Int. J. Environ. Res. Public Health, Volume 17, Issue 23 (December-1 2020) – 446 articles

Ambient air pollution is a global health threat that causes severe mortality and morbidity from respiratory, cardiovascular, and other diseases. Its impact is especially concerning in cities; as the urban population increases, especially in low- and middle-income countries, large populations risk suffering from these health effects. The Economic Community of West African States (ECOWAS) comprises 15 West African countries, in which many cities are currently experiencing fast growth and industrialization. However, government-led initiatives in air quality monitoring are scarce in ECOWAS countries, which makes it difficult to effectively control and regulate air quality and subsequent health issues. A scoping study was performed following the Arksey and O’Malley methodological framework in order to assess the precise status of air quality monitoring, related policy, and legislation in this region. Scientific databases and gray literature searches were conducted, and the results were contrasted through expert consultations. It was found that only two ECOWAS countries monitor air quality, and most countries have insufficient legislation in place. Public health surveillance data in relation to air quality data is largely unavailable. In order to address this, improved air quality surveillance, stricter and better-enforced regulations, regional cooperation, and further research are strongly suggested for ECOWAS. Full article

Realtors match home-seekers with neighborhoods that have built and social characteristics they desire to pursue active lifestyles. Studies have yet to explore realtors’ perspectives on neighborhood design that supports active living. Using qualitative description, our study was to explore the perceptions and understandings of neighborhood design (walkability, healthy, bike-ability, vibrancy, and livability) among urban residential realtors. Nineteen (6 men; 13 women; average age 48 years) self-identified residential realtors from Calgary, Edmonton, and Lethbridge (Canada) completed semi-structured telephone interviews. Content analysis identified themes from the interview data. Specifically, walkability was described as: perceived preferences, destinations and amenities, and connections; a healthy community was described as: encourages outdoor activities, and promotes social homogeneity; bike-ability was described as: bike-ability attributes, and was controversial; vibrancy was described as: community feel, and evidence of life; and livability was described as: subjective, and preferences and necessities. Our findings can inform the refinement of universal definitions and concepts used to in neighborhood urban design. Full article

The determinants of children’s independent school mobility and the contextual discrepancies between these determinants have not been comprehensively investigated in previous studies. It is important to examine these determinants because independent school mobility is associated with children’s physical activity, according to the literature. This paper examined the associations of different groups of variables such as household, mobility, perceptions, and the built environment with independent school mobility of children between 9 and 12 years using a sample of 1304 girls (50.9%) and boys (49.1%) in seven European countries. The sample was analyzed by Multinomial Logistic Regression, Chi-square test of independence, and Proportional Reduction in Error methods. According to the findings, father’s and mother’s commute mode choice, child’s mode choice of commute to school, child’s bike ownership, parent’s perception of safety, parent’s evaluation of bike lane and sidewalk quality, child’s commute distance, number of driving licenses in the household, accessibility of public transport, and population density in the neighborhood and around the school proved to be very strong and significant determinants of children’s independent school mobility in the Europe-wide sample. The comparison of the levels of independent school mobility did not show any significant differences between high-income countries such as Germany, Italy, and the Netherlands, and emerging economies and developing countries like Poland, Greece, Turkey, and Croatia. However, a direct comparison between Poland (emerging economy) (33.6%) and the Netherlands (high-income) (31.7%) revealed significant differences in the level of independent school mobility. This study found the motives for this discrepancy due to the significant difference in bike ownership, the number of household members working outside of the house, household size, commute distances of parents, and driving license possession. Full article

No studies have addressed the way the effectiveness of fear and hope advertisements differs across differently characterized individuals. The present study aims to find out in which situations related to different individual characteristics do fear and hope advertisements work as tools in generating healthy eating intention and physical activity intention. This study conducted an experiment using 283 adults from Chile. The results suggest that fear versus hope appeals in health advertisements have a more positive influence on healthy eating intention. The results suggest that the effect of fear advertisements on healthy eating intention is positively moderated by the frequency of fast food consumption and is negatively moderated by self-efficacy. The results suggest that fear versus hope appeals in health advertisements have no main effect on physical activity intention. However, the results suggest that the effect of fear advertisements on physical activity intention is positively moderated by perceived body weight and past healthy eating behavior and is negatively moderated by subjective norms. The results indicate that when making health advertising, homogenous messages are not persuasive for heterogeneous audiences. The present study results suggest that fear and hope advertisements should be delivered considering the individual characteristics identified in the present study. Full article

