Int. J. Environ. Res. Public Health, Volume 18, Issue 1 (January-1 2021) – 359 articles

Recent studies have suggested the common co-occurrence of hypertension and diabetes in South Africa. Given that hypertension and diabetes are known to share common socio-demographic, anthropometric and lifestyle risk factors, the aim of this study was to jointly model the shared and disease-specific geographical variation of hypertension and diabetes. The current analysis used the Study on Global Ageing and Adult Health (SAGE) South Africa Wave 2 (2014/15) data collected from 2761 participants. Of the 2761 adults (median age = 56 years), 641 (23.2%) had high blood pressure on measurement and 338 (12.3%) reported being diagnosed with diabetes. The shared component has distinct spatial patterns with higher values of odds in the eastern districts of Kwa-Zulu Natal and central Gauteng province. The shared component may represent unmeasured health behavior characteristics or the social determinants of health in our population. Our study further showed how a shared component (latent and unmeasured health behavior characteristics or the social determinants of health) is distributed across South Africa among the older adult population. Further research using similar shared joint models may focus on extending these models for multiple diseases with ecological factors and also incorporating sampling weights in the spatial analyses. Full article

Cohort studies showed consistently low risks for malignant mesothelioma (MM) among agricultural workers, however the investigated exposures did not include asbestos. Our aim is to describe sources of asbestos exposure of MM in agriculture. Twenty-six MM cases in agricultural or seed trades workers were identified through the MM registry of the Lombardy region, Italy in 2000–2016. Asbestos exposures were investigated through a standardized questionnaire. The most frequent exposure circumstances were recycled jute bags previously containing asbestos (11 cases) and maintenance and repair of asbestos roofs (12 subjects). Three subjects performed maintenance and repair of tractor asbestos brakes and two used asbestos filters for wine production. Our data suggest asbestos exposure opportunities in the agricultural setting, underlining the need to look for this exposure in subjects affected with mesothelioma. Full article

Close economic ties encourage production and trade of meat between Canada, Mexico, and the US. Understanding the patterns of red and processed meat consumption in North America may inform policies designed to reduce meat consumption and bolster environmental and public health efforts across the continent. We used nationally-representative cross-sectional survey data to analyze consumption of unprocessed red meat; processed meat; and total red and processed meat. Generalized linear models were used to separately estimate probability of consumption and adjusted mean intake. Prevalence of total meat consumers was higher in the US (73.6, 95% CI: 72.3–74.8%) than in Canada (65.6, 63.9–67.2%) or Mexico (62.7, 58.1–67.2%). Men were more likely to consume unprocessed red, processed, and total meat, and had larger estimated intakes. In Mexico, high wealth individuals were more likely to consume all three categories of meat. In the US and Canada, those with high education were less likely to consume total and processed meat. Estimated mean intake of unprocessed red, processed, and total meat did not differ across sociodemographic strata. Overall consumption of red and processed meat remains high in North America. Policies to reduce meat consumption are appropriate for all three countries. Full article

(1) Background: The prevalence of complementary and alternative methods (CAM) use among oncological patients has been rising constantly over the last few decades and a variety of both pharmacological and non-pharmacological methods have been developed. Many advertisements promise to relieve side effects of chemotherapy or even to cure the disease, thus encouraging patients to use CAM; (2) Methods: The objective of the study was to determine which patients’ characteristics are associated with the use of complementary medicine during cancer treatment, their pattern of use, and if it has any association with its safety profile. This survey-based prospective multicenter study of 316 patients examined the use of complementary medicine among patients undergoing chemotherapy treatment in cancer centers in Poland between 2017 and 2019; (3) Results: The Chi2 analysis showed that patients’ opinion regarding the safety of unconventional methods is related to the use of CAM (p = 0.00147). Moreover, patients’ thinking that alternative medicine can replace traditional therapy was correlated with his/her education (p = 0.01198). Moreover, we performed univariate and multivariate analysis to determine factors associated with CAM use including sociodemographic and clinical characteristics. Finally, we conducted survival analysis of patients undergoing chemotherapy treatment with 42 months of follow-up time of our prospective study. Using Kaplan–Meier curves and log-rank analysis, we found no statistical difference in overall survival between the groups that used and did not use any form of CAM (p = 0.211); (4) Conclusions: CAM use is common among patients undergoing chemotherapy treatment and should be considered by medical teams as some agents may interact with chemotherapy drugs and affect their efficacy or cause adverse effects. Full article

