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Int. J. Environ. Res. Public Health, Volume 18, Issue 24 (December-2 2021) – 564 articles

Cover Story (view full-size image): Currently, human interactions are important, and facial attractiveness is one of the most significant aspects of such interactions. The aim of this paper was to determine if asymmetric facial features, nasal and chin deviations affect the perception of attractiveness. From a symmetrical facial model taken, six asymmetrical images were made, with different directions and degrees of inclination of the dental midline. A total of 236 laypersons and 242 dentists completed and rated the online questionnaire of the images. The results showed a significant difference in the perception of attractiveness between laypeople and dentists. The conclusions determined that dentists are more rigorous about dental midline inclinations than laypersons. The perception of attractiveness was affected by the age group and sex of the participants.View this paper
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Review
Perspectives on Social and Environmental Determinants of Oral Health
Int. J. Environ. Res. Public Health 2021, 18(24), 13429; https://doi.org/10.3390/ijerph182413429 - 20 Dec 2021
Viewed by 602
Abstract
Most oral conditions have a multifactorial etiology; that is, they are modulated by biological, social, economic, cultural, and environmental factors. A consistent body of evidence has demonstrated the great burden of dental caries and periodontal disease in individuals from low socioeconomic strata. Oral [...] Read more.
Most oral conditions have a multifactorial etiology; that is, they are modulated by biological, social, economic, cultural, and environmental factors. A consistent body of evidence has demonstrated the great burden of dental caries and periodontal disease in individuals from low socioeconomic strata. Oral health habits and access to care are influenced by the social determinants of health. Hence, the delivery of health promotion strategies at the population level has shown a great impact on reducing the prevalence of oral diseases. More recently, a growing discussion about the relationship between the environment, climate change, and oral health has been set in place. Certainly, outlining plans to address oral health inequities is not an easy task. It will demand political will, comprehensive funding of health services, and initiatives to reduce inequalities. This paper sought to give a perspective about the role of social and physical environmental factors on oral health conditions while discussing how the manuscripts published in this Special Issue could increase our knowledge of the topic. Full article
(This article belongs to the Special Issue Perspectives on Social and Environmental Determinants of Oral Health)
Article
Fidgety Movements Assessment Accuracy Survey in Japan
Int. J. Environ. Res. Public Health 2021, 18(24), 13428; https://doi.org/10.3390/ijerph182413428 - 20 Dec 2021
Viewed by 423
Abstract
To investigate the accuracy of fidgety movements (FMs) assessment in Japanese assessors. Sixty specialists participated in the first survey. Of the participants, 18 were assessors certified by the GMs basic-training course. The surveys were composed of FMs assessment of 20 video clips. The [...] Read more.
To investigate the accuracy of fidgety movements (FMs) assessment in Japanese assessors. Sixty specialists participated in the first survey. Of the participants, 18 were assessors certified by the GMs basic-training course. The surveys were composed of FMs assessment of 20 video clips. The correct assessment rates (CARs) were investigated. The survey videos were judged into three types: normal (F + +, F +), abnormal (AF) and absent (F + -, F -). After the first survey, each participant performed a self-learning exercise using clips of the first survey. The follow-up survey was conducted three months after the first survey. The median CAR of the first survey was 65% in certified assessors and 50% in noncertified assessors. The median CARs of certified assessors were significantly higher than that of noncertified assessors for all clips and for normal FMs and AF clips (p < 0.01). After 3 months of self-learning exercise the CARs in each judgement type improved in 28 follow-up survey participants. Their median CAR improved from 60% in the first survey to 84% in the follow-up survey. To practise general movements assessment (GMA), course certification is required. The self-learning exercise with the confirmed judgement FMs clips may be effective for improving the ability of FMs judgement. Full article
(This article belongs to the Section Exercise and Health)
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Article
Experiencing the Unprecedented COVID-19 Lockdown: Abu Dhabi Older Adults’ Challenges and Concerns
Int. J. Environ. Res. Public Health 2021, 18(24), 13427; https://doi.org/10.3390/ijerph182413427 - 20 Dec 2021
Viewed by 406
Abstract
This study focused on older adults (60+ years old) of both genders in Abu Dhabi during the COVID-19 pandemic before vaccines were made available (age ranged from 60 years to 75 years). They faced more strict rules of movement restriction and isolation that [...] Read more.
This study focused on older adults (60+ years old) of both genders in Abu Dhabi during the COVID-19 pandemic before vaccines were made available (age ranged from 60 years to 75 years). They faced more strict rules of movement restriction and isolation that might have resulted in certain psychological feelings and social reactions. The main objective was to understand Abu Dhabi older adults’ psychological feelings during the pandemic and to identify their main concerns and challenges considering the various COVID-19-related policies and restrictions. The psychological feelings focused on fear, loneliness, sadness, irritability, emotional exhaustion, depressive symptoms, sleeping disorders, overeating, and excessive screen use. The objectives also included the changes in the psychological feelings concerning time. Other objectives covered better understanding the differences in (some activities) compared to the other age categories. Data were gathered through an online survey of community members from February to July 2020 as part of government initiatives (Department of Community Development). Responses were collected from 574 older adults in Abu Dhabi (60.1% male and 39.9% female). The analysis mainly used descriptive analysis, t-tests, analysis of variance (ANOVA), and simple trend analysis. For all tests, a p-value less than 0.05 was used for significance. The results pointed to the significant rise in feelings related to excessive screen use, fear, loneliness, and stress. The most significant concerns were related to more restrictions being imposed and not being able to see the grandchildren.The impact of new technologies on their quality of life was significantly reflected by respondents. The influence of the pandemic on older adults’ health and weight was also investigated. Analysis of variance, t-tests, and regression analysis with relevant tests were employed. The relevant results showed that some negative psychological feelings were common among older adults during the pandemic. However, the psychological feelings did not portray significant changes with time, except for sleeping disorders and overeating. Overall, older adults scored significantly different from other age groups on many challenges, concerns, and views regarding new technologies during the pandemic. No significant differences were observed regarding gender and marital status for the challenges and concerns. The research summarizes some policy guidance while noting some limitations of this study and future research directions. Full article
(This article belongs to the Topic Burden of COVID-19 in Different Countries)
Review
WhatsApp in Clinical Practice—The Challenges of Record Keeping and Storage. A Scoping Review
Int. J. Environ. Res. Public Health 2021, 18(24), 13426; https://doi.org/10.3390/ijerph182413426 - 20 Dec 2021
Viewed by 434
Abstract
The use of WhatsApp in health care has increased, especially since the COVID-19 pandemic, but there is a need to safeguard electronic patient information when incorporating it into a medical record, be it electronic or paper based. The aim of this study was [...] Read more.
