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Int. J. Environ. Res. Public Health, Volume 18, Issue 21 (November-1 2021) – 729 articles

Cover Story (view full-size image): Multiple chemical sensitivity (MCS) is a multisystem, recurrent, environmental disorder that flares in response to different exposures (i.e., pesticides, solvents, toxic metals, and molds) under the threshold limit value (TLV) calculated for age and gender in the general population. MCS is a syndrome and may present with cutaneous, allergic, gastrointestinal, rheumatological, endocrinological, cardiological, and neurological signs and symptoms. Since MCS management remains challenging due to the lack of guidelines, we performed a systematic review of the literature to detect evidence and derive the unmet needs. Then, we involved physicians, scientists, and patient representatives to produce the first Italian MCS consensus. View this paper
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Article
Running Performance during the Holy Month of Ramadan in Elite Professional Adult Soccer Players in Russia
Int. J. Environ. Res. Public Health 2021, 18(21), 11731; https://doi.org/10.3390/ijerph182111731 - 08 Nov 2021
Viewed by 663
Abstract
Religious fasting in the Holy Month of Ramadan is an important element of the Muslim culture during which no eating or drinking is permitted from dawn till dusk. A considerable number of Muslim soccer players abide by these restrictions, which may cause a [...] Read more.
Religious fasting in the Holy Month of Ramadan is an important element of the Muslim culture during which no eating or drinking is permitted from dawn till dusk. A considerable number of Muslim soccer players abide by these restrictions, which may cause a negative impact on key running performance parameters during competitive matches. Alterations to diet and water intake during the Holy Month of Ramadan may affect various running performance parameters in elite Muslim professional adult soccer players. This study was conducted with two groups of soccer players from the Russian Premier League (RPL): The Exposure Group (EG) consisted of 13 Muslims age 24.0 ± 2.8 years abiding by religious fasting and the Control Group (CG) included 13 non-Muslim age 26.0 ± 4.4 years. Using the Instat system, the running performance of each player was controlled in both groups during matches from the RPL before and in the third week of Ramadan (a total of two matches for every player). None of the measured parameters demonstrated significant changes in any match. In conclusion, restrictions in diet and liquid intake during the Holy Month of Ramadan had no negative influence on the running performance of elite Muslim professional adult soccer players during daytime matches. Full article
(This article belongs to the Section Sport and Health)
Article
A Sensor-Based mHealth Platform for Remote Monitoring and Intervention of Frailty Patients at Home
Int. J. Environ. Res. Public Health 2021, 18(21), 11730; https://doi.org/10.3390/ijerph182111730 - 08 Nov 2021
Viewed by 580
Abstract
Frailty syndrome is an independent risk factor for serious health episodes, disability, hospitalization, falls, loss of mobility, and cardiovascular disease. Its high reversibility demands personalized interventions among which exercise programs are highly efficient to contribute to its delay. Information technology-based solutions to support [...] Read more.
Frailty syndrome is an independent risk factor for serious health episodes, disability, hospitalization, falls, loss of mobility, and cardiovascular disease. Its high reversibility demands personalized interventions among which exercise programs are highly efficient to contribute to its delay. Information technology-based solutions to support frailty have been recently approached, but most of them are focused on assessment and not on intervention. This paper describes a sensor-based mHealth platform integrated in a service-based architecture inside the FRAIL project towards the remote monitoring and intervention of pre-frail and frail patients at home. The aim of this platform is constituting an efficient and scalable system for reducing both the impact of aging and the advance of frailty syndrome. Among the results of this work are: (1) the development of elderly-focused sensors and platform; (2) a technical validation process of the sensor devices and the mHealth platform with young adults; and (3) an assessment of usability and acceptability of the devices with a set of pre-frail and frail patients. After the promising results obtained, future steps of this work involve performing a clinical validation in order to quantify the impact of the platform on health outcomes of frail patients. Full article
(This article belongs to the Special Issue M-Health: Emerging Mobile Health Systems)
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Article
A Preliminary Evaluation of the Unified Protocol among Trauma-Exposed Adults with and without PTSD
Int. J. Environ. Res. Public Health 2021, 18(21), 11729; https://doi.org/10.3390/ijerph182111729 - 08 Nov 2021
Viewed by 483
Abstract
The purpose of this study was to evaluate whether the Unified Protocol (UP)—a mechanistically transdiagnostic psychological treatment—provides benefit to individuals with a range of trauma histories, psychological difficulties, and diagnostic comorbidity. Using data from a sequential multiple-assignment randomized trial (SMART), this exploratory analysis [...] Read more.
The purpose of this study was to evaluate whether the Unified Protocol (UP)—a mechanistically transdiagnostic psychological treatment—provides benefit to individuals with a range of trauma histories, psychological difficulties, and diagnostic comorbidity. Using data from a sequential multiple-assignment randomized trial (SMART), this exploratory analysis included a sample of 69 community-recruited adults seeking outpatient mental health treatment. We examined reductions in anxiety and depressive symptoms and changes in aversive and avoidant reactions to intense emotions—the UP’s putative mechanism—first by comparing individuals with and without trauma histories and then specifically among participants with PTSD. Findings suggest that the UP may lead to similar improvements in clinical diagnostic severity, anxiety, and depression among patients with trauma exposure as those without trauma exposure. Roughly half of participants with PTSD demonstrated reductions in PTSD clinical severity, anxiety, depression, and distress aversion, suggesting the UP may be an efficacious treatment for people with PTSD and comorbid conditions. Full article
Article
Group-Treatment for Dealing with the Work-Family Conflict for Healthcare Professionals
Int. J. Environ. Res. Public Health 2021, 18(21), 11728; https://doi.org/10.3390/ijerph182111728 - 08 Nov 2021
Viewed by 483
Abstract
Healthcare professionals’ exposure to work-family conflict negatively affects the health and well-being of the whole family and organizational outcomes. Specified workplace interventions are lacking. Therefore, the aim of the study was to evaluate the feasibility of a two-day group-treatment specifically designed for the [...] Read more.
