International Journal of Environmental Research and Public Health

Cervical cancer-preventive behaviors in Korean sexual minority women (SMW) are underexplored. We aimed to assess the differences in cervical cancer screening uptake and completion of human papillomavirus (HPV) vaccination among Korean SMW by sex of their sexual partners. This cross-sectional study used data from the 2017 Korean Sexual Minority Women’s Health Study; we included Korean lesbian and bisexual women aged ≥20 years. They were divided into three groups: SMW with more than one male sexual partner (male only/both), SMW with only female sexual partners (female-only), or no sexual partner (no partner). Among the 671 participants, 266 (39.6%), 294 (43.8%), and 111 (16.5%) belonged to the male-only/both, female-only, and no partner groups, respectively. Compared to the male-only/both group, the female-only group was significantly less likely to have undergone cervical cancer screening (Adjusted odds ratio (AOR) = 0.24, 95% confidence interval (CI) = 0.15–0.37) and to have completed HPV vaccinations (AOR = 0.58, 95% CI = 0.37–0.91). In conclusion, Korean SMW with only female sexual partners had lower cervical cancer screening and HPV vaccination completion rates than SMW who had male sexual partners. More extensive efforts are needed to improve cervical cancer-preventive behaviors among Korean SMW. Full article

This study examined the association between smart device usage and the 1-year change in refractive error among a representative sample of Hong Kong children and adolescents aged 8–14 years. A total of 1597 participants (49.9% male, mean age 10.9, SD 2.0) who completed both baseline (2017–2018) and 1-year follow-up (2018–2019) eye examinations were included in the present study. The non-cycloplegic auto-refractive error was measured and the average spherical equivalent refraction (SER) was analyzed. The participants also self-reported their smart device usage at baseline. Multivariate regression adjusted for age, sex, baseline SER, parents’ short-sightedness, BMI, time spent on moderate-to-vigorous physical activity (MVPA), and caregiver-reported socio-economic status showed that, compared with the reference group (<2 hours per day on both smartphone and tablet usages), those who spent ≥2 hours per day using a smartphone and <2 hours per day using a tablet had a significantly negative shift in refractive error (1-year change in SER −0.25 vs. −0.09 D, p = 0.01) for the right eye, while the level of significance was marginal (1-year change −0.28 vs. −0.15 D, p = 0.055) for the left eye. To conclude, our data suggested spending at most 2 hours per day on both smartphones and tablets. Full article

Achieving the educational inclusion of students with special educational needs (SEN) is one of the significant challenges of the current Spanish educational system. This is a group of students with a high rate of bullying that leads to academic failure, as well as significant psychological and social consequences. Despite the fact that the behaviours and psychological characteristics of their peers seem to influence the degree of inclusion, there is no detail on this subject. Therefore, the aim of this paper is to determine the relationship between emotional intelligence, psychological flexibility, prosocial behaviour and inclusive behaviour. To carry out this study, a sample of 642 students between the ages of 12 and 19 years old participated and answered four questionnaires, one for each variable under study. The relationships established were extracted from different statistical analyses and a hypothesised predictive model. The results obtained revealed that emotional intelligence is positively related to psychological flexibility and prosocial behaviour and that these, in turn, are positively related to the development of inclusive behaviour. Therefore, the importance of considering the variables under study during the teaching–learning processes carried out in the classroom is highlighted. Full article

Infinite factors can influence the spread of COVID-19. Evaluating factors related to the spread of the disease is essential to point out measures that take effect. In this study, the influence of 14 variables was assessed together by Artificial Neural Networks (ANN) of the type Self-Organizing Maps (SOM), to verify the relationship between numbers of cases and deaths from COVID-19 in Brazilian states for 110 days. The SOM analysis showed that the variables that presented a more significant relationship with the numbers of cases and deaths by COVID-19 were influenza vaccine applied, Intensive Care Unit (ICU), ventilators, physicians, nurses, and the Human Development Index (HDI). In general, Brazilian states with the highest rates of influenza vaccine applied, ICU beds, ventilators, physicians, and nurses, per 100,000 inhabitants, had the lowest number of cases and deaths from COVID-19, while the states with the lowest rates were most affected by the disease. According to the SOM analysis, other variables such as Personal Protective Equipment (PPE), tests, drugs, and Federal funds, did not have as significant effect as expected. Full article