The current article examined the relationship between preferred styles of coping with stress and occupational burnout among probation officers in Poland. The probation system in Poland is unique in comparison to similar organizations in Europe and the world. It is characterized by two separate specializations in the area of performed tasks: probation officers for adults and for family and juvenile clients. The main purpose of the study was to assess the relationship between occupational burnout levels among probation officers (n = 390) and their preferred styles of coping with stress. Two psychological tools were used in the study: the Maslach Burnout Inventory (MBI) and the Coping Inventory for Stressful Situations (CISS). A linear regression analysis was carried out to explain the variance in occupational burnout. Occupational burnout was the dependent variable and the CISS scales were the predictors. In order to test the moderating role of the sociodemographic factors of gender, work experience, age, and probation specialization in the relationship between coping styles and occupational burnout, a range of moderation analyses using Hayes’ PROCESS macro on SPSS was carried out. Full article

Bhutan experienced its largest and first nation-wide dengue epidemic in 2019. The cases in 2019 were greater than the total number of cases in all the previous years. This study aimed to characterize the spatiotemporal patterns and effective reproduction number of this explosive epidemic. Weekly notified dengue cases were extracted from the National Early Warning, Alert, Response and Surveillance (NEWARS) database to describe the spatial and temporal patterns of the epidemic. The time-varying, temperature-adjusted cohort effective reproduction number was estimated over the course of the epidemic. The dengue epidemic occurred between 29 April and 8 December 2019 over 32 weeks, and included 5935 cases. During the epidemic, dengue expanded from six to 44 subdistricts. The effective reproduction number was <3 for most of the epidemic period, except for a ≈1 month period of explosive growth, coinciding with the monsoon season and school vacations, when the effective reproduction number peaked >30 and after which the effective reproduction number declined steadily. Interventions were only initiated 6 weeks after the end of the period of explosive growth. This finding highlights the need to reinforce the national preparedness plan for outbreak response, and to enable the early detection of cases and timely response. Full article

Pedestrians are the most vulnerable road users in the traffic system and thousands of pedestrians are injured or killed globally as a result of traffic crashes every year. With their popularity and enriched functions, mobile phones are playing an increasingly important role in people’s lives, and records of vehicle crashes involving pedestrians have shown the hazards caused by distraction of mobile phone use, especially in the context of crossing the street. The present study employed the theory of planned behavior (TPB) to investigate the behavior of using a mobile phone while crossing the street in China. An online questionnaire based on the TPB framework was developed to collect data, and 387 eligible samples were retained after inspection. Mobile phone use while crossing the street is prevalent in China (i.e., 53%). The results show that three standard TPB constructs (i.e., attitudes, intention and perceived behavioral control) emerged as significant predictors of the behavior of using mobile phone while crossing, and two extended constructs (i.e., situation, mobile phone involvement) also significantly predicted the behavior. In addition, for this population, intention was the strongest predictor of the behavior among these significant constructs. Moreover, the results were discussed and compared with some existing studies and safety interventions were also provided. Full article

The objective of this study is to assess the evidence about the demographic transformation of the Down Syndrome population, with a specific focus on prenatal testing, and to identify sources frequently used for demographic assessment of Down Syndrome in the world. We reviewed existing studies on demographic transformations in the population with Down Syndrome, specifically birthrate indicators, under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The searches were made in Medline (via EBSCO Host), Academic Search Complete (via EBSCO Host), PsycINFO (via EBSCO Host), Web of Science (Core Collection), Public Health Database (via ProQuest), and The Cochrane Library. The terms were developed through Medical Subject Headings (MESH) and American Psycological Asociation Thesaurus of Psychological Index Terms (APA). Full texts were reviewed if information was given regarding location and birthrate for a range of three years or more, and if the first and last year considered was within 1960 and 2019. We found 22 references with a period of study between 1960 and 2019 following the global spread of prenatal testing for Down Syndrome. We found a consistent association between prenatal diagnosis and birthrate, enough to explain the significant fall in the prevalence of Down Syndrome, a somewhat rising incidence of Down Syndrome related to increased maternal age and extension of fertility services in healthcare systems, a generalized use of specific congenital birth defect registries as the primary source of data, and an unclear influence of socio-cultural and territorial variables. Our findings can inform research, policy, and practice to improve the reproductive health and quality of life of the population with Down Syndrome. Full article

