International Journal of Environmental Research and Public Health

Assisted living (AL) is an emerging model of care in countries where long-term care needs are escalating, with emphasis given to promoting independence and autonomy among the residents to achieve active and healthy ageing. Unlike established nursing homes, the governance of AL is nebulous due to its novelty and diverse nature of operations in many jurisdictions. A comprehensive understanding of how AL is governed globally is important to inform regulatory policies as the adoption of AL increases. A systematic literature review was undertaken to understand the different levels of regulations that need to be instituted to govern AL effectively. A total of 65 studies, conducted between 1990 to 2020, identified from three major databases (PubMed, Medline, and Scopus), were included. Using a thematic synthesis analytical approach, we identified macro-level regulations (operational authorisation, care quality assessment and infrastructural requirements), meso-level regulations (operational management, staff management and distribution, service provision and care monitoring, and crisis management), and micro-level regulations (clear criteria for resident admission and staff hiring) that are important in the governance of AL. Large-scale adoption of AL without compromising the quality, equity and affordability would require clear provisions of micro-, meso- and macro-level regulations. Full article

We present a comparative environmental and social life cycle assessment (ELCA and SLCA) of algal fuel and fodder co-production (AF + fodder) versus algal fuel and energy co-production (AF + energy). Our ELCA results indicate that fodder co-production offers an advantage in the following categories: climate change (biogenic land use and land use change total), ecotoxicity, marine eutrophication, ionizing radiation, photochemical ozone creation, and land use. By contrast, the AF + energy system yields lower impacts in the other 11 out of 19 Environmental Footprint impact categories. Only AF + fodder offers greenhouse gas reduction compared to petroleum diesel (−25%). Our SLCA results indicate that AF + fodder yields lower impacts in the following categories: fair salaries, forced labor, gender wage gap, health expenditure, unemployment, and violation of employment laws and regulations. AF + energy performs favorably in the other three out of nine social indicators. We conclude that the choice of co-products has a strong influence on the sustainability of algal fuel production. Despite this, none of the compared systems are found to yield a consistent advantage in the environmental or social dimension. It is, therefore, not possible to recommend a co-production strategy without weighing environmental and social issues. Full article

SARS-CoV-2 (COVID-19) resulted in school closures and contingencies across the U.S. that limited access to school meals for students. While some schools attempted to provide alternative meal access points where students or parents could pick up meals, many students—especially those in low-income households—lacked adequate transportation to these access points. Thus, physical proximity to meal access points was particularly important during the pandemic. In this study, we explore how school meal access changed during the COVID-19 pandemic, especially as it relates to race/ethnicity and socio-economic status. Taking into account both the “supply” (meal access points) and the “demand” (low-income students) for free meals, we employed a two-step floating catchment area analysis to compare meal accessibility in St. Louis, Missouri before and during the pandemic in the spring and summer of 2019 and 2020. Overall, while school meal access decreased during the spring of 2020 during the early months of the pandemic, it increased during the summer of 2020. Moreover, increased access was greatest in low-income areas and areas with a higher proportion of Black residents. Thus, continuing new policies that expanded access to school meals—especially for summer meal programs—could lead to positive long-term impacts on children’s health and well-being. Full article

This systematic review was aimed at gathering technical and clinical applications of CAD/CAM technology for the preoperative planning of craniofacial implants placement, designing of molds and substructures and fabrication of orbital prostheses. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, an electronic search was executed. Human studies that utilized digital planning systems for the prosthetic rehabilitation of orbital defects were included. A total of 16 studies of 30 clinical cases, which were virtually planned through various digital planning and designing software, were included. The most common preoperative data required for digital planning were CT scans in 15 cases, the 3DSS-STD-II scanning system in 5 cases, an Artec Color 3D scanner in 3 cases and a NextEngine Desktop 3D laser scanner in 2 cases. Meanwhile, the digital designing software were Ease Orbital Implant Planning EOIPlan software in eight cases, Geomagic software in eight cases, Simplant software in four cases and Artec Studio 12 Professional in three cases. Surgical templates were fabricated for 12 cases to place 41 craniofacial implants in the orbital defect area. An image-guided surgical navigation system was utilized for the placement of five orbital implants in two cases. Digital designing and printing systems were reported for the preoperative planning of craniofacial implants placement, designing of molds and substructures and fabrication of orbital prostheses. The studies concluded that the digital planning, designing and fabrication of orbital prostheses reduce the clinical and laboratory times, reduces patient visits and provide a satisfactory outcome; however, technical skills and equipment costs are posing limitations on the use of these digital systems. Full article

