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

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

High-temperature weather appears in high frequency, big strength, and long duration in the summer. It is therefore important to study the effects of high-temperature weather on sleep quality and appetite. Ten healthy college students were selected as subjects. The experiment conditions were divided by the daily maximum temperature into 28 °C, 32 °C, 36 °C, and 38 °C. The objective sleep quality was measured by an intelligent sleep monitoring belt, and the subjective sleep quality was measured by a questionnaire survey. The subjective appetites were assessed by a visual analog scale (VAS), and the objective appetites were assessed by the meal weight and the meal time. For sleep quality, the objective results indicated that the sleep quality at 32 °C was the best, followed by 28 °C, while the sleep quality at 36 °C and 38 °C was the worst. Significant effects were mainly reflected in sleep duration and shallow sleep. The subjective results showed that temperature had significant effects on sleep calmness, difficulty in falling asleep, sleep satisfaction, and sleep adequateness. For appetite, the VAS results indicated that high temperatures mainly led to a reduction of appetite at lunch time. The meal weights of lunch were larger than those of supper except for 28 °C, and the meal time of lunch and supper was longer than that of breakfast. The meal time of lunch was longer than that of supper except for 36 °C. This paper can provide a study method and reference data for the sleep quality and appetite of human in high-temperature weather. Full article

Background Noise in the vicinity of airports is a public health problem. Many laboratory studies have shown that heart rate is altered during sleep after exposure to road or railway noise. Fewer studies have looked at the effects of exposure to aircraft noise on heart rate during sleep in populations living near airports. Objective The aim of this study was to investigate the relationship between the sound pressure level (SPL) of aircraft noise and heart rate during sleep in populations living near airports in France. Methods In total, 92 people living near the Paris-Charles de Gaulle and Toulouse-Blagnac airports participated in this study. Heart rate was recorded every 15 s during one night, using an Actiheart monitor, with simultaneous measurements of SPL of aircraft noise inside the participants’ bedrooms. Energy and event-related indicators were then estimated. Mixed linear regression models were applied, taking into account potential confounding factors, to investigate the relationship between energy indicators and heart rate during sleep measured every 15 s. Event-related analyses were also carried out in order to study the effects of an acoustic event associated with aircraft noise on heart rate during sleep. Results The more the SPL from all sources (L_Aeq,15s) and the SPL exceeded for 90% of the measurement period (L_A90,15s) increased, the more heart rate also increased. No significant associations were observed between the maximum 1-s equivalent SPL associated with aircraft overflight (L_Amax,1s) and differences between the heart rate recorded during or 15 or 30 s after an aircraft noise event and that recorded before the event. On the other hand, a positive and significant association was found between L_Amax,1s and the heart rate amplitude calculated during an aircraft noise event. Results were unchanged when analyses were limited to participants who had lived more than five years in their present dwelling. Conclusion Our study shows that exposure to the maximum SPL linked to aircraft overflight affect the heart rate during sleep of residents near airports. However, further studies on a larger number of participants over several nights are needed to confirm these results. Full article

Cadmium (Cd) is a highly toxic metal that can affect human health and environmental safety. The purpose of this study was to research the removal of Cd from an environmental perspective. In this article, four highly urease-active strains (CZW-2, CZW-5, CZW-9 and CZW-12) were isolated from an abandoned mine and their phylogenetic trees were analyzed. The maximum enzyme activities, the mineralized precipitate and the removal rates of these strains were compared. The results showed that CZW-2 had the highest urease activity at 51.6 U/mL, and the removal rates of CZW-2, CZW-5, CZW-9 and CZW-12 after 120 h were 80.10%, 72.64%, 76.70% and 73.40%, with an initial concentration of Cd of 2 mM in the Cd precipitation experiments. XRD (X-ray diffractometer), EDS (Energy dispersive spectrometer) and FTIR (Fourier transform infrared spectroscopy) analysis indicated that the mineralized precipitate was CdCO₃. SEM (Scanning electron microscopy) analysis revealed that the diameter of the oval-shaped mineralized product ranked from 0.5 to 2 μm. These strains were used to remedy Cd-contaminated soil, and five different fractions of Cd were measured. Compared with the control, the results of spraying pre-cultured strains containing 2% urea to remove Cd from contaminated soils showed that the exchangeable fraction of Cd decreased by 53.30%, 27.78%, 42.54% and 53.80%, respectively, whereas the carbonate-bound fraction increased by 55.42%, 20.27%, 39.67% and 34.36%, respectively, after one month. These data show that these strains can effectively reduce the bioavailability and mobility of Cd in contaminated soils. The results indicate that biomineralization based on the decomposition of substrate urea can be applied to remedy heavy contaminated soil and water. Full article

