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

A high body mass (BMI) index has repeatedly been associated with non-atopic asthma, but the biological mechanism linking obesity to asthma is still poorly understood. We aimed to test the hypothesis that inflammation and/or innate immunity plays a role in the obesity-asthma link. DNA methylome was measured in blood samples of 61 non-atopic participants with asthma and 146 non-atopic participants without asthma (non-smokers for at least 10 years) taking part in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA) study. Modification by DNA methylation of the association of BMI or BMI change over 10 years with adult-onset asthma was examined at each CpG site and differentially methylated region. Pathway enrichment tests were conducted for genes in a priori curated inflammatory pathways and the NLRP3-IL1B-IL17 axis. The latter was chosen on the basis of previous work in mice. Inflammatory pathways including glucocorticoid/PPAR signaling (p = 0.0023), MAPK signaling (p = 0.013), NF-κB signaling (p = 0.031), and PI3K/AKT signaling (p = 0.031) were enriched for the effect modification of BMI, while NLRP3-IL1B-IL17 axis was enriched for the effect modification of BMI change over 10 years (p = 0.046). DNA methylation measured in peripheral blood is consistent with inflammation as a link between BMI and adult-onset asthma and with the NLRP3-IL1B-IL17 axis as a link between BMI change over 10 years and adult-onset asthma in non-atopic participants. Full article

Sleep disorder is a symptom of many neurological diseases that may significantly affect the quality of daily life. Traditional methods are time-consuming and involve the manual scoring of polysomnogram (PSG) signals obtained in a laboratory environment. However, the automated monitoring of sleep stages can help detect neurological disorders accurately as well. In this study, a flexible deep learning model is proposed using raw PSG signals. A one-dimensional convolutional neural network (1D-CNN) is developed using electroencephalogram (EEG) and electrooculogram (EOG) signals for the classification of sleep stages. The performance of the system is evaluated using two public databases (sleep-edf and sleep-edfx). The developed model yielded the highest accuracies of 98.06%, 94.64%, 92.36%, 91.22%, and 91.00% for two to six sleep classes, respectively, using the sleep-edf database. Further, the proposed model obtained the highest accuracies of 97.62%, 94.34%, 92.33%, 90.98%, and 89.54%, respectively for the same two to six sleep classes using the sleep-edfx dataset. The developed deep learning model is ready for clinical usage, and can be tested with big PSG data. Full article

In the 21st century, with ever-increasing consciousness and social awareness, researchers must tackle the microbial infections that pose a major threat to human safety. For many reasons, the emergence/re-emergence of threatening pathogens has increased and poses a serious challenge to health care services. Considering the changing dynamics of 21st-century materials with medical potentialities, the integration of bioactive agents into materials to engineer antibacterial matrices has received limited attention so far. Thus, antimicrobial active conjugates are considered potential candidates to eradicate infections and reduce microbial contaminations in healthcare facilities. In this context, eco-friendly and novel conjugates with antimicrobial, antibiofilm, and anticancer potentialities were developed using biogenic silver nanoparticles (AgNPs) from Convolvulus arvensis (C. arvensis) extract and chitosan (CHI). A range of instrumental and imaging tools, i.e., UV-Vis and FTIR spectroscopy, scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive spectroscopy (EDX), and X-ray diffraction (XRD), were employed to characterize the freshly extracted C. arvensis AgNPs. Biogenic AgNPs obtained after a 24-h reaction period were used to engineer CHI-based conjugates and designated as CHI‒AgNPs1 to CHI‒AgNPs5, subject to the C. arvensis AgNPs concentration. After the stipulated loading period, 92% loading efficiency (LE) was recorded for a CHI‒AgNPs3 conjugate. Gram+ and Gram- bacterial isolates, i.e., Staphylococcus aureus, and Escherichia coli, were used to test the antibacterial activities of newly developed CHI‒AgNPs conjugates. In comparison to the control sample with bacterial cell count 1.5 × 10⁸ CFU/mL, a notable reduction in the log values was recorded for the CHI‒AgNPs3 conjugate. The antibiofilm potential of CHI‒AgNPs conjugates was tested against Pseudomonas aeruginosa. Moreover, the CHI‒AgNPs3 conjugate also showed substantial cytotoxicity against the MCF-7 (breast cancer) cell line. In summary, the newly engineered CHI‒AgNPs conjugates with antibacterial, antibiofilm, and anticancer potentialities are potential candidate materials for biomedical applications. Full article

