International Journal of Environmental Research and Public Health — Open Access Journal

It has been reported that oxidative and nitrative stress might be the pathogenesis of endometriosis. This prospective case-control study attempted to check the connection between single nucleotide polymorphism (SNP) of three antioxidant enzymes (glutathione peroxidase 4 (GPX4), thioredoxin 2 (TXN2), thioredoxin reductase 1 (TXNRD1)) and endometriosis. We recruited 90 patients with histology-approved endometriosis as the case group and 130 age-matched women for an annual pap smear examination as the control group. The stage of endometriosis was evaluated with revised ASRM score. Both groups were genotyped in the peripheral leukocytes for the SNP of GPX4 (rs713041), TXN2 (rs4821494) and TXNRD1 (rs1128446) by PCR-based methods. An X² test was used to analysis of the difference of allele frequency and SNP distribution between two groups. The results revealed GPX4 (rs713041) has a significantly different distribution between two groups (C:T = 116 (44.6%):144 (55.4%) in control and C:T = 104 (57.8%): 76 (42.2%) in endometriosis groups, p = 0.007). The SNP in TXN2 (rs4821494) also showed a difference in allele frequency (G:T = 180 (69.2%):80 (30.8%) in control and G:T = 141 (78.3%):39 (21.6%) in endometriosis group, p = 0.030). In addition, the SNP GPX4 (rs713041) was associated with the severity of the endometriosis. Women who have advanced stage endometriosis were different from mild endometriosis in genetic variants of GPX4 gene (p = 0.001). In conclusion, the relationship between endometriosis and SNP of antioxidant enzymes, GPX4 and TXN2, was confirmed by the present study. According to the result, we suggested that the GPX4 might contribute to the pathogenesis of endometriosis. Full article

The state of Qatar suffers from diabetes epidemic due to obesity-associated metabolic syndrome. However, the prevalence of insulin resistance prior to obesity, which could play an important role in the high prevalence of diabetes, has not yet been described. This study aims to compare the prevalence of insulin resistance in apparently healthy non-obese and obese participants from Qatar and identify the predictors of insulin resistance in different body mass index (BMI)-groups. In this cross-sectional study, 150 young healthy females from Qatar were dichotomized into four groups (underweight, normal weight, overweight and obese) based on their BMI. Anthropometric measures as well as fasting plasma levels of lipids, adipokines, blood glucose and insulin were recorded. The prevalence of insulin resistance as per homeostatic model assessment of insulin resistance (HOMA-IR) was estimated and differences between insulin sensitive and insulin resistant were compared. Linear models were used to identify predictors of insulin resistance in every BMI group. Prevalence of insulin resistance in non-obese healthy females from Qatar ranges between 7% and 37% and increases with BMI. Overall, predictors of insulin resistance in the Qatari population are triglycerides/high-density lipoprotein (HDL) ratio and free fat mass but vary according to the BMI group. The main predictors were triglycerides in normal weight, triglycerides/HDL in overweight and triglycerides/HDL and interleukin-6 (IL-6) in obese individuals. The high prevalence of insulin resistance in non-obese Qataris may partially explain diabetes epidemic. Larger studies are warranted to confirm these findings and identify underlying causes for insulin resistance in non-obese individuals in Qatar, aiming at targeted intervention before diabetes onset. Full article

Prenatal smoking exposure and early-life respiratory infections are major determinants of asthma during childhood. We investigate the factors influencing allergic sensitization (AS), asthma, and lung function in children and the balance between individual and environmental characteristics at different life stages. 1714 children aged 7–16 years and living in southern Italy were investigated using a parental questionnaire, skin prick tests, and spirometry. We found 41.0% AS prevalence: among children without parental history of asthma, male sex, maternal smoking during pregnancy (MatSmoke), and acute respiratory diseases in the first two years of life (ARD2Y) were significant risk factors for AS. MatSmoke was associated (OR = 1.79) with ARD2Y, and this association was influenced by sex. ARD2Y was, in turn, a significant risk factor (OR = 8.53) for childhood current asthma, along with AS (OR up to 3.03) and rhinoconjuctivitis (OR = 3.59). Forced mid-expiratory flow (FEF_25–75%) was negatively affected by ARD2Y, with a sex-related effect. Thus, males exposed to MatSmoke had significantly lower FEF_25–75% than unexposed males. Despite the difficulty of discriminating among the complex interactions underlying the development of allergic respiratory diseases, ARD2Y appears to strongly influence both asthma and lung function during childhood. In turn, ARD2Y is influenced by prenatal exposure to tobacco smoke with a sex-dependent effect. Full article

