Int. J. Environ. Res. Public Health, Volume 17, Issue 24 (December-2 2020) – 444 articles

As a crucial element of China’s political and cultural life, “banners”, or biāoyǔ, have been around for decades, in support of national-level policies such as family planning and the governing mottos of Presidents. The banners that have emerged during the Covid-19 pandemic which was also the subject of a national-level driven policy, have been involved in a nation-wide public debate over the language styles of banners used to urge people to stay indoors. Based on the analysis of the early COVID-19 banners and the related online comments, this article analyzes the language style patterns of the banners and the mode of banner circulation. The study found that the manner in which the banners are circulated goes beyond a unidirectional path of on-site instant communication. This process is facilitated by social networks and mass media, which, during circulation, twice created a banner upgrade. The upgrades created decontextualization and function extension of the banners, whereas audience feedback triggered an adaptive adjustment of the language style of the banners. This article suggests that the study of the use and spread of banners, especially the early COVID-19 banners, sheds light on the study of mass communication and discourse style, and also how measures to contain pandemics such as COVID-19 can be communicated. Full article

Objective: The need to make sense of coherence in placement support for student dental hygienists has been shown. On this basis, this study investigated the relationship between the sense of coherence of student dental hygienists and their view of the profession and attitude to work in order to clarify how they perceive their prospects for employment. Methods: The subjects were graduation-year students at all of the dental hygienist training institutions in Japan, and anonymous, self-administered questionnaires were sent to the institutions by post in 2019. The results were analyzed by χ² tests, as well as one-way analysis of variance and multiple comparisons using Tukey’s test, with the level of significance set at 5%. Results: Of 6270 questionnaires that were returned, 6264 were analyzed. The sense of coherence (SOC) component senses were manageability (F(26,221) = 5306.06, p < 0.01), meaningfulness (F(26,222) = 4373.48, p < 0.01), and comprehensibility (F(26,216) = 3986.12, p < 0.01), with meaningfulness scoring significantly higher than the other two (p < 0.01). Analysis with SOC scores divided into the low, medium, and high groups showed a relationship between the SOC of student dental hygienists and their view of the profession and attitude to work (p < 0.01), such that higher SOC scores were associated with a better view of the profession and a better attitude to work (F(26,225) = 282.18, p < 0.01). Conclusions: The results suggest that education that increases SOC in dental hygienist training programs may positively affect future prospects for student dental hygienists. Full article

The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. It brought about the implementation of various measures and restrictions at a global level. Iran has been one of the countries with the highest rates of COVID-19 cases. This study reviews the initial outbreak of COVID-19 in Iran and examines the mitigation strategies adopted by the country. Moreover, it reports the socioeconomic challenges faced by the authorities during the efforts to contain the virus. A transdisciplinary literature review was carried out and a political measures timeline was constructed. A broad overview of the initial phase of the COVID-19 outbreak in Iran is presented, starting from the first confirmed case on 19 February 2020 until April 2020. The results of this epidemiological and socioeconomic case review of Iran suggests that the political measures undertaken by the Republic of Iran contributed to the decrease of the prevalence of COVID-19. However, due to the existing financial bottleneck, Iran has faced limited health system resources. Therefore, the response was not sufficient to restrict the spread and the efficient handling of the virus in the long-term. Full article

As of November 2020, the number of COVID-19 cases was increasing rapidly in many countries. In Europe, the virus spread slowed considerably in the late spring due to strict lockdown, but a second wave of the pandemic grew throughout the fall. In this study, we first reconstruct the time evolution of the effective reproduction numbers $\mathcal{R}\left(t\right)$ for each country by integrating the equations of the classic Susceptible-Infectious-Recovered (SIR) model. We cluster countries based on the estimated $\mathcal{R}\left(t\right)$ through a suitable time series dissimilarity. The clustering result suggests that simple dynamical mechanisms determine how countries respond to changes in COVID-19 case counts. Inspired by these results, we extend the simple SIR model for disease spread to include a social response to explain the number $X\left(t\right)$ of new confirmed daily cases. In particular, we characterize the social response with a first-order model that depends on three parameters ${\nu }_1,{\nu }_2,{\nu }_3$. The parameter ${\nu }_1$ describes the effect of relaxed intervention when the incidence rate is low; ${\nu }_2$ models the impact of interventions when incidence rate is high; ${\nu }_3$ represents the fatigue, i.e., the weakening of interventions as time passes. The proposed model reproduces typical evolving patterns of COVID-19 epidemic waves observed in many countries. Estimating the parameters ${\nu }_1,{\nu }_2,{\nu }_3$ and initial conditions, such as ${\mathcal{R}}_0$, for different countries helps to identify important dynamics in their social responses. One conclusion is that the leading cause of the strong second wave in Europe in the fall of 2020 was not the relaxation of interventions during the summer, but rather the failure to enforce interventions in the fall. Full article

