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Int. J. Environ. Res. Public Health, Volume 17, Issue 6 (March-2 2020) – 358 articles

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Cover Story (view full-size image) Neighborhood environments have been identified as important sources of both stress and protection [...] Read more.
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Open AccessReview
Water Management for Construction: Evidence for Risk Characterization in Community and Healthcare Settings: A Systematic Review
Int. J. Environ. Res. Public Health 2020, 17(6), 2168; https://doi.org/10.3390/ijerph17062168 (registering DOI) - 24 Mar 2020
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Abstract
Construction activities are a known risk contributing to the growth and spread of waterborne pathogens in building water systems. The purpose of the study is to integrate evidence for categorizing construction activity risk factors contributing to waterborne disease in community and healthcare settings, [...] Read more.
Construction activities are a known risk contributing to the growth and spread of waterborne pathogens in building water systems. The purpose of the study is to integrate evidence for categorizing construction activity risk factors contributing to waterborne disease in community and healthcare settings, establish severity of such risk factors and identify knowledge gaps. Using a systematic review, the inclusion criteria were: (1) studies with disease cases suspected to be associated with construction activities and waterborne pathogens, and (2) active construction work described in a community or healthcare setting. Each construction activity risk factor was correlated across all studies with the number of disease cases and deaths to establish risk severity. The eligibility review and quantitative synthesis yielded 31 studies for inclusion (community, n = 7 and healthcare, n = 24). From 1965 to 2016, a total of 894 disease cases inclusive of 112 deaths were associated with nine construction activity risk factors and waterborne pathogens. The present study findings support the need for building owners, water management teams and public health professionals to address construction activity risk factors and the analysis of current knowledge deficiencies within the scope of an ongoing water management program. The impact of construction activities on waterborne disease is preventable and should no longer be considered incidental nor accidental. Full article
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Open AccessArticle
Assessment of Static Plantar Pressure, Stabilometry, Vitamin D and Bone Mineral Density in Female Adolescents with Moderate Idiopathic Scoliosis
Int. J. Environ. Res. Public Health 2020, 17(6), 2167; https://doi.org/10.3390/ijerph17062167 - 24 Mar 2020
Viewed by 405
Abstract
(1) Background: Adolescent idiopathic scoliosis (AIS) can be associated with vitamin D deficiency and osteopenia. Plantar pressure and stabilometry offer important information about posture. The objectives of our study were to compare static plantar pressure and stabilometric parameters, serum 25-OH-vitamin D3 and calcium [...] Read more.
(1) Background: Adolescent idiopathic scoliosis (AIS) can be associated with vitamin D deficiency and osteopenia. Plantar pressure and stabilometry offer important information about posture. The objectives of our study were to compare static plantar pressure and stabilometric parameters, serum 25-OH-vitamin D3 and calcium levels, and bone mineral densitometry expressed as z-score in patients with moderate AIS and healthy subjects. (2) Methods: 32 female adolescents (idiopathic S shaped moderate scoliosis, main lumbar curve) and 32 gender and age-matched controls performed: static plantar pressure, stabilometry, serum 25-OH-vitamin D3 and calcium levels, and dual X-ray absorptiometry scans of the spine. (3) Results: In scoliosis patients, significant differences were recorded between right and left foot for total foot, first and fifth metatarsal, and heel loadings. Stabilometry showed a poorer postural control when compared to healthy subjects (p < 0.001). Patients had significantly lower vitamin D, calcium levels, and z-scores. Lumbar Cobb angle was significantly correlated with the z-score (r = −0.39, p = 0.02), with right foot fifth metatarsal load (r = −0.35, p = 0.04), center of pressure CoPx (r = −0.42, p = 0.01), CoP displacement (r = 0.35, p = 0.04) and 90% confidence ellipse area (r = −0.38, p = 0.03). (4) Conclusions: In our study including female adolescents with idiopathic S shaped moderate scoliosis, plantar pressure and stabilometric parameters were influenced by the main scoliotic curve. Full article
(This article belongs to the Special Issue Feature Papers in Children's Health)
Open AccessArticle
Who Benefits from An Intervention Program on Foundational Skills for Handwriting Addressed to Kindergarten Children and First Graders?
Int. J. Environ. Res. Public Health 2020, 17(6), 2166; https://doi.org/10.3390/ijerph17062166 (registering DOI) - 24 Mar 2020
Viewed by 383
Abstract
This study examined the effectiveness of a 10-wk intervention program based on occupational therapy principles on visual-motor integration skills and fine motor abilities in kindergartners and first graders. We recruited 55 students tested three times with the Visual-Motor Integration Test (VMI) and Movement [...] Read more.
This study examined the effectiveness of a 10-wk intervention program based on occupational therapy principles on visual-motor integration skills and fine motor abilities in kindergartners and first graders. We recruited 55 students tested three times with the Visual-Motor Integration Test (VMI) and Movement Assessment Battery for Children-2 (MABC-2): before the intervention (T1), post-intervention (T2) and one month later (T3). Research findings: Significant improvements were found on VMI between T1 and T2, particularly for kindergartners. Neither group of children demonstrated changes on manual dexterity scores. The present study showed that the intervention program led to different changes in the at-risk of motor impairment group than in the not at-risk children. Results indicated that games and stimulation activities helped children below the 16th percentile over time in the manual dexterity domain. A gender effect was observed, with female children increasing their abilities over time more than male peers. Future research should concentrate on stimulating fine motor skills in hand manipulation and test how these abilities influence graphomotor skills and handwriting over time. Finally, more research is needed to determine the impact of activities and games carried out in educational settings. Full article
(This article belongs to the Special Issue Children Development and Health Care in Stress and Wellbeing Contexts)
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Open AccessArticle
A Lean Quality Improvement Initiative to Enhance Tobacco Use Treatment in a Cancer Hospital
Int. J. Environ. Res. Public Health 2020, 17(6), 2165; https://doi.org/10.3390/ijerph17062165 - 24 Mar 2020
Viewed by 341
Abstract
Sustained tobacco use after cancer diagnosis decreases treatment effectiveness while increasing treatment side effects, primary cancer recurrence, and the occurrence of secondary cancers. Delivering tobacco use treatment to fewer patients due to inefficient workflow represents missed opportunities to deliver life-saving care. In 2017, [...] Read more.
