International Journal of Environmental Research and Public Health

South Korea was a hotspot of the COVID-19 pandemic with confirmed infections quickly surpassing 10,000 people. However, the country quickly responded and contained additional infections with minimal costs of lives. Hence, the question, “what did they do differently?” Building on empirical fingerprints from over 1507 pages of South Korean government press briefings on their public sector response between 31 January 2020 and 1 July 2020, we capture the sufficiency-based mechanism in operation with two key findings. First, mechanisms matter in pandemic containment, i.e., sequence, complementary activities, and systematic settings are consequential to the witnessed outcome. Second, central government-led efforts were effective and in parts necessary to deal with invisible and rapidly spreading infections beyond a single jurisdictional boundary. These findings lead to a timely discussion on whether pandemics should be treated in the same scholarly limelight as other natural disasters. Full article

This study assessed the mineralogical and geochemical characteristics of geophagic clays sold in some markets in Cameroon to ascertain their provenance, contamination status and human health risk. To achieve this, 40 samples from 13 markets in Cameroon were purchased and analysed using X-ray diffractometry, X-ray fluorescence and laser ablation inductively coupled plasma mass spectrometry for their mineralogy and geochemistry, respectively. The geophagic clays were dominantly made up of kaolinite and quartz. Their chemistry was dominated by SiO₂, Al₂O₃ and LOI with means of 48.76 wt%, 32.12 wt% and 13.93 wt%, respectively. The major, trace and rare earth elements data showed that these geophagic clays were predominantly derived from felsic rocks. The contamination assessment indicated no enrichment of metals from anthropogenic sources, except for Zn in samples from Acacia, Madagascar and Mfoudi markets. The index of geo-accumulation indicated no contamination to moderate contamination of the clays. The non-carcinogenic index values for Fe, Co, Cr, Cu, Ni, Pb and Zn were generally less than 1, suggesting no non-carcinogenic risk exposure to children and adults consuming the geophagic clays from these metals. The carcinogenic risk index (TCR) for Ni and Cr were above 10⁻⁶, which implies that children and adults are vulnerable to minimal carcinogenic health risk. The TCR values from Ni posed the highest risk, especially to children consuming clays from some markets. Full article

University students have high rates of health risk behaviours, and these may be predictive of academic success. This cross-sectional study aimed to determine the association between individual and multiple health risk behaviours and academic achievement in a sample of Australian university students. Data from the University of Newcastle Student Healthy Lifestyle Survey 2019 were used. Health risk behaviours (diet, physical activity, sitting time, sleep, alcohol consumption, smoking) were assessed, and total number of risk factors calculated. Academic achievement was assessed using self-reported grade point average (GPA). The association between health risk behaviours and GPA was explored using linear regression, adjusted for socio-demographic and student characteristics. The sample included 1543 students (mean age 25.0 ± 7.9 years, 70.6% female). Lower GPA was associated with not meeting fruit consumption recommendations (β = −0.203), consuming >1 cup of soft drink/week (β = −0.307), having takeaway foods ≥1 time/week (β = −0.130), not consuming breakfast daily (β = −0.261), not meeting sleep recommendations (β = −0.163), exceeding single occasion alcohol consumption risk (β = −0.277), smoking (β = −0.393), and having a higher number of risk factors (β = −0.105). This study identified modest associations between GPA and health risk behaviours, suggesting that further research is warranted into whether strategies to improve university students’ health could modestly improve their academic achievement. Full article

A systematic review of published literature (2000–2019) evaluating the impact of sanitation interventions on the prevalence of disease, parasite infestation, and/or child growth using randomized controlled trials (RCTs) was done according to the PRISMA checklist. Earlier reviews indicated mixed evidence citing relatively poor quality evidence from mixed designs. Public health policy and practice appear to rely on evidence from RCTs. Records were searched in six electronic databases. The methodological quality of RCTs was assessed using the Cochrane collaboration risk of bias tool. Fifteen records (2.0%) were included for review. Impact trials were done in rural communities of African and Asian countries. The significant effect of sanitation-focus interventions was found in one trial for the prevalence of childhood diarrhea (14.3%), three trials for parasite infestation (37.5%), and two trials (25.0%) for child growth. Results indicate mixed quality evidence from RCT designs. Evidence is limited and suggestive of the impact of sanitation on parasite infestation and child growth. Further rigorous sanitation intervention trials under varying settings are needed to show what really works and under what settings. Future work may explore sanitation behavior change strategies and latrine options to address the challenges of poor latrine use under high sanitation coverage. Full article