There is conflicting evidence regarding the association between insomnia and the onset of mild cognitive impairment (MCI) or dementia. This study aimed to evaluate if time-varying insomnia is associated with the development of MCI and dementia. Data from the Health and Retirement Study (n = 13,833) from 2002 to 2014 were used (59.4% female). The Brief Insomnia Questionnaire was used to identify insomnia symptoms which were compiled in an insomnia severity index, ranging from 0 to 4. In analysis, participants’ symptoms could vary from wave-to-wave. Dementia was defined using results from the Health and Retirement Study (HRS) global cognitive assessment tool. Respondents were classified as either having dementia, MCI, or being cognitively healthy. Cox proportional hazards models with time-dependent exposure using the counting process (start-stop time) were used for analysis. For each one-unit increase in the insomnia symptom index, there was a 5-percent greater hazard of MCI (HR = 1.05; 95% CI: 1.04–1.06) and dementia (HR = 1.05; 95% CI: 1.03–1.05), after fully adjusting. Using a nationally representative sample of adults age 51 and older, this study found that time-varying insomnia symptoms are associated with risk of MCI and dementia. This highlights the importance of identifying sleep disturbances and their change over time as potentially important risk factors for MCI and dementia. Full article

This study aimed to identify the relationship between selected trace elements in human milk and depression, breastfeeding self-efficacy, sleep satisfaction, and the demographic and obstetric characteristics of lactating mothers. Forty lactating mothers recovering after birth in two postpartum care centers located in Changwon, South Korea, were studied. Calcium, sodium, iron, and selenium concentrations in human milk were analyzed using inductively coupled plasma mass spectrometry at the analysis center of Kyungnam University. Data were analyzed using descriptive statistics, the Kruskal-Wallis test, the Mann-Whiney U test, and Spearman’s correlation coefficients using an SPSS 23.0 program. There were no significant differences in concentration of selected trace elements (calcium, sodium, iron, and selenium) in human milk according to demographic and obstetric characteristics. Sodium concentration was negatively correlated with breastfeeding self-efficacy (r = −0.51, CI = −0.71 to −0.24). Selenium concentration was negatively correlated with calcium concentration (r = −0.34, CI = −0.58 to 0.38). Postpartum depression was negatively correlated with sleep satisfaction (r = −0.46, CI = −0.67 to −0.17) and with breastfeeding self-efficacy (r = −0.41, CI = −0.64 to −0.11). Breastfeeding self-efficacy was positively correlated with sleep satisfaction (r = 0.48, CI = 0.20 to 0.69). This study suggests that sodium concentration in human milk is associated with breastfeeding self-efficacy. Full article

Objectives: The aim of this ecological study was to investigate what the impact of digital learning due to the COVID-19 pandemic was on the burnout and overall mental health (MH) of medical students. Background: During the unprecedented era of the COVID-19 pandemic, the majority of countries worldwide adopted very strong measures. Universities closed their doors, and education continued through digital learning lectures. Methods: An anonymous questionnaire was administered to all 189 eligible candidates before and during the COVID-19 pandemic. Mental health was assessed via the MH domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory—Student Survey (MBI-SS). Results: The overall response rate was 81.5%. The overall burnout prevalence did not differ significantly between the two periods (pre-COVID-19 18.1% vs. COVID-19 18.2%). However, the burnout prevalence dropped significantly in year 4 (pre-COVID-19 40.7% vs. COVID-19 16.7%, p = 0.011), whereas it increased significantly in year 6 (pre-COVID-19 27.6% vs. COVID-19 50%, p = 0.01). When looking at each MBI-SS dimension separately, we found that emotional exhaustion decreased significantly in year 4 but increased in year 6, and cynicism increased in all years. The overall MH deteriorated significantly between the two periods (pre-COVID-19 58.8 ± 21.6 vs. COVID-19 48.3 ± 23, p < 0.001). Conclusions: Digital learning in medical studies carries significant risks. Not only does the MH deteriorate, but cynicism levels also increase. Emotional exhaustion was found to increase particularly in final year students, who struggle with the lack of clinical experience just before they start working as qualified junior doctors. Full article

Background and objective: Pain is a bothersome issue that is common among newborns and children of all ages. Pain can be managed using various pharmacological and/or non-pharmacological strategies, which can be delivered by healthcare providers or parents. The aim of this study is to assess the attitude of mothers toward their children’s pain and its management. Methods and materials: A descriptive cross-sectional web-based study was conducted using a developed self-reported questionnaire, from March 2018 to April 2018. Participants involved were Arabic-speaking mothers of children aged between 0 and 12. The data collected included pharmacological and non-pharmacological treatment methodologies utilized to treat pain and the mothers’ attitude towards pain management. Statistical Package for Social Sciences, version 25 was applied to analyze the data, and descriptive statistics were performed. Results: As per the results of this study, the most common site of children’s pain as reported by the mothers was mouth/throat (211; 52.9%), abdomen (199; 49.9%), followed by head (58; 14.5%), and finally, ears (69; 17.3%). The frequency of children’s pain, as stated by the mothers, was less than once a month (196; 49.1%), once in a month (137; 34.3%), and once in a week (48; 12%). The non-pharmacological methods used by mothers at home for the management of their children’s pain were as follows: letting them take rest or sleep (250; 62.6%), feeding them with fluids (228; 57.1%), applying cold packs (161; 40.4%), providing massage therapy (147; 36.8%), using warm packs (141; 35.3%), and taking them to play (119; 29.8%). Conclusion: The misconceptions about pediatric pain management among Saudi mothers that can affect the children’s quality of life are quite noticeable. Implementing educational and awareness programs about the management of child pain could play a major role in making the parents understand the impacts of their misconceptions. Full article