Sustained tobacco use after cancer diagnosis decreases treatment effectiveness while increasing treatment side effects, primary cancer recurrence, and the occurrence of secondary cancers. Delivering tobacco use treatment to fewer patients due to inefficient workflow represents missed opportunities to deliver life-saving care. In 2017, the National Cancer Institute initiated the Cancer Cessation Initiative (C3I) to push new tobacco cessation resources into cancer centers across the United States. This grant allowed the University of North Carolina Tobacco Treatment Program (UNC TTP) to dramatically expand tobacco use treatment (TUT) services to patients at the North Carolina Cancer Hospital (NCCH). With this push, the team saw an opportunity to utilize Lean Six Sigma, a set of quality improvement (QI) tools, to streamline their processes and uncover the root causes of program inefficiencies. A 12-month QI project using the Lean A3 problem-solving tool was implemented to examine the team’s workflow. The study team mapped out the processes and, as a result, developed multiple “experiments” to test within the NCCH to address workflow efficiency and clinical reach. Outcome measures from the baseline to follow-up included: (1) the number of new patient referrals per month, and (2) the number of counseling sessions delivered per month. From the baseline to final state, the team’s referrals increased from a mean of 10 to 24 per month, and counseling sessions increased from a mean of 74 to 84 per month. This project provided a deeper understanding of how workflow inefficiencies can be eliminated in the clinical setting, how technology can be harnessed to increase reach, and finally, that soliciting and using feedback from NCCH leadership can remove barriers and improve patient care. Full article
(This article belongs to the Special Issue Tobacco Use and Treatment among Cancer Survivors)
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Open AccessArticle
Cohort Profile: Effectiveness of a 12-Month Patient-Centred Medical Home Model Versus Standard Care for Chronic Disease Management among Primary Care Patients in Sydney, Australia
Int. J. Environ. Res. Public Health 2020, 17(6), 2164; https://doi.org/10.3390/ijerph17062164 - 24 Mar 2020
Viewed by 376
Abstract
Evidence suggests that patient-centred medical home (PCMH) is more effective than standard general practitioner care in improving patient outcomes in primary care. This paper reports on the design, early implementation experiences, and early findings of the 12-month PCMH model called ‘WellNet’ delivered across [...] Read more.
Evidence suggests that patient-centred medical home (PCMH) is more effective than standard general practitioner care in improving patient outcomes in primary care. This paper reports on the design, early implementation experiences, and early findings of the 12-month PCMH model called ‘WellNet’ delivered across six primary care practices in Sydney, Australia. The WellNet study sample comprises 589 consented participants in the intervention group receiving enhanced primary care in the form of patient-tailored chronic disease management plan, improved self-management support, and regular monitoring by general practitioners (GPs) and trained clinical coordinators. The comparison group consisted of 7750 patients who were matched based on age, gender, type and number of chronic diseases who received standard GP care. Data collected include sociodemographic characteristics, clinical measures, and self-reported health assessments at baseline and 12 months. Early study findings show the mean age of the study participants was 70 years with nearly even gender distribution of males (49.7%) and females (50.3%). The most prevalent chronic diseases in descending order were circulatory system disorders (69.8%), diabetes (47.4%), musculoskeletal disorders (43.5%), respiratory diseases (28.7%), mental illness (18.8%), and cancer (13.6%). To our knowledge, the WellNet study is the first study in Australia to generate evidence on the feasibility of design, recruitment, and implementation of a comprehensive PCMH model. Lessons learned from WellNet study may inform other medical home models in Australian primary care settings. Full article
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
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Open AccessArticle
Optimization of a Capacitated Vehicle Routing Problem for Sustainable Municipal Solid Waste Collection Management Using the PSO-TS Algorithm
Int. J. Environ. Res. Public Health 2020, 17(6), 2163; https://doi.org/10.3390/ijerph17062163 - 24 Mar 2020
Viewed by 331
Abstract
Sustainable management of municipal solid waste (MSW) collection has been of increasing concern in terms of its economic, environmental, and social impacts in recent years. Current literature frequently studies economic and environmental dimensions, but rarely focuses on social aspects, let alone an analysis [...] Read more.
Sustainable management of municipal solid waste (MSW) collection has been of increasing concern in terms of its economic, environmental, and social impacts in recent years. Current literature frequently studies economic and environmental dimensions, but rarely focuses on social aspects, let alone an analysis of the combination of the three abovementioned aspects. This paper considers the three benefits simultaneously, aiming at facilitating decision-making for a comprehensive solution to the capacitated vehicle routing problem in the MSW collection system, where the number and location of vehicles, depots, and disposal facilities are predetermined beforehand. Besides the traditional concerns of economic costs, this paper considers environmental issues correlated to the carbon emissions generated from burning fossil fuels, and evaluates social benefits by penalty costs which are derived from imbalanced trip assignments for disposal facilities. Then, the optimization model is proposed to minimize system costs composed of fixed costs of vehicles, fuel consumption costs, carbon emissions costs, and penalty costs. Two meta-heuristic algorithms, particle swarm optimization (PSO) and tabu search (TS), are adopted for a two-phase algorithm to obtain an efficient solution for the proposed model. A balanced solution is acquired and the results suggest a compromise between economic, environmental, and social benefits. Full article
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Open AccessArticle
Specific NDM-1 Inhibitor of Isoliquiritin Enhances the Activity of Meropenem against NDM-1-positive Enterobacteriaceae in vitro
Int. J. Environ. Res. Public Health 2020, 17(6), 2162; https://doi.org/10.3390/ijerph17062162 - 24 Mar 2020
Viewed by 335
Abstract
NDM-1-positive Enterobacteriaceae have caused serious clinical infections, with high mortality rates. Carbapenem was the ultimate expectation for the treatment of such infections in clinical practice. However, since the discovery of plasmid-mediated New Delhi metallo-β-lactamase-1 (NDM-1), the efficient therapeutic effects of carbapenems have been [...] Read more.
NDM-1-positive Enterobacteriaceae have caused serious clinical infections, with high mortality rates. Carbapenem was the ultimate expectation for the treatment of such infections in clinical practice. However, since the discovery of plasmid-mediated New Delhi metallo-β-lactamase-1 (NDM-1), the efficient therapeutic effects of carbapenems have been increasingly restricted. Here, we identified isoliquiritin, a novel specific inhibitor of the NDM-1 enzyme that restored the activity of carbapenem against NDM-1-producing E. coli isolates and K. pneumoniae isolates without affecting the growth of bacteria. A checkerboard test, growth curve assays and time-kill assays confirmed the significant synergistic effect of isoliquiritin combined with meropenem in vitro. It is worth noting that isoliquiritin only inhibited the activity of NDM-1 and had no obvious inhibitory effect on other class B metallo-β-lactamases (VIM-1) or NDM-1 mutants (NDM-5). The FIC indices of meropenem with isoliquiritin on NDM-1-positive E. coli and K. pneumoniae were all less than 0.5. Isoliquiritin had no influences on the expression of NDM-1-positive strains at concentrations below 64 µg/mL. Collectively, our results show that isoliquiritin is a potential adjuvant therapy drug that could enhance the antibacterial effect of carbapenems, such as meropenem, on NDM-1-positive Enterobacteria and lay the foundation for subsequent clinical trials. Full article
(This article belongs to the Section Environmental Microbiology)
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Open AccessArticle
Use of Multiple Tobacco and Tobacco-Like Products Including Heated Tobacco and E-Cigarettes in Japan: A Cross-Sectional Assessment of the 2017 JASTIS Study
Int. J. Environ. Res. Public Health 2020, 17(6), 2161; https://doi.org/10.3390/ijerph17062161 - 24 Mar 2020
Viewed by 493
Abstract
Information on the use of multiple tobacco and tobacco-like products (hereafter multiple tobacco products use, i.e., use of more than one product) is important for tobacco control. Use of heated tobacco products (HTPs), which first became popular in Japan, has been spreading over [...] Read more.
