Int. J. Environ. Res. Public Health, Volume 17, Issue 4 (February-2 2020) – 336 articles

Currently, whether the urban development in China satisfies Zipf’s law across different scales is still unclear. Thus, this study attempted to explore whether China’s urban development satisfies Zipf’s law across different scales from the National Polar-Orbiting Partnership’s Visible Infrared Imaging Radiometer Suite (NPP-VIIRS) nighttime light data. First, the NPP-VIIRS data were corrected. Then, based on the Zipf law model, the corrected NPP-VIIRS data were used to evaluate China’s urban development at multiple scales. The results showed that the corrected NPP-VIIRS data could effectively reflect the state of urban development in China. Additionally, the Zipf index (q) values, which could express the degree of urban development, decreased from 2012 to 2018 overall in all provinces, prefectures, and counties. Since the value of q was relatively close to 1 with an R² value > 0.70, the development of the provinces and prefectures was close to the ideal Zipf’s law state. In all counties, q > 1 with an R² value > 0.70, which showed that the primate county had a relatively stronger monopoly capacity. When the value of q < 1 with a continuous declination in the top 2000 counties, the top 250 prefectures, and the top 20 provinces in equilibrium, there was little difference in the scale of development at the multiscale level with an R² > 0.90. The results enriched our understanding of urban development in terms of Zipf’s law and had valuable implications for relevant decision-makers and stakeholders. Full article

We tested whether karaoke training improves cognitive skills and reduces the risk of physical function impairments. We conducted a single-blinded randomized controlled trial in 26 elderly participants at residential care facilities, who were generally healthy or required the lowest level of care. Participants were near the threshold for mild cognitive impairment with the Montreal Cognitive Assessment (MoCA) and close to the sarcopenia cut-off with the skeletal muscle mass index. Pulmonary function as measured with spirometry and tongue strength were used as markers for physical functions affected by sarcopenia. Karaoke training occurred once a week for two hours, with an hour of homework assigned weekly. Karaoke training significantly improved the Frontal Assessment Battery at bedside (FAB) compared with an active control group receiving scratch art training (F = 8.04, permutation p-value = 0.013). Subscore improved with inhibitory control (F = 7.63, permutation p-value = 0.015) and sensitivity to interference (F = 11.98, permutation p-value = 0.001). We observed improved tongue pressure (F = 4.49, permutation p-value = 0.040) and pulmonary function by a greater increase in FIV1 (F = 5.22, permutation p-value = 0.047). Engaging elderly people, especially those in care homes, with karaoke training exercises that are moderately physically challenging may be a key to slowing cognitive decline and preventing dysphagia by sarcopenia. Full article

The main objective of this study was the validation of the Healthy Lifestyle Questionnaire (EVS II), using a confirmatory factorial analysis of the measurement model, with veteran athletes. A total of 348 veteran Portuguese athletes of both genders, aged between 30 and 60 years (M = 41.64, SD = 9.83), of whom 200 were males and 148 were females, from several sports. The results of the confirmatory factor analysis demonstrate the adequacy of the adapted version of the EVS II, as the factorial structure (6 factors/24 items) has acceptable validity indexes: χ² = 305.925, p = 0.000, df = 120.017, χ²/df = 2.549, NFI (Normed Fit Index) = 0.909, TLI (Tucker Lewis Index) = 0.918, CFI (Comparative Fit Index) = 0.944, GFI (Goodness of Fit Index) = 0.944, AGFI (Adjusted Goodness of Fit Index) = 0.909, SRMR (Standardized Root Mean Square Residual) = 0.048, RMSEA (Root Mean Square of Approximation) = 0.060, allowing evaluation of the dimensions of balanced diet, respect for mealtime, tobacco and alcohol consumption, other drugs consumption and resting habits. The adaptation to sport of the Portuguese version of EVS II can be used with reasonable confidence in the evaluation of healthy lifestyles in the context of sport. Full article