The use of WhatsApp in health care has increased, especially since the COVID-19 pandemic, but there is a need to safeguard electronic patient information when incorporating it into a medical record, be it electronic or paper based. The aim of this study was to review the literature on how clinicians who use WhatsApp in clinical practice keep medical records of the content of WhatsApp messages and how they store WhatsApp messages and/or attachments. A scoping review of nine databases sought evidence of record keeping or data storage related to use of WhatsApp in clinical practice up to 31 December 2020. Sixteen of 346 papers met study criteria. Most clinicians were aware that they must comply with statutory reporting requirements in keeping medical records of all electronic communications. However, this study showed a general lack of awareness or concern about flaunting existing privacy and security legislation. No clear mechanisms for record keeping or data storage of WhatsApp content were provided. In the absence of clear guidelines, problematic practices and workarounds have been created, increasing legal, regulatory and ethical concerns. There is a need to raise awareness of the problems clinicians face in meeting these obligations and to urgently provide viable guidance. Full article
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Article
Metal Pollution and Bioaccumulation in the Nhue-Day River Basin, Vietnam: Potential Ecological and Human Health Risks
Int. J. Environ. Res. Public Health 2021, 18(24), 13425; https://doi.org/10.3390/ijerph182413425 - 20 Dec 2021
Viewed by 545
Abstract
(1) Background: Metal pollution in the Nhue-Day River basin has impacted approximately 12 million people. However, none of the previous studies considered the entire basin’s environmental and health risks. Thus, this research aims to fill knowledge gaps and reduce risks. (2) Methods: Sediment [...] Read more.
(1) Background: Metal pollution in the Nhue-Day River basin has impacted approximately 12 million people. However, none of the previous studies considered the entire basin’s environmental and health risks. Thus, this research aims to fill knowledge gaps and reduce risks. (2) Methods: Sediment and fish samples from the basin were analyzed to determine the levels of Zn, Cu, Pb, and Cd pollution and their potential ecological (EF, modified Pollution Index—mPI, and expanded, modified potential ecological risk index—emRI) and human health risks (THQ, HI, and TR indices). (3) Results: Metal levels in sediment exceeded Canadian aquatic life protection guidelines, indicating moderate to severe contamination (EFs: 1.3–58.5 and mPIs: 4–39). Compared to the new proposed ecological risk threshold, all river sites and Site 1 for ponds had elevated metal levels; and these posed a very high ecological risk in spring (emRI > 4.5), with Cd being the most hazardous. Lead levels in all fish tissues surpassed Vietnamese and EU food regulations. In agreement with THQ, EWI (Zn, Cu) and EMI (Cd) were both less than 2.5% of the PTWI and PTMI, respectively. However, HI values of 0.67–1.26 suggested a moderate health risk. Carcinogenic risk (TR > 10−6; estimated for Pb) was detected in several localities for Common carp and Tilapia during the warm season. (4) Conclusions: Metals had a negative impact on the basin’s ecosystem, with Cd being the most dangerous. Because of lead, consumption of Common carp and Tilapia from the basin may pose both non-carcinogenic and carcinogenic health concerns. Full article
(This article belongs to the Special Issue Human Health and Water Pollution)
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Article
Response of Saudi Population to Strict Preventive Measures against COVID-19
Int. J. Environ. Res. Public Health 2021, 18(24), 13424; https://doi.org/10.3390/ijerph182413424 - 20 Dec 2021
Viewed by 530
Abstract
The Saudi ministry of health (MOH) started the preventive measures very early on before having a single case of COVID-19. There were very few studies regarding the awareness and adherence to the preventive measures against COVID-19 among the Saudi population in the literature. [...] Read more.
The Saudi ministry of health (MOH) started the preventive measures very early on before having a single case of COVID-19. There were very few studies regarding the awareness and adherence to the preventive measures against COVID-19 among the Saudi population in the literature. Objectives: The study aims to examine the awareness and commitment to the strict Saudi government preventive measures against COVID-19. Methods: A cross-sectional online survey targeted Saudi and non-Saudi populations aged 18+ in March–April 2020. The online questionnaire was designed to explore the participant’s sociodemographic data, washing hygiene habits, the general level of awareness regarding COVID-19, and the extent to which they adhere to the government’s strict instructions. Results: Out of the 2958 participants in the survey, 23% washed their hands for between 20 and 30 s, 59.6% washed their hands after shaking hands with other people, 67.9% washed their hands after use of other’s utilities, 65.9% had appropriately followed the MOH recommended guidelines for home quarantine and social distancing. People in different age groups differed significantly on their practiced hygienic practices score p < 0.001. Respondents’ educational level had converged considerably and positively on their clean proper prevention practices score, f(2838.3) = 15.70. Conclusion: The majority of the participants adhere to the strict government instructions regarding COVID-19 as they have to obey the law. Health sector employees measured significantly greater hygienic preventive measures and precautions in comparison to other sectors. More public health efforts should increase hygienic best practice scores to achieve the best outcome. Full article
(This article belongs to the Topic Burden of COVID-19 in Different Countries)
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Review
Hard to Reach or Just Not Enough? A Narrative Review of Inpatient Tobacco Cessation Programs in Pediatrics
Int. J. Environ. Res. Public Health 2021, 18(24), 13423; https://doi.org/10.3390/ijerph182413423 - 20 Dec 2021
Viewed by 376
Abstract
Caregiver smoking is a significant risk factor for children with acute and chronic diseases. Hospitalization presents an opportunity to explore caregiver smoking as a modifiable risk factor during a time of crisis when the motivation to change could be heightened. To date, there [...] Read more.
