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

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

The rise of food trucks as an eating out option requires knowledge of this sector. Balancing the reality of the food truck sector with access to safe food should guide actions and public policies to cater to its peculiarities. Therefore, this study aimed to characterize the Brazilian food truck vendors’ profile regarding their socioeconomic status and compliance with food safety rules. From the 118 food truck vendors registered in the Brazilian Federal District, 30% (n = 35) participated in the study. We conducted structured interviews from December 2017 to April 2018. We ranked compliance levels according to a five-point Likert scale based on calculated compliance scores. The interviews revealed that food truck vendors were mostly married males, who had completed at least a tertiary education level, and wanted to start up their own businesses. The compliance levels depict good compliance with food safety rules (overall compliance (OC)-score = 0.69, on a 0 to 1 scale). The food trucks assessed in this study distinguished themselves from the street food and food retail sectors due to their operational structure and the complexity of food production processes. Those particular features should be considered to ensure adequate and effective sanitary control and inspections, as well as to reduce the probability of microbial growth and food contamination and the consequent risk of foodborne illnesses. Full article

Chronic musculoskeletal pain (CMP) is a serious health concern especially among the elderly population and has significant bearing on health and quality of life. Not much is known about the relationship between chronic pain with self-reported health and quality of life among older populations in low-resource settings. Based on sub-national data from South Africa and Uganda, the present study aimed to explore whether the older population living with CMP report health and quality of life differently compared to those with no CMP complaints. This study was based on cross-sectional data on 1495 South African and Ugandan men and women collected from the SAGE Well-Being of Older People Study. Outcome variables were self-reported physical and mental health and quality of life (QoL). Mental health was assessed by self-reported depressive symptoms during the last 12 months. CMP was assessed by self-reported generalised pain as well as back pain. Multivariable logistic regression models were used to measure the association between health and QoL with CMP by adjusting for potential demographic and environmental confounders. The prevalence of poor self-rated health (61.2%, 95% CI = 51.7, 70.0), depression (37.2%, 95% CI = 34.8, 39.6) and QoL (80.5%, 95% CI = 70.8, 87.5) was considerably high in the study population. Mild/moderate and Severe/extreme generalised pain were reported respectively by 34.5% (95% CI = 28.9, 40.5) and 15.7% (95% CI = 12.2, 19.9) of the respondents, while back pain was reported by 53.3% (95% CI = 45.8, 60.4). The prevalence of both types was significantly higher among women than in men (p < 0.001). In the multivariate analysis, both generalised pain and back pain significantly predicted poor health, depression and QoL, however, it varied between the two different populations. Back pain was associated with higher odds of poor self-rated health [OR = 1.813, 95% CI = 1.308, 2.512], depression [1.640, 95% CI = 1.425, 3.964] and poor QoL [1.505, 95% CI = 1.028, 2.202] in South Africa, but not in Uganda. Compared to having no generalised pain, having Mild/Moderate [OR = 2.309, 95% CI = 1.219, 7.438] and Severe/Extreme [OR = 2.271, 95% CI = 1.447, 4.143] generalised pain was associated with significantly higher odds of poor self-rated health in South Africa. An overwhelmingly high proportion of the sample population reported poor health, quality of life and depression. Among older individuals, health interventions that address CMP may help promote subjective health and quality and life and improve psychological health. Full article

Abdominal aortic aneurysm (AAA) represents an important public health problem with a prevalence between 1.3% and 12.5%. Several population-based randomized trials have evaluated ultrasound screening for AAA providing evidence of a reduction in aneurysm-related mortality in the screened population. The aim of our study was to perform a systematic review and meta-analysis of the risk factors for AAA. We conducted a systematic review of observational studies and we performed a meta-analysis that evaluated the following risk factors: gender, smoking habits, hypertension, coronary artery disease and family history of AAA. Respect to a previous a meta-analysis we added the funnel plot to examine the effect sizes estimated from individual studies as measure of their precision; sensitivity analysis to check the stability of study findings and estimate how the overall effect size would be modified by removal of one study; cumulative analysis to evaluate the trend between studies in relation to publication year. Abdominal aortic aneurysm prevalence is higher in smokers and in males. On the other hand, while diabetes is a risk factor for many cardiovascular diseases, it is not a risk factor for AAA. In addition, it is important to underline that all countries, where AAA screening was set up, had high income level and the majority belong to Western Europe (United Kingdom, Sweden, Italy, Poland, Spain and Belgium). Abdominal aortic aneurysm screening is fundamental for public health. It could avoid deaths, ruptures, and emergency surgical interventions if abdominal aortic aneurysm was diagnosed early in the population target for screening. Full article

