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

Background: Recent evidence has converged in showing that the lateral occipitotemporal cortex is over-recruited during implicit motor imagery in elderly and in patients with neurodegenerative disorders, such as Parkinson’s disease. These data suggest that when automatically imaging movements, individuals exploit neural resources in the visual areas to compensate for the decline in activating motor representations. Thus, the occipitotemporal cortex could represent a cortical target of non-invasive brain stimulation combined with cognitive training to enhance motor imagery performance. Here, we aimed at shedding light on the role of the left and right lateral occipitotemporal cortex in implicit motor imagery. Methods: We applied online, high-frequency, repetitive transcranial magnetic stimulation (rTMS) over the left and right lateral occipitotemporal cortex while healthy right-handers judged the laterality of hand images. Results: With respect to the sham condition, left hemisphere stimulation specifically reduced accuracy in judging the laterality of right-hand images. Instead, the hallmark of motor simulation, i.e., the biomechanical effect, was never influenced by rTMS. Conclusions: The lateral occipitotemporal cortex seems to be involved in mental representation of the dominant hand, at least in right-handers, but not in reactivating sensorimotor information during simulation. These findings provide useful hints for developing combined brain stimulation and behavioural trainings to improve motor imagery. Full article

It seems that the medical personnel in contact with patients infected with SARS-CoV-2 are at an especially high risk of adverse psychological effects. Therefore, the aim of this study was to assess the mental health factors among healthcare workers by quantifying the severity of anxiety, depression, and sleep disorders during the current SARS-CoV-2 pandemic, while taking into account coexisting diseases. The study involved 441 healthcare professionals including 206 healthcare workers at emergency wards, infectious wards, and intensive care units. The control group consisted of 235 healthcare workers working in wards other than those where individuals from the study group worked. Regression adjusted by age, gender, the occurrence of hypertension, diabetes mellitus, dyslipidemia, asthma, autoimmune diseases, and cigarette smoking showed the elevated risk of anxiety on the Generalized Anxiety Disorder (GAD-7) scale (OR = 1.934; p < 0.001), depression on the Patient Health Questionnaire (PHQ-9) scale (OR = 2.623; p < 0.001), and sleep disorders on the Insomnia Severity Index (ISI) scale (OR = 3.078; p < 0.001). Our study showed that healthcare workers who are exposed to SARS-CoV-2-infected patients at emergency wards, infectious wards, and intensive care units are at a much higher risk of showing symptoms of anxiety, depression, and sleep disorders than healthcare workers working in other wards. Full article

The COVID-19 pandemic has changed the orders and structures of societies, particularly in the fields of medical and nursing professions. The researcher aims to understand the experiences, sense of belonging, and decision-making processes about Japanese pre-service nursing students and how the COVID-19 pandemic, social distancing, and lockdown has influenced their understanding as pre-service nursing professionals in Japan. As this study focuses on the issues of pre-service nursing students, the researcher invited forty-nine pre-service nursing students for a virtual interview due to the recommendation of social distancing. To increase the coverage of the population, the researcher employed snowball sampling to recruit participants from all over Japan. Although the COVID-19 pandemic influenced the overall performance of the medical and nursing professions, all participants showed a sense of belonging as Japanese citizens and nursing professionals due to the natural disaster of their country. More importantly, all expressed their desires and missions to upgrade and improve the overall performance of the public health system due to the influence of the COVID-19 pandemic. The results discovered that many Japanese nursing students advocated that Japan’s national development, the benefits and advantages of their country, were of a greater importance than their own personal development and goals. Full article

This study tested the effect of person–organization fit (P-O fit) in mediating the link between job satisfaction and hospital performance with income as a moderator. A questionnaire survey was conducted on 301 physicians from two public hospitals in Zhejiang province of China. Respondents were asked to rate their job satisfaction, value congruence (P-O fit) with the hospital, and the hospital’s performance. The mediating effect of P-O fit on the link between job satisfaction and hospital performance was tested through partial least squares-structural equation modeling (PLS-SEM). Income was introduced to the model as a moderator on the “P-O fit → hospital performance” and “job satisfaction → hospital performance” path, respectively. Higher job satisfaction and P-O fit were associated with higher ratings on hospital performance (p < 0.01). P-O fit had a partial mediating effect on the association between job satisfaction and hospital performance, accounting for 73% of the total effect. The effects of P-O fit and job satisfaction on hospital performance were stronger in the respondents with higher income. Overall, high job satisfaction is associated with high ratings on hospital performance, which is partially mediated through P-O fit. Value congruence is particularly important when financial tools are used to incentivize hospital physicians. Full article