Food allergies are a potentially life-threatening health issue, and few studies have determined their prevalence throughout Saudi Arabia. The main objective of our study was to estimate the prevalence and distribution of self-reported food allergies, and explore their association with other health conditions among adults in Saudi Arabia. This study was a nationwide cross-sectional survey conducted via phone interviews in June 2020. A proportional quota-sampling technique was used to obtain equal distributions of participants by age and gender across the 13 regions of Saudi Arabia. Self-reported food allergy, height, weight, health conditions, mental health status, and demographic variables were collected. Of the 6239 participants contacted, 4709 (75.48%) participants responded and completed the interview. Furthermore, 50.1% of the participants were female, with a mean age of 36.4 ± 13.5 years (18–90 years). The prevalence of food allergies was 19.7%. The most self-reported food allergies were egg, shellfish and shrimp, and peanuts, with a prevalence of 3.7%, 3.1%, and 3.0%, respectively. There was an association between the presence of food allergies and reported bariatric surgery, asthma, colon disease, and being at risk of depression. Bariatric surgery was significantly associated with lower likelihood of self-reported allergy (OR 1.69, 95% CI 1.22–2.34, p = 0.002). This study revealed, for the first time, a high prevalence of self-reported food allergies among adults in Saudi Arabia in a large nationwide sample, and food allergy association with bariatric surgery, asthma, colon disease, and being at risk of depression. This information is valuable for clinicians and policymakers, particularly in terms of food allergen labeling. Full article

The COVID-19 pandemic has negatively impacted on the health and wellbeing of populations directly through infection, as well as through serious societal and economic consequences such as unemployment and underemployment. The consequences could be even more severe for those more vulnerable to the disease, such as the elderly and those with underlying health conditions. Indeed, there is evidence that such vulnerable populations are disproportionately affected in terms of both, their health and the socioeconomic impact. The aim of our study was to determine whether occupational health (OH) professionals thought that the COVID-19 pandemic might further disadvantage any particular group(s) of vulnerable workers globally, and if so, which group(s). A cross-sectional study was carried out with a sample of OH professionals by means of an online questionnaire which was shared via email within the ICOH (International Commission for Occupational Health) community. Data was collected over a period of two weeks in May 2020 and 165 responses from 52 countries were received. In this paper, the responses relating to questions about vulnerable workers are reported and discussed. Globally, our responders felt that those in less secure jobs (precarious employment (79%) and informal work (69%)), or unemployed (63%), were the most at risk of further disadvantage from this pandemic. The majority felt that their governments could act to mitigate these effects. There were suggestions of short-term alleviation such as financial and social support, as well as calls for fundamental reviews of the underlying inequalities that leave populations so vulnerable to a crisis such as COVID-19. Full article

There is growing interest in Phase I dose-finding studies studying several doses of more than one agent simultaneously. A number of combination dose-finding designs were recently proposed to guide escalation/de-escalation decisions during the trials. The majority of these proposals are model-based: a parametric combination-toxicity relationship is fitted as data accumulates. Various parameter shapes were considered but the unifying theme for many of these is that typically between 4 and 6 parameters are to be estimated. While more parameters allow for more flexible modelling of the combination-toxicity relationship, this is a challenging estimation problem given the typically small sample size in Phase I trials of between 20 and 60 patients. These concerns gave raise to an ongoing debate whether including more parameters into combination-toxicity model leads to more accurate combination selection. In this work, we extensively study two variants of a 4-parameter logistic model with reduced number of parameters to investigate the effect of modelling assumptions. A framework to calibrate the prior distributions for a given parametric model is proposed to allow for fair comparisons. Via a comprehensive simulation study, we have found that the inclusion of the interaction parameter between two compounds does not provide any benefit in terms of the accuracy of selection, on average, but is found to result in fewer patients allocated to the target combination during the trial. Full article