Background: Malnutrition is frequently underdiagnosed in geriatric patients and is considered to be a contributing factor for worse outcomes during hospitalization. In addition, elderly patients who undergo trauma are often malnourished at the time of incurring fractures. The geriatric nutritional risk index (GNRI), calculated based on the serum albumin level and the ratio of present body weight to ideal body weight, was proposed for the assessment of the nutritional status of elderly patients with various illnesses. This study aimed to investigate whether the GNRI has a prognostic value that links the nutritional status and mortality outcomes of elderly patients who have previously undergone trauma with femoral fractures. Methods: From January 1, 2009 to December 31, 2019, a total of 678 elderly patients with femoral fractures were categorized into four nutritional risk groups: a major-risk group (GNRI <82; group 1, n = 127), moderate-risk group (GNRI 82– <92; group 2, n = 179), low-risk group (GNRI 92–98; group 3, n = 123), and no-risk group (GNRI >98; group 4, n = 249). To minimize the confounding effects of sex, age, preexisting comorbidities, and injury severity of patients on outcome measurements, propensity score-matched patient cohorts were created to assess the impact of patients being in different nutritional risk groups on the in-hospital mortality outcomes against the no-risk group. Results: The patients in groups 1–3 were significantly older and presented a significantly lower body mass index and lower serum albumin levels than those in group 4. Compared with patients in group 4 (3.6%), a significantly higher mortality rate was found in the patients in group 1 (17.3%, p < 0.001), but not in those in group 2 (6.7%) or group 3 (2.4%). The study of propensity score-matched patient cohorts provided similar results; group 1 patients had significantly higher odds of mortality than group 4 patients (odds ratio, 6.3; 95% confidence interval, 1.34–29.37; p = 0.009), but there were no significant differences in mortality risks among patients in groups 2 and 3 compared with those in group 4. Conclusions: This preliminary study suggested that the GNRI may be used as a screening tool to identify patients with malnutrition at a high risk of mortality among elderly patients with femoral fractures. A prospective study is needed to validate the suggestion. Full article

This pilot study used accelerometers to investigate the effectiveness of a multiple recess school intervention on physical activity patterns in younger elementary children using a post-test only with nonequivalent groups design. First and second grade students (N = 157) participating in a larger study, the LiiNK Project^® (Let’s inspire innovation ‘N Kids), wore accelerometers for the duration of the school day for two weeks to measure physical activity intensity and number of steps taken daily. Students attended either an intervention school (N = 90), participating in four 15-min unstructured, outdoor recesses and one 15-min character development lesson daily, or a control school (N = 67), participating in two 15-min unstructured, outdoor recesses daily and no character development program. The intervention students, grades 1 and 2, took more steps (p < 0.001) and time spent in moderate (p < 0.001) and vigorous (p < 0.001) physical activity (MVPA) than the control school students. Intervention students averaged approximately 900 more steps per day than the control school students. These results show young children given 60 min of recess daily continue to increase physical activity patterns over those with 30 min of recess daily. Next steps are to evaluate if children demonstrate healthier body fat levels as a result of these higher patterns of MVPA daily. Full article

The aim of this study was to check whether following the recommendations of the World Health Organization (WHO) concerning physical activity protects children and adolescents against the occurrence of overweight and obesity. A total of 1002 children were included in the analysis. The average age of the studied children was 9.36 years ± 3.52 years. Measurement of height and body mass was performed for every child, followed by physical activity assessment over seven days. In each group analyzed, the overweight and obese children had a shorter time in moderate to vigorous physical activity (MVPA) than the children with normal body mass. Among the children spending < 60 min per day in MVPA, the risk of occurrence of overweight and obesity was greater than among children with physical activity > 60 min per day. It was also shown that the greatest risk of occurrence of body mass disorder was a situation in which the mother’s gestational weight gain (GWG) is over 18 kg and the child does not spend a minimum of 60 min/day in MVPA. Not meeting the recommendation is connected with an increased chance of the occurrence of overweight and obesity. The level of physical activity influences the incidence of overweight and obesity. The children with overweight and obesity spent less time per day in MVPA. An increased body mass in mothers during pregnancy associated with a child’s low level of physical activity increases the risk of the occurrence of overweight and obesity. Full article