Caregiver smoking is a significant risk factor for children with acute and chronic diseases. Hospitalization presents an opportunity to explore caregiver smoking as a modifiable risk factor during a time of crisis when the motivation to change could be heightened. To date, there has not been a published review on inpatient smoking cessation interventions in pediatrics that focus on supporting caregivers of hospitalized children. The goals of this review were to identify and assess the reach and efficacy of tobacco cessation strategies implemented across inpatient units in pediatrics and mother-baby units. This review also proposes clinical and research implications along with program-building recommendations that can help inform future practice in tobacco cessation. A narrative review of the literature identified 14 peer-reviewed studies that described smoking cessation interventions between 2002 and 2021. There were five randomized controlled trials, seven prospective studies, and one retrospective study. The primary kinds of interventions were counseling to heighten caregiver contemplation to quit (n = 12), provision of Nicotine Replacement Therapy (NRT) medications (n = 7), and follow-up with the local Quitline (n = 12). A diverse range of deliverers implemented interventions across studies. Variation in defining quit attempts along with tobacco reduction and cessation outcomes contributed to mixed findings across studies. Full article
(This article belongs to the Special Issue Environmental Tobacco Smoke Exposures in Pediatric Populations)
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Article
Usability Study of a Multicomponent Exergame Training for Older Adults with Mobility Limitations
Int. J. Environ. Res. Public Health 2021, 18(24), 13422; https://doi.org/10.3390/ijerph182413422 - 20 Dec 2021
Viewed by 480
Abstract
The global population aged 60 years and over rises due to increasing life expectancy. More older adults suffer from “geriatric giants”. Mobility limitations, including immobility and instability, are usually accompanied by physical and cognitive decline, and can be further associated with gait changes. [...] Read more.
The global population aged 60 years and over rises due to increasing life expectancy. More older adults suffer from “geriatric giants”. Mobility limitations, including immobility and instability, are usually accompanied by physical and cognitive decline, and can be further associated with gait changes. Improvements in physical and cognitive functions can be achieved with virtual reality exergame environments. This study investigated the usability of the newly developed VITAAL exergame in mobility-impaired older adults aged 60 years and older. Usability was evaluated with a mixed-methods approach including a usability protocol, the System Usability Scale, and a guideline-based interview. Thirteen participants (9 female, 80.5 ± 4.9 years, range: 71–89) tested the exergame and completed the measurement. The System Usability Scale was rated in a marginal acceptability range (58.3 ± 16.5, range: 30–85). The usability protocol and the guideline-based interview revealed general positive usability. The VITAAL exergame prototype received positive feedback and can be considered usable by older adults with mobility limitations. However, minor improvements to the system in terms of design, instructions, and technical aspects should be taken into account. The results warrant testing of the feasibility of the adapted multicomponent VITAAL exergame, and its effects on physical and cognitive functions, in comparison with conventional training, should be studied. Full article
(This article belongs to the Special Issue Innovations in Healthy Aging)
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Article
The Response of Social Crime Prevention Police to Cyberbullying Perpetrated by Youth in Rural Areas of South Africa
Int. J. Environ. Res. Public Health 2021, 18(24), 13421; https://doi.org/10.3390/ijerph182413421 - 20 Dec 2021
Viewed by 381
Abstract
Recently, South Africa has seen a surge in violence, cyberbullying by learners against peers, and online malicious acts against teachers. In response, the South African Department of Basic Education invited the social crime prevention police to intervene. This study reports on the developmental [...] Read more.
Recently, South Africa has seen a surge in violence, cyberbullying by learners against peers, and online malicious acts against teachers. In response, the South African Department of Basic Education invited the social crime prevention police to intervene. This study reports on the developmental issues contributing to cyberbullying and the police response to this violence in rural schools. An extensive literature review was conducted, and a conceptual framework was developed to guide the study and development of a mobile application. This framework was tested using data collected from focus groups, 8 police officers, 9 teachers, 52 grade-10 learners, and 27 grade-12 learners. The data were analyzed using thematic and quantitative techniques. The findings reveal some developmental issues. For instance, teachers are often targeted by learners online because they fail to take prompt action when learners report cyberbullying incidents. This finding is consistent with the developmental theory which predicts that lack of support would create a permissive context for cyberbullying. In addition, the popularity of cyberbullying has a stronger influence on older, rather than younger, adolescents. Older adolescents are more concerned about gaining popularity than being socially accepted. Recommendations are made which can be useful to schools, learners, and the police force in their fight against cyberbullying. Full article
(This article belongs to the Special Issue Cyberbullying from a Lifespan Perspective)
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Article
Do China’s Urban–Environmental Quality and Economic Growth Conform to the Environmental Kuznets Curve?
Int. J. Environ. Res. Public Health 2021, 18(24), 13420; https://doi.org/10.3390/ijerph182413420 - 20 Dec 2021
Viewed by 426
Abstract
The environmental Kuznets curve (EKC) expresses the relationship between environmental quality and economic growth. Based on the defects of previous studies on EKC using only environmental pollution indicators, this study holds that environmental quality is the result of pollutants after treatment, absorption, and [...] Read more.
The environmental Kuznets curve (EKC) expresses the relationship between environmental quality and economic growth. Based on the defects of previous studies on EKC using only environmental pollution indicators, this study holds that environmental quality is the result of pollutants after treatment, absorption, and self-purification, including two dimensions of pollution and absorption. Therefore, the environmental pollution and absorption data of 74 key environmental monitoring cities in China from 2005 to 2017 were selected, and a comprehensive index of environmental quality was constructed using the vertical and horizontal grading method. Then, based on the relevant economic growth indicators of these cities, they were divided into first-tier and new first-tier, second-tier, third-tier, and below. It was found that the EKC of the total sample, the first-tier and new first-tier cities, and the second-tier cities presented an inverted N-shape and had passed the second inflection point, where environmental quality continues to improve with the deepening of economic growth. There was no EKC in the third-tier and below cities. The findings have important implications. China can cross the second inflection point of the EKC and improve environmental quality at a low income level. Therefore, by vigorously developing cleaner production technologies and raising residents’ awareness of environmental protection, it is possible to improve environmental quality at a lower income level than expected, which provides a useful reference for other developing countries. Full article
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Article
Obesity and Diet Predict Attitudes towards Health Promotion in Pre-Registered Nurses and Midwives
Int. J. Environ. Res. Public Health 2021, 18(24), 13419; https://doi.org/10.3390/ijerph182413419 - 20 Dec 2021
Viewed by 579
Abstract
Nurses and midwives are integral to public health promotion; in the UK, they are advised to act as role models by their governing body, but overweight or obesity rates are high. We explored whether obesity and dietary habits are related to attitudes towards [...] Read more.