Epidemiological studies on residential radon exposure and the risk of histological types of lung cancer have yielded inconsistent results. We conducted a meta-analysis on this topic and updated previous related meta-analyses. We searched the databases of Cochrane Library, Embase, PubMed, Web of Science and Chinese National Knowledge Infrastructure for papers published up to 13 November 2018. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using fixed and random effects models. Subgroup and dose‒response analyses were also conducted. This study was registered with PROSPERO (No. CRD42019127761). A total of 28 studies, which included 13,748 lung cancer cases and 23,112 controls, were used for this meta-analysis. The pooled OR indicated that the highest residential radon exposure was significantly associated with an increased risk of lung cancer (OR = 1.48, 95% CI = 1.26–1.73). All histological types of lung cancer were associated with residential radon. Strongest association with small-cell lung carcinoma (OR = 2.03, 95% CI = 1.52–2.71) was found, followed by adenocarcinoma (OR = 1.58, 95% CI = 1.31–1.91), other histological types (OR = 1.54, 95% CI = 1.11–2.15) and squamous cell carcinoma (OR = 1.43, 95% CI = 1.18–1.74). With increasing residential radon levels per 100 Bq/m³, the risk of lung cancer, small-cell lung carcinoma and adenocarcinoma increased by 11%, 19% and 13%, respectively. This meta-analysis provides new evidence for a potential relationship between residential radon and all histological types of lung cancer. Full article

The aim of the present study was to compare external loads (EL) between elite, junior, male and female basketball players. Male (n = 25) and female players (n = 48) were monitored during 11 competitive matches (3 matches per team). EL was measured using local positioning system and microsensor technology to determine total, high-intensity (14–21 km·h⁻¹), and sprint (>21 km·h⁻¹) distance (m) covered, total (n) and relative (n·min⁻¹) accelerations and decelerations, ratio of accelerations:decelerations, and total (arbitrary units [AU]) and relative (AU·min⁻¹) player load. EL was compared between sexes overall and according to each playing position (guards, forwards, and centers). Males covered larger (p < 0.05) high-intensity and sprint distances, and completed more (p < 0.05) decelerations than females; while female players experienced a greater (p < 0.05) ratio of accelerations:decelerations. Greater decelerations (p < 0.05) were observed for males in the guard position compared to females, while more (p < 0.05) accelerations·min⁻¹ were apparent for females in the forward position compared to males. The current findings indicate differences in EL, particularly the high-intensity and acceleratory demands, exist between elite, junior, male and female basketball players during competition and are affected by playing position. These outcomes can be used in developing sex- and position-specific training plans, and in turn improving the physical preparedness of junior basketball players for competition demands at the elite level. Full article

Evidence has shown for over 20 years that patients residing in rural areas face poorer outcomes for cancer. The inequalities in survival that rural cancer patients face are observed throughout the developed world, yet this issue remains under-examined and unexplained. There is evidence to suggest that rural patients are more likely to be diagnosed as a result of an emergency presentation and that rural patients may take longer to seek help for symptoms. However, research to date has been predominantly epidemiological, providing us with an understanding of what is occurring in these populations, yet failing to explain why. In this paper we outline the problems inherent in current research approaches to rural cancer inequalities, namely how ‘cancer symptoms’ are conceived of and examined, and the propensity towards a reductionist approach to rural environments and populations, which fails to account for their heterogeneity. We advocate for a revised rural cancer inequalities research agenda, built upon in-depth, community-based examinations of rural patients’ experiences across the cancer pathway, which takes into account both the micro and macro factors which exert influence on these experiences, in order to develop meaningful interventions to improve cancer outcomes for rural populations. Full article

Loneliness and social isolation are increasingly recognized as important challenges of our times. Inspired by research hinting at beneficial effects of interacting with nature on social connectedness and opportunities provided by ambient technology to simulate nature in a rich and engaging manner, this study explored to what extent digital nature projections can stimulate social aspirations and related emotions. To this end, participants (N = 96) were asked to watch, individually or in pairs, digital nature projections consisting of animated scenes which were either dense or spacious and depicting either wild or tended nature. Subsequently, they filled out a questionnaire comprising measures for social aspirations, awe and fascination. Results show that spacious scenes elicited significantly higher social aspiration and awe scores, especially when watching alone. Design implications are discussed for making digital nature accessible for people with limited access to real nature. Full article

The stigmatized character of hazardous chemicals has caused individuals in hazards to take excessive protective actions. Here, social capital is introduced to discuss its influence on the protective action decision model (PADM), considering this variable has a relatively high individual trust level in regards to information on hazardous chemicals. A model was constructed by taking protective action perceptions as the dependent variable, social capital as the independent variable, the pre-decision process as the mediating variable, and socioeconomic status as the moderating variables. Data were collected with a neighborhood sampling method, and a total of 457 questionnaires were obtained from neighboring residents near a large cold ammonia storage house in Haidian District, Beijing. Results: While the family and friendship networks produced a larger positive influence, the kinship network produced a smaller positive influence; furthermore, the influence of social capital must be brought through the pre-decision process; finally, socioeconomic status has a directional moderation on the friendship network, an enhancing moderation on the kinship network, and a weakening moderation on the family network. Full article