Although environmental epidemiology studies often rely on geocoding procedures in the process of assigning spatial exposure estimates, geocoding methods are not commonly reported, nor are consequent errors in exposure assignment explored. Geocoding methods differ in accuracy, however, and, given the increasing refinement of available exposure models for air pollution and other exposures, geocoding error may account for an increasingly larger proportion of exposure misclassification. We used residential addresses from a reasonably large, dense dataset of asthma emergency department visits from all New York City hospitals (n = 21,183; 26.9 addresses/km²), and geocoded each using three methods (Address Point, Street Segment, Parcel Centroid). We compared missingness and spatial patterning therein, quantified distance and directional errors, and quantified impacts on pollution exposure estimates and assignment to Census areas for sociodemographic characterization. Parcel Centroids had the highest overall missingness rate (38.1%, Address Point = 9.6%, Street Segment = 6.1%), and spatial clustering in missingness was significant for all methods, though its spatial patterns differed. Street Segment geocodes had the largest mean distance error (µ = 29.2 (SD = 26.2) m; vs. µ = 15.9 (SD = 17.7) m for Parcel Centroids), and the strongest spatial patterns therein. We found substantial over- and under-estimation of pollution exposures, with greater error for higher pollutant concentrations, but minimal impact on Census area assignment. Finally, we developed surfaces of spatial patterns in errors in order to identify locations in the study area where exposures may be over-/under-estimated. Our observations provide insights towards refining geocoding methods for epidemiology, and suggest methods for quantifying and interpreting geocoding error with respect to exposure misclassification, towards understanding potential impacts on health effect estimates. Full article

Fungal community analyses in homes have been attracting attention because fungi are now generally considered to be allergens. Currently, these analyses are generally conducted using the culture method, although fungal communities in households often contain species that are difficult to culture. In contrast, next-generation sequencing (NGS) represents a comprehensive, labor- and time-saving approach that can facilitate species identification. However, the reliability of the NGS method has not been compared to that of the culture method. In this study, in an attempt to demonstrate the reliability of this application, we used the NGS method to target the internal transcribed spacer 1 (ITS1) in the fungal genome, conducted fungal community analyses for 18 house-dust samples and analyzed fungal community structures. The NGS method positively correlated with the culture method regarding the relative abundance of Aspergillus, Penicillium, Cladosporium and yeasts, which represent the major fungal components found in houses. Furthermore, several genera, such as Malassezia, could be sensitively detected. Our results imply that the reliability of the NGS method is comparable to that of the culture method and indicates that easily available databases may require modifications, including the removal of registrations that have not been sufficiently classified at the genus level. Full article

The aim of this cross-sectional study was to determine non-medical and organizational needs among cancer patients during diagnosis and treatment. The study included 384 cancer patients treated in five oncological centers in Poland. A questionnaire designed for the study was used. Most of the patients received psychological support from their partner/family/friends (88%), to a lesser extent from a psychologist (21%) and priests (4%). Forty-three percent of patients received social support from their partner/family/friends and only 7% of respondents received support from a social worker. Most patients stated they would like to have a professional who would help them with their non-medical problems during the diagnostic process and cancer treatment. The youth, with a higher education level who were professionally active and living in cities seemed to be more aware of their needs. Improvements to the oncological system in Poland should focus on expanding patient access to professional support of non-medical needs. Full article

The first two years of a child’s life are a critical period in preventing several lifestyle-related health problems. A qualitative study was conducted to explore parental experiences and perspectives in relation to lifestyle-related child-rearing practices in order to minimize risk factors at an early stage. Data were collected through interviews (n = 25) and focus groups (n = 4) with parents of children aged 0–2 years, in a disadvantaged neighborhood in Amsterdam, the Netherlands. Results showed that parents were often uncertain about a number of lifestyle-related practices. Ambiguity also appeared regarding the parents’ intentions to engage in certain practices and what they were able to achieve in everyday life. In addition, parents experienced strong sociocultural influences from their family, which interfered with their ability to make their own decisions on lifestyle-related practices. Parents also expressed a need for peer-support and confirmation of their practices. Future studies should focus on supporting parents in their parental practices during the first two years of their child’s life. Any such study should take into account the specific sociocultural context accompanying lifestyle-related parental practices. Full article