Promoting healthy lifestyle factors (e.g., physical activity, healthy eating, less screen time) among young people is a relevant and challenging step toward reducing non-communicable diseases. This study aimed to evaluate the effect of a multicomponent intervention on lifestyle factors among adolescents from schools in low Human Development Index (HDI < 0.500) areas. The Fortaleça sua Saúde program was conducted with 548 adolescents aged 11–18 years old in the intervention group and 537 in the control group. The four-month intervention included strategies focused on training teachers, new opportunities for physical activity in the school environment, and health education strategies for the school community (including parents). Moderate- to-vigorous physical activity level (≥420 min/week), TV watching and computer use/gaming (<2 h/day), daily consumption of fruit juice, fruit, vegetables, soft drinks, savory foods and sweets, and current alcohol and tobacco use were measured before and after intervention. McNemar’s test and logistic regression (odds ratio [OR] and a 95% confidence interval [95% CI]) were used, considering p < 0.05. In the intervention schools, a significant increase occurred in the number of adolescents who met physical activity guidelines (5.3%; 95% CI = 0.8; 9.8) and who reported using computer for <2 h a day (8.6%; 95% CI = 3.8; 13.4) after intervention. No changes were observed in the control schools. At the end of the intervention, adolescents from intervention schools were more likely to practice physical activity at recommended levels (OR = 1.44; 95% CI = 1.00; 2.08) than adolescents from control schools. No significant change was observed for the other lifestyle factors. In conclusion, this multicomponent intervention was effective in promoting physical activity among adolescents from vulnerable areas. However, other lifestyle factors showed no significant change after intervention. This study is registered at Clinicaltrials.gov NCT02439827. Full article

The Chenyulan watershed, located in the central mountain area of Taiwan, has been suffering from earthquakes, typhoons, and heavy rainfalls in recent decades. These sequential natural disturbances have a cumulative impact on the watershed, leading to more fragile and fragmented land cover and loss of capacity of soil water conservation. In this study, the Soil and Water Assessment Tool (SWAT) and a landscape metrics tool (FRAGSTATS) were used to assess the direct impact (e.g., by annual rainfall) and indirect impact (e.g., by landscape configuration and composition) of natural disturbances on the ecohydrological processes of the Chenyulan watershed. Six SPOT satellite images from 2008 to 2013 were analyzed by using the nearest feature line embedding (NFLE) approach and reclassified into six land cover types: forest, cultivated land, grassland, river, landslide, and built-up. Forest was found to have the largest patch size, indicating that it is more resilient to disturbances, while agricultural land tended to expand from the river side toward the hill. Two land cover change scenarios were compared in the SWAT model. The results showed that there was no significant difference in simulated streamflow during 2004–2015 and sediment loading during 2004–2009; however, the model performed better for sediment loading during 2010–2015 with dynamic land cover change (coefficient of determination (R²) = 0.66, Nash-Sutcliffe efficiency coefficient (NSE) = 0.62, percent bias (PBIAS) = 10.5%, root mean square error observation standard deviation ratio (RSR) = 0.62) than with constant land cover (R² = 0.61, NSE = 0.54, PBIAS = −17.3%, RSR = 0.68), indicating that long-term land cover change should be considered in hydrologic modeling. Changes in landslides during 2008–2013 were found to significantly affect ecohydrological processes, especially after 2011. In general, annual precipitation plays a dominant role, and landscape composition had by far the strongest influence on water yield and sediment yield compared to landscape configuration. The results can be useful for understanding the effects of land cover change on ecohydrological processes in the Chenyulan watershed and the potential impact of ecohydrological changes on the environment and public health. Full article