A series of efficient adsorbents were prepared by a wet-impregnation method for CO₂ separation from simulated biogas. A type of commercially available silica, named as FNG-II silica (FS), was selected as supports. FS was modified with a mixture of polyethyleneimine (PEI) and ethanolamine (MEA) to improve the initial CO₂ adsorption capacity and thermal stability of the adsorbents. The influence of different adsorbents on CO₂ adsorption performance was investigated by breakthrough experiments. Scanning electron microscopy (SEM), fourier transform infrared spectroscopy (FTIR), and N₂ adsorption–desorption isotherm were used to characterize the silica before and after impregnating amine. Additionally, the thermal stability of adsorbents was measured by differential thermal analysis (TDA). Silica impregnated with mixtures of MEA and PEI showed increased CO₂ adsorption performance and high thermal stability compared with those obtained from silica impregnated solely with MEA or PEI. With a simulated biogas flow rate of 100 mL/min at 0.2 MPa and 25 °C, FS-10%MEA-10%PEI exhibited a CO₂ adsorption capacity of ca. 64.68 mg/g which increased by 81 % in comparison to FS-20%PEI. The thermal stability of FS-10%MEA-10%PEI was evidently higher than that of FS-20%MEA, and a further improvement of thermal stability was achieved with the increasing value of PEI/MEA weight ratio. It was showed that MEA was able to impose a synergistic effect on the dispersion of PEI in the support, reduce the CO₂ diffusion resistance and thus increase CO₂ adsorption performance. Additionally, if the total percentage of amine was the same, FS impregnated by different ratios of PEI to MEA did not exhibit an obvious difference in CO₂ adsorption performance. FS-15%PEI-5%MEA could be regenerated under mild conditions without obvious loss of CO₂ adsorption activity. Full article

To explore the joint toxicity and bio-accumulation of multi-heavy metals and potential chemoprevention strategies, Male Sprague Dawley (SD) rats (n = 30) were treated orally once a week for six months with 500mg/kg•bw of eight heavy metals which were commonly identified in aquatic products in the Ningbo area including chromium, manganese, nickel, copper, zinc, cadmium, mercury, and lead. At the same time, 200mg/kg•bw of epigallocatechin-3-gallate (EGCG), trisodium citrate dihydrate (TCD) or glutathione (GSH) were administered to evaluate their antagonistic effects against adverse effects of multi-heavy metal mixture. The Morris water maze test was used to evaluate spatial learning and memory in the treated rats. Then the rats were anesthetized by pentobarbital sodium (40 mg/kg•bw) to obtain blood samples for biochemical analysis and organs (heart, liver, spleen, lungs, kidneys, brain, testis) to be conducted for biopsy and organ coefficients. Inductively coupled plasma mass spectrometer (ICP-MS) was used to analyze the concentrations of heavy metals. Results indicated that six months of exposure to a multi-heavy metal mixture under this experimental dosage resulted in accumulation in organs and adverse effects on the blood, reproductive system, and liver function. EGCG, TCD or GSH all showed certain chemoprevention effects against the joint toxicity induced by the multi-heavy metal mixture and indicated alleviation and the potential mechanism that also included the promotion of excretion of metals to which animals were exposed. Full article

Background: Reliability refers to the precision of an assessment, so it is a critical topic to take the right decisions related to health management. People usually perform several tasks at the same time in their daily life. The aim of this study was to examine the reliability of the 30-s chair stand test in people with type 2 Diabetes Mellitus (T2DM) with test–retest, with and without dual-task (motor + cognitive task). Methods: Twenty-six subjects with T2DM and 30 subjects without T2DM performed the 30-s Chair Stand Test (30sCST) in which they must sit and stand as many times as possible in 30 s. They performed the test in the usual way (30sCST) and also with an additional cognitive task (30sCST-DT). A retest was conducted 7–14 days later. Results: Relative reliability was excellent in both groups (intraclass correlation coefficient > 0.9). In 30sCST-DT, relative reliability was high in the T2DM group (intraclass correlation coefficient > 0.7) and excellent in subjects without T2DM (intraclass correlation coefficient > 0.9). Conclusions: The 30sCST and the 30sCST-DT tests are reliable tools for people with T2DM to measure changes after an intervention. The smallest real difference was 15% and 20% upper in the T2DM group in the 30sCST and 30sCST-DT tests, respectively. Full article

