International Journal of Environmental Research and Public Health

The construction industry still leads the world as one of the sectors with the most work-related injuries and worker fatalities. Considering that one of the barriers to improving construction safety is its stressful working environment, which increases risk of inattentiveness among construction workers, safety managers seek practices to measure and enhance worker focus and reduce stress, such as mindfulness. Considering the important role of mindfulness in curbing frequency and severity of incidents, researchers are interested in understanding the relationship between mindfulness and other common, more static human characteristics. As a result, this study examines the relationship between mindfulness and such variables as personality and national culture in the context of construction safety. Collecting data from 155 participants, this study used elastic net regression to examine the influence of independent (i.e., personality and national culture) variables on the dependent (i.e., mindfulness) variable. To validate the results of the regression, 10-fold cross-validation was conducted. The results reveal that certain personality traits (e.g., conscientiousness, neuroticism, and agreeableness) and national cultural dimensions (e.g., uncertainty avoidance, individualism, and collectivism) can be used as predictors of mindfulness for individuals. Since mindfulness has shown to increase safety and work performance, safety managers can utilize these variables to identify at-risk workers so that additional safety training can be provided to enhance work performance and improve safety outcomes. The results of this study will inform future work into translating personal and mindfulness characteristics into factors that predict specific elements of unsafe human behaviors. Full article

The coach-created motivational climate influences variations in athletes’ motivation and emotional experiences. The present study aimed to examine social environmental antecedents of athletes’ emotions. Participants (N = 262, 52% female, M age = 22.75 ± 6.92) completed questionnaires assessing perceptions of coach-created motivational climates, goal orientations, motivation regulations, and emotions. The mediation effects of goal orientations (i.e., task/ego) and motivation regulations (i.e., autonomous/controlled) on the relationship between motivational climate (i.e., empowering/disempowering) and emotions (i.e., happiness, excitement, anxiety, dejection, and anger) were examined. Structural equation modeling revealed positive direct effects of perceptions of an empowering motivational climate on happiness. Indirect effects of empowering climate to happiness and excitement via task orientation and autonomous motivation emerged. Perceptions of a disempowering climate positively predicted anxiety, dejection, and anger via ego orientation and controlled motivation. Overall, the findings have implications for coach education as they highlight the importance of creating more empowering environments and avoiding or reducing social comparisons. Full article

Pedestrian exposure to traffic-related air pollution depends on many factors; including the nature of the traffic on nearby roads and the route characteristics. In this study, we investigated the effects of differences in vehicle fleet and transport infrastructure on children’s exposure to traffic-related air pollution during their morning walk to school in Auckland, New Zealand. Five pairs of routes to schools—each including a low and a high socioeconomic status (SES) school—were selected and traversed over 7–8 days for each pair while measuring particle number concentration (PNC) and GPS coordinates. At the same time, a sample of 200 license plates of cars from each school’s neighborhood was captured using videos, and the age of each car was extracted using an online database. Both the mean age of the cars and the percentage of old cars (>14 years) were found to be higher in the low SES areas. However, neither measure of vehicle age was associated with a significant difference in exposure to PNC for pedestrians. Route features including narrow footpaths and a higher density of traffic lights may be associated with higher levels of PNC exposure. These findings provide insight into the role of urban design in promoting healthy commutes to school. Full article

Prior to the COVID-19 pandemic, studies in the US have identified wide variations in telehealth use across medical specialties. This is an intriguing problem, because the US has historically lacked a standardized set of telehealth coverage and reimbursement policies, which has posed a barrier to telehealth use across all specialties. Although all medical specialties in the US have been affected by these macro (policy-level) barriers, some specialties have been able to integrate telehealth use into mainstream practice, while others are just gaining momentum with telehealth during COVID-19. Although the temporary removal of policy (coverage) restrictions during the pandemic has accelerated telehealth use, uncertainties remain regarding future telehealth sustainability. Since macro (policy-level) factors by themselves do not serve to explain the variation in telehealth use across specialties, it would be important to examine meso (organizational-level) and micro (individual-level) factors historically influencing telehealth use across specialties, to understand underlying reasons for variation and identify implications for widespread sustainability. This paper draws upon the existing literature to develop a conceptual framework on macro-meso-micro factors influencing telehealth use within a medical specialty. The framework is then used to guide a narrative review of the telehealth literature across six medical specialties, including three specialties with lower telehealth use (allergy-immunology, family medicine, gastroenterology) and three with higher telehealth use (psychiatry, cardiology, radiology) in the US, in order to synthesize themes and gain insights into barriers and facilitators to telehealth use. In doing so, this review addresses a gap in the literature and provides a foundation for future research. Importantly, it helps to identify implications for ensuring widespread sustainability of telehealth use in the post-pandemic future. Full article