A necessarily high standard for physical readiness in tactical environments is often accompanied by high incidences of injury due to overaccumulations of neuromuscular fatigue (NMF). To account for instances of overtraining stimulated by NMF, close monitoring of neuromuscular performance is warranted. Previously validated tests, such as the countermovement jump, are useful means for monitoring performance adaptations, resiliency to fatigue, and risk for injury. Performing such tests on force plates provides an understanding of the movement strategy used to obtain the resulting outcome (e.g., jump height). Further, force plates afford numerous objective tests that are valid and reliable for monitoring upper and lower extremity muscular strength and power (thus sensitive to NMF) with less fatiguing and safer methods than traditional one-repetition maximum assessments. Force plates provide numerous software and testing application options that can be applied to military’s training but, to be effective, requires the practitioners to have sufficient knowledge of their functions. Therefore, this review aims to explain the functions of force plate testing as well as current best practices for utilizing force plates in military settings and disseminate protocols for valid and reliable testing to collect key variables that translate to physical performance capacities. Full article

Insufficient vaccination rates against pneumococcal disease are a major problem in primary health care, especially in adult patients. Shared decision-making (SDM) may address major barriers to vaccination. The objective of this review was to assess the impact of SDM on pneumococcal vaccination rates in adult patients. We conducted a systematic literature search in MEDLINE, EMBASE, CENTRAL, PsycINFO, and ERIC. RCTs and cluster RCTs were included, if they aimed to enhance pneumococcal vaccination rates in adult patients and comprised a personal interaction between health care provider (HCP) and patient. Three further aspects of the SDM process (patient activation, bi-directional exchange of information and bi-directional deliberation) were assessed. A meta-analysis was conducted for the effects of interventions on vaccination rates. We identified eight studies meeting the inclusion criteria. The pooled effect size was OR (95% CI): 2.26 (1.60–3.18) comparing intervention and control groups. Our findings demonstrate the efficacy of interventions that enable a SDM process to enhance pneumococcal vaccination rates; although, the quality of evidence was low. In exploratory subgroup analyses, we concluded that an impersonal patient activation and an exchange of information facilitated by nurses are sufficient to increase vaccination rates against pneumococcal disease in adult patients. However, the deliberation of options between physicians and patients seemed to be more effective than deliberation of options between nurses and patients. Full article

Since the advent of the Internet, websites have become the nerve center of the digital ecosystems of media, companies and all kinds of institutions. Currently, the impact of the global coronavirus pandemic has placed healthcare issues at the center of social debate, including hospitals and their websites as digital sources of trustworthy information. COVID-19 has intensified the need for quality information and the legitimacy of sources fighting the infodemic situation. In this regard hospitals become essential social actors in the spread of healthcare information. Within this framework, a qualitative study is presented with descriptive components and based on content analysis. This study examines 58 websites from the best hospitals included in the “América Economía” ranking health sector from Latin America. The study applies an analysis methodology based on previous research focusing on specialized web studies, defining an analysis model on six variables and 65 thematic indicators. The research concludes that hospitals occupying first positions in the medical services directory are not necessarily those that have the best websites. Similarly, it is worth noting that a quarter of the studied sample do not devote a specific space to reporting coronavirus information. Brazil, Colombia and Chile are the countries with the highest number of hospitals among those with the best websites. In conclusion, digital media, specifically websites, could constitute legitime resources of healthcare information consumption, so their accuracy and proper development seem to be significant to become genuine sources that not only could provide better healthcare services but help avoid the spread of misinformation about the COVID-19 pandemic. Full article

Guidelines recommend a healthy lifestyle and regularly physical activity (PA) after kidney transplantation (KTx). The KTx360° program is a multicenter, multisectoral, multimodal, telemedicine-based follow-up care program. Effects of the first COVID-19 wave restrictions on health-related quality of life and PA of supervised KTx360° patients were evaluated using an online questionnaire. Six hundred and fifty-two KTx360° patients were contacted via email and were asked to complete the Freiburg questionnaire of physical activity and the Short form 12 Health Survey (SF-12) online. Pre-pandemic and lockdown data were compared in 248 data sets. While sporting activity decreased during the COVID-19 pandemic, basic and leisure activity increased, resulting in increased overall activity. The physical component scale of the SF-12 was in the low normal range before as well as during the pandemic, with a small but significant increase during the pandemic. The mental component scale showed normal values before and during pandemic with a small but statistically significant decrease. Our study supports the effectiveness of a telemedicine based program for KTx patient care in maintaining PA and quality of life during the first peak of the COVID-19 pandemic. However, further research and observation during the ongoing pandemic are required. Full article

