Green Transformation and Upgrading of Manufacturing Enterprises
Int. J. Environ. Res. Public Health 2020, 17(20), 7680; https://doi.org/10.3390/ijerph17207680 - 21 Oct 2020
Viewed by 298
Abstract
Since environmental problems are becoming increasingly prominent, macro policies and social development have placed higher requirements on manufacturing enterprises to promote green transformation and upgrading (GTU) in China. Considering that different manufacturing enterprises choose different green technology innovation levels for GTU under environmental [...] Read more.
Since environmental problems are becoming increasingly prominent, macro policies and social development have placed higher requirements on manufacturing enterprises to promote green transformation and upgrading (GTU) in China. Considering that different manufacturing enterprises choose different green technology innovation levels for GTU under environmental regulation, a game model between manufacturing enterprises and the government is constructed. The relationship between the green technology innovation level (GTIL) and the environmental regulation intensity is analyzed. Through numerical examples, the influences of environmental regulation and consumer preference on system decisions are further examined. Moreover, an econometric model is constructed to explore the influence that the environmental regulation exerts on the GTIL using panel data from the Chinese manufacturing industry. Our results show that the increase in environmental regulation intensity contributes to improving GTIL and promoting the GTU of manufacturing enterprises. Furthermore, as the environmental regulation is enhanced, the sales price decreases, benefiting consumers. Consumers’ preference for high-GTIL products is conducive to GTU under environmental regulation. Empirical analysis shows that there is a U-shaped relationship between environmental regulation and the GTIL. Only when the intensity reaches a threshold can the environmental regulation be beneficial to improve the GTIL and promote the GTU of Chinese manufacturing enterprises. Full article
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Open AccessReview
mHealth and Perinatal Depression in Low-and Middle-Income Countries: A Scoping Review of the Literature
Int. J. Environ. Res. Public Health 2020, 17(20), 7679; https://doi.org/10.3390/ijerph17207679 - 21 Oct 2020
Viewed by 300
Abstract
Women in low- and middle-income countries have high rates of perinatal depression. As smartphones become increasingly accessible around the world, there is an opportunity to explore innovative mHealth tools for the prevention, screening, and management of perinatal depression. We completed a scoping review [...] Read more.
Women in low- and middle-income countries have high rates of perinatal depression. As smartphones become increasingly accessible around the world, there is an opportunity to explore innovative mHealth tools for the prevention, screening, and management of perinatal depression. We completed a scoping review of the literature pertaining to the use of mobile phone technologies for perinatal depression in low-and middle-income countries. PubMed CINHAL, and Google Scholar databases were searched, generating 423 results. 12 articles met our inclusion criteria. Two of the 12 articles reviewed mobile phone applications. The remaining 9 articles were study protocols or descriptive/intervention studies. Our results reveal that minimal literature is currently available on the use of mobile health for perinatal depression in low- and middle-income countries. We found four articles that present the results of an intervention that were delivered through mobile phones for the treatment of perinatal depressive symptoms and an additional qualitative study describing the perceptions of mothers receiving cognitive behavioral therapy via telephones. These studies demonstrated that depressive symptoms improved after the interventions. There is potential to improve the quality of mHealth interventions, specifically mobile phone applications for perinatal depressive symptoms and depression, through meaningful collaborative work between healthcare professionals and application developers. Full article
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Open AccessArticle
Assessing Communication during Remote Follow-Up of Users with Pacemakers in Norway: The NORDLAND Study, a Randomized Trial
Int. J. Environ. Res. Public Health 2020, 17(20), 7678; https://doi.org/10.3390/ijerph17207678 - 21 Oct 2020
Viewed by 261
Abstract
As effective communication is a key ingredient for the provision of quality healthcare services, this study aimed to explore the communication experiences in the remote monitoring of older adults with a pacemaker. The study was based on a non-masked randomized observational design. The [...] Read more.