The number of patients diagnosed with temporomandibular joint (TMJ) internal derangements, who are seeking orthodontic treatment, is increasing. The aim of the study was to assess the relationship between the presence of TMJ reciprocal clicking and the morphology and position of the mandible, and position of lower incisors, examined on the lateral cephalograms. Fifty patients diagnosed with reciprocal clicking in at least one of the TMJs and 55 patients with no symptoms of TMJ dysfunction were included in the study. Cephalometric analysis was used for the assessment of: skeletal class, sagittal and vertical position of the mandible, angle of the mandible, inclination of the mandibular ramus and the mandibular corpus, as well as for the assessment of the position of the mandibular incisors. The statistical significance level was set at p = 0.05. There were no statistically significant differences between the examined groups regarding the sagittal and vertical position of the mandible, as well as regarding the sagittal position of the mandibular incisors. Presence of TMJ reciprocal clicking is not associated with the position and the morphology of the mandible, as well as with the sagittal position of the mandibular incisors. Patients with early stages of TMJ internal derangements do not present any significant changes in Cephalometrics. Patients diagnosed with TMJ internal derangements before orthodontic treatment require an interdisciplinary approach to the treatment, including physiotherapy. Full article

Parents caring for children with rare diseases fear the long-term progression of the child’s disease. The current study aims to systematically investigate the quality of life (QoL) in parents of children with different rare diseases. We performed a systematic literature search including quantitative studies on QoL of parents caring for children and adolescents with rare diseases in five databases (APA PsycArticles, APA PsycInfo, MEDLINE, PSYNDEXplus, and PubMed) published between 2000–2020. Of the 3985 titles identified, 31 studies met the inclusion criteria and were selected for narrative review. Studies were included if they investigated predictors of parental QoL or reported QoL compared to normative samples, parents of healthy children, or children with other chronic diseases. We used the Newcastle–Ottawa Scale to assess methodological quality. The systematic review revealed that parents of children with rare diseases experience reduced QoL compared to parents with healthy children and norm values. Psychosocial factors, beyond disease-specific predictors, were shown to influence parental QoL substantially and may thus present an essential aspect within interventions for this highly burdened group. Health care professionals should consider and address the impairment of parental QoL due to the child’s rare disease. We discuss insights into existing research gaps and improvements for subsequent work. Full article

Childhood obesity is a public health problem with multiple effects on children’s life. Promoting Active School Travel (AST) could provide an inclusive opportunity for physical activity and shape healthy behaviours. Data for this cross-sectional study were drawn from questionnaires carried out in five primary schools located in Newcastle upon Tyne, UK, in neighbourhoods chosen for their variability in IMD (index of multiple deprivation) and spatial structure of street networks (measured through space syntax measure of integration). A randomly selected and heterogenic sample of 145 pupils (aged 9–10) completed an open-ended questionnaire to state what they like and dislike about their journey to school. Thematic analysis identified four typologies (environmental context, emotions, social influences and trip factors) based on the Theoretical Domains Framework (TDF) and specific themes and sub-themes underlying children’s affective experiences of their journeys to school. This study is the first known to authors to attempt to adapt the Capability, Opportunity and Motivation Behaviour (COM-B) model into AST and children’s experiences and associated behavioural domains with design aspects. Such an insight into children’s attitudes could inform urban planners and designers about how to apply more effective behaviour change interventions, targeting an AST increase among children. Full article