Despite the widespread use of the expression “physical activity pattern” (PAP), there apparently is no general consensus regarding its definition. This systematic review aimed to examine available research focussing on (1) definitions of PAP, (2) instruments/techniques used to describe PAP, (3) statistical approaches used to analyse PAP, and (4) implications of PAP on children’s health. A systematic review of the available literature was done to identify studies published up to October 2019, and 76 studies were eligible. None of the studies presented a formal definition of PAP; a wide range of instruments were used to investigate children’s PAP, and most of the revised studies did not explicitly present a formal statistical model to define PAP. Twenty-four papers purported to examine associations between PAP and health indicators. The review highlights no consensus on a clear PAP definition whatever the instrument used to capture it, and we did not find any agreement regarding how best to analyse PAP. We suggest that PAP should be used when targeting the investigation of similarities/dissimilarities, as well as stabilities and/or changes in children’s PA at an intra-personal level. In sum, PAP should be used to best describe individual streams of behaviours, and not exclusively PA levels/intensities. Full article

Although studies have shown that per- and polyfluoroalkyl substances (PFAS) are potential environmental ototoxicants, epidemiologic study has been limited. I conducted a cross-sectional study to re-examine the associations between PFAS and hearing impairment. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999–2000, 2003-06, 2009-12, and 2015-16. Perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA) were measured in serum samples. Participants were divided into quartiles for each PFAS. Air conduction pure-tone audiometry was administered. Hearing impairment (1: yes, 0: no) was defined as a hearing threshold of more than 25 dB at 500, 1000, 2000, 4000, and 8000 Hz in the worse ear. I assessed the relation of serum PFAS with hearing impairment by the generalized linear mixed model with a logit link and binary distribution. Tests for linear trend across quartiles of serum PFAS were conducted using the median serum PFAS in each quartile as a continuous variable. After adjusting for age, sex, body mass index, education, ethnicity group, and family income, I found positive correlations between PFOA and hearing impairment at 2000 Hz (p-trend < 0.01) and 3000 Hz (p-trend = 0.02); between PFOS and hearing impairment at 500 Hz (p-trend < 0.01), 2000 Hz (p-trend < 0.0001) and 3000 Hz (p-trend = 0.02); between PFNA and hearing impairment at 2000 Hz (p-trend = 0.05), 3000 Hz (p-trend < 0.01), 4000 Hz (p-trend = 0.02), and 8000 Hz (p-trend < 0.01); between PFHxS and hearing impairment at 500 Hz (p-trend = 0.04), 1000 Hz (p-trend = 0.03), and 2000 Hz (p-trend < 0.01). However, some of the findings were not significant when only comparing the highest with the lowest quartile of PFASs. In conclusion, several background serum PFASs are positively correlated with hearing impairment in the United States adult population. Full article

Background: To determine the relationship between physiological fatigue and the quality of cardiopulmonary resuscitation (CPR) in trained resuscitators in hostile thermal environments (extreme cold and heat) simulating the different conditions found in an out-of-hospital cardiorespiratory arrest. Methods: Prospective observational study involving 60 students of the health sciences with training in resuscitation, who simulated CPR on a mannequin for 10 min in different thermal environments: thermo-neutral environment (21 °C and 60% humidity), heat environment (41 °C and 98% humidity) and cold environment (−35 °C and 80% humidity). Physiological parameters (heart rate and lactic acid) and CPR quality were monitored. Results: We detected a significant increase in the number of compressions per minute in the “heat environment” group after three minutes and in the mean rate after one minute. We observed a negative correlation between the total number of compressions and mean rate with respect to mean depth. The fraction of compressions (proportion of time in which chest compressions are carried out) was significant over time and the mean rate was higher in the “heat environment”. Physiological parameters revealed no differences in heart rate depending on the resuscitation scenario; however, there was a greater and faster increase in lactate in the “heat environment” (significant at minute 3). The total proportion of participants reaching metabolic fatigue was also higher in the “heat environment”. Conclusions: A warm climate modifies metabolic parameters, reducing the quality of the CPR maneuver. Full article