Due to the continuous changes of political environment, consumption habits, technological progress and other factors, the external environment of enterprises is full of uncertainty. The turbulence of external environment is not conducive to the long-term operation and development of enterprises, but also brings great challenges to the selection of suppliers. This makes the competition of enterprises focus on how to choose long-term cooperation suppliers in the uncertain external environment. In addition, due to the deterioration of the global environment, governments pay more and more attention to environmental pollution, and consumers are more and more inclined to green consumption, which makes many companies pay more and more attention to environmental indicators when selecting suppliers. In the case of external environment turbulence and serious environmental pollution, the evaluation and selection of green suppliers in uncertain environment is particularly important for the long-term development of enterprises. What’s more, when the supplier’s capability gap is small, the decision-maker often hesitates among several suppliers. In this paper, the hesitant fuzzy is used to describe the hesitant psychology of decision-makers in selecting suppliers, the variance fluctuation is used to describe the characteristics of hesitant fuzzy numbers, and the probability is used to measure the uncertainty of the environment. A green supplier evaluation model under the uncertainty environment is proposed, which comprehensively evaluates the green suppliers under the uncertain environment. Furthermore, it is compared with other methods that do not consider the uncertainty and the adaptability of evaluation method and right confirmation method, so as to reflect the influence of uncertainty to green supplier evaluation and the importance of adaptability of evaluation method and right confirmation method. Full article

Background: Tobacco growing has been considered a mainstay of Mozambique’s economy, but there is a dearth of analysis of the tobacco policy landscape in the country. Methods: Review of government and non-government documents and academic papers addressing Mozambique’s tobacco-growing history, the changes in the political economy of tobacco, and health policies addressing tobacco use and prevention of noncommunicable diseases. Results: Despite its tobacco growing and exporting history, the contribution of tobacco to the economy has been in steady decline in the past two decades, including in the areas dedicated to growing. At the same time there has been an increase in multinational control of the tobacco economy. In parallel, Mozambique’s commitment to addressing the growing burden of noncommunicable disease and accession to the Framework Convention on Tobacco Control indicate a potential for internal government tensions to balance immediate economic interests with long term health goals. Conclusions: With the decline in tobacco share of the overall economy, Mozambique may be well-positioned to explore alternative, sustainable livelihoods for farmers that grow tobacco, but it must overcome inter-sectoral barriers and advocate for a whole of government approach to address the health and economic impact of tobacco. Full article

This study was to investigate the association of long-term fruit and vegetable (FV) intake with all-cause mortality. We utilized data from the China Health and Nutrition Survey (CHNS), a prospective cohort study conducted in China. The sample population included 19,542 adult respondents with complete mortality data up to 31 December 2011. Cumulative FV intake was assessed by 3 day 24 h dietary recalls. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality. Covariates included sociodemographic characteristics, lifestyle factors, health-related factors, and urban index. A total of 1409 deaths were observed during follow-up (median: 14 years). In the fully adjusted model, vegetable intake of the fourth quintile (327~408 g/day) had the greatest negative association with death compared to the lowest quintile (HR = 0.63, 95% CI: 0.53–0.76). Fruit intake of the fifth quintile (more than 126 g/day) had the highest negative association (HR = 0.24, 95% CI: 0.15–0.40) and increasing general FV intake were also negatively associated with all-cause mortality which demonstrated the greatest negative association in the amount of fourth quintile (HR = 0.59, 95% CI: 0.49–0.70) compared to the lowest quintile. To conclude, greater FV intake is associated with a reduced risk of total mortality for Chinese adults. High intake of fruit has a stronger negative association with mortality than differences in intake of vegetables. Our findings support recommendations to increase the intake of FV to promote overall longevity. Full article

Opioid abuse and misuse have led to an epidemic which is currently spreading worldwide. Since the number of opioid overdoses is still increasing, it is becoming obvious that current rather unsystematic approaches to tackle this health problem are not effective. This review suggests that fighting the opioid epidemic requires a structured public health approach. Therefore, it is important to consider not only scientific and biomedical perspectives, but societal implications and the lived experience of groups at risk as well. Hence, this review evaluates the risk factors associated with opioid overdoses and investigates the rates of chronic opioid misuse, particularly in the context of chronic pain as well as post-surgery treatments, as the entrance of opioids in people’s lives. Linking pharmaceutical biology to narrative analysis is essential to understand the modulations of the usual themes of addiction and abuse present in the opioid crisis. This paper shows that patient narratives can be an important resource in understanding the complexity of opioid abuse and addiction. In particular, the relationship between chronic pain and social inequality must be considered. The main goal of this review is to demonstrate how a deeper transdisciplinary-enriched understanding can lead to more precise strategies of prevention or treatment of opioid abuse. Full article