Due to the rapid increase in the number of elderly people in Chinese cities, the development and planning of aged care facilities, and particularly community care facilities, which will gradually become the mainstream choice for the elderly in China, is becoming an important topic for urban sustainability. Previous studies have shown that the number and scale of aged care facilities in many cities are far from meeting the needs of the elderly and the overall occupation rate is low. Some of these cities are still expanding and some are undergoing urban renovation. In this process, the scientific planning of community care facilities to promote efficient use of facility resources has become an urgent problem that needs to be solved. In this study, the two-step floating catchment area (2SFCA) method and a potential model based on the Geographic Information System (GIS) were used to carry out a scientific evaluation of the spatial accessibility of community care facilities in the Beilin district of Xi’an. The aims were to explore the best quantitative research methods for assessing the distribution of Xi’an community care facilities’ spatial accessibility, provide ideas for similar studies in the future, and further the understanding of spatial allocation of urban community care facilities resources. Full article

The present study examines the association between cognitive social capital and structural social capital and aging-in-place among older adults living in rural Northeastern Chinese communities. Data were derived from a survey conducted in Dongliao County, Jilin Province, China, in late 2019. A quota sampling approach was used to recruit 458 respondents aged 60 years and older. Structural equation modeling was applied to test the proposed model. The results show that the measurement models of cognitive social capital and structural social capital were established in rural Chinese communities. Structural social capital was found to have a higher effect on aging in place than cognitive social capital (structural social capital: β = 0.241, p < 0.001; cognitive social capital: β = 0.118, p < 0.05). The findings highlight the crucial role both cognitive and structural social capital play in affecting the preference for aging in place among older rural Chinese adults. Policy and intervention implications are discussed. Full article

Green walls have previously demonstrated the capacity to reduce particulate matter (PM), noise pollution, and temperature conditions in manipulative experiments and computational models. There is, however, minimal evidence that green walls can influence ambient environmental conditions, especially taking into account the variable environmental conditions encountered in situ. The aim of this paper was to determine if green walls have a quantitative effect on ambient air quality in an urban environment. Ambient PM, noise, and temperature were recorded at 12 green wall and adjacent reference wall locations across a dense urban centre, over a 6-month period. The results indicated that PM levels and temperature did not significantly differ between the green wall and reference wall sites. Ambient noise at the green wall sites, however, was significantly lower than at the reference wall locations. It is suggested that mechanically assisted, or ‘active’ green wall systems may have a higher PM and temperature reduction capacity, and if so, they will be more valuable for installation in situ compared to standard passive systems, although this will require further research. Full article

Obesity affects both medical and surgical outcomes in renal transplant recipients (RTRs). Dietary diversity, an important component of a healthy diet, might be a useful nutritional strategy for monitoring patients with obesity. In this cross-sectional study, the data of 85 eligible RTRs were analyzed. Demographic data, routine laboratory data, and 3-day dietary data were collected. Participants were grouped into nonobesity and obesity groups based on body mass index (BMI) (for Asian adults, the cutoff point is 27 kg/m²). Dietary diversity score (DDS) was computed by estimating scores for the six food groups emphasized in the Food Guide. The mean age and BMI of participants were 49.7 ± 12.6 years and 24.0 ± 3.8 kg/m², respectively. In the study population, 20.0% (n = 17) were obese. DDS was significantly lower in obese participants than in those who were not obese (1.53 ± 0.87 vs. 2.13 ± 0.98; p = 0.029). In addition, DDS was correlated with nutrition adequacy of the diet. Multivariate analysis showed that the odds of obesity decreased with each unit increase in DDS (odds ratio, 0.278; 95% confidence interval, 0.101–0.766; p = 0.013). We conclude that patients with higher dietary diversity have a lower prevalence of obesity. Full article

The aim of this study was to investigate the prevalence of the clinical features of the SARS-CoV-2 infection in Romanian population through a novel online survey. The survey included categorical socio-demographic and health-related variables. A total of 1830 participants were selected for statistical data processing (a response rate of 90.9%). We determined reasonable reliability of the survey section for clinical features of SARS-CoV-2 infection (Cronbach’s Alpha 0.671). Two meaningful dimensions were identified through CATPCA (Categorical Principal Component Analysis) for the survey’s items. We separated two significant clusters of items, each measuring a distinct factor: the sociodemographic characteristics linked to social distancing and the relevant clinical features of SARS-CoV-2 infection. Next, a two-step cluster analysis helped to classify the sample group taking into consideration the similarity of subjects. The clustering revealed a three-cluster solution, with significant differences between clusters and allowed the cluster detection of a group of individuals, possibly more affected by the infection with the SARS-CoV-2 virus. Through binomial logistic regression analysis, we identified a statistically significant prediction model for the presumptive diagnostic of some relevant clinical features of SARS-CoV-2 infection. Our study validated a cost-effective model for rapid assessment of the health status of subjects, adapted to the context of SARS-CoV-2 pandemic. Full article