Information on the use of multiple tobacco and tobacco-like products (hereafter multiple tobacco products use, i.e., use of more than one product) is important for tobacco control. Use of heated tobacco products (HTPs), which first became popular in Japan, has been spreading over the world, while information about use of multiple tobacco products, including HTPs, is insufficient. We analyzed data of 10,114 responders from the 2017 Japan “Society and New Tobacco” Internet Survey (JASTIS) study. The prevalence and adjusted odds ratio (aOR) of multiple tobacco products use were estimated with inverse probability weighting using multivariable logistic regression models to approximate the results to whole Japanese estimates. Tobacco and tobacco-like products included cigarettes, cigars, e-cigarettes, HTPs, pipes/water pipes, and smokeless tobacco products. Among Japanese adults, 18.4% were single tobacco product users and 3.2% were multiple tobacco product users in 2017. Among current product users (100%), cigarettes were the most popular product in single (78.8%) and multiple (14.2%) tobacco products use, while HTPs were the second most popular product in single (5.2%) and multiple (10.6%) tobacco products use. People with no perception of risk regarding e-cigarettes/HTPs were more likely to use multiple tobacco products (aOR = 1.47, 95% CI = 1.12–1.92) than those who perceived a risk. Prevalence rates and predictors of multiple tobacco products use, including HTPs, were studied first. In multiple tobacco products use, high popularity of HTPs among current product users was revealed. Risk perception of e-cigarettes/HTPs was associated with multiple tobacco products use. This study provides baseline information on multiple tobacco products use in Japan, which will enable the examination of trends in the future. Full article
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Open AccessArticle
Ranking Preventive Interventions from Different Policy Domains: What Are the Most Cost-Effective Ways to Improve Public Health?
Int. J. Environ. Res. Public Health 2020, 17(6), 2160; https://doi.org/10.3390/ijerph17062160 (registering DOI) - 24 Mar 2020
Viewed by 506
Abstract
It is widely acknowledged that in order to promote public health and prevent diseases, a wide range of scientific disciplines and sectors beyond the health sector need to be involved. Evidence-based interventions, beyond preventive health interventions targeting disease risk factors and interventions from [...] Read more.
It is widely acknowledged that in order to promote public health and prevent diseases, a wide range of scientific disciplines and sectors beyond the health sector need to be involved. Evidence-based interventions, beyond preventive health interventions targeting disease risk factors and interventions from other sectors, should be developed and implemented. Investing in these preventive health policies is challenging as budgets have to compete with other governmental expenditures. The current study aimed to identify, compare and rank cost-effective preventive interventions targeting metabolic, environmental, occupational and behavioral risk factors. To identify these interventions, a literature search was performed including original full economic evaluations of Western country interventions that had not yet been implemented in the Netherlands. Several workshops were held with experts from different disciplines. In total, 51 different interventions (including 13 cost saving interventions) were identified and ranked based on their incremental cost-effectiveness ratio (ICER) and potential averted disability-adjusted life years (DALYs), resulting in two rankings of the most cost-effective interventions and one ranking of the 13 cost saving interventions. This approach, resulting in an intersectoral ranking, can assist policy makers in implementing cost-effective preventive action that considers not only the health sector, but also other sectors. Full article
(This article belongs to the Special Issue A More Sustainable and Healthier Future for All: What Works?)
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Open AccessArticle
Population Attributable Fraction of Early Age of Onset of Alcohol Use in Alcohol Abuse and Dependence: A 3-Year Follow-Up Study in University Students
Int. J. Environ. Res. Public Health 2020, 17(6), 2159; https://doi.org/10.3390/ijerph17062159 - 24 Mar 2020
Viewed by 306
Abstract
Background: we aimed to determine the risk factors and associated population attributable fractions (PAFs) for the age of onset of alcohol use and also to identify protective factors. Methods: we analyzed follow-up data collected between autumn 2011 and spring 2016 (n = [...] Read more.
Background: we aimed to determine the risk factors and associated population attributable fractions (PAFs) for the age of onset of alcohol use and also to identify protective factors. Methods: we analyzed follow-up data collected between autumn 2011 and spring 2016 (n = 5170) from the first two cohorts (2011, 2012) of the Spit for ScienceTM project. The dependent variables were alcohol abuse and dependence, and the independent variables were age of drinking onset, residence, ethnicity, religiosity, sexual orientation and work status. We determined the odds ratios (OR) using multilevel logistic regression for repeated measures in SPSSv.20. Results: the early onset of alcohol use was associated with an increased risk of alcohol abuse and dependence among females (OR = 14.98; OR = 11.83) and males (OR = 7.41; OR = 6.24). The PAFs for the early onset of alcohol use in alcohol abuse and dependence were respectively 80.9% and 71.7% in females and 71.0% and 63.5% in males. Among females, being white (OR = 1.58; OR = 1.51), living off-campus (OR = 1.73; OR = 2.76) and working full-time (OR = 1.69; OR = 1.78) were also risk factors. Strong religious beliefs were found to protect males from alcohol abuse (OR = 0.58), while same-gender sexual orientation increased the risk among females (OR = 2.09). Conclusion: delaying the age of onset by one year would reduce alcohol abuse among young adults. Full article
(This article belongs to the Special Issue Alcohol Use Among Adolescents and Young People)
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Open AccessArticle
Characterisation of Microbial Community Associated with Different Disinfection Treatments in Hospital hot Water Networks
Int. J. Environ. Res. Public Health 2020, 17(6), 2158; https://doi.org/10.3390/ijerph17062158 - 24 Mar 2020
Viewed by 330
Abstract
Many disinfection treatments can be adopted for controlling opportunistic pathogens in hospital water networks in order to reduce infection risk for immunocompromised patients. Each method has limits and strengths and it could determine modifications on bacterial community. The aim of our investigation was [...] Read more.