This study aimed to evaluate the effects of an oral function training program and indicators of oral health status on improvements in physical performance induced by physical function training in dependent older adults. The participants were 131 potentially dependent older adults (age: ≥65 years) who were randomly divided into two groups: an oral intervention and a control group. All participants underwent physical function training, but only the intervention group took part in the oral function training program. In total, 106 participants completed all of the survey components (60 and 46 participants from the intervention and control groups, respectively). The measures of physical fitness examined included the one-leg standing time with eyes open (OLST) and the timed up and go test (TUG). Logistic regression analyses were carried out to determine the effects of the oral function intervention and health status on physical fitness. The results revealed that the oral function intervention significantly improved OLST and TUG times. These findings suggest that evaluations of oral health status and interventions aimed at activating oral functions are associated with improvements in physical fitness among potentially dependent older adults. Full article

Gait and physical fitness are related to cognitive function. A decrease in motor function and physical fitness can serve as an indicator of declining global cognitive function in older adults. This study aims to use machine learning (ML) to identify important features of gait and physical fitness to predict a decline in global cognitive function in older adults. A total of three hundred and six participants aged seventy-five years or older were included in the study, and their gait performance at various speeds and physical fitness were evaluated. Eight ML models were applied to data ranked by the p-value (LP) of linear regression and the importance gain (XI) of XGboost. Five optimal features were selected using elastic net on the LP data for men, and twenty optimal features were selected using support vector machine on the XI data for women. Thus, the important features for predicting a potential decline in global cognitive function in older adults were successfully identified herein. The proposed ML approach could inspire future studies on the early detection and prevention of cognitive function decline in older adults. Full article

Mining dam failures have increased worldwide since the 1980s. Two large mining dam failures occurred recently in Mariana and Brumadinho, both in the state of Minas Gerais, Brazil. We hypothesize that there were significant differences in legal post-disaster decisions. The aim of this article is to understand the similarities and differences of post-disaster actions and controversies in Mariana and Brumadinho. We reviewed 686 news reports about court decisions and settlement agreements from the websites of state and federal courts and judicial institutions. After classifying the reports using an adapted protocol from a media health observatory, we conducted a thematic analysis. Our analysis suggests that there were significant differences in legal post-disaster decisions in the cases of Mariana and Brumadinho. In Mariana, there was privatization of post-disaster management, with the creation of the Renova Foundation, a mediated indemnity program, lack of access to information for those affected, and uncertainties in health and resettlement issues. In Brumadinho, there was faster implementation of the recovery and compensation measures, faster recognition of affected parties, and stronger participation of the population since the first hearings. Even though there were particularities in post-disaster management, the ultimate goal of the corporations responsible for the disasters was to protect their profits. Full article

Juvenile perpetrators account for over 25% of all sexual offenses, and over one-third of such offenses are against victims under the age of 18. Given empirical connections between adverse childhood experience (ACE) exposure and perpetration of violence, we create victim typologies based on the juveniles’ relationship to their victims among 5539 justice-involved adolescents who have committed violent against-person sexual felonies. Multinomial logistic regression is used to assess which covariates, including individual ACE exposures and cumulative traumatic exposures, are associated with victim typologies. This approach allows for better targeting of violence prevention efforts, as a more nuanced understanding of the increased likelihood to victimize specific victim groups lends to potential differences in treatment provision, beyond simplistic findings regarding ACE exposure increasing offending. Results indicate five classes of victim types, ranging from a low of 6.4%, with primarily strangers as victims, to 31.3%, with predominately acquaintances as victims, and only 12.9% with a diverse array of relationships to victims. Importantly, many demographic and individual risk factors, and specific traumatic exposures were related to victimizing one’s sibling, while cumulative trauma as measured by an ACE score decreased the likelihood of victimizing classmates, while increasing the likelihood of victimizing siblings and other relatives compared to victimizing acquaintances. Full article