Healthcare professionals’ exposure to work-family conflict negatively affects the health and well-being of the whole family and organizational outcomes. Specified workplace interventions are lacking. Therefore, the aim of the study was to evaluate the feasibility of a two-day group-treatment specifically designed for the needs of healthcare professionals with family responsibilities concerning participation, satisfaction with the intervention and family- and individual-related outcome variables. 24 mostly female (85.7%) participants of a community hospital in southern Germany attended the treatment. Data were collected at baseline (T0), directly after the treatment (T1) and two months later (T2). A two-factor analysis of variance with repeated measures showed a statistically significant time x group effect for self-efficacy (F = 5.29, p = 0.011). Contrasts displayed substantial pre-post (T1-T0, T2-T0) increases of self-efficacy in the intervention group as compared with the control group. Non-parametric Mann-Whitney-U tests are in line with these findings. The results indicate that the group-treatment adapted to the needs of healthcare professionals has the potential to boost self-efficacy among healthcare professionals and that participants were predominantly satisfied. Perspectives for future research and practical implications are discussed in the light of the manifest lack of healthcare professionals. Full article
(This article belongs to the Special Issue Mental Health Care and Promotion)
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Article
The Feasibility of Information-Entropy-Based Behavioral Analysis for Detecting Environmental Barriers
Int. J. Environ. Res. Public Health 2021, 18(21), 11727; https://doi.org/10.3390/ijerph182111727 - 08 Nov 2021
Viewed by 335
Abstract
The enhancement of physical activity is highly correlated with the conditions of the built environment. Walking is considered to be a fundamental daily physical activity, which requires an appropriate environment. Therefore, the barriers of the built environment should be identified and addressed. Barriers [...] Read more.
The enhancement of physical activity is highly correlated with the conditions of the built environment. Walking is considered to be a fundamental daily physical activity, which requires an appropriate environment. Therefore, the barriers of the built environment should be identified and addressed. Barriers can act as external stimuli for pedestrians, so pedestrians may diversely respond to them. Based on this consideration, this study examines the feasibility of information-entropy-based behavioral analysis for the detection of environmental barriers. The physical responses of pedestrians were collected using an inertial measurement unit (IMU) sensor in a smartphone. After the acquired data were converted to behavioral probability distributions, the information entropy of each grid cell was calculated. The grid cells whereby the participants indicated that environmental barriers were present yielded relatively high information entropy values. The findings of this study will facilitate the design of more pedestrian-friendly environments and the development of diverse approaches that utilize citizens for monitoring the built environment. Full article
(This article belongs to the Section Environmental Science and Engineering)
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Article
Motivation for COVID-19 Vaccination in Priority Occupational Groups: A Cross-Sectional Survey
Int. J. Environ. Res. Public Health 2021, 18(21), 11726; https://doi.org/10.3390/ijerph182111726 - 08 Nov 2021
Viewed by 508
Abstract
Due to the limited availability of COVID-19 vaccines, occupational groups with priority access were identified prior to vaccination. The study aimed to analyze motives for vaccination in these occupational groups. Methods: Members of occupational groups, who were vaccinated at the vaccination center of [...] Read more.
Due to the limited availability of COVID-19 vaccines, occupational groups with priority access were identified prior to vaccination. The study aimed to analyze motives for vaccination in these occupational groups. Methods: Members of occupational groups, who were vaccinated at the vaccination center of University Hospital Olomouc before 30 April 2021, were asked to fill in an online questionnaire. Results: A total of 3224 completed questionnaires were obtained from 1332 healthcare workers, 1257 school employees, 363 social service workers, 210 security force members, and 62 critical infrastructure workers. The most frequent motive for vaccination was the effort to protect family members (76.2%), the effort to prevent the spread of COVID-19 in one’s profession (72.3%), followed by concerns about COVID-19 itself (49.1%) and exemptions from anti-epidemic measures (36.8%). Only for social services, the motive focused on one’s profession was mentioned more often (75.2%) than the motive focused on the family (71.1%). At the level of detailed profession-oriented motives, a collegial effort of security force members to protect co-workers and not to endanger the workplace was dominant. Conclusions: The effort to prevent the spread of COVID-19 in the professional environment is a strong motive for vaccination, and strongest among social service workers. Full article
(This article belongs to the Collection COVID-19 Research)
Article
Factors Related to Oral Intake of Food by Hospitalized Patients with Malnutrition under the Care of a Nutrition Support Team
Int. J. Environ. Res. Public Health 2021, 18(21), 11725; https://doi.org/10.3390/ijerph182111725 - 08 Nov 2021
Viewed by 457
Abstract
This study aimed to evaluate the role of the general condition and oral health status in determining the primary nutritional route and suitable food form for oral ingestion among malnourished inpatients. This cross-sectional study included 255 inpatients referred to a nutrition support team [...] Read more.
This study aimed to evaluate the role of the general condition and oral health status in determining the primary nutritional route and suitable food form for oral ingestion among malnourished inpatients. This cross-sectional study included 255 inpatients referred to a nutrition support team (NST), which included dental professionals, at an acute care hospital. We assessed the participants’ basic information, and Dysphagia Severity Scale (DSS) and Oral Health Assessment Tool (OHAT) scores. The nutritional intake mode was evaluated based on the Functional Oral Intake Scale scores at the initial NST consultation (FOIS-I), and then revised by the NST based on the participants’ general condition and oral health (FOIS-R). There was a divergence between FOIS-I and FOIS-R, with FOIS-R being significantly higher than FOIS-I (p < 0.001). Logistic regression analysis of FOIS-R identified that consciousness level (odds ratio (OR): 0.448; 95% confidence interval (CI): 0.214–0.935) and DSS (OR: 3.521; 95% CI: 2.574–4.815) significantly affected the oral nutrition intake. Among participants who could ingest orally (FOIS-R ≥ 3; n = 126), FOIS score had significant negative and positive associations with the OHAT and DSS scores, respectively. These findings suggest that appropriate assessment of oral health status, including swallowing function, might contribute to high-quality nutrition management. Full article
(This article belongs to the Special Issue Relationships between Oral Health Management and Systemic Health)
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Article
Sexual and Gender Minorities and Risk Behaviours among University Students in Italy
Int. J. Environ. Res. Public Health 2021, 18(21), 11724; https://doi.org/10.3390/ijerph182111724 - 08 Nov 2021
Viewed by 410
Abstract
Sexual and gender minorities (SGM) may experience stigma, discrimination and show higher prevalence of behavioural risk factors than heterosexual counterparts. In Italy, the information on SGM is scarce and outdated. The present cross-sectional study aims to provide a more up-to-date estimate of the [...] Read more.
