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

Migration can be a stressful experience and may lead to poor health and behavioral changes. The immigrant population in Switzerland is disproportionately burdened by several negative health outcomes, chief among these is mental health issues. The aim of the study was to investigate whether sleep disturbances are more prevalent among immigrants compared to non-immigrants and whether emotional distress might explain sleep differences. Based on the Swiss Health Survey 2012 dataset, we analyzed the data of 17,968 people, of which 3406 respondents were immigrants. We examined variables including insomnia symptoms, emotional distress and clinical and socio-demographic data using unadjusted and adjusted generalized linear models. Compared to non-immigrants, immigrants suffer significantly more often from insomnia symptoms. Immigrants also endured higher levels of emotional distress. Higher values of emotional distress are related to other symptoms of sleep disorders. Immigrants with emotional distress were at significant risk of sleep disturbances. Sleep disparities between immigrants and non-immigrants may be influenced by emotional distress. Migration health care should address emotional distress, a more proximal and modifiable factor, as a possible cause of insomnia symptoms in immigrants. Full article

This study reviews and evaluates the national drug formulary system used to improve patient access to new drugs by making reimbursement decisions for new drugs as part of the South Korean national health insurance system. The national health insurance utilizes three methods for improving patient access to costly drugs: risk-sharing agreements, designation of essential drugs, and a waiver of cost-effectiveness analysis. Patients want reimbursement for new drugs to be processed quickly to improve their access to these drugs, whereas payers are careful about listing them given the associated financial burden and the uncertainty in cost-effectiveness. However, pharmaceutical companies are advocating for drug prices above certain thresholds to maintain global pricing strategies, cover the costs of drug development, and fund future investments into research and development. The South Korean government is expected to develop policies that will improve patient access to drugs with unmet needs for broadening health insurance coverage. Simultaneously, the designing of post-listing management methods is warranted for effectively managing the financial resources of the national health insurance system. Full article

Haze pollution has become the most serious environmental risk in China and generated a large amount of public concerns. Influencing almost all the citizens in the polluted area, it is necessary and important to take public perception as an essential element in haze abatement. From the perspective of social psychology, this paper explores haze tolerance in Beijing, Shanghai, and Guangzhou, also the key influential factors on haze tolerance from four dimensions: political trust, perceived risk, cost perception, and haze knowledge. Based on the sample of 517 respondents, the results show that compared with Shanghai and Guangzhou, Beijing residents had the lowest tolerance level of haze pollution but have the highest levels of trust in the government’s capacity to control haze and self-evaluation of their own haze knowledge. People in Shanghai had the lowest cost perception and the strongest willingness to acquire haze knowledge. Meanwhile, the empirical analysis revealed that political trust and cost perception could enhance the public’s haze tolerance while perceived risk and haze knowledge had negative impacts on tolerance. Also, our research could provide some suggestions to government officials when making policies for abating haze pollution from the perspective of social risk control. Policy makers are supposed to launch various policy instruments to control haze effectively and engage the citizens in the decision-making process to improve their political trust, and publicize the knowledge of haze pollution to help the public to acquire objective and scientific knowledge and diminish unnecessary worries. Full article

High or low ambient temperatures pose a risk factor for the worsening or onset of psychiatric disorders. The aim of this study was to investigate the association between ambient temperature and psychiatric emergency visits in an urban region in a temperate climate. The daily number of visits to a psychiatric emergency room (PEVs) at Sahlgrenska University Hospital, Gothenburg, Sweden and the daily mean temperature were extracted for the study period 1 July 2012 to 31 December 2017. Case-crossover analysis with distributed lag non-linear models was used to analyse the data by season. The warm season was defined as May to August and the cold season as November to February. Shorter lags periods were used for the warm season than the cold season. In the analysis, temperatures at the 95th percentile was associated with 14% (95% confidence interval (CI): 2%, 28%) increase in PEVs at lag 0–3 and 22% (95%CI: 6%, 40%) for lags 0–14 during the warm season, relative to the seasonal minimum effect temperature (MET). During the cold season temperatures at the 5th percentile were associated with 25% (95% CI: −8%, 13%) and 18% (95% CI: −30%, 98%) increase in PEVs at lags 0–14 and 0–21 respectively. We observed an increased number of PEVs at high and low temperatures; however, not to a statistically significant extent for low temperatures. Our findings are similar to what has been found for somatic diseases and in studies of other mental health outcomes in regions with more extreme climates. This merits the inclusion of individuals with psychiatric disorders in awareness planning for climate warning systems. Full article