The current study examined how neighborhood environments are related to older adults’ perceived control over time. A longitudinal study design was employed using data sampled from the Health and Retirement Study (HRS) 2014 and 2018. In total, 3170 older adults, whose age ranged between 60 and 99 years at the baseline, were followed up with a 4-year lag. Measures included two domains of neighborhood characteristics: social cohesion and physical disorder (at baseline and follow-up) and perceived control (at follow-up). Path coefficients between the latent factors were examined using structural equation modeling. Results showed that there was a significant cross-sectional and longitudinal association between neighborhood social cohesion and older adults’ perceived control, while neighborhood physical disorder was cross-sectionally associated with perceived control. Study findings provide evidence for promoting social integration and social capital in their neighborhood that might contribute to older adults’ perceived competence and beliefs in control. Full article

Background: For people with long-term illness, debilitated by severe symptoms, it can be difficult to attend regular yoga classes. We have therefore developed a tele-health format of yoga that can be delivered in the home. The tele-yoga was co-designed with members of a patient-organisation, yoga-instructor, and IT-technician. It includes live-streamed group-yoga sessions twice a week and an app with instructions on how to self-perform yoga. Aim: To describe a study protocol for a randomised controlled trial (RCT) including a process evaluation and report on a pilot study evaluating method- and intervention-related components including feasibility, safety, and efficacy. Methods: Ten participants with heart failure aged between 41–76 years were randomised to tele-yoga (n = 5) or to the control group (n = 5). In the pilot study recruitment, enrolment, randomisation, and data collection of all outcomes including primary, secondary and process evaluation measures were tested according to the study protocol. Fidelity, adherence and acceptability to the tele-yoga group training and app use was determined. Safety was assessed by adverse events. Results: The pilot revealed that the methodological aspect of the protocol worked sufficiently in all aspects except for missing data in the physical test of two participants and one participant in the control-group that dropped out of the study at three months follow-up. The tele-yoga training did not lead to any adverse events or injuries, adherence of tele-yoga was sufficient according to preset limits. The tele-yoga intervention also showed some favourable trends of improvements in the composite-end point compared to the active control group. However, since data only was presented descriptively due to the small sample size, the impact of these trends should be interpreted carefully. Conclusion: Our pilot study showed promising results in feasibility, safety, and acceptability of the tele-yoga intervention. Some changes in the protocol have been made to decrease the risk of missing data in the measures of physical function and in the full-scale RCT now ongoing the results of the sample size calculation for 300 participants have included the estimated level of drop outs and missing data. Full article

In response to the drug-resistant tuberculosis (DRTB) ototoxicity burden in South Africa, ototoxicity monitoring has been decentralised, with community health workers (CHWs) acting as facilitators. This study describes a community-based ototoxicity monitoring programme (OMP) for patients with DRTB. Findings are compared to the recommended guidelines for ototoxicity monitoring, the OMP protocol and published studies. This was a retrospective study of longitudinal ototoxicity monitoring of 831 patients with DRTB, using data collected at community-based clinics in the City of Cape Town between 2013 and 2017. Approximately half (46.8%) of the patients had an initial assessment conducted in accordance with the OMP protocol recommendations, and follow-up rates (79.5%) were higher than those of a similar DRTB programme. However, patients in this study were not monitored within the timeframes or with the regularity recommended by the guidelines or the OMP protocol. Extended high-frequency pure-tone audiometry (27.5%) was underutilised by testers and data recording was inconsistent (e.g. 37.7% of patient gender was not recorded by testers). Community-based OMP using CHWs to facilitate monitoring showed improvement over previous hospital-based reports, with more accessible services and higher follow-up rates. However, to improve OMP outcomes, OMP managers should reassess current protocols and data recording practices. Full article

In the first quarter of 2020, Italy became one of the earliest hotspots of COVID-19 infection, and the government imposed a lockdown. During the lockdown, an online survey of 2053 adults was conducted that asked about health behaviors and about the psychological and overall impact of COVID-19. The present study is a secondary analysis of that data. We hypothesized that self-control, higher socio-economic status, existing health conditions, and fear of infection were all inversely related to actions (or intentions) that violated the lockdown (i.e., infractions). Using partial least squares structural equation modeling (PLS-SEM), we found that only the fear of infection significantly dissuaded people from violating lockdown rules. Since it is not practical or ethical to sow a fear of infection, our study indicates that enacting rules and enforcing them firmly and fairly are important tools for containing the infection. This may become more important as vaccines become more widely available and people lose their fear of infection. Full article