In Poland, in addition to mandatory, free of charge vaccines, listed in the national immunization schedule, numerous self-paid vaccinations are recommended, including meningococcal vaccination (MV). To assess MV uptake among ≤5-year-old children and to evaluate parental knowledge and attitudes regarding invasive meningococcal disease (IMD). A cross-sectional study was conducted in 2018 among 350 parents (mean age: 32.3 years), attending three randomly selected primary care clinics in Szczecin region, Poland. Anonymous questionnaires were administered to the parents by researchers, present at the time the survey was conducted, to self-complete on a voluntary basis. Chi-square or Fisher’s exact for categorical and Mann–Whitney U test for continuous variables. Variables significantly (p < 0.05) associated with ‘good knowledge’ in the bivariate analysis were used to build a logistic regression model. It was found that the response rate was 93.4%, and MV uptake among children was 29.5%. The main knowledge sources were medical staff and media; 72.5% had ever received information about IMD. Only 18.8% of parents self-assessed their knowledge regarding IMD as good; 61.8% scored >50% in the knowledge test 58.9% knew the mode of transmission, 58.7% recognized the severity of meningitis, and 79.7% knew that bacterial meningitis is a vaccine-preventive disease. Knowledge regarding IMD was higher among parents with higher educational level (OR = 3.37; p = 0.01), from urban facilities (OR = 2.20; p = 0.02), who received previous information about IMD (OR = 2.85; p = 0.01) and self-assessed their knowledge as good (OR = 2.59; p = 0.04). Low MV coverage among children up to five years old and knowledge gaps about IMD call for awareness campaigns which may increase the coverage. Although educational interventions should cover all parents, those from provincial facilities, representing lower education level need special attention. Full article

Phytotoxicity thresholds for heavy metals are derived from dose–response curves, which show the relationships between exposure dose and toxicity response. However, the results of tests or observations are commonly based on total heavy metal concentration, not the exposure dose that causes phytotoxicity; additionally, the phytotoxicity response differs with plant species. In the present study, the ethylenediaminetetraacetic acid (EDTA)-extractable copper (Cu) concentration was determined in order to evaluate Cu extractability. As two important horticultural food crops in Asia, tomato (Lycopersicon esculentum ‘Meifen No. 1’) and bok choy (Brassica rapa var. chinensis ‘Susheng 28’) were used to investigate Cu phytotoxicity in a wide range of Chinese soils with and without leaching treatment, after which relationships between Cu phytotoxicity thresholds based on EDTA-extractions and soil properties were established. The phytotoxicity thresholds showed that biomass of bok choy was more sensitive to Cu than tomato. Multiple linear regression analyses showed that soil factors, including organic carbon (OC), citrate dithionate extractable manganese (CD-Mn), cation exchange capacity (CEC), and CaCO₃ explained over 85% of the variance in Cu phytotoxicity thresholds. The EDTA-extractable Cu dose–response relationships were further improved by incorporating soil properties. The new phytotoxicity predictive models indicated soil properties (soil pH, OC, CEC, and oxalate-extractable Mn) and EDTA-extractable Cu concentration explained more than 90% of the variance in the phytotoxicity response of tomato and bok choy biomass. The new phytotoxicity predictive models could be used to develop a reasonable remediation strategy for contaminated soils. Full article

The inhalation of particulate matter (PM) in second-hand smoke (SHS) is hazardous to health of smokers and non-smokers. Tobacco strength (amount of tar, nicotine, and carbon monoxide) and different additives might have an effect on the amount of PM. This study aimed to investigate the influence of tobacco strength or additives on PM. Four cigarette types of the brand Marlboro with different strengths and with or without additives were analyzed in comparison to the 3R4F reference cigarette. SHS was generated by an automatic environmental tobacco smoke emitter (AETSE) in an enclosed space with a volume of 2.88 m³. PM concentrations (PM₁₀, PM_2.5, PM₁) were measured with a laser aerosol spectrometer followed by statistical analysis. The two strongest Marlboro brands (Red and Red without additives) showed the highest PM concentrations of all tested cigarettes. The measured mean concentrations Cmean of PM₁₀ increased up to 1458 µg/m³ for the Marlboro Red without additives (PM_2.5: 1452 µg/m³, PM₁: 1263 µg/m³). The similarly strong Marlboro Red showed very similar PM values. The second strongest type Marlboro Gold showed 36% (PM₁₀, PM_2.5) and 32% (PM₁) lower values, respectively. The “lightest” type Marlboro Silver Blue showed 54% (PM₁₀, PM_2.5) or 50% (PM₁) lower PM values. The results indicate that the lower the tar, nicotine, and carbon monoxide amounts, as well as the longer the cigarette filter, the lower are the PM levels. An influence of additives could not be determined. Full article