Sexual and gender minorities (SGM) may experience stigma, discrimination and show higher prevalence of behavioural risk factors than heterosexual counterparts. In Italy, the information on SGM is scarce and outdated. The present cross-sectional study aims to provide a more up-to-date estimate of the SGM proportion in young adults and to assess differences in the adoption of risk behaviours compared to their heterosexual counterparts. The study involved university students aged 18–25. Information on socio-demographic and behavioural characteristics were collected. The effect of sexual orientation on risk behaviours was assessed with a multinomial single-step logistic regression analysis. A total of 9988 participants were included. Overall, 518 students (5.2%) self-identified as SGM. While lesbians showed significantly higher odds of only non-regular use of protective barriers (AOR: 11.16), bisexuals showed higher odds for frequent drinking (AOR: 2.67), smoking (AOR: 1.85), multiple sexual partnerships (AOR: 1.78) and non-regular use of protective barriers (AOR: 1.90) compared with heterosexual women. Gay men showed higher odds of multiple sexual partnerships compared with heterosexual males (AOR: 5.52). SGM accounted for 5.2% of the sample, slightly more than the proportion found in the general population, but substantially in line with similarly aged populations abroad. Our findings confirm that unhealthy risk behaviours are more frequent among LGBTQ+, in particular among bisexual women. Rather than targeting specific subpopulations, our study aims to show the need for health promotion interventions that aim at the empowerment of all students regardless of sexual orientation, being aware that SGMs can benefit to a relatively greater extent. Full article
Article
Changes in Caregiver Personal Support Networks: Gender Differences and Effects on Health (CUIDAR-SE Study)
Int. J. Environ. Res. Public Health 2021, 18(21), 11723; https://doi.org/10.3390/ijerph182111723 - 08 Nov 2021
Viewed by 491
Abstract
Technological changes have led to important advances in medical diagnoses and treatments that prolong the informal care process. Support from the personal network of informal caregivers is an undervalued resource and the changes that have occurred over time are unknown. The aim of [...] Read more.
Technological changes have led to important advances in medical diagnoses and treatments that prolong the informal care process. Support from the personal network of informal caregivers is an undervalued resource and the changes that have occurred over time are unknown. The aim of this study was to analyze the changes in personal network support among informal caregivers and to examine the effect of these changes on self-perceived caregiver health, with a focus on differences between men and women and caregivers with high and low levels of burden We also investigated caregiver perceptions and explanations of changes to their support network (losses and additions and no change). Using a mixed-methods approach, data were obtained from 32 caregivers that were intentionally selected in Spain, who were interviewed twice with a one-year interval. In the quantitative phase, personal networks analysis was performed with Egonet software, which obtained data on the composition and functional content in social support from 1600 personal relationships (25 alters for each ego in the two waves). In the qualitative phase, semi-structured interviews were conducted in the two waves with a guide in order to explore the changes in informal support resources over time. The selected men with high levels of burden pointed out a loss of network support with more discouraging reports compared with the low-burden male caregivers. Furthermore, the selected women with low burden levels mentioned losses too; however, their reports were more positive. Women reported improved health, especially those with low burden scores in the first wave and those who did not lose support. Caregivers with a high initial burden and who lost support reported worse health, particularly men and women with a strong sense of duty toward care. Social support from personal networks is important for caregiver health and its effects are influenced by gender roles. Our findings could help by improving the relational and social capital of informal caregivers and adapting them to the new needs of formal home care systems. Full article
(This article belongs to the Special Issue Social Support and Social Networks in Long-Term Conditions)
Article
Impact of Family Separation on Subjective Time Pressure and Mental Health in Refugees from the Middle East and Africa Resettled in North Rhine-Westphalia, Germany: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2021, 18(21), 11722; https://doi.org/10.3390/ijerph182111722 - 08 Nov 2021
Viewed by 435
Abstract
Little is known about social determinants among refugees resettled in Germany. This study aims to examine the impact of family separation on refugees’ subjective time pressure and mental health. Data come from the FlueGe Health Study (n = 208), a cross-sectional study [...] Read more.
Little is known about social determinants among refugees resettled in Germany. This study aims to examine the impact of family separation on refugees’ subjective time pressure and mental health. Data come from the FlueGe Health Study (n = 208), a cross-sectional study administered by Bielefeld University. We used logistic regression analysis to investigate the effect of family separation on (i) being time-stressed and (ii) having a high risk for adverse mental health, considering sociodemographic and postmigration factors. As a result, more than 30% of participants with a spouse or partner and about 18% with a child or children reported separation. Multiple logistic regression showed that family separation was not associated with being time-stressed, but separation from at least one child was associated with adverse mental health (OR = 3.53, 95% CI = [1.23, 10.11]). In conclusion, family separation primarily contributes to adverse mental health among refugees from the Middle East and Africa resettled in North Rhine-Westphalia, Germany. Therefore, policies and practices that facilitate family reunification can contribute significantly to the promotion of refugees’ mental health and well-being. Full article
(This article belongs to the Special Issue Migration, Resilience, Vulnerability and Migrants’ Health)
Article
Hemodynamic Effects of Permanent His Bundle Pacing Compared to Right Ventricular Pacing Assessed by Two-Dimensional Speckle-Tracking Echocardiography
Int. J. Environ. Res. Public Health 2021, 18(21), 11721; https://doi.org/10.3390/ijerph182111721 - 08 Nov 2021
Viewed by 378
Abstract
We compared the effects of right ventricular (RVP; n = 26) and His bundle (HBP; n = 24) pacing in patients with atrioventricular conduction disorders and preserved LVEF. Postoperatively (1D), and after six months (6M), the patients underwent global longitudinal strain (GLS) and [...] Read more.