Many disinfection treatments can be adopted for controlling opportunistic pathogens in hospital water networks in order to reduce infection risk for immunocompromised patients. Each method has limits and strengths and it could determine modifications on bacterial community. The aim of our investigation was to study under real-life conditions the microbial community associated with different chemical (monochloramine, hydrogen peroxide, chlorine dioxide) and non-chemical (hyperthermia) treatments, continuously applied since many years in four hot water networks of the same hospital. Municipal cold water, untreated secondary, and treated hot water were analysed for microbiome characterization by 16S amplicon sequencing. Cold waters had a common microbial profile at genera level. The hot water bacterial profiles differed according to treatment. Our results confirm the effectiveness of disinfection strategies in our hospital for controlling potential pathogens such as Legionella, as the investigated genera containing opportunistic pathogens were absent or had relative abundances ≤1%, except for non-tuberculous mycobacteria, Sphingomonas, Ochrobactrum and Brevundimonas. Monitoring the microbial complexity of healthcare water networks through 16S amplicon sequencing is an innovative and effective approach useful for Public Health purpose in order to verify possible modifications of microbiota associated with disinfection treatments. Full article
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Open AccessArticle
Spatio-Temporal Variations of Satellite-Based PM2.5 Concentrations and Its Determinants in Xinjiang, Northwest of China
Int. J. Environ. Res. Public Health 2020, 17(6), 2157; https://doi.org/10.3390/ijerph17062157 - 24 Mar 2020
Viewed by 326
Abstract
With the aggravation of air pollution in recent years, a great deal of research on haze episodes is mainly concentrated on the east-central China. However, fine particulate matter (PM2.5) pollution in northwest China has rarely been discussed. To fill this gap, [...] Read more.
With the aggravation of air pollution in recent years, a great deal of research on haze episodes is mainly concentrated on the east-central China. However, fine particulate matter (PM2.5) pollution in northwest China has rarely been discussed. To fill this gap, based on the standard deviational ellipse analysis and spatial autocorrelation statistics method, we explored the spatio-temporal variation and aggregation characteristics of PM2.5 concentrations in Xinjiang from 2001 to 2016. The result showed that annual average PM2.5 concentration was high both in the north slope of Tianshan Mountain and the western Tarim Basin. Furthermore, PM2.5 concentrations on the northern slope of the Tianshan Mountain increased significantly, while showing an obviously decrease in the western Tarim Basin during the period of 2001–2016. Based on the result of the geographical detector method (GDM), population density was the most dominant factor of the spatial distribution of PM2.5 concentrations (q = 0.550), followed by road network density (q = 0.423) and GDP density (q = 0.413). During the study period (2001–2016), the driving force of population density on the distribution of PM2.5 concentrations showed a gradual downward trend. However, other determinants, like DEM (Digital elevation model), NSL (Nighttime stable light), LCT (Land cover type), and NDVI (Normalized Difference Vegetation Index), show significant increased trends. Therefore, further effort is required to reveal the role of landform and vegetation in the spatio-temporal variations of PM2.5 concentrations. Moreover, the local government should take effective measures to control urban sprawl while accelerating economic development. Full article
(This article belongs to the Special Issue Spatio-Temporal Environmental Monitoring and Social Sensing)
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Open AccessArticle
How to Educate Pregnant Women about Endocrine Disruptors?
Int. J. Environ. Res. Public Health 2020, 17(6), 2156; https://doi.org/10.3390/ijerph17062156 (registering DOI) - 24 Mar 2020
Viewed by 278
Abstract
Background: Despite mediatization, only half of pregnant women are informed about endocrine disruptors (EDs). We wished to inquire about appropriate environmental health education procedures during pregnancy: Who, when, and how? Methods: The question stems from a comprehensive population health intervention research project. It [...] Read more.
Background: Despite mediatization, only half of pregnant women are informed about endocrine disruptors (EDs). We wished to inquire about appropriate environmental health education procedures during pregnancy: Who, when, and how? Methods: The question stems from a comprehensive population health intervention research project. It includes qualitative studies aimed at constructing an educational program in environmental health and an accompanying assessment tool. The validation of a customized questionnaire (PREVED© for Pregnancy Prevention Endocrine Disruptors) about the knowledge, attitudes, and practices (KAP) of pregnant women regarding exposure to EDs was carried out in a quantitative study. Results: Health education by a prenatal professional with communication skills should take place as early as possible, during the preconception period or early pregnancy, as part of individual consultation or group workshops. In order to customize the discourse and to develop women’s empowerment, concomitant presentation of the risks by the products used in each room and of previous solutions is recommended. Conclusion: Appropriate health education procedures on EDs should be done at every contact but taking the KAP of pregnant women into account first. We propose all educational actions should be accompanied by questioning of the KAP of pregnant women; for example, with questions from the PREVED© questionnaire. Full article
(This article belongs to the Special Issue Potential Risks and Factors of Women's Health Promotion)
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Open AccessReview
International Perspective on Health Literacy and Health Equity: Factors That Influence the Former Soviet Union Immigrants
Int. J. Environ. Res. Public Health 2020, 17(6), 2155; https://doi.org/10.3390/ijerph17062155 - 24 Mar 2020
Viewed by 338
Abstract
Among the world’s 272 million international migrants, more than 25 million are from the former Soviet Union (FSU), yet there is a paucity of literature available about FSU immigrants’ health literacy. Besides linguistic and cultural differences, FSU immigrants often come from a distinct [...] Read more.
Among the world’s 272 million international migrants, more than 25 million are from the former Soviet Union (FSU), yet there is a paucity of literature available about FSU immigrants’ health literacy. Besides linguistic and cultural differences, FSU immigrants often come from a distinct healthcare system affecting their ability to find, evaluate, process, and use health information in the host countries. In this scoping review and commentary, we describe the health literacy issues of FSU immigrants and provide an overview of FSU immigrants’ health literacy based on the integrated health literacy model. We purposefully consider the three most common locations where FSU immigrants have settled: the USA, Germany, and Israel. For context, we describe the healthcare systems of the three host countries and the two post-Soviet countries to illustrate the contribution of system-level factors on FSU immigrants’ health literacy. We identify research gaps and set a future research agenda to help understand FSU immigrants’ health literacy across countries. Amidst the ongoing global population changes related to international migration, this article contributes to a broad-scope understanding of health literacy among FSU immigrants related to the system-level factors that may also apply to other immigrants, migrants, and refugees. Full article
Open AccessArticle
Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices
Int. J. Environ. Res. Public Health 2020, 17(6), 2154; https://doi.org/10.3390/ijerph17062154 - 24 Mar 2020
Viewed by 316
Abstract
Given the widespread lack of access to dental care for many vulnerable Americans, there is a growing realization that integrating dental and primary care may provide comprehensive care. We sought to model the financial impact of integrating dental care provision into a primary [...] Read more.
