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

This paper focuses on the results of computational fluid dynamics (CFD) modeling of radon concentration distribution in living areas within residences. The COMSOL Multiphysics^® 5.3 software package has been employed for solving coupled momentum and species transport problems together with pseudo-reaction term modeling of the radon radioactive decay process. The reliability and verification of the simulation model was tested by comparing with available experimental data. The obtained results show the existence of stagnant zones where the concentration of radon is substantially higher than the average values. The impact of factors such as wind velocity, air tightness, and incoming radon flux were taken into consideration. Full article

Bangladesh is a densely populated developing country. Both industrialization and geological sources have caused widespread heavy metal and metalloid pollution in Bangladesh, which is now posing substantial threats to the local people. In this review, we carried out one of the most exhaustive literature analyses on the current status of Bangladesh heavy metal and metalloid pollution, covering water, soil, and foods. Analysis showed that soils near high traffic and industrial areas contain high concentrations of heavy metals and metalloids. Agricultural land and vegetables in sewage-irrigated areas were also found to be heavy metal- and metalloid-contaminated. River water, sediment, and fish from the Buriganga, Turag, Shitalakhya, and Karnaphuli rivers are highly contaminated with cadmium (Cd), lead (Pb), and chromium (Cr). Particularly, groundwater arsenic (As) pollution associated with high geological background levels in Bangladesh is well reported and is hitherto the largest mass poisoning in the world. Overall, the contamination levels of heavy metals and metalloids vary among the cities, with industrial areas being most polluted. In all, this review provides a quantitative identification of the As, Pb, Cd, and Cr contamination hotspots in Bangladesh based on the literature, which may be useful to environmental restorationists and local policy makers. Full article

Physical activity has numerous associated benefits for cancer survivors. Compared to their urban counterparts, rural and remote Australians experience a health disadvantage, including poorer survival rate after the diagnosis of cancer. The purpose of this qualitative study was to (a) investigate factors that motivated or inhibited walking in rural participants during a 12-week intervention and (b) to investigate factors that motivated or inhibited physical activity behavior change three months post-intervention. Ten cancer survivors living in rural areas of South Australia participated in a 12-week computer-delivered walking-based intervention during which they reported daily steps, daily affect, and ratings of perceived exertion. Based on this information, individualized daily step goals were sent to them to increase walking. Following the intervention, participants engaged in face-to-face semi-structured interviews. Interviews were recorded, transcribed and coded using thematic analysis. Participants identified a range of physical, psychological, social, environmental, and organizational motivators and barriers. Participants appreciated the monitoring and support from the research team, but some voiced a need for better transition to post-program and many desired ongoing support to maintain their motivation. Future studies should incorporate strategies to help walking behavior to become more intrinsically motivated and therefore sustained. Full article

In April 2017, several travelers with acute gastroenteritis on a cruise ship were reported. We conducted an investigation to identify the pathogen, mode of transmission, and risk factors. We searched and classified case-patient according to structured case definition, and collect date of the onset, clinical manifestations, and demographic information of cases. A case-control study was implemented to compare foods consumption between cases and asymptomatic travelers. Samples such as feces, rectal swab, vomitus, and environment swab were collected for testing. The attack rate was 18.2% (101/555), four cold dishes served on 11th, April were independently associated with an increased risk of disease: cold potherb (odds ratio (OR): 14.4; 95% confidence interval (CI): 2.2–93.3) and cold garlic sprout (OR: 26.1; 95% CI: 4.9–138.0) served at lunch, cold broad bean (OR: 5.8; 95% CI: 1.3–26.2), and cold cucumber (OR: 13.9; 95% CI: 2.3–84.2) served at dinner. A total of 15 samples were positive for norovirus genogroup II (GII) by using reverse transcription polymerase chain reaction (RT-PCR). This outbreak that occurred on the cruise ship was caused by norovirus GII. The evidence indicated that norovirus was mainly transmitted through consumption of cold dishes on 11th, April, which might be contaminated by asymptomatic cold dish cook. Full article