Facing the increasingly serious waste electrical and electronic equipment (WEEE) recycling problem, recycling enterprises actively introduce online recycling channels, build dual channel reverse supply chains (DRSC), and use high-level recycling price and service levels to enhance consumers’ recycling enthusiasm and recycling amount. Nevertheless, in China, where the imbalance of regional development is widespread, the recycling center, third-party recycler (TPR), and third-party platform (TPP) are faced with the choices of pricing and service level when facing multi-regional consumers. This paper mainly answers the following questions: (1) When the recycling center and TPP introduce online recycling channels in multi-regional situations, how should they set online recycling price, transfer price, and service level? (2) When consumer preference for online channels changes in a certain region, how should recycling enterprises adjust their optimal pricing and service level decisions for different regions to maximize their own profits? How do the profits of recycling enterprises change? In order to solve the above problems, in this paper, we propose three pricing and service level decision models for the recycling center with online channels, namely, keeping prices unchanged, unifying all prices, and maximizing its own profits. By using the Stackelberg game to solve the model, we get the optimal pricing, service level decisions, as well as the maximum profits of the recycling center, TPP, and TPR when consumer preference changes. By analyzing the results of the model, we find that the change of consumer preference for online channels in a certain region will affect the decision and profits of multi-regional recycling enterprises. Specifically, consumer preference for online channels in a certain region will not only lead to an increase in the profits of the recycling center and TPP and a decrease in the profit of local TPRs, but also an increase in the profit of TPRs in other regions. In addition, at the beginning of introducing online channels, the recycling center can adopt two strategies to avoid conflicts among channels: keeping offline transfer prices unchanged and unifying all transfer prices, but the former promotes its economic profits more significantly. Full article

Far too little attention has been paid to health effects of air pollution and physical (in)activity on musculoskeletal health. The purpose of the Healthy aging in industrial environment study (4HAIE) is to investigate the potential impact of physical activity in highly polluted air on musculoskeletal health. A total of 1500 active runners and inactive controls aged 18–65 will be recruited. The sample will be recruited using quota sampling based on location (the most air-polluted region in EU and a control region), age, sex, and activity status. Participants will complete online questionnaires and undergo a two-day baseline laboratory assessment, including biomechanical, physiological, psychological testing, and magnetic resonance imaging. Throughout one-year, physical activity data will be collected through Fitbit monitors, along with data regarding the incidence of injuries, air pollution, psychological factors, and behavior collected through a custom developed mobile application. Herein, we introduce a biomechanical and musculoskeletal protocol to investigate musculoskeletal and neuro-mechanical health in this 4HAIE cohort, including a design for controlling for physiological and psychological injury factors. In the current ongoing project, we hypothesize that there will be interactions of environmental, biomechanical, physiological, and psychosocial variables and that these interactions will cause musculoskeletal diseases/protection. Full article

Simple lighting solutions may mitigate the harmful effects of shiftwork. This hybrid effectiveness–implementation study evaluated a multi-component lighting intervention in hospital nurses that included 6500 K architectural lighting in the nurses’ station plus optional behavioral components (a lightbox, blueblocker glasses, eyemasks) with instruction about appropriately timed usage. Selective improvements from baseline were observed in on-shift performance, sleep quality, and caffeine consumption in day workers (all p < 0.05); off-shift sleepiness scores improved for night workers (p < 0.05). Further, self-reported measures of quality of life improved for both groups (p < 0.05). Preliminary implementation data from interviews and questionnaires suggest perceived benefits and high acceptability of the intervention. Full article

Although studies have suggested environmental factors to be triggers of headache, the contribution of long-term air pollution exposure to recurrent headaches is poorly understood. Hence, we executed this nationwide cohort study to investigate associations between levels of ambient air pollutants and risks of recurrent headaches in children in Taiwan from 2000 to 2012. We used data from the Taiwan National Health Insurance Research Database and linked them to the Taiwan Air Quality Monitoring Database. Overall, 218,008 children aged < 18 were identified from 1 January 2000, and then followed until they were diagnosed by a physician for ≥3 times with recurrent headaches or until 31 December 2012. We categorized the annual average concentration of each air pollutant (fine particulate matter, total hydrocarbon, methane, sulfur dioxide, and nitrogen dioxide) into quartiles (Q1–Q4). We measured the incidence rate, hazard ratios (HRs), and the corresponding 95% confidence intervals for recurrent headaches. stratified by the quartiles. A total of 28,037 children (12.9%) were identified with recurrent headaches. The incidence rate and adjusted HR for recurrent headaches increased with higher-level exposure of air pollutants, except sulfur dioxide. We herein demonstrate that long-term ambient air pollutant exposure might be a risk factor for childhood recurrent headaches. Full article

