International Journal of Environmental Research and Public Health

Background: Perceived harm, social influences, smoke-free policies, and media exposure have been understudied in relation to tobacco-related attitudes/behaviors in aggregate or in low and middle-income countries; thus, this study examined these factors collectively in relation to smoking-related outcomes among Armenian and Georgian adults. Methods: Using 2018 cross-sectional survey data (n = 1456), multivariable regression analyses examined these factors in relation to smoking status, perceived harm among nonsmokers, and readiness to quit and past-year quit attempts among smokers. Results: Significant predictors (p < 0.05) of current smoking (27.3%) included lower perceived harm, more smoking friends, and fewer home and vehicle restrictions. Among nonsmokers, more home and restaurant/bar restrictions, fewer vehicle restrictions, greater anti-tobacco media exposure, and less pro-tobacco media exposure predicted greater perceived harm. Among smokers, greater perceived social acceptability of smoking, less anti-tobacco media exposure, and greater pro-tobacco media exposure predicted readiness to quit (12.7% of smokers). More smoking friends, more home restrictions, less anti-tobacco media exposure, and greater pro-tobacco media exposure predicted past-year quit attempts (19.2%). Conclusions: Findings support the importance of smoke-free policies but were counterintuitive regarding the roles of social and media influences, underscoring the need to better understand how to address these influences, particularly in countries with high smoking rates. Full article

An increasing number of manufacturing enterprises are adopting environmental technologies to cope with the increasingly severe environmental regulatory pressure, but the existing studies about the impact of environmental technologies on economic performance come up with mixed results. This paper contributes to the literature by using the financial constraints and market advantages as a dual mediating process in this relationship. An empirical test using a sample of Chinese manufacturing enterprises listed in the Shanghai and Shenzhen exchange from 2011 to 2018 is established. The results of regression analyses show that end-of-pipe technologies and clean technologies have a positive effect on firms’ economic performance. Moreover, we find that clean technologies not only directly affect economic performance but also indirectly affect economic performance through mitigating financial constraints. With the negative influence of end-of-pipe technologies on market advantages, the positive economic effect caused by end-of-pipe technologies is weakened. This research provides useful insights into the selection of environmental technologies for manufacturing firms and the establishment of new policies to promote green finance and green consumption. Full article

Hymenoptera venom allergy significantly affects the quality of life. Due to the divergences in the results of the available test and clinical symptoms of patients, the current widely applied diagnostic methods are often insufficient to classify patients for venom immunotherapy (VIT). Therefore it is still needed to search for new, more precise, and accurate diagnostic methods. Hence, this research aimed to discover new biomarkers of Hymenoptera venom allergy in a group of inflammation factors using set of multi-marker Bioplex panel. The adoption of a novel methodology based on Luminex/xMAP enabled simultaneous determination of serum levels of 37 different inflammatory proteins in one experiment. The study involved 21 patients allergic to wasp and/or honey bee venom and 42 healthy participants. According to univariate and multivariate statistics, soluble CD30/tumor necrosis factor receptor superfamily, member 8 (sCD30/TNFRSF8), and the soluble tumor necrosis factor receptor 1 (sTNF-R1) may be considered as effective prognostic factors, their circulating levels were significantly decreased in the allergy group (p-value < 0.05; the Area Under the Curve (AUC) ~0.7; Variable Importance in Projection (VIP) scores >1.2). The obtained results shed new light on the allergic inflammatory response and may contribute to modification and improvement of the diagnostic and monitoring methods. Further, large-scale studies are still needed to explain mechanisms of action of studied compounds and to definitively prove their usefulness in clinical practice. Full article

Soldiers are often required to carry heavy loads that can exceed 45 kg. The physiological costs and biomechanical responses to these loads, whilst varying with the contexts in which they are carried, have led to soldier injuries. These injuries can range from musculoskeletal injuries (e.g., joint/ligamentous injuries and stress fractures) to neurological injuries (e.g., paresthesias), and impact on both the soldier and the army in which they serve. Following treatment to facilitate initial recovery from injuries, soldiers must be progressively reconditioned for load carriage. Optimal conditioning and reconditioning practices include load carriage sessions with a frequency of one session every 10–14 days in conjunction with a program of both resistance and aerobic training. Speed of march and grade and type of terrain covered are factors that can be adjusted to manipulate load carriage intensity, limiting the need to adjust load weight alone. Factors external to the load carriage program, such as other military duties, can also impart physical loading and must be considered as part of any load carriage conditioning/reconditioning program. Full article