Psychological distress imposed by the SARS-CoV-2 outbreak particularly affects patients with pre-existing medical conditions, and the progression of their diseases. Patients who fail to keep scheduled medical appointments experience a negative impact on care. The aim of this study is to investigate the psychosocial factors contributing to the cancellation of medical appointments during the pandemic by patients with pre-existing health conditions. Data were collected in eleven Italian hospitals during the last week of lockdown, and one month later. In order to assess the emotional impact of the SARS-CoV-2 outbreak and the subject’s degree of psychological flexibility, we developed an ad hoc questionnaire (ImpACT), referring to the Acceptance and Commitment Therapy (ACT) model. The Impact of Event Scale-Revised (IES-R), the Depression, Anxiety and Stress Scale (DASS) and the Cognitive Fusion Questionnaire (CFQ) were also used. Pervasive dysfunctional use of experiential avoidance behaviours (used with the function to avoid thought, emotions, sensations), feelings of loneliness and high post-traumatic stress scores were found to correlate with the fear of COVID-19, increasing the likelihood of cancelling medical appointments. Responding promptly to the information and psychological needs of patients who cancel medical appointments can have positive effects in terms of psychological and physical health. Full article

Firefighters have a sustained risk for experiencing a sudden cardiac event after completing a fire call. Heart rate recovery (HRR) can be utilized to characterize autonomic nervous system (ANS) recovery and has been linked to cardiac events. Research suggests that body composition influences post-exercise HRR responses in non-firefighter populations. The purpose of this study was to examine the influence of body mass index (BMI), waist circumference (WC), and percent body fat (BF) on the HRR response of firefighter recruits. BMI (kg·m⁻²), WC (cm), and BF (%) data from 57 firefighter recruits were collected. HRR (b·min⁻¹) data were collected at completion (HR₀), as well as 15 (HR₁₅), 30 (HR₃₀), 45 (HR₄₅), 60 (HR₆₀), 120 (HR₁₂₀), and 180 (HR₁₈₀) seconds following a submaximal step test, and commonly utilized clinical HRR indices were calculated (ΔHRR₃₀, ΔHRR₆₀, ΔHRR₁₂₀, and ΔHRR₁₈₀). After controlling for sex, linear mixed regression models did not identify significant interactions between body composition (ps > 0.05) and HRR response across time. However, significant (ps < 0.05) indirect semi-partial correlations were identified between BF and ΔHRR₃₀ (r_sp = −0.31) and ΔHRR₆₀ (r_sp = −0.27), respectively. Reducing overall BF (vs. BMI or WC) should be prioritized to improve the post-exercise ANS recovery of firefighter recruits. Full article

Empathy plays a fundamental role in health related occupations. In this study, we analysed empathy levels in professionals (117) and students (170) from various healthcare fields in Ecuador during the COVID-19 pandemic. The Interpersonal Reactivity Index was used in an online survey. The results show high levels of empathy in both groups, influenced by age and gender. The students presented higher levels of personal distress, and their age was negatively correlated to empathy. Additionally, professionals working in physical health scored higher levels of personal distress compared to those in the field of emotional health. COVID-19 has placed social health systems in great stress. Despite this, the personal capacities for empathy of both students and health professionals have not been diminished. Full article

(1) Background: The present study aims to assess the level of professional burnout and secondary traumatic stress (STS), and to identify potential risk or protective factors among health care workers (HCWs) during the coronavirus disease 2019 (COVID-19) outbreak.; (2) Methods: This cross-sectional study, based on an online survey, collected demographic data and mental distress outcomes from 184 HCWs from 1 May 2020, to 15 June 2020, from 45 different countries. The degree of STS, perceived stress and burnout was assessed using the Secondary Traumatic Stress Scale (STSS), the Perceived Stress Scale (PSS) and Maslach Burnout Inventory Human Service Survey (MBI-HSS) respectively. Stepwise multiple regression analysis was performed to identify potential risk and protective factors for STS; (3) Results: 184 HCWs (M = 90; Age mean: 46.45; SD: 11.02) completed the survey. A considerable proportion of HCWs had symptoms of STS (41.3%), emotional exhaustion (56.0%), and depersonalization (48.9%). The prevalence of STS was 47.5% in frontline HCWs while in HCWs working in other units it was 30.3% (p < 0.023); 67.1% for the HCWs exposed to patients’ death and 32.9% for those HCWs which were not exposed to the same condition (p < 0.001). In stepwise multiple regression analysis, perceived stress, emotional exhaustion, and exposure to patients’ death remained as significant predictors in the final model for STS (adjusted R2 = 0.537, p < 0.001); (4) Conclusions: During the current COVID-19 pandemic, HCWs facing patients’ physical pain, psychological suffering, and death are more likely to develop STS. Full article