The associations between children’s pocket money and their eating behaviors and weight status have not been examined using longitudinal data in China. Examined child and parental factors associated with children’s pocket money, and longitudinal effects of pocket money on children’s eating behaviors and weight status. Data were collected in 2015, 2016, and 2017 from 3261 school-age children and their parents in mega-cities across China (Beijing, Shanghai, Nanjing, Xi’an, Chengdu). Children’s weight, height, and waist circumference were measured; pocket money and eating behaviors were self-reported. Mixed effect models were used. Older children received more pocket money than younger children (incident rate ratio (IRR) = 1.21, 95% confidence interval (CI): 1.15, 1.26). Fathers gave their children more pocket money than mothers did (IRR = 1.22, 95% CI: 1.16, 1.30). Children with fathers having ≥ college education received more pocket money than the others did (IRR = 1.20, 95% CI: 1.04, 1.40). Some nutrition-related parenting behaviors and attitude were also associated with children’s pocket money. Compared with children receiving no weekly pocket money, those having 1–10 or 10–30 or >30-yuan weekly pocket money were 12.0–136% more likely to consume unhealthy foods and were 66–132% more likely to be overweight or obese. Some child and parental factors were associated with children’s pocket money, which increased risks of having unhealthy eating behaviors and being overweight and obese. Full article

Travelling to school by car diminishes opportunities for physical activity and contributes to traffic congestion and associated noise and air pollution. This meta-analysis examined sociodemographic characteristics and built environment associates of travelling to school by car compared to using active transport among New Zealand (NZ) adolescents. Four NZ studies (2163 adolescents) provided data on participants’ mode of travel to school, individual and school sociodemographic characteristics, distance to school and home-neighbourhood built-environment features. A one-step meta-analysis using individual participant data was performed in SAS. A final multivariable model was developed using stepwise logistic regression. Overall, 60.6% of participants travelled to school by car. When compared with active transport, travelling to school by car was positively associated with distance to school. Participants residing in neighbourhoods with high intersection density and attending medium deprivation schools were less likely to travel to school by car compared with their counterparts. Distance to school, school level deprivation and low home neighbourhood intersection density are associated with higher likelihood of car travel to school compared with active transport among NZ adolescents. Comprehensive interventions focusing on both social and built environment factors are needed to reduce car travel to school. Full article

Artificial intelligence virtual health assistants are a promising emerging technology. This study is a process evaluation of a 12-week pilot physical activity and diet program delivered by virtual assistant “Paola”. This single-arm repeated measures study (n = 28, aged 45–75 years) was evaluated on technical performance (accuracy of conversational exchanges), engagement (number of weekly check-ins completed), adherence (percentage of step goal and recommended food servings), and user feedback. Paola correctly asked scripted questions and responded to participants during the check-ins 97% and 96% of the time, respectively, but correctly responded to spontaneous exchanges only 21% of the time. Participants completed 63% of weekly check-ins and conducted a total of 3648 exchanges. Mean dietary adherence was 91% and was lowest for discretionary foods, grains, red meat, and vegetables. Participants met their step goal 59% of the time. Participants enjoyed the program and found Paola useful during check-ins but not for spontaneous exchanges. More in-depth knowledge, personalized advice and spontaneity were identified as important improvements. Virtual health assistants should ensure an adequate knowledge base and ability to recognize intents and entities, include personality and spontaneity, and provide ongoing technical troubleshooting of the virtual assistant to ensure the assistant remains effective. Full article