With the rapid development of urbanization, industrialization, and motorization, a large number of Chinese cities have been affected by heavy air pollution. In order to promote the development quality of Chinese cities, mixed regulations to control air pollution have been implemented under the lead of government. The principal component analysis and efficacy coefficient method are used to estimate urban development quality, according to the panel data of 285 prefecture-level cities in China over the period 2003–2016. On this basis, the paper uses the spatial Durbin model to study the direct impact and the spatial spillover effect of air pollution control on urban development quality in China. Results show that the control of smoke and dust has improved urban development quality in China, however, the control of sulfur dioxide has led to the decline of urban development quality in China. Furthermore, the impact of air pollution control on urban development quality in the eastern region is of great significance in statistical tests, while the situation in the central and western regions has not passed the test, implying the spatial heterogeneity among different regions. The different effects of air pollution control on urban development quality in different regions also illustrate the consciousness and supervision of local governments’ environment protection. Finally, the effects decomposition of the influencing factors based on spatial Durbin model (SDM) also supports the robust findings. Promoting the upgrading of energy consumption structure, raising awareness of environmental protection and supervision, and strengthening cooperation of different regions are suggested. Further recommendations are provided to improve the conceptual design and increase the credibility of our research. Our study not only provides new evidence on the impact of air pollution control on urban development quality in China, but also proposes a new perspective to promote urban development quality in China. Full article

Eating away from home is a risk factor for poor diet quality and obesity. With an ever-increasing proportion of household food spend directed toward eating out, the proliferation of these food establishments may contribute to their use, a potential precursor to less healthy food choices and low overall diet quality. However few studies are conducted at the national level and across a range of away from home food sources. The purpose of this study was to examine the association between the density of away from home food establishments (e.g., restaurants, fast food outlets and cafés) and household spend on away from home food within a nationally representative sample for England, UK. A cross-sectional analysis of data from Wave 1 of the UK Household Longitudinal Survey (n = 24,047 adults aged ≥19y) was conducted. Exposure was characterised as the density of away from home food establishments to all other food sources within 1 mile of the home, divided into quintiles (Q1 as lowest exposure and Q5 as highest exposure). The primary outcome included households with a high away from home equivalised monthly food spend (≥25% of total food spend). Logistic regression was used to estimate associations between away from home food establishment exposure and high away from home food spend. Away from home food establishment density was significantly associated with a greater odds of high monthly food spend (Q3: OR = 1.18, 95% CI = 1.07, 1.30; Q4: OR = 1.30, 95% CI = 1.18, 1.43; and Q5: OR = 1.52, 95% CI = 1.37, 1.68) with attenuation after controlling for known socioeconomic confounders (Q4: OR = 1.13, 95% CI = 1.02, 1.25; and Q5: OR = 1.16, 95% CI = 1.04, 1.30) compared to those least exposed (Q1). Those most exposed to away from home food establishments had a 16% greater odds of allocating more than 25% of household food spend on away from home food sources. This study provides one of the first analyses at the national level to examine the role of the local food environment in relation to household food spend, a potential precursor to diet quality and health. Full article

(1) Medical doctors and medical students show increased psychological stress levels. International medical students seem to be particularly vulnerable. (2) We compared different methods of assessing stress levels in international and local first year medical students. First, study participants completed questionnaires related to stress, depression, empathy, and self-efficacy (MBI, PSQ, PHQ-9, JSPE-S, and GSE) at three separate points in time (T1 to T3). Second, their heart rate variabilities (HRVs) were recorded in an oral examination, a seminar, and in a relaxing situation. Third, hair samples were collected at the beginning and at the end of the semester to assess the cortisol concentration. (3) Included were 20 international and 20 local first semester medical students. At T1, we found considerable differences between international and local students in the JSPE-S; at T2 in the MBI factor “professional efficacy”, the PHQ-9, and in the JSPE-S; and at T3 in the MBI factors “cynicism” and “professional efficacy”, the PHQ-9, and in the JSPE-S. International and local students also differed concerning their HRVs during relaxation. Over the course of the semester, international students showed changes in the MBI factors “emotional exhaustion” and “professional efficacy”, the PHQ-9, and the GSE. Local students showed changes in the GSE. No effects were found for students’ hair cortisol concentrations. (4) All participants showed low levels of stress. However, while international students experienced their stress levels to decrease over the course of the semester, local students found their stress levels to increase. Full article