Physical activity (PA) pre-COVID-19 was lower in rural areas compared to non-rural areas. The purpose of this study was to determine COVID-19’s impact on PA in rural and non-rural residents. A cross-sectional study consisting of a convenience sample of 278 participants (50% rural, 50% non-rural) from 25 states completed an online survey describing their PA behaviors and perceptions during COVID-19. The global physical activity questionnaire was used to determine PA in various domains and summed to determine if the participant met the PA guidelines. Rural participants had a significantly higher body mass index, lower income, and a lower educational attainment. Conversely, non-rural participants reported more barriers to PA. There was no difference in the perception of COVID-19’s impact on PA, specifically; however, rural participants were significantly less likely to meet cardiorespiratory PA recommendations compared to non-rural participants. Conclusions: This study demonstrates the continued disparity in PA between rural and non-rural residents, despite the supposition of COVID-19 being less impactful in rural areas due to sparse populations. Efforts should be pursued to close the PA gap between rural and non-rural residents. Full article

The shortage of healthcare human resources is an important challenge for coping with the aging society in Macao. Since little attention has been paid to continuous education of healthcare assistants, this study aims to develop and evaluate a continuous education program, supporting the expansion and optimization of the competence of healthcare assistants. It is a cluster-randomized trial study. All healthcare assistants who were employed in nursing homes in Macao were eligible for this study. Six nursing homes were recruited and randomly assigned either an experimental group (3 nursing homes; 45 healthcare assistants) or a control group (3 nursing homes; 40 healthcare assistants). Healthcare assistants were assessed at baseline and after intervention with the Healthcare Assistants Care Knowledge Test and the Healthcare Assistants Care Competence Self-Assessment. The experimental group received a continuous education program with 10 themes during 2017–2018 while the control groups did not. The results of the generalized estimating equation showed that care knowledge in the experimental group was significantly different from that of the control group (Wald Chi Square = 3.848, p < 0.05) as well as care competence (Wald Chi Square = 13.361, p < 0.001). This study developed a continuous program for health assistants and provided evidence that continuous education programs improve and maintain the level of care knowledge and care competency of healthcare assistants. Full article

(1) Background: Tooth loss is an important component of the global burden of oral disease, greatly reducing the quality of life of those affected. Tooth loss can also affect diet and subsequent incidences of lifestyle diseases, such as hypertension and metabolic syndromes. This study aimed to evaluate the oral health-related quality of life (OHRQoL) score using the oral impacts on daily performance (OIDP) index in relation to tooth loss patterns among adults. (2) Methods: From 2014 to 2016, a cross-sectional study was conducted on adults living in Bellville South, Cape Town, South Africa. The OHRQoL measure was used to evaluate the impact of tooth loss. (3) Results: A total of 1615 participants were included, and 143 (8.85%) had at least one impact (OIDP > 0). Males were less likely to experience at least one impact compared to the females, OR=0.6, 95% C.I.: 0.385 to 0.942, p = 0.026. Those participants who did not seek dental help due to financial constraints were 6.54 (4.49 to 9.54) times more likely to experience at least one impact, p < 0.001. (4) Conclusions: Tooth loss did not impact the OHRQoL of these subjects. There was no difference in the reported odds for participants experiencing at least one oral impact with the loss of their four anterior teeth, the loss of their posterior occlusal pairs, or the loss of their other teeth. Full article

Low motor competence (MC) can cause low participation in physical activities in preschool children, and together with a high caloric intake, it can lead to obesity. Interventions on motor skills are effective in the short term to improve MC, therefore the objectives of this study were (1) to investigate the effect of a short six-week program on levels of motor competence in preschool children, and (2) to examine the effects of gender-based intervention. A total of 156 preschool children (5.20 ± 0.54 years old) from Lugo (Spain) participated. A quasi-experimental pre–post-test design was used with a control group of 76 students. The Movement Assessment Battery for Children—2nd Edition (MABC-2) was used to collect the data. Significant differences between the control and experimental groups were found after the intervention program in aiming and catching (p < 0.001), balance (p < 0.001), the total score of eight tests (p < 0.001), and total percentile score (p < 0.001). The results regarding gender in the experimental group showed a reduction in differences with respect to the initial results except in aiming and catching, where scores were higher in boys. The data suggest that the application of specific intervention programs in MC could positively influence the improvement of MC in preschool children, thus reducing differences between genders. Full article