A third of Aotearoa New Zealand’s increasingly ageing population resides in Tāmaki Makaurau Auckland. This most populous cosmopolitan urban area in the country is also home to the largest Polynesian population of any global city. Sprawling across a North Island isthmus inclusive of Hauraki Gulf islands, 70% of the city region is rural, whilst almost 90% of the ethnically diverse residents live in urban areas. Members of Auckland Council’s Seniors Advisory Panel (SAP) advocated for, and in 2018 secured unanimous support from the governing body to resource an Age-friendly City (AFC) Project. This case study inquiry applied bricolage methodology to provide diverse contextual perspectives of this unique Polynesian setting, prior to exploring interview narratives of three SAP members who served two consecutive terms (six years) as AFC advocates. Weaving insights gleaned from their interview transcripts responding to relational leadership prompts about their age-friendly advocacy with the findings from the council’s AFC Community Engagement report highlighted the achievements and challenges of the evolving AFC Project. Service-learning recommendations include co-developing: (1) A sustainable co-governance framework for an independent steering group that embodies the values and principles of Te Tiriti o Waitangi to enable empowered active ageing for all residents; (2) A succession plan that enables the timely transfer of knowledge and skills to empower incoming SAP members. Full article

Background: Improving balance-related ability is an important goal in stroke rehabilitation. Evidence is needed to demonstrate how this goal could be better achieved. Aim: Determine if trunk exercises on unstable surfaces would improve trunk control and balance for persons in the subacute stage of stroke. Design: An assessor-blind randomized controlled trial. Setting: Inpatients in the department of rehabilitation in a general hospital. Population: Patients who suffered a first-time stroke with onset from one to six months. Methods: Inpatients with stroke were assigned to upper limb exercises (control group, n = 17) or trunk exercises on unstable surfaces (experimental group, n = 18) to receive training twice a week for six weeks, in addition to their daily conventional stroke rehabilitation. Sensorimotor function tests, including hand grip, plantar sensitivity, stroke rehabilitation assessment of movement and Fugl-Meyer lower extremity motor scale, and clinical outcome assessments, including Trunk Impairment Scale and 6 m walk test, were conducted before and after six weeks of training. The center of the pressure area while maintaining static posture and peak displacement while leaning forward, as well as the average speed of raising the unaffected arm, were measured in sitting without foot support, sitting with foot support and standing to reflect trunk control, sitting balance and standing balance, respectively. Results: The between-group differences in the sensorimotor functions were nonsignificant before and after training. Compared with the control group, the experimental group had significantly greater forward leaning and faster arm raising in sitting without foot support, higher Trunk Impairment Scale total score, and shorter 6 m walking time after training, but not before training. Conclusion: Trunk exercises on unstable surfaces could further improve trunk control, the ability to raise the unaffected arm rapidly in sitting, and walking for persons in the subacute stage of stroke. This intervention may be considered to be included in stroke rehabilitation. Full article

Dengue is the most rapidly spreading mosquito-borne viral disease in the world. The detection of clinical cases enables us to measure the incidence of dengue infection, whereas serological surveys give insights into the prevalence of infection. This study aimed to determine dengue seroprevalence and seroconversion rates in northeastern Thailand and southern Laos and to assess any association of mosquito control methods and socioeconomic factors with dengue virus (DENV) infection. Cross-sectional seroprevalence surveys were performed in May and November 2019 on the same individuals. Blood samples were collected from one adult and one child, when possible, in each of 720 randomly selected households from two urban and two rural sites in both northeastern Thailand and southern Laos. IgG antibodies against DENV were detected in serum using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Overall, 1071 individuals participated in the study. The seroprevalence rate was high (91.5%) across all 8 study sites. Only age and province were associated with seroprevalence rates. There were 33 seroconversions during the period from May to November, of which seven reported fever. More than half of the seroconversions occurred in the rural areas and in Laos. Dengue seroconversion was significantly associated with young age (<15 years old), female gender, province, and duration of living in the current residence. No socioeconomic factors or mosquito control methods were found to be associated with seroprevalence or seroconversion. Notably, however, the province with most seroconversions had lower diurnal temperature ranges than elsewhere. In conclusion, our study has highlighted the homogeneity of dengue exposure across a wide range of settings and most notably those from rural and urban areas. Dengue can no longer be considered to be solely an urban disease nor necessarily one linked to poverty. Full article

