International Journal of Environmental Research and Public Health

Vascular injuries constitute a significant problem worldwide. Nearly 90% of arterial injuries concern the vessels in the limbs, of which the arteries of the lower limbs are most often damaged in military operations, while in other cases (mainly road accidents), the vessels of the upper limbs are damaged more often. In this report, the authors present a case of occupational brachial artery injury by a foreign body with subsequent soft tissue hematoma superinfection. The presented case emphasizes the importance of computed tomography angiography as a precise diagnostic tool facilitating the planning of a surgical procedure in patients with an occupational upper limb injury. Full article

There is agreement that the pandemic has affected the healthcare system and behaviour of patients. This study aims to identify problems encountered by patients with phenylketonuria (PKU) and their parents/caregivers during the six-week pandemic lockdown in Poland (15 March to 30 April 2020). To determine the factors that influenced health and treatment-related issues, as well as the respondents’ perception of the impact of the pandemic, study participants were asked to complete a non-validated online questionnaire comprising 31 questions (including 27 single-choice, two multiple-choice and two open-ended ones). A total of 571 patients or their parents completed the questionnaire, with 9.5% of respondents not performing any blood phenylalanine (Phe) test in the analysed period, 21.3% declaring a blood Phe increase, and 15.3% a decrease. Increased problems in contacting the doctor or dietitian were reported by 26.1% of subjects, whereas 39.3% of them felt restricted access to dietary products. Most (63.4%) participants were satisfied with remote contact with their PKU clinic. Better compliance was associated with higher odds of acceptance of remote contact and of reporting fewer problems with contacting the doctor, and with lower odds of missing Phe testing. Self-reported high stress was associated with higher odds of reporting the limited availability of low-Phe products and Phe-free formulas, as well as with increased Phe concentrations and non-PKU-related health problems. These patients also had poor dietary compliance and experienced more problems in contacting specialists. Health and treatment-related problems experienced during the pandemic lockdown were related to a higher intensity of stress in patient’s family and worse therapy compliance before the pandemic. Previous experience of remote visits resulted in a better perception of this method of contact. It seems that this form of communication should be popularized and improved to increase therapy effectiveness in case of different limitations in the future. Special attention should be paid to vulnerable patients who may be at extra risk when the provision of standard care is affected. Full article

We tested the Youth Physical Activity Promotion (YPAP) framework on Romanian students in order to identify actionable determinants to support participation in physical activity. Our sample consisted of 665 responses to an online survey, with participants aged 18–23 (mean = 19 years); 70% were women. We used the partial least squares algorithm to estimate the relationships between students’ behavior and possible predictors during the COVID-19 pandemic. Our results indicate that all the theoretical dimensions of YPAP (predisposing, enabling and reinforcing) have a positive and significant impact on physical activity, with two mediating mechanisms expressed as predisposing factors: able and worth. Unlike previous research, we used second-order latent constructs, unveiling a particular structure for the enabling dimension that only includes sport competence, fitness and skills, but not the environmental factors. Full article

Practices such as “Reiki”, therapeutic touch, healing touch, and external “Qigong” have been regarded as some form of “energy medicine” or “biofield therapy”. The biofield concept has been studied and debated by researchers of distinct areas of expertise, and although the phenomenon was sometimes described as physically related to electromagnetics, other factors such as “subtle energy” and focused intention might be involved. These nonconventional practices integrate contact and non-contact techniques, and those dealing with so-called distant healing interventions are perhaps the most difficult to understand and accept. Practitioners describe these so-called nonlocal interventions as involving intentional factors and particular states of consciousness. With a spiritual mindset and a particular state of awareness, compassion is said to work out as a catalyst to produce physiological and physical changes through mechanisms that are still unknown. At the body level, these vegetative changes might be related to individual self-perception variations as part of the body neurovegetative feedback system of regulation. Further mechanisms are difficult to document and measure, and might be more accessible to research by using physical signal detectors, chemical dynamics methods, detectors using biological materials, detectors using living sensors, and detectors using the human body. The growing interest in these practices and the considerable amount of research exploring their effects and clinical applications encouraged this narrative review, which aims to provide an easy to consult partial overview of the history, theory and findings of quantitative research strategies exploring non-contact biofield-based practices. This work also aims to stimulate the reader’s mind with the raised hypotheses, catalyzing further research on the subject to confirm or deny the reported outcomes. Full article