Background: Dental cellulitis management is no longer a simple procedure, as more and more patients are needing long-time hospitalization, several surgeries and intensive care follow-up. This prospective study seeks to highlight criteria that can split patients with severe odontogenic infection into two groups: those with simple evolution and those for whom complex management is necessary. Methods: In this observational study, all patients considered with a severe odontogenic infection (which necessitated hospital admission, intravenous antibiotics and general anaesthesia) were enrolled between January 2004 and December 2014 from Clermont-Ferrand University Hospital (France). They were split into two groups: those who needed one surgical intervention with tooth extraction and collection drainage combined with probabilistic antibiotic to treat infection and those who need several surgeries, intensive care unit follow-up or tracheotomy to achieve healing. Results: 653 patients were included, of which 611 (94%) had one surgery, 42 (6%) had more than one surgery before healing. Penicillin allergy (p < 0.001), psychiatric disorders (p = 0.005), oropharyngeal oedema (p = 0.008), floor oedema (p = 0.004), fever (p = 0.04) and trismus (p = 0.018) on admission were the most relevant predictors of complex evolution. A conditional inference tree (CTREE) illustrated the association of prognostic factors and the need of multiple surgery. Conclusions: Besides clinical symptoms of severity, complications of severe odontogenic infection are predicted by measurables and objectives criteria as penicillin allergy, mandibular molar, C-reactive protein level, psychiatric disorders and alcohol abuse. Their specific association potentialize the risks. IRB number: CE-CIC-GREN-12-08. Full article

Self-care monitoring at home can be a challenge for patients with heart failure (HF). Tools that leverage information and communication technology (ICT), comprise medical devices, or have written material may support their efforts at home. The aim of this study was to describe HF patients’ experiences and their prioritization of tools that support, or could support, self-care monitoring at home. A descriptive qualitative design employing semi-structured interviews was used with HF patients living at home and attending an HF outpatient clinic in Norway. We used a deductive analysis approach, using the concept of self-care monitoring with ICT tools, paper-based tools, medical devices, and tools to consult with healthcare professionals (HCPs) as the categorization matrix. Nineteen HF patients with a mean age of 64 years participated. ICT tools are used by individual participants to identify changes in their HF symptoms, but are not available by healthcare services. Paper-based tools, medical devices, and face-to-face consultation with healthcare professionals are traditional tools that are available and used by individual participants. HF patients use traditional and ICT tools to support recognizing, identifying, and responding to HF symptoms at home, suggesting that they could be used if they are available and supplemented by in-person consultation with HCPs. Full article

Due to the accumulation of heat, the urban environment and human health are threatened. Land surface cover has effects on the thermal environment; nevertheless, the effects of land surface features and spatial patterns remain poorly known in a community-based microclimate. This study quantified and verified the impacts of normalized difference vegetation index (NDVI) on land surface temperature (LST) (K, the slope of the trend line of a linear regression between NDVI and LST) in different building density by using building outline and Landsat 8 satellite imagery. Comparing the cooling effect and distribution of vegetation showed that the vegetative cover had a cooling effect on LST, characterized by synchronous change, and building density had a significant impact on the cooling effect of vegetation. Through identification and simulation, it was found that the key factor is the wind speed between the buildings because, in different building densities, the wind speed was different, and studies had shown that when the building density was between 0.35 and 0.50, the wind speed between buildings was higher, resulting in a better cooling effect of vegetation. This conclusion has important reference significance for urban planning and mitigating the impact of the thermal environment on human health. Full article

Humanization of nursing is related to certain social and moral variables. Moral sensitivity, empathy, and prosocial behavior help understand a situation and make decisions that benefit the patient. The objective of this study is to find out how these variables are related, and define the differences in moral sensitivity, empathy, and prosocial behavior in humanization of nursing. We also analyzed the mediating role of empathy in the relationship between moral sensitivity and prosocial behavior. The sample was made up of 330 Spanish nurses aged 22 to 56, who completed the HUMAS Scale and adapted versions of the Basic Empathy Scale, the Moral Sensitivity Questionnaire, and the Prosocial Behavior Scale. Descriptive analyses, bivariate correlations and multiple mediation models were calculated. The results found significantly different mean scores between all the groups in responsibility and moral strength, cognitive empathy, and prosocial behavior, and in moral burden, the differences were in the high-humanization-score group compared to the low-score group. Furthermore, the mediation models showed the mediating effect of cognitive empathy between the responsibility, strength, and moral burden factors on prosocial behavior, but not of affective empathy. The study concluded that humanization in nursing is closely related to moral sensitivity, cognitive empathy, and prosocial behavior. This facilitates a helping, caring, and understanding attitude toward patient needs, but without the affective flooding that affective empathy can lead to. Full article

