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

One of the most common neurodevelopmental disorders worldwide is autism spectrum disorder (ASD), which is characterized by language delay, impaired communication interactions, and repetitive patterns of behavior caused by environmental and genetic factors. This review aims to provide a comprehensive survey of recently published literature on ASD and especially novel insights into excitatory synaptic transmission. Even though numerous genes have been discovered that play roles in ASD, a good understanding of the pathophysiologic process of ASD is still lacking. The protein–protein interactions between the products of NLGN, SHANK, and NRXN synaptic genes indicate that the dysfunction in synaptic plasticity could be one reason for the development of ASD. Designing more accurate diagnostic tests for the early diagnosis of ASD would improve treatment strategies and could enhance the appropriate monitoring of prognosis. This comprehensive review describes the psychotropic and antiepileptic drugs that are currently available as effective pharmacological treatments and provides in-depth knowledge on the concepts related to clinical, diagnostic, therapeutic, and genetic perspectives of ASD. An increase in the prevalence of ASD in Gulf Cooperation Council countries is also addressed in the review. Further, the review emphasizes the need for international networking and multidimensional studies to design novel and effective treatment strategies. Full article

A delicate balance of reactive oxygen species (ROS) exists inside the cell: when the mechanisms that control the level of ROS fail, the cell is in an oxidative stress state, a condition that can accelerate aging processes. To contrast the pro-aging effect of ROS, the supplementation of antioxidants has been recently proposed. Sulforaphane (SFN) is an isothiocyanate isolated from Brassica plants that has been shown to modulate many critical factors inside the cells helping to counteract aging processes. In the present work, we exposed human dermal fibroblast to short, sublethal and repeated treatments with hydrogen peroxide for eight days, without or in combination with low concentration of SFN. Hydrogen peroxide treatments did not affect the oxidative status of the cells, without any significant change of the intracellular ROS levels or the number of mitochondria or thiols in total proteins. However, our regime promoted cell cycle progression and cell viability, increased the anti-apoptotic factor survivin and increased DNA damage, measured as number of foci positive for $\gamma$-H2AX. On the other hand, the treatment with SFN alone seemed to exert a protective effect, increasing the level of p53, which can block the expansion of possible DNA damaged cells. However, continued exposure to SFN at this concentration could not protect the cells from stress induced by hydrogen peroxide. Full article

Botswana has the third highest rate of HIV infection, as well as one of the highest mobile phone density rates in the world. The rate of mobile cell phone adoption has increased three-fold over the past 10 years. Due to HIV infection rates, youth and young adults are the primary target for prevention efforts. One way to improve prevention efforts is to examine how risk reduction messages are disseminated on social media platforms such as Twitter. Thus, to identify key words related to safer sex practices and HIV prevention, we examined three months of Twitter data in Botswana. 1 December 2015, was our kick off date, and we ended data collection on 29 February 2016. To gather the tweets, we searched for HIV-related terms in English and in Setswana. From the 140,240 tweets collected from 251 unique users, 576 contained HIV-related terms. A representative sample of 25 active Twitter users comprised individuals, one government site and 2 organizations. Data revealed that tweets related to HIV prevention and AIDS did not occur more frequently during the month of December when compared to January and February (t = 3.62, p > 0.05). There was no significant difference between the numbers of HIV related tweets that occurred from 1 December 2015 to 29 February 2016 (F = 32.1, p > 0.05). The tweets occurred primarily during the morning and evening hours and on Tuesdays followed by Thursdays and Fridays. The least number of tweets occurred on Sunday. The highest number of followers was associated with the Botswana government Twitter site. Twitter analytics was found to be useful in providing insight into information being tweeted regarding risky sexual behaviors. Full article