The HealthLit4Kids program aims to build health literacy in a participatory and contextually relevant way. Whole-of-school and curriculum strategies aim to empower and build capacity to make informed health choices amongst students, teachers, parents, and their local community. The aim of this study was to evaluate the HealthLit4Kids program from the perspective of parents, using a Self-Determination Theory framework. This is one component within a larger evaluation of the program. Parents at four Australian primary schools were interviewed post-program. Qualitative data collected through parent interviews were analyzed thematically to identify themes, and coding checks were completed by experienced qualitative researchers. The three key themes identified were student engagement, behaviour change, and parent engagement. Findings also indicated that parents placed a high value on effective communication from schools and raised a range of health areas such as food and nutrition, physical activity, and mental health with the interviewer. Parent opinions of the HealthLit4Kids program were positive, with many reporting a perceived increase in their children’s ability to understand, communicate and act on health-related knowledge at home. The HealthLit4Kids program requires further research to determine its viability as an optimal pedagogical strategy for the health literacy development of primary school-aged children. Full article

Workplace bullying adversely affects mental health, yet little is known about the outcomes for suicidal ideation. The current study used Australian population-based data to investigate the association between workplace bullying and suicidal ideation. The sample included 1488 employed participants aged 52–58 from wave 4 of the Personality and Total Health (PATH) Through Life Study. Workplace bullying was measured in two ways: (a) a single item asked about experiences of bullying ‘currently’, ‘previously in the current workplace’ and ‘in a past workplace’, and (b) 15 items asked about bullying behaviours experienced in the past 6 months. Suicidal ideation was measured using items from the Psychiatric Symptom Frequency Scale (PSF) and the Patient Health Questionnaire-9 (PHQ-9). Psychosocial job quality, both current and prior, was adjusted for. Current and past experiences of workplace bullying were associated with increased risk of suicidal ideation. Current experiences were no longer associated after adjusting for concurrent indicators of psychosocial job stress, although a tendency for increased ideation remained. Reported prior experience of workplace bullying in a past workplace remained associated with higher odds of suicidal ideation after adjusting for prior psychosocial job stressors and excluding individuals with prior suicidal ideation. Being bullied at work is associated with increased risk of suicidal thoughts, although this occurs within the broader influence of other psychologically stressful employment conditions. Full article

Sensory processing difficulties may have potential detrimental consequences on the physical, social and intellectual development of children. It includes serious disturbances affecting emotional regulation, motor performance, social behavior and daily life functioning, among others factors. Since these symptoms are more frequent among children with disabilities, most research has been carried out in clinical populations. However, recent studies have suggested that sensory problems may be prevalent in around 20% of children without clinical conditions. To date, epidemiological research on sensory dysfunctions in normally developing children is lacking; therefore, it is unknown whether or not sensory processing difficulties are significant factors that affect child’s development. Hence, this study has a double general purpose: (1) to determine the sensory profile of school-aged children; (2) to examine the associations between atypical sensory processing patterns and socio-demographic, health and lifestyle features of these children and their parents. The Infancia y Procesamiento Sensorial (InProS, Childhood and Sensory Processing in English) project is a population-based cross-sectional study of Spanish children aged 3–7 years. Data were gathered from different ad hoc questionnaires and several standardized tests. We propose an objective and reliable methodology using statistical and research procedures to describe and determine associations with sensory processing outcomes. We believe that this project will contribute to filling the gap in epidemiological research on sensory issues by providing more convincing evidence. Nevertheless, the potential results should be corroborated in other larger samples. Full article

In the rapid development of marine aquaculture, the water quality of aquatic environments is regarded as a main limiting factor. Therefore, it is necessary to assess the water quality and environmental conditions in marine aquaculture areas and find out the main influencing factors regarding damage to the water quality environment. In the present research, pond aquaculture and cage aquaculture areas were sampled in May, August and November in 2018. Nine water quality indicators were detected, including pH, temperature, salinity, dissolved oxygen, molybdate-reactive phosphorus, chemical oxygen demand, chlorophyll a, inorganic nitrogen and antibiotic resistance genes (ARGs). Principal component analysis (PCA) was used to analyze the water quality conditions, spatial–temporal changes, and the driving factors in pond and cage aquaculture areas. The results showed that three main components were extracted from the pond aquaculture area, which explained 66.82% of the results, the most relevant factors are salinity, dissolved oxygen and ARGs. For the cage aquaculture area, three main components were extracted which can account for 72.99% of the results, the most relevant factors are chlorophyll a, salinity and dissolved oxygen. The comprehensive scores of the principal components indicated that the heaviest polluted months in pond and aquaculture areas were August and November, respectively. The water quality of the pond aquaculture area is mainly limited by the volume of the pond, while aquaculture activities and seasonality are the main factors for cage aquaculture. ARGs in cage culture areas showed more variety and frequency compared with pond culture areas, which indicated that terrestrial input might be one of the sources for ARGs occurrence. The results would be helpful for the relevant authorities to select water quality monitoring parameters in marine aquaculture areas. Full article