The potential for risky play and independent mobility to increase children’s physical activity, and enhance cognitive development and emotional wellbeing has been recognised for some time. The aim of this study was to describe the attitudes of New Zealand parents towards such risky play practices and independent mobility, the barriers preventing them from allowing their children to participate, and how often their children engaged in risky play activities. An online survey comprised mostly of validated scales and standardised questions was completed by a nationally representative sample of 2003 parents. We found that parents had neutral feelings about the risk of injury to their child through play, rather they were concerned about road safety and “stranger danger”. There was strong agreement that there are multiple benefits to be gained from exposure to risk and challenge, and that health and safety rules are too strict. However, 73% of respondents stated that their 5–12 year old child seldom or never engaged in four or more risky activities, and only 14.3% engaged in four or more often or always. While parents agree that their child is likely to benefit from risky play, they do not have the confidence to allow their children to engage in such activities. Future research should address barriers and fears when implementing strategies to facilitate risky play. Full article

In this paper, we conduct an empirical study on the impact of CEOs’ environmental awareness on technological innovation. To this end, we obtain a large sample with 7615 observations from Chinese A-share listed firms between the years of 2003 and 2014. Our empirical results show that a CEO’s environmental awareness has a significant positive impact on technological innovation of his/her enterprise. Environmentally conscious CEOs will invest more in R&D and obtain more patents. This will help their enterprises achieve higher efficiency of technological innovation. Furthermore, the environmental awareness of a CEO has a more significant impact on technological innovation if his/her enterprise is subject to a higher level of monitoring. We also conduct robustness check of our findings and provide managerial insights and proactive government policies to raise the environmental awareness of CEOs and improve the innovation vitality of enterprises. Full article

Health-related quality of life (HRQOL) was reported to reflect overall quality of life and individual perceptions related to health. Decreased lung function is associated with reduced ventilation and oxygen intake and reported to affect body functions. However, the effect of lung function reduction on HRQOL is still unclear. A total of 8398 retired workers from Dongfeng-Tongji Cohort Study were included in this cross section study. Lung function was measured using an electronic spirometer. HRQOL was evaluated through a questionnaire designed according to the WHOQOL-BREF. The mean of the HRQOL scores of its four domains (physical health, psychological state, social relationships and environment) is the total HRQOL score. A general linear model was used to analyse the association between lung function and HRQOL. In the continuous analysis by the general linear model, FVC was associated with the total HRQOL, physical health domain and social relationships domain scores. In the categorical analysis, there was a linear trend between FVC and the total HRQOL and physical health scores. We also found a similar relationship between FEV₁ and HRQOL scores. Further analysis suggested that elevated lung function could improve the scores of pain and discomfort facet and independence facet of physical health domain. The lung function was significantly positively associated with HRQOL in middle-aged and older Chinese. Full article

Medical students are vulnerable to depression and anxiety due to the nature of their academic life. This study aimed to determine the prevalence of depressive and anxiety symptoms among medical students and the association between religious coping, religiosity and socio-demographic factors with anxiety and depressive symptoms. A cross sectional design was used for this study. Scales used were the Malay version of the Duke Religious Index (DUREL-M), the Malay version of the Brief Religious Coping Scale (Brief RCOPE) and the Malay version Hospital and Anxiety Depression Scale (HADS-M). 622 students participated in this study. They scored moderately on the organized (mean: 3.51) and non-organized religious (mean: 3.85) subscales of the DUREL, but had high intrinsic religiosity (mean: 12.18). The prevalence of anxiety and depressive symptoms were 4.7% and 17.4% respectively, which is lower than local as well as international data. Islam, negative religious coping and the presence of depressive symptoms were significantly associated with anxiety symptoms. Only the presence of anxiety symptoms was significantly associated with depressive symptoms. Negative religious coping, rather than positive religious coping, has significant association with depressive and anxiety symptoms. Redirecting focus towards negative religious coping is imperative to boost mental health outcomes among medical students. Full article