We collected and analysed 58 samples of groundwater from wells in the Barcellona-Milazzo Plain, one of the most important coastal aquifers of Sicily (Italy), to determine major, minor, and trace element concentrations. In this area, geogenic and anthropogenic sources of heavy metals and other pollutants co-act, making the individuation of the main pollution sources difficult. Our work was aimed at the application of geostatistical criteria for discriminating between these pollution sources. We used probability plots for separating anomalous values from background concentrations, which were plotted on maps and related to possible sources of pollutants. Our results indicate that hydrothermal fluid circulation and the water–rock interaction of country rocks that host mineralized ore deposits generate a significant flux of heavy metals to groundwater, as well as anthropogenic sources like intense agriculture and industrial activities. In particular, NO₃, F, and Ni exceed the Maximum Admitted Concentrations (MACs) established by the WHO and Italian legislation for drinking-water. The spatial distributions of geogenic and anthropogenic sources were so deeply interlocked that their separation was not easy, also employing geostatistical tools. This complex scenario makes the implementation of human health risk mitigation actions difficult, since the flow of pollutants is in many cases controlled by simple water–rock interaction processes. Full article

Background/Objective: China is now faced with a serious population aging challenge, and the health of the Chinese elderly is becoming an imminent concern. Consequently, it is critical to establish a lifestyle evaluation system for promoting the health of the Chinese elderly. Methods: Interviews with experts and questionnaire surveys were conducted. Factor analysis, analytic hierarchy process, and statistical analyses were also adopted in this study. Results: Besides evaluation metrics and standards, a two-level category system including 50 indices and associated weights from three level 1 categories (physical and mental health and social wellbeing) and thirteen level 2 categories were obtained. Discussion and Conclusions: Based on the confirmatory factor analysis and Cronbach’s test, such an evaluation system excels in effectiveness and reliability, and is ready to be popularized in Chinese society. We expect that the Chinese elderly will benefit from our system and that it will lead to a healthy lifestyle accordingly. Full article

Food security (FS) during infancy is associated with lifelong outcomes. New Zealand is a developed economy that reports poor childhood nutrition-related health statistics, particularly among minority children, yet has no measure of FS applicable to infancy. The objective was to develop an FS index for New Zealand infants and examine its association with demographic covariates and health outcomes. Within a large (n = 6853) nationally representative cohort, variables describing infant food consumption, breastfeeding, and maternal food-related coping methods were collected from mothers during late infancy. An FS index was derived using confirmatory factor analysis. Associations were assessed by logistic regressions and described using odds ratios (OR) and ≥95% confidence intervals (CI). Fifteen percent of the cohort was highly FS, 43% tenuously food insecure (FIS), and 16% highly food insecure (FIS). Infants from minority ethnic groups had lower odds of being food secure, as did those born to the youngest mothers, mothers who smoked, or those who lived in low-income households. FIS infants had higher odds of morbidity. Interventions to improve infant FS should focus on improving dietary quality, and should give particular consideration to minority infants. We identified that FIS shows wide ethnic and socioeconomic inequity, and is associated with poorer health. The most important driving factors of FIS included poor quality weaning diets, as well as poverty and its proxies. Any interventions to improve infant FS should focus on increasing fruit and vegetable consumption to recommended intake levels, and should give particular consideration to minority infants. Full article

The present study seeks to demonstrate how Bayesian Network analysis can be used to support Total Worker Health^® research on correction workers by (1) revealing the most probable scenario of how psychosocial and behavioral outcome variables in corrections work are interrelated and (2) identifying the key contributing factors of this interdependency relationship within the unique occupational context of corrections work. The data from 353 correction workers from a state department of corrections in the United States were utilized. A Bayesian Network analysis approach was used to probabilistically sort out potential interrelations among various psychosocial and behavioral variables. The identified model revealed that work-related exhaustion may serve as a primary driver of occupational stress and impaired workability, and also that exhaustion limits the ability of correction workers to get regular physical exercise, while their interrelations with depressed mood, a lack of work engagement, and poor work-family balance were also noted. The results suggest the importance of joint consideration of psychosocial and behavioral factors when investigating variables that may impact health and wellbeing of correction workers. Also, they supported the value of adopting the Total Worker Health^® framework, a holistic strategy to integrate prevention of work-related injury and illness and the facilitation of worker well-being, when considering integrated health protection and promotion interventions for workers in high-risk occupations. Full article

