International Journal of Environmental Research and Public Health

The aim of this study was to identify changes in the hazardous consumption of alcohol, tobacco, and cannabis, due to the COVID-19 lockdown in 2020 in a cohort of schooled adolescents from Central Catalonia. We also analyzed the effect of the individual and social factors on risky consumption during confinement. This longitudinal study involved a subsample of 303 adolescents aged 14–18 years, who were attending 4th year of compulsory secondary education (ESO), 2nd year of college preparation (baccalaureate), or Vocational and Educational Training (VET). We collected data before COVID-19 lockdown (October 2019–February 2020) and 2 months after the lockdown ended. We estimated the prevalence of risky substance use in the sample at baseline for each independent variable. We used Poisson regression models with robust variance to compute the Cumulative Incidence (CI) and Relative Risk (RR), with their respective 95% confidence interval. We found that VET students had a significantly (p < 0.05) higher risk of substance use: binge drinking (RR = 3.21 (95%CI: 1.00–10.34)); hazardous drinking of alcohol (RR = 3.75 (95%CI: 1.12–12.54)), hazardous consumption of cannabis (RR = 3.75 (95%CI: 0.65–21.59)) and daily smoking of tobacco (RR = 4.82 (95%CI: 1.74–13.39)). The results showed a general trend of reduction of consumption during COVID-19 confinement period. This study suggests that VET students were more likely to engage in hazardous drinking of alcohol and daily smoking of tobacco. No statistically significant differences were found for the other age groups and variables. Full article

The COVID-19 pandemic has spread uncertainty, promoted psychological distress, and fueled interpersonal conflict. The concomitant upsurge in endorsement of COVID-19 conspiracy theories is worrisome because they are associated with both non-adherence to public health guidelines and intention to commit violence. This study investigates associations between endorsement of COVID-19 conspiracy theories, support for violent radicalization (VR) and psychological distress among young adults in Canada. We hypothesized that (a) endorsement of COVID-19 conspiracy theories is positively associated with support for VR, and (b) psychological distress modifies the relationship between COVID-19 conspiracy theories and support for VR. A total of 6003 participants aged 18–35 years old residing in four major Canadian cities completed an online survey between 16 October 2020 and 17 November 2020, that included questions about endorsement of COVID-19 conspiracy theories, support for VR, psychological distress, and socio-economic status. Endorsement of conspiracy theories was associated with support for VR in multivariate regression (β = 0.88, 95% confidence interval (CI) 0.80–0.96). There is a significant interaction effect between endorsement of COVID-19 conspiracy theories and psychological distress (β = 0.49, 95% CI 0.40–0.57). The magnitude of the association was stronger in individuals reporting high psychological distress (β = 1.36, 95% CI 1.26–1.46) compared to those reporting low psychological distress (β = 0.47, 95% CI 0.35–0.59). The association between endorsement of COVID-19 conspiracy theories and VR represents a public health challenge requiring immediate attention. The interaction with psychological distress suggests that policy efforts should combine communication and psychological strategies to mitigate the legitimation of violence. Full article

The total isolation of patients with coronavirus disease 2019 (COVID-19) requires non-face-to-face medical assistance. There is evidence of the efficacy of home treatments with exercises in patients with respiratory disorders which could become the therapeutic method of choice for the treatment and supervision of patients isolated due to infection during home confinement. This study’s objective was to analyse the experience and opinions of isolated patients with COVID-19 included in a programme of telerehabilitation exercises for 14 days and it is intended to reflect, from a qualitative point of view, the viability and usefulness of telerehabilitation tools in the management of these patients. Twenty-five participants of a telerehabilitation programme were interviewed by telephone through semi-structured interviews, following a positivist and objective model. The data were categorised and analysed through NVIVO qualitative analysis software. The information obtained was classified into four main topics (telerehabilitation programme, perception of clinical benefit, psychological aspects and level of health care) and six subtopics (technical aspects, communication, improvement aspects, exercise plan, motivation and applicability to public health systems). The telerehabilitation programme established in patients confined by COVID-19 is very well received, without considerable technical difficulties and generates physical and psychological improvements. Patients highlight the importance of applying this type of programme in public health systems. Full article