Knowledge of human behaviors is important for improving indoor-environment design, building-energy efficiency, and productivity, and for studies of infection spread. However, such data are lacking. In this study, we designed a device for detecting and recording, second by second, the 3D indoor positioning and head and body motions of each graduate student in an office. From more than 400 person hours of data. Students spent 92.2%, 4.1%, 2.9%, and 0.8% of their time in their own office cubicles, other office cubicles, aisles, and areas near public facilities, respectively. They spent 9.7% of time in close contact, and each student averagely had 4.0 close contacts/h. Students spent long time on close contact in the office which may lead to high infection risk. The average interpersonal distance during close contact was 0.81 m. When sitting, students preferred small relative face orientation angle. Pairs of standing students preferred a face-to-face orientation during close contact which means this pattern had a lower infection risk via close contact. Probability of close contact decreased exponentially with the increasing distance between two students’ cubicles. Data on human behaviour during close contact is helpful for infection risk analysis and infection control and prevention. Full article

Air pollution exposure during pregnancy has been associated with impaired fetal growth and postnatal weight gain, but few studies have examined the effect on weight growth trajectories. We examine the association between validated 1 km² resolution particulate matter (PM_2.5) concentrations, averaged over pregnancy, and sex-specific growth trajectories from birth to age six of participants in the Boston-based Children’s HealthWatch cohort (4797 participants, 84,283 measures). We compared weight trajectories, predicted using polynomial splines in mixed models, between prenatal PM_2.5 above or below the median (9.5 µg/m³), and examined birth weight as an effect modifier. Females exposed to average prenatal PM_2.5 ≥ 9.5 µg/m³ had higher weights compared to females exposed to < 9.5 µg/m³ throughout the study period (0.16 kg at 24 months, 0.61 kg at 60 months). In males, higher prenatal PM_2.5 exposure was associated with significantly lower weights after 24 months of age, with differences increasing with time (−0.17 at 24 months, −0.72 kg at 60 months). Associations were more pronounced among low birth weight (<2500 g) females, but did not differ by birth weight status in males. Our findings demonstrate the complex association between air pollution exposures and childhood weight trajectories and emphasize the importance of sex-stratified analyses. Full article

This study developed and tested a model, which involves the effects of work–family conflicts on job satisfaction and job performance of construction professionals, with a focus on the mediating role of affective organizational commitment. A structured questionnaire survey was conducted among construction professionals in China, resulting in 317 valid responses. The results, generated from structural equation modelling, revealed two interrelated dimensions of work-family conflicts, work’s interfering with family life and family life’s interfering with work. We found these two types of work-family conflicts directly, negatively affected affective organizational commitments and job satisfaction but not job performance. Additionally, affective organizational commitment positively affected job satisfaction and job performance, and mediated the effects of work–family conflicts on job satisfaction. This study advances our understanding of how or why work–family conflicts produce dysfunctional effects on employees’ job outcomes in the context of construction projects. Full article

The construction industry is considered as one of the most dangerous industries in terms of occupational safety and has a high rate of occupational incidents and risks compared to other industries. Given the importance of identifying and assessing the occupational hazards in this industry, researchers have conducted numerous studies using statistical methods, multi-criteria decision-making methods, expert-based judgments, and so on. Although, these researchers have used linguistic variables, fuzzy sets and interval-valued intuitionistic fuzzy sets to overcome challenges such as uncertainty and ambiguity in the risk assessment conducted by experts; the previous models lack in efficiency if the experts are hesitant in their assessment. This leads to the inability to assign a specific membership degree to any risk. Therefore, in this research, it is tried to provide an improved approach to the Failure Mode and Effects Analysis (FMEA) method using an Multi-Criteria Decision-Making (MCDM) method based on the hesitant fuzzy set, which can effectively cope with the hesitance of the experts in the evaluation. Also, Stepwise Weight Assessment Ratio Analysis (SWARA) method is applied for risk factor weighing in the proposed approach. This model is applied to a construction industry case study to solve a realistic occupational risk assessment. Moreover, a comparison is made between the results of this model and those obtained by the conventional FMEA and some other aggregation operators. The results indicate that the newly developed approach is useful and flexible to address complex FMEA problems and can generate logical and reliable priority rankings for failure modes. Full article