Technological advances, coupled with increasing demands by consumers, have led to a drastic increase in plastic production. After serving their purposes, these plastics reach our water bodies as their destination and become ingested by aquatic organisms. This ubiquitous phenomenon has exposed humans to microplastics mostly through the consumption of sea food. This has led the World Health Organization (WHO) to make an urgent call for the assessment of environmental pollution due to microplastics and its effect on human health. This review summarizes studies between 1999 and 2020 in relation to microplastics in aquatic ecosystems and human food products, their potential toxic effects as elicited in animal studies, and policies on their use and disposal. There is a paucity of information on the toxicity mechanisms of microplastics in animal studies, and despite their documented presence in food products, no policy has been in place so far, to monitor and regulates microplastics in commercial foods meant for human consumption. Although there are policies and regulations with respect to plastics, these are only in a few countries and in most instances are not fully implemented due to socioeconomic reasons, so they do not address the problem across the entire life cycle of plastics from production to disposal. More animal research to elucidate pathways and early biomarkers of microplastic toxicity that can easily be detected in humans is needed. This is to create awareness and influence policies that will address this neglected threat to food safety and security. Full article

Students suffer from a decrease in physical activity during their education period. This lower level of activity could affect, through various paths, their academic performance, mental health, and satisfaction with life. In these two studies, we assumed that vigor, a positive affect variable, would act as a mediating variable in the above relationship, and thus, we proposed an instrument for evaluating vigor in academic contexts. In Study 1, 707 undergraduates (59.7% women) responded to the vigor scale adapted for students to test factorial validation (through confirmatory factor analysis) and obtain reliability indicators. In Study 2, 309 undergraduates (55.3% women) completed a questionnaire measuring physical activity, mental health, satisfaction with life, vigor, and academic performance to test a structural model of the relationships between the variables to obtain construct validity. A measurement model with three related factors, each representing one dimension of vigor, optimally fit the data, and the reliability indices were adequate (Study 1). Moreover, the mediational model confirmed a complete influence of physical activity on satisfaction with life, academic performance, and mental health levels through students’ vigor levels with optimal adjusting values (Study 2). Proposing an instrument such as the Shirom-Melamed Vigor Measure for students allows the opening of a research venue that is focused on the study of positive affects in academic contexts, as well as the testing of the physical activity pathways of action in obtaining positive results. Full article

Mega infrastructure projects provide a basic guarantee for social development, economic construction, and livelihood improvement. Their operation and maintenance (O&M) management are of great significance for the smooth operation and the realization of the value created by the projects. In order to provide an approach for effectively evaluating O&M management, this study develops a holistic indicator system using a mixed-review method from the national macro perspective in China. In this study, literature analysis, policy texts, expert interviews, and grounded theory were used to collect relevant data at home and abroad, and establish an initial evaluation indicator system with 23 indicators covering two dimensions and five aspects. Then the questionnaire survey and factor analysis were used to score and categorize the indicators, and finally an evaluation indicator system for O&M management of mega infrastructure projects was formed. The results show that social relations, environmental benefits, macro policy, and operational capacities play an important role in the evaluation of the O&M of mega infrastructure projects. This study helps the management team to avoid negative impacts in the O&M management of mega infrastructure projects and lays a theoretical foundation for future research. The indicator system in this study is based on the Chinese context, and it remains to be verified whether the indicator system is applicable to other countries due to the differences in political and cultural backgrounds in different regions. Full article

No study to date has simultaneously examined the commonalities and unique aspects of positive psychological factors and whether these factors uniquely account for a reduction in suicide risk. Using a factor analytic approach, the current study examined the relationships between grit, hope, optimism, and their unique and overlapping relationships in predicting suicide ideation. Results of principle axis factor analysis demonstrated close relationships between these variables at both the construct and item level. Item-level analyses supported a five-factor solution (Stick-to-Itiveness, Poor Future, Consistency of Interest, Positive Future, and Poor Pathways). Four of the five factors (excluding Stick-to-Itiveness) were associated with suicide ideation. Additionally, results of a multiple regression analysis indicated that two of the five factors (Consistency of Interest and Positive Future) negatively predicted suicide ideation while Poor Future positively predicted suicide ideation. Implications regarding the interrelationships between grit, hope, and optimism with suicide ideation are discussed. Full article