Objective: This study was designed to assess the prevalence of reproductive tract infections (RTIs) among an internal-migrant population of reproductive age in China. We also analyzed the knowledge, attitude, and practices related to these infections. Methods: A cross-sectional study using the quota-sampling method was conducted in three cities from March 2016 to February 2017. A total of 3320 participants (40.7% men and 59.3% women) were enrolled in the study, of whom, 1124, 1015, and 1181 were from Yinchuan, Urumchi, and Shanghai, respectively. Data on the included subjects were collected using a self-administered questionnaire. Results: We found that 3.2% and 22.6% of all subjects lacked knowledge regarding the identification and prevention of RTIs, respectively. More than 80% of the participants approved of developing RTI surveillance and taking RTI-related courses. While 45.1% of the respondents changed their underwear every 2–3 days, 49.0% cleaned their genitals daily, and 34.9% reported taking a bath daily. Among contraceptive users, 47.4% and 29.7% used condoms and IUDs (intrauterine devices), respectively. Overall, 48.2% of the participants had laboratory-confirmed sexually transmitted infections, and 19.7% of the female participants had endogenous infections. After controlling the socio-demographic variables, participants who cleaned their genitals and took a bath less frequently, as well as used condoms or pills had a lower prevalence of sexually transmitted infections, while those who were unwilling to take RTI-related courses and changed their underwear less frequently were more likely to contract sexually transmitted infections. While women who were unwilling to take RTI-related courses had a lower prevalence of endogenous infections, those with more children had a higher prevalence. Conclusion: The status of RTIs among the internal-migrant population of reproductive-age is not optimistic and is related to multiple factors. We believe this study will contribute to improving the knowledge, attitude, and practices related to RTIs. Full article

In this study, aluminosilicate rich clay soils were prepared through mechanochemical activation. The chemical and mineralogical properties were investigated using X-Ray Fluorescence (XRF) and X-ray diffraction (XRD). The functional groups, morphology and surface area were evaluated using Fourier Transform Infra-Red (FTIR), Scanning electron microscopy (SEM) and Brunauer-Emmett-Teller (BET) analysis. Batch experiments were used to evaluate its defluoridation efficiency while antibacterial activities were assessed using well diffusion method. Maximum adsorption capacity was found to be 1.87 mg/g with 32% fluoride removal. Fluoride adsorption was found to reduce in the presence of Cl⁻, PO₄²⁻ and CO₃²⁻ while it increased in the presence of SO₄²⁻ and NO₃⁻. Adsorption data fitted well to Freundlich isotherms, hence, confirming heterogeneous multilayer adsorption. Kinetic studies revealed that fluoride adsorption fitted well to pseudo-second order model. The sorption of F⁻ onto the clays’ surface followed intra-particle diffusion mode. High correlation coefficient indicates that the sorption process was greatly controlled by particle diffusion while it is minimal in pore diffusion model. Antibacterial studies revealed no zone of inhibition for all the activated clays, hence indicating that they are not active against the bacterial strains of Escherichia coli used in this study. The results showed activated clays’ potential for defluoridation. Its effectiveness in pathogen removal is limited. Hence further modifications of the clays’ surfaces are hereby recommended. Full article

Decreases in injury rates globally and in Europe in the past decades, although encouraging, may mask previously reported social inequalities between and within countries that persist or even increase. European research on this issue has not been systematically reviewed, which is the aim of this article. Between and within-country studies from the WHO European Region that investigate changes in social inequalities in injuries over time or in recent decades were sought in PubMed, Scopus, and Web of Science. Of the 27 studies retained, seven were cross-country and 20 were country-specific. Twelve reported changes in inequalities over time and the remaining 15 shed light on other aspects of inequalities. A substantial downward trend in injuries is reported for all causes and cause-specific ones—alongside persisting inequalities between countries and, in a majority of studies, within countries. Studies investigate diverse questions in different population groups. Depending on the social measure and injury outcome considered, many report inequalities in injuries albeit to a varying degree. Despite the downward trends in risk levels, relative social inequalities in injuries remain a persisting public health issue in the European Region. Full article