(1) Background: This study investigated the changes in step frequency, walking ability, and standing posture of students with intellectual disabilities by integrating step training into the students’ physical education curriculum; (2) Methods: The centroid formula was used to estimate the geometric center of the students’ bodies in video footage of each participant. Each participant’s stepping frequency per minute was recorded. After training, the teachers involved were interviewed regarding the participants’ everyday activities in school. Each step training session was recorded by two video cameras. Each step training session was observed and photographed by a senior physical education teacher with special education qualifications; (3) Results: The step training increased the stability of the participants’ body axes. The participants’ average steps per minute of the participants significantly improved from 24.200 ± 7.554 to 28.700 ± 8.629. Additionally, despite the students exhibiting anxious behavior (e.g., squeezing their hands and grasping at their clothes) at baseline, the frequency of these behaviors decreased significantly from week 4. Overall, the students’ daily activities, motivation, interpersonal interaction, self-confidence, and anxiety behaviors improved; (4) Conclusions: After the 8-week step program, the participants with intellectual disabilities improved their step frequency, movement stability, ability to perform daily activities, walking speed, motivation, interpersonal interaction, and self-confidence, and they exhibited a lower level of anxiety-related behaviors. Full article

Population-based data linkage has a long history in Australia from its beginnings in Western Australia in the 1970s to the coordinated national data linkage infrastructure that exists today. This article describes the journey from an idea to a national data linkage network which has impacts on the health and well-being of Australians from preventing developmental anomalies to responding to the COVID-19 pandemic. Many enthusiastic and dedicated people have contributed to Australia’s data linkage capability over the last 50 years. They have managed to overcome a number of challenges including gaining stakeholder and community support; navigating complex legal and ethical environments; establishing cross-jurisdictional collaborations, and gaining ongoing financial support. The future is bright for linked data in Australia as the infrastructure built over the last 50 years provides a firm foundation for further expansion and development, ensuring that Australia’s linked health and human services data continues to be available to address the evolving challenges of the next half century. Full article

Exposure to online drinking on social media is associated with real-life alcohol consumption. Building on the Theory of planned behavior, the current study substantially adds to this line of research by identifying the predictors of sharing drunk references on social media. Based on a cross-sectional survey among 1639 adolescents with a mean age of 15 (59% female), this study compares and discusses multiple regression tree algorithms predicting the sharing of drunk references. More specifically, this paper compares the accuracy of classification and regression tree, bagging, random forest and extreme gradient boosting algorithms. The analysis indicates that four concepts are central to predicting adolescents’ sharing of drunk references: (1) exposure to them on social media; (2) the perceived injunctive norms of the mother towards alcohol consumption; (3) the perceived descriptive norms of best friends towards alcohol consumption; and (4) willingness to drink alcohol. The most accurate results were obtained using extreme gradient boosting. This study provides theoretical, practical, and methodological conclusions. It shows that maternal norms toward alcohol consumption are a central predictor for sharing drunk references. Therefore, future media literacy interventions should take an ecological perspective. In addition, this analysis indicates that regression trees are an advantageous method in youth research, combining accurate predictions with straightforward interpretations. Full article

The aim of the study was to analyse and evaluate the determinants influencing the overall satisfaction of patients with inpatient healthcare in the conditions of the Czech Republic. A total of the 1425 patients, who experienced hospitalisation and agreed to participate, were questioned in the study. A research questionnaire was used to obtain data on satisfaction with hospitalisation. The subject of the research consisted of the indicators related to the following factors: (i) satisfaction with the hospital, clinic, room and meals; (ii) satisfaction with medical staff—nurses, physician expertise and other staff; (iii) the quality of the treatment provided; (iv) satisfaction with leaving the hospital. The formulated statistical hypotheses were evaluated through structural equation modelling. The results of the analyses brought interesting findings. Satisfaction with medical staff is the most significant factor which has a positive effect on satisfaction with hospitalisation. Physician expertise (with trust and good communication skills) is more important for patients than satisfaction with nurses or other staff. The results obtained from the study represent valuable information for policymakers, regional healthcare plans, as well as for managers of hospitals. Full article