The purpose of the research was to assess the usefulness of thermography as a complementary method in musculoskeletal dysfunction, with particular emphasis on scoliosis. The children, aged 7–16, were classified into one of two groups: the study group—children with scoliosis (n = 20), and the reference group—healthy children (n = 20). All children underwent anthropometric tests, body mass index determination, four pictures each with a FLIR T1030sc HD thermal imaging camera, and measurement of spinal rotation with a scoliometer (Gima, Italy). There is a temperature differential (about 4 °C) within the upper and lower body in children. In healthy children, differences in temperature of contralateral areas of the body do not exceed 0.5 °C. Thermography is a useful and noninvasive method of assessing muscular tension disbalance in the course of scoliosis. In the case of scoliosis, the areas of the body with a significant thermal asymmetry of the surface are the upper back, thighs, and back of the lower legs. Due to the high positive correlation of the spinal rotation angle with the amount of thermal asymmetry, the areas that should be subjected to a detailed thermal assessment in the supplementary diagnosis of scoliosis using thermovision are the upper back, chest, thighs, and back of the lower legs. Full article

The regular consumption of sweets has been shown to have an adverse association with the academic performance of children in developed countries; however, the situation in developing countries is less clear. Therefore, we examined the association between the consumption of sweets and academic performance among Mongolian children via a cross-sectional study employing data from 787 children aged 8–16 from two public schools in Ulaanbaatar, the capital of Mongolia. The frequency of the consumption of sweets by the children was captured using a questionnaire and then linked to their academic scores; the association between the consumption of sweets and scores in mathematics and the Mongolian language was evaluated using multiple linear regression adjusted for other covariates. It was found that out of 787 students, 58.6% ate sweets every day. After adjusting for covariates, no significant association was observed between the consumption of sweets and mathematics scores (coefficient: 0.15; 95% confidence interval (CI): −0.02–0.32), while a higher consumption of sweets was significantly associated with higher scores in the Mongolian language (coefficient: 0.25; 95% CI: 0.09–0.41). The associations established in this study are inconsistent with the reports of other studies. Full article

We aimed to assess the effects of plyometric jump training (PJT) on female soccer player’s physical fitness. To this aim, a systematic review with meta-analysis (SRMA) was conducted. The electronic databases PubMed, MEDLINE, Web of Science, and SCOPUS were used. To qualify for inclusion, peer-reviewed studies must have included (i) a PJT programme of ≥2 weeks, (ii) healthy athletes, (iii) a control group, and (iv) physical fitness outcomes (e.g., jump; sprint). Studies were excluded if (i) they incorporated injuried female soccer players, (ii) did not involve PJT or an active control group, (iv) lack of baseline and/or follow-up data. Data was meta-analyzed using the inverse variance random-effects model. Ten moderate-to-high quality studies were included in the analyses, comprising 13 training groups (n = 140) and 10 control groups (n = 110). Small to large (ES = 0.60–2.24; p = 0.040 to <0.001) effects were noted for countermovement jump, drop jump, kicking performance, linear sprint, change of direction speed, and endurance. The moderator analyses (i.e., PJT duration, age groups, competitive level, and soccer experience) revealed no significant differences between groups. In conclusion, PJT may improve the physical fitness of female soccer players. Such improvements might be expected after PJT interventions with six or more weeks of duration, and in players with different chronological ages, competitive levels and soccer experience. Full article

In this study, we analyzed the accidents associated with the Asian elephant (Elephas maximus Linnaeus) and issues pertaining to compensation in Xishuangbanna Nature Reserve from 2011 to 2018. We conducted interviews and a questionnaire survey with 217 villagers. The results show that: (1) the main Asian elephants damage is crop loss (more than 95% of the total damage), and the villagers suffer economic losses; (2) through the influence of traditional culture and natural education, the majority of local villagers still have a favorable impression of Asian elephants; (3) female respondents, those engaged in agricultural production, those who had experienced crop loss and those who had never seen Asian elephants had more negative attitudes toward Asian elephants; (4) most villagers believe that the Asian elephant population has increased in the past decade; and (5) the villagers are quite passive in the human–elephant conflict, and most of them do not take action. Finally, based on the research results, this paper discusses the causes of human elephant conflict and proposes targeted mitigation measures. Full article