We compared the effects of right ventricular (RVP; n = 26) and His bundle (HBP; n = 24) pacing in patients with atrioventricular conduction disorders and preserved LVEF. Postoperatively (1D), and after six months (6M), the patients underwent global longitudinal strain (GLS) and peak systolic dispersion (PSD) evaluation with 2D speckle-tracking echocardiography, assessment of left atrial volume index (LAVI) and QRS duration (QRSd), and sensing/pacing parameter testing. The RVP threshold was lower than the HBP threshold at 1D (0.65 ± 0.13 vs. 1.05 ± 0.20 V, p < 0.001), and then it remained stable, while the HBP threshold increased at 6M (1.05 ± 0.20 vs. 1.31 ± 0.30 V, p < 0.001). The RVP R-wave was higher than the HBP R-wave at 1D (11.52 ± 2.99 vs. 4.82 ± 1.41 mV, p < 0.001). The RVP R-wave also remained stable, while the HBP R-wave decreased at 6M (4.82 ± 1.41 vs. 4.50 ± 1.09 mV, p < 0.02). RVP QRSd was longer than HBP QRSd at 6M (145.0 ± 11.1 vs. 112.3 ± 9.3 ms, p < 0.001). The absolute value of RVP GLS decreased at 6M (16.32 ± 2.57 vs. 14.03 ± 3.78%, p < 0.001), and HBP GLS remained stable. Simultaneously, RVP PSD increased (72.53 ± 24.15 vs. 88.33 ± 30.51 ms, p < 0.001) and HBP PSD decreased (96.28 ± 33.99 vs. 84.95 ± 28.98 ms, p < 0.001) after 6 months. RVP LAVI increased (26.73 ± 5.7 vs. 28.40 ± 6.4 mL/m2, p < 0.05), while HBP LAVI decreased at 6M (30.03 ± 7.8 vs. 28.73 ± 8.7 mL/m2, p < 0.01). These results confirm that HBP does not disrupt ventricular synchrony and provides advantages over RVP. Full article
(This article belongs to the Special Issue Advances in Heart Electrotherapy)
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Article
Predictors of Burnout in Hospital Health Workers during the COVID-19 Outbreak in South Korea
Int. J. Environ. Res. Public Health 2021, 18(21), 11720; https://doi.org/10.3390/ijerph182111720 - 08 Nov 2021
Viewed by 503
Abstract
This study aimed to identify the factors that influence the components of burnout—emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA)—among hospital health workers, including doctors and nurses, during the COVID-19 pandemic. We analyzed 200 healthcare workers’ responses to the Employee Health Promotion [...] Read more.
This study aimed to identify the factors that influence the components of burnout—emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA)—among hospital health workers, including doctors and nurses, during the COVID-19 pandemic. We analyzed 200 healthcare workers’ responses to the Employee Health Promotion Survey conducted at a general hospital in Seoul with over 200 hospital beds. The questionnaire included items about COVID-19-related burnout and its influencing factors. We performed three different multiple regression analyses using EE, DP, and PA as the dependent variables. The results show that sex, marital status, workload of treating suspected COVID-19 patients, fear of COVID-19 infection, anxiety, and depression predicted EE. The predictors of DP were job category, consecutive months of work in the current department, satisfaction with work environment, anxiety, and depression. The predictors of PA were the workload of directly interacting with patients, socioeconomic status, and job stress. For EE and DP, burnout was found to be worse in doctors and nurses than in other health workers; moreover, burnout was worse among nurses than among doctors across all three aspects of burnout. The findings can be used to establish tailored policies to address each burnout component. Full article
(This article belongs to the Special Issue Workplace Health and Wellbeing during and beyond COVID-19)
Article
Do Gender, Age, Body Mass and Height Influence Eye Biometrical Properties in Young Adults? A Pilot Study
Int. J. Environ. Res. Public Health 2021, 18(21), 11719; https://doi.org/10.3390/ijerph182111719 - 08 Nov 2021
Viewed by 480
Abstract
Background: Do gender, age, body mass and height influence eye biometrical properties in young adults? Methods: A total of 155 eyes (92 female, 63 male) of healthy subjects between the ages of 18 and 39 years were included in the study. The subjects’ [...] Read more.
Background: Do gender, age, body mass and height influence eye biometrical properties in young adults? Methods: A total of 155 eyes (92 female, 63 male) of healthy subjects between the ages of 18 and 39 years were included in the study. The subjects’ gender and age were recorded, and their body mass, height and biometrical properties of the eyes were measured. Results: The male subjects had significantly thicker and flatter corneas and lower minimal rim-to-disk ratios than the female subjects did. In both genders, age showed strong, negative correlations with anterior chamber depth and pupil diameter and a positive correlation with lens thickness. We also found significant, negative correlations between body height and mass with keratometry measurements, negative correlations between body height and optic disk rim area and rim volume, and positive correlations between body mass and axial length in both genders. Conclusions: Biometric eye parameters differ among people. In addition to age and gender, which are usually taken into consideration when interpreting ocular biometry findings, we strongly suggest that body height and mass should be also routinely considered when interpreting eye biometry data, as these factors have an impact on ocular biometry. Full article
Article
Public Stigma of COVID-19 and Its Correlates in the General Population of China
Int. J. Environ. Res. Public Health 2021, 18(21), 11718; https://doi.org/10.3390/ijerph182111718 - 08 Nov 2021
Viewed by 513
Abstract
This study aimed to examine the profile of COVID-19-related public stigma and its correlates in the general population of China. A cross-sectional online survey was conducted in China from 7 May to 25 May in 2020. A total of 1212 participants from the [...] Read more.
This study aimed to examine the profile of COVID-19-related public stigma and its correlates in the general population of China. A cross-sectional online survey was conducted in China from 7 May to 25 May in 2020. A total of 1212 participants from the general population completed the survey measuring their stigmatizing attitudes towards COVID-19, as well as knowledge and causal attributions of COVID-19. Univariate and multivariate analyses were performed to examine the correlates of COVID-19-related public stigma. A total of 31.8% of participants endorsed stigmatization towards people with COVID-19. Those who were of older age (t = −3.97, p < 0.001), married (F = 3.04, p < 0.05), had a lower level of education (F = 8.11, p < 0.001), and a serious psychological response (F = 3.76, p < 0.05) reported significantly higher scores of public stigma. Dangerousness (B = 0.047, p < 0.001), fear (B = 0.059, p < 0.001), anger (B = 0.038, p < 0.01), and responsibility (B = 0.041, p < 0.001) were positively associated with public stigma. This study shows that public stigma related to COVID-19 is prevalent in the general population of China. Actions against public stigma need to contain the spread of misinformation about COVID-19, alter inappropriate attributions, alleviate unfavorable reactions, and provide psychosocial support for the public. Full article
(This article belongs to the Topic Burden of COVID-19 in Different Countries)
Article
Assessment of the Strength Parameters of the Quadriceps Femoris Muscles in Polish University Students after a 3-Week Program of Neuromuscular Electrical Stimulation Using the RSQ1 Method
Int. J. Environ. Res. Public Health 2021, 18(21), 11717; https://doi.org/10.3390/ijerph182111717 - 08 Nov 2021
Viewed by 441
Abstract
A rehabilitative program for patients who lose strength and muscle mass along with the ability to perform intensive exercises is lacking. We developed a 3-week training program based on neuromuscular electrical stimulation (NMES) using a RSQ1 device (modulated current resulting from the overlapping [...] Read more.