The purpose of this systematic review and meta-analysis was to address disparities related to sexual health among students by examining the effectiveness of sexually transmitted infection (STI) preventive interventions in educational settings. PubMed, Medline, Cochrane Library, Public Health Database, and EMBASE databases were used to conduct searches. Information relating to studies, programs, participants, and quantitative outcome variables were extracted. Risk of bias was assessed and meta-analysis was conducted. This systematic review included 16 articles. The outcomes were classified into behavioral and psychosocial categories. The behavioral category included sexual partners, sexual activity, condom use, STI/HIV testing, and alcohol/drug use before sex. The psychosocial category consisted of knowledge, motivational factors, and skills. Interventions had a significantly positive impact on both behavioral (OR, 1.28; 95% CI, 1.17–1.39) and psychosocial (OR, 1.92; 95% CI, 1.36–2.72) outcomes. Among the psychosocial outcomes, the interventions were most effective at promoting knowledge (OR, 3.17; 95% CI, 2.13–4.72), followed by enhancing motivational factors (OR, 1.69; 95% CI, 1.04–2.75) and increasing behavioral skills (OR, 1.43; 95% CI, 1.13–1.81). The results of this systematic review provide empirical evidence for public health professionals and policy makers regarding planning, implementation, evaluation, and modification of STI preventive intervention programs in educational settings. Full article

Research on the environment, health, and well-being nexus (EHWB) is shifting from a silo toward a systemic approach that includes the socio-economic context. To disentangle further the complex interplay between the socio-exposome and internal chemical exposure, we performed a meta-analysis of human biomonitoring (HBM) studies with internal exposure data on per-and polyfluoroalkyl substances (PFASs) and detailed information on risk factors, including descriptors of socio-economic status (SES) of the study population. PFASs are persistent in nature, and some have endocrine-disrupting properties. Individual studies have shown that HBM biomarker concentrations of PFASs generally increase with SES indicators, e.g., for income. Based on a meta-analysis (five studies) of the associations between PFASs and SES indicators, the magnitude of the association could be estimated. For the SES indicator income, changes in income were expressed by a factor change, which was corrected by the Gini coefficient to take into account the differences in income categories between studies, and the income range between countries. For the SES indicator education, we had to conclude that descriptors (<college, x years of study, etc.) differed too widely between studies to perform a meta-analysis. Therefore, the use of the uniform ISCED (International Standard Classification of Education) is recommended in future studies. The meta-analysis showed that a higher income is associated with a higher internal exposure to PFASs (PFOS or perfluorooctanesulfonic acid, PFOA or perfluorooctanoic acid, PFNA or perfluorononanoic acid, PFHxS or perfluorohexane sulfonate). This is opposite to the environmental justice hypothesis, referring to an inequitable distribution of detrimental environmental effects toward poor and minority communities by a practice or policy. With a doubling of the income, internal exposure increased on average by 10%–14%. Possible explanations for this difference are given, e.g., underlying differences in diet. However, other sources can also contribute, and the exact causes of SES-related differences in PFAS concentrations remain unclear. Studies are needed that include social descriptors together with lifestyle and dietary information as explanatory variables for internal chemical exposure levels. This will help clarify the underlying factors that link SES with inequity to environmental exposures, and will raise awareness and knowledge to strengthen the capacities of people and communities to advocate chemical exposure reduction in order to reduce this health inequity. Full article

The biodegradation of particulate substrates starts by a hydrolytic stage. Hydrolysis is a slow reaction and usually becomes the rate limiting step of the organic substrates biodegradation. The objective of this work was to evaluate a novel hydrolysis concept based on a modification of the activated sludge model (ASM2d) and to compare it with the original ASM2d model. The hydrolysis concept was developed in order to accurately predict the use of internal carbon sources in enhanced biological nutrient removal (BNR) processes at a full scale facility located in northern Poland. Both hydrolysis concepts were compared based on the accuracy of their predictions for the main processes taking place at a full-scale facility. From the comparison, it was observed that the modified ASM2d model presented similar predictions to those of the original ASM2d model on the behavior of chemical oxygen demand (COD), NH₄-N, NO₃-N, and PO₄-P. However, the modified model proposed in this work yield better predictions of the oxygen uptake rate (OUR) (up to 5.6 and 5.7%) as well as in the phosphate release and uptake rates. Full article

Knowledge is considered to be an important resource; it is the source of competitive advantage. However, if knowledge is managed well with Knowledge Management (KM), then it becomes a source for sustainable competitive advantage for organizations. If KM is implemented in an organization, it would improve the organizational competitiveness, performance, and productivity, and facilitate the efficient use of resources. Due to intense competition in the global market, many organizations are moving towards the adoption of KM. The healthcare sectors of many developed countries have moved towards the implementation of KM because it can improve the procuring of knowledge from ongoing activities by the effective use of data repositories. Developing countries have now realized the potential and benefits of KM adoption. Pakistan is one of the developing countries that have recently shown an inclination towards the adoption of KM in its healthcare sector to improve performance of its healthcare. This study was composed of two main research phases. Firstly, the enablers of KM were reviewed from earlier studies. Secondly, interpretive structural modeling (ISM) and MICMAC (Cross-Impact Matrix Multiplication Applied to Classification) techniques were used to show the interrelationships between KM enablers and driving and dependence power of each enabler. The application of ISM and MICMAC technique shows that policy incentive, long-term strategic planning, Information Technology (IT), and alignment of KM efforts with business strategy are the main enablers of KM adoption in the healthcare of Pakistan. Focusing on the identified enablers will help in the implementation of KM. Policy incentives can work as a catalyst to promote KM adoption in the healthcare of Pakistan. Full article

