International Journal of Environmental Research and Public Health

The achievement of high performance levels in a complex structured sport such as karate is determined by the competitor’s physical fitness, fighting technique, tactics and mental state. This study aimed to identify the most important determinants of top-level performance in karate. Methods: The participants were 32 karate competitors (12 women and 20 men) aged 18–25 years. A series of tests measuring 11 anthropometric features was undertaken twice during a year, separated by a 6-week interval during a training camp at the Olympic Preparation Center in Walcz, Poland. Motor skills were measured with strength, speed, endurance, flexibility and reaction time tests. Special motor fitness was assessed with tests of karate technical skills. The results were subject to statistical analysis using multiple stepwise regression of the Polish Karate Federation ranking points as the dependent variable. Results: The multiple regression analysis revealed two main determinants of high scores in female and male karate competitors. In women, these were thigh circumference and the speed of the mawashi-geri-kick roundhouse technique (i.e., the maximum number of delivered kicks in 30 s), whilst for men they were the extent of the sideway leg swing to the highest possible height (yoko-geri) and general endurance assessed with the bent arm hang test. Conclusion: Karate training should account for the determinants of high-level competitive karate performance identified in this study. Strengthening the lower limbs, exercises increasing hip joint mobility, low position movements, performing leg techniques in various planes and applying external loads undoubtedly increase a karate athlete’s strength and lead to the development of a more extensive repertoire of karate leg techniques, especially at the highest-scoring head level (jodan). Full article

The pressing problem of multimorbidity and polypharmacy is aggravated by the lack of specific care models for this population. We aimed to investigate the evolution of multimorbidity and polypharmacy patterns in a given population over a 4-year period (2011–2015). A cross-sectional, observational study among the EpiChron Cohort, including anonymized demographic, clinical and drug dispensation information of all users of the public health system ≥65 years in Aragon (Spain), was performed. An exploratory factor analysis, stratified by age and sex, using an open cohort was carried out based on the tetra-choric correlations among chronic diseases and dispensed drugs during 2011 and compared with 2015. Seven baseline patterns were identified during 2011 named as: mental health, respiratory, allergic, mechanical pain, cardiometabolic, osteometabolic, and allergic/derma. Of the epidemiological patterns identified in 2015, six were already present in 2011 but a new allergic/derma one appeared. Patterns identified in 2011 were more complex in terms of both disease and drugs. Results confirmed the existing association between age and clinical complexity. The systematic associations between diseases and drugs remain similar regarding their clinical nature over time, helping in early identification of potential interactions in multimorbid patients with a high risk of negative health outcomes due to polypharmacy. Full article

This study analyzed the body composition of individuals with type 2 diabetes (T2DM). In this retrospective chart review study, body composition was measured through multifrequency bioelectrical impedance analysis (InBody 770). Body composition assessments were conducted in individuals with T2DM, who were aged ≥18 years. The parameters included body mass index (BMI), body fat mass (BFM), fat-free mass (FFM), visceral fat area, percent body fat (PBF), appendicular skeletal muscle mass (ASM), and skeletal muscle index (SMI). One-way ANOVA and independent t-tests were used to calculate differences in body composition distribution by age and sex. A total of 2404 participants were recruited. The prevalence of overall low muscle mass and sarcopenic obesity was 28.0% and 18.7%, respectively, which increased with age. The overall prevalence of obesity when PBF was used was 71.5%, which was higher than that when BMI was applied (32.4%). The normal BMI group exhibited a prevalence of low muscle mass of 55.6% and sarcopenic obesity of 34.8%. For both men and women, bodyweight, BFM, FFM, ASM, and SMI all decreased with age. The prevalence of low muscle mass and sarcopenic obesity was high in older adults and people with normal BMI. Using BMI to assess obesity and determine insufficient muscle mass underestimates the prevalence of obesity and neglects the problems of sarcopenia and high body fat in people with normal BMI. Full article