Factors related to metabolically healthy obesity (MHO) are not well characterized in adolescents. The study’s aim was to investigate the impact of skeletal muscle mass (SMM) on MHO in adolescents. A secondary analysis was performed using the data of 221 Korean overweight and obese adolescents aged 12–18 years from the Korean National Health and Nutrition Examination Survey. Appendicular skeletal muscle (ASM) mass and total body fat mass were measured by dual-energy X-ray absorptiometry. Being metabolically unhealthy was defined using three definitions: Having ≥1, ≥2, or ≥3 cardiometabolic risk factors (CRFs; waist circumference, blood pressure, glucose, triglycerides, and HDL-cholesterol). Multiple logistic regression analyses adjusted for age and lifestyle factors were performed to assess the association between ASM and MHO. In boys, the risk for having either ≥2 CRFs or ≥3 CRFs was significantly lower with higher weight-adjusted ASM and ratio of ASM to fat mass after controlling for covariates, but this association was not significant with CRFs ≥ 1. In girls, all adjusted odds ratios were not significant. Findings indicate that SMM is a potentially protective factor against cardiometabolic abnormality in adolescents with MHO, showing gender difference. This heightens the importance of SMM in the management of obesity, especially in boys. Full article

The focus of this study is on examining sufficiency and quality of play space in a densely populated city from the spatial perspective. The study employed a three-stage multilevel mixed-method design using spatial analysis, user questionnaire, and site surveys. Provision of play space was assessed based on location, user perception, and proximity to residential areas and roads. The spatial distribution of play space was mapped and examined by applying GIS-based multicriteria analysis. Without considering play space provided by private housing estates, the study found a mismatch between children population and location of play space. The study also identified stair, slope, and sidewalk conditions as key issues of accessibility to selected playgrounds, even in districts with sufficient play space. Kowloon has limited play space of which a high percentage is inferior in terms of safety and pollution standards. Spatial analysis can help inform optimal locations for play space. Future studies should be based on more well-rounded and complete data to advise urban planning. Additionally, policy makers should focus more on quality standards of play space (i.e., openness, absence of pollution, attraction, safety, etc.) when planning as opposed to simply meeting the minimum area per person quota for open space. Full article

Excessive sitting and standing are proposed risk factors for cardiovascular diseases (CVDs), possibly due to autonomic imbalance. This study examines the association of objectively measured sitting and standing with nocturnal autonomic cardiac modulation. The cross-sectional study examined 490 blue-collar workers in three Danish occupational sectors. Sitting and standing during work and leisure were assessed during 1–5 days using accelerometers. Heart rate (HR) and heart rate variability (HRV) were obtained during nocturnal sleep as markers of resting autonomic modulation. The associations of sitting and standing still (h/day) with HR and HRV were assessed with linear regression models, adjusted for age, gender, body mass index, smoking, and physical activity. More sitting time during leisure was associated with elevated HR (p = 0.02), and showed a trend towards reduced HRV. More standing time at work was associated with lower HR (p = 0.02), and with increased parasympathetic indices of HRV (root mean squared successive differences of R-R intervals p = 0.05; high-frequency power p = 0.07). These findings, while cross-sectional and restricted to blue-collar workers, suggest that sitting at leisure is detrimental to autonomic cardiac modulation, but standing at work is beneficial. However, the small effect size is likely insufficient to mitigate the previously shown detrimental effects of prolonged standing on CVD. Full article

The widespread use of reclaimed water has alleviated the water resource crisis worldwide, but long-term use of reclaimed water for irrigation, especially in agricultural countries, might threaten the soil environment and further affect groundwater quality. An in-situ experiment had been carried out in the North China Plain, which aimed to reveal the impact of long-term reclaimed water irrigation on soil properties and distribution of potentially toxic elements (As, Cd, Cr, Hg, Zn and Pb) in the soil profile as well as shallow groundwater. Four land plots were irrigated with different quantity of reclaimed water to represent 0, 13, 22 and 35 years’ irrigation duration. Pollution Load Index (PLI) values of each soil layer were calculated to further assess the pollution status of irrigated soils by potentially toxic elements (PTEs). Results showed that long-term reclaimed water irrigation caused appreciable increase of organic matter content, and might improve the soil quality. High soil organic matter concentrations conduced to high adsorption and retention capacity of the soils toward PTEs, which could reduce the risk of PTEs leaching into deep layers or shallow groundwater. Highest levels of Cr, Pb and Zn were observed at 200–240 cm and 460–500 cm horizons in plots. Longer irrigation time (35 years and 22 years) resulted in a decreasing trend of As, Cd, Hg, Pb and Zn in lower part of soil profiles (>540 cm) compared with that with 13-years’ irrigation years. Long-term reclaimed water irrigation still brought about increases in concentrations of some elements in deep soil layer although their content in soils and shallow groundwater was below the national standard. Totally speaking, proper management for reclaimed water irrigation, such as reduction of irrigation volume and rate of reclaimed water, was still needed when a very long irrigation period was performed. Full article