Airborne particles are composed of inorganic species and organic compounds. PM₁ particles, with an aerodynamic diameter smaller than 1 μm, are considered to be important in the context of adverse health effects. Many compounds bound to particulate matter, such as polycyclic aromatic hydrocarbons (PAH), are suspected to be genotoxic, mutagenic, and carcinogenic. In this study, PAHs in the PM₁ particle fraction were measured for one year (1/1/2018–31/12/2018). The measuring station was located in the northern residential part of Zagreb, the Croatian capital, close to a street with modest traffic. Significant differences were found between PAH concentrations during cold (January–March, October–December) and warm (April–September) periods of the year. In general, the mass concentrations of PAHs characteristic for car exhausts (benzo(ghi)perylene (BghiP), indeno(1,2,3-cd)pyrene (IP), and benzo(b)fluoranthene (BbF)) were higher during the whole year than concentrations of fluoranthene (Flu) and pyrene (Pyr), which originated mostly from domestic heating and biomass burning. Combustion of diesel and gasoline from vehicles was found to be one of the main PAH sources. The incremental lifetime cancer risk (ILCR) was estimated for three age groups of populations and the results were much lower than the acceptable risk level (1 × 10⁻⁶). However, more than ten times higher PAH concentrations in the cold part of the year, as well as associated health risk, emphasize the need for monitoring of PAHs in PM₁. These data represent a valuable tool in future plans and actions to control PAH sources and to improve the quality of life of urban populations. Full article

This study investigated eight types of Slovak dry fermented meat products (salami and sausages) that are available on the market and were produced by three different producers in different regions of Slovakia. The total counts of enterococci in these products ranged from 2.0 up to 6.0 cfu/g (log10). Three species were identified among the 15 selected enterococcal strains; Enterococcus faecium (8 strains), Enterococcus faecalis (3) and Enterococcus hirae (4). They were hemolysis-negative (γ-hemolysis) with a biofilm-forming ability, which was evaluated as low-grade biofilm formation, susceptible to conventional antibiotics and mainly susceptible to lantibiotic bacteriocins, namely, gallidermin and nisin; they even showed a higher susceptibility to gallidermin than to nisin. They were also susceptible to enterocin–durancin, but most strains showed resistance to enterocin A/P. This study indicated that bacteriocins can play a key role in preventing and/or protecting from undesirable bacterial multiplication or contamination in the food industry and that they have great potential for further experimental applications. Full article

Active ageing (AA) policies aim to improve quality of life of older people by enabling better social participation and inclusion. Despite many international initiatives to promote AA undertaken in recent years, Italy did not systematically address this policy challenge until very recently. This paper presents the first national Plan-of-Action (PoA) (2019–2022) adopted by this country for supporting policy design and recommendation in this field. The PoA aims to create a multilevel, co-managed coordination of AA policies, by involving a network of national and regional policy makers, experts, researchers and stakeholders in civil society. The ad-hoc consultation process established for this purpose helps the recognition of different interests and expectations on AA, fostering new solutions by involvement, consultation and joint discussion of policy options. The PoA is designed to cover the traditional policy cycle, including the stages of agenda setting, policy formulation, decision-making, implementation and monitoring. At the end of the period covered by the PoA, an Italian AA Strategy will be launched to achieve systematic impact in this field, thus ensuring a long-term, sustainable impact on national and regional policy makers, civil society and research community. Full article

Mortality is obviously intended for epidemiological studies of community-dwelling older adults. There are several health-related factors associated with nutritional status and mortality. The aim of this study was to elucidate the risk factor for mortality in community-dwelling oldest-older adults at the age of 90 and clarify the structure of health-related factors associated with mortality. A 10-year follow-up study was performed for 93 subjects at the age of 90. The mean and median of their survival days were 2373 and 2581 days for women, and 1694 and 1793 days for men. By Cox’s proportional hazards model, health-related factors associated with mortality were self-assessed for chewing ability, activities of daily living (ADLs), serum albumin, total cholesterol, serum creatinine, and gripping power for women but not for men. These factors interacted with each other, and the association of these factors was different in women and men. Self-assessed chewing ability was a powerful risk factor for mortality in women at the age of 90. It acted independently from nutritional status. For older adults, addressing healthy food choices together with improved oral functions is useful. However, risk factors for mortality may depend on the life stage of subjects. To investigate the risk factor for the mortality, the life course approach is necessary. Full article