This study examined the prevalence and factors associated with inconsistent condom use among men who have sex with men (MSM) who use gay mobile geo-social networking applications (gay mobile apps) in Greater Tokyo. Among a sample of 1657 MSM recruited through advertisements on gay mobile apps, inconsistent condom use was reported by over one-third (37%) of participants with regular male partners, 18% with casual male partners, and 20% with female partners. In multiple regression analysis, inconsistent condom use with both regular and casual male partners was more commonly reported among participants without a university education, and among participants reporting lower self-efficacy for safer sex. Inconsistent condom use with casual male partners was more commonly reported among participants living in the central 23 wards of Tokyo. Inconsistent condom use with regular male partners was more commonly reported among participants who identified as a member of the gay community, and who only had male partners. These results indicate that a substantial proportion of Greater Tokyo gay mobile app users use condoms inconsistently, particularly with regular partners, and may be at risk for HIV. This paper provides useful information to help design tailored strategies to reduce inconsistent condom use. Full article

Reduction in child mortality is a demographic progress of significant socioeconomic development relevance in Africa. This paper analyzed the effect of maternal education and fertility on child survival in the Islands of Comoros. The 2012 Demographic and Health Survey (DHS) data were used. A two-stage probit regression method was used for data analysis. The results showed that about 75% of the children’s mothers had given birth to between one and five children, while more than half did not have any form of formal education. The results of the two-stage probit regression showed that while child survival reduced significantly (p < 0.05) with the age of the heads of households, residence in the Ngazidja region, being born as twins, mother’s number of business trips, and number of marital unions, it increased with maternal education, fertility, male household headship, and the child being breastfed immediately after birth. It was concluded that efforts to enhance maternal education would reduce child mortality. It is also critical to promote child breastfeeding among women, while regional characteristics promoting differences in child mortality in Comoros Islands should be properly addressed with keen focus on the Ngazidja region. Full article

The prevalence of type 2 diabetes is escalating rapidly in Asian countries, with the rapid increase likely attributable to a combination of genetic and lifestyle factors. Recent research suggests that common genetic risk variants contribute minimally to the rapidly rising prevalence. Rather, recent changes in dietary patterns and physical activity may be more important. This nested case-control study assessed the association and predictive utility of type 2 diabetes lifestyle risk factors in participants from Malaysia, an understudied Asian population with comparatively high disease prevalence. The study sample comprised 4077 participants from The Malaysian Cohort project and included sub-samples from the three major ancestral groups: Malay (n = 1323), Chinese (n = 1344) and Indian (n = 1410). Association of lifestyle factors with type 2 diabetes was assessed within and across ancestral groups using logistic regression. Predictive utility was quantified and compared between groups using the Area Under the Receiver-Operating Characteristic Curve (AUC). In predictive models including age, gender, waist-to-hip ratio, physical activity, location, family history of diabetes and average sleep duration, the AUC ranged from 0.76 to 0.85 across groups and was significantly higher in Chinese than Malays or Indians, likely reflecting anthropometric differences. This study suggests that obesity, advancing age, a family history of diabetes and living in a rural area are important drivers of the escalating prevalence of type 2 diabetes in Malaysia. Full article

Garbage collection is an important part of municipal engineering. An effective service network design can help to reduce the municipal operation cost and improve its service level. In this paper, we propose an optimization model for the network design of municipal solid waste (MSW) collection in the Nanjing Jiangbei new area. The problem was formulated as a mixed integer nonlinear programming (MINLP) model with an emphasis on minimizing the annual operation cost. The model simultaneously decides on the optimal number of refuse transfer stations (RTSs), determines the relative size and location for each RTS, allocates each community to a specific RTS, and finally identifies the annual operation cost and service level for the optimal scenario as well as other scenarios. A custom solution procedure which hybrids an enumeration rule and a genetic algorithm was designed to solve the proposed model. A sensitivity analysis was also conducted to illustrate the impact of changes in parameters on the optimality of the proposed model. Test results revealed that our model could provide tangible policy recommendations for managing the MSW collection. Full article