Background: Prostate cancer (PCa) represents a common disease in men aged >65 years. The role of physical activity (PA) in patients at risk or diagnosed with PCa represents an evolving issue. We aimed to summarize available evidences about the impact of PA on the pathophysiology and clinical outcomes of PCa. Methods: We performed a narrative review. Evidences about the role of PA in elderly patients in terms of PCa biology, epidemiology, oncological and functional outcomes, as well as in terms of impact on the outcomes of androgen deprivation therapy (ADT) were summarized. Results: Potential pathophysiological pathways hypothesized to explain the benefits of PA in terms of prostate carcinogenesis include circulating levels of Insulin-like growth factor-1 (IGF-1), oxidative stress, systemic inflammation, sex hormones, and myokines. Clinically, emerging evidences support the hypothesis that PA is associated with decreased PCa risk, improved PCa-related survival, improved functional outcomes, and reduced ADT-related adverse events. Full article

Recent data indicate that acute kidney damage leads to inflammation in the brain and other distant organs. The purpose of this study was to investigate the effect of acute kidney injury (AKI) according to the Kidney Disease Improving Global Outcome (KDIGO) criteria on the occurrence of postoperative delirium in patients undergoing coronary artery bypass grafting (CABG). We performed a retrospective cohort analysis that included all consecutive patients undergoing elective CABG. The CAM-ICU (Confusion Assessment Method for Intensive Care Unit) was used for delirium assessment. Patients were divided into four groups, depending on the occurrence of AKI in the perioperative period according to KDIGO criteria. Overall, 902 patients were included in the final analysis, the mean age was 65.95 ± 8.01 years, and 76.83% were males (693/957). The majority of patients presented with normal kidney function-baseline creatinine level of 0.91 ± 0.21 (mg/dL). The incidence of AKI in the perioperative setting was 22.17% (200/902). Postoperative delirium was diagnosed in 115/902 patients (12.75%). Compared with no AKI, the odds of developing POD were increased for KDIGO stage 1 (OR 2.401 (95% confidence interval 1.484–3.884), p < 0.001); KDIGO stage 2 (OR 3.387 (95% confidence interval 1.459–7.866), p = 0.005); and highest for KDIGO stage 3 (OR equal to 9.729 (95% confidence interval 2.675–35.382), p = 0.001). Acute kidney injury, based on AKI staging, should be regarded as an independent risk factor for postoperative delirium after cardiac surgery. Full article

Population aging and public health expenditure mainly dedicated to older dependent persons present major challenges for the European Union (EU) Member States, with profound implications for their economies and labor markets. Sustainable economic development relies on a well-balanced workforce of young and older people. As this balance shifts in favor of older people, productivity tends to suffer, on the one hand, and the older group demands more from health services, on the other hand. These requisites tend to manifest differently within developed and developing EU countries. This research aimed to assess population aging impacts on labor market coordinates (employment rate, labor productivity), in the framework of several health dimensions (namely, health government expenditure, hospital services, healthy life years, perceived health) and other economic and social factors. The analytical approach consisted of applying structural equation models, Gaussian graphical models, and macroeconometric models (robust regression and panel corrected standard errors) to EU panel data for the years 1995–2017. The results show significant dissimilarities between developed and developing EU countries, suggesting the need for specific policies and strategies for the labor market integration of older people, jointly with public health expenditure, with implications for EU labor market performance. Full article

Recent research calls for distinguishing whether the failure to comply with World Health Organisation hand hygiene guidelines is driven by omitting to rub/wash hands, or subsequently recontamination of clean hands or gloves prior to a procedure. This study examined the determinants of these two behaviours. Across the 10 highest-volume labour wards in Zanzibar, we observed 103 birth attendants across 779 hand hygiene opportunities before aseptic procedures (time-and-motion methods). They were then interviewed using a structured cross-sectional survey. We used mixed-effect multivariable logistic regressions to investigate the independent association of candidate determinants with hand rubbing/washing and avoiding glove recontamination. After controlling for confounders, we found that availability of single-use material to dry hands (OR:2.9; CI:1.58–5.14), a higher workload (OR:29.4; CI:12.9–67.0), more knowledge about hand hygiene (OR:1.89; CI:1.02–3.49), and an environment with more reminders from colleagues (OR:1.20; CI:0.98–1.46) were associated with more hand rubbing/washing. Only the length of time elapsed since donning gloves (OR:4.5; CI:2.5–8.0) was associated with avoiding glove recontamination. We identified multiple determinants of hand washing/rubbing. Only time elapsed since washing/rubbing was reliably associated with avoiding glove recontamination. In this setting, these two behaviours require different interventions. Future studies should measure them separately. Full article