(1) Objective: The purpose was to analyze the effectiveness of myofascial therapy on musculoskeletal pain and functionality of the upper extremities in female breast cancer survivors, and to evaluate the changes in range of motion, quality of life, and mood state of these patients. (2) Methods: Systematic searches were performed on the MEDLINE/PubMed, Web of Science, Scopus, and Physiotherapy Evidence Databases for articles published until October 2020, in order to identify randomized controlled trials which analyzed the effectiveness of myofascial therapy as compared to a control group, passive treatment, placebo, or another intervention, and allowed co-interventions on female breast cancer survivors. Two reviewers examined the sources individually, calculated the risk of bias and extracted the data (PROSPERO number CRD42020215823). (3) Results: A total of eight RCTs were included. The results suggested that myofascial therapy does not have a greater statistically significant immediate effect on pain intensity (SMD: −0.15; 95% CI −0.48, 0.19), functionality (SMD: −0.17; 95% CI −0.43, 0.09) and range of motion in flexion (SMD: 0.30; 95% CI −0.13, 0.74) than an inactive, passive treatment or another intervention. However, a statistically significant result was observed for the abduction shoulder in favor of the experimental group (SMD: 0.46; 95% CI 0.05, 0.87; p = 0.03). (4) Conclusion: In general, although we found greater overall effects in support of the intervention with myofascial therapy than other control groups/types of interventions, the subgroup analysis revealed inconsistent results supporting myofascial therapy applied to breast cancer survivors. Full article

Remote sensing retrieval is an important technology for studying water eutrophication. In this study, Guanting Reservoir with the main water supply function of Beijing was selected as the research object. Based on the measured data in 2016, 2017, and 2019, and Landsat-8 remote sensing images, the concentration and distribution of chlorophyll-a in the Guanting Reservoir were inversed. We analyzed the changes in chlorophyll-a concentration of the reservoir in Beijing and the reasons and effects. Although the concentration of chlorophyll-a in the Guanting Reservoir decreased gradually, it may still increase. The amount and stability of water storage, chlorophyll-a concentration of the supply water, and nitrogen and phosphorus concentration change are important factors affecting the chlorophyll-a concentration of the reservoir. We also found a strong correlation between the pixel values of adjacent reservoirs in the same image, so the chlorophyll-a estimation model can be applied to each other. Full article

Emergency service workers (ESWs) are at high risk of experiencing poor mental health, including posttraumatic stress disorder (PTSD). Programs led by ex-service organizations may play an unrecognized but critical role in mental health prevention and promotion. Behind the Seen (BTS) is an Australian ex-service organization that runs workshops to raise awareness and facilitate conversations around the mental health of ESWs. The purpose of the study is to conduct a qualitative evaluation of workshop participants’ experiences, to understand the acceptability and perceived usefulness over the immediate- (within 1 month), intermediate- (6 months) and longer-terms (12 months). Participants (n = 59 ESWs) were recruited using purposive sampling across five fire and rescue services in metropolitan, regional, and rural locations. Focus groups methodology was used for data collection and data were analyzed using iterative categorization techniques. Participants reported (i) a high perceived need for education about PTSD, (ii) highly salient aspects of the presentation that made for a positive learning experience, including the importance of the lived experiences of the facilitators in the learning process, (iii) key features of changes to intentions, attitudes, and behavior, and (iv) major aspects of the organizational context that affected the understanding and uptake of the program’s key messages. BTS was perceived as an acceptable means of delivering mental health, PTSD, and help-seeking information to ESWs. The program is a promising candidate for scaling-up and further translation. Full article

In a globalized, media-driven society, people are being exposed to different cultural and philosophical ideas. In Europe, the School of Internal Arts (pseudonym) follows key principles of the ancient Chinese text The Yijinjing (The Muscle-Tendon Change Classic) “Skeleton up, flesh down”, in its online and offline pedagogy. This article draws on an ongoing ethnographic, netnographic and cross-cultural investigation of the transmission of knowledge in this atypical association that combines Taijiquan with a range of practices such as Qigong, body loosening exercises and meditation. Exploring the ideal body cultivated by the students, we describe and illustrate key (and often overlooked) body areas—namely the spine, scapula, Kua and feet, which are continually worked on in the School of Internal Arts’ exercise-based pedagogy. We argue that Neigong and Taijiquan, rather than being forms of physical education, are vehicles for adult physical re-education. This re-education offers space in which mind-body tension built over the life course are systematically released through specific forms of attentive, meditative exercise to lay the foundations for a strong, powerful body for martial artistry and health. Full article