Childhood malnutrition remains an important public health and development problem in low- and middle-income countries. This study aimed to systematically review the community-based nutrition-specific interventions and their effectiveness and/or cost-effectiveness on the nutritional status of children under 5 years of age in the Eastern Mediterranean Region (EMR). A systematic literature search of the English electronic databases, including PubMed, Scopus, ISI Web of Knowledge, Ovid, EMBASE, as well as Persian databases (SID and Magiran) was performed up to May 2019. Studies regarding the effectiveness/cost-effectiveness of the community-based nutrition-specific programs and interventions targeted at under-five-year children in EMR countries were selected. The primary outcomes were mean of Weight-for-age z-score (WAZ), Height-for-Age z-score (HAZ), and Weight-for-Height z-score (WHZ) of children or prevalence of wasting, stunting, and/or underweight among the children. Meta-analysis was also performed on the selected articles and intervention effects (mean differences) were calculated for each outcome for each study and pooled using a weighted random effects model. Risk of bias (ROB) of each included study was assessed based on the Cochrane Handbook for Systematic Reviews. The study protocol was registered in PROSPERO (CRD42020172643). Of 1036 identified studies, eight met the inclusion criteria. Amongst these, seven were from Pakistan and one from Iran. Only one study conducted in Pakistan reported the cost-effectiveness of nutrition-specific interventions in the region. Nutrition education/consultation and cash-based interventions were the most common nutrition-specific strategies used for management of child malnutrition in the EMR countries. Out of these eight studies, four were included in the meta-analysis. When different interventions were pooled, they had resulted in a significant improvement in WHZ of children (MD: 0.26; 95% CI: 0.07 to 0.46, three studies, I² 82.40%). Considering the high prevalence of child malnutrition in a number of countries in the region, capacity building and investigation regarding the implementation of new approaches to improve nutritional status of children and their effect(s) and cost-effectiveness assessment are highly recommended. Full article

Depression constitutes a major public health problem due to its high prevalence and difficulty in diagnosis. The Hopkins Symptom Checklist-25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use in primary care (PC). The purpose of the study was to assess the psychometric properties of the HSCL-25 and validate its Spanish version. A multicenter cross-sectional study was carried out at six PC centers in Spain. Validity and reliability were assessed against the structured Composite International Diagnostic Interview (CIDI). Out of the 790 patients, 769 completed the HSCL-25; 738 answered all the items. Global Cronbach’s alpha was 0.92 (0.88 as calculated for the depression dimension and 0.83 for the anxiety one). Confirmatory factor analysis (CFA) showed one global factor and two correlated factors with a correlation of 0.84. Area under the curve (AUC) was 0.89 (CI 95%, 0.86–0.93%). For a 1.75 cutoff point, sensibility was 88.1% (CI 95%, 77.1–95.1%) and specificity was 76.7% (CI 95%, 73.3–79.8%). The Spanish version of the HSCL-25 has a high response percentage, validity, and reliability and is well-accepted by PC patients. Full article

Diet management or caloric restriction for diabetes mellitus patients is essential in order to reduce the disease’s burden. Mathematical programming problems can help in this regard; they have a central role in optimal diet management and in the nutritional balance of food recipes. The present study employed linear optimization models such as linear, pre-emptive, and non-pre-emptive goal programming problems (LPP, PGP and NPGP) to minimize the deviations of over and under achievements of specific nutrients for optimal selection of food menus with various energy (calories) levels. Sixty-two food recipes are considered, all selected because of being commonly available for the Indian population and developed dietary intake for meal planning through optimization models. The results suggest that a variety of Indian food recipes with low glycemic values can be chosen to assist the varying glucose levels (>200 mg/dL) of Indian diabetes patients. Full article