Human populations worldwide have experienced substantial environmental issues in part due to air pollution, notably in China. Gaps in the scientific literature remain regarding the relationship between air pollution and sedentary behavior among young adults in China. The purpose of this study is to examine the effect of air pollution on sedentary behavior among college students living in Beijing, China. We conducted follow-up health surveys on 12,174 freshman students enrolled at Tsinghua University from 2013 to 2017. Sedentary behavior was measured using the short version of the International Physical Activity Questionnaire (IPAQ). Corresponding air pollution data measured by the Ministry of Environmental Protection of the People’s Republic of China were collected to include the average hourly air quality index (AQI), PM_2.5, PM₁₀, and NO₂ (µg/m³). The data were analyzed using linear individual fixed-effect regressions. An increase in air pollution concentration of one standard deviation in AQI, PM_2.5, PM₁₀, and NO₂ was associated with an increase in weekly total hours of sedentary behavior by 7.35 (95% confidence interval (CI) = 5.89, 8.80), 6.24 (95% CI = 5.00, 7.49), 6.80 (95% CI = 5.46, 8.15), and 7.06 (95% CI = 5.65, 8.47), respectively. In the presence of air pollution, women students tended to increase their sedentary behavior more than men. Air pollution increases sedentary behavior among freshman students living in Beijing, China. Replication of this study is warranted among various populations within China. Full article

Elderly suicide is a rising concern. Despite the advent of mobile technology, there remained a gap in the evidence base as to whether smartphone applications could be used for mindfulness intervention for suicidality in Asian older adults. This paper aimed to review recent research relevant to smartphone applications that could be used in providing mindfulness interventions for suicidality to Asian older adults. The inclusion criteria for this review were papers published in peer-reviewed journals from 2008 to 2018 with the usage of specific search terms, namely, ‘smartphone application’, ‘mobile application’, and ‘mindfulness’, assessed against the inclusion criteria and screened by an experienced Asian clinician to be of clinical utility for mindfulness intervention for suicidality with Asian older adults. Initial search on databases yielded 236 results. A total of 35 full text papers that fit the inclusion criteria were assessed for eligibility and 10 papers were included in the current review. This review highlighted the paucity of rigorous empirically validated research into effective smartphone applications that can be used for mindfulness interventions for suicidality with Asian older adults. Full article

Background: Process mining is a relatively new discipline that helps to discover and analyze actual process executions based on log data. In this paper we apply conformance checking techniques to the process of surveillance of melanoma patients. This process consists of recurring events with time constraints between the events. Objectives: The goal of this work is to show how existing clinical data collected during melanoma surveillance can be prepared and pre-processed to be reused for process mining. Methods: We describe an approach based on time boxing to create process models from medical guidelines and the corresponding event logs from clinical data of patient visits. Results: Event logs were extracted for 1023 patients starting melanoma surveillance at the Department of Dermatology at the Medical University of Vienna between January 2010 and June 2017. Conformance checking techniques available in the ProM framework and explorative applied process mining techniques were applied. Conclusions: The presented time boxing enables the direct use of existing process mining frameworks like ProM to perform process-oriented analysis also with respect to time constraints between events. Full article

The Korea Simulation Exposure Model for fine particulate matter (PM_2.5) (KoSEM-PM) was developed to estimate population PM_2.5 exposure in Korea. The data were acquired based on 59,945 min of the actual microenvironmental PM_2.5 measurements and on the time–activity patterns of 8072 residents of Seoul. The aims of the study were to estimate daily PM_2.5 exposure of Seoul population, and to determine the characteristics of a high exposure group. KoSEM-PM estimated population exposures by applying the PM_2.5 distribution to the matching time–activity patterns at 10-min intervals. The mean personal PM_2.5 exposure level of the surveyed subjects in Seoul was 26.0 ± 2.7 µg/m³ (range: 21.0–40.2 µg/m³) in summer. Factors significantly associated with high exposure included day of the week, age, industry sector, job type, and working hours. Individuals surveyed on Saturdays were more likely to be in the high exposure group than those surveyed on weekdays and Sundays. Younger, non-office-working individuals with longer working hours were more likely to be in the high exposure group. KoSEM-PM could be a useful tool to estimate population exposure levels to other region in Korea; to expand its use, microenvironmental measurements are required for other region in Korea. Full article