Admission to a care facility is assumed to enhance depressive symptoms and dependent behavior in old age. In this context, the relevance of participation in activities that make everyday life in a care facility more pleasant has been pointed out. This study examines if there is a relationship between participation in different activities as well as the frequency of this participation and the positive affect of nursing home residents aged over 80. Data from the unique cross-sectional representative study ‘Quality of life and subjective well-being of the very old in North Rhine-Westphalia’ in Germany (n = 150, aged 90.15 years in average) were used. The data were collected between 08/2017 and 02/2018 using computer-assisted personal interviewing. The variability in and frequency of activity participation functioned as independent, and positive affect as dependent variable. Multiple regression analysis was performed. Residents’ predicted positive affect significantly increased with a higher variability in activity participation. There was no independent effect of frequency in participation. Our findings indicate that there is a significant and positive relationship between participating in a high number of different activities and the overall positive affect of residents aged over 80 years. This does not hold true for the frequency of participation. Full article

This study investigated the preventive effects of lactoferrin (LF) on subjective acute gastrointestinal symptoms during the winter in a randomized, double-blinded, placebo-controlled parallel-group comparative trial. The eligible subjects were healthy adults working at kindergartens and nursery schools. We randomized the subjects to the Placebo group (0 mg/day), the Low LF group (200 mg/day), and the High LF group (600 mg/day) for 12 weeks. The prevalence of acute gastrointestinal symptoms was significantly lower in the High LF (13/112 vs. 26/116; p = 0.030) and the Low LF (13/107 vs. 26/116; p = 0.040) groups than in the Placebo group. The adjusted odds ratio for the prevalence of acute gastrointestinal symptoms was 2.78 (95% CI: 1.19–6.47) in the Placebo group compared with the High LF group. LF is useful to prevent acute gastrointestinal symptoms among childcare workers, who mainly consist of women. Full article

Human exposure to particulate air pollution (e.g., PM_2.5) can lead to adverse health effects, with compelling evidence that it can increase morbidity and mortality from respiratory and cardiovascular disease. More recently, there has also been evidence that long-term environmental exposure to particulate air pollution is associated with type-2 diabetes mellitus (T2DM) and dementia. There are many occupations that may expose workers to airborne particles and that some exposures in the workplace are very similar to environmental particulate pollution. We conducted a cross-sectional analysis of the UK Biobank cohort to verify the association between environmental particulate air pollution (PM_2.5) exposure and T2DM and dementia, and to investigate if occupational exposure to particulates that are similar to those found in environmental air pollution could increase the odds of developing these diseases. The UK Biobank dataset comprises of over 500,000 participants from all over the UK. Environmental exposure variables were used from the UK Biobank. To estimate occupational exposure both the UK Biobank’s data and information from a job exposure matrix, specifically developed for UK Biobank (Airborne Chemical Exposure–Job Exposure Matrix (ACE JEM)), were used. The outcome measures were participants with T2DM and dementia. In appropriately adjusted models, environmental exposure to PM_2.5 was associated with an odds ratio (OR) of 1.02 (95% CI 1.00 to 1.03) per unit exposure for developing T2DM, while PM_2.5 was associated with an odds ratio of 1.06 (95% CI 0.96 to 1.16) per unit exposure for developing dementia. These environmental results align with existing findings in the published literature. Five occupational exposures (dust, fumes, diesel, mineral, and biological dust in the most recent job estimated with the ACE JEM) were investigated and the risks for most exposures for T2DM and for all the exposures for dementia were not significantly increased in the adjusted models. This was confirmed in a subgroup of participants where a full occupational history was available allowed an estimate of workplace exposures. However, when not adjusting for gender, some of the associations become significant, which suggests that there might be a bias between the occupational assessments for men and women. The results of the present study do not provide clear evidence of an association between occupational exposure to particulate matter and T2DM or dementia. Full article

A high consumption of sugar-rich discretionary food and drinks has several health implications, which have been traced from childhood into adulthood. Parents act as primary mediators shaping children’s dietary habits, and interventions that engage parents have shown to result in positive outcomes. Further, collaboration with local school health nurses and dentists provides an effective structural frame to support behaviour change and anchor new initiatives. The multicomponent 3.5-month cluster randomised family-focused intervention “Are you too Sweet?” aims to evaluate the effectiveness of communicating new Danish guidelines for sugar-rich discretionary food and drinks for school starters (5–7 years). This paper describes the development, outcomes and process evaluation of the intervention that includes three main components: extended dialogue during a school health nurse consultation, a box with home-use materials, and a social media platform to facilitate interaction among participants. Children (n = 160) and their parents were scheduled for a baseline interview at six different schools. The intervention was developed to increase self-efficacy, knowledge about guidelines, observational learning and reduce impediments for behavioural change. The desired primary outcome was a reduction in intake of sugar-rich food measured through a 7-day dietary record. The results contribute to the evidence on effective health promotion strategies. Full article