Changing patterns of heat waves are part of the global warming effect and the importance of changes is reinforced by their negative impact on society. Firstly, heat waves were analyzed in Brnik (Slovenia) and Larisa (Greece) in the period 1981–2017 to reflect the environment which workers are exposed to. Secondly, outdoor workers (70 from Greece, 216 from Slovenia) provided a self-assessment of heat stress. The heat wave timeline is presented as an effective way of illustrating long-term changes in heat waves’ characteristics for various stakeholders. In both countries, workers assessed as significant the heat stress impact on productivity (Greece 69%, Slovenia 71%; p > 0.05), and in Slovenia also on well-being (74%; p < 0.01). The main experienced symptoms and diseases were thirst (Greece 70%, Slovenia 82%; p = 0.03), excessive sweating (67%, 85%; p = 0.01), exhaustion (51%, 62%; p > 0.05) and headache (44%, 53%; p > 0.05). The most common way to reduce heat stress was drinking more water (Greece 64%, Slovenia 82%; p = 0.001). Among the informed workers, the prevalent source of information was discussions. Therefore, educational campaigns are recommended, together with the testing of the efficiency of mitigation measures that will be proposed on the Heat-Shield project portal. Full article

Climate change-related extreme events are increasing in frequency and severity. Understanding household emergency preparedness capacity in Health-Emergency and Disaster Risk Management (Health-EDRM) for at risk urban communities is limited. The main objective of the study is to explore the association among risk perception, household preparedness, and the self-reported short-term impacts of Typhoons for urban residents. A population-based, cross-sectional telephone survey using random digit-dialling was conducted among Hong Kong adults within 2 weeks following 2018 Typhoon Mangkhut, the most intense typhoon that affected Hong Kong, a subtropical city, in thirty years. Among the 521 respondents, 93.9% and 74.3% reported some form of emergency preparedness and typhoon-specific preparedness measure (TSPM) against Mangkhut, respectively. Respondents who perceived a higher risk at home during typhoons and had practiced routine emergency preparedness measures (during nonemergency periods) were more likely to undertake TSPM. Of the respondents, 33.4% reported some form of impact (11.1% were household-specific) by Typhoon Mangkhut. Practicing TSPM was not associated with the reduction of short-term household impacts. Current preparedness measures may be insufficient to address the impact of super typhoons. Strategies for health-EDRM for urban residents will be needed to cope with increasing climate change-related extreme events. Full article

Disclosure of HIV status to infected children, though challenged by caregiver dilemma, remains central in achieving the United Nations Programme on HIV and AIDS (UNAIDS) global goal of 90/90/90. This study explores children’s HIV disclosure experiences across Northern and Southern Ghana. A qualitative interpretative phenomenological design facilitated the recruitment of 30 HIV positive disclosed children and adolescents aged 9–19 years in 12 antiretroviral treatment (ART) centers in Northern and Southern Ghana between January 2017 and June 2018. Data was collected via in-depth interviews. We used phenomenological analysis applying concepts and categories identification, patterns and interconnections searching, mapping, theme building and constant comparative technique to draw conclusions. Disclosure of HIV status to children occurred with little or no preparation. Caregivers intentionally or out of dilemma often prolonged or postponed disclosure to when children aged older. Illness severity and disease progression principally defined the need for disclosure. Children preference for early status disclosure averaged at age 10 was demonstrated despite the initial disclosure experience of shock and disappointment. There was improved medication adherence despite the challenge of limited knowledge about HIV transmission, financial difficulty and food insecurity. Context and culturally adapted pre- and post- disclosure guideline laced with social protection package is needed to support HIV positive children. Full article