The demand for medical assistance in dying remains high and controversial with a large knowledge gap to support optimal patient care. The study aimed to explore physicians’ attitudes regarding euthanasia and examine the factors that related to these attitudes. We surveyed 135 physicians working at a tertiary-care hospital in Israel. The questionnaire was comprised of demographic and background information, DNR procedure information, encounters with terminally ill patients, familiarity with the law regarding end-of-life questions, and Attitudes toward Euthanasia. About 61% agreed that a person has the right to decide whether to expedite their own death, 54% agreed that euthanasia should be allowed, while 29% thought that physicians should preserve a patients’ life even when they expressed the wish to die. A negative statistically significant relationship was found between the level of religiosity and attitudes toward euthanasia. The physicians’ attitudes towards euthanasia are quite positive when compared to other countries. The data shows a conflict of values: the sacredness of human life versus the desire to alleviate patients’ suffering. The Coronavirus-19 outbreak reinforces the importance of supporting physicians’ efforts to provide ethical and empathic communication for terminally ill patients. Future studies should aim to improve our understanding and treatment of the specific types of suffering that lead to end-of-life requests. Full article

Providing universal quality health services is one of the Sustainable Development Goals (SDG) to achieve by 2030. We evaluated the sustainable and coordinated development of urban and rural medical care from 2008–2017 in Dalian, China, by developing an evaluation system based on population and health services. We used a comprehensive development index model and a coupling coordination model to evaluate the status and sustainable development of population and medical services in Dalian. The overall level of population development index in urban areas was significantly lower than in rural areas in the past decade. Comparing the data for 2008 and 2017, Zhongshan District (−31.51%), Ganjingzi District (−25.67%), Lyshunkou District (−35.45%), and Pulandian District (−19.59%) posted significant declines in the population development index. The overall medical service development index for both urban and rural areas registered a steady upward trend. In terms of the relationship between population and medical services, a more pronounced coupling running-in stage was observed among urban areas than among rural areas. Among urban areas, the coupling running-in stage in Zhongshan District (2013–2016) and Shahekou District (2011–2014) was most pronounced, while among rural areas, Jinzhou District (2012–2016, 0.684~0.756) had the most distinct coupling running-in stage. In terms of coordination development, we found that both urban and rural areas experienced a long period of moderate coordination stage. Among urban areas, except for some middle and mountainous districts with unstable changes in the coordination degree, the overall development trend in the region showed a stable transition from moderate coordination stage towards high coordination stage. From 2008 to 2017, only the coordination degree in Jinzhou District (−9.17%) showed negative growth. Although considerable efforts have been initiated to improve the coordinated development of Dalian’s urban and rural populations and its medical services, the medical and healthcare systems still face numerous challenges. Full article

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic that was reported at the end of 2019 in Wuhan, China, and was rapidly disseminated to all provinces in around one month. The study aims to assess the changes in intercity railway passenger transport on the early spatial transmission of COVID-19 in mainland China. Examining the role of railway transport properties in disease transmission could help quantify the spatial spillover effects of large-scale travel restriction interventions. This study used daily high-speed railway schedule data to compare the differences in city-level network properties (destination arrival and transfer service) before and after the Wuhan city lockdown in the early stages of the spatial transmission of COVID-19 in mainland China. Bayesian multivariate regression was used to examine the association between structural changes in the railway origin-destination network and the incidence of COVID-19 cases. Our results show that the provinces with rising transfer activities after the Wuhan city lockdown had more confirmed COVID-19 cases, but changes in destination arrival did not have significant effects. The regions with increasing transfer activities were located in provinces neighboring Hubei in the widthwise and longitudinal directions. These results indicate that transfer activities enhance interpersonal transmission probability and could be a crucial risk factor for increasing epidemic severity after the Wuhan city lockdown. The destinations of railway passengers might not be affected by the Wuhan city lockdown, but their itinerary routes could be changed due to the replacement of an important transfer hub (Wuhan city) in the Chinese railway transportation network. As a result, transfer services in the high-speed rail network could explain why the provinces surrounded by Hubei had a higher number of confirmed COVID-19 cases than other provinces. Full article

The aim of this study was to try to compare the effectiveness of manual therapy techniques in combination with stabilization techniques: the so-called Australian method and the Neurac method in relation to pain sensations and the level of kinesiophobia. A total of 69 people were examined, divided into three groups of 23 people each. The Visual Analogue Scale was used to assess the antalgic effect, and the Kinesiophobia Causes Scale questionnaire was used to assess the level of kinesiophobia. Patients improved over four weeks, during which they were assessed three times. The evaluation of the desired parameters was also performed over a 24-week period to assess long-term performance. Stabilization techniques are an effective extension of manual therapy techniques in patients with low back pain. People in the groups additionally improved in terms of stabilization techniques, which are characterized by a lower level of kinesiophobia. Its lowest level was found in the group additionally improved with the Neurac method. In the long-term study, the level of kinesiophobia in this group was still maintained at a reduced level. The use of stabilization techniques involving patients in action may significantly affect the level of kinesiophobia, and thus have a much wider effect than just pain reduction. Full article