A rehabilitative program for patients who lose strength and muscle mass along with the ability to perform intensive exercises is lacking. We developed a 3-week training program based on neuromuscular electrical stimulation (NMES) using a RSQ1 device (modulated current resulting from the overlapping of two-component currents) for RSQ1 electrostimulation to improve strength parameters of the quadricep femoris muscles and compare its effectiveness to isometric training. Nineteen university students were randomly divided into the NMES group (10 sessions) and the control group who trained. We measured the circumference of the thigh, as well as peak torques of the flexor and extensor muscles before and after the start and after the end of the training program. Both tested training programs gave similar results. Differences between measured parameters were not significant except for differences in the peak torques of the knee flexors (9.9% for left limb; p = 0.2135 vs. 7.8% for rift limb; p = 0.2135) and the circumference of the left thigh—2% for both (left p = 0.5839 and right p = 0.1088). Comparable results of the tested training programs suggest that NMES is a good alternative for people who cannot perform exercises, but want to maintain or improve their physical fitness. Full article
(This article belongs to the Special Issue Monitoring and Evaluation of Training in Sport and Exercise)
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Effects of the Healing Beats Program among University Students after Exposure to a Source of Psychological Stress: A Randomized Control Trial
Int. J. Environ. Res. Public Health 2021, 18(21), 11716; https://doi.org/10.3390/ijerph182111716 - 08 Nov 2021
Viewed by 389
Abstract
This study is a randomized pre- and post-controlled trial to determine the effects of the Healing Beats program on anxiety, autonomic nervous balance, Bispectral (BIS) index, and heart rate among university students after exposure to a source of mental stress. Data were collected [...] Read more.
This study is a randomized pre- and post-controlled trial to determine the effects of the Healing Beats program on anxiety, autonomic nervous balance, Bispectral (BIS) index, and heart rate among university students after exposure to a source of mental stress. Data were collected from candidates who volunteered from November 2018 to May 2019 in response to recruitment announcements. The analysis was performed using data of 99 participants in three groups: 32 in an experimental group, 35 in a placebo group, and 32 in a control group. The experimental group who received treatment via the Healing Beats program exhibited a significant effect on calming anxiety, autonomic nervous balance, BIS index, and heart rate, compared with the placebo group and the control group. The group interaction also showed a significant difference. The Healing Beats program can be used as an effective intervention for sedation in clinical situations or calmness in stressful situations in everyday life. Specifically, the Healing Beats program could serve as basic data for nursing interventions, according to the stability effect in stressful situations; it can also be applied to effective nursing practice as an initial study to confirm theoretical and practical indicators. Full article
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The Impact of Gastrointestinal Symptoms on Patients’ Well-Being: Best–Worst Scaling (BWS) to Prioritize Symptoms of the Gastrointestinal Symptom Score (GIS)
Int. J. Environ. Res. Public Health 2021, 18(21), 11715; https://doi.org/10.3390/ijerph182111715 - 08 Nov 2021
Viewed by 419
Abstract
Background: The gastrointestinal symptom score (GIS) is used in a standardized form to ascertain dyspeptic symptoms in patients with functional dyspepsia in clinical practice. As a criterion for evaluating the effectiveness of a treatment, the change in the summed total point value is [...] Read more.
Background: The gastrointestinal symptom score (GIS) is used in a standardized form to ascertain dyspeptic symptoms in patients with functional dyspepsia in clinical practice. As a criterion for evaluating the effectiveness of a treatment, the change in the summed total point value is used. The total score ranges from 0 to 40 points, in which a higher score represents a more serious manifestation of the disease. Each symptom is included with equal importance in the overall evaluation. The objective of this study was to test this assumption from a patients’ perspective. Our aim was to measure the priorities of patients for the ten gastrointestinal symptoms by using best–worst scaling. Method: A best–worst scaling (BWS) object scaling (Case 1) was applied. Therefore, the symptoms of the GIS were included in a questionnaire using a fractional factorial design (BIBD—balanced incomplete block design). In each choice set, the patients selected the component that had the most and the least impact on their well-being. The BIB design generated a total of 15 choice sets, which each included four attributes. Results: In this study, 1096 affected patients were asked for their priorities regarding a treatment of functional dyspepsia and motility disorder. Based on the data analysis, the symptoms abdominal cramps (SQRT (B/W): −1.27), vomiting (SQRT (B/W): −1.07) and epigastric pain (SQRT (B/W): −0.76) were most important and thus have the greatest influence on the well-being of patients with functional dyspepsia and motility disorders. In the middle range are the symptoms nausea (SQRT (B/W): −0.69), acid reflux/indigestion (SQRT (B/W): −0.29), sickness (SQRT (B/W): −0.26) and retrosternal discomfort (SQRT (B/W): 0.26), whereas the symptoms causing the least impact are the feeling of fullness (SQRT (B/W): 0.80), early satiety (SQRT (B/W): 1.54) and loss of appetite (SQRT(B/W): 1.95). Discussion: Unlike the underlying assumption of the GIS, the BWS indicated that patients did not weight the 10 symptoms equally. The results of the survey show that the three symptoms of vomiting, abdominal cramps and epigastric pain are weighted considerably higher than symptoms such as early satiety, loss of appetite and the feeling of fullness. The evaluation of the BWS data has illustrated, however, that the restrictive assumption of GIS does not reflect the reality of dyspeptic patients. Conclusions: In conclusion, a preference-based GIS is necessary to make valid information about the real burden of illness and to improve the burden of symptoms in the indication of gastrointestinal conditions. The findings of the BWS demonstrate that the common GIS is not applicable to represent the real burden of disease. The results suggest the potential modification of the established GIS by future research using a stated preference study. Full article
(This article belongs to the Section Health Care Sciences & Services)
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Article
High Rate of Depression among Saudi Children with Type 1 Diabetes
Int. J. Environ. Res. Public Health 2021, 18(21), 11714; https://doi.org/10.3390/ijerph182111714 - 08 Nov 2021
Viewed by 357
Abstract
Saudi Arabia ranks among the top ten in type 1 diabetes (T1D) prevalence. The psychological burden, including depression, among T1D children, affects short-term and long-term outcomes. In Saudi Arabia, studies on depression among T1D children are limited. We determined the prevalence of depression [...] Read more.