Muscle activity during a hemodialysis procedure improves its efficacy. We have formulated a hypothesis that vibrations generated by a specially-designed dialysis chair can, the same as physical exercise, affect the filtering of various fluids between fluid spaces during the hemodialysis procedure. This prospective and interventional study included 21 dialyzed patients. During a single dialysis session, each patient used a prototype device with the working name “vibrating chair”. The chair’s drive used a low-power cage induction motor, which, along with the worm gear motor, was a part of the low-frequency (3.14 Hz) vibration-generating assembly with an amplitude of 4 mm. Tests and measurements were performed before and after the vibration dialysis. After a single hemodialysis session including five 3-min cycles of vibrations, an increase in $Kt/V$ in relation to non-vibration $Kt/V$ ($1.53\pm 0.26$ vs. $1.62\pm 0.23$) was seen. Urea reduction ratio increased significantly ($0.73\pm 0.03$ vs. $0.75\pm 0.03$). A significant increase in systolic blood pressure was observed between the first and the third measurement ($146\pm 18$ vs. $156\pm 24$). The use of a chair generating low-frequency vibrations increased dialysis adequacy; furthermore, it seems an acceptable and safe alternative to intradialytic exercise. Full article

A growing number of fast-food outlets in close proximity to residential areas raises a question as to its impact on childhood overweight and obesity. This study aimed at determining the relationship between the availability of fast-food outlets that were in close proximity to residential areas and overweight among Malaysian children aged 5 to 18 years. Measurement data on the weight and height of 5544 children (2797 boys, 2747 girls) were obtained from the National Health and Morbidity Survey 2011. Overweight (including obesity) is defined as BMI-for-age z-score > +1 SD based on the WHO growth reference. Geographic information system geospatial analysis was performed to determine the number of fast-food outlets within 1000 m radius from the children’s residential address. Multiple logistic regression was conducted to examine the association between the availability of fast-food outlets (none or more than one outlet) and overweight with adjustment for age, sex, ethnicity, monthly household income, parental educational level, residential area and supermarket density. Our results showed that the prevalence of overweight was 25.0% and there was a statistically significant association between the density of fast-food outlets and overweight (odds ratio: 1.23, 95% confidence interval: 1.03, 1.47). Our study suggested that the availability of fast-food outlets with close proximity in residential areas was significantly associated with being overweight among children. Limiting the number of fast-food outlets in residential areas could have a significant effect in reducing the prevalence of overweight among Malaysian children. Full article

Since the establishment of blown sand physics, surface roughness has been widely used in current research to indicate the ability of a surface to resist wind erosion and to evaluate the windproof effect of protective measures. However, since the calculation of surface roughness can result in different values and its applicability is poor, there are disadvantages to its use. Therefore, it is proposed that the boundary layer displacement thickness should be used rather than roughness as an indicator to solve such problems. To analyze the new indicator’s accuracy and applicability when evaluating the effect of protective measures, a wind tunnel simulation experiment on a typical mechanical protection measure commonly used for sand control in China was conducted. Indicators of roughness and boundary layer displacement thickness were compared in evaluating the windproof performance of a Salix psammophila sand barrier of differing heights, side lengths, and porosities. The wind speed acceleration rate and effective protection area, which can directly reflect the protective effect of a sand barrier, were analyzed as evaluation criteria. The results show that roughness can only reflect the influence of height on the windbreak effect of sand barriers, whereas the boundary layer displacement thickness accurately showed the influence of height, side length, and porosity on the windproof effect of the sand barriers. Compared with roughness, the boundary layer displacement thickness was more strongly correlated with the effective protection area. Therefore, the boundary layer displacement thickness, rather than roughness, should be used as a new indicator when evaluating the windproof effect of protective measures. Full article