Background: Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both facilities and home environments. Current improvement interventions focus on only one environment and target limited caregivers, primarily birth attendants and mothers. To inform the design of a hand hygiene behavioural change intervention in rural Cambodia, a formative mixed-methods observational study was conducted to investigate the context-specific behaviours and determinants of handwashing among healthcare workers, and maternal and non-maternal caregivers along the early newborn care continuum. Methods: Direct observations of hygiene practices of all individuals providing care to 46 newborns across eight facilities and the associated communities were completed and hand hygiene compliance was assessed. Semi-structured interactive interviews were subsequently conducted with 35 midwives and household members to explore the corresponding cognitive, emotional and environmental factors influencing the observed key hand hygiene behaviours. Results: Hand hygiene opportunities during newborn care were frequent in both settings (n = 1319) and predominantly performed by mothers, fathers and non-parental caregivers. Compliance with hand hygiene protocol across all caregivers, including midwives, was inadequate (0%). Practices were influenced by the lack of accessible physical infrastructure, time, increased workload, low infection risk perception, nurture-related motives, norms and inadequate knowledge. Conclusions: Our findings indicate that an effective intervention in this context should be multi-modal to address the different key behaviour determinants and target a wide range of caregivers. Full article

We qualitatively investigated end-of-life care needs. Data were collected via focus-group interviews with three groups: young adults, middle-aged adults, and older adults. The key question was, “What kind of care would you like to receive at the end of life?” Interview data were transcribed and analyzed using content analysis. End-of-life care needs were classified into six categories: life-sustaining treatment needs, physical care needs, emotional care needs, environmental needs, needs for respect, and needs for preparation for death. Because the Korean culture is family-oriented and talking about death is taboo, Korean patients at the end of their life do not make decisions about life-sustaining treatment or actively prepare for death. Therefore, to provide proper end-of-life care, conversations and shared decision-making among patients and their families are crucial. Further, we must respect patients’ dignity and help them achieve a good death by understanding patients’ basic care preferences. Future research should continue examining end-of-life care needs that reflect the social and cultural context of Korea to inform instrument development. Full article

A total of 83 third trimester pregnant women were recruited to examine the role of pre-pregnancy versus late-pregnancy physical activity on maternal insulin resistance. Principal component analysis plots demonstrated a distinction between the high and low Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) groups. The variation was driven primarily by exercise prior to and during pregnancy. Specifically, higher levels of physical activity prior to pregnancy was associated with a lower HOMA-IR and is not modified by other variables. Women who were active prior to pregnancy were more active during pregnancy. These results suggest that being active before pregnancy may be a good strategy for mitigating the risk of insulin resistance during late pregnancy. Full article

Waste recycling is a critical method to effectively address environmental issues raised by construction and demolition waste (C&DW). As highlighted in previous studies, the contractor is considered the primary purchaser for recycled C&DW products. However, there is a limited understanding of the factors affecting the contractor’s purchase willingness towards C&DW recycling products. This study investigated these key drivers using the Exploratory Sequential Mixed Approach. Firstly, a hypothetical model was developed based on the theory of planned behavior (TPB). Secondly, a questionnaire survey was then employed in data collection. Thirdly, structural equation modeling (SEM) was adopted for data analysis. It is revealed that multiple factors directly affect the contractor’s purchase willingness towards C&DW recycling products. These factors include government measures, the contractor’s attitude, perceived behavioral control, perceived consumer effectiveness, and subjective norms. Besides, recycling product information indirectly affects the contractor’s purchase willingness. Based on the findings, the study provides strategies for the government, contractors, recycling enterprises, and public buyers to increase C&DW recycling products’ purchase willingness. Findings derived from the empirical study can be used as a theoretical reference for government departments to develop related promotion policies. Moreover, the suggestions provided are helpful to guide recycling enterprises to promote their products. Full article

This study examined the acute effects of stretch tensions of kinesiology taping (KT) on the soleus (SOL), medial (MG), and lateral (LG) gastrocnemius Hoffmann-reflex (H-reflex) modulation in physically active healthy adults. A cross-over within-subject design was used in this study. Twelve physically active collegiate students voluntarily participated in the study (age = 21.3 ± 1.2 years; height = 175.6 ± 7.1 cm; body weight = 69.9 ± 7.1 kg). A standard Y-shape of KT technique was applied to the calf muscles. The KT was controlled in three tension intensities in a randomised order: paper-off, 50%, and 100% of maximal stretch tension of the tape. The peak-to-peak amplitude of maximal M-wave (M_max) and H-reflex (H_max) responses in the SOL, MG, and LG muscles were assessed before taping (pre-taping), taping, and after taping (post-taping) phases in the lying prone position. The results demonstrated significantly larger LG H_max responses in the pre-taping condition than those in the post-taping condition during paper-off KT (p = 0.002). Moreover, the ΔH_max/M_max of pre- and post-taping in the SOL muscle was significantly larger during 50%KT tension than that of paper-off (p = 0.046). In conclusion, the stretch tension of KT contributes minor influence on the spinal motoneuron excitability in the triceps surae during rest. Full article