Background: The COVID-19 pandemic has globally overwhelmed all sectors of life. The fast development of vaccines against COVID-19 has had a significant impact on the course of the pandemic. Methods: Global data from Google Trends was analyzed for vaccines against flu, BCG, HPV, pneumococcal disease, polio, and COVID-19. The time frame includes the last five-year period starting from 17 April 2016. Multiple training of time series models with back testing, including Holt–Winters forecasting, Exponential Smoothing State Space, Linear model with trend and seasonal components (tlsm), and ARIMA was conducted. Forecasting according to the best fitting model was performed. Results: Correlation analysis did not reveal a decrease in interest in vaccines during the analyzed period. The prediction models provided a short-term forecast of the dynamics of interest for flu, HPV, pneumococcal and polio vaccines with 5–10% growth in interest for the first quarter of 2022 when compared to the same quarter of 2021. Conclusions: Despite the huge interest in the COVID-19 vaccine, there has not been a detectable decline in the overall interest in the five analyzed vaccines. Full article

Introduction: Adolescents and young women become increasingly aware of their bodies through images presented to them through social structures during their developmental stage. These images may drive them toward unhealthy behaviors including overeating, starving, and skin bleaching. This paper is part of a study that examined the Older Adolescent Banyankole Girl’s Response to the socio-cultural constructions of body image in The Ankole Region, Uganda. It aimed to understand the self-perceptions of adolescent girls of their body image within Ankole society. Methods: The study collected narrative interviews of 30 adolescent and young adult females (16–24) recruited from various institutions of learning as well as the Ankole community of southwestern Uganda. Results: Adolescent girls’ perceptions of beauty were influenced by pull and push factors that included beauty expectations, beauty comparisons, relationships, and dietary habits that keep them oscillating between traditional and contemporary beauty ideals. Findings suggest that young women could benefit from social shifting of focus from physical appearance to other valuable developmental assets. Conclusion: Government-sponsored programs that provide education and positive media messages may be beneficial to building the self-esteem of young women. Full article

This exploratory, nationwide cross-sectional study was performed to investigate the well-being of Portuguese nutritionists, in addition to outlining their professional and demographic profile. Descriptive analyses were carried out to determine the measures relating to centralising tendency and dispersion of the sample. We compared means and proportions through t-tests and Analysis of Variance (ANOVA). The sample size was 206 individuals, respecting a minimum of eight respondents per item to validate the instrument. We recruited Nutritionists from Portugal nationwide using the list of electronic mail provided by the Order of Nutritionists. We sent an electronic mail to all the Nutritionists registered in this Order. We also used messaging applications and social networks (Instagram, Facebook) to reach Nutritionists who were not accessing electronic mail. Most respondents are women (92.5%), young (mean age = 31.4 ± 8.07 years; 54.2% of participants aging under 30 years), single, and with no children. More than half are Catholic (73.8%) and have less than ten years of nutritionist undergraduate completion (55.4%). The only variable that influences well-being at work is the economic variable Household Monthly Income. Those who earn less than € 500.00 per month perceive themselves at a lesser state of work well-being than those who earn from € 2501.00 to € 5000.00 per month. Full article

Married female nurses experience work–family conflict (WFC) as they manage excessive work and various working-hour types while rearing children and tending household chores, and as a result, they continuously constantly deliberate over quitting their job or moving to a different workplace. Married nurses were found to have shorter sleep duration and sleep latency compared to single nurses, and high job stress not only hinders their family life but also causes sleep problems. Depression is a classic negative emotion experienced by married working women who must manage both work and family. This study aims to examine WFC in married female nurses and investigate its predictors, namely depression and sleep quality. A total of 229 married female nurses completed a Google questionnaire link consisting of the Work–Family Conflict Scale, Sleep-Quality Scale, and the Center for Epidemiologic Studies Depression Scale (CES-D). Data were analyzed by descriptive statistics, t-test, ANOVA, LSD post hoc test, Pearson’s correlation coefficients, and multiple regression using the SPSS/WIN 26.0 program. The average WFC score was 4.84 ± 1.12 (range 1–7); WFC showed a statistical difference according to a stage of the lifecycle (F = 7.12, p = 0.001) and perceived health (F = 12.01, p < 0.001). WFC was low among those in the non-parenthood stage of the lifecycle (β = −0.26, p < 0.001), those with good (β = −0.18, p = 0.011) or moderate perceived health (β = −0.15, p = 0.023), and those without turnover intention (β = −0.13, p = 0.016). On the other hand, WFC was high among those who were extremely dissatisfied with their job (β = 0.16, p = 0.008) and those who had a high level of depression (β = 0.22, p = 0.002); these variables explained 20.2% of WFC (F = 7.663, p < 0.001). Based on these results, subsequent studies should develop and implement coping programs that help reduce WFC and improve depression and sleep quality in married female nurses. Full article