Health organizations have widely adopted social media for health promotion, public health communication conveyance, and organizational promotion activities. However, little published data exists on the factors that facilitate health information diffusion in South East Asia, especially Malaysia compared with Western countries. This study aimed to investigate factors associated with good engagement rates among internet users on the Facebook (FB) page of Ministry of Health Malaysia. In this observational study, 2123 FB posts were randomly selected. Data dated from 1 November 2016 to 31 October 2017 was gathered from the Facebook Insight. The logistic regression model was applied to identify factors associated with good engagement rates. This study found that a FB post with a good engagement rate was significantly associated with a health education post (Adjusted Odd Ratio (AOR): 3.80, 95% Confidence Interval CI: 3.02–4.78, p < 0.001), a risk communication post (AOR: 1.77, 95% CI: 1.39–2.26, p < 0.001), a post in the afternoon (AOR: 1.76, 95% CI: 1.34–2.31, p < 0.001) or in the evening (AOR: 1.48, 95% CI: 1.20–1.82, p < 0.001), and a video format (AOR: 3.74, 95% CI: 1.44–9.71, p = 0.007). Therefore, we present the first comprehensive analysis of health information engagement among internet users in Malaysia. The growing trends of online health information-seeking behaviors and demand for the availability of validated health information require effective strategies by public health organizations to disseminate health information and achieve better audience engagement on social media. Full article

Participatory methods used in Total Worker Health^® programs have not been well studied, and little is known about what is needed to successfully implement these programs. We conducted a participatory health promotion program with grocery store workers using the Healthy Workplace Participatory Program (HWPP) from the Center for the Promotion of Health in the New England Workplace. We recruited a design team made up of six line-level workers and a steering committee with management and union representatives; a research team member facilitated the program. Using a formal evaluation framework, we measured program implementation including workplace context, fidelity to HWPP materials, design team and steering committee engagement, program outputs, and perceptions of the program. The HWPP was moderately successful in this setting, but required a substantial amount of worker and facilitator time. Design team members did not have the skills needed to move through the process and the steering committee did not offer adequate support to compensate for the team’s shortfall. The evaluation framework provided a simple and practical method for identifying barriers to program delivery. Future studies should address these barriers to delivery and explore translation of this program to other settings. Full article

Aim: Use the National Health Insurance Research Database of Taiwan to determine whether patients with posttraumatic epilepsy (PTE) have an increased risk of mortality. Methods: Patients ≥20 years old ever admitted because of head injury (per International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 850–854 and 959.01) during 2000–2012 were enrolled into a traumatic brain injury (TBI) cohort. The TBI cohort was divided into with PTE (ICD-9-CM code 345) and posttraumatic nonepilepsy (PTN) cohorts. We compared the PTE and PTN cohorts in terms of age, sex, and comorbidities. We calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk in these cohorts. Results: Patients with PTE had a higher incidence rate (IR) of mortality than did patients with TBI alone (IR per 1000 person-years: 71.8 vs. 27.6), with an aHR 2.31 (95% CI = 1.96–2.73). Patients with PTE aged 20–49, 50–64, and ≥65 years had, respectively, 2.78, 4.14, and 2.48 times the mortality risk of the PTN cohort. Patients with any comorbidity and PTE had 2.71 times the mortality risk as patients in the PTN cohort. Furthermore, patients with PTE had 28.2 increased hospital days and 7.85 times as frequent medical visits per year compared with the PTN cohort. Conclusion: Taiwanese patients with PTE had approximately 2 times the mortality risk and an increased medical burden compared to patients with TBI only. Our findings provide crucial information for clinicians and the government to improve TBI outcomes. Full article