Perfectionistic Automatic Thoughts (PATs) are currently being studied due to their association with maladaptive variables. This study aims to validate the Spanish version of the Perfectionism Cognitions Inventory (PCI) in a sample of Ecuadorian undergraduates as well as to analyze latent mean differences across sex. The sample was composed by 3060 undergraduates (M_age = 22.7, SD = 2.46). The Spanish model of the PCI composed by 17 items divided into three first-order dimensions (perfectionistic concerns, strivings, and demands) and a second-order factor was supported by confirmatory factor analysis. Acceptable levels of reliability and factorial invariance across sex were observed. Higher latent mean scores for males in comparison with females in the second-order factor of the PCI were found. The three dimensions of the PCI significantly and positively correlated with interpersonal difficulties. Overall, results demonstrate that the Spanish version of the PCI is a valid and reliable measure to evaluate PATs in Ecuadorian undergraduates. Full article

The aim of this study was to determine the possible changes in plasma of several hormones such as Luteinizing Hormone, Testosterone, Cortisol and Insulin in endurance runners during the sports season. Twenty-one high-level male endurance runners (22 ± 3.2 years, 1.77 ± 0.05 m) participated in the study. Basal plasma hormones were measured at four moments during the season (initial, 3, 6 and 9 months), and were analyzed using ELISA (enzyme-linked immunosorbent assay). Testosterone and Luteinizing Hormone (LH) suffered very significant decreases (p < 0.01) at 3 months compared with the beginning and an increase (p < 0.05) at 6 and 9 months compared with 3 months. Insulin level was significantly lower (p < 0.05) at 3, 6 and 9 months compared with the initial test. Insulin and cortisol were associated inversely (r = 0.363; β = −0.577; p = 0.017) and positively (r = 0.202; β = 0.310; p = 0.043), respectively, with the amount of km per week performed by the runners. There was a significant association between km covered at a higher intensity than the anaerobic threshold and I (r = 0.580; β = −0.442; p = 0.000). Our findings indicate that testosterone, LH and insulin were more sensitive to changes in training volume and intensity than cortisol in high-level endurance runners. Basal testosterone and LH concentrations decrease in athletes who perform a high volume of aerobic km in situations of low energy availability. Full article

The move to university is a major life transition associated with precipitous declines in physical activity (PA). While it remains unclear how these declines can be best attenuated, the concept of physical literacy (PL) or enhancements of PL may be a promising modality to promote PA during life transitions. The purpose of the current study was to evaluate the impact of a pilot PL-based intervention on PA and fitness for students transitioning into university. Participants included 65 first-year students (M_age = 17.85 ± 0.51; n = 46 females), enrolled in a quasi-experimental study. Intervention participants (n = 26) participated in a 12-week novel movement skills program conducted in a group-based environment. Results from the 2 × 2 repeated measures ANOVA found moderate effects in the time by condition interaction F(1,56) = 2.70, p = 0.11, η_p² = 0.08 for PA behaviors as well as for estimated cardiorespiratory fitness F(1,61) = 8.35, p = 0.005, η_p² = 0.12. Findings from our pilot program suggest that PL may be an effective modality to help first-year university students maintain fitness and attenuate the declines in PA behaviors when transitioning into university. Similar trials with larger samples are required. Full article

In response to the emergent public health event of COVID-19, the efficiency of transport of medical waste from hospitals to disposal stations is a worthwhile issue to study. In this paper, based on the actual situation of COVID-19 and environmental impact assessment guidelines, an immune algorithm is used to establish a location model of urban medical waste storage sites. In view of the selection of temporary storage stations and realistic transportation demand, an efficiency-of-transport model of medical waste between hospitals and temporary storage stations is established by using an ant colony–tabu hybrid algorithm. In order to specify such status, Wuhan city in Hubei Province, China—considered the first city to suffer from COVID-19—was chosen as an example of verification; the two-level model and the immune algorithm–ant colony optimization–tabu search (IA–ACO–TS) algorithm were used for simulation and testing, which achieved good verification. To a certain extent, the model and the algorithm are proposed to solve the problem of medical waste disposal, based on transit temporary storage stations, which we are convinced will have far-reaching significance for China and other countries to dispatch medical waste in response to such public health emergencies. Full article