Background: Long-term use of opioids for chronic noncancer pain is associated with sex hormone disturbances. The interferences with sex hormones, sexual function, and depression were investigated in patients with chronic noncancer pain. Methods: A cross-sectional multicenter survey was conducted on 170 officially registered outpatients receiving long-term opioid treatment in nine medical centers in Taiwan between October 2018 and July 2019. Serum sex hormone levels were examined after the collection of self-administered questionnaires containing the Taiwanese version of the Brief Pain Inventory, depressive status, and sexual function interference. Results: Among 117 (68.8%) questionnaire responses from 170 enrolled outpatients, 38 women and 62 men completed the sex hormone tests, among whom only 23 (23%) had previously received blood hormone tests. Low serum total testosterone levels were detected in 34 (89.5%) women (<30 ng/dL) and 31 (50%) men (<300 ng/dL). Over 60% of women and men reported reduced sexual desire and function despite a nearly 50% reduction in pain intensity and daily function interference over the previous week after opioid treatment. Women generally had higher risks of a depression diagnosis (p = 0.034) and severe depressive symptoms (p = 0.003) and nonsignificantly lower opioid treatment duration (median 81 vs. 120 months) and morphine milligram equivalent (median 134 vs. 165 mg/day) compared with men. Conclusions: This survey demonstrated the high prevalence of depression diagnosis, low sex hormone levels, and reduced sexual function among Taiwanese patients with chronic noncancer pain receiving prolonged opioid therapy. Regular hypogonadal screenings are recommended for further management. Full article

Mastering the coupling and coordination relationship and driving mechanism of urbanization and ecosystem service value (ESV) is of great significance to ecological protection and regional sustainable development. In this paper, the coupling coordination model, geographic detector and GWR model are used to analyze the spatio-temporal coupling interaction between urbanization and ESV and the spatial differentiation characteristics of influencing factors from 1995 to 2018. The results of the study are as follows: (1) During the study period, cities in the Yellow River Basin experienced accelerated urban expansion, and the ESV of forests, water and wetlands increased, which offset the reduction in ESV due to the expansion of construction land and farmland and grassland. (2) The degree of coupling and coordination between the two gradually improved, but the overall situation showed a low-level coupling and coordination process. Mild coupling coordination gradually increased, reaching an increase of 38.10%; severe imbalance types tended to disappear, decreasing by 52.38%, and coupling subtypes developed from lagging urbanization to ESV backward types. The high-value areas of the coupling coordination degree are distributed in the high-value areas of ESV in the north of the upper reaches, and the low-value areas are distributed in the cities of Henan and Shandong with high urbanization levels in the downstream and most resource-based cities in the middle reaches. (3) In addition, the spatial intensity of the effect of each dominant factor on the degree of coupling coordination is different. Economic growth, technological development, environmental regulations and the proportion of forest land have positive and belt-shaped alienation characteristics for the coupling and coordination of the two, and infrastructure and temperature show negative driving characteristics. Therefore, the coupling and coordination relationship between ESV and urbanization should be clarified to help future urban planning. On the basis of determining the regional environmental carrying capacity and the adjustment direction of the rational planning of land resources, the impact of urban barriers formed by administrative boundaries and natural geographical conditions on the development of urban agglomerations should be broken to achieve the overall high-quality and coordinated development of the basin. Full article