Physical activity has been proposed as an effective alternative treatment option for the increasing occurrence of sleep problems in older adults. Although higher physical activity levels are associated with better sleep, the association between specific physical activity intensities and sedentary behaviour (SB) with sleep remains unclear. This study examines the associations of statistically modelled time reallocations between sedentary time and different physical activity intensities with sleep outcomes using isotemporal substitution analysis. Device-measured physical activity data and both objective and subjective sleep data were collected from 439 adults aged 55+ years. Replacing 30 min of SB with moderate to vigorous intensity physical activity (MVPA) was significantly associated with an increased number of awakenings. Moreover, a reallocation of 30 min between light physical activity (LPA) and MVPA was significantly associated with increased sleep efficiency. Furthermore, reallocating 30 min of SB to LPA showed a significant association with decreased sleep efficiency. There were no significant associations of time reallocations for wake time after sleep onset, length of awakenings, and sleep quality. These results improve our understanding of the interrelationships between different intensities of movement behaviours and several aspects of sleep in older adults. Full article

Local warming induced by rapid urbanization has been threatening residents’ health, raising significant concerns among urban planners. Local climate zone (LCZ), a widely accepted approach to reclassify the urban area, which is helpful to propose planning strategies for mitigating local warming, has been well documented in recent years. Based on the LCZ framework, many scholars have carried out diversified extensions in urban zoning research in recent years, in which urban functional zone (UFZ) is a typical perspective because it directly takes into account the impacts of human activities. UFZs, widely used in urban planning and management, were chosen as the basic unit of this study to explore the spatial heterogeneity in the relationship between landscape composition, urban morphology, urban functions, and land surface temperature (LST). Global regression including ordinary least square regression (OLS) and random forest regression (RF) were used to model the landscape-LST correlations to screen indicators to participate in following spatial regression. The spatial regression including semi-parametric geographically weighted regression (SGWR) and multiscale geographically weighted regression (MGWR) were applied to investigate the spatial heterogeneity in landscape-LST among different types of UFZ and within each UFZ. Urban two-dimensional (2D) morphology indicators including building density (BD); three-dimensional (3D) morphology indicators including building height (BH), building volume density (BVD), and sky view factor (SVF); and other indicators including albedo and normalized difference vegetation index (NDVI) and impervious surface fraction (ISF) were used as potential landscape drivers for LST. The results show significant spatial heterogeneity in the Landscape-LST relationship across UFZs, but the spatial heterogeneity is not obvious within specific UFZs. The significant impact of urban morphology on LST was observed in six types of UFZs representing urban built up areas including Residential (R), Urban village (UV), Administration and Public Services (APS), Commercial and Business Facilities (CBF), Industrial and Manufacturing (IM), and Logistics and Warehouse (LW). Specifically, a significant correlation between urban 3D morphology indicators and LST in CBF was discovered. Based on the results, we propose different planning strategies to settle the local warming problems for each UFZ. In general, this research reveals UFZs to be an appropriate operational scale for analyzing LST on an urban scale. Full article

In the context of the rapid development of urbanization and increasing population mobility in China, the outbreak of COVID-19 has had a significant impact on China’s economy and society. This article uses China UnionPay transaction data and takes Hubei, the worst-hit region by COVID-19 in China, as an example, to conduct empirical analysis using the generalized method of moments (GMM) of the impact of current urbanization patterns on the spread of the epidemic and economic recovery from the perspectives of time, industry, and regional differences. The study found that during the different stages of COVID-19, including discovery, outbreak, and subsidence, the overall impact of urbanization on the economy in Hubei Province was first positive, then became negative, and finally gradually increased. This process had significant industrial and urban heterogeneity, which was mainly manifested in losses in tourism and catering industries that were significantly greater than those in the audio-visual entertainment and digital office industries. Similarly, the recovery speed of large cities was lower than that of small and medium-sized cities. The main reason for these differences is that the one-sided problem of urbanization is more obvious in areas with higher urbanization rates. COVID-19 has drawn attention to the development of urbanization in the future, that is, the development path of one-sided economic resource agglomeration and scale expansion should be abandoned, with greater attention paid to the improvement of service functions and the development of amenities. This transformation is necessary to enhance urban economic resilience and reduce public health risks. Full article