Saudi Arabia ranks among the top ten in type 1 diabetes (T1D) prevalence. The psychological burden, including depression, among T1D children, affects short-term and long-term outcomes. In Saudi Arabia, studies on depression among T1D children are limited. We determined the prevalence of depression among T1D children and adolescents in the Saudi Arabia-Qassim region and investigated risk factors for depressive symptoms. This quantitative cross-sectional study was conducted among T1D children and adolescents in the outpatient clinic of Maternity and Children Hospital, Buraydah, Saudi Arabia, between October 2020 and April 2021. Using a validated questionnaire translated into Arabic, we interviewed patients during clinic appointment. Questionnaires on sociodemographic characteristics, clinical data, and Clinical Depression Inventory scale were used to measure depression. There were 148 T1D respondents (children: 58.1%; adolescents: 41.9%). More than half were females (53.4%), with most Saudis (94.6%). Depression prevalence among children and adolescents was 27%. Mild, moderate, and severe depression occurred in 80%, 12.5%, and 7.5% of depressed patients, respectively. Factors significant for depression were female sex (p = 0.014), uncontrolled HbA1c level (p = 0.037), and longer diabetes duration (p = 0.013). Depression among children and adolescents was more prevalent in this study than in previous reports. Early detection of depression will improve diabetes control and quality of life. Full article
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Article
The Influence of Discrepancies between Parents’ Educational Aspirations and Children’s Educational Expectations on Depressive Symptoms of Left-Behind Children in Rural China: The Mediating Role of Self-Efficacy
Int. J. Environ. Res. Public Health 2021, 18(21), 11713; https://doi.org/10.3390/ijerph182111713 - 08 Nov 2021
Viewed by 399
Abstract
Although long-term separation has made discrepancies between parents’ educational aspirations and children’s own educational expectations among families with left-behind children (LBC), limited researches on the influence of these discrepancies on children’s mental health are carried out at present. Based on China Family Panel [...] Read more.
Although long-term separation has made discrepancies between parents’ educational aspirations and children’s own educational expectations among families with left-behind children (LBC), limited researches on the influence of these discrepancies on children’s mental health are carried out at present. Based on China Family Panel Studies (CFPS) conducted in 2018, we selected 875 LBC aged 9~15 as the sample, explored the influence of the direction and degree of these discrepancies on LBC’s depressive symptoms by hierarchical regression, and examined the mediating role of children’s academic self-efficacy and mediation effect pathway with Baron and Kenny method and Bootstrap mediation analysis methods. Results showed that LBC’s mental health was worse when parents’ educational aspirations were higher than their children’s educational expectations, compared to that without discrepancies. The degree of such discrepancies was negatively associated with LBC’s mental health. In the relationship between the direction of discrepancies and LBC’s depressive symptoms, academic self-efficacy played a mediating role partially. In addition, the study indicated that mothers played a significant role in the development of LBC’s mental health. These findings also provided critical evidence for the intervention practice of LBC’s mental health. Full article
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Article
Boredom Intervention Training Phase I: Increasing Boredom Knowledge through a Psychoeducational Video
Int. J. Environ. Res. Public Health 2021, 18(21), 11712; https://doi.org/10.3390/ijerph182111712 - 08 Nov 2021
Viewed by 454
Abstract
Boredom is a salient emotion experienced in postsecondary settings, and evidence reveals that it can negatively impact academic achievement and motivation. Drawing from the control-value theory (CVT) of achievement emotions (Pekrun, 2006) and the component process model of emotions (CPM; Scherer, 1984), our [...] Read more.
Boredom is a salient emotion experienced in postsecondary settings, and evidence reveals that it can negatively impact academic achievement and motivation. Drawing from the control-value theory (CVT) of achievement emotions (Pekrun, 2006) and the component process model of emotions (CPM; Scherer, 1984), our study examines the first phase of a multi-sequenced online boredom intervention training (BIT) program. The goal of Phase I of BIT was to increase university students’ (N = 85) knowledge about boredom as a scholarly construct. Students completed four components of the Phase I BIT session, including: (a) a baseline survey and knowledge quiz, (b) a psychoeducational video, (c) a consolidation exercise, and (d) a follow-up knowledge quiz. We employed a repeated measures analysis to measure changes in knowledge after students watched the psychoeducational boredom video. Our findings reveal that students became more knowledgeable about boredom, learned something novel, and were interested in the intervention. The results are discussed in terms of the implications for research, theory, and practice. Full article
(This article belongs to the Special Issue Boredom in Health, Education and Sports)
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Review
Drug Interactions for Patients with Respiratory Diseases Receiving COVID-19 Emerged Treatments
Int. J. Environ. Res. Public Health 2021, 18(21), 11711; https://doi.org/10.3390/ijerph182111711 - 08 Nov 2021
Viewed by 640
Abstract
Pandemic of coronavirus disease (COVID-19) is still pressing the healthcare systems worldwide. Thus far, the lack of available COVID-19-targeted treatments has led scientists to look through drug repositioning practices and exploitation of available scientific evidence for potential efficient drugs that may block biological [...] Read more.
Pandemic of coronavirus disease (COVID-19) is still pressing the healthcare systems worldwide. Thus far, the lack of available COVID-19-targeted treatments has led scientists to look through drug repositioning practices and exploitation of available scientific evidence for potential efficient drugs that may block biological pathways of SARS-CoV-2. Till today, several molecules have emerged as promising pharmacological agents, and more than a few medication protocols are applied during hospitalization. On the other hand, given the criticality of the disease, it is important for healthcare providers, especially those in COVID-19 clinics (i.e., nursing personnel and treating physicians), to recognize potential drug interactions that may lead to adverse drug reactions that may negatively impact the therapeutic outcome. In this review, focusing on patients with respiratory diseases (i.e., asthma or chronic obstructive pulmonary disease) that are treated also for COVID-19, we discuss possible drug interactions, their underlying pharmacological mechanisms, and possible clinical signs that healthcare providers in COVID-19 clinics may need to acknowledge as adverse drug reactions due to drug-drug interactions. Full article
(This article belongs to the Section Environmental Health)
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Systematic Review
Family and School Relationship during COVID-19 Pandemic: A Systematic Review
Int. J. Environ. Res. Public Health 2021, 18(21), 11710; https://doi.org/10.3390/ijerph182111710 - 08 Nov 2021
Viewed by 462
Abstract
Education systems worldwide have been affected by a sudden interruption in classroom learning because the coronavirus pandemic forced both the closure of all schools in March 2020 and the beginning of distance learning from home, thus compelling families, schools, and students to work [...] Read more.