As effective communication is a key ingredient for the provision of quality healthcare services, this study aimed to explore the communication experiences in the remote monitoring of older adults with a pacemaker. The study was based on a non-masked randomized observational design. The Healthcare Communication Questionnaire and in-depth interviews were conducted for data collection. A total of 49 patients participated in the study. The study findings reveal overall positive communication experiences by pacemaker users in remote monitoring with no significant differences from users in hospital monitoring. The remote option is perceived as safe and convenient, and communicating with the clinicians from home is considered comfortable and confidential. The study provides insights into the content of communication experiences in telehealth and practical implications in healthcare contexts. In a world that increasingly relies on remote communication, it is crucial to match technologies to patient needs and assess communication with patients. This will ensure the success of new models of care and establish appropriate criteria for the use of telehealth services. These criteria are all relevant in the implementation of health technology in the future as a part of effective patient-centered care. Full article
Open AccessReview
Understanding the Intersection of Race/Ethnicity, Socioeconomic Status, and Geographic Location: A Scoping Review of U.S. Consumer Food Purchasing
Int. J. Environ. Res. Public Health 2020, 17(20), 7677; https://doi.org/10.3390/ijerph17207677 - 21 Oct 2020
Viewed by 355
Abstract
Disparities in diet quality persist in the U.S. Examining consumer food purchasing can provide unique insight into the nutritional inequities documented by race/ethnicity, socioeconomic status (SES), and geographic location (i.e., urban vs. rural). There remains limited understanding of how these three factors intersect [...] Read more.
Disparities in diet quality persist in the U.S. Examining consumer food purchasing can provide unique insight into the nutritional inequities documented by race/ethnicity, socioeconomic status (SES), and geographic location (i.e., urban vs. rural). There remains limited understanding of how these three factors intersect to influence consumer food purchasing. This study aimed to summarize peer-reviewed scientific studies that provided an intersectional perspective on U.S. consumer food purchasing. Thirty-four studies were examined that presented objectively measured data on purchasing outcomes of interest (e.g., fruits, vegetables, salty snacks, sugar-sweetened beverages, Healthy Eating Index, etc.). All studies were of acceptable or high quality. Only six studies (17.6%) assessed consumer food purchases at the intersection of race/ethnicity, SES, or geographic location. Other studies evaluated racial/ethnic or SES differences in food purchasing or described the food and/or beverage purchases of a targeted population (example: low-income non-Hispanic Black households). No study assessed geographic differences in food or beverage purchases or examined purchases at the intersection of all three factors. Overall, this scoping review highlights the scarcity of literature on the role of intersectionality in consumer food and beverage purchasing and provides recommendations for future studies to grow this important area of research. Full article
(This article belongs to the Special Issue Retail Strategies to Support Healthy Eating)
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Open AccessArticle
Belonging and Inclusivity Make a Resilient Future for All: A Cross-Sectional Analysis of Post-Flood Social Capital in a Diverse Australian Rural Community
Int. J. Environ. Res. Public Health 2020, 17(20), 7676; https://doi.org/10.3390/ijerph17207676 - 21 Oct 2020
Viewed by 296
Abstract
In 2017, marginalised groups were disproportionately impacted by extensive flooding in a rural community in Northern New South Wales, Australia, with greater risk of home inundation, displacement and poor mental health. While social capital has been linked with good health and wellbeing, there [...] Read more.
In 2017, marginalised groups were disproportionately impacted by extensive flooding in a rural community in Northern New South Wales, Australia, with greater risk of home inundation, displacement and poor mental health. While social capital has been linked with good health and wellbeing, there has been limited investigation into its potential benefits in post-disaster contexts, particularly for marginalised groups. Six months post-flood, a cross-sectional survey was conducted to quantify associations between flood impact, individual social capital and psychological distress (including probable post-traumatic stress disorder). We adopted a community-academic partnership approach and purposive recruitment to increase participation from socio-economically marginalised groups (Aboriginal people and people in financial hardship). These groups reported lower levels of social capital (informal social connectedness, feelings of belonging, trust and optimism) compared to general community participants. Despite this, informal social connectedness and belonging were important factors for all participant groups, associated with reduced risk of psychological distress. In this flood-prone, rural community, there is a pressing need to build social capital collectively through co-designed strategies that simultaneously address the social, cultural and economic needs of marginalised groups. Multiple benefits will ensue for the whole community: reduced inequities; strengthened resilience; improved preparedness and lessened risk of long-term distress from disaster events. Full article
(This article belongs to the Special Issue Disaster Mental Health Risk Reduction)
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Open AccessArticle
Screening for Autism Spectrum Disorder in Premature Subjects Hospitalized in a Neonatal Intensive Care Unit
Int. J. Environ. Res. Public Health 2020, 17(20), 7675; https://doi.org/10.3390/ijerph17207675 - 21 Oct 2020
Viewed by 324
Abstract
Considering that the average age for diagnosis of autism spectrum disorder (ASD) is 4–5 years, testing screening methods for ASD risk in early infancy is a public health priority. This study aims to identify the risks for development of ASD in children born [...] Read more.