Amid the COVID-19 pandemic, digital health literacy (DHL) has become a significant public health concern. This research aims to assess information seeking behavior, as well as the ability to find relevant information and deal with DHL among university students in Pakistan. An online-based cross-sectional survey, using a web-based interviewing technique, was conducted to collect data on DHL. Simple bivariate and multivariate linear regression was performed to assess the association of key characteristics with DHL. The results show a high DHL related to COVID-19 in 54.3% of students. Most of the Pakistani students demonstrated ~50% DHL in all dimensions, except for reliability. Multivariate findings showed that gender, sense of coherence and importance of information were found to be significantly associated with DHL. However, a negative association was observed with students′ satisfaction with information. This led to the conclusion that critical operational and navigations skills are essential to achieve COVID-19 DHL and cope with stress, particularly to promote both personal and community health. Focused interventions and strategies should be designed to enhance DHL amongst university students to combat the pandemic. Full article

Non-Hodgkin lymphoma (NHL), multiple myeloma and chronic lymphocytic leukemia are possibly related to environmental and/or occupational exposure. The primary objective of this study was to develop a questionnaire for screening patients with these blood disorders who might benefit from a specialized consultation for possible recognition of the disease as an occupational disease. The study included 205 subjects (male gender, 67.3%; mean age, 60 years; NHL, 78.5%). The questionnaire performed very satisfactorily in identifying the exposures most frequently retained by experts for their potential involvement in the occurrence of NHL. Its sensitivity and specificity in relation to the final expertise were 96% and 96% for trichloroethylene, 85% and 82% for benzene, 78% and 87% for solvents other than trichloroethylene and dichloromethane, 87% and 95% for pesticides, respectively. Overall, 15% of the subjects were invited to ask National Social Insurance for compensation as occupational disease. These declarations concerned exposure to pesticides (64%), solvents (trichloroethylene: 29%; benzene: 18%; other than chlorinated solvents: 18%) and sometimes multiple exposures. In conclusion, this questionnaire appears as a useful tool to identify NHL patients for a specialized consultation, in order to ask for compensation for occupational disease. Full article

A personal perspective is given on the processes involved in managing and sustaining a high-performing mental health recovery research group. The broader context of scholarship in the United Kingdom is outlined, in which academic productivity is commodified specifically in relation to peer-reviewed journal papers. Four leadership choices in developing a high-performing research group are discussed: optimal group size; sharing the workload; maintaining a programmatic focus; and performance expectations. Approaches to maximising innovation are identified, including emotional and intellectual engagement of team members, working with diverse stakeholders and convening communities of practice. We use a highly managed approach to publications from inception to acceptance, which is described in detail. The use of these approaches is illustrated in relation to the Recovery Research Team which was formed in 2009. Specific recovery-related issues covered include demonstrating the ability to develop a significant recovery research portfolio (our four current large [>UK£2 m] studies relate to recovery narratives, global mental health peer support work, digital interventions and Recovery Colleges); the positive implications of actively recruiting researchers with mental health lived experience; how performance issues are managed; our approach to involving lived experience co-authors in papers; and our decision to conduct mixed-methods rather than solely qualitative studies. Full article

Technological advancement is constantly evolving, and it is also developing in the mental health field. Various applications, often based on virtual reality, have been implemented to carry out psychological assessments and interventions, using innovative human–machine interaction systems. In this context, the LEAP Motion sensing technology has raised interest, since it allows for more natural interactions with digital contents, via an optical tracking of hand and finger movements. Recent research has considered LEAP Motion features in virtual-reality-based systems, to meet specific needs of different clinical populations, varying in age and type of disorder. The present paper carried out a systematic mini-review of the available literature using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The inclusion criteria were (i) publication date between 2013 and 2020, (ii) being an empirical study or project report, (iii) written in English or Italian languages, (iv) published in a scholarly peer-reviewed journal and/or conference proceedings, and (v) assessing LEAP Motion intervention for four specific psychological domains (i.e., autism spectrum disorder, attention-deficit/hyperactivity disorder, dementia, and mild cognitive impairment), objectively. Nineteen eligible empirical studies were included. Overall, results show that protocols for attention-deficit hyperactivity disorder and autism spectrum disorder can promote psychomotor and psychosocial rehabilitation in contexts that stimulate learning. Moreover, virtual reality and LEAP Motion seem promising for the assessment and screening of functional abilities in dementia and mild cognitive impairment. As evidence is, however, still limited, deeper investigations are needed to assess the full potential of the LEAP Motion technology, possibly extending its applications. This is relevant, considering the role that virtual reality could have in overcoming barriers to access assessment, therapies, and smart monitoring. Full article