Education systems worldwide have been affected by a sudden interruption in classroom learning because the coronavirus pandemic forced both the closure of all schools in March 2020 and the beginning of distance learning from home, thus compelling families, schools, and students to work together in a more coordinated fashion. The present systematic review was carried out following PRISMA guidelines. The main objective was to present critical information on the relationship between the family and the school in the face of the imposed distance learning scenario caused by COVID-19. A total of 25 articles dealing with the relationships established during the pandemic of any of the three agents involved (family, students, and school) were analysed. The results showed that the relationships between the three groups involved must be improved to some extent to meet the needs that have arisen as a result of distance learning. In conclusion, the educational scenario during the pandemic has been one of the most significant challenges experienced in the recent history of education. Full article
(This article belongs to the Special Issue Effects of COVID-19: Issues on Health Economics and Education)
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Article
Changes in Air Pollution-Related Behaviour Measured by Google Trends Search Volume Index in Response to Reported Air Quality in Poland
Int. J. Environ. Res. Public Health 2021, 18(21), 11709; https://doi.org/10.3390/ijerph182111709 - 08 Nov 2021
Viewed by 462
Abstract
Decreased air quality is connected to an increase in daily mortality rates. Thus, people’s behavioural response to sometimes elevated air pollution levels is vital. We aimed to analyse spatial and seasonal changes in air pollution-related information-seeking behaviour in response to nationwide reported air [...] Read more.
Decreased air quality is connected to an increase in daily mortality rates. Thus, people’s behavioural response to sometimes elevated air pollution levels is vital. We aimed to analyse spatial and seasonal changes in air pollution-related information-seeking behaviour in response to nationwide reported air quality in Poland. Google Trends Search Volume Index data was used to investigate Poles’ interest in air pollution-related keywords. PM10 and PM2.5 concentrations measured across Poland between 2016 and 2019 as well as locations of monitoring stations were collected from the Chief Inspectorate of Environmental Protection databases. Pearson Product-Moment Correlation Coefficients were used to measure the strength of spatial and seasonal relationships between reported air pollution levels and the popularity of search queries. The highest PM10 and PM2.5 concentrations were observed in southern voivodeships and during the winter season. Similar trends were observed for Poles’ interest in air pollution-related keywords. Greater interest in air quality data in Poland strongly correlates with both higher regional and higher seasonal air pollution levels. It appears that Poles are socially aware of this issue and that their intensification of the information-seeking behaviour seems to indicate a relevant ad hoc response to variable threat severity levels. Full article
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Article
The Unmet Medical Demand among China’s Urban Residents
Int. J. Environ. Res. Public Health 2021, 18(21), 11708; https://doi.org/10.3390/ijerph182111708 - 08 Nov 2021
Viewed by 286
Abstract
Our work aimed to build a reasonable proxy for unmet medical demands of China’s urban residents. We combined health demand modeling and stochastic frontier analysis to produce a frontier medical demand function, which allowed us to disentangle unmet medical demands from the unobservable [...] Read more.
Our work aimed to build a reasonable proxy for unmet medical demands of China’s urban residents. We combined health demand modeling and stochastic frontier analysis to produce a frontier medical demand function, which allowed us to disentangle unmet medical demands from the unobservable effects. We estimated unmet medical demands by using China’s provincial dataset that covered 2005–2018. Our estimates showed that unmet medical demand at the national level was 12.6% in 2018, and regions with high medical prices confronted more unmet medical demands than regions with moderate or low medical prices during 2005–2018. Furthermore, medical prices and education were the main factors that affected unmet medical demand; therefore, policy making should pay more attention to reducing medical costs and promoting health education. Full article
(This article belongs to the Section Health Economics)
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Article
Role of Socio-Demographic and Environmental Determinants on Performance of Community Health Workers in Western Kenya
Int. J. Environ. Res. Public Health 2021, 18(21), 11707; https://doi.org/10.3390/ijerph182111707 - 08 Nov 2021
Viewed by 376
Abstract
Background: The performance of community health workers remains an area of significant global focus. The role of community health workers in sub-Saharan Africa has evolved over time in response to changing health priorities, disease burdens, and workforce demands. Recently, Kenya revised its [...] Read more.
Background: The performance of community health workers remains an area of significant global focus. The role of community health workers in sub-Saharan Africa has evolved over time in response to changing health priorities, disease burdens, and workforce demands. Recently, Kenya revised its community health strategy in response to challenges faced with the implementation of grassroots primary health care initiative. Implementation of community health programs is often inconsistent, and they vary widely in many attributes. The purpose of this study was to explore factors influencing performance of community health workers in Vihiga County, Western Kenya in light of the political devolution. Methods: The study was a cross-sectional study design that involved a quantitative method of data collection. A sample of 309 participants was selected through cluster and simple random sampling. A self-administered and -structured questionnaire was used to gather data, s, and those who were not able to respond individually were guided by the research assistants. Results: The community health workers were 75.2% females and 24.8% males. Performance was significantly associated with not being employed, (OR = 2.4; 95% CI, 1.4–4.4), secondary education (OR = 0.7; 95% CI, 0.5–1.1), lack of conflict resolution mechanism (OR = 2.2; p = 0.017), lack of support (OR = 1.5; p = 0.03), and community health work not seen as important (OR = 1.5; p = 0.041). Poor communication skills were also more likely to influence performance of community health workers (OR = 0.5; p = 0.050) and poor road network (OR = 0.361; p = 0.000). Conclusions: These findings offer a deeper understanding of the interaction between CHWs contextual situations, structural challenges, and performance. Addressing influential factors of CHWs performance in multi-task settings is important in preventing overtaxing their work capacity and to maintain quality performance as countries move towards universal health coverage. Strategies for incentivizing, attracting, and sustaining men in CHWs is important to broaden perspectives about this critical role in society. Full article
(This article belongs to the Special Issue Primary Care and Global Community Health)
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Article
Human Papillomavirus Prevalence in Urine Samples of Asymptomatic Male Sexual Partners of Women with Sexually Transmitted Diseases
Int. J. Environ. Res. Public Health 2021, 18(21), 11706; https://doi.org/10.3390/ijerph182111706 - 08 Nov 2021
Viewed by 427
Abstract
Human papillomavirus (HPV) infection in males is associated with various cancers, including cervical cancer in women and penile and bladder cancers in men. However, there is limited research on the prevalence and prevention of male HPV infection. Moreover, a rapid test that can [...] Read more.