Mangrove forests are paramount for sustaining and enhancing ecosystem services benefitting both local and regional communities, and the global environment. Scholars have long studied the values of ecosystem services of mangrove forests. However, the number of recent primary studies monetizing ecosystem services is rather limited. This paper ascertains the values of ecosystem services of 66 primary valuation studies with a total of 250 observations. The results indicate that the range of values is substantially wide. This range cannot be explained sufficiently by the various differences of the studies, as the explanatory power of the econometric estimations is low. Main influential factors on the values of ecosystem services are the elicitation methods, the types of ecosystem services considered, and the conservation status of the respective mangrove forest as Ramsar site. The results stress the significant economic values of ecosystem services of mangrove forests and the importance for conservation management. However, the results also caution against a direct transfer of benefits between sites. The substantial variety of site and country specifics warrants the implementation of separate, original valuation studies. Full article

Occupational heat stress has an important negative impact on the well-being, health and productivity of workers and should; therefore, be recognized as a public health issue in Europe. There is no comprehensive heat health warning system in Slovenia combining public health measures with meteorological forecasts. The aim of this research was to provide insight into the development of such a system in Slovenia, turning the communication from the current meteoalarm into a broader system that has more information for different social groups. To achieve this goal, the following steps were used: Analysis of summer temperatures and issued meteoalarms, a survey of the general knowledge about heat among the public, organization and management of two stakeholder symposia, and a final survey on workers’ opinions on heat stress and measures, supplemented by interviews with employers. Summer average daily temperature distributions in Slovenia changed during the investigated period (1961–2019) and the mean values increased over time by 2–3 °C. Additionally, the number of days with fulfilled yellow (potentially dangerous) and especially orange (dangerous) meteoalarm conditions increased significantly after 1990. The survey of the general public about heat stress and warnings showed that efforts to raise awareness of heat issues need to be intensified and that public health measures should effectively target vulnerable groups. Stakeholder symposia and further surveys have shown that awareness and understanding of the negative effects of heat stress on health and productivity are still quite low, so effective ways of disseminating information to different sectors while striking the best balance between efficiency, feasibility and economic cost have to be found. Full article

We investigated if greenness and air pollution exposure in parents’ childhood affect offspring asthma and hay fever, and if effects were mediated through parental asthma, pregnancy greenness/pollution exposure, and offspring exposure. We analysed 1106 parents with 1949 offspring (mean age 35 and 6) from the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study. Mean particulate matter (PM_2.5 and PM₁₀), nitrogen dioxide (NO₂), black carbon (BC), ozone (O₃) (µg/m³) and greenness (normalized difference vegetation index (NDVI)) were calculated for parents 0–18 years old and offspring 0–10 years old, and were categorised in tertiles. We performed logistic regression and mediation analyses for two-pollutant models (clustered by family and centre, stratified by parental lines, and adjusted for grandparental asthma and education). Maternal medium PM_2.5 and PM₁₀ exposure was associated with higher offspring asthma risk (odds ratio (OR) 2.23, 95%CI 1.32–3.78, OR 2.27, 95%CI 1.36–3.80), and paternal high BC exposure with lower asthma risk (OR 0.31, 95%CI 0.11–0.87). Hay fever risk increased for offspring of fathers with medium O₃ exposure (OR 4.15, 95%CI 1.28–13.50) and mothers with high PM₁₀ exposure (OR 2.66, 95%CI 1.19–5.91). The effect of maternal PM₁₀ exposure on offspring asthma was direct, while for hay fever, it was mediated through exposures in pregnancy and offspring’s own exposures. Paternal O₃ exposure had a direct effect on offspring hay fever. To conclude, parental exposure to air pollution appears to influence the risk of asthma and allergies in future offspring. Full article

The aim of this study was to identify regional differences based on playing position in terms of the technical performances among FIBA Female Continental Basketball Championships by controlling the influence of situational variables including the game outcome, game type, teams and opponent quality. The samples comprised of 9208 performance records from 471 games in the America, Africa, Asia and Europe Championships during 2013–2017 and were collected and analyzed by generalized mixed linear modeling. Our study highlighted that, although positional differences were clear among different continental championships, it is worth noting that African guards, forwards, and centers made more turnovers (TOV) compared with the corresponding positional players from other continental championships. In addition, European guards presented the lowest number of steals (STL) compared with African (ES = 0.28), Asian (ES = 0.21), and American guards (ES = 0.24). The results provide coaches to have a better understanding of game-play styles among FIBA Female Continental Basketball Competitions, which could optimize the development of female basketball and the selection and recruitment of female players at the international level. Full article