Nurses and midwives are integral to public health promotion; in the UK, they are advised to act as role models by their governing body, but overweight or obesity rates are high. We explored whether obesity and dietary habits are related to attitudes towards healthy role modelling and health promotion practice. A total of 346 pre-registered UK nurses and midwives (92.6% female; 18–53 years) completed an online survey. Items included body composition, dietary habits assessed by the Lifestyle Behaviour Questionnaire (LBQ), attitudes towards being role models for health (RA: role attitudes) and attitudes toward health promotion practice (ATHPP): 33.8% of the sample self-reported as overweight or obese; 67.6% did not consume 5-a-day portions of fruit/veg; 31.5% reported a healthy diet; and 89.6% believed their diet could be healthier. Positive RA was significantly linked to health promotion engagement (HP) (ß = 0.33, p < 0.001). Positive ATHPP was significantly predicted by lower BMI (ß = −0.08, p = 0.078), positive RA (ß = 0.67, p < 0.001), lower HP (ß = −0.25, p < 0.001) and male gender (ß = 0.09, p = 0.02). Greater confidence in patients valuing healthcare professional’s advice was predicted by healthier diet (ß = 0.11, p = 0.03), lower BMI (ß = −0. 16, p < 0.01), more positive RA (ß = 0.14, p < 0.01) as well as HP engagement during training (ß = 0.20, p < 0.01). One’s own motivation to promote health, similarly to ATHPP, was predicted by RA (ß = 0.17, p = 0.001) and previous HP engagement (ß = 0.39, p < 0.001). Findings show that overweight and obesity are prevalent in pre-registered nurses and midwives; the majority did not consume a healthy diet. Individual’s body composition, diet and attitudes towards role modelling are positively associated with their attitudes towards, and confidence in, health promotion practice. Experiences of health promotion practice during training can have either a positive or a negative influence on attitudes. Mentors and educators could actively promote healthy lifestyles for pre-registered nurses and midwives and facilitate more opportunities for health promotion practice during placements, which includes time for reflection. Full article
(This article belongs to the Special Issue Safety, Health and Wellbeing of Healthcare Workers)
Article
Epidemiological Study on Burnout in Spanish Dentists: Underlying Psychological Factors
Int. J. Environ. Res. Public Health 2021, 18(24), 13418; https://doi.org/10.3390/ijerph182413418 - 20 Dec 2021
Viewed by 499
Abstract
The aim of this work is to study the personality factors and coping styles of Spanish dentists when facing burnout syndrome, through epidemiological work. An epidemiological study of 1928 Spanish dentists was undertaken through an online survey, which registered the age and gender, [...] Read more.
The aim of this work is to study the personality factors and coping styles of Spanish dentists when facing burnout syndrome, through epidemiological work. An epidemiological study of 1928 Spanish dentists was undertaken through an online survey, which registered the age and gender, and three questionnaires: NEO-FFI (personality traits), Brief COPE (coping styles), and MBI-HSS (burnout questionnaire). A multivariate analysis and an explanatory binary logistic regression model were used to estimate the presence of burnout. Neuroticism turned out to be the strongest indicator (OR 1.10; IC 95% 1.09–1.14), while extraversion (OR 0.93; IC 95% 0.91–0.95) and agreeableness (OR 0.94; IC95% 0.92–0.98) showed an inverse relationship with the occurrence of burnout, as did age (OR 0.9; IC95% 0.96–0.99). Conscientiousness (OR 1.0; IC95% 1.00–1.06) had a direct relationship with the presence of burnout. An avoidant coping style was the only indicative coping style (OR 1.04 IC95% 1.02–1.06). Approximately 70% of the dentists scored high on one of the three dimensions of burnout. No differences were found in the degree of burnout according to gender. Certain personality factors (neuroticism, extraversion, agreeableness, and conscientiousness), the avoidant coping style, and age are powerful indicators to attempt to forecast the presence of burnout syndrome in dentists. Full article
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Article
Analysis of Falls from Height Variables in Occupational Accidents
Int. J. Environ. Res. Public Health 2021, 18(24), 13417; https://doi.org/10.3390/ijerph182413417 - 20 Dec 2021
Viewed by 401
Abstract
Fall-from-height accidents are linked to severe and fatal consequences for impacted workers. A better understanding of the related variables is necessary to improve worker safety. This study analyzed all fall-from-height occupational accidents recorded in Spain from 2009 to 2019, selected significant variables, and [...] Read more.
Fall-from-height accidents are linked to severe and fatal consequences for impacted workers. A better understanding of the related variables is necessary to improve worker safety. This study analyzed all fall-from-height occupational accidents recorded in Spain from 2009 to 2019, selected significant variables, and evaluated the influence concerning the seriousness of the falls from height. Based on a total of 290,583 fall-from-height accidents, the study shows that a male inexperienced worker in a small company working in a non-habitual workplace is more likely to suffer fatal consequences once the accident happens. An improved knowledge of fall-from-height accidents will improve safety conditions. The workers should be trained and informed about their specific risk depending on the variables analyzed. Safety training should consider more risky profiles. Results from the current study can help identify suitable fall prevention and risk mitigation actions in safety programs for companies. Full article
(This article belongs to the Special Issue Occupational Accidents and Risk Prevention)
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Article
Effect of Obstructive Sleep Apnea on the Risk of Injuries—A Nationwide Population-Based Cohort Study
Int. J. Environ. Res. Public Health 2021, 18(24), 13416; https://doi.org/10.3390/ijerph182413416 - 20 Dec 2021
Viewed by 536
Abstract
Obstructive sleep apnea (OSA) has been reported to increase the risk of motor vehicle accidents. However, only few studies have investigated the effects of OSA on overall risk injury. The aim of study is to investigate whether OSA increases the risk of overall [...] Read more.
Obstructive sleep apnea (OSA) has been reported to increase the risk of motor vehicle accidents. However, only few studies have investigated the effects of OSA on overall risk injury. The aim of study is to investigate whether OSA increases the risk of overall injury. The data were collected during 2000–2015 from Taiwan’s National Health Insurance Research Database. A total of 8901 individuals diagnosed with OSA were inpatients, or outpatients at least three times were enrolled. Finally, 6915 participants with OSA were included as the study cohort. We matched the study cohort with a comparison cohort, at a ratio of 1:4. Cox proportional hazards regression was used to analyse the association between OSA and overall injury. Patients with OSA had 83.1% increased risk of overall injury, compared to non-OSA individuals [adjusted hazards ratio (HR) = 1.831, confidence interval (CI) = 1.674–2.020, p < 0.001]. In the stratified age group, patients aged ≧65 years had the highest risk of injury (adjusted HR= 2.014; CI = 1.842–2.222, p < 0.001). Patients with OSA were at a higher risk of falls, traffic injury, poisoning, suffocation, suicide, and abuse or homicide than non-OSA individuals, with falls and traffic injury as the leading causes of injuries. The data demonstrated that patients with OSA have a higher risk of overall injury. The study results can be a reference for developing injury prevention strategies in the future. The general population and clinicians should have more awareness regarding OSA and its negative effects on injury development. Full article
(This article belongs to the Special Issue Big Data for Public Health Research and Practice)
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Exploring Risk and Protective Factors for Cyberbullying and Their Interplay: Evidence from a Sample of South Korean College Students
Int. J. Environ. Res. Public Health 2021, 18(24), 13415; https://doi.org/10.3390/ijerph182413415 - 20 Dec 2021
Viewed by 477
Abstract
This study explored risk and protective factors for cyberbullying perpetration and examined whether they independently and interactively predicted cyberbullying perpetration. Based on key propositions of micro-level theories of crime and delinquency, we adopted two risk factors, cyberbullying victimization and association with cyberbullying peers, [...] Read more.