The aim of the study was functional evaluation of soft tissue mobilization in patients with temporomandibular disorder-myofascial pain with referral. The study group consisted of 50 individuals—37 females and 13 males. The average age was 23.36 ± 2.14 years. All subjects were diagnosed with myofascial pain with referral (diagnostic criteria for temporomandibular disorders). Soft tissue mobilization was applied three times. Electromyography of selected masticatory muscles was performed six times—before and after the treatment. After each mobilization, a decreasing tendency of muscular activity was observed in the entire study group. The Friedman test indicated that mobilization altered the activity of the right temporal muscle (p = 0.00010), both masseters (p = 0.0000), right sternocleidomastoid (p = 0.00251), left sternocleidomastoid (p = 0.00033), and right and left digastric muscles (p = 0.00045 and p = 0.00000, respectively). With respect to symmetry a statistically significant difference was noted in the case of the sternocleidomastoid muscles (p = 0.00729). In conclusion, soft tissue mobilization seems to be effective in the relaxation of masticatory muscles in patients with temporomandibular disorders. Our findings proved that soft tissue mobilization does not improve the symmetry and synergy of the masticatory muscles limited by dental occlusion. Full article

Growing evidence suggests that micronutrient status is adversely impacted by toxic metals (e.g., cadmium, lead, and arsenic) exposures; however, the micronutrient status of e-waste recyclers who are amongst the highest metal-exposed groups is not known. This study, therefore, assessed the micronutrient status of e-waste recyclers using dietary information (2-day 24-h recall survey) and biomarker data (whole blood and urine) among 151 participants (100 e-waste recyclers at Agbogbloshie and 51 controls at Madina Zongo from the Accra region, Ghana) in March 2017. Biomarker levels of iron (Fe), calcium (Ca), magnesium (Mg), selenium (Se), zinc (Zn) and copper (Cu) were analyzed by the ICP-MS. Linear regression models were used to assess associations ofwork-related factors and sociodemographic characteristics with micronutrient intake, blood, and urine micronutrient levels. The results showed that apart from Fe and Zn, e-waste recyclers at Agbogbloshie did not meet the day-to-day dietary requirements for Ca, Cu, Se, and Mg intake. Except for the low levels of Mg and Fe detected in blood of e-waste recyclers, all other micronutrients measured in both blood and urine of both groups fell within their reference range. Exposure to biomass burning was associated with lower blood levels of Fe, Mg, and Zn among the e-waste recyclers. Further, among e-waste recyclers, significant relationships were found between the number of years spent recycling e-waste and urinary Ca and Cu excretion. Given that, some dietary and blood levels of micronutrients were below their reference ranges, the implementation of evidence-based nutrition strategies remains necessary among e-waste recyclers to reduce their risk of becoming malnourished. Full article

With the rising trend in obesity, the incidence of gestational diabetes mellitus (GDM) and perinatal complications associated with the condition are also on the rise. Since the early 1900s, much knowledge has been gained about the diagnosis, implications, and management of gestational diabetes with improved outcomes for the mother and fetus. Worldwide, there is variation in the definition of GDM, methods to screen for the condition, and management options. The International Association of Diabetes in Pregnancy Study Groups has published recommendations for a one-step approach to screen pregnant women for GDM, in order to develop outcome-based criteria that can be used internationally. However, management of GDM continues to be varied, and currently several options are available for treatment of hyperglycemia during pregnancy. A review of various aspects of GDM is discussed with a focus on the medical management during pregnancy, as practiced in the United States. Full article

Particulate air components can be of anthropogenic or natural origin. It is assumed that in different geographical areas varying concentrations of mesophilic bacteria are present in the ambient air. The aim of this study was to determine the background concentrations of airborne culturable mesophilic bacteria and particulate matter in the ambient air. Furthermore, the association between their concentrations and some environmental factors was analysed. In the period from July to October 2019, concentrations of mesophilic bacteria and dust particles were measured in urban, rural and mountain areas using the single-stage air sampler and the particle counter. The concentrations of bacteria and dust particles in the air were counted as number of Colony Forming Units per cubic metre (CFU/m³) and particles per cubic metre (pa/m³). Staphylococcus sp. were identified. The median values of the cultivated mesophilic bacteria at 30 °C and 37 °C were 7.1 × 10² CFU/m³ and 2.3 × 10¹ CFU/m³ in mountain regions, 1.3 × 10² CFU/m³ and 6.9 × 10¹ CFU/m³ in rural regions and 2.1 × 10² CFU/m³ and 6.5 × 10¹ CFU/m³ in urban regions. The median of Staphylococcus sp. was 2.5 × 10⁰ CFU/m³ in alpine areas and 7.5 × 10⁰ CFU/m³ in urban and rural areas. Higher bacterial concentrations were measured in sunshine and in windy weather. A relationship was observed between the concentrations of airborne mesophilic bacteria and the coarse particles in all three areas. The present study determined values between 5.0 × 10⁰ and 4.6 × 10² CFU/m³ as natural background concentrations of airborne mesophilic bacteria and 1.2 × 10⁷ pa/m³ and 6.5 × 10⁴ pa/m³ for fine and coarse particles, respectively. These results can be proposed as baseline for the assessment of the emission sources of mesophilic bacteria for summer and early autumn. Full article