Given the widespread lack of access to dental care for many vulnerable Americans, there is a growing realization that integrating dental and primary care may provide comprehensive care. We sought to model the financial impact of integrating dental care provision into a primary care practice. A microsimulation model was used to estimate changes in net revenue per practice by simulating patient visits to a primary dental practice within primary care practices, utilizing national survey and un-identified claims data from a nationwide health insurance plan. The impact of potential changes in utilization rates and payer distributions and hiring additional staff was also evaluated. When dental care services were provided in the primary care setting, annual net revenue changes per practice were −$92,053 (95% CI: −93,054, −91,052) in the first year and $104,626 (95% CI: 103,315, 105,316) in subsequent years. Net revenue per annum after the first year of integration remained positive as long as the overall utilization rates decreased by less than 25%. In settings with a high proportion of publicly insured patients, the net revenue change decreased but was still positive. Integrating primary dental and primary care providers would be financially viable, but this viability depends on demands of dental utilization and payer distributions. Full article
(This article belongs to the Special Issue Big Data in Dental Research and Oral Healthcare)
Open AccessArticle
Dynamic Navigation in Dental Implantology: The Influence of Surgical Experience on Implant Placement Accuracy and Operating Time. An in Vitro Study
Int. J. Environ. Res. Public Health 2020, 17(6), 2153; https://doi.org/10.3390/ijerph17062153 - 24 Mar 2020
Viewed by 314
Abstract
Aim: the aim of this in vitro study was to test whether the implant placement accuracy and the operating time can be influenced by the operator’s experience. Materials and methods: sixteen models underwent a (Cone Beam Computer Tomography) CBCT and implant positioning was [...] Read more.
Aim: the aim of this in vitro study was to test whether the implant placement accuracy and the operating time can be influenced by the operator’s experience. Materials and methods: sixteen models underwent a (Cone Beam Computer Tomography) CBCT and implant positioning was digitally planned on this. The models were randomly assigned to four operators with different levels of surgical experience. One hundred and twelve implant sites were drilled using a dynamic navigation system and operating times were measured. Based on postoperative CBCTs, dental implants were virtually inserted and superimposed over the planned ones. Two-dimensional and 3D deviations between planned and virtually inserted implants were measured at the entry point and at the apical point. Angular and vertical errors were also calculated. Results: considering coronal and apical 3D deviations, no statistically significant differences were found between the four operators (p = 0.27; p = 0.06). Some vectorial components of the deviation at the apical point and the angular errors of some operators differed from each other. Conclusions: within the limitations of this study, dynamic navigation can be considered a reliable technique both for experienced and novice clinicians. Full article
(This article belongs to the Special Issue Implant-Prosthetic Rehabilitation and Maintenance)
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Open AccessArticle
Health Literacy Associations with Periodontal Disease among Slovak Adults
Int. J. Environ. Res. Public Health 2020, 17(6), 2152; https://doi.org/10.3390/ijerph17062152 - 24 Mar 2020
Viewed by 295
Abstract
Periodontal disease is inflammation of the gums and without good oral hygiene, it can progress to periodontitis. Oral hygiene might be related to a patient’s health literacy (HL), defined as ability to gain access, understand, and use information to promote and maintain good [...] Read more.
Periodontal disease is inflammation of the gums and without good oral hygiene, it can progress to periodontitis. Oral hygiene might be related to a patient’s health literacy (HL), defined as ability to gain access, understand, and use information to promote and maintain good health. The aim of our study is to examine the associations of HL with indicators of periodontal disease. A cross-sectional study on 1117 adults (36.2% males; mean age = 36.4, SD = 14.2) attending dental hygiene treatment was conducted. Data on demographics, socioeconomic status, and nine domains of HL (Health Literacy Questionnaire, HLQ) were collected by questionnaire, and Community Periodontal Index of Treatment Needs (CPITN) was established by the dental hygienist. Data were analysed using t-tests and logistic regression. Respondents with periodontal disease (N = 152) had statistically significantly lower levels of HL in seven out of nine HLQ domains compared to intact patients (N = 818) (t from 3.03 to 4.75, p < 0.01). Association of higher HL in seven domains with lower chance of diagnosed periodontal disease remain significant even after adjustment for age, gender and educational attainment (adjusted ORs 0.55–0.67, p < 0.05). Our findings confirm that an individual’s lower HL is significantly associated with higher chance of periodontal disease incidence, specifically among Slovak adults attending oral hygiene clinics. HL might be a promising factor in the improvement of oral health in this population, worthy of consideration in intervention and preventive activities. Full article
(This article belongs to the Special Issue Routes to Improve Health Literacy during the Life-Course)
Open AccessArticle
The Relationships of Experiencing Workplace Bullying with Mental Health, Affective Commitment, and Job Satisfaction: Application of the Job Demands Control Model
Int. J. Environ. Res. Public Health 2020, 17(6), 2151; https://doi.org/10.3390/ijerph17062151 - 24 Mar 2020
Viewed by 318
Abstract
There have been very few theoretical models published to understand the relationship between workplace bullying and different outcome variables. Applying the Job Demands Control (JDC) model, this study analyzed workplace bullying alongside ‘traditional’ job stressors of role overload and low job control to [...] Read more.
There have been very few theoretical models published to understand the relationship between workplace bullying and different outcome variables. Applying the Job Demands Control (JDC) model, this study analyzed workplace bullying alongside ‘traditional’ job stressors of role overload and low job control to determine the relative associations of each with mental health and wellbeing. These relative associations have not been well documented. Data were obtained from an organizational climate questionnaire administered to 21 Australian Defence Force units (n = 3193). Results indicated that the correlations between bullying and psychological distress (r = 0.39), job satisfaction (r = −0.28), and affective commitment (r = −0.22) were all significant and for some outcomes greater than those involving the traditional job stressors. Furthermore, for each of these three outcomes, bullying contributed incremental variance after controlling for other job demands. These results support earlier claims that workplace bullying requires the same attention given to traditional work stressors. The JDC model provides a strong theoretical base to investigate workplace bullying. Testing against other stressors allows for consideration of the broader context of workplace bullying when managing the workforce. Full article
(This article belongs to the Section Health Care Sciences & Services)
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Open AccessArticle
The Relationship between Self-Rated Economic Status and Falls among the Elderly in Shandong Province, China
Int. J. Environ. Res. Public Health 2020, 17(6), 2150; https://doi.org/10.3390/ijerph17062150 - 24 Mar 2020
Viewed by 317
Abstract
(1) Background: Older people are more vulnerable and likely to have falls and the consequences of these falls place a heavy burden on individuals, families and society. Many factors directly or indirectly affect the prevalence of falls. The aims of this study were [...] Read more.