Physical Education classes are a key context for the development of creativity due to interactions with peers and the resolution of complex motor skills. Therefore, the aim of this study is to analyze the influence of the teacher’s social behaviors on the mindwandering, emotional state, and academic performance of Physical Education students. The study involved 606 high school students and 36 physical education teachers. A structural equation model was used to analyze the relationship between the variables of the study. The results showed how the teacher’s prosocial and antisocial behaviors had a negative influence on mindwandering. In turn, mindwandering negatively predicted creative intelligence. Likewise, creative intelligence positively predicted a positive emotional state and academic performance and negatively predicted a negative emotional state. Finally, a positive emotional state positively predicted academic performance, while a negative emotional state predicted it negatively. Therefore, the results achieved in the study showed how mindwandering should be promoted in the educational field as a means of encouraging creativity and therefore increasing the well-being of students, which is conducive to academic performance. Full article

In many countries, health literacy research, practice, and policy have been moving away from a focus only on medical care and health-care settings to a much broader conceptualization. In this broader perspective, health literacy can be obtained and used across many other settings (e.g., school, home, workplaces, government) towards achieving health and wellness goals across the life-course for individuals, families, and communities. The education sector is a critical domain towards these achievements and education for health literacy is a fundamental process and outcome. This can help towards important public health goals, including critical health literacy, as oriented not only towards individual actions, but also towards supporting effective social and political action. This Perspective Article describes the importance and utility of the education for health literacy perspective, which, follows a view that health literacy is a key outcome of health education from which improved population health, health promotion and disease prevention could be achieved across diverse contexts. We first describe different educational paradigms to address health literacy and clarify the education for health literacy perspective as a supportive, instructional and capacity-building global resource across the life-course. Then, using specific examples from Canada, America, and Germany, we provide a snapshot of the diverse ways in which the education for health literacy perspective can be found in national policies. These include broad national goals and standards (Germany and Canada) and major health care reform (America). We next consider the tensions and gaps that can arise in the translation and implementation of these policies relative to the ideal education for health literacy perspective, especially related to equity. These include the need for funding, goals of the educational system, and limited evaluation of policy in practice. Finally, we highlight strategic opportunities to achieve education for health literacy and equity especially offering examples from innovative practice in Canada across the lifespan. Full article

Banana farming represents an important segment of agricultural production in Ecuador. The health of farmworkers might be compromised by the extensive use of pesticides in plantations applied under poorly regulated conditions. Due to an increased awareness of pesticide-related problems for nature, as well as for worker and consumer health, ecological farming has been established in some plantations of Ecuador. We set out to investigate the occupational health of workers in both conventional and ecological farming. Nuclear anomalies in buccal epithelial cells were used as short-term indicators for genotoxicity and a potentially increased cancer risk in the two groups of farmworkers. By application of the Buccal Micronucleus Cytome Assay (BMCA), we found the frequency of micronuclei in conventional pesticide using farmworkers significantly increased by 2.6-fold, and other nuclear anomalies significantly increased by 24% to 80% (except pyknosis with a non-significant increase of 11%) compared to the farmworkers on ecological plantations. These results demonstrate that ecological farming may provide an alternative to extensive pesticide use with significantly reduced indicators of cancer risk. In conventional farming, improvements in education and instruction regarding the safe handling of pesticides and protective equipment, as well as regulatory measures, are urgently needed. Full article

Microorganisms area treasure in terms of theproduction of various bioactive compounds which are being explored in different arenas of applied sciences. In agriculture, microbes and their bioactive compounds are being utilized in growth promotion and health promotion withnutrient fortification and its acquisition. Exhaustive explorations are unraveling the vast diversity of microbialcompounds with their potential usage in solving multiferous problems incrop production. Lipopeptides are one of such microbial compounds which havestrong antimicrobial properties against different plant pathogens. These compounds are reported to be produced by bacteria, cyanobacteria, fungi, and few other microorganisms; however, genus Bacillus alone produces a majority of diverse lipopeptides. Lipopeptides are low molecular weight compounds which havemultiple industrial roles apart from being usedas biosurfactants and antimicrobials. In plant protection, lipopeptides have wide prospects owing totheirpore-forming ability in pathogens, siderophore activity, biofilm inhibition, and dislodging activity, preventing colonization bypathogens, antiviral activity, etc. Microbes with lipopeptides that haveall these actions are good biocontrol agents. Exploring these antimicrobial compounds could widen the vistasof biological pest control for existing and emerging plant pathogens. The broader diversity and strong antimicrobial behavior of lipopeptides could be a boon for dealing withcomplex pathosystems and controlling diseases of greater economic importance. Understanding which and how these compounds modulate the synthesis and production of defense-related biomolecules in the plants is a key question—the answer of whichneeds in-depth investigation. The present reviewprovides a comprehensive picture of important lipopeptides produced by plant microbiome, their isolation, characterization, mechanisms of disease control, behavior against phytopathogens to understand different aspects of antagonism, and potential prospects for future explorations as antimicrobial agents. Understanding and exploring the antimicrobial lipopeptides from bacteria and fungi could also open upan entire new arena of biopesticides for effective control of devastating plant diseases. Full article