In this study, we performed a logistic regression analysis according to the frequency of participation in social leisure activities (education, clubs, social groups, volunteer activities, religious activities, and senior citizens’ welfare center use) by men and women aged ≥ 65 years. We investigated the frequency of participation in social leisure activities and their association with the level of frailty (health vs. pre-frailty, health vs. frailty, pre-frailty vs. frailty). This study included 10,297 older adults (men: 4128, women: 6169) who participated in the 2017 National Survey of Older Koreans, and were divided into three groups (healthy, pre-frailty, and frailty). Five frailty index components were used to measure the frailty level. There was a positive relationship between the elderly’s religious activities, four times a week, from the healthy stage to the frailty stage, from the healthy stage to the pre-frailty stage, and from the pre-frailty stage to the frailty. In addition, positive associations emerged in leisure activities and club activities, respectively, from the healthy stage to the frailty stage (once a week, respectively). Positive association also emerged from the healthy stage to the pre-frailty and from the pre-frailty stage to the frailty stage (once a month to once in a two-week period). Full article

Evidence suggests that countries with neoliberal political and economic philosophical underpinnings have greater health inequalities compared to less neoliberal countries. But few studies examine how neoliberalism specifically impacts health inequalities involving highly vulnerable populations, such as Indigenous groups. Even fewer take this perspective from an oral health viewpoint. From a lens of indigenous groups in five countries (the United States, Canada, Australia, Aotearoa/New Zealand and Norway), this commentary provides critical insights of how neoliberalism, in domains including colonialism, racism, inter-generational trauma and health service provision, shapes oral health inequalities among Indigenous societies at a global level. We posit that all socially marginalised groups are disadvantaged under neoliberalism agendas, but that this is amplified among Indigenous groups because of ongoing legacies of colonialism, institutional racism and intergenerational trauma. Full article

Temporomandibular disorders are multi-factorial conditions that are caused by both physical and psychological factors. It has been well established that stress triggers or worsens TMDs. This paper looks to present early research, still unfolding, on the relationship between COVID-19 as a major life stressor and TMDs. The main aims of this study were to: investigate the presence of symptoms related to TMDs and the time of onset and the worsening of painful symptoms in relation to the changes in social life imposed by the coronavirus pandemic; and to evaluate the perception of COVID-19 as a major stressful event in subjects who report worsening of painful TMD symptoms. One hundred and eighty-two subjects answered questionnaires—Axis II of the RDC/TMD, the PSS, and specific items about coronavirus as a stressful event—during the lockdown period for COVID-19 in Italy to evaluate the presence of reported symptoms of TMD and the level of depression, somatization, and stress perceived. The results showed that 40.7% of subjects complained about TMD symptoms in the past month. Regarding the time of onset, 60.8% of them reported that facial pain started in the last three months, while 51.4% of these subjects reported that their symptoms worsened in the last month and were related to the aggravation of pain due to the coronavirus lockdown as a major life event and to the stress experienced. The results of this study seem to support the hypothesis that stress during the pandemic lockdown influenced the onset of temporomandibular joint disorders and facial pain, albeit with individual responses. Full article

Occupation can be defined as all activities that occupy a person’s time. The Satisfaction with Daily Occupations and Occupational Balance instrument evaluates the perceived satisfaction with performance and the balance in time dedicated to different occupations. The main aim was to translate the original instrument to Spanish and examine and establish the psychometric properties. This is a quantitative, cross-sectional study conducted in two stages: translation and cultural adaptation (forward translation, expert panel, back-translation, second expert panel and pre-testing and cognitive interviewing) and collecting data to evaluate psychometric properties (homogeneity, construct validity, known-groups validity, and floor/ceiling effects). One hundred participants took part in the study, adults with a diagnosis of a mental health disorder and adults without any known health problems. The Spanish version showed known-groups validity, acceptable internal consistency, and construct validity, although the relationships with some of the indicators of discriminant validity were somewhat higher than expected. The instrument shows promise as a useful screening tool for assessing activity level and satisfaction with daily occupations among a Spanish speaking population. Full article