(1) Background: Older people are more vulnerable and likely to have falls and the consequences of these falls place a heavy burden on individuals, families and society. Many factors directly or indirectly affect the prevalence of falls. The aims of this study were to understand the prevalence and risk factors of falls among the elderly in Shandong, China; the relationship between economic level and falls was also preliminary explored. (2) Methods: Using a multi-stage stratified sampling method, 7070 elderly people aged 60 and over were selected in Shandong Province, China. General characteristics and a self-rated economic status were collected through face to face interviews. Chi-square tests, rank sum tests and two logistic regression models were performed as the main statistical methods. (3) Results: 8.59% of participants reported that they had experienced at least one fall in the past half year. There was a significant difference in experienced falls regarding gender, residence, marital status, educational level, smoking, drinking, hypertension, diabetes, coronary disease, and self-reported hearing. The worse the self-rated economic status, the higher the risk of falling, (poor and worried about livelihood, OR = 3.60, 95%; CI = 1.76–7.35). (4) Conclusions: Women, hypertension, diabetes and self-reported hearing loss were identified as the risk factors of falls in the elderly. The difference of economic level affects the falls of the elderly in rural and urban areas. More fall prevention measures should be provided for the elderly in poverty. Full article
Open AccessArticle
Analysis of Cumulative Cancer Risk Associated with Disinfection Byproducts in United States Drinking Water
Int. J. Environ. Res. Public Health 2020, 17(6), 2149; https://doi.org/10.3390/ijerph17062149 - 24 Mar 2020
Viewed by 318
Abstract
Hundreds of different disinfection byproducts form in drinking water following necessary treatment with chlorine and other disinfectants, and many of those byproducts can damage DNA and increase the risk of cancer. This study offers the first side-by-side comparison of cancer risk assessments based [...] Read more.
Hundreds of different disinfection byproducts form in drinking water following necessary treatment with chlorine and other disinfectants, and many of those byproducts can damage DNA and increase the risk of cancer. This study offers the first side-by-side comparison of cancer risk assessments based on toxicological and epidemiological studies of disinfection byproducts using a comprehensive contaminant occurrence dataset for haloacetic acids and trihalomethanes, two groups of disinfection byproducts that are regulated in drinking water. We also provide the first analysis of a new occurrence dataset for unregulated haloacetic acids that became available from the latest, fourth round of the U.S. EPA-mandated unregulated contaminant monitoring program (UCMR4). A toxicological assessment indicated that haloacetic acids, and in particular brominated haloacetic acids, are more carcinogenic and are associated with a greater number of attributable cancer cases than trihalomethanes. Based on the toxicological analysis, cumulative lifetime cancer risk due to exposure to trihalomethanes and haloacetic acids for community water systems monitored under UCMR4, estimated with standard default parameters for body weight and water intake, corresponds to 7.0 × 10−5 (3.5 × 10−5–1.3 × 10−4). The same analysis conducted with age sensitivity factors to account for elevated risk in infants and children yielded a cumulative risk estimate of 2.9 × 10−4 (1.7 × 10−4–6.2 × 10−4). Epidemiological data suggest that lifetime cancer risk from disinfection byproducts for the U.S. population served by community water systems is approximately 3.0 × 10−3 (2.1 × 10−4–5.7 × 10−3), or a lifetime cancer risk of three cases per thousand people. Overall, this analysis highlights the value of using human data in health risk assessments to the greatest extent possible. Full article
(This article belongs to the Section Environmental Health)
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Open AccessArticle
The Age-Related Performance Decline in Ironman 70.3
Int. J. Environ. Res. Public Health 2020, 17(6), 2148; https://doi.org/10.3390/ijerph17062148 - 24 Mar 2020
Viewed by 239
Abstract
Although the age-related decline in sport events has been well studied, little is known on such a decline in recreational triathletes for the Half Ironman distance. Indeed, the few existing studies concentrated on specific aspects such as top events, elite groups, some consecutive [...] Read more.
Although the age-related decline in sport events has been well studied, little is known on such a decline in recreational triathletes for the Half Ironman distance. Indeed, the few existing studies concentrated on specific aspects such as top events, elite groups, some consecutive years, single locations, or age categories instead of analyzing all the data available. Therefore, the aim of the present study was to examine recreational triathletes’ performance in three split disciplines (swimming, cycling, and running) as well as in overall race time by analyzing all data of Half Ironman finishers found on ironman.com (i.e., 690 races; years 2004 through 2018; 206,524 women (24.6%) and 633,576 men (75.4%), in total 840,100 athletes). The age-dependent decline in Half Ironman started earliest in swimming (from the very first age group on) with a smallest age group delta between 35–49 years in men and 40–54 years in women. The performance decline started at 26 and 28 years in men and women for running; at 34 years for men and 35 years for women in cycling; and at 32 years for men and 31 years for women with regard to overall race time. The results may be used by coaches and recreational athletes alike to plan a triathlon career. Full article
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Open AccessArticle
Knowledge, Attitudes, and Practices towards Infectious Diseases Related to Travel of Community Pharmacists in Italy
Int. J. Environ. Res. Public Health 2020, 17(6), 2147; https://doi.org/10.3390/ijerph17062147 - 24 Mar 2020
Viewed by 323
Abstract
Pharmacists should be educated about travel medicine, since they could influence their own choices and those of the individuals they encounter. This study aims to investigate the knowledge, attitudes, and behaviors towards infectious diseases related to travel among community pharmacists in Italy. The [...] Read more.
Pharmacists should be educated about travel medicine, since they could influence their own choices and those of the individuals they encounter. This study aims to investigate the knowledge, attitudes, and behaviors towards infectious diseases related to travel among community pharmacists in Italy. The data was collected from September 2018 to September 2019 using semi-structured telephone interviews. Only 1.8% answered correctly to all seven questions regarding the infectious diseases related to travel. Community pharmacists who had heard about travel medicine and those who had received information were more likely to have good knowledge. More than two-thirds of the respondents believed that it is important to provide information to the public about travel medicine. Pharmacists who worked a higher number of hours per week, were more knowledgeable about the more frequent infectious diseases related to travel, believed that travel medicine was a pharmacist competency, believed that they could give advice to the public, and had received information from scientific journals and educational activities were more likely to have this positive attitude. More than two-thirds often/always informed the public about the importance of having travel health center counseling. Pharmacists who had heard about travel medicine and those who believed that they could give advice to the public were more likely to inform. Interventions are needed to improve knowledge in order that community pharmacists can play an active role in counseling the public. Full article
Open AccessFeature PaperArticle
Cancer and Non-Cancer Risk Concerns from Metals in Electronic Cigarette Liquids and Aerosols
Int. J. Environ. Res. Public Health 2020, 17(6), 2146; https://doi.org/10.3390/ijerph17062146 - 24 Mar 2020
Viewed by 554
Abstract
We evaluated metal concentrations in e-liquids and e-aerosols from eight studies and estimated the range of corresponding cancer and non-cancer risks. Chromium and nickel were the leading contributors to cancer risk, with minor contributions from cadmium, lead, and arsenic. The increased cancer risks, [...] Read more.