The purpose of this study was to analyse in detail body weight squat (BWS)’ fatigue effect on the range of motions (ROM) of the hip, knee, ankle and ground reaction forces (GRF). Twenty male recreational athletes (24.0 ± 3.1 years, 178.85 ± 7.12 cm and 78.7 ± 11.45 kg) participated in this study. BWS were performed on four load cell platforms until the participants failed to continue. Participants performed 73 ± 27 repetitions and the duration to complete of the repetitions was 140.72 ± 62.28 s during the BWS exercise. The forefoot and hindfoot of the feet were on two load cells, thus, there were two under each foot. All of the data collected was divided into three sections for analysis (24 ± 9 repetitions for each). In terms of GRF of the fore feet and hind feet, significant differences and medium to large effect size were found between each section (p = 0.006~0.040, ES = 0.693~0.492). No significant differences were found between right and left leg in all sections. Significant differences were found in the ROM of the hip between the sections of first-third (p = 0.044, ES = 0.482) and second-third (p = 0.034, ES = 0.510), the ROM of the knee first-third (p = 0.014, ES = 0.602) and second-third (p = 0.005, ES = 0.701) and for the ROM of the ankle first-second (p = 0.045, ES = 0.479). As a result, end-of-exercise fatigue caused an increase in the ROM of the hip, knee and ankle. Thus, it is observed that fatigue induced increased ROM, also increases the GRF towards the forefeet. Full article

Tobacco smoking in pregnancy is a worldwide public health problem. A majority of pregnant smokers need assistance to stop smoking. Most scientific societies recommend nicotine replacement therapy (NRT) during pregnancy but this recommendation remains controversial because of the known fetal toxicity of nicotine. The objective of this systematic review was to provide an overview of human studies about child health outcomes associated with NRT use during pregnancy. The electronic databases MEDLINE, the Cochrane Database, Web of Science, and ClinicalTrials.gov were searched from the inception of each database until 26 December 2020. A total of 103 articles were identified through database searching using combination of keywords. Out of 75 screened articles and after removal of duplicates, ten full-text articles were assessed for eligibility and five were included in the qualitative synthesis. NRT prescription seems to be associated with higher risk of infantile colic at 6 months as in case of smoking during pregnancy, and with risk of attention-deficit/hyperactivity disorder. No association between NRT during pregnancy and other infant health disorders or major congenital anomalies has been reported. Well-designed controlled clinical trials with sufficient follows-up are needed to provide more information on the use of NRT or other pharmacotherapies for smoking cessation during pregnancy on post-natal child health outcomes. Full article

The purpose of this study is to develop metrics for stigma-producing factors by conducting a survey among stigma inflictors, that is, people who participate in the stigmatization of others. This study attempted to develop a stigma measurement scale for service industry workers. This study focused airline cabin crew members in accordance with a seven-step scale development procedure to derive stigma measurement variables. As a result, the stigma scale developed in this study consists of 6 factors (work ability, conscientiousness, selfishness, work ethics, appearance, neuroticism) containing 28 measurement items. This study indicates the need to find countermeasures that can reduce stigmatization of employees within organizations. At a personal level, the practical implication is to prevent stigmatization from occurring within the organization by improving the perception of stigma by cabin crew within the airline organization. At the organizational level, the practical implication is to analyze and reduce the factors of social stigma that negatively affect organizational performance. Full article

Background: Since 2012, education standards in medical faculties in Poland have allowed medical universities to introduce content related to multiculturalism. On the one hand, this creates a necessity to introduce new strategies, forms, and techniques of education aimed at the development of knowledge, skills, and attitudes in terms of multiculturalism. On the other hand, there is a need to evaluate their effects. The main goal of this study was to evaluate the cultural competence and cultural intelligence of master’s degree nursing students before the commencement of and two months after cultural education training in the form of the intercultural communication workshops included in the study program. Methods: The following questionnaires were used in the study: the Cross-Cultural Competence Inventory (CCCI) and the Cultural Intelligence Scale (CQS). Two consecutive classes (2019 and 2020) of master’s nursing students were tested twice (pre-test, post-test). The study was conducted at a leading medical university that educates nurses at a master’s level in Poland. In total, 130 master’s nursing students took part in this evaluative study: 64 individuals in 2019 (study 1) and 66 individuals in 2020 (study 2). Results: In comparison to the pre-test, the post-test showed that the surveyed students in both study 1 and study 2 obtained significantly higher overall results in terms of cultural intelligence (p = 0.001; p = 0.004, respectively) as well as in the behavioral (p = 0.001; p = 0.002) and cognitive (p = 0.001; p = 0.008, respectively) subscales. The cultural competence results were also higher overall, but the difference was insignificant. Conclusions: The study shows the efficiency of training/workshops in the development of culturally specific knowledge and cultural intervention skills. At the same time, it postulates the need to plan and organize cultural education programs in a form that aims to improve the development of culturally sensitive attitudes. Full article