Considering that the average age for diagnosis of autism spectrum disorder (ASD) is 4–5 years, testing screening methods for ASD risk in early infancy is a public health priority. This study aims to identify the risks for development of ASD in children born prematurely and hospitalized in a neonatal intensive care unit (NICU) and explore the association with pre-, peri- and postnatal factors. Methods: The children’s families were contacted by telephone when their child was between 18 and 24 months of age, to apply the Modified Checklist for Autism in Toddlers (M-CHAT). The sample consisted of 40 children (57.5% boys). M-CHAT screening revealed that 50% of the sample showed early signs of ASD. Although the frequency of delayed development was higher in boys, this difference was not statistically significant between the sexes (p = 0.11). Assessment of the association between perinatal conditions and early signs of autism in children hospitalized in an NICU exhibited no correlation between the factors analyzed (birth weight and type of delivery). The findings indicate a high risk of ASD in premature children, demonstrating no associations with gestational and neonatal variables or the hospitalization conditions of the NICUs investigated. Full article
Open AccessArticle
Study on the Relationship between Leisure Activity Participation and Wearing a Mask among Koreans during COVID-19 Crisis: Using TPB Model
Int. J. Environ. Res. Public Health 2020, 17(20), 7674; https://doi.org/10.3390/ijerph17207674 - 21 Oct 2020
Viewed by 351
Abstract
This study utilizes the Theory of Planned Behavior (TPB) variables—including “attitude,” “subjective norms,” and “perceived behavioral control”—to understand the relationship between mask-wearing behavior and physical/non-physical leisure activity participation in Koreans as well as the tendencies behind mask-wearing intentions within leisure activities. The measurement [...] Read more.
This study utilizes the Theory of Planned Behavior (TPB) variables—including “attitude,” “subjective norms,” and “perceived behavioral control”—to understand the relationship between mask-wearing behavior and physical/non-physical leisure activity participation in Koreans as well as the tendencies behind mask-wearing intentions within leisure activities. The measurement tools used attitude, subjective norms, control, and mask use intention factors based on the TPB. Overall, 545 individuals participated, and the non-overlapping regions, sex, and age were considered through the stratified sampling method. The survey was conducted online owing to COVID-19, and collected data were derived through descriptive and multiple linear regression analyses. First, a difference in mask-wearing intention based on physical and non-physical leisure activities was identified; second, attitudes and perceived behaviors were considered in light of the dangers posed by COVID-19. It was found that control influences the tendency of intention to wear a mask depending on whether the group was engaged in physical or non-physical activity. Therefore, it can be stated that mask-wearing must be mandatory during physical and non-physical activities owing to respiratory diseases such as COVID-19. It is also important to simultaneously promote a positive attitude toward mask-wearing to enable people to believe that they can stay in full control of their own health. Full article
(This article belongs to the Special Issue The World in Crisis: Current Health Issues)
Open AccessArticle
Roma Ethnicity and Sex-Specific Associations of Serum Uric Acid with Cardiometabolic and Hepatorenal Health Factors in Eastern Slovakian Population: The HepaMeta Study
Int. J. Environ. Res. Public Health 2020, 17(20), 7673; https://doi.org/10.3390/ijerph17207673 - 21 Oct 2020
Viewed by 294
Abstract
Background: Health characteristics associated with uric acid (UA) in the Roma minority remain less well known. The study sought to determine the ethnicity- and sex-specific associations of serum UA with health factors in Eastern Slovakian Roma and non-Roma populations. Methods: Data from the [...] Read more.