This case study focuses on the epidemiological situation of the COVID-19 outbreak, its impacts and the measures South Korea undertook during the first wave of the COVID-19 pandemic. Since the first case was confirmed on 20 January 2020, South Korea has been actively experiencing the COVID-19 outbreak. In the early stage of the pandemic, South Korea was one of the most-affected countries because of a large outbreak related to meetings of a religious movement, namely the Shincheonji Church of Jesus, in a city called Daegu and North Gyeongsang province. However, South Korea was held as a model for many other countries as it appeared to slow the spread of the outbreak with distinctive approaches and interventions. First of all, with drastic and early intervention strategies it conducted massive tracing and testing in a combination of case isolation. These measures were underpinned by transparent risk communication, civil society mobilization, improvement of accessibility and affordability of the treatment and test, the consistent public message on the potential benefit of wearing a mask, and innovation. Innovative measures include the mobile case-tracing application, mobile self-quarantine safety protection application, mobile self-diagnosis application, and drive-thru screening centres. Meanwhile, the epidemic has brought enormous impacts on society economically and socially. Given its relationship with China, where the outbreak originated, the economic impact in South Korea was predicted to be intense and it was already observed since February due to a decline in exports. The pandemic and measures undertaken by the government also have resulted in social conflicts and debates, human-right concerns, and political tension. Moreover, it was believed that the outbreak of COVID-19 and the governmental responses towards it has brought a huge impact on the general election in April. Despite of the large outbreak in late February, the Korean government has flattened the COVID-19 curve successfully and the downward trend in the number of new cases remained continuously as of 30 April. The most distinctive feature of South Korea’s responses is that South Korea conducted proactive case finding, contacts tracing, and isolations of cases instead of taking traditional measures of the containment of the epidemic such as boarder closures and lockdowns. Full article

As the catering sector has increasingly contributed to population-level salt intake, many countries have begun developing salt-reduction strategies for restaurants. This paper aims to provide an overview of global salt reduction policies in restaurants. Scientific papers and website materials were systematically searched from Web of Science, Science Direct, and PubMed, as well as official websites of government departments and organizations. A total of 78 full-text papers and grey literature works were included. From 58 countries and regions, 62 independent policies were identified, 27 of which were mandatory (3 with fines). The most common strategy was menu labeling, which was a component of 40 policies. Target setting (n = 23) and reformulation (n = 13) of dishes were also widely implemented. Other salt-reduction strategies included education campaign, chef training, toolkits delivery, table salt removal, media campaign, and government assistance such as free nutrition analysis and toolkits distribution. Most policies focused on chain restaurants. Evaluations of these policies were limited and showed inconsistent results, and more time is needed to demonstrate the clear long-term effects. Attention has been paid to salt reduction in restaurants around the world but is still at its early stage. The feasibility and effectiveness of the strategies need to be further explored. Full article

This study compared the physical fitness level and weight status of children and adolescents in China and Japan. Children and adolescents aged 7–18 years were recruited (China: n = 5660; Japan: n = 5660). Physical fitness was assessed using seven core items—grip strength, 30-s sit-ups, standing long jump, sit-and-reach, 20-s repeated straddling, 20-m shuttle run test, and 50-m dash. A physical fitness index (PFI) was calculated by adding all items’ Z-scores. We conducted comparisons of PFI and its distribution, each physical fitness item, and weight status for individuals from China and Japan across all ages. The PFI was lower in China than in Japan for all age groups, with an especially large difference at age 18 years for boys (a difference of 9.05) and girls (a difference of 9.10) (p < 0.001). The same result was seen for the seven items. The PFI distribution for children and adolescents was more disperse among those in Japan than among those in China. Obesity prevalence was 2.84 times higher in China than in Japan. An inverted U-shaped relationship was observed between physical fitness and nutritional status. Children and adolescents showed markedly lower physical fitness and higher obesity prevalence in China than in Japan. Full article