(1) Background: The COVID-19 outbreak has created pressure in people’s daily lives, further threatening public health. Thus, it is important to assess people’s perception of stress during COVID-19 for both research and practical purposes. The Perceived Stress Scale (PSS) is one of the most widely used instruments to measure perceived stress; however, previous validation studies focused on specific populations, possibly limiting the generalization of results. (2) Methods: This study tested the psychometric properties of three versions of the Chinese Perceived Stress Scale (CPSS-14, CPSS-10, and CPSS-4) in the Chinese general population during the COVID-19 pandemic. A commercial online survey was employed to construct a nationally representative sample of 1133 adults in Mainland China (548 males and 585 females) during a one-week period. (3) Results: The two-factor (positivity and negativity) solution for the three versions of the CPSS showed a good fit with the data. The CPSS-14 and CPSS-10 had very good reliability and the CPSS-4 showed acceptable reliability. Scores on all three versions of the CPSS were significantly correlated in the expected direction with health-related variables (e.g., depression, anxiety, and perceived COVID-19 risk), supporting the concurrent validity of the CPSS. (4) Conclusions: All three versions of the CPSS appear to be appropriate for use in research with samples of adults in the Chinese general population under the COVID-19 crisis. The CPSS-10 and CPSS-14 both have strong psychometric properties, but the CPSS-10 would have more utility because it is shorter than the CPSS-14. However, the CPSS-4 is an acceptable alternative when administration time is limited. Full article

This study classified leisure activity types into active, passive, and social leisure activities based on theory, and focused on determining the type that has a significant influence on the self-efficacy and social adjustment of immigrants staying in South Korea. The results of multivariate analysis of variance (MANOVA), including post-hoc analysis using SPSS 23.0, were as follows: in principle, immigrants who participate in active or social leisure activities perceive their self-efficacy and social adjustment to be high. Differing slightly from this, the passive leisure activity type, which includes activities such as reading alone, listening to music, and surfing the web, may relieve their stress or provide them with psychological stability, but it was not found to be helpful in their adjustment to the new culture. The significance of this study lies in the finding that leisure activities help immigrants with social adjustment, in addition to physical and psychological aids that are already well known. We hope that the findings of the present study can be used as basic data for helping immigrants with smooth social adjustment and increasing their quality of life. Full article

Pandemics impose an immense psychological burden on healthcare workers due to a combination of workplace stressors and personal fears. Nurses and auxiliary nursing care technicians (ANCTs) are on the front line of this pandemic and form the largest group in healthcare practice. The aim of this study is to determine the symptoms of depression and/or anxiety among nurses and ANCTs during the periods known as the first wave (March–June) and second wave (September–November) of theCOVID-19 pandemic in Spain. An observational cross-sectional study was carried out using an anonymous, self-administered questionnaire among nurses and ANCTs practising in Spain. During the first period, 68.3% and 49.6% of the subjects presented anxiety and depression, respectively, decreasing in the second period (49.5% for anxiety and 35.1% for depression). There were statistically significant differences between the different categories and periods (p < 0.001). The COVID-19 pandemic has negatively influenced mental health in nurses and ANCTs. Mental health should be monitored and coping strategies promoted to improve the health, productivity and efficiency of these professionals. Full article

Accurate measures of alexithymia, an inability to recognise and describe one’s own emotions, that are suitable for children are crucial for research into alexithymia’s development. However, previous research suggests that parent versus child reports of alexithymia do not correlate. Potentially, children may report on the awareness of their emotions, whereas parent-report measures may reflect children’s verbal expression of emotion, which may be confounded by children’s communicative abilities, especially in conditions such as Developmental Language Disorder (DLD). Given theoretical arguments that alexithymia may develop due to language impairments, further research into alexithymia in DLD is also needed. This project examined parent and child report measures of alexithymia in children with DLD (n = 106) and without DLD (n = 183), and their association to children’s communication skills. Parent and child reports were not significantly correlated in either group, and children with DLD had higher alexithymia scores on the parent-report measure only. Thus, parent and child measures of alexithymia likely reflect different constructs. Pragmatic language problems related to more parent-reported alexithymia, over and above group membership. Structural language abilities were unrelated to alexithymia. We suggest decreased social learning opportunities, rather than a language measure artefact, underlie increased alexithymic difficulties in DLD. Full article