Active vitamin D (calcitriol, or 1.25 (OH) 2 D) is associated with muscle weakness, falls, and fracture in community-dwelling older people. This study aimed to investigate the relationship between a serum active vitamin D level and lower extremity muscle strength in elderly patients with pre-dialysis chronic kidney disease (CKD). This cross-sectional study included 231 patients with CKD treated conservatively as outpatients. We analyzed patient background factors, including age, sex, body mass index (BMI), intact parathyroid hormone (PTH), phosphorus, calcium, albumin, serum calcitriol level as an indicator of active vitamin D, and estimated glomerular filtration rate (eGFR) collected from medical records. As an index of lower extremity muscle strength, the isometric knee extension muscle strength-to-weight ratio (kgf/kg) was calculated. The mean patient age was 75.9 ± 6.1 years (68.8% male), and the BMI was 24.1 ± 3.8 kg/m². A significant correlation was observed between knee extensor muscle strength and serum calcitriol level (r = 0.32, p < 0.01), age (r = –0.30, p < 0.01), BMI (r = −0.31, p < 0.01), intact PTH (r = −0.22, p < 0.01), phosphorus (r = −0.29, p < 0.01), albumin (r = −0.28, p < 0.01), and eGFR (r = 0.25, p < 0.01). Multiple regression analysis showed calcitriol to be significantly associated with knee extensor muscle strength (β: 0.14, 95% confidence interval: 0–0.002, p = 0.04) after adjustment for covariates. These results suggest that the serum active vitamin D level is associated with lower extremity muscle strength in older adults with pre-dialysis CKD. It is necessary to verify whether vitamin D supplementation increases lower extremity muscle strength in pre-dialysis CKD patients. Full article

Understanding eco-innovation is an essential endeavor to achieve global sustainable development. In this sense, further research on implementation is needed to expand knowledge beyond current boundaries. The aim of this paper is to contribute to this debate by conducting an original multidimensional analysis using Spanish agri-food sector data. The empirical methodology applies a combination of descriptive statistics, cluster analysis and the chi-squared test. Two groups of well-differentiated eco-innovative firms are identified, those with high and low eco-innovation implementation levels. Quality certifications, environmental consulting and cooperation with stakeholders are the variables that contribute most to distinguishing these two groups. The results also reveal that operating income volume, number of employees and commercialization volume are key factors to become more eco-innovative. In this sense, larger firms are found to have a higher level of eco-innovation implementation than small- and medium-sized enterprises. The main contributions of this work are fourfold. Firstly, it presents a comprehensive framework of eco-innovation implementation in its four dimensions (product, process, organizational and marketing). Secondly, it fills existing gaps in the literature by analyzing green organizational and marketing eco-practices. Thirdly, it expands the sectorial scope of eco-innovation research primarily focused on high-tech sectors. Finally, this study makes it possible to design certain policies for public and private decision makers. Full article

Health-related quality of life (HRQoL) and functional capacity values immediately after pacemaker (PM) implantation have been well established; however, not much has been known about its long-term effects. The present study compared the long-term effectiveness and safety of remote monitoring plus a clinic visit versus clinic visits alone during follow-up of adults implanted with PMs. This study was a single-centre, controlled, non-randomised, non-blinded clinical trial. Data were collected pre-implantation and after 60 months. The patients in the PONIENTE study were assigned to two different groups: remote monitoring (RM) and conventional monitoring (CM). The EuroQol-5D (EQ-5D) questionnaire was used to assess HRQoL and Duke Activity Status Index was used for the functional capacity. After five years, 55 patients completed the study (RM = 21; CM = 34). EuroQol-5D and functional capacity values were improved; however, significant differences were observed only in the EQ5D visual analogue scale (p < 0.001). Remote monitoring was equally feasible, reliable, safe, and clinically useful as CM. The frequencies of rehospitalisations and emergency visits did not differ between the groups. RM was found to be safe and effective in early detection and treatment of medical- and device-related events and in reducing hospital visits. Improved HRQoL was described not only immediately after PM implantation but also extended over a long time. Full article