Prior cross-sectional research indicates that the negative effects of quantitative job insecurity (i.e., threat to job loss) on employees’ wellbeing are fully mediated by qualitative job insecurity (i.e., threat to job characteristics). In the current longitudinal study, we replicated and further extended this view to include a direct effect of qualitative job insecurity on quantitative job insecurity. We explored these reciprocal relations in the context of their concurrent effects on work related outcomes by means of dual-mediation modelling. We identified a wide range of the outcomes, classified as: job strains (i.e., exhaustion, emotional and cognitive impairment), psychological coping reactions (i.e., job satisfaction, work engagement, turnover intention), and behavioral coping reactions (i.e., in-role and extra role performance, counterproductive behavior). We employed a three-wave panel design and surveyed 2003 Flemish employees. The results showed that the dual-mediation model had the best fit to the data. However, whereas qualitative job insecurity predicted an increase in quantitative job insecurity and the outcome variables six months later, quantitative job insecurity did not affect qualitative job insecurity or the outcomes over time. The study demonstrates the importance of qualitative job insecurity not only as a severe work stressor but also as an antecedent of quantitative job insecurity. Herewith, we stress the need for further research on the causal relations between both dimensions of job insecurity. Full article

Inhalational exposure to dust from engineered stone (ES), also known as artificial or composite stone, is associated with a specific disease profile, namely accelerated silicosis, and scleroderma. The pathogenic mechanisms are poorly understood, particularly the role of resin and metal ions. Metal ions are present in pigments and constituent minerals and may be considered potential contributors to toxicity. The aim of this preliminary study was to understand the solubility of ES-containing metals in artificial lysosomal fluid (ALF) simulating the acidic intracellular environment of the lung macrophage lysosome. Differences with respect to ES types and temporal release were explored. Ten ES products of variable colour and company origin were comminuted and assessed for four different metals, solubilized into ALF solutions at 1,2,4 and 8 weeks at 37 °C. There was significant variability in metal release, particularly with regard to iron and manganese, which could be correlated with the reflected brightness of the stone. A majority of the available Mn, Fe, Al and Ti was solubilized. Time trends for metal release varied with ES type but also with metal ion. The data suggest a high metal ion bioavailability once engulfed by lung macrophages. There is a need to investigate a wider range of ES dust and relate metal content to markers of ES toxicity. Full article

Epilepsy is a common consequence of brain tumors, occurring in 35 to 75% of cases. Here we evaluated the influence of epilepsy on the quality of life (QoL) of patients with malignant brain tumors (primary and metastatic) and assessed which areas of function are most affected by epilepsy and brain tumors. Sixty patients undergoing brain tumor surgery at the Neurosurgery Clinic of the 10th Military Research Hospital, Bydgoszcz, Poland (30 with epilepsy and 30 without epilepsy) were studied. Relationships between categorical variables were determined with Pearson’s chi-squared test, while continuous data were analyzed with the Mann-Whitney U-test. A p value < 0.05 was considered statistically significant. A multiple regression model was used for multivariate analysis of QoL. Patients with epilepsy more frequently reported memory disorders as a problem in their daily life. There were trends towards greater impairments in social, professional, and family life, sports and recreational activities, and daily physical activities in brain tumor patients with epilepsy rather than those without epilepsy. Higher frequency and generalized seizures significantly and adversely influenced the ability of patients to leave home and drive vehicles, but a proportion of patients with frequent, generalized seizures continued to drive regardless. Patients with generalized seizures considered the adverse effects of taking medicines as significantly disruptive. Memory disorders significantly affect the QoL of patients with epilepsy, and the importance of stopping driving must be emphasized by all healthcare professionals. Full article

This study aimed to assess change in school-based food waste after training and implementing the Smarter Lunchrooms Movement (SLM) strategies with school food service workers. This non-controlled trial was implemented in a random sample of 15 elementary and middle schools in a Community Eligibility Program school district in the Northeast, the United States. Baseline and post-intervention food waste measurements were collected at two different time points in each school (n = 9258 total trays measured). Descriptive statistics, independent t-tests, and regression analyses were used to assess SLM strategies’ impact on changes in percent food waste. The mean number of strategies schools implemented consistently was 7.40 ± 6.97 SD, with a range of 0 to 28 consistent strategies. Independent t-tests revealed that at post-test, there was a significant (p < 0.001) percent reduction (7.0%) in total student food waste and for each food component: fruit (13.6%), vegetable (7.1%), and milk (4.3%). Overall, a training session on food waste and the SLM strategies with school-based food service workers reduced school food waste. However, the extent of the training and SLM strategies to reduce food waste varied on the basis of the consistency and type of strategies implemented. Full article