Oropharyngeal dysphagia is a condition characterized by swallowing difficulty in the mouth and pharynx, which can be due to various factors. Animal models of oropharyngeal dysphagia are essential to confirm the cause-specific symptoms, pathological findings, and the effect of treatment. Recently, various animal models of dysphagia have been reported. The purpose of this review is to organize the rodent models of oropharyngeal dysphagia reported to date. The articles were obtained from Medline, Embase, and the Cochrane library, and selected following the PRISMA guideline. The animal models in which oropharyngeal dysphagia was induced in rats or mice were selected and classified based on the diseases causing oropharyngeal dysphagia. The animal used, method of inducing dysphagia, and screening methods and results were collected from the selected 37 articles. Various rodent models of oropharyngeal dysphagia provide distinctive information on atypical swallowing. Applying and analyzing the treatment in rodent models of dysphagia induced from various causes is an essential process to develop symptom-specific treatments. Therefore, the results of this study provide fundamental and important data for selecting appropriate animal models to study dysphagia. Full article

Quality of the granular sludge developed during the start-up of anaerobic up-flow sludge bed reactors is of crucial importance to ensure the process feasibility of treating industrial wastewater such as those containing solvents. In this study, the microbial granule formation from suspended-growth biomass was investigated in two chitosan-assisted reactors. These reactors operated mimicking industrial sites working with night closures treating a mixture of ethanol, ethyl acetate, and 1-ethoxy-2-propanol. Each reactor operated under different hydrodynamic regimes typical from UASB (R1: <0.15 m h⁻¹) and EGSB (R2: 3 m h⁻¹). High soluble COD removal efficiencies (>90%) accompanied by rapid formation of robust anaerobic granules were achieved at both up-flow velocity levels. After three weeks from the start-up, mean size diameters of 475 µm and 354 µm were achieved for R1 and R2, respectively. The performance of the process was found to be stable for the whole operational period of 106 days treating intermittent OLR up to 13 kg COD m⁻³ d⁻¹. A memory dose of chitosan at day 42 was beneficial to guarantee good quality of the granules by offsetting the negative impact of intermittent water supply on the granular size. Methanocorpusculum was identified as the dominant archaea at both up-flow velocities. Acetobacterium, Geobacter and Desulfovibrio bacteria were also abundant, demonstrating its role on the degradation of light-oxygenated solvents. Full article

Many long-term adverse effects of smoking during pregnancy are known. Increasingly, adverse effects in the grandchild after grandmaternal smoking during pregnancy are reported. We explored this in a birth cohort of 24,000 grandmother–mother–child triads identified from the Finnish Medical Birth Register in 1991–2016. Multiple logistic regression was used to analyze the association between any smoking during pregnancy by both grandmother and mother, or only grandmother or mother on adverse birth outcomes. No smoking by neither grandmother nor mother was used as the reference. As endpoints, preterm birth, low birth weight, small for gestational age (birth weight, birth length, head circumference), and body proportionality (low ponderal index, high brain-to-body ratio, high head-to-length ratio) were included. Smoking by both grandmother and mother was consistently associated with higher risks than smoking only by the mother. Birth length and weight were especially sensitive to (grand)maternal smoking. In conclusion, the combined effect of grandmaternal and maternal smoking is associated with higher risks than only maternal smoking. Full article

While appropriate hand hygiene practices (HHP) are protective against infections, the paucity of evidence on global estimates and determinants of HHP in adolescents limits effective design and planning of intervention to improve HHP in young people. We examined the prevalence and correlates of HHP in adolescents. We used nationally representative data from the Global School-based Student Health Survey (2003–2017) from 92 countries. HHP were categorized as “appropriate”, “inappropriate” and “lacking” based on the information about “hand washing before eating”, “hand washing after using the toilet”, and “hand washing with soap”. Multinomial logistic regression analyses were used to assess the role of socio-demographic, health, lifestyle, school, and family-related variables in HHP. Among 354,422 adolescents (13–17 years), only 30.3% were found to practice appropriate hand hygiene. Multivariable models suggest that sedentary behavior (adjusted relative risk ratio (ARRR) 1.41, 95% CI 1.31–1.51)), and bullying victimization (ARRR 1.20, 95% CI 1.10–1.30) promoted inappropriate HHP. In contrast, parental supervision (ARRR 0.55, 95% CI 0.50–0.59) and parental bonding (ARRR 0.81, 95% CI 0.75–0.87) were protective against inappropriate HHP. From a policy perspective, hand hygiene promotion policies and programs should focus on both school (bullying, exercise) and family-level factors (parental supervision and parental bonding) factors. Full article