Background: COVID-19 has greatly attacked China, spreading in the whole world. Articles were posted on many official WeChat accounts to transmit health information about this pandemic. The public also sought related information via social media more frequently. However, little is known about what kinds of information satisfy them better. This study aimed to explore the characteristics of health information dissemination that affected users’ information behavior on WeChat. Methods: Two-wave data were collected from the top 200 WeChat official accounts on the Xigua website. The data included the change in the number of followers and the total number of likes on each account in a 7-day period, as well as the number of each type of article and headlines about coronavirus. It was used to developed regression models and conduct content analysis to figure out information characteristics in quantity and content. Results: For nonmedical institution accounts in the model, report and story types of articles had positive effects on users’ following behaviors. The number of headlines on coronavirus positively impacts liking behaviors. For medical institution accounts, report and science types had a positive effect, too. In the content analysis, several common characteristics were identified. Conclusions: Characteristics in terms of the quantity and content in health information dissemination contribute to users’ information behavior. In terms of the content in the headlines, via coding and word frequency analysis, organizational structure, multimedia applications, and instructions—the common dimension in different articles—composed the common features in information that impacted users’ liking behaviors. Full article

Digitalization of knowledge work is essential for today’s organizations, responding to diversified employee needs. Many organizations are already implementing some form of flexibility to help workers perform work and non-work duties, while maintaining high productivity. While these changes in workplaces, “New Ways of Working (NWW)”, have been discussed in the literature, a systematic appraisal of evidence of NWW has not been conducted. Relating to poor work-related mental health worldwide, this systematic review analyzed the psychological impacts of NWW, and the quality and quantity of NWW research. Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, NWW studies targeting psychological outcomes were evaluated. Initial literature search on ProQuest, PsycINFO, Science Direct, and Google Scholar retrieved 308 titles, from which seven articles fulfilled all inclusion criteria. Our appraisal revealed that NWW research evaluated diverse psychological outcomes. While NWW can help workers’ engagement, work-related flow, and connectivity among staff, NWW can also increase blurred work-home boundary, fatigue, and mental demands. The quality of NWW research was overall medium, needing more rigorous studies. Our findings can inform decision-makers in the workplace to effectively implement NWW, and researchers to improve the quality and the usefulness of future NWW studies. Full article

We describe an effort to improve the care of Medicaid and uninsured individuals through a three-way partnership between a Medicaid managed care insurer, front-line providers, and an academic university. The project provided annual funding over eleven years, for research, pilot programs, and demonstration projects. Projects were provider-driven in design and methods. The Medicaid-managed care insurer-funded proposals were vetted by a neutral university team experienced in grant writing and community-based research and scored by a community-based review panel. The grant program ran from 2007 to 2018, funding 41 projects, totaling USD 2,097,842. The partnership of an insurer, a university, and frontline providers was not only viable and sustainable for over a decade, but also flexible, free of project selection issues, and well-received by all stakeholders. Funded providers worked in both urban and rural settings and included hospitals, community non-profits, outpatient clinics, academic and community health partnerships, and public health agencies. The projects generally reflected common issues in the Medicaid and uninsured population needs, such as childhood obesity, and they were consistent with the targeted goals of the program. Broad health foci included child and/or maternal health, chronic conditions, mental health, preventive health, screening, system effectiveness, special populations including refugees, Latinos, and rural individuals, and substance use disorders. Details of the awarded grantee goals, the grants management process, and lessons learned from the partnership are presented. The partnership triad model was effective and stable, with each partner adding unique value. The use of the academic institution to administrate the program provided an arms-length relationship between the insurer and the providers in project selection and allowed assistance to less experienced researchers in community settings. Full article