Background: Health characteristics associated with uric acid (UA) in the Roma minority remain less well known. The study sought to determine the ethnicity- and sex-specific associations of serum UA with health factors in Eastern Slovakian Roma and non-Roma populations. Methods: Data from the comparative cross-sectional HepaMeta study conducted in Slovakia in 2011 were used. The study enrolled 452 Roma subjects (35.2% men) and 403 non-Roma individuals (45.9% men) aged 18–55 years. Results: All study parameters differed between the sexes in both the Roma and non-Roma participants (p < 0.05). UA was related to sex with odds ratio for female sex 0.873, 95% CI 0.853–0.893 (p < 0.0001) per 10-unit increase of UA. Average level of UA ± standard deviation was lower in Roma than in non-Roma (226.54 ± 79.8 vs. 259.11 ± 84.53 umol/L; p < 0.0001). The Roma population presented with greater levels of high-sensitivity C-reactive protein (hsCRP) (3.07 ± 4 mg/L vs. 1.98 ± 2.83 mg/L; p < 0.0001) and ferritin in Roma males (403.78 ± 391.84 vs. 302.67 ± 236.26 mg/L; p < 0.0001). Conclusions: Serum UA is sex- and ethnicity specific. Elevated levels of hsCRP and ferritin particularly in Roma males can reflect low-grade systemic inflammation and thus serve as a marker of an increased cardiovascular risk. Full article
(This article belongs to the Special Issue Roma Health Disadvantage)
Open AccessReview
Burnout in Palliative Care Nurses, Prevalence and Risk Factors: A Systematic Review with Meta-Analysis
Int. J. Environ. Res. Public Health 2020, 17(20), 7672; https://doi.org/10.3390/ijerph17207672 - 21 Oct 2020
Viewed by 333
Abstract
Palliative care nurses are exposed to hard situations, death, and duel feelings in their daily practice. These, and other work stressors, can favor burnout development. Thus, it is important to analyze the prevalence and risk factors of burnout in palliative care nurses and [...] Read more.
Palliative care nurses are exposed to hard situations, death, and duel feelings in their daily practice. These, and other work stressors, can favor burnout development. Thus, it is important to analyze the prevalence and risk factors of burnout in palliative care nurses and estimate its prevalence. A systematic review and meta-analysis was done with quantitative primary studies. n = 15 studies were included with n = 6 studies including information for the meta-analysis. The meta-analytic prevalence estimation of emotional exhaustion was 24% (95% CI 16–34%), for depersonalization was 30% (95% CI 18–44%) and for low personal accomplishment was 28% with a sample of n = 693 palliative care nurses. The main variables related with burnout are occupational variables followed by psychological variables. Some interventions to improve working conditions of palliative care nurses should be implemented to reduce burnout. Full article
(This article belongs to the Special Issue Burnout Syndrome and Prevention)
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Open AccessArticle
Significant Associations between AXIN1 rs1805105, rs12921862, rs370681 Haplotypes and Variant Genotypes of AXIN2 rs2240308 with Risk of Congenital Heart Defects
Int. J. Environ. Res. Public Health 2020, 17(20), 7671; https://doi.org/10.3390/ijerph17207671 - 21 Oct 2020
Viewed by 278
Abstract
This study aimed to investigate possible associations of the susceptibility to congenital heart defects (CHDs) with AXIN1 rs1805105, rs12921862 and rs370681 gene variants and haplotypes, and AXIN2 rs2240308 gene variant. Significant associations were identified for AXIN1 rs370681 and AXIN2 rs2240308 variants. AXIN1 rs370681 [...] Read more.
This study aimed to investigate possible associations of the susceptibility to congenital heart defects (CHDs) with AXIN1 rs1805105, rs12921862 and rs370681 gene variants and haplotypes, and AXIN2 rs2240308 gene variant. Significant associations were identified for AXIN1 rs370681 and AXIN2 rs2240308 variants. AXIN1 rs370681 variant was significantly associated with decreased odds of CHDs (adjusted OR varying from 0.13 to 0.28 in codominant, dominant and recessive gene models), while the AXIN2 rs2240308 variant was associated with increased odds of CHD in the dominant model. The haplotype-based generalized linear model regression of AXIN1 rs1805105, rs12921862 and rs370681 variants revealed that C-C-C and C-C-T haplotypes significantly increased the risk of CHDs (p < 0.05). No significant second order epistatic interactions were found between investigated variants (AXIN1 rs1805105, rs12921862, rs370681, and AXIN2 rs2240308). Our conclusion is that AXIN1 rs1805105, rs12921862, and rs370681 (C-C-C and C-C-T) haplotypes and AXIN2 rs2240308 contribute to CHDs susceptibility. Full article
(This article belongs to the Section Children's Health)
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