This study aimed to clarify the psychological benefits of brief walks through forest areas. In addition, we aimed to examine the associations between psychological responses and trait anxiety levels. Five-hundred-and-eighty-five participants (mean age, 21.7 ± 1.6 years) were instructed to walk predetermined courses through forest (test) and city (control) areas for 15 min. The Profile of Mood State (POMS) questionnaire and State-Trait Anxiety Inventory were used to assess participants’ psychological responses and trait anxiety levels, respectively. The results revealed that walking through forest areas decreased the negative moods of “depression-dejection”, “tension-anxiety”, “anger-hostility”, “fatigue”, and “confusion” and improved the participants’ positive mood of “vigor” compared with walking through city areas. Furthermore, a significant correlation was found between participants’ trait anxiety levels and their changes in the subscale of “depression-dejection” of POMS after walking through forest areas. A more effective reduction in the feeling of “depression-dejection” after walking through forest areas was observed for participants with high trait anxiety levels than for those with normal and low trait anxiety levels. This study showed the psychological benefits of walking through forest areas and identified a significant correlation between psychological responses to walking through forests and trait anxiety levels. Full article

The aim of this paper is to evaluate the link between the history of exposure to tuberculosis (TB) in the household and diagnosed TB cases at school, and to compare the detection rate of active TB among household contacts and classroom contacts of adolescent TB cases with the rates among contacts of healthy controls. From November 2016 to December 2017, a prospective matched case-control study was conducted using passively identified index adolescent student cases from the TB surveillance system and healthy controls (matched by county, school type, sex, age and ethnicity). Contacts in households and classrooms of index cases and of controls were investigated. Matched tabulation of 117 case-control pairs revealed exposure to TB in the household as a strong risk factor (odds ratio (OR) = 21.0, 95% confidence interval (CI): 3.4, 868.6). Forty-five (case detection rate 0.69%) and two (case detection rate 0.03%) new active TB cases were detected among 6512 and 6480 classroom contacts of the index cases and controls, respectively. Having an index case in the classroom significantly increased the risk of classmates contracting active TB (OR = 22.5, 95% CI: 5.9, 191.4). Our findings suggested that previous exposure to TB in the household could lead a child to catch TB at school, then spread TB to classmates. Full article

Walking School Buses (WSBs), organized groups for children to walk to school under the supervision of adults, help reduce traffic congestion and contribute towards exercise. Routes are based largely on need, traffic safety and travel time, with exposure to air pollution not generally considered. This paper explores whether reductions in exposure can be achieved based on the side of the road travelled using data collected in Auckland, New Zealand. Exposure to air pollution was measured for a 25-min commute consisting of a 10-min segment along a quiet cul-de-sac and a 15-min segment along a main arterial road with traffic congestion heavier in one direction. Two participants were each equipped with a portable P-Trak ultrafine particle monitor and a portable Langan carbon monoxide monitor, and walked the route on opposite sides of the road simultaneously, for both morning and afternoon, logging 10-s data. The results suggest that pedestrians travelling on the footpath next to the less congested side of the road in the morning avoid many short-term peaks in concentration and experience significantly lower mean exposures than those travelling on the footpath next to the more congested side. Significant reductions in air pollution exposure could be made for children by taking into account the side of the road in WSB route design. Full article

Meteorological parameters play an important role in determining the prevalence of ambient particulate matter (PM) in the upper north of Thailand. Mae Hong Son is a province located in this region and which borders Myanmar. This study aimed to determine the relationships between meteorological parameters and ambient concentrations of particulate matter less than 10 µm in diameter (PM₁₀) in Mae Hong Son. Parameters were measured at an air quality monitoring station, and consisted of PM₁₀, carbon monoxide (CO), ozone (O₃), and meteorological factors, including temperature, rainfall, pressure, wind speed, wind direction, and relative humidity (RH). Nine years (2009–2017) of pollution and climate data obtained from the Thai Pollution Control Department (PCD) were used for analysis. The results of this study indicate that PM₁₀ is influenced by meteorological parameters; high concentration occurred during the dry season and northeastern monsoon seasons. Maximum concentrations were always observed in March. The PM₁₀ concentrations were significantly related to CO and O₃ concentrations and to RH, giving correlation coefficients of 0.73, 0.39, and −0.37, respectively (p-value < 0.001). Additionally, the hourly PM₁₀ concentration fluctuated within each day. In general, it was found that the reporting of daily concentrations might be best suited to public announcements and presentations. Hourly concentrations are recommended for public declarations that might be useful for warning citizens and organizations about air pollution. Our findings could be used to improve the understanding of PM₁₀ concentration patterns in Mae Hong Son and provide information to better air pollution measures and establish a warning system for the province. Full article