Health is correlated to people’s socioeconomic status (SES) and lifestyle. This study examined the impact of SES on respondents’ physical and psychological health. Moreover, we explored the potential mediating effect of lifestyle on the relationship between SES and health. The participants were 986 respondents from the 2015 Chinese General Social Survey (CGSS). Structural equation modeling (SEM) was used to test the hypothesized relationship between the variables. The results indicated that SES had a significant impact on people’s physical health, but the impact of SES on psychological health was not significant. Lifestyle had significant positive effects on both physical and psychological health. In addition, lifestyle mediated the relationship between SES and health. This research is helpful in gaining a better understanding of the relationship and mediating mechanism between SES, lifestyle, and health. It is recommended that research with longitudinal design and comprehensive indicators be undertaken in the future. Full article

This cross-sectional survey has compared subjective outcomes obtained from workers in shared (2–5 occupants) and open-plan (+5 occupants) offices, related to irrelevant speech, which is the noise that is generated from conversations between colleagues, telephone calls and laughter. Answers from 1078 subjects (55% in shared offices and 45% in open-plan offices) have shown that irrelevant speech increases noise annoyance, decreases work performance, and increases symptoms related to mental health and well-being more in open-plan than in shared offices. Workers often use headphones with music to contrast irrelevant speech in open-plan offices, while they take a break, change their working space, close the door or work from home in shared offices. Being female, when there are more than 20 occupants, and working in southern cities without acoustic treatments in the office, make it more likely for the occupants to be annoyed by irrelevant speech noise in open-plan offices. While, working in southern cities and with acoustic treatments in the office makes it more likely that noise annoyance will be reported in shared offices. Finally, more than 70% of the interviewed in open-plan offices were willing to reduce their voice volumes when advised by a noise monitoring system with a lighting feedback. Full article

Intensive greenhouse horticulture can cause various environmental problems. Among these, the management, storage, and processing of crop residues can provoke aquifer contamination, pest proliferation, bad odors, or the abuse of phytosanitary treatments. Biosolarization adds value to any fresh plant residue and is an efficient technique for the control of soil-borne diseases. This study aims to examine an alternative means of managing greenhouse crop residues through biosolarization and to investigate the influence of organic matter on yield and quality of tomato (Solanum lycopersicum, L.) fruit. With this purpose, the following nutritional systems were evaluated: inorganic fertilization with and without brassica pellets (Fert, Fert +, and Fert ++), fresh tomato plant debris with and without brassica pellets (Rest, Rest +, and Rest ++), and no fertilizer application (Control). The addition of organic matter was equal across all the treatments except for the control with regard to yield and quality of the tomato fruit. In light of these results, the application of tomato plant debris to the soil through biosolarization is postulated as an alternative for the management of crop residues, solving an environmental problem and having a favorable impact on the production and quality of tomatoes as a commercial crop. Full article

This study examines the impact of social engagement on elderly health in China. A two-stage residual inclusion (2SRI) regression approach was used to examine the causal relationship. Our dataset comprises 9253 people aged 60 or above from the China Health and Retirement Longitudinal Survey (CHARLS) conducted in 2011 and 2013. Social engagement significantly improved the self-rated health of the elderly and reduced mental distress, but had no effect on chronic disease status. Compared with the rural areas, social engagement played a more important role in promoting the elderly health status in urban areas. Social engagement could affect the health status of the elderly through health behavior change and access to health resources. To improve the health of the elderly in China and promote healthy aging, the government should not only improve access to effective medical care but also encourage greater social engagement of the elderly. Full article

Adolescents spend significant amounts of time engaged in various types of sedentary behaviour (SB). This study examined associations between adolescents’ objectively measured sedentary time, sitting time, specific self-reported SBs and social connectedness. Adolescents (n = 429, 15.5 years, 41% male) completed an online survey reporting time in seven SBs (TV/videos/DVDs, computer/video games, internet, homework, reading, car and bus travel; examined individually and summed for screen time and total SB), and social connectedness using the eight-item Social Connectedness Scale. A subsample (n = 353) also wore an ActiGraph GT3X+ (model GT3X+, Pensacola, FL, USA) accelerometer to measure sedentary time (<100 cpm) and n = 237 wore an activPAL (PAL Technologies Ltd., Glasgow, Scotland) inclinometer to measure sitting time. Multiple linear mixed models determined associations between each SB variable and social connectedness, adjusting for confounders. Adolescents spent on average 7.8 h/day in self-reported total SB, 4.4 h/day in screen time, 9.1 h/day in ActiGraph-measured sedentary time, and 9.5 h/day in activPAL-measured sitting time. After adjusting for age, sex and area level socioeconomic status,total SB (−0.24, 95%CI: −0.37, −0.11), screen time (−0.23, 95%CI: −0.41, −0.05) and two individual SBs (computer/video games (−1.07, 95%CI: −1.53, −0.60), homework (−0.61, 95%CI: –1.04, −0.18) were negatively associated with social connectedness. There were no associations with the objective measures. The relationships may be bi-directional; therefore, future research should involve longitudinal designs and explore other potential contributing factors. Full article