This study explored risk and protective factors for cyberbullying perpetration and examined whether they independently and interactively predicted cyberbullying perpetration. Based on key propositions of micro-level theories of crime and delinquency, we adopted two risk factors, cyberbullying victimization and association with cyberbullying peers, and two protective factors, morality and self-control. Using a sample of South Korean college students (N = 244; 112 women (45.9%), 132 men (54.1%); Mean (age) = 22), we found that the two risk factors were positively associated with cyberbullying perpetration, while only one of the two protective factors, which is morality, had a negative relationship with cyberbullying perpetration. In addition, the two protective factors partially buffered the effects of both risk factors on cyberbullying perpetration. The implications and limitations of these findings were also discussed. Full article
(This article belongs to the Special Issue Cyberbullying from a Lifespan Perspective)
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Article
Motion Analysis for Jumping Discus Throwing Correction
Int. J. Environ. Res. Public Health 2021, 18(24), 13414; https://doi.org/10.3390/ijerph182413414 - 20 Dec 2021
Viewed by 374
Abstract
The purpose of this study was to explore the kinematical characteristics of jumping discus throwing. Eight male right-handed discus throwers who used to practice the jumping throwing technique were recruited as participants. Two high-speed digital cameras with 120 Hz sampling rate were synchronized [...] Read more.
The purpose of this study was to explore the kinematical characteristics of jumping discus throwing. Eight male right-handed discus throwers who used to practice the jumping throwing technique were recruited as participants. Two high-speed digital cameras with 120 Hz sampling rate were synchronized to capture the movement. The captured images were processed using a motion analysis suite, and the markers attached to joints on images were digitized manually. Based on the results, throwers should keep smaller the shoulder–hip twisting and the right anterior superior iliac spine (abbreviated: ASIS) in front of the right acromion (for right-handed throwers) from the instant the right foot lands to the instant the left foot lands, before the instant of the right foot lands; keep the discus at a depressed position; and reduce the time before discus release, particularly the time of the non-support phase and the second single-support phase. Additionally, release velocity must be improved because throwing distance is directly proportional to squared release velocity. In conclusion, the current study demonstrated comprehensive kinematical analyses, which can be used to instruct the jumping discus throwing technique with duration and angle characteristics of throwing movement for athletes by coaches with videos. Full article
(This article belongs to the Special Issue Sports Medicine and Sports Science)
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The Challenge of Sustainability of High-Cost Oncological Drugs: A Budgeting Model in an Italian Cancer Center
Int. J. Environ. Res. Public Health 2021, 18(24), 13413; https://doi.org/10.3390/ijerph182413413 - 20 Dec 2021
Viewed by 376
Abstract
In Italy, drug expenditure governance is achieved by setting caps based on the percentage increase in hospital spending compared to the previous year. This method is ineffective in identifying issues and opportunities as it does not consider an analysis of the number of [...] Read more.
In Italy, drug expenditure governance is achieved by setting caps based on the percentage increase in hospital spending compared to the previous year. This method is ineffective in identifying issues and opportunities as it does not consider an analysis of the number of treated cases and per capita consumption in local and regional settings. The IRCCS (Scientific hospitalization and treatment institute) Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori” in Meldola, has developed and adopted an effective management model designed to oversee pharmaceutical expenditure, guarantee prescription appropriateness and quality of care to patients. The budget setting follows a structured process which evaluates determining factors of the expenditure such as expected patients calculated according to the epidemiology and to national and regional indications of appropriateness, mean cost per patient calculated on the average period of demonstrated efficacy of the drug and use of drugs with the best cost-effectiveness ratio. Strict monitoring and integrated purchasing processes allow for immediate corrective actions on expenditures, as well as a continuous dialogue with the region in order to guarantee consistent funding of IRST activities. The model, presented in this article is efficient and implements concepts beyond the conventional “silos” approach and national and regional governance tools, in terms of patient centricity. Full article
(This article belongs to the Section Health Economics)
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Use of Oral Health Impact Profile-14 (OHIP-14) in Different Contexts. What Is Being Measured?
Int. J. Environ. Res. Public Health 2021, 18(24), 13412; https://doi.org/10.3390/ijerph182413412 - 20 Dec 2021
Viewed by 321
Abstract
The Oral Health Impact Profile-14 (OHIP-14) has been used to assess the impact that oral health problems can have on an individual’s life. Different theoretical models were proposed to evaluate the results. The aims of this study were to evaluate the fit of [...] Read more.