As the attitudes of healthcare staff are thought to influence the quality and effectiveness of interventions targeting patients’ suicide risk, attitudes are often used as an outcome in the evaluation of suicide-preventive training. Due to various problems related to the validity and reliability of commonly used scales, there is a lack of overall agreement on how to measure these attitudes. Confirmatory factor analysis (CFA) was used to cross-validate previously used models and to investigate new models to measure professionals’ attitudes toward work with suicidal individuals and to test the longitudinal stability of the models by analyzing new sets of data. The population in the first study consisted of a heterogenous group of 1350 professionals who managed suicidal individuals relatively frequently. The second study included 640 professionals. The results of the cross-validation of previous models were described and a new questionnaire measuring attitudes toward suicide prevention, suicidal individuals, and organizational-facilitated self-efficacy (OSAQ-12) was presented. The three presented models retained a good fit and were stable over time. Valid and reliable measurement models that measure aspects of attitudes toward suicide are a prerequisite for conducting both cross-sectional and intervention studies. Full article

The landscape patterns of plantations (PT) are the results of human disturbances on local vegetation, and in turn, differ greatly from natural forests (NF), since the patterns strongly influence the natural circulation of material and energy. There is a need to understand the differences of landscape patterns between PT and NF, to establish a near natural afforestation strategy. This study chose three typical silvicultural counties in the middle reaches of the Yangtze River as the research areas and compared the landscape patterns of NF and PT, with other land use types (grassland, GL; cropland, CL; shrubland, SL; orchard, OR; built-up land, BUL; bare land, BL; and water bodies, WB). The results revealed that the areas of PT accounted for 7.67%, 12.05%, and 18.97% of three counties, bigger than GL, OC, BUL, BL, and WB, as one of main land use types. The landscape patterns of PT (mean patch size between 2.06 to 6.05 ha) were more fragmented than NF (mean patch size between 5.83 to 53.91 ha). NF areas increased along the relative altitude gradient, from 0 to 2500 m, while PT areas peaked from 100–1000 m. The higher the altitude, the more typical the zonal distribution of PT, the more aggregated the NF. NF had significant negative correlations with BL, BUL, CL, PT, GL, and OC, which suggest that human activities had seriously interfered with NF. Although PT as an ecological protection strategy was increasing, the landscape patterns of PT were obviously different from NF. This may affect the material energy flow in the ecological environment. The results in the present study have great implications in the other regions in China and the relevant parts of the world where natural forests were heavily disturbed. Full article

Health complaints are increasing among adolescents and are recognized as a global public health issue. Health complaints are an indicator for subjective ill-being, but little is known about the relationship between sadness and other health complaints. The aim of this study was to investigate sadness and other health complaints among Swedish adolescents. A survey with a cross-sectional design was completed by adolescents (n = 1489, 15–17 years old) in the south of Sweden. A logistic regression analysis was used to analyze the relationship between sadness and other health complaints. The result show that sadness and other health complaints were common among adolescents, and sadness was related to health complaints (headache (OR: 1.58), sleeping difficulties (OR: 2.00), reduced appetite (OR: 1.43), tension (OR: 2.44), and concentration difficulties (OR: 2.75)). When adolescents express sadness or other health complaints it is important to reflect on what these complaints are an expression of, and take into account the body as physical and psychological intertwined. This might entail person-centered support that hopefully leads to an improvement in adolescents’ well-being. Future research that profoundly highlights adolescents’ existential health is needed. Full article

Considering the constant increase in breast cancer patients, identifying factors that influence the moment of diagnosis is essential for optimizing therapeutic management and associated cost. The purpose of the study is to evaluate the impact of the economic crisis on the moment of a breast cancer diagnosis. This retrospective observational study analyzed a cohort of 4929 patients diagnosed with breast cancer over the course of 19 years in the Western region of Romania. The time interval was divided based on the onset of the economic crisis into 3 periods: pre-crisis (2001–2006), crisis (2007–2012), and post-crisis (2013–2019). The disease stage at the moment of diagnosis was considered either early (stages 0, I, II) or advanced (stages III, IV). Although recording a similar mean number of patients diagnosed per year during the pre- and crisis periods, a significantly higher percentage of patients were diagnosed with late-stage breast cancer during the economic crisis period compared to the previous interval (46.9% vs. 56.3%, p < 0.01). This difference was further accentuated when accounting for environmental setting, with 65.2% of patients from a rural setting being diagnosed with advanced disease during the crisis interval. An overall improvement of 12% in early-stage breast cancer diagnosis was recorded in the post-crisis period (55.7%, p < 0.001). The findings of this study support periods of economic instability as potential factors for a delay in breast cancer diagnosis and highlight the need for the development of specific strategies aimed at reducing cancer healthcare and associated financial burden in times of economic crisis. Full article