Each year, more than half a million women die worldwide from causes related to pregnancy and childbirth, and nearly 4 million newborns die within 28 days of birth. In Uganda, 15 women die every single day from pregnancy and childbirth-related causes, 94 babies are stillborn, and 81 newborn babies die. Cost-effective solutions for the continuum of care can be achieved through Village Health Teams to improve home care practices and health care-seeking behavior. This study aims at examining the implementation of the timed and targeted counseling (ttC) model, as well as improving maternal and newborn health care practices. We conducted a quantitative longitudinal study on pregnant mothers who were recruited on suspicion of the pregnancy and followed-up until six weeks post-delivery. The household register was the primary data source, which was collected through a secondary review of the ttC registers. All outcome and process variables were analyzed using descriptive statistics. The study enrolled 616 households from 64 villages across seven sub-counties in Hoima district with a 98.5% successful follow-up rate. Over the course of the implementation period of ttC, there was an increase of 29.6% in timely 1st antenatal care, 28.7% in essential newborn care, 25.5% in exclusive breastfeeding, and 17.5% in quality of antenatal care. All these improvements were statistically significant. The findings from this study show that the application of the ttC model through Village Health Teams has great potential to improve the quality of antenatal and newborn care and the health-seeking practices of pregnant and breastfeeding mothers in rural communities. Full article

Health authorities recommend digital tools for home-based sport and exercise routines to stay active and healthy during the COVID-19 pandemic. The study investigates the prevalence, duration, most popular activities, and social selectivity of home-based digital sport and its contribution to overall levels of sporting activity during the pandemic. It is based on cross-sectional survey data (n = 1508), representing the population >14 years living in Germany. Data collection took place in October 2020, using computer-assisted web interviewing. Results show that overall, 23% of respondents used digital media for sports activities at least one time during the COVID-19 pandemic. Numbers increased during the lockdown and decreased afterwards. People engaged in a variety of fitness workouts, most frequently practiced with the help of publicly accessible fitness videos from video-sharing platforms. Digital sports practitioners are younger, better educated, and financially better off. Females are overrepresented. Individuals engaged in digital sports achieved 30 min/week more sports activity during the pandemic compared to individuals solely involved in offline sports. Hence, home-based digital sports activities were a popular means to stay active, particularly in the period of the lockdown. Strong social disparities indicate that the possible health benefits of digital sports only reach out to particular population groups. Full article

Dietary habits are influenced by various determinants that may evolve over time. This study aimed to examine, among adolescents in Belgium, trends in the dietary habits between 1990 and 2014 and to determine changes in family and regional disparities related to diet during this time period. In the 1990, 2002 and 2014 cross-sectional “Health Behaviour in School-aged Children” (HBSC) surveys, food consumption was estimated using a short Food Frequency Questionnaire. The Relative Index of Inequality (RII) enabled quantification of the gradients of inequality related to the family structure and to the region for non-daily fruit and vegetable and daily sugar-sweetened beverage (SSB) consumption. Between 1990 and 2014, the prevalence of non-daily fruit consumption increased from 27.7% to 60.6%, whereas the daily SSB consumption decreased from 58.9% to 34.8%. Over time, a downward trend in family disparities (p = 0.007) was observed for daily fruit consumption (RII: 1.58 (1.33–1.88) to 1.18 (1.13–1.23)). An upward trend in region-related disparities (p < 0.001) for SSB was found (RII: 1.15 (1.07–1.23) to 1.37 (1.28–1.47)). The overall trend of increasing disparities when dietary habits improved and decreasing disparities when dietary habits worsened highlights the need to implement actions that improve overall dietary habits while ensuring that disparities do not increase. Full article