We evaluated metal concentrations in e-liquids and e-aerosols from eight studies and estimated the range of corresponding cancer and non-cancer risks. Chromium and nickel were the leading contributors to cancer risk, with minor contributions from cadmium, lead, and arsenic. The increased cancer risks, assuming exposure to 2 mL/day, ranged from 5.7 to 30,000 additional cancers in a million e-cigarette users. The average cancer risk was 3 in 1000. Cancer risks in the mid to upper end of these ranges exceed acceptable levels. The hazard quotient (HQ) approach was used to evaluate non-cancer risks. Hazard quotients exceeding 1.0 indicate the possibility for non-cancer adverse health effects. Estimated exposures at the maximum reported concentrations of nickel, chromium, and manganese resulted in HQ values of 161, 1.1, and 1.0, respectively, with additional contributions from lead. The average concentration of nickel resulted in an HQ value of 14. We conclude from these studies that exposure to metals in e-cigarette liquids and aerosols may pose a significant cancer and non-cancer health risk at the mid and upper end of the reported ranges. The device design and heating elements appear to be the main source of metals in e-aerosols. The large range of metals within and across e-cigarette brands indicate the need for improvements in product design, enforced product safety regulations and manufacturing quality control. Implementation of such measures could reduce metal exposure in e-cigarette users. Full article
(This article belongs to the Special Issue Toxicology and Environmental Epidemiology: Feature Papers)
Open AccessReply
Reply to Comment on Małgorzata Krówczyńska and Ewa Wilk. Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland. Int. J. Environ. Res. Public Health 2019, 16, 2611
Int. J. Environ. Res. Public Health 2020, 17(6), 2145; https://doi.org/10.3390/ijerph17062145 - 24 Mar 2020
Viewed by 313
Abstract
Thank you for the possibility of enabling us to provide a response to the comment on our paper “Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland” [...] Full article
Open AccessArticle
Glomerular Filtration Rate in Former Extreme Low Birth Weight Infants over the Full Pediatric Age Range: A Pooled Analysis
Int. J. Environ. Res. Public Health 2020, 17(6), 2144; https://doi.org/10.3390/ijerph17062144 - 24 Mar 2020
Viewed by 349
Abstract
Various cohort studies document a lower glomerular filtration rate (GFR) in former extremely low birth weight (ELBW, <1000 g) neonates throughout childhood when compared to term controls. The current aim is to pool these studies to describe the GFR pattern over the pediatric [...] Read more.
Various cohort studies document a lower glomerular filtration rate (GFR) in former extremely low birth weight (ELBW, <1000 g) neonates throughout childhood when compared to term controls. The current aim is to pool these studies to describe the GFR pattern over the pediatric age range. To do so, we conducted a systematic review on studies reporting on GFR measurements in former ELBW cases while GFR data of healthy age-matched controls included in these studies were co-collected. Based on 248 hits, 6 case-control and 3 cohort studies were identified, with 444 GFR measurements in 380 former ELBW cases (median age 5.3–20.7 years). The majority were small (17–78 cases) single center studies, with heterogeneity in GFR measurement (inulin, cystatin C or creatinine estimated GFR formulae) tools. Despite this, the median GFR (mL/min/1.73 m2) within case-control studies was consistently lower (−13%, range −8% to −25%) in cases, so that a relevant minority (15–30%) has a eGFR<90 mL/min/1.73 m2). Consequently, this pooled analysis describes a consistent pattern of reduced eGFR in former ELBW cases throughout childhood. Research should focus on perinatal risk factors for impaired GFR and long-term outcome, but is hampered by single center cohorts, study size and heterogeneity of GFR assessment tools. Full article
(This article belongs to the Section Global Health)
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Open AccessArticle
Passion or Perseverance? The Effect of Perceived Autonomy Support and Grit on Academic Performance in College Students
Int. J. Environ. Res. Public Health 2020, 17(6), 2143; https://doi.org/10.3390/ijerph17062143 - 24 Mar 2020
Viewed by 415
Abstract
Background: Individuals who possess passion and perseverance to extensively work and study through challenges and adversity to achieve a set of goals are likely to reach higher achievement compared to others who lack similar facets. However, an under-researched question lingers over the effect [...] Read more.
Background: Individuals who possess passion and perseverance to extensively work and study through challenges and adversity to achieve a set of goals are likely to reach higher achievement compared to others who lack similar facets. However, an under-researched question lingers over the effect of teacher-induced behaviors on academic outcomes such as grades and performance. The purpose of this study was to examine the relationships between teacher-induced autonomy support and student academic performance considering the mediating effect of basic psychological needs satisfaction, intrinsic motivation, and grit as two-independent factors. Methods: A convenience sample of 474 Sports Science students (Mage = 21.83 years; SD = 3.91) participated in the study. All participants completed a multi-section survey assessing the variables under analysis. Results: The measurement and structural model displayed acceptable fit, hence direct and indirect effects were examined among the variables of interest. Basic psychological needs and intrinsic motivation seem to display a mediating role between perceived autonomy support and academic performance, through perseverance. Contrarily, grit-passion did not exhibit a significant indirect effect. Conclusions: Current results shed new insights on how perseverance can shape student motivation and school success considering the autonomy support induced by teachers. Full article
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Open AccessArticle
Total Worker Health Leadership and Business Strategies Are Related to Safety and Health Climates in Small Business
Int. J. Environ. Res. Public Health 2020, 17(6), 2142; https://doi.org/10.3390/ijerph17062142 - 24 Mar 2020
Viewed by 478
Abstract
The purpose of this study was to investigate the relationship between Total Worker Health® (TWH) business strategies and employee perceptions of leadership commitment and safety and health climates. Using data from 53 small enterprises and 1271 of their workers collected as part [...] Read more.