Anigrides Nymphes of Lake Kaiafas is a thermal spring that is well known for its therapeutical properties, as the hot water (32–34 °C) is rich in sulfur compounds and minerals. Nowadays, efforts are made from the Hellenic Republic to modernize the existing facilities and infrastructure networks of the area. To study the complex ecosystem of the thermal spring, we collected water from four sampling points (Lake, and Caves 1, 2, and 3). Filtration method was used for microbial enumeration. In parallel, total bacterial DNA was extracted and subjected to next-generation sequencing (NGS). A total of 166 different bacterial families were detected. Differences in families, genera, and species abundances were detected between the different sampling points. Specifically, Comamonadaceae was the most common family detected in Lake and Cave 3. Similarly, in Caves 1 and 2, Rhodobacteraceae was detected at a higher percentage compared to the rest of the families. Moreover, the detection of sequences assigned to waterborne or opportunistic pathogens, i.e., Enterobacteriaceae, Legionellaceae, Coxiellaceae, and Clostridiaceae, as well as Enterococcus and Vibrio, is of great importance. Although the presence of pathogens was not examined by quantitative PCR, the detection of their sequences strengthens the need of the planned rehabilitation actions of this natural environment in order to allow human swimming. Full article

Understanding age-specific injury patterns allows the continued improvement of prevention strategies. This is a retrospective study analyzing the Korea Emergency Department-Based Injury In-depth Surveillance data, including those aged ≤19 years old between January 2011 and December 2017. In this study, we focused on changes in the modes of injury and severity, and prevention potential by dividing the patients into four age groups: group 1 (0–4 years), group 2 (5–9 years), group 3 (10–14 years), and group 4 (15–19 years). The most common mode of injury in younger age groups 1 and 2 was a fall or slip. Most injuries in older age groups 3 and 4 were unintentional and intentional collisions combined. Traumatic brain injuries (2.1%), intensive care unit admissions (1.8%), and overall death (0.4%) were the highest in group 4. The proportions of severe and critical injury (EMR-ISS ≥ 25) were 7.5% in group 4, 3.2% in group 3, 2.5% in group 1, and 1% in group 2. This study presents a comprehensive trend of injuries in the pediatric population in South Korea. Our results suggest the importance of designing specific injury-prevention strategies for targeted groups, circumstances, and situations. Full article

The ability of mangroves in taking up and storing heavy metal (HM) helps in reducing HM pollution. However, HMs likewise adversely affect the growth of mangroves. We assess the effects of the long-term soil HMs enrichment on the growth of Rhizophora apiculata forest in the Can Gio Mangrove Forest (Southern Vietnam) in different environmental conditions of soil salinity, ground elevation, and tree density based on a novel set of measured data. These data were analyzed and were used to calibrate and validate for a tree growth model with influencing factors salinity, elevation, tree density, and heavy metals content. Three scenario simulations were performed to predict the mangrove dynamics under different levels of heavy metal pollution in combined environmental conditions of salinity and elevation. Simulation results show the decline of total forest biomass from 1,750,000 tons (baseline scenario with no HM pollution) down to 850,000 tons and 350,000 tons for the current HM pollution and double HM pollution scenarios, respectively. Both data analysis and simulations have shown that although mangroves can assist in reducing HM pollution, the quality and health of this ecosystem will be severely affected if the environment is excessively polluted. In addition, a data-and-model driven management tool is devised for the sustainable management of the mangrove environmental resources. Full article

This study is an observational and cross-sectional study on the prevalence of sarcopenic disease in 202 autonomous older adults; 18.8 and 81.2% were men and women, respectively, living in their own homes in Valencia, Spain. Sarcopenia was diagnosed using the criteria and cutting points for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), using the tests: SARC-F, grip strength, sit-to-stand, gait speed, appendicular skeletal muscle mass and short physical performance battery. According to the EWGSOP2 criteria, probable sarcopenia was present in 21.1% and 18.3% of men and women, respectively, and the sum of confirmed and severe sarcopenia was 7.9% and 7.3% in men and in women, respectively. A relationship was shown between the prevalence of the disease and the age of the participants, but no significant differences were found between the sum of confirmed and severe sarcopenia between the sexes, nor a relationship between the amount of muscle mass and the strength of grip. The SARC-F questionnaire diagnosed 40% of the sarcopenia cases present in the study. More thorough research is needed to continue using the EWGSOP2 criteria in different populations to establish a correct prevalence of sarcopenic disease in different populations of the world. Full article