Taxes are a demonstrably effective method to suppress tobacco use. This study examined the effects of the tobacco parity (i.e., imposing taxes equally on all tobacco products) and the harm reduction (i.e., applying taxes in proportion to the products’ levels of harm) tax proposals on demand and substitution across products. A crowdsourced sample of cigarette smokers (n = 35) completed purchasing trials with increasing tax magnitudes across different tax tiers in the Experimental Tobacco Marketplace in a repeated-measures design. Products were placed in three tax tiers (high, medium, and no tax) according to each proposal’s goal. The results indicated that total nicotine (mg) purchased was not significantly different between the proposals, with higher taxes yielding lower demand. However, as taxes increased, the tobacco parity proposal decreased the purchasing of all tobacco products and increased the purchasing of medicinal nicotine (i.e., the no tax tier). Conversely, the harm reduction proposal resulted in greater purchases of electronic nicotine delivery systems and smokeless tobacco (i.e., the medium tax tier). These findings support tobacco taxation as a robust tool for suppressing purchasing and suggest that differential taxation in proportion to product risk would be an effective way to incentivize smokers to switch from smoked to unsmoked products. Further studies should investigate the unintended consequences of their implementation. Full article

Background: The theory of planned behaviour (TPB) explanation of smoking cessation intentions consists of gender differences. The purpose of this study is to adopt the extended TPB to discuss factors influencing the smoking cessation intentions of young adult volunteer soldiers and to further compare the respective factors for both genders. Methods: This is a cross-sectional study. Data were collected from 139 and 165 male and female volunteer soldiers who smoked, respectively. Research participants completed a self-administered questionnaire that comprised items pertaining to the participants’ demographic characteristics, smoking behaviours, smoking cessation experiences, social environments, and TPB variables. Results: Subjective norms (friends) are a positive key factor for young adult male (β = 0.033, p = 0.012) and female (β = 0.076, p < 0.001) volunteer soldiers’ smoking cessation intentions, and perceived behavioural control is a key factor for male young (β = 0.226, p = 0.040) adult volunteer soldiers’ smoking cessation intention. The extended TPB accounted for 27.9% and 53.2% of the variance in the intention to quit smoking in the male and female volunteer soldiers, respectively. Conclusions: We suggest that smoking cessation strategies can reinforce gender-specific intervention strategies to assist young adult volunteer soldiers in smoking cessation. Full article

Body mass index (BMI) is thought to reflect excess adiposity in both youth and adults alike. However, the association between BMI and fatness varies, especially as children grow into adults. Thus, the present study sought to address this issue by characterizing how BMI reflects age and sex differences in body fatness in 7–16-year-old children. Methods: This cross-sectional study was conducted with 2150 children and adolescents, aged 7 to 16 years from the city of Santa Cruz do Sul, Brazil. BMI (kg/m²), and percentage body fat, using tricipital and subscapular folds, were assessed. For statistical analysis, ANOVA and ANCOVA were used. Results: When considered in isolation, there was no significant interaction in the age-by-sex differences in BMI (p = 0.69). However, when we controlled for percent body fatness, the analysis revealed considerable age-by-sex differences in BMI (p < 0.001). Conclusion: For the same body fat (%), there are no differences in BMI in children <10 years. Full article

Primary dysmenorrhea (PD) refers to painful cramps before and/or during menstruation. There is a need for emphasis on alternative methods of conservative treatment, so as to reduce the dependence on drugs for alleviating the symptoms. The aim was to find out the effectiveness of some physiotherapy techniques in the treatment of PD. A systematic review and meta-analysis was conducted according to PRISMA standards. The descriptors were “dysmenorrhea”, “physical the-rapy”, “physiotherapy”, and “manual therapy”. The search was performed in five databases: Scopus, PubMed, PEDro, Web of Science, and Medline, in February 2021. The inclusion criteria were randomized controlled trials over the last six years. Articles not related to the treatment of PD or using pharmacology as the main treatment were excluded. Nine articles met the objectives and criteria, with a total of 692 participants. The most used scale to measure pain was the VAS (visual analogue scale). The main techniques were isometric exercises, massage therapy, yoga, electrotherapy, connective tissue manipulation, stretching, kinesio tape, progressive relaxation exercises and aerobic dance. Meta-analysis shows benefits of physiotherapy treatment for pain relief compared with no intervention or placebo (MD: −1.13, 95% CI: −1.61 to −0.64, I²: 88%). The current low-quality evidence suggests that physiotherapy may provide a clinically significant reduction in menstrual pain intensity. Given the overall health benefits of physiotherapy and the low risk of side effects reported, women may consider using it, either alone or in conjunction with other therapeutic modalities. Full article