The purpose of this study was to investigate the relationship between Total Worker Health® (TWH) business strategies and employee perceptions of leadership commitment and safety and health climates. Using data from 53 small enterprises and 1271 of their workers collected as part of the Small + Safe + Well (SSWell) Study, we confirm the primacy of the relationship between leadership commitment to safety and workplace safety climate. After accounting for leadership commitment to safety, business-reported policies and practices that promote the health, safety, and well-being of workers (i.e., TWH strategies) were no longer related to safety climate. In contrast, the relationship between TWH strategies and health climate were significantly associated with the level of small business leadership commitment to worksite wellness. Relatedly, our results demonstrate that leadership is a common correlate to both safety climate and health climate. Future research should investigate integrated TWH leadership development strategies as a means of simultaneously improving safety and health climates. Full article
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Open AccessArticle
Predisposition to Change Is Linked to Job Satisfaction: Assessing the Mediation Roles of Workplace Relation Civility and Insight
Int. J. Environ. Res. Public Health 2020, 17(6), 2141; https://doi.org/10.3390/ijerph17062141 - 23 Mar 2020
Viewed by 386
Abstract
The globalization processes typical of liquid modern society require organizations to have high levels of flexibility, dynamism, and rapidity of change, testing the adaptability of workers with possible repercussions on well-being and productivity. Therefore, this study aimed to investigate the role of several [...] Read more.
The globalization processes typical of liquid modern society require organizations to have high levels of flexibility, dynamism, and rapidity of change, testing the adaptability of workers with possible repercussions on well-being and productivity. Therefore, this study aimed to investigate the role of several psychological factors in favoring job satisfaction in a group of organizational workers (mean age = 46.24; SD = 9.99; 40.9% males and 59.1% females). Firstly, the impact of predisposition to change on job satisfaction through workplace relational civility (others with me) or insight orientation as independent mediating variables was analyzed. After that, this relationship was also studied by testing the effect that the simultaneous interaction of both mediators could have. Results show that workplace relational civility (others with me) significantly mediated the relationship between predisposition to change and job satisfaction, while no significance was found in the effect of insight when considered individually. However, the latter acquires greater relevance if placed in interaction with the other mediator, that is found to be the most proximal factor linking job satisfaction to the other more distal variables. Such findings might have a relevant role in strengthening preventive intervening, favoring positive results for greater well-being of both subjects and organizations. Full article
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Open AccessArticle
Diarrhea in Under Five Year-old Children in Nepal: A Spatiotemporal Analysis Based on Demographic and Health Survey Data
Int. J. Environ. Res. Public Health 2020, 17(6), 2140; https://doi.org/10.3390/ijerph17062140 (registering DOI) - 23 Mar 2020
Viewed by 394
Abstract
Background: Diarrhea in children under five years of age remains a challenge in reducing child mortality in Nepal. Understanding the spatiotemporal patterns and influencing factors of the disease is important for control and intervention. Methods: Data regarding diarrhea prevalence and its potential influencing [...] Read more.
Background: Diarrhea in children under five years of age remains a challenge in reducing child mortality in Nepal. Understanding the spatiotemporal patterns and influencing factors of the disease is important for control and intervention. Methods: Data regarding diarrhea prevalence and its potential influencing factors were extracted from the Demographic and Health Surveys in Nepal and other open-access databases. A Bayesian logistic regression model with district-specific spatio-temporal random effects was applied to explore the space and time patterns of diarrhea risk, as well as the relationships between the risk and the potential influencing factors. Results: Both the observed prevalence and the estimated spatiotemporal effects show a decreasing diarrhea risk trend from 2006 to 2016 in most districts of Nepal, with a few exceptions, such as Achham and Rasuwa. The disease risk decreased with mothers’ years of education (OR 0.93, 95% Bayesian Credible Interval (BCI) 0.87, 0.997). Compared to spring, autumn and winter had lower risks of diarrhea. The risk firstly increased and then decreased with age and children under 12–24 months old were the highest risk group (OR 1.20, 95% BCI 1.04, 1.38). Boys had higher risk than girls (OR 1.24, 95% BCI 1.13, 1.39). Even though improved sanitation wasn’t found significant within a 95% BCI, there was 93.2% of chance of it being a protective factor. There were no obvious spatiotemporal clusters among districts and each district tended to have its own spatiotemporal diarrhea prevalence pattern. Conclusions: The important risk factors identified by our Bayesian spatial-temporal modeling provide insights for control and intervention on children diarrhea in Nepal. Special attention should be paid to high risk groups of children and high risk seasons, as well as districts with high risk or increased trend of risk. Effective actions should be implemented to improve sanitation and women’s education level. District-specific control planning is recommended for local governments for effective control of children diarrhea in Nepal. Full article
(This article belongs to the Section Children's Health)
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Open AccessArticle
Physical Disorders are Associated with Health Risk Behaviors in Chinese Adolescents: A Latent Class Analysis
Int. J. Environ. Res. Public Health 2020, 17(6), 2139; https://doi.org/10.3390/ijerph17062139 - 23 Mar 2020
Viewed by 357
Abstract
It is known that health risk behaviors (HRBs) can lead to a variety of physical and mental health problems among adolescents, but few studies have paid attention to the relationship between latent classes of HRBs and adolescent diseases. The purpose of this study [...] Read more.
It is known that health risk behaviors (HRBs) can lead to a variety of physical and mental health problems among adolescents, but few studies have paid attention to the relationship between latent classes of HRBs and adolescent diseases. The purpose of this study was to use latent class analysis (LCA) to clarify the potential subgroups of HRBs (smoking, drinking, screen time, non-suicidal self-injuries, suicidal behaviors, and unintentional injuries) and examine the association between the subgroups of HRBs and physical disorders (diarrhea, fever, cough, and vomiting) with multiple logistic regression analysis, in Chinese adolescents. Self-reported HRBs and physical disorders were used to evaluate 22,628 middle school students in six cities of China, from November 2015 to January 2016, based on a multistage stratified cluster sampling approach. The prevalence of diarrhea, fever, cough, and vomiting was 23.5%, 15.9%, 50.6%, and 10.7%, respectively. We identified four latent classes of HRBs by LCA, including low-risk class, moderate-risk class 1 (smoking, drinking, and screen time), moderate-risk class 2 (non-suicidal self-injuries and suicidal behaviors, unintentional injuries), and high-risk class (smoking, drinking, screen time, non-suicidal self-injuries, suicidal behaviors, and unintentional injuries), which were 64.0%, 4.5%, 28.8% and 2.7% of participants, respectively. Compared to the low-risk class, all other classes showed higher risk for these physical disorders (P < 0.01 for each). In particular, the high-risk class had the highest risk (diarrhea (odds ratio (OR) = 2.628, 95% confidence interval (CI) 2.219 to 3.113), fever (OR = 3.103, 95% CI 2.591 to 3.717), cough (OR = 2.142, 95% CI 1.805 to 2.541), and vomiting (OR = 3.738, 95% CI 3.081 to 4.536). In conclusion, these results indicated that heterogeneity exists in HRBs, and subgroups of HRBs were correlated to the occurrence of common physical disorders in Chinese adolescents. Therefore, multiple HRBs rather than single factors should be considered for the prevention of common physical disorders in schools. Full article
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
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