Background: This study aims to explore the relationship between quality of life (QOL) and social capital factors among “people living with HIV/AIDS” (PLWHA), in order to improve their quality of life and help them to release AIDS discrimination. Methods: A cross-sectional survey with 225 PLWHA was done in Nanchang, China, between January and June of 2015. Questionnaires consisted of a socio-demographic questionnaire, Personal Social Capital Scale and Medical Outcomes Study HIV Health Survey. To identify social capital factors influencing QOL among PLWHA, t-test and multiple linear regression were used as statistical tools. The analysis of data was conducted using SPSS 22.0 with a significant value of p < 0.05. Results: The scores of total social capital, bonding social capital and bridging social capital were 23.68 ± 5.55, 14.11 ± 3.40 and 9.46 ± 3.43 respectively. The scores of Physical Health Summary (PHS) and Mental Health Summary (MHS) were 51.88 ± 7.04 and 49.29 ± 6.60. Multiple linear regression analysis showed that age (B = −0.137, p = 0.020), income (B = 0.2170, p ≤ 0.001), employment (B = 0.112, p = 0.043) and bonding social capital (B = 0.178, p = 0.001) had significant effects on PHS. Bonding social capital was the most important influencing factor for MHS (B = 0.506, p < 0.001). There was no significant relationship between bridging social capital and QOL (p > 0.05). Conclusions: The PLWHA community has low social capital and a poor QOL in Nanchang. Bonding social capital had a positive impact on the QOL of PLWHA. There is an urgent need to build a better social support system based on bonding social capital for PLWHA. It is worth further exploring to identify how to make full use of bridging social capital for improving QOL among PLWHA. Full article

Constructed Floating Wetlands (CFWs) are increasingly being used globally in freshwater environments such as urban lakes and ponds to remove pollutants from urban stormwater runoff. However, to date there has been limited research into the use and performance of these systems in saline environments. This study compared the root and shoot biomass growth and nutrient uptake of five different plant species, Chrysopogon zizanioides, Baumea juncea, Isolepis nodosa, Phragmites australis and Sarcocornia quinqueflora, in three different saltwater treatments over a 12-week period. The aim of the study was to identify which of the plant species may be most suitable for use in CFWs in saline environments. Plant nutrient uptake testing revealed that Phragmites australis had the greatest percentage increase (1473–2477%) of Nitrogen mass in the shoots in all treatments. Sarcocornia quinqueflora also had impressive Nitrogen mass increase in saltwater showing an increase of 966% (0.208 ± 0.134 g). This suggests that the use of Phragmites australis and Sarcocornia quinqueflora plants in CFWs installed in saline water bodies, with regular harvesting of the shoot mass, may significantly reduce Nitrogen concentrations in the water. Isolepis nodosa had the greatest percentage increase (112% or 0.018 ± 0.020 g) of Phosphorous mass in the shoots in the saltwater treatment. Baumea juncea had the greatest percentage increase (315% or 0.026 ± 0.012 g) of Phosphorous mass in the roots in the saltwater treatment. This suggests that the use of Isolepis nodosa and Baumea juncea plants in CFWs installed in saline water bodies may significantly reduce Phosphorous concentrations in the water if there was a way to harvest both the shoots above and the roots below the CFWs. The study is continuing, and it is anticipated that more information will be available on CFW plants installed in saline environments in the near future. Full article

Background: Cadmium and lead are widespread and non-biodegradable pollutants of great concern to human health. In real life scenarios, we are exposed to mixtures of chemicals rather than single chemicals, and it is therefore of paramount importance to assess their toxicity. In this study, we investigated the toxicity of Cd and Pb alone and as a mixture in an animal model of acute exposure. Methods: Experimental groups received a single treatment of aqueous solution of Cd-chloride (15 and 30 mg/kg body weight (b.w.) and Pb-acetate (150 mg/kg b.w.), while the mixture group received 15 mg Cd/kg b.w. and 150 mg Pb/kg b.w. Toxic effects of individual metals and their mixture were investigated on hematological and biochemical parameters, and the redox status in the plasma, liver, and kidneys of treated Wistar rats. Results: Tissue-specific changes were recorded in various parameters of oxidative damage, while the accumulation of metals in tissues accompanied the disturbances of both hematological and biochemical parameters. It was observed that the level of toxic metals in tissues had a different distribution pattern after mixture and single exposure. Conclusions: Comprehensive observations suggest that exposure to Cd and Pb mixtures produces more pronounced effects compared to the response observed after exposure to single metal solutions. However, further research is needed to confirm toxicokinetic or toxicodynamic interactions between these two toxic metals in the organisms. Full article