Human papillomavirus (HPV) infection in males is associated with various cancers, including cervical cancer in women and penile and bladder cancers in men. However, there is limited research on the prevalence and prevention of male HPV infection. Moreover, a rapid test that can prevent the increase in HPV infection is needed. In this study, the prevalence of sexually transmitted pathogen (STP) and HPV infection was analyzed using real-time polymerase chain reaction assay in random urine samples collected from asymptomatic male sexual partners of women with sexually transmitted diseases. Among 130 men, 65 (50.0%) had STP and 12 (9.23%) had HPV infection. There was no association between STP and HPV infection. Among 12 cases of HPV infection, three were HPV-16 single infections, six were multiple infections, including HPV-16, and three of other high-risk HPV infections. Our results suggest the need for STP testing, including HPV testing, in sexual partners of high-risk women with sexually transmitted diseases, even in men without clinical symptoms (asymptomatic). Further research should be conducted by diversifying urine samples. We report the most convenient method for HPV detection, and it is expected to be widely applied to prevent sexually transmitted diseases in men and women. Full article
Review
Health and Access to Health Services for People with Disability in Australia: Data and Data Gaps
Int. J. Environ. Res. Public Health 2021, 18(21), 11705; https://doi.org/10.3390/ijerph182111705 - 08 Nov 2021
Viewed by 415
Abstract
The right of people with disability to enjoyment of the highest attainable standard of health without discrimination on the basis of disability is enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Among its obligations as a signatory [...] Read more.
The right of people with disability to enjoyment of the highest attainable standard of health without discrimination on the basis of disability is enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Among its obligations as a signatory to the CRPD, Australia is required to collect appropriate information, including statistical and research data, to inform development and implementation of policies to give effect to the Convention. In this commentary, we first describe how the International Classification of Functioning, Disability and Health (ICF) conceptual model of disability can be operationalised in statistical data collections, with a focus on how this is achieved in key Australian data sources such that people with disability can be identified as a population group. We then review existing statistical data on health and health service use for people with disability in Australia, highlighting data gaps and limitations. Finally, we outline priorities and considerations for improving data on health and access to health services for people with disability. As well as conceptual, practical, and ethical considerations, a key principle that must guide future disability data development is that people with disability and their representative organisations must be involved and participate fully in the development of disability data and statistics, and in their use. Full article
(This article belongs to the Special Issue Health Statistics: The Australian Experience and Opportunities)
Editorial
Epidemiological, Mitigation and Economic Impact of Zoonoses
Int. J. Environ. Res. Public Health 2021, 18(21), 11704; https://doi.org/10.3390/ijerph182111704 - 08 Nov 2021
Viewed by 323
Abstract
There is increasing evidence on the negative impacts of animal diseases on global productivity [...] Full article
(This article belongs to the Special Issue Epidemiological, Mitigation and Economic Impact of Zoonoses)
Article
Preliminary Assessment of COVID-19 Implications for the Water and Sanitation Sector in Latin America and the Caribbean
Int. J. Environ. Res. Public Health 2021, 18(21), 11703; https://doi.org/10.3390/ijerph182111703 - 08 Nov 2021
Viewed by 604
Abstract
COVID-19 has had a severe impact on human health, as well as in social and economic terms, with implications for the management and governance of the water and sanitation sector. These implications are evident in Latin America and the Caribbean due to existing [...] Read more.
COVID-19 has had a severe impact on human health, as well as in social and economic terms, with implications for the management and governance of the water and sanitation sector. These implications are evident in Latin America and the Caribbean due to existing challenges the region faces in accessing water and sanitation services. In spite of significant advances, around 65 million people in the LAC region currently lack appropriate access to water and soap to wash their hands—one of the most basic measures to prevent the spread of disease. Furthermore, social and economic vulnerabilities have exacerbated the effects of the pandemic in the region, particularly among those living in poverty. The COVID-19 pandemic thus requires the mobilization of frameworks such as the human rights to water and sanitation, specifically considering the region’s realities. This paper provides a review of some of the challenges currently faced in the region and advances a series of recommendations for enhancing access to water, sanitation and hygiene. The importance of effective governance, management and communication strategies in the water provisioning sector is highlighted in the context of the pandemic, and the role of science and research for adequate decision making is emphasized. Full article
Article
COVID-19 Vaccine Hesitancy among the Younger Generation in Japan
Int. J. Environ. Res. Public Health 2021, 18(21), 11702; https://doi.org/10.3390/ijerph182111702 - 07 Nov 2021
Viewed by 628
Abstract
Japan has vaccinated its older population; a mass vaccination program for younger citizens is underway. Accordingly, this study investigated vaccine hesitancy among younger Japanese citizens. We used online panel survey data from the Hiroshima Institute of Health Economics Research of Hiroshima University and [...] Read more.
Japan has vaccinated its older population; a mass vaccination program for younger citizens is underway. Accordingly, this study investigated vaccine hesitancy among younger Japanese citizens. We used online panel survey data from the Hiroshima Institute of Health Economics Research of Hiroshima University and applied probit regression models. Our study found that vaccine hesitancy among younger people was significantly higher than among older people. Moreover, vaccine hesitancy was significantly higher among younger women than younger men and inter-age-group differences in vaccine hesitancy were higher for younger men than for younger women. Regression demonstrated that subjective health status and anxiety about the future were significantly associated with vaccine hesitancy among younger women and younger men of all ages, respectively. Furthermore, marital status, university degree, anxiety about the future, and myopic view of the future had specific associations with vaccine hesitancy among younger women of different ages, while subjective health status, university degree, having children, financial literacy, household income and assets, and myopic view about the future had specific associations with vaccine hesitancy among younger men of varying ages. Therefore, these results suggest that policymakers should consider the diversity among the younger generation while developing effective, tailored communication strategies to reduce their vaccine hesitancy. Full article
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