Based on the transactional and salutogenic perspectives, we explored individual profiles that integrate psychosocial factors and compositional elements of the built home environment. Adults with different socio-demographic characteristics completed several self-report measures on psychological factors (personality traits, self-efficacy, mental health, and happiness) and architectural elements constituting the ideal home environment. Adopting an individual-centered perspective, three distinct intra-individual psycho-architectural (person-environment) profiles were found with different compositional preferences and psychosocial characteristics in terms of functioning, health, and well-being: endopathic (characterized by higher levels of psychosocial resources and well-being indicating a highly adapted and successful profile, and architectural preferences corresponding to their identities and experiences—expression through spaces), assimilative (characterized by average levels in all regulatory parameters indicating moderately adaptive individuals, and architectural preferences of spaces created in interactive processes—introjection of spaces), and additive individuals (characterized by a comparatively dysfunctional, poorer psychosocial profile, and architectural preferences in line with provoking a restorative effect—change with spaces). An awareness of the psychosocial features of the users for whom the homes are built can help in designing spaces to inhabit that are adapted to them for an enhancement of their overall well-being. Therefore, a better understanding of the interconnections between psychology and architecture will help in designing healthy spaces. Full article

Objective: To investigate if case fatality and other indicators of the severity of human pesticide poisonings can be used to prioritize pesticides of public health concern. To study the heterogeneity of data across countries, cause of poisonings, and treatment facilities. Methods: We searched literature databases as well as the internet for studies on case-fatality and severity scores of pesticide poisoning. Studies published between 1990 and 2014 providing information on active ingredients in pesticides or chemical groups of active ingredients were included. The variability of case-fatality-ratios was analyzed by computing the coefficient of variation as the ratio of the standard deviation to the mean. Findings: A total of 149 papers were identified of which 67 could be included after assessment. Case-fatality-ratio (CFR) on 66 active ingredients and additionally on 13 groups of active ingredients were reported from 20 countries. The overall median CFR for group of pesticides was 9%, for single pesticides 8%. Of those 12 active ingredients with a CFR above 20% more than half are WHO-classified as “moderately hazardous” or “unlikely to present acute hazard”. Two of seven pesticides considered “unlikely to present hazard in normal use” showed a CFR above 20%. The cross-study variability of reported case fatality was rather low. Studies most often utilized the Glasgow Coma Score for grading the severity of poisoning. Conclusion: Although human pesticide poisoning is a serious public health problem, an unexpectedly small number of publications report on the clinical outcomes within our study period. However, CFRs of acute human pesticide poisoning are available for several groups of pesticides as well as for active ingredients showing moderate cross-study variability. Our results underline that CFR is an indicator of the human toxicity of pesticides and can be utilized to prioritize highly hazardous pesticides especially since there is limited correspondence between the animal-test-based hazard classification and the human CFR of the respective pesticide. The reporting of available poisoning data should be improved, human case-fatality data are a reasonable tool to be included systematically in the periodic statutory review of pesticides and their regulation. Full article

Gender-based violence is considered a serious social and public health problem. Overcoming this situation implies a process that results in the favorable biopsychosocial rehabilitation of the resilience of women. The objective of this study was to analyze the tools, resources and personal and psychosocial mechanisms used by women survivors of gender-based violence. The design was an interpretative phenomenology. It was carried out with 22 women who have overcome gender-based violence. Data were collected through personal interviews and narration. The results were grouped into four themes: “Process of violence”, “Social resources for coping and overcoming GBV”, “Personal tools for coping and overcoming GBV” and “Feelings identified, from the abuse stage to the survival stage”. Several studies concluded that overcoming abuse is influenced by the women’s social network, and it can be the action of these people determining their survival to gender violence. Despite the recognized usefulness of these available resources, it would be desirable to strengthen them in order to be able to drive more women toward survival, assuming a strengthening of coping and overcoming, without forgetting the importance of other support mechanisms, such as their family and group therapies. Full article