The Oral Health Impact Profile-14 (OHIP-14) has been used to assess the impact that oral health problems can have on an individual’s life. Different theoretical models were proposed to evaluate the results. The aims of this study were to evaluate the fit of different factorial models of the OHIP-14 to non-dental patients (NDP) and dental patients (DP) samples from Brazil and Finland and to estimate the differential functioning of the items in the OHIP-14 between the samples. Two studies were conducted, one in Brazil and the other in Finland, composed of five samples (Brazil—Sample 1 (S1): DP, n = 434, age: 25.3 [SD = 6.3] years; S2: NDP, n = 1486, age: 24.7 [SD = 5.6] years; S3: DP, n = 439, age: 29.0 [SD = 6.7] years; Finland—S4: DP, n = 482, age: 26.3 [SD = 5.4] years; S5: NDP, n = 2425, age: 26.7 [DP = 5.5] years). The fit of the OHIP-14 models to the data was estimated using a confirmatory strategy (validity based on the internal structure). Differential item functioning (DIF) between samples was estimated. For NDP from both countries, the response pattern severely violated the normality assumption in six items of the OHIP-14, indicating that the instrument does not fit for these samples. For DP, the model with the best fit was unifactorial, which deals with the estimation of the general impact of oral health on an individual’s life, without addressing specific dimensions. Configural invariance was refuted between samples. DIF indicated that the characteristic of the sample (NDP and DP) in both countries interfered in the response given to the items, with the response level being more adequate for the latent PD trait. The validity of data related to the impact of oral health problems on an individual’s life was confirmed through a unifactorial model. OHIP-14 works properly in DP samples and was limited in NDP samples, being also influenced by cultural context and age. Full article
(This article belongs to the Special Issue Health Services Research on Dentistry in Aged Society)
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Article
Sustainable Land-Use Allocation Model at a Watershed Level under Uncertainty
Int. J. Environ. Res. Public Health 2021, 18(24), 13411; https://doi.org/10.3390/ijerph182413411 - 20 Dec 2021
Viewed by 328
Abstract
Land-use allocation models can effectively support sustainable land use. A large number of studies solve the problems of land-use planning by constructing models, such as mathematical models and spatial analysis models. However, these models fail to fully and comprehensively consider three uncertain factors [...] Read more.
Land-use allocation models can effectively support sustainable land use. A large number of studies solve the problems of land-use planning by constructing models, such as mathematical models and spatial analysis models. However, these models fail to fully and comprehensively consider three uncertain factors of land-use systems: randomness, interval and fuzziness. 33Therefore, through the study of the watershed land-use system, this paper develops a land-use allocation model considering the regional land–society–economy–environment system under uncertain conditions. On the basis of this model, an interval fuzzy two-stage random land-use allocation model (IFTSP-LUAM) combining social, economic and ecological factors is proposed to provide sustainable development strategies at the basin level. In addition, the proposed IFTSP-LUAM takes into account the above three uncertainties and multistage, multiobjective, dynamic, systematic and complex characteristics of typical land-use planning systems. The results showed that the model considers more socioeconomic and ecological factors and can effectively reflect the quantitative relationship between the increase in economic benefits and the decrease in environmental costs of a land-use system. The model was applied to land-use planning of Nansihu River Basin in Shandong Province. The results provided a series of suitable land-use patterns and environmental emission scenarios under uncertain conditions, which can help the watershed environmental protection bureau and watershed land-use decision-makers to formulate appropriate land-use policies, so as to balance social and economic development and ecological protection. The simulation results can provide support for an in-depth analysis of land-use patterns and the trade-off between economic development and ecological environment protection. Full article
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Article
Visitor’s Willingness to Pay for National Park Entrance Fees in China: Evidence from a Contingent Valuation Method
Int. J. Environ. Res. Public Health 2021, 18(24), 13410; https://doi.org/10.3390/ijerph182413410 - 20 Dec 2021
Viewed by 295
Abstract
China has been making efforts in nature conservation by developing a new national park system. Setting a fee-based entrance policy for the newly established national parks can be challenging without information on visitors’ willingness to pay (WTP). Thus, this study aims to evaluate [...] Read more.
China has been making efforts in nature conservation by developing a new national park system. Setting a fee-based entrance policy for the newly established national parks can be challenging without information on visitors’ willingness to pay (WTP). Thus, this study aims to evaluate visitors’ WTP entrance fees with a dataset of 1215 visitors collected in China’s planned Qinling National Park (QNP). Using the double bounded dichotomous choice format of the contingent valuation method, we obtained the mean WTP for the entrance fee of QNP of 200 yuan. Visitors’ demand becomes relatively inelastic at the recommended entrance fee of 160 yuan when the expected ticket revenue will reach its maximum of 13.8 billion yuan. Our study also indicates that visitors’ WTP is significantly influenced by their gender difference, education level, income, number of trips to natural attractions, duration of stay, the intention of a future visit, and concern about commercial exploitation. Our empirical study provides insights into developing effective pricing policies and appropriate marketing strategies for China’s new national park system. Full article
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Review
Machine Learning and Its Application in Skin Cancer
Int. J. Environ. Res. Public Health 2021, 18(24), 13409; https://doi.org/10.3390/ijerph182413409 - 20 Dec 2021
Viewed by 675
Abstract
Artificial intelligence (AI) has wide applications in healthcare, including dermatology. Machine learning (ML) is a subfield of AI involving statistical models and algorithms that can progressively learn from data to predict the characteristics of new samples and perform a desired task. Although it [...] Read more.
Artificial intelligence (AI) has wide applications in healthcare, including dermatology. Machine learning (ML) is a subfield of AI involving statistical models and algorithms that can progressively learn from data to predict the characteristics of new samples and perform a desired task. Although it has a significant role in the detection of skin cancer, dermatology skill lags behind radiology in terms of AI acceptance. With continuous spread, use, and emerging technologies, AI is becoming more widely available even to the general population. AI can be of use for the early detection of skin cancer. For example, the use of deep convolutional neural networks can help to develop a system to evaluate images of the skin to diagnose skin cancer. Early detection is key for the effective treatment and better outcomes of skin cancer. Specialists can accurately diagnose the cancer, however, considering their limited numbers, there is a need to develop automated systems that can diagnose the disease efficiently to save lives and reduce health and financial burdens on the patients. ML can be of significant use in this regard. In this article, we discuss the fundamentals of ML and its potential in assisting the diagnosis of skin cancer. Full article
(This article belongs to the Special Issue Prevention and Digital Health in Dermatology)
Article
Effect of Public Empathy with Infection-Control Guidelines on Infection-Prevention Attitudes and Behaviors: Based on the Case of COVID-19
Int. J. Environ. Res. Public Health 2021, 18(24), 13408; https://doi.org/10.3390/ijerph182413408 - 20 Dec 2021
Viewed by 388
Abstract
Since the outbreak of the novel coronavirus disease (COVID-19), the government has provided infection-control guidelines to prevent the spread of the virus. The authors of this study examined the structure (causal relationship) of factors that influence public behavior toward COVID-19 and verified the [...] Read more.