The prolonged use of intranasal cocaine can destroy the nasal architecture with the erosion of the palate, turbinates, and ethmoid sinuses causing cocaine-induced midline lesions (CIMDL). The CIMDL display a clinical pattern mimicking variable diseases. The aim of this study was to highlight the difficulties in reaching a correct diagnosis through the evaluation of eight new cases. The diagnostic procedures followed in these patients included: detailed medical history, clinical and histological examination, computed tomography and magnetic resonance imaging, laboratory findings (complete blood count, sedimentation rate, antinuclear antibody test, rheumatoid factor, venereal disease research laboratory test, leishmaniasis and fungal serology, antineutrophil cytoplasmic antibodies ANCA test), and chest X-ray. All patients complained of epistaxis, halitosis, nasal scabs and obstruction, decreased sense of smell and/or taste, oro-nasal regurgitation of solids and liquids with recurrent sinus infections, and chronic facial pain. On clinical examination, all patients showed palate perforation with variable nasal structure involvement and presented a strong positivity for ANCA tests with a p-ANCA pattern. The followed protocol for the CIMDL diagnosis allowed for a relatively quick and conclusive diagnosis in all patients. A multidisciplinary approach is mandatory in the management of CIMDL, involving dental professionals, maxillofacial surgeons, and psychologists. Full article

This study delineated the templestay experience in the context of the authenticity of tourism. To understand the phenomenon of templestay experience, the study applied the hermeneutic phenomenology method. Furthermore, the researcher tried to approach the experience with an open perspective in observing essential meanings and lived phenomena. From the hermeneutic guide, the study discovered “structure of perceptions (situation, emotion, thought, action),” “perceptual experiences (rational experience, sentimental experience, judgmental experience, experimental experience),” and “experiential authenticity (superficial authenticity, situational authenticity, relational authenticity, space-time authenticity, existential authenticity)” from the lived templestay experience and developed a “descriptive model of the integrative phenomenon of templestay experience.” This study suggests the possibility of discovering new phenomena by expanding the boundaries of the perceptions of the authentic experience of tourism. Full article

This study examined the relationships of cyberbullying and traditional bullying victimization and perpetration, perceived family function, frustration discomfort, and hostility with self-reported depressive symptoms and suicidality in adolescents diagnosed as having attention-deficit/hyperactivity disorder (ADHD). Both the self-reported severity of depressive symptoms on the Center for Epidemiological Studies Depression Scale and the occurrence of suicidal ideation or a suicide attempt on the suicidality module of the Kiddie Schedule for Affective Disorders and Schizophrenia were assessed in 195 adolescents with ADHD. The adolescents completed the Cyberbullying Experiences Questionnaire, Chinese version of the School Bullying Experience Questionnaire, Frustration–Discomfort Scale, Buss–Durkee Hostility Inventory, and Family APGAR Index. Caregivers completed the ADHD problems component of the Child Behavior Checklist for Ages 6–18. Multiple regression analyses were used to examine the correlates for each of self-reported depressive symptoms and suicidality. The results showed that after the effects of gender, age, ADHD symptoms, and family function were controlled, greater frustration discomfort and bullying perpetration significantly predicted self-reported depressive symptoms. Being cyberbullying victims and displaying hostility significantly predicted the risk of suicidality. Various types of bullying involvement, frustration intolerance, and hostility significantly predicted self-reported depressive symptoms and suicidality in adolescents with ADHD. By monitoring and intervening in these factors, we can reduce the risk of depression-related problems and suicidality in adolescents with ADHD. Full article