Objective: To evaluate the bone response to an 8 month aerobic gymnastics training program in young opioid-addicted women. Design: Randomized controlled trial (parallel design). Setting: Women's Specific Drug Rehabilitation Center in China. Patients: One hundred and two young women with low bone quality and previous opioid addiction were divided into two groups: (a) the low bone quality intervention experimental group (n = 55; age: 30.3 ± 6.1) and (b) the low bone quality observed control group (observation group; n = 47; age: 29.0 ± 5.3). Interventions: The intervention group took aerobic gymnastics regularly for 80 min/d and 5 d/wk for 8 months and completed follow-up testing. Main Outcome Measures: Substance use history and other life habits affecting bone quality were assessed by questionnaire-based interviews. Bone quality (stiffness-index, T-score, Z-score) was examined with quantitative ultrasound. Anthropometric characteristics (body weight, fat-free mass, fat mass) were obtained by bioelectrical impedance analysis. Results: After the 8 month intervention, the stiffness index of bone quality increased significantly (before: 82 ± 6, after: 108 ± 14, p < 0.05) in the experimental group. However, the bone quality did not change significantly in the controls (before: 79 ± 10, after: 77 ± 13, p > 0.05). The bone change in the difference group was significant (experimental group: 31.7% vs. observation group: −0.03%). Fat mass decreased in the experimental group (experimental group: before: 19.6 ± 3.7 kg, after: 18.8 ± 4.0 kg, p < 0.05). Meanwhile, the change in fat-free mass was the determination of the change in bone quality in the experimental group. Conclusions: Our results suggested that aerobic gymnastics intervention can be an effective strategy for the prevention and treatment of drug-induced osteoporosis in detoxification addicts. Full article

This study aimed to understand differences in leisure, educational/work and social screen time behaviours experienced by parents and children due to COVID-19 lockdown restrictions, which may inform behaviour change strategies and policy in the transition to a COVID-normal life. Participants in the “Our Life at Home” study (n = 218 parents from Australia, 43.4 ± 6.8 years, 88% female) completed a cross-sectional online survey in April/May 2020. Parents recalled their own and their child (8.7 ± 2.0 years, 42% female) or adolescents (15.0 ± 1.5 years, 50% female) participation in nine screen time behaviours in the past month (during lockdown) and retrospectively for February 2020 (pre-lockdown), providing data on 436 individuals. Screen time behaviours included leisure (computer/laptop and tablet/smartphone for leisure, TV/videos/DVDs and game consoles); education/work (computer/laptop and tablet/smartphone for work/education); and social screen time (computer/tablet/smartphone for social communication with friends, family and work (parents only)). Wilcoxon signed-rank tests and effect sizes (r) compared the time spent in each behaviour pre-lockdown and during lockdown. Large differences were observed in social (parents: r = 0.41–0.57; children: r = 0.55–0.65; adolescents: r = 0.28–0.43) and education (children: r = 0.50–0.65 and adolescents: r = 0.25–0.37) behaviours. There were small or no differences in leisure time screen use. COVID-19 lockdown restrictions have impacted parent’s and children’s screen time, and future research and policy should consider strategies to support families to manage screen time. Full article

Objective: To test the efficacy of the Athletics Injury Prevention Programme (AIPP) to reduce the percentage of athletes presenting at least one injury complaint leading to participation restriction (ICPR) over an athletics season. Methods: During the 2017–2018 athletics season, we included in this cluster randomised controlled trial (ClinicalTrials.gov Identifier: NCT03307434) 840 athletes randomly assigned (randomisation unit: athletic clubs) to a control group (regular training) or to an intervention group (regular training plus the AIPP 2/week). Using a weekly online questionnaire, athletes reported the ICPR, training and competition exposures, and, for the intervention group, the compliance with the AIPP. The primary outcome was the percentage of athletes presenting at least one ICPR over the study follow-up. Results: A total of 449 and 391 athletes were included in the intervention and control groups, respectively. From them, 68 (15.1%) and 100 (25.6%) athletes, respectively, provided 100% of the requested information during the follow-up (39 weeks). A total of 6 (8.8%) performed the AIPP 2/week or more. The proportion of athletes who had at least one ICPR over the follow-up period was similar in the intervention (64.7%) and control groups (65.0%), with adjusted odds ratios: 0.81 (95% CI 0.36 to 1.85). There were no between-group differences when comparing separately the subgroups corresponding with the different compliance levels. Conclusion: This cluster randomised controlled trial reported no efficacy of the AIPP. However, the overall response proportion and the compliance with the AIPP in the intervention group were low. In individual sports especially, efforts should be first made to improve the implementation and adoption of interventions. Full article