Although mental health problems among Hong Kong university students are serious, there is a lack of studies examining the psychometric properties of related assessment scales and correlates. This study attempted to validate the Depression Anxiety Stress Scales (DASS) in Hong Kong university students and examine the demographic (gender), time (cohort), and well-being correlates (positive youth development attributes and life satisfaction) of psychological morbidity. Confirmatory factor analysis (CFA) was used to examine the factor structure of the DASS (n = 6704). Gender and cohort invariance were further established using a multigroup CFA. The three-factor model of the DASS showed a superior fit and factorial invariance across gender and five different cohorts. Regarding gender and cohort correlates of psychological morbidity, males exhibited more depression, anxiety, and stress symptoms than their female counterparts. The intensity of psychological distress also escalated after the Umbrella Movement in 2014. Furthermore, well-being measures (positive youth development and life satisfaction) were negatively associated with depression, anxiety, and stress. In short, the Chinese DASS demonstrated good psychometric properties. This study also showed that gender, cohort (occurrence of political events), and well-being were associated with psychological morbidity indexed by the DASS measures. Full article

Antibiotic resistance (AR) in the environment is of great global concern and a threat to public health. Soil bacteria, including Bacillus spp., could act as recipients and reservoirs of AR genes of clinical, livestock, or agricultural origin. These genes can be shared between bacteria, some of which could be potentially human pathogens. This process can be favored in conditions of abiotic stress, such as heavy metal contamination. The Almadén mining district (Ciudad Real, Spain) is one of the environments with the highest mercury (Hg) contamination worldwide. The link between heavy metal contamination and increased AR in environmental bacteria seems clear, due to co-resistance and co-selection phenomena. In the present study, 53 strains were isolated from rhizospheric and bulk soil samples in Almadén. AR was tested using Vitek^®®2 and minimum inhibitory concentration (MIC) values were obtained and interpreted based on the criteria of the Clinical and Laboratory Standards Institute (CLSI) guidelines. Based on the resistance profiles, five different antibiotypes were established. The Hg minimum bactericidal concentration (MBC) of each strain was obtained using the plating method with increasing concentrations of HgCl2. A total of 72% of Bacillus spp. showed resistance to two or more commonly used antibiotics. A total of 38 isolates expressed AR to cephalosporins. Finally, the environmental co-selection of AR to cephalosporins and tetracyclines by selective pressure of Hg has been statistically demonstrated. Full article

The nature and extent of the impacts of intimate partner violence (IPV) on victims are well documented, particularly male partner violence against women. However, less is known about how these impacts might change over time, including their legacy after women leave an abusive relationship and the lasting effects in their later lives. The purpose of this study was to examine women’s experiences of IPV at different stages over their life courses. Interviews with a cohort of 18 older women who had left an abusive relationship were analysed using thematic narrative analysis and the findings were presented according to trajectories, transitions, and turning points over their life courses. When in the relationship, the women experienced direct impacts on their physical, mental, social, and financial wellbeing. During separation, many experienced continued abuse and housing, legal, and financial stress. Life after separation was marked by loneliness, trauma, financial insecurity, and damaged relationships. Some women reached a turning point in their recovery through helping others. Understanding these impacts can inform interventions during each stage. Crisis support is critical when women are in an abusive relationship and during the dangerous phase of separation. Interventions can also assist women’s longer-term wellbeing and help them recover through post-traumatic growth. Full article

Social distancing and the shortage of healthcare professionals during the COVID-19 pandemic, the impact of population aging on the healthcare system, as well as the rapid pace of digital innovation are catalyzing the development and implementation of new technologies and digital services in psychiatry. Is this transformation a blessing or a curse for psychiatry? To answer this question, we conducted a literature review covering a broad range of new technologies and eHealth services, including telepsychiatry; computer-, internet-, and app-based cognitive behavioral therapy; virtual reality; digital applied games; a digital medicine system; omics; neuroimaging; machine learning; precision psychiatry; clinical decision support; electronic health records; physician charting; digital language translators; and online mental health resources for patients. We found that eHealth services provide effective, scalable, and cost-efficient options for the treatment of people with limited or no access to mental health care. This review highlights innovative technologies spearheading the way to more effective and safer treatments. We identified artificially intelligent tools that relieve physicians from routine tasks, allowing them to focus on collaborative doctor–patient relationships. The transformation of traditional clinics into digital ones is outlined, and the challenges associated with the successful deployment of digitalization in psychiatry are highlighted. Full article