Research findings concerning burnout prevalence rate among nurses from the medical area are contradictory. The aim of this study was to analyse associated factors, to determine nurse burnout levels and to meta-analyse the prevalence rate of each burnout dimension. A systematic review, with meta-analysis, was conducted in February 2018, consulting the next scientific databases: PubMed, CUIDEN, CINAHL, Scopus, LILACS, PsycINFO and ProQuest Health & Medical Complete. In total, 38 articles were extracted, using a double-blinded procedure. The studies were classified by the level of evidence and degrees of recommendation. The 63.15% (n = 24) of the studies used the MBI. High emotional exhaustion was found in the 31% of the nurses, 24% of high depersonalisation and low personal accomplishment was found in the 38%. Factors related to burnout included professional experience, psychological factors and marital status. High emotional exhaustion prevalence rates, high depersonalisation and inadequate personal accomplishment are present among medical area nurses. The risk profile could be a single nurse, with multiple employments, who suffers work overload and with relatively little experience in this field. The problem addressed in this study influence the quality of care provided, on patients’ well-being and on the occupational health of nurses. Full article

The co-occurrence of health-related markers and their associations with individual, family, and environmental characteristics have not yet been widely explored in siblings. We aimed to identify multivariate profiles of health-related markers, analyze their associations with biological, sociodemographic, and built environment characteristics, and estimate sibling resemblance in these profiles. The sample includes 736 biological siblings aged 9–20 years. Body fat was measured with a portable bioelectrical impedance scale; biological maturation was assessed with the maturity offset; handgrip strength, standing long jump, one-mile run, and shuttle run were used to mark physical fitness. Health behaviors, sociodemographic, and built environmental characteristics were recorded by questionnaire. Latent profile analysis and multilevel logistic regression models were used; sibling resemblance was estimated with the intraclass correlation (ρ). Two multivariate profiles emerged: “P1 = fit, lower fat and poorer diet” (86.7%) and “P2 = higher fat and lower fit, but better diet” (13.3%). Siblings whose fathers were less qualified in their occupation were more likely to belong to P2 (OR = 1.24, p = 0.04); those whose fathers with Grade 12 and university level education were more likely to fit in P2 compared to peers living with fathers having an educational level below Grade 12 (OR = 3.18, p = 0.03, and OR = 6.40, p = 0.02, Grade 12 and university level, respectively). A moderate sibling profile resemblance was found (0.46 ≤ ρ ≤ 0.55). In conclusion, youth health-related markers present substantial differences linked with their body composition, physical fitness and unhealthy diet. Furthermore, only father socio-demographic characteristics were associated with profile membership. Sibling´s profile resemblance mirrors the effects of genetics and shared characteristics. Full article

Falls incidence rates and associated injuries are projected to increase among rural-dwelling older adults, which highlights the need for effective interventions to prevent falls and manage fall-related risks. The purpose of this descriptive study was to identify the geospatial dissemination of eight evidence-based fall prevention programs (e.g., A Matter of Balance, Stepping On, Tai Chi, Otago Exercise Program) across the United States (U.S.) in terms of participants enrolled, workshops delivered, and geospatial reach. These dissemination characteristics were compared across three rurality designations (i.e., metro areas; non-metro areas adjacent to metro areas; and, non-metro areas not adjacent to metro areas). Data were analyzed from a national repository of 39 Administration for Community Living (ACL) grantees from 2014–2017 (spanning 22 states). Descriptive statistics were used to assess program reach, delivery-site type, and completion rate by rurality. Geographic information systems (GIS) geospatially represented the collective reach of the eight interventions. Of the 45,812 participants who attended a fall prevention program, 12.7% attended workshops in non-metro adjacent areas and 6.6% attended workshops in non-metro non-adjacent areas. Of the 3755 workshops delivered (in over 550 unique counties), most were delivered in senior centers (26%), residential facilities (20%), healthcare organizations (13%), and faith-based organizations (9%). On average, the workshop attendance/retention rates were consistent across rurality (~70%). Findings highlight the need to diversify the delivery infrastructure for fall prevention programs to adequately serve older adults in rural areas. Ongoing efforts are needed to offer sustainable technical assistance and to develop scalable clinical-community referral systems to increase fall prevention program participation among rural-dwelling older adults. Full article

Cumulative risk assessment (CRA) has been proposed as a means of evaluating possible additive and synergistic effects of multiple chemical, physical and social stressors on human health, with the goal of informing policy and decision-making, and protecting public health. Routine application of CRA to environmental regulatory and policy decision making, however, has been limited due to a perceived lack of appropriate quantitative approaches for assessing combined effects of chemical and nonchemical exposures. Seven research projects, which represented a variety of disciplines, including population health science, laboratory science, social sciences, geography, statistics and mathematics, were funded by the US Environmental Protection Agency (EPA) to help address this knowledge gap. We synthesize key insights from these unique studies to determine the implications for CRA practice and priorities for further research. Our analyses of these seven projects demonstrate that the necessary analytical methods to support CRA are available but are ultimately context-dependent. These projects collectively provided advancements for CRA in the areas of community engagement, characterization of exposures to nonchemical stressors, and assessment of health effects associated with joint exposures to chemical and psychosocial stressors. Full article