The COVID-19 pandemic provided an extraordinary and naturalistic context to observe young people’s psychosocial profiles and to study how a condition of environmental deprivation and lack of direct social contact, affects the well-being and health status of adolescents. The study explored whether the COVID-19 outbreak changes, in the short term, the acute well-being perception in adolescents, as measured by a Personalized Well-Being Index (PWBI) and the four components affecting health (i.e., lifestyle habits, social context, emotional status, mental skills), in a sample of early adolescent students. Data from 10 schools were collected on 1019 adolescents (males 48.3%, mean age 12.53 ± 1.25 y). Measurements were obtained at two time points, in September/October 2019, (baseline condition, BC) as part of the “A new purpose for promotion and eVAluation of healTh and well-being Among healthy teenageRs” (AVATAR) project and during the Italian Lockdown Phase (mid–late April 2020, LP), with the same students using an online questionnaire. During COVID-19 quarantine, adolescents showed a lower PWBI (p < 0.001) as compared to the BC. Considering the four health-related well-being components, lifestyle habits (p < 0.001), social context (p < 0.001), and emotional status (p < 0.001), showed significantly lower values during LP than BC. However, mental skills, in LP, displayed a significant increase as compared to BC (p < 0.001). In this study, we have provided data on the personalized well-being index and the different components affecting health in adolescents during the COVID-19 lockdown, showing a general decrease in well-being perception, expressed in lifestyle habits, social, and emotional components, demonstrating detrimental effects in the first phase of quarantine on adolescents’ psychosocial profiles. Our results shed new light on adolescence as a crucial period of risk behavior, especially when social support is lacking. Full article

A growing body of research conducted in general life settings has found positive associations between happiness and prosocial behavior. Unfortunately, equivalent studies in the workplace are lacking. Organizational citizenship behaviors (OCBs), the prosocial behaviors at work, have not been properly studied in relation to happiness, despite the positive consequences of both constructs for workers and companies. In response, our research aims to better understand this relationship from several angles. First, using a three-wave longitudinal design, we explored how OCBs and happiness are related to each other over time. Second, happiness was measured from a broad perspective, and three conceptualizations were adopted: the hedonic (e.g., positive affect and life satisfaction), the eudaimonic (e.g., relatedness and autonomy), and the flourishing (e.g., meaning and engagement) approaches. Thus, not only the prospective link between OCBs and happiness was tested, but it was also explored using the three models of happiness previously mentioned. Third, we conducted this longitudinal design in a less typical sample than previous research (i.e., Chile). We found results that supported our main hypotheses: (1) OCBs are prospective positive predictors of hedonic happiness, eudaimonic happiness, and flourishing; (2) the three models of happiness also prospectively predict OCBs. Our findings suggest that OCBs foster a broad range of happiness facets, which in turn fosters back the emergence of more OCBs, leading to a virtuous circle of prosociality and well-being in the workplace. This positive spiral benefits not only workers’ quality of life, but also organizations’ profitability and sustainability. Theoretical and applied implications for the field of Positive Organizational Psychology are discussed. Full article

Although corticosteroids can serve as an effective anti-inflammatory adjuvant therapy, the role of adjunctive steroid therapy in pediatric bacterial meningitis in Taiwan remains under-investigated. Cases of acute bacterial meningitis, aged between 1 month and 20 years, were divided into a steroid group (empirical antibiotics with adjunctive steroid therapy) and a non-steroid group (empirical antibiotics only). Data were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision codes. Of the 8083 episodes enrolled in this study, 26% (2122/8083) and 74% (5961/8083) were divided into the steroid and non-steroid groups, respectively. The fatality rates were 7.9% in the steroid group and 1.7% in the non-steroid group during hospitalization (p < 0.0001). In the steroid and non-steroid groups, the median length of hospital stay was 13 and 6 days, respectively (p < 0.0001). Medical costs (median (interquartile range)) of hospitalization were 77,941 (26,647–237,540) and 26,653 (14,287–53,421) New Taiwan dollars in the steroid and non-steroid groups, respectively (p < 0.0001). The steroid group had a more fulminant course at baseline, a higher fatality rate, length of hospital stay, and medical cost of hospitalization. Therefore, the beneficial effects of the adjunctive use of corticosteroids in pediatric bacterial meningitis are inconclusive, and additional prospective multicenter investigations are required to clarify this issue. Full article