Web-based samples of e-cigarette users commonly report significant vaping-related health improvements (HIs) and mild adverse events (AEs). This cross-sectional study with in-person interviewing data collection examined self-reported AEs and perceived HIs among Hungarian adult current daily exclusive e-cigarette (n = 65) and dual users (n = 127), and former daily e-cigarette users (n = 91) in 2018. Logistic regression was used to evaluate associations between reporting any AEs/HIs, vaping status, and covariates. More former users (52.7%) reported AEs than current users (39.6%; p = 0.038). Exclusive and dual daily users reported similar rates of AEs (44.6% and 37.0%, respectively; p = 0.308). More current users (46.9%) experienced HIs than former users (35.2%; p = 0.064). Exclusive daily users were more likely to report HIs than dual users (63.1% versus 38.6%; p = 0.001). Former user status and smoking cessation/reduction reasons increased the odds of reporting AEs, whereas nicotine-containing e-liquid use and older age decreased the odds of reporting AEs. Exclusive vaper status, using advanced generation devices, and smoking cessation/reduction reasons increased the odds of experiencing HIs. This study, which used a traditional data collection methodology, found a higher rate of AEs and a lower rate of HIs compared to web-based surveys. Our results highlight that experiencing AEs and HIs is affected by users’ characteristics, in addition to the device and e-liquid type. Full article

The main challenge of interventions in penitentiary institutions is the re-education and reintegration of inmates, i.e., that inmates have the intention and ability to live law-abiding lives. Therefore, an increase in self-control or, on the contrary, the decrease or elimination of impulsive versus compulsive behaviors becomes necessary. This study aimed to evaluate the role of impulsivity versus compulsivity in treatment adherence in the prison population. The study included 134 men from the Penitentiary Center of Granada who were divided into two groups. Group 1 was considered treatment adherent, and Group 2 was considered non-adherent to treatment. The following instruments were used: Symptom Inventory (SCL-90-R), Addiction Severity Index (EuropASI), Impulsivity Scale (UPPS-P), and Compulsive Belief Questionnaire (OBQ-44). Statistically significant differences were found in impulsivity in the dimensions of negative urgency, sensation seeking, and positive urgency, with higher scores in all cases for the non-adherent group than for the adherent group. We also found statistically significant differences in responsibility/inhibition, perfectionism/uncertainty, and importance/control, with higher scores for the non-adherent group compared to the adherent group. Treatment adherence is inversely related to impulsive and compulsive behaviors. Full article

Sarcopenia is a geriatric syndrome which is likely to cause disability, body unbalance, and mortality and thus can lead to heavy healthcare expenditure and caregiver burden. Although some studies have addressed the prevalence of sarcopenia for older adults, there are limited studies conducted in daycare centers. The present study aimed to (i) estimate the prevalence of sarcopenia and (ii) explore associated factors of sarcopenia and standing balance among older adults admitted to daycare centers in Taiwan. The cross-sectional study collected data on demographics, health status, handgrip strength, gait speed (GS), skeletal muscle mass, Taiwan-Mini Nutritional Assessment Short-Form (TW-MNA-SF), and Short Physical Performance Battery from daycare centers in northern Taiwan. The definition of sarcopenia followed the Asian Working Group for Sarcopenia 2019 guidelines. Among 173 participants ≥65 year-old, 50.9% had confirmed sarcopenia, 47.4% possible sarcopenia, and 1.7% normal. Results showed that calf circumference, TW-MNA-SF, dementia, and body mass index (BMI) were associated with sarcopenia. Moreover, BMI, GS, and sarcopenia were associated factors of standing balance. The study estimated a high prevalence of sarcopenia in daycare centers and identified some significant factors of sarcopenia and standing balance. Early nutritional and physiotherapy interventions could benefit older adults to prevent sarcopenia or unbalance. Full article

Background: The first wave of the COVID-19 pandemic in Spain posed a major challenge for Spanish dental professionals. The objective of this work is to describe the dental hygienists’ work status and employment patterns during the de-escalation phase in order to analyse the standards of knowledge, compliance with official recommendations, and dental activities both in the public health service and in the private sector. Material and Methods: A cross-sectional questionnaire was answered by Spanish dental hygienists via WhatsApp, Facebook, and Instagram. The questionnaire was piloted before it was distributed and carried out during June 2020. Results: Here, 517 dental hygienists were surveyed, of which 86.2% followed the official recommendations to avoid contagion and 63.8% agreed with the gradual return to work by limiting the use of aerosols. Private dental hygienists identified more with returning to work without restrictions (14.5%) versus those working for the public service (1.2%) (p < 0.005). Conclusions: Dental hygienists’ return to work has involved different strategies, aimed at controlling infection and guaranteeing the safety of patients and the rest of the dental team. The availability of personal protective equipment, the adaptation of clinical infrastructure, and patient care management have differed between professionals working in the private and public sectors. Full article