A systematic review and meta-analysis were employed to address the associated factors of gender-based violence (GBV) in sub-Saharan African (SSA) countries. The Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed. Ovid Medline, CINAHL, Cochrane Central, Embase, Scopus and Web of Science were used to source articles with stringent eligibility criteria. A total of 4931 studies were found and 50 studies met the inclusion criteria. Pooled meta-analyses revealed that low educational attainment, higher alcohol consumption, substance use, history of child and family abuse, limited decision-making skills, experiencing depression, males having multiple sexual partners, and younger age were found to be individual- and family-associated factors that increase the experiences of GBV. Community tolerant attitudes to violence, women’s unemployment, being Muslim, lower socioeconomic class, food and social insecurity were found to be community- and societal-associated factors of GBV. Alcohol consumption, low educational attainment, experiencing depression, being younger, a history of child and family abuse, tolerant attitudes to violence, and low socioeconomic status were poignant factors associated with GBV amongst women in SSA countries. The need to develop a multipronged approach of intervention is a top priority in SSA to reach the Sustainable Development Goals’ (SDGs) target of 2030 to eliminate all forms of violence. Socio-behavioural change communication interventions at individual and community levels need to be introduced, and interventions need to address the prevention of child and family abuse and increase women’s feelings of empowerment in order to prevent GBV in SSA. Full article

Chronic disease burdens continue to rise in highly dense urban environments where clustering of type II diabetes mellitus, acute myocardial infarction, stroke, or any combination of these three conditions is occurring. Many individuals suffering from these conditions will require longer-term care and access to clinics which specialize in managing their illness. With Singapore as a case study, we utilized census data in an agent-modeling approach at an individual level to estimate prevalence in 2020 and found high-risk clusters with >14,000 type II diabetes mellitus cases and 2000–2500 estimated stroke cases. For comorbidities, 10% of those with type II diabetes mellitus had a past acute myocardial infarction episode, while 6% had a past stroke. The western region of Singapore had the highest number of high-risk individuals at 173,000 with at least one chronic condition, followed by the east at 169,000 and the north with the least at 137,000. Such estimates can assist in healthcare resource planning, which requires these spatial distributions for evidence-based policymaking and to investigate why such heterogeneities exist. The methodologies presented can be utilized within any urban setting where census data exists. Full article

Objective: To examine the association between phase angle (PhA) and bioelectrical impedance vector analysis (BIVA) and components of physical performance in male youth soccer players. Design: Cross-sectional. Methods: Sixty-two players from two professional soccer academies were recruited. Electrical bioimpedance was used to obtain the PhA and BIVA. Body fat (BF) and lean soft tissue mass (LSTM) were measured by dual-energy X-ray absorptiometry. All players completed physical tests including the standing long jump (SLJ), Carminatti’s test (peak speed at the end of the test, PS_T-CAR), 10 m and 30 m straight-line sprints, and repeated-sprint ability (RSA) test (RSAbest and RSAmean times). Results: Adjusting for chronological age, BF, and LSTM, multiple regression analysis outputs showed that PhA remained inversely related to RSAmean (β = −0.362; p < 0.001), RSAbest (β = −0.239; p = 0.020), 10 m (β = −0.379; p = 0.012), and 30 m (β = −0.438; p < 0.001) sprint times, while the association with PS_T-CAR and SLJ performance were statistically non-significant. In addition, BIVA showed that differences in confidence ellipses were found between athletes in the reference population and the study sample (p < 0.05). The tolerance ellipses indicated that the athletes in the present study had more total body water (TCW) and lower proportions of intracellular water (ICW) to extracellular water (ECW). The reference population had more TCW and ICW/ECW. Conclusions: Our results suggest that young soccer players with higher PhA values, indicating better cell integrity and functionality, have better performance in typical anaerobic running activities, such as sprinting speed and RSA performance, adjusted to age and body composition characteristics. Full article

In partnership with communities of the Williams Treaties First Nations in southern Ontario (Canada), we describe an approach to work with communities, and highlight perspectives of food security and sustainability, including priorities and opportunities to revitalize local food systems as a pathway to food security and food sovereignty. The objectives of our project were: (1) to build a shared understanding of food security and sustainability; and (2) to document community priorities, challenges and opportunities to enhance local food access. Utilizing an Indigenous methodology, the conversational method, within the framework of community-based participatory research, formative work undertaken helped to conceptualize food security and sustainability from a community perspective and solidify interests within the four participating communities to inform community-led action planning. Knowledge generated from our project will inform development of initiatives, programs or projects that promote sustainable food systems. The community-based actions identified support a path towards holistic wellbeing and, ultimately, Indigenous peoples’ right to food security and food sovereignty. Full article