Involving and engaging stakeholders is crucial for studying and managing the complex interactions between marine ecosystems and human health and wellbeing. The Oceans and Human Health Chair was founded in the town of Roses (Catalonia, Spain, NW Mediterranean) in 2018, the fruit of a regional partnership between various stakeholders, and for the purpose of leading the way to better health and wellbeing through ocean research and conservation. The Chair is located in an area of the Mediterranean with a notable fishing, tourist, and seafaring tradition and is close to a marine reserve, providing the opportunity to observe diverse environmental conditions and coastal and maritime activities. The Chair is a case study demonstrating that local, collaborative, transdisciplinary, trans-sector, and bottom-up approaches offer tremendous opportunities for engaging coastal communities to help support long-lasting solutions that benefit everyone, and especially those living by the sea or making their living from the goods and services provided by the sea. Furthermore, the Chair has successfully integrated most of its experts in oceans and human health from the most prestigious institutions in Catalonia. The Chair focuses on three main topics identified by local stakeholders: Fish and Health; Leisure, Health, and Wellbeing; and Medicines from the Sea. Led by stakeholder engagement, the Chair can serve as a novel approach within the oceans and human health field of study to tackle a variety of environmental and public health challenges related to both communicable and non-communicable diseases, within the context of sociocultural issues. Drawing on the example provided by the Chair, four principles are established to encourage improved participatory processes in the oceans and human health field: bottom-up, “think local”, transdisciplinary and trans-sectorial, and “balance the many voices”. Full article

Globally, water scarcity has become a common challenge across many regions. Digital surveillance holds promise for monitoring environmental threats to population health due to severe drought. The 2019 Chennai water crisis in India resulted in severe disruptions to social order and daily life, with local residents suffering due to water shortages. This case study explored public opinion captured through the Twitter social media platform, and whether this information could help local governments with emergency response. Sentiment analysis and topic modeling were used to explore public opinion through Twitter during the 2019 Chennai water crisis. The latent Dirichlet allocation (LDA) method identified topics that were most frequently discussed. A naïve Tweet classification method was built, and Twitter posts (called tweets) were allocated to identified topics. Topics were ranked, and corresponding emotions were calculated. A cross-correlation was performed to examine the relationship between online posts about the water crisis and actual rainfall, determined by precipitation levels. During the Chennai water crisis, Twitter users posted content that appeared to show anxiety about the impact of the drought, and also expressed concerns about the government response. Twitter users also mentioned causes for the drought and potential sustainable solutions, which appeared to be mainly positive in tone. Discussion on Twitter can reflect popular public opinion related to emerging environmental health threats. Twitter posts appear viable for informing crisis management as real-time data can be collected and analyzed. Governments and public health officials should adjust their policies and public communication by leveraging online data sources, which could inform disaster prevention measures. Full article

This article attempts to investigate the impacts of bilateral trade on the environment by estimating the embodied carbon emissions between China and Germany over the period 1999–2018. The above impacts are broadly explored in the literature both under the framework of theoretical and empirical analysis. However, there exist fewer empirical studies exploring the nonlinear relationship between trade volumes and carbon emissions between a well-developed and emerging economies. By applying the multiregional input-output (MRIO) model, this article aims to reveal the impacts of trade on the environment in the case of China–Germany. Specifically, trade amounts between China and Germany rank high with a similarly increasing trend and both of them are large net exporting countries. However, China experienced much larger carbon emissions embodied in its exports to Germany. Despite potential concerns on the carbon leakage issue of China from Germany, we find that the bilateral trades fit an inverse U-shape in the embodied carbon emissions, which suggests that the trade between the two countries can finally reduce carbon intensity without obstructing economic development particularly in the long-term. This paper guides policy-makers to quantify the issue of CO₂ transfer among bilateral trades in order to achieve the target of trading sustainability. Full article

Quantitative assessment can scientifically determine the health status of a regional ecosystem, identify regional eco-environmental problems, and assist in promoting regional sustainable development and environmental management. Taking China’s important ecological function region, the Yellow River affected area as an example, this study constructed an extended evaluation index system based on the pressure-state-response framework, and remote sensing and GIS techniques were used to dynamically evaluate the spatial and temporal characteristics of ecosystem health in the study area. Furthermore, influencing factors on ecosystem health in the study area were extensively analyzed using the GeoDetector model. The results show that the ecosystem health level in the study area shows significant spatial heterogeneity from 1995–2015, and showed a fluctuating change process. Areas with large fluctuations in health level were mainly distributed in extreme climate areas, ecologically fragile areas, on plains and in hilly areas. Spatial differences of ecosystem health were well explained by using the biological abundance index, relief degree of land surface, soil type, annual average precipitation, elevation, annual average temperature, and population density. Influencing factors have significant interactive effects on ecosystem health. Full article