The International Agency for Research on Cancer (IARC) at the World Health Organization (WHO) categorized in 2011 radiofrequency (RF) as a possible human carcinogen, Group 2B. During use of the handheld wireless phone, especially the smartphone, the thyroid gland is a target organ. During the 21st century, the incidence of thyroid cancer is increasing in many countries. We used the Swedish Cancer Register to study trends from 1970 to 2017. During that time period, the incidence increased statistically significantly in women with average annual percentage change (AAPC) +2.13%, 95% confidence interval (CI) +1.43, +2.83%. The increase was especially pronounced during 2010–2017 with annual percentage change (APC) +9.65%, 95% CI +6.68, +12.71%. In men, AAPC increased during 1970–2017 with +1.49%, 95% CI +0.71, +2.28%. Highest increase was found for the time period 2001–2017 with APC +5.26%, 95% CI +4.05, +6.49%. Similar results were found for all Nordic countries based on NORDCAN 1970–2016 with APC +5.83%, 95% CI +4.56, +7.12 in women from 2006 to 2016 and APC + 5.48%, 95% CI +3.92, +7.06% in men from 2005 to 2016. According to the Swedish Cancer Register, the increasing incidence was similar for tumors ≤4 cm as for tumors >4 cm, indicating that the increase cannot be explained by overdiagnosis. These results are in agreement with recent results on increased thyroid cancer risk associated with the use of mobile phones. We postulate that RF radiation is a causative factor for the increasing thyroid cancer incidence. Full article

Previous studies have demonstrated that ambient air pollution leads to a decrease in mental and physical function. Although studies on the relationship between long-term exposure to air pollution and health-related quality of life have been conducted, the impact of short-term exposure has rarely been reported. This study explored the association between short-term exposure to air pollution and EuroQol-visual analog scale (EQ-VAS) scores, an indicator of health-related quality of life, using repeated measures. We selected 5420 respondents from seven metropolitan cities (Seoul, Busan, Daegu, Incheon, Gwangju, Daejeon, Ulsan) and one province (Jeju) in South Korea who had participated three or more times in the Korea Health Panel survey conducted from 2009 to 2013. A total of 24,536 observations were used. We applied the daily lag effects of air pollutants on the EQ-VAS stratified by sex and age group using the generalized linear mixed model. After controlling confounders, the EQ-VAS scores decreased statistically significantly in males aged 40–49 years, and females aged 50–64 years with chronic disease. The EQ-VAS scores reduced the most to −1.571 (95% confidence interval: −2.307–−0.834) and −1.722 (95% confidence interval: −2.499–−0.944) per interquartile range increment of carbon monoxide in males aged 40–49 years and per interquartile range increment of sulfur dioxide in females aged 50–64 years, respectively. This study provides evidence that short-term exposure to air pollution is related to the discomfort experienced by individuals in their daily lives. Full article

Habitual nut intake is associated with a range of health benefits; however, population consumption data suggests that most individuals do not meet current recommendations for nut intake. The literature has highlighted a range of barriers and facilitators to nut consumption, which should be considered when designing strategies to promote nut intake. Common barriers include confusion regarding the effects of nut consumption on body weight, perceptions that nuts are high in fat, or too expensive, and challenges due to dentition issues or nut allergies. Conversely, demographic characteristics such as higher education and income level, and a healthier lifestyle overall, are associated with higher nut intakes. Health professionals appear to play an important role in promoting nut intake; however, research suggests that knowledge of the benefits of nut consumption could be improved in many health professions. Future strategies to increase nut intake to meet public health recommendations must clarify misconceptions of the specific benefits of nut consumption, specifically targeting sectors of the population known to have lower nut consumption, and educate health professionals to promote nut intake. In addition, given the relatively small body of evidence exploring barriers and facilitators to nut consumption, further research exploring these factors is justified. Full article

The identification of groundwater chemical characteristics and the controlling factors is of major concern in water environment studies. In this study, we identified the groundwater chemical characteristics, evolution laws and main control factors in a region severely affected by human activities using hydrochemical and multivariate statistical techniques. The results showed that the concentrations of NO₃⁻ and TH were the primary pollution factors in the region with intensive human activity because of high concentration and over the standard rates. The major types of groundwater chemistry were HCO₃·SO₄–Ca and HCO₃·SO₄–Ca·Mg. The sulfate-type water was as high as 75.0%, 69.2% and 41.2% in the three hydrogeological units. In addition, there were Cl-type and Na-type waters, indicating that the groundwater in this area has been significantly affected by human activities. A principal component analysis (PCA) indicated that the three factors affecting groundwater hydrochemistry in the study area are domestic sewage and fertilizer, water–rock interactions and industrial wastewater. Therefore, we suggest that the government and water environment management departments should prevent the discharge of domestic and industrial wastewater without standardized treatment first in order to effectively prevent the further deterioration of groundwater quality in this area. Full article