In the present study, we evaluated the effects of different concentrations of the polybrominated diphenyl ethers (PBDEs) BDE-209, BDE-47 and BDE-99, on the vitality and oxidative stress of a HS-68 human cell culture exposed to the compounds for three days. The results showed that for this exposure time, only the highest concentrations produced a significant vitality reduction and oxidative stress induction (p < 0.05), measured as reactive oxygen species (ROS). Subsequently, in order to verify the effects of sub-lethal doses, cells were exposed for a longer time and data collected, after 12 and 20 days, to study ROS production and some molecular markers related to cell cycle and stress (p53, pRB, PARP, c-Jun and c-Fos), antioxidant status and proliferation (ERK, c-Jun and c-Fos), energy balance (NRF2, AMPK, HIF). Most of the biomarkers were influenced by the treatments, indicating that sub-lethal doses of PBDEs, for longer time, can enhance the production of ROS, altering the energetic metabolism, cell cycle and antioxidant balance, determining possible negative effects on the cell proliferation equilibrium. Full article

Canada regularly faces environmental public health (EPH) disasters. Given the importance of evidence-based, risk-informed decision-making, we aimed to critically assess the integration of EPH expertise and research into each phase of disaster management. In-depth interviews were conducted with 23 leaders in disaster management from Canada, the United States, the United Kingdom, and Australia, and were complemented by other qualitative methods. Three topics were examined: governance, knowledge creation/translation, and related barriers/needs. Data were analyzed through a four-step content analysis. Six critical success factors emerged from the analysis: blending the best of traditional and modern approaches; fostering community engagement; cultivating relationships; investing in preparedness and recovery; putting knowledge into practice; and ensuring sufficient human and financial resources. Several promising knowledge-to-action strategies were also identified, including mentorship programs, communities of practice, advisory groups, systematized learning, and comprehensive repositories of tools and resources. There is no single roadmap to incorporate EPH expertise and research into disaster management. Our findings suggest that preparation for and management of EPH disaster risks requires effective long-term collaboration between science, policy, and EPH practitioners at all levels in order to facilitate coordinated and timely deployment of multi-sectoral/jurisdictional resources when and where they are most needed. Full article

The aim of the study was to analyze the effect of the treatment given to patients in a pain clinic on their assessment of pain intensity and the incidence of emotional disturbances in the form of anxiety, depression, and aggression. The study was conducted from January 2014 to April 2018 among patients under the care of two Warsaw pain clinics. The study tools were the Hospital Anxiety and Depression Scale—Modified Version (HADS-M) and the Numerical Rating Scale (NRS). The project enrolled 325 patients, with women comprising 60.62% of patients, and the age bracked of 65–79 years comprising 39.38% of patient. The major reasons for attending the pain clinic were osteoarticular pain (44.92%) and neuropathic pain (42.77%). The therapy applied lowered the patients’ pain intensity (4.98 vs. 3.83), anxiety (8.71 vs. 8.12), aggression (3.30 vs. 3.08), and the overall HADS-M score (18.93 vs. 17.90), which shows that the treatment of both the pain symptoms and the associated emotional disturbances in the form of anxiety and aggression was effective. Sex is a factor affecting pain intensity. The level of mental disorders was influenced by the sex and age of the patients and how long they had been treated in the pain clinics. Full article

Engagement in organized sports is associated with developmental factors, such as, healthy growth, cognitive abilities, psychological well-being and lower substance use. Research also suggest that the spontaneous free play that characterises self-organized physical activity (PA) provides young people with opportunities to learn social skills, such as self-regulation and conflict-resolution skills. We assessed associations between participation in the two activity types and several demographics along with developmental factors (e.g., body mass index (BMI)). Data was from a representative sample of 2060 students attending 38 schools in Norway (mean age (M_age) = 15.29, standard deviation (SD) = 1.51; 52% females). Results indicated that while engagement in organized sports was more related to developmental factors, relative to self-organized PA, engaging concurrently in both activities for at least an hour a week was more developmentally beneficial than engaging only in one for the same amount of time. Thus, PA programmes for students will enhance their effectiveness if they focus on structured activities but also self-organized activities where students can coordinate themselves. Full article