Psychological distress during the COVID-19 pandemic is not solely limited to SARS-CoV-2 infection. It may also be related to social, cultural, and environmental factors, which may act as additional stressors. The aim of the current study was to explore the association between psychological distress and subjective overload among dentists in different countries, and whether it is associated with COVID-19-related factors. A cross-sectional survey was conducted among 1302 dentists from China, India, Israel, Italy, and the UK, who filled out demographics data, COVID-19-related factor questions, subjective overload, and psychological distress scales. Our findings showed that the positive association between subjective overload and psychological distress was different among countries, suggesting higher rate of intensity in Italy compared to China, India, and Israel (the UK was near significance with China and Israel). The interaction variable of the subjective overload × psychological distress was significantly associated with a particular country, with those individuals reporting fear of contracting COVID-19 from patients, fear of their families contracting COVID-19, and receiving enough professional knowledge regarding COVID-19. Given the above, dentists were found to have elevated levels of subjective overload and psychological distress, which differed among the countries, presumably due to certain background issues such as social, cultural, and environmental factors. Full article

This study aimed to examine the mediating effects of self-stigma and depression on the public stigma and nurses’ attitudes toward psychiatric help. A cross-sectional study with 184 nurses at one general hospital in South Korea was conducted employing a self-administered survey, using the Attitudes toward Seeking Psychological Help Scale, the Beck Depression Inventory-II Scale, and the modified Depression Stigma Scale. A multiple-mediation analysis procedure was applied to analyze the data. Each indirect effect of self-stigma (B = −0.0974, bootLLCI, bootULCI: −0.1742, −0.0436) and depression (B = −0.0471, bootLLCI, bootULCI: −1014, −0.0060) is statistically significant in the relationship between public stigma and attitudes toward psychiatric help. The individualized intervention for enhancing positive attitude or motivation for seeking help at the personal level of the nurse and depression tests—including regular physical health check-ups—is necessary. Full article

End-of-life (EOL) care for terminal illness and life-limiting conditions is a sector in the health service spectrum that is drawing increased attention. Despite having the world’s longest life expectancy and an ever-escalating demand for long-term care, Hong Kong’s EOL care was underdeveloped. The current study aims to provide a holistic picture of gaps and issues to EOL care in Hong Kong. Data collection was conducted using a multi-method qualitative approach that included focus groups and in-depth interviews with key informants and stakeholders, and longitudinal case studies with patients and families. Deductive thematic analysis was used to examine service gaps in current EOL care through the lens of a socioecological model where gaps and issues in various nested, hierarchical levels of care as well as the relationships between these levels were studied in detail. Using the model, we identified gaps and issues of EOL care among older populations in Hong Kong at the policy, legal, community, institutional, as well as intrapersonal and interpersonal levels. These include but are not limited to a lack of overarching EOL care policy framework, ambiguity in the legal basis for mental incapacity, legislative barriers for advance directives, inadequate capacity, resources, and support in the community to administer EOL care, inadequate knowledge, training, and resources for EOL care in health and social care sectors, inadequate medical-social interface, general reluctance and fear of death and dying, as well as the cultural interpretation of filial piety that may lengthen the suffering of the dying patients. Findings highlight the multi-level gaps and issues of EOL care in a place where western and eastern culture meet, and shed light on how best to design more effective and comprehensive policy interventions that will likely have a more sustainable and instrumental impact on facilitating person-centered EOL care during the end of life. Full article

Acute respiratory infections have been established as the principal cause of disease in the Mexican population from 2000 to 2018; however, even when these diseases may aggravate asthma, there is a lack of epidemiologic evidence on the health outcomes when both conditions coexist. Learning about the asthma hospitalizations trends will help us identify monthly variation of hospitalizations, vulnerable groups, needed services, and improvements in therapeutics and prevention. This study aims to analyze the variation in asthma hospitalizations and mortality during the 2010–2018 period in Mexico. Data were obtained from the General Board of Health Information (DGIS) Open Access datasets, which were analyzed taking hospital discharges and hospital deaths recorded from 2010 to 2018 from all public hospitals nationwide. The binomial logistic regression analyses were performed to determine the association between patient ages, hospitalization month, and mortality. The death rate from asthma in Mexico decreased between 2010 and 2018. Still, the hospital mortality rate shows recent improvement; however, prognosis of hospitalized patients depends on their age, accurate diagnosis, length of hospital stay and occurrence of nosocomial infection. Full article