This study aims to describe the spatial and temporal characteristics of human infections with H7N9 virus in China using data from 19 February 2013 to 30 September 2017 extracted from Centre for Health Protection of the Department of Health (CHP) and electronic databases managed by China’s Center for Disease Control (CDC) and provincial CDCs synthetically using the Geographic Information System (GIS) software ArcMap™ 10.2 and SaTScan. Based on the multiple analyses of the A(H7N9) epidemics, there was a strong seasonal pattern in A(H7N9) virus infection, with high activity in the first quarter of the year, especially in January, February, and April, and a gradual dying out in the third quarter. Spatial distribution analysis indicated that Eastern China contained the most severely affected areas, such as Zhejiang Province, and the distribution shifted from coastline areas to more inland areas over time. In addition, the cases exhibited local spatial aggregation, with high-risk areas most found in the southeast coastal regions of China. Shanghai, Jiangsu, Zhejiang, and Guangdong were the high-risk epidemic areas, which should arouse the attention of local governments. A strong cluster from 9 April 2017 to 24 June 2017 was also identified in Northern China, and there were many secondary clusters in Eastern and Southern China, especially in Zhejiang, Fujian, Jiangsu, and Guangdong Provinces. Our results suggested that the spatial-temporal clustering of H7N9 in China is fundamentally different, and is expected to contribute to accumulating knowledge on the changing temporal patterns and spatial dissemination during the fifth epidemic and provide data to enable adequate preparation against the next epidemic. Full article

The aim of this study was to verify whether eight-week-long swimming exercise training would evaluate the level of selected indicators of the pro-oxidant/antioxidant status in response to cold water in comparison with swimming under thermoneutral conditions in sedentary male and female elderly rats. The exercise-trained groups swam four min/day and five days a week during eight weeks of housing. Exercise was performed by swimming in glass tanks containing tap water maintained according to group at 5 °C and 36 °C. At the end of treatment (48 h after the last session), all rats were anaesthetized. The level of chosen biomarkers of oxidative stress and antioxidant enzyme activity was determined in the red blood cells and plasma. The results of study show that female rats seem to be better adapted to changing thermal conditions of the environment, developing not only morphological, but also antioxidant, defense mechanisms, mainly in the form of increased erythrocyte superoxide dismutase (SOD) activity and glutathione (GSH) concentration to restore the pro-oxidant/oxidant balance of the organism. Significantly higher concentrations of GSH were observed in the female rats of the group swimming in cold water (by 15.4% compared to the control group and by 20.5% in relation to the group of female rats swimming at 36 °C). In the group exposed to swimming training exercise in cold water, a significantly higher activity of SOD1 (by 13.4%) was found compared to the control group. On the other hand, the organs of ageing male rats show a reduced capacity to increase the metabolic response to low temperatures compared to female ones. In addition, it was demonstrated that cold exposure leads to an increase in lipid peroxidation in tissues. On the other hand, the repeated exposure to low levels of oxidative stress may result in some adaptive changes in organisms that help them to resist stress-induced damage. Full article

Background: Berberine (BBR) is a pharmaceutical chemical with a broad antibacterial spectrum, and its biological treatment has been of research and practical interest. In this study, a pure bacterial strain B16 was isolated from the activated sludge in a pharmaceutical wastewater treatment plant. The aim of the study is to characterize the properties of the strain B