Uncertainty and insecurity in the relationship between the mother and father of a child are responsible for heightened maternal stress, which can lead to preterm birth (PTB). Different intensities of prenatal stress (proxied by four levels of marital status linked with the presence or absence of paternal data on birth records) were defined as the Marital-Father Data index. We assessed the impact of those varying intensities of prenatal stress on PTB with respect to parity among a group of Polish mothers residing in Krakow (N = 87,916). We found a pattern across the adjusted risk ratios (RR) of preterm birth that ordered these estimates in an increasing trend towards higher risk, beginning with the group of married mothers with father data present (baseline), through the groups of legitimizing marriages—married after conception with father data present (RR = 1.1; 95% Confidence Intervals (CI) 1.0–1.2) and unmarried mothers with father data present (RR = 1.3; 95% CI 1.2–1.5) to the group of unmarried mothers with father data absent (RR = 1.9; 95% CI 1.7–2.2). The adjusted p for the linear trend between Marital-Father Data index and PTB was less than 0.001. The adjusted effect of perceived prenatal stress differed with respect to parity (confirmed by statistically significant interactions between Marital-Father Data index levels and parity), with a higher magnitude of this effect noted among multiparous versus primiparous women. Low paternal involvement and support during pregnancy may negatively affect PTB risk and this effect may differ in relation to parity status. More attention should be paid to maternal pregnancy stress, especially of multiparous mothers, to decrease the risk of unfavorable birth outcomes. Full article

The use of microfiltered water dispensers (MWDs) for treatment of municipal water is increasing rapidly, however, the water quality produced by MWDs has not been widely investigated. In this work a large-scale microbiological investigation was conducted on 46 MWDs. In accordance with Italian regulations for drinking water, we investigated the heterotrophic plate counts at 36 and 22 °C for indicator bacteria and pathogenic bacteria, such as Enterococci, Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus. Two different MWDs were compared: Type A with Ag⁺ coated carbon filter and two ultraviolet (UV) lamps, and Type B with a carbon filter and one UV lamp. For each type, the contamination of the input and output points was analyzed. Our findings showed that MWDs are a source of bacteria growth, with output being more contaminated than the input point. Type B was widely contaminated for all parameters tested in both sampling points, suggesting that water treatment by Type A is more effective in controlling bacterial contamination. MWDs are critical devices for water treatment in term of technologies, intended use, and sanitization procedures. The adoption of an appropriate drinking water safety plan associated with clear maintenance procedures and periodic environmental monitoring can ensure the safe and healthy operation of these devices. Full article

Exposure to environmental chemicals with hormonal effects, such as organochlorine compounds (OCs), during developmental periods of breast cells may have an impact on the incidence of breast cancer later in life. However, the assessment of exposure to these chemicals that occurred in early life at the time of breast cancer development in adult women is a difficult challenge in epidemiological studies. Plasma levels of the OCs p,p’-dichlorodiphenyl dichloroethene (DDE) and polychlorinated biphenyl congener 153 (PCB153) were measured in 695 cases and 1055 controls of a population-based case-control study conducted in France (CECILE study). Based on these values, we used a physiologically-based pharmacokinetic (PBPK) model to estimate PCB153 levels at age 11–20 years when the women were adolescents. Overall, there was no clear association between breast cancer risk and measured levels of DDE and PCB153 at the time of diagnosis, but there was a trend of decreasing odds ratios of breast cancer with increasing DDE and PCB153 levels in women aged 50 years and over. The PBPK model revealed that PCB153 concentrations estimated during adolescence were highest in the youngest women born after 1960 who reached adolescence at a time when environmental contamination was maximum, and very low in the oldest women who attained adolescence before the contamination peak. Negative associations between breast cancer and PCB153 estimates during adolescence were also found. The negative associations between DDE and PCB153 levels measured at the time of diagnosis or estimated during adolescence in our study were unexplained. Further investigations are needed to clarify whether this finding is real or related to study artifacts. However, this study suggests that using PBPK models in epidemiological studies to back-estimate OC exposures during early life stages may be useful to address critical questions on cancer development. Full article