Since the outbreak of the novel coronavirus disease (COVID-19), the government has provided infection-control guidelines to prevent the spread of the virus. The authors of this study examined the structure (causal relationship) of factors that influence public behavior toward COVID-19 and verified the effect of public empathy with infection-control guidelines in each structure. Data were collected using a self-administered questionnaire survey from 211 Korean adults. The results showed that (1) the perceived susceptibility and severity of economic damage had a positive effect on infection-prevention attitudes and infection-prevention attitudes had a positive effect on infection-prevention behaviors; (2) the perceived severity of economic damage had a positive effect on infection-prevention attitudes; and (3) public empathy with infection-control guidelines positively moderated the effect of the perceived severity of economic damage on infection-prevention behaviors and that of perceived susceptibility on infection-prevention attitudes. Accordingly, the authors of this study present the following three suggestions to prevent the spread of an infectious disease: engage in risk communication focused on a potential virus infection and cooperation, make multifaceted efforts to increase public empathy with infection-control guidelines, and implement measures to alleviate or reduce economic damage to the public in a viral pandemic. Full article
(This article belongs to the Special Issue Population Behavior during COVID-19)
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Article
Parental Response Style to Adolescent Self-Harm: Psychological, Social and Functional Impacts
Int. J. Environ. Res. Public Health 2021, 18(24), 13407; https://doi.org/10.3390/ijerph182413407 - 20 Dec 2021
Viewed by 305
Abstract
Adolescent self-harm is a significant public health issue. We aimed to understand how parent stress response styles to their child’s self-harm affects their wellbeing and functioning and the wider family. Thirty-seven participants in Australia (parents; 92% female) completed a mixed methods survey regarding [...] Read more.
Adolescent self-harm is a significant public health issue. We aimed to understand how parent stress response styles to their child’s self-harm affects their wellbeing and functioning and the wider family. Thirty-seven participants in Australia (parents; 92% female) completed a mixed methods survey regarding their adolescent child’s self-harm. We conducted Pearson zero-order correlations and independent t-tests to examine the impact of parent response style on their quality of life, health satisfaction, daily functioning, and mental health. We also used thematic analysis to identify patterns of meaning in the data. Two-thirds of participants reported mental ill health and reduced functional capacity due to their adolescent’s self-harm. Parents with a more adaptive response style to stress had better mental health. Qualitative analyses revealed parents experienced sustained feelings of distress and fear, which resulted in behavioural reactions including hypervigilance and parental mental health symptoms. In the wider family there was a change in dynamics and parents reported both functional and social impacts. There is a need to develop psychological support for the adolescent affected and parents, to support more adaptive response styles, and decrease the negative effects and facilitate the wellbeing of the family unit. Full article
Article
Personal Safety and Fear of Sexual Harassment among Female Garment Workers in Bangladesh
Int. J. Environ. Res. Public Health 2021, 18(24), 13406; https://doi.org/10.3390/ijerph182413406 - 20 Dec 2021
Viewed by 386
Abstract
Personal safety and fear of sexual harassment may discourage women from participating at work and in public life, limiting their life opportunities. The study proposed to determine personal safety and fear of sexual harassment among female garment workers in Bangladesh. This cross-sectional study [...] Read more.
Personal safety and fear of sexual harassment may discourage women from participating at work and in public life, limiting their life opportunities. The study proposed to determine personal safety and fear of sexual harassment among female garment workers in Bangladesh. This cross-sectional study was conducted among 201 female garment workers from Dhaka and Chittagong cities. Participants were selected using snowballing sampling techniques with the data collected by using anonymised questionnaires. The Pearson product–moment correlation and analysis of variance were employed using SPSS version 27.0. Results showed that 25% of the participants perceived that they were most likely to be sexually harassed by their manager and 25% never felt safe going to work. Age and the marital status of the participants were significantly associated with personal safety and fear of sexual harassment (p < 0.05). The correlation analysis found a significant positive correlation between personal safety and the fear of sexual harassment [r (201) = 0.85 **, p < 0.05], among the participants. A deep commitment from leadership with cooperation at all levels of the organisations is required to address these acts of violence and organisational conditions, rather than a form of unreflective compliance or a ‘gender-neutral’ approach that fails to recognise individual needs and maintain gender inequality. Full article
(This article belongs to the Special Issue Occupational Accidents and Risk Prevention)
Article
The Impact of Demographic, Socio-Economic and Geographic Factors on Mortality Risk among People Living with Dementia in England (2002–2016)
Int. J. Environ. Res. Public Health 2021, 18(24), 13405; https://doi.org/10.3390/ijerph182413405 - 20 Dec 2021
Viewed by 564
Abstract
Increasing numbers of people living with dementia (PLWD), and a pressured health and social care system, will exacerbate inequalities in mortality for PLWD. There is a dearth of research examining multiple factors in mortality risk among PLWD, including application of large administrative datasets [...] Read more.
Increasing numbers of people living with dementia (PLWD), and a pressured health and social care system, will exacerbate inequalities in mortality for PLWD. There is a dearth of research examining multiple factors in mortality risk among PLWD, including application of large administrative datasets to investigate these issues. This study explored variation mortality risk variation among people diagnosed with dementia between 2002–2016, based on: age, sex, ethnicity, deprivation, geography and general practice (GP) contacts. Data were derived from electronic health records from a cohort of Clinical Practice Research Datalink GP patients in England (n = 142,340). Cox proportional hazards regression modelled mortality risk separately for people with early- and later- onset dementia. Few social inequalities were observed in early-onset dementia; men had greater risk of mortality. For early- and later-onset, higher rates of GP observations—and for later-onset only dementia medications—are associated with increased mortality risk. Social inequalities were evident in later-onset dementia. Accounting for other explanatory factors, Black and Mixed/Other ethnicity groups had lower mortality risk, more deprived areas had greater mortality risk, and higher mortality was observed in North East, South Central and South West GP regions. This study provides novel evidence of the extent of mortality risk inequalities among PLWD. Variance in mortality risk was observed by social, demographic and geographic factors, and frequency of GP contact. Findings illustrate need for greater person-centred care discussions, prioritising tackling inequalities among PLWD. Future research should explore more outcomes for PLWD, and more explanatory factors of health outcomes. Full article
(This article belongs to the Special Issue Health Inequalities in Dementia Care)
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Article
Association between Children’s Engagement in Community Cultural Activities and Their Mental Health during the COVID-19 Pandemic: Results from A-CHILD Study
Int. J. Environ. Res. Public Health 2021, 18(24), 13404; https://doi.org/10.3390/ijerph182413404 - 20 Dec 2021
Viewed by 377
Abstract
Social learning experiences developed through engagement in community cultural activities can affect a child’s development. Few studies have examined how children’s engagement in community activities is related to their mental health. This study aimed to examine associations between children’s participation in community cultural [...] Read more.