Background: The ongoing novel coronavirus (COVID-19) global pandemic has resulted in significant levels of morbidity and mortality worldwide, particularly among the elderly and immuno-suppressed groups. Although adequate hand hygiene (HH) behaviour and compliance is widely accepted as being the most effective self-protective measure in preventing the spread of diseases like COVID-19, previous research suggests that normal hand hygiene compliance is poor, but generally improves during a disease pandemic. This research aimed to evaluate the hand hygiene behaviour and compliance of the general public in the initial weeks of the COVID-19 pandemic in Northern Ireland (NI). Methods: This cross-sectional study involved the use of infrared-imaging cameras to observe the hand hygiene behaviour and compliance of the general public when using one set of male and female public restrooms. Results: The findings of this study indicated that the level of hand hygiene compliance of the general public was poor in the initial weeks, with 82.93% overall not washing their hands adequately. Conclusions: Inadequate HH behaviour and compliance may have added significantly to the rapid rate of spread of COVID-19 in the initial weeks of the pandemic in NI. Current public health campaigns do not appear, based on this study, to have the desired impact and may need to be reviewed or re-enforced in order to achieve the levels of hand hygiene compliance required to slow the spread of COVID-19 and other communicable diseases in the future. Full article

Ambient air pollution accounts for an estimated 4.2 million deaths worldwide. Particulate matter (PM)_2.5 particles are believed to be the most harmful, as when inhaled they can penetrate deep into the lungs. The aim of this study was to examine the relationship between PM_2.5 daily air concentrations and pediatric emergency department (ED) visits for respiratory diseases in a Greek suburban area. All pediatric ED visits for asthma-, pneumonia- and upper respiratory infection (URI)-related complaints were recorded during the one-year period. The 24-h PM_2.5 air pollution data were prospectively collected from twelve fully automated air quality monitoring stations. The mean annual concentration of PM2.5 was 30.03μg/m³ (World Health Organization (WHO) Air Quality Guidelines (AQG) Annual mean concentration: 10 μg/m³). PM2.5 levels rose above the WHO Air Quality Guidelines (AQG) 24-h concentrations (25 μg/m³)), 178 times (48.6% of the study period). When PM2.5 levels were above the daily limit, an increase of 32.44% (p < 0.001) was observed in daily pediatric ED visits for respiratory diseases and the increase was much higher during spring (21.19%, p = 0.018). A 32% (p < 0.001) increase was observed in URI-related visits, when PM_2.5 levels were ≥ 25 μg/m³, compared to the mean daily visits when PM_2.5 levels were < 25 μg/m³. Air pollution levels were associated with increased pediatric ED visits for respiratory-related diseases. Full article

A reduced mitochondrial DNA (mtDNA) copy number, the ratio of mitochondrial DNA to genomic DNA (mtDNA:gDNA), has been linked with dysfunctional mitochondria. Exercise can acutely induce mtDNA damage manifested as a reduced copy number. However, the influence of a paired (exercise and temperature) intervention on regional mtDNA (MINor Arc and MAJor Arc) are unknown. Thus, the purpose of this study was to determine the acute effects of exercise in cold (7 °C), room temperature (20 °C), and hot (33 °C) ambient temperatures, on regional mitochondrial copy number (MINcn and MAJcn). Thirty-four participants (24.4 ± 5.1 yrs, 87.1 ± 22.1 kg, 22.3 ± 8.5 %BF, and 3.20 ± 0.59 L·min⁻¹ VO₂peak) cycled for 1 h (261.1 ± 22.1 W) in either 7 °C, 20 °C, or 33 °C ambient conditions. Muscle biopsy samples were collected from the vastus lateralis to determine mtDNA regional copy numbers via RT-qPCR. mtDNA is sensitive to the stressors of exercise post-exercise (MIN fold change, −1.50 ± 0.11; MAJ fold change, −1.70 ± 0.12) and 4-h post-exercise (MIN fold change, −0.82 ± 0.13; MAJ fold change, −1.54 ± 0.11). The MAJ Arc seems to be more sensitive to heat, showing a temperature-trend (p = 0.056) for a reduced regional copy number ratio after exercise in the heat (fold change −2.81 ± 0.11; p = 0.019). These results expand upon our current knowledge of the influence of temperature and exercise on the acute remodeling of regional mtDNA. Full article