As is already well known, demographic changes will presumably lead to a rising number of old aged individuals and loneliness is a tremendous concern in aging populations. Poor health can be a potential consequence of loneliness, as well as a determining factor. Thus, the objective of the current study was to determine whether postponed dental appointments due to costs affect loneliness longitudinally. Focusing on Germany, data from two waves (waves 5 and 6) of the “Survey of Health Ageing, and Retirement in Europe” (SHARE) were analyzed (n = 7703). The three-item loneliness scale (modified version of the revised UCLA Loneliness scale) was used to quantify loneliness. The presence of postponed dental appointments due to costs in the past 12 months (no; yes) served as a key independent variable. Socioeconomic factors as well as health-related factors were adjusted in the longitudinal regression analysis. After adjusting for confounding variables, regression analyses revealed that loneliness increased with decreases in self-rated health among men. Among women, loneliness increased when self-rated health decreased, when fewer chronic diseases and postponed dental appointments due to costs were reported. Among older women, postponed dental appointments due to costs are associated with feelings of loneliness. The study results add evidence that proper dental care (i.e., regular and appropriate visits to the dentist) is vital not only to one’s oral health, but also plays a role in one’s physical and emotional health. Full article

Objective: Female infections affecting the genital tract include sexually transmitted diseases, endogenous infections such as vulvovaginal candidiasis, bacterial vaginosis (BV) or aerobic vaginitis (AV) and healthcare-associated infections. The aim of the study was to analyze the etiological factors of the vaginal dysbacteriosis, and the antimicrobial susceptibility of the dominant bacterial and fungal infections in different age groups of outpatient women from the Silesian Region. Materials and methods: A retrospective laboratory-based multi-center study encompassed 4994 women of different ages in Silesian Voivodeship, in the south of Poland; patients who had vaginal swabs collected as per physicians’ orders during the period from 1 January 2017 until 30 June 2018 were included in the study. The inclusion criteria were: non-hospitalized female, aged ≤80, with suspected vulvovaginal candidiasis or bacterial vaginosis and clinical sings of infections. Results: Gram-positive cocci were the ones most often isolated: Enterococcus faecalis (29.2%) and Streptoccoccus agalactiae (13.1%), followed by bacilli from the Enterobacteriaceae group, including Escherichia coli (26.3%). The presence of Streptococcus agalactiae was confirmed in 13.1%, slightly more often in the 45–80 age group, and Gardnerella vaginalis in 6.4%, most often in women aged 15–24. The prevalence of yeast-like infections was 24.3%, Candida albicans accounted for 78.3%, whereas among C. non-albicans spp.—C. glabrata dominated (14.9%) followed by C. parapsilosis (3.8%). The highest resistance was observed only in Streptococcus agalactiae as the MLSB mechanism (Macrolide-lincosamide-streptogramin B) was identified in 38.6% of strains. The prevalence of vulvovaginal candidiasis was 24.3%, the highest in women aged 15–44. Conclusions: Drug resistance in studied vulvovaginitis was associated only with Streptococcus agalactiae. A high proportion of yeast-like aetiology was found, probably associated with recurrent infections. In the analyzed cases only the Amsel criteria and culture methods were used for diagnosis without preparations and microbiological Nugent criteria. Full article

Governments are increasingly using cloud computing to reduce cost, increase access, improve quality, and create innovations in healthcare. Existing literature is primarily based on successful examples from developed western countries, and there is a lack of similar evidence from Asia. With a population close to 4.5 billion people, Asia faces healthcare challenges that pose an immense burden on economic growth and policymaking. Cloud computing in healthcare can potentially help increase the quality of healthcare delivery and reduce the economic burden, enabling governments to address healthcare challenges effectively and within a short timeframe. Advanced Asian countries such as Japan, South Korea, and Singapore provide successful examples of how cloud computing can be used to develop nationwide databases of electronic health records; real-time health monitoring for the elderly population; genetic database to support advanced research and cancer treatment; telemedicine; and health cities that drive the economy through medical industry, tourism, and research. This article examines these countries and identifies the drivers and barriers of cloud adoption in healthcare and makes policy recommendations to enable successful public health innovations through cloud adoption. Full article

Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction that is still rarely diagnosed. For safety reasons, patients should visit an allergologist to identify potential causes and cofactors of this reaction. This paper presents the analysis of data from the Anaphylaxis Registry gathered over ten years at the Allergy Clinic, Pomeranian Medical University (PMU). A questionnaire-based survey was used for patients visiting the Allergy Clinic to identify potential augmentation factors/comorbidities and/or cofactors of anaphylaxis in patients with a history of moderate to severe anaphylaxis. The registry comprised patients with grade II or higher anaphylaxis. The gathered data concerned chronic comorbidities (cardiovascular diseases, respiratory diseases, and others), recurrence of anaphylaxis, and potential cofactors in anaphylaxis. In the analyzed group, the incidence rate of anaphylaxis was the highest for women aged 19–60 years. Most common comorbidities in patients with moderate to severe anaphylaxis included: cardiovascular diseases, respiratory tract diseases, features of atopy, and thyroid diseases. More than 30% of drug-induced reactions were anaphylactic reactions due to the re-exposure to the same drug, which points to the need for educational initiatives in this area. The incidence rate of anaphylaxis induced by Hymenoptera stings was comparable in patients who had a previous generalized reaction and those who had good tolerance to the previous sting. It is important to take these cofactors into consideration when evaluating patients with anaphylaxis as they may play a role in future anaphylactic reactions. Full article