Mine tailings have been analyzed by a sequential extraction procedure after their pre-treatment with a leaching solution for 24 h and electrodialytic remediation during 15 days with a constant electric field of 2.7 V cm⁻¹. Four leaching solutions were tested: H₂SO₄ + HNO₃ (2:1 vol.) pH = 1.9; H₂SO₄ + HNO₃ (2:1 vol) pH = 4.2; NH₄Cl 0.8M, pH = 5.5 and 30% H₂O₂ adjusted to pH 2 with HNO₃ 1M + HCl 1M. After the treatment, the tailings were divided in six slices from anode to cathode. The highest removal efficiency of copper was obtained with H₂SO₄ + HNO₃ pH = 1.9, which allows one to remove 67% of the copper in the total cell and 85% of the copper in the slice closest to anode. The same solution with pH = 4.2 allows one to remove 62% of the total copper. The analysis realized by the sequential extraction method indicates the easy removal of water-soluble and exchangeable fractions in all experiments, moreover, residual and sulfide are the less mobile fractions. The general trend was the movement of copper associated to different fractions from anode to cathode and its accumulation closest to the cathode in the case of exchangeable, Fe-Mn oxides and acid soluble fractions, possibly due to some precipitation of copper compounds associated with less acidic conditions. Full article

Nitrogen pollution in reservoirs has received increasing attention in recent years. Although a number of aerobic denitrifying strains have been isolated to remove nitrogen from eutrophic waters, the situation in oligotrophic water environments has not received significant attention. In this study, a mixed aerobic denitrifying consortium screened from reservoir samples was used to remove nitrogen in an oligotrophic denitrification medium and actual oligotrophic source water. The results showed that the consortium removed 75.32% of nitrate (NO₃⁻-N) and 63.11% of the total nitrogen (TN) in oligotrophic reservoir water during a 24-h aerobic cultivation. More initial carbon source was helpful for simultaneous removal of carbon and nitrogen in the reservoir source water. NO₃⁻-N and TN were still reduced by 60.93% and 46.56% at a lower temperature (10 °C), respectively, though the rates were reduced. Moreover, adding phosphorus promoted bacterial growth and increased TN removal efficiency by around 20%. The performance of the immobilized consortium in source water was also explored. After 6 days of immobilization, approximately 25% of TN in the source water could be removed by the carriers, and the effects could last for at least 9 cycles of reuse. These results provide a good reference for the use of aerobic denitrifiers in oligotrophic reservoirs. Full article

In China, upper-level healthcare (ULHC) and lower-level healthcare (LLHC) provide different public medical and health services. Only when these two levels of healthcare resources are distributed equally and synergistically can the public’s demands for healthcare be met fairly. Despite a number of previous studies having analysed the spatial distribution of healthcare and its determinants, few have evaluated the differences in spatial equity between ULHC and LLHC and investigated their institutional, geographical and socioeconomic influences and spillover effects. This study aims to bridge this gap by analysing panel data on the two levels of healthcare resources in 31 Chinese provinces covering the period 2003–2015 using Moran’s I models and dynamic spatial Durbin panel models (DSDMs). The results indicate that, over the study period, although both levels of healthcare resources improved considerably in all regions, spatial disparities were large. The spatio-temporal characteristics of ULHC and LLHC differed, although both levels were relatively low to the north-west of the Hu Huanyong Line. DSDM analysis revealed direct and indirect effects at both short-and long-term scales for both levels of healthcare resources. Meanwhile, the influencing factors had different impacts on the different levels of healthcare resources. In general, long-term effects were greater for ULHC and short-term effects were greater for LLHC. The spillover effects of ULHC were more significant than those of LLHC. More specifically, industrial structure, traffic accessibility, government expenditure and family healthcare expenditure were the main determinants of ULHC, while industrial structure, urbanisation, topography, traffic accessibility, government expenditure and family healthcare expenditure were the main determinants of LLHC. These findings have important implications for policymakers seeking to optimize the availability of the two levels of healthcare resources. Full article