Background: As coronary heart disease (CHD) is a highly complex disease, complex continuity of care (CoC) service should be provided for the patients, and the quality of life (QoL) needs to be regarded as an important measuring indicator for the health-care outcome. Purpose: To understand the general situation of CHD QoL and important predictors. Method: A cross-sectional study design was adopted from August 2019 to July 2020 by structured questionnaires. A total of 163 patients were enrolled, and data were statistically analyzed using SPSS 25.0. Result: The average score of the QoL questionnaire is 56.56/80, and the CoC is 4.32. The overall regression model can explain 58.7% of the variance regarding QoL. Patients’ instrumental activities of daily living (IADLs) (26.1%), age (18.1%), living situation (7%), information transfer (4.8%), main source of income (1.8%), and risk of disability are significantly different from their overall QoL in depression (0.9%). Conclusions: In order to improve the QoL of patients, it is suggested that medical teams should assess the needs of patients immediately upon hospitalization, provide patients with individual CoC, encourage them to participate in community health promotion activities, and strengthen the function of IADL to improve the QoL of patients. Full article

This cross-sectional pilot study aimed to assess the relationships of fat and muscle mass with chronic kidney disease (CKD) in older adults. Serum creatinine concentration was used to measure estimated glomerular filtration rate (mL/min/1.73 m²) in the 236 subjects, who were allocated to three groups: a normal (≥60.0), a mild CKD (45.0–59.9), and a moderate to severe CKD (<45.0) group. The Jonckheere-Terpstra test and multivariate logistic regression were employed to assess body composition trends and the relationships of % fat mass (FM) or % muscle mass index (MMI) with moderate-to-severe CKD. Body weight, fat-free mass, MMI, and %MMI tended to decrease with an increase in the severity of CKD, but the opposite trend was identified for %FM. No relationship with BMI was identified. The participants in the middle-high and highest quartile for %FM were 6.55 and 14.31 times more likely to have moderate to severe CKD. Conversely, the participants in the highest quartile for %MMI were 0.07 times less likely to have moderate to severe CKD. Thus, high fat and low muscle mass may be more strongly associated with CKD than obesity per se. Full article

Parent-implemented language interventions have been used for children with expressive language delays, but no study has yet been carried out using this intervention for low-risk preterm children. The current study examined the effect of a parent-implemented dialogic book reading intervention, determining also whether the intervention differently impacted low-risk preterm and full-term children. Fifty 31-month-old late talkers with their parents participated; 27 late talkers constituted the intervention group, and 23 constituted the control group. The overall results indicated that more children in the intervention group showed partial or full recovery of their lexical expressive delay and acquired the ability to produce complete sentences relative to the control group. Concerning full-term late talkers, those in the intervention group showed a higher daily growth rate of total words, nouns, function words, and complete sentences, and more children began to produce complete sentences relative to those in the control group. Concerning low-risk preterm late talkers, children in the intervention group increased their ability to produce complete sentences more than those in the control group. We conclude that a parent-focused intervention may be an effective, ecological, and cost-effective program for improving expressive lexical and syntactic skills of full-term and low-risk preterm late talkers, calling for further studies in late talkers with biological vulnerabilities. Full article

Identifying the most vulnerable subjects is crucial for the effectiveness of health interventions aimed at limiting the adverse consequences of high temperatures. We conducted a case crossover study aimed at assessing whether suffering from mental health disorders modifies the effect of high temperatures on mortality. We included all deaths occurred in the area of Bologna Local Health Trust during the summers 2004–2017. Subjects with mental disorders were identified by using the local Mental Health Registry. A conditional logistic model was applied, and a z-test was used to study the effect modification. Several models were estimated stratifying by subjects’ characteristics. For every 1 °C above 24 °C, mortality among people without mental disorders increased by 1.9% (95% CI 1.0–2.6, p < 0.0001), while among mental health service users, mortality increased by 5.5% (95% CI 2.4–8.6, p < 0.0001) (z-test equal to p = 0.0259). The effect modification varied according to gender, residency and cause of death. The highest probability of dying due to an increase in temperature was registered in patients with depression and cognitive decline. In order to reduce the effects of high temperatures on mortality, health intervention strategies should include mental health patients among the most vulnerable subjects taking account of their demographic and clinical characteristics. Full article