E-cigarette-only use and dual-use are emerging behaviours among adolescent nicotine product users which have not yet been sufficiently explored. This study examines the prevalence of, and the factors associated with, nicotine product use in adolescence. The study is a cross-sectional analysis of the 2018 Planet Youth survey completed by 15–16 year olds in the West of Ireland in 2018. The outcome of interest was current nicotine product use, defined as use at least once in the past 30 days. A main effects multinomial logistic regression model was used to examine the association between potential risk and protective factors and nicotine product use. Among 4422 adolescents 22.1% were current nicotine product users, consisting of 5.1% e-cigarette only users, 7.7% conventional cigarette only users, and 9.3% dual-users. For risk factors, the odds of association were weaker for e-cigarette only use compared to conventional cigarette and dual use. Participating in team sport four times/week or more significantly reduced the odds of conventional cigarette and dual use but had no association with e-cigarette only use (Cig: adjusted odds ratio (AOR) 0.63, 95% confidence interval (CI) 0.44–0.90; Dual-use: AOR 0.63, 95% CI 0.43–0.93). Similarly, having higher value for conventional social norms reduced the odds of conventional cigarette and dual use but not e-cigarette only use. This is the first study to show, among a generalisable sample, that dual-use is the most prevalent behaviour among adolescent nicotine product users in Ireland. Risk factor profiles differ across categories of use and prevention initiatives must be cognisant of this. Full article

In this era of globalization, preventing organizations from undermining and degrading the environment has become a great challenge, especially when considering that organizations are among the major contributors to environmental deterioration. As a result, scholars have recently begun to focus on understanding the key determinants of employee green behavior (EGB), a nascent field within the area of sustainable development and organizational behavior. This study extends the emerging discussion over EGB by investigating how green behavior can be inculcated into employees’ mindsets and under what conditions this can best be accomplished. The present research examines the relationship between ethical leadership and EGB by the mediating mechanisms of green psychological climate, employees’ harmonious environmental passion, and employees’ environmental commitment, through the underpinnings of social learning theory. Further, the study examines the contingency effects of leaders’ pro-environmental attitudes to determine how leaders with ethical attributes and pro-environmental attitudes can create a green psychological climate that ultimately leads to EGB through employees’ harmonious environmental passion and employees’ environmental commitment. The approach to implementing theory development is deductive as the research employed a quantitative research design and survey administration with a time-lagged approach. Multi-level data were collected from 400 respondents working in public and private sector hospitals and universities in Pakistan. The analysis was conducted in MPlus. The results show positive and statistically significant effects of ethical leadership on EGB through the serial mediations of a green psychological climate and employees’ harmonious environmental passion, and a green psychological climate and employees’ environmental commitment. Moreover, the leaders’ pro-environmental attitude contingency strengthens the indirect impact of ethical leadership on EGB. This research provides several managerial implications through which organizations can strategically concentrate on EGB, including saving energy by turning off unused lights, reducing waste, and recycling. Full article

Dental professionals have a major role in the fight against the spread and transmission of COVID-19. This study aimed to evaluate awareness and practice of dentists in Saudi Arabia regarding COVID-19 and the utilization of infection control methods. A 24-item questionnaire was developed and distributed through social media to 627 dentists working in Saudi Arabia. 177 questionnaires were completed (28.2% response rate). Most dentists were aware about the transmission, incubation time and main clinical symptoms of COVID-19. Almost 83% of the respondents appreciate the risk of droplets, aerosols and airborne particles in transmission of COVID-19 in the dental clinic. Among the common practices of participants are measuring patient’s body temperature before undertaking a dental treatment (88.7%), cleaning the environmental surfaces at the dental clinic after each patient (91.5%) and restriction of dental treatment to emergency cases (82.5%). It seems that practicing dentists in Saudi Arabia are fairly aware about COVID-19. The practices of the surveyed dentists appear to be mostly consistent with the current guidelines and recommendations for infection control of COVID-19 in the dental clinic. Some drawbacks in knowledge and a number of inappropriate practices can be identified and require the attention of health authorities. Full article