Social learning experiences developed through engagement in community cultural activities can affect a child’s development. Few studies have examined how children’s engagement in community activities is related to their mental health. This study aimed to examine associations between children’s participation in community cultural activities and their mental health. We targeted all sixth-grade children in all 69 primary schools in Adachi City, Tokyo, using the Adachi Child Health Impact of Living Difficulty (A-CHILD) study (n = 4391). Parents answered the validated Japanese version of the Strength and Difficulties Questionnaire (SDQ) to assess child mental health, the child’s engagement in community cultural activities. The community activity in which children most frequently participated was local festivals. Participating in local festivals was significantly associated with lower behavioral difficulties (β = −0.49, SE = 0.17, p = 0.005) and higher prosocial behaviors (β = 0.25, SE = 0.07, p < 0.001) after adjusting for demographic variables, family social capital, and parent-child interactions. These results highlight the importance of children’s engagement in community cultural activities for their mental health during the COVID-19 pandemic. Full article
(This article belongs to the Section Children's Health)
Article
Prevalence of Asthma and Its Associating Environmental Factors among 6–12-Year-Old Schoolchildren in a Metropolitan Environment—A Cross-Sectional, Questionnaire-Based Study
Int. J. Environ. Res. Public Health 2021, 18(24), 13403; https://doi.org/10.3390/ijerph182413403 - 20 Dec 2021
Viewed by 377
Abstract
We aimed to evaluate the prevalence of asthma and its associating environmental factors within a 6–12-year-old population. A cross-sectional, questionnaire-based study was conducted in primary schools located in the capital of Hungary; 3836 eligible parent-reported questionnaires were evaluated. Besides the International Study of [...] Read more.
We aimed to evaluate the prevalence of asthma and its associating environmental factors within a 6–12-year-old population. A cross-sectional, questionnaire-based study was conducted in primary schools located in the capital of Hungary; 3836 eligible parent-reported questionnaires were evaluated. Besides the International Study of Asthma and Allergies in Childhood (ISAAC) phase three core questions for asthma, the survey also assessed various potential risk factors. We introduced the umbrella term cumulative asthma as the union of physician-diagnosed asthma and current wheezing to estimate the lifetime prevalence of asthma. Current wheezing and physician-diagnosed asthma showed a frequency of 9.5% and 6.3%, respectively. They contributed to a cumulative asthma prevalence of 12.6% among the sampled population, with a girl-boy percentage of 37.4% to 62.6%. Air-pollution and weedy areas were associated with greater risk for asthma, while a suburban residence showed lesser odds. Indoor smoking, visible mold, and keeping a dog were defined as risk factors for asthma, while the presence of plants in the bedroom and pet rodents were associated with lower odds ratios. The consumption of fast food, beverages containing additives and margarine were significantly higher in asthmatics, while we found frequent sport activity and cereal intake associated with lower odds ratios for asthma. In this urban environment, we identified an increased asthma prevalence compared to some previously published studies, but the cross-sectional design and the different methodology did not permit us to draw timeframe-dependent conclusions. Full article
(This article belongs to the Section Children's Health)
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Review
Adolescent Congenital Central Hypoventilation Syndrome: An Easily Overlooked Diagnosis
Int. J. Environ. Res. Public Health 2021, 18(24), 13402; https://doi.org/10.3390/ijerph182413402 - 20 Dec 2021
Viewed by 348
Abstract
Congenital central hypoventilation syndrome (CCHS), also known as Ondine’s curse, is a rare, potentially fatal genetic disease, manifesting as a lack of respiratory drive. Most diagnoses are made in pediatric patients, however late-onset cases have been rarely reported. Due to the milder symptoms [...] Read more.
Congenital central hypoventilation syndrome (CCHS), also known as Ondine’s curse, is a rare, potentially fatal genetic disease, manifesting as a lack of respiratory drive. Most diagnoses are made in pediatric patients, however late-onset cases have been rarely reported. Due to the milder symptoms at presentation that might easily go overlooked, these late-onset cases can result in serious health consequences later in life. Here, we present a case report of late-onset CCHS in an adolescent female patient. In this review we summarize the current knowledge about symptoms, as well as clinical management of CCHS, and describe in detail the molecular mechanism responsible for this disorder. Full article
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Editorial
Contaminants of Emerging Concern (CECs): Occurrence and Fate in Aquatic Ecosystems
Int. J. Environ. Res. Public Health 2021, 18(24), 13401; https://doi.org/10.3390/ijerph182413401 - 20 Dec 2021
Viewed by 335
Abstract
Contaminants of emerging concern (CECs) are typically divided into chemicals, as they are properly called, and biological CECs, such as pathogens [...] Full article
Article
High Intensity Functional Training (HIFT) Improves Fitness in Recruit Firefighters
Int. J. Environ. Res. Public Health 2021, 18(24), 13400; https://doi.org/10.3390/ijerph182413400 - 20 Dec 2021
Cited by 1 | Viewed by 443
Abstract
Background: Firefighting is a strenuous profession requiring adequate levels of fitness for effective job performance. Providing firefighters with a safe and effective fitness program is essential for optimal performance. The purpose of this project was to examine changes in various parameters of physical [...] Read more.
Background: Firefighting is a strenuous profession requiring adequate levels of fitness for effective job performance. Providing firefighters with a safe and effective fitness program is essential for optimal performance. The purpose of this project was to examine changes in various parameters of physical fitness and firefighter ability following a 7-week high intensity functional training (HIFT) program. Methods: Participants were male firefighter recruits (N = 89; age = 27.1 ± 4.2 years, height = 1.78 ± 0.1 m, BMI = 28.1 ± 4.2) enrolled in a Basic Operations Firefighter Academy. Fitness and firefighting ability (via the Academy Firefighter Challenge) were assessed at Weeks 1 and 7 of the Academy. Results: Significant improvements in both fitness and firefighter ability were seen following the HIFT program. Specifically, fitness (BMI, cardiovascular fitness, muscular endurance) improved significantly [Hotelling’s T2 = 8.98, F(5, 84) = 150.92, p < 0.001, η2p = 0.90]. Firefighter ability also improved significantly [Hotelling’s T2 = 3.95, F(7, 88) = 46.26, p < 0.001, η2p = 0.80]. Conclusions: Following a 7-week Basic Operations Firefighter Academy that included daily HIFT, significant increases in fitness and firefighting ability were observed. These findings suggest that HIFT appears to be an effective means of improving fitness and firefighting ability in recruit firefighters. Full article
(This article belongs to the Special Issue Health and Fitness Outcomes from High Intensity Group Training)
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