(1) Background: Non-alcoholic fatty liver disease (NAFLD) is associated with various cardiometabolic diseases. However, the association between NAFLD and stroke is not well known. The purpose of our study is to reveal the relationship between NAFLD and Stroke incidence. (2) Methods: Using data from a Korean prospective cohort study, we excluded participants with heavy alcohol consumption and a history of stroke; hence, 7964 adults aged 40–69 years were included in this study. According to their fatty liver index (FLI), participants were divided into three groups: <30 (n = 4550, non-NAFLD), 30–59.9 (n = 2229, intermediate), and ≥60 (n = 1185, NAFLD). The incidence of stroke according to the degree of FLI was evaluated using the Cox proportional hazard model. (3) Results: During the 12-year follow-up period, 168 strokes occurred. A graded association between NAFLD and stroke incidence was observed, i.e., 1.7% (n = 76), 2.5% (n = 56), and 3.0% (n = 36) for non-NAFLD, intermediate, and NAFLD FLI groups, respectively. After adjusting for confounding variables and compared to the risk of stroke in the non-NAFLD group, the risk of stroke in the NAFLD group was the highest (hazard ratio [HR]: 1.98, 95% confidence interval [CI]: 1.17–3.34), followed by the risk of stroke in the intermediate group (HR: 1.41, 95% CI: 0.94–2.21) (p for trend < 0.001). However, the level of aspartate aminotransferase, alanine aminotransferase, or gamma-glutamyltransferase alone did not show any significant association with stroke. (4) Conclusions: This study demonstrated that the risk of stroke incidence gradually increased with the degree of FLI. Individuals with NAFLD should be properly counseled and monitored for risk for stroke. Full article

Focused attention meditation (FAM) is a category of meditation based on an EEG pattern, which helps the wandering mind to focus on a particular object. It seems that prayer may, in certain respects, be similar to FAM. It is believed that emotional experience correlates mainly with theta, but also with selective alpha, with internalized attention correlating mainly with the synchronous activity of theta and alpha. The vast majority of studies indicate a possible impact of transcendence in meditation on the alpha wave in EEG. No such reports are available for prayer. Seventeen women and nineteen men aged 27–64 years with at least five years of intensive meditation/prayer experience were recruited to participate in the study. We identified the two largest groups which remained in the meditation trend originating from the Buddhist system (14 people) (Buddhist meditators) and in the Christian-based faith (15 people) (Christian meditators). EEG signal was recorded with open eyes, closed eyes, during meditation/prayer, and relaxation. After the EEG recording, an examination was conducted using the Scale of Spiritual Transcendence. Buddhist meditators exhibited a statistically significantly higher theta amplitude at Cz during meditation compared to relaxation. Meanwhile, spiritual openness favored a higher theta amplitude at Pz during relaxation. Our study did not reveal statistically significant differences in frontal areas with regard to alpha and theta, which was often indicated in previous studies. It seems necessary to analyze more closely the midline activity in terms of dispersed neural activity integration. Full article

Urbanization and climate change have been rapidly occurring globally. Evidence-based healthy city development is required to improve living quality and mitigate the adverse impact of the outdoor neighborhood environment on public health. Taking Guangzhou as an example to explore the association of neighborhood environment and public health and preferably to offer some implications for better future city development, we measured ten environmental factors (temperature (T), wind-chill index (WCI), thermal stress index (HSI), relative humidity (RH), average wind speed (AWS), negative oxygen ions (NOI), PM2.5, luminous flux (LF), and illuminance (I)) in four seasons in four typical neighborhoods, and the SF-36 health scale was employed to assess the physical and mental health of neighborhood residents in nine subscales (health transition(HT), physiological functions (PF), general health status (GH), physical pain (BP), physiological functions (RP), energy vitality (VT), mental health (MH), social function (SF), and emotional functions (RE)). The linear mixed model was used in an analysis of variance. We ranked the different environmental factors in relation to aspects of health and weighted them accordingly. Generally, the thermal environment had the greatest impact on both physical and mental health and the atmospheric environment and wind environment had the least impact on physical health and mental health, respectively. In addition, the physical health of the resident was more greatly affected by the environment than mental health. According to the results, we make a number of strategic suggestions for the renewal of the outdoor neighborhood environment in subtropical monsoon climate high-density cities and provide a theoretical basis for improving public health through landscape architecture at the neighborhood scale. Full article