Gastric cancer is a common malignancy worldwide and poses a serious threat to human public health. The difficulty in obtaining epidemiological data limits the development of cross-disciplinary related research. In this study, 99,364 publications on gastric cancer from 1991 to 2019 were obtained using web-crawler technology, and a technical framework for extracting toponyms from these publications was constructed to analyze spatiotemporal hotspots of study areas in gastric cancer research in China. The results showed the following: (1) The accuracy of toponym extraction was greatly improved after eliminating the systematic exclusion words and adding historical toponyms, with a precision of 95.31% and a recall of 94.86%. (2) Gastric cancer research (GCR) and gastric cancer research with toponyms (GCRWT) are attracting increasing amounts of attention. The amount of GCR results published in Chinese and English is gradually leveling off, and the imbalance between those of GCRWT is gradually widening. (3) The spatial distribution of gastric cancer research in China is uneven, and the hotspots are mainly located in the eastern coastal areas. There were huge advances in gastric cancer research at the province/city/county scale in Eastern China, while the central region has only increased research at the county scale. We suggest that gastric cancer research should pay more attention to the central region, which has the highest gastric cancer incidence/mortality. This study provides important clues for research on and investigations of gastric cancer. Full article

According to the health field concept, the most important factor affecting health is a lifestyle. The current upward trend in overweight and obesity among younger populations is a consequence of inadequate lifestyle habits. The study aimed to characterise youth nutrition behaviour and knowledge in the context of the risk of developing overweight or obesity. The study group consisted of 307 high school students, 59% females and 41% males, aged between 15 and 19. Nutrition behaviours were studied using the standardised Questionnaire of Eating Behaviour. Body weight and body height were measured with a body composition analyser and a body height meter, respectively. It was observed that the average body mass index was 21.7 ± 3.4 kg/m² for the females and 22.3 ± 3.1 kg/m² for the males (p = 0.036). Disturbed weight-to-height ratios (i.e., overweight and obesity) were found in 15.6% of the females and 16.5% of the males. The diets of approximately 90% of these youth were characterised by excessively low pro-health product content. The males showed a significantly higher intensity of adverse health traits compared to the females (8.1% vs. 0.7%, p = 0.002). More than half of the males presented insufficient knowledge about food and nutrition (53.5% vs. 30.8%, p < 0.001). Regardless of gender, the study showed a positive correlation between adolescents’ level of knowledge and the pro-health diet index (gamma coefficient: 0.42, p < 0.001) and a negative correlation between their level of knowledge and the unhealthy diet index (gamma coefficient: −0.66, p < 0.001). The level of knowledge was closely related to the indicators of the intensities and adverse health characteristics of their diets. These results indicate the need for educational programs to raise awareness among youth in civilisation backgrounds. Full article

Much of the UK’s ageing population lives in care homes, often with complex care needs including dementia. Optimal care requires strong clinical leadership, but opportunities for staff development in these settings are limited. Training using simulation can enable experiential learning in situ. In two nursing homes, Health Care Assistants (HCAs) received training in clinical communication skills (Situation-Background-Assessment-Recommendation Education through Technology and Simulation, SETS: group training with an actor simulating scenarios); and dementia (A Walk Through Dementia, AWTD: digital simulation, delivered one-to-one). In this qualitative descriptive study, we evaluated the potential of this training to enhance HCAs’ clinical leadership skills, through thematic analysis of 24 semi-structured interviews with HCAs (before/after training) and their managers and mentors. Themes were checked by both interviewers. HCAs benefitted from watching colleagues respond to SETS scenarios and reported greater confidence in communicating with registered healthcare professionals. Some found role-play participation challenging. AWTD sensitised HCAs to the experiences of residents with dementia, and those with limited dementia experience gained a fuller understanding of the disease’s effects. Staffing constraints affected participation in group training. Training using simulation is valuable in this setting, particularly when delivered flexibly. Further work is needed to explore its potential on a larger scale. Full article