The Water–Food Nexus (WF) has been proposed to reach equitable, balanced, and sustainable access to water and food resources in the face of the growing population demand. Therefore, developing models to assess them has become more relevant. This work systematically reviews the literature on the tools used to evaluate water and food resources between 2002 and 2020. Furthermore, it reports a critical analysis of the software used to assess the WF Nexus quantitatively. The models analyzed were Life Cycle Assessment (LCA), Common Agricultural Policy Regional Impact (CAPRI), Global Food and Water System (GFWS), Soil and Water Assessment Tool (SWAT), Water Evaluation And Planning system (WEAP), and Soil Water Atmosphere Plant (SWAP). We deduced that the following are necessary in evaluating the WF Nexus: (1) the capacity to generate future scenarios, (2) a global application, and (3) the application in case studies. The present paper is the first review to provide an overview of the software applied to evaluate WF Nexus, including the advantages and disadvantages of the tools found. They can help build sustainability criteria when designing policies that reduce water and food security risks and promote efficient water and food use. Full article

There is a strong relationship between body composition and performance in male soccer players. This study aimed to display an optimal body height and weight, and body composition profile of male soccer players for four competitive age groups. This cross-sectional study included four groups: U-15 (n = 152), U-17 (n = 154), U-19 (n = 61), and seniors (n = 27). Body height and weight were measured under standard conditions, and the bioelectrical impedance analyzer (BIA) analyzed body composition. On average, soccer players in the U-15 group had significantly lower body height, weight, body mass index, skeletal muscle mass, fat-free mass, total body water and basal metabolic rate than U-17, U-19 and seniors, but a higher percentage of body fat than U-17 and U-19, p < 0.05. In addition, the results show significant non-linear increases in body height, weight and body composition as the age of soccer players increases, with the exception of the percentage of body fat mass, which tends to significantly decrease with age. The main findings of this study are that body fat mass remains stable and similar across all age groups, including in the senior squad. Full article

The purpose of this study was to examine Internet trends data and sentiment in tweets mentioning autism, Asperger syndrome, and Greta Thunberg during 2019. We used mixed methods in analyzing sentiment and attitudes in viral tweets and collected 1074 viral tweets on autism that were published in 2019 (tweets that got more than 100 likes). The sample from Twitter was compared with search patterns on Google. In 2019, Asperger syndrome was closely connected to Greta Thunberg, as of the tweets specifically mentioning Asperger (from the total sample of viral tweets mentioning autism), 83% also mentioned Thunberg. In the sample of tweets about Thunberg, the positive sentiment expressed that Greta Thunberg was a role model, whereas the tweets that expressed the most negativity used her diagnosis against her and could be considered as cyberbullying. The Google Trends data also showed that Thunberg was closely connected to search patterns on Asperger syndrome in 2019. The study showed that being open about health information while being an active participant in controversial debates might be used against you but also help break stigmas and stereotypes. Full article

As detailed data on labor market affiliation become more accessible, new approaches are needed to address the complex patterns of labor market affiliation. We introduce the expected labor market affiliation (ELMA) method by estimating the time-restricted impact of perceived stress on labor market affiliation in a large sample of Danish employees. Data from two national surveys were linked with a national register. A multi-state proportional hazards model was used to calculate ELMA estimates, i.e., the number of days in work, sickness absence, and unemployment during a 4-year follow-up period, stratified by gender and age. Among employees reporting frequent work-related stress, the expected number of working days decreased with age, ranging from 103 days lost among older women to 37 days lost among younger and middle-aged men. Young and middle-aged women reporting frequent work- and personal life-related stress lost 62 and 81 working days, respectively, and had more days of sickness absence (34 days and 42 days). In conclusion, we showed that perceived stress affects the labor market affiliation. The ELMA estimates provide a detailed understanding of the impact of perceived stress on labor market affiliation over time, and may inform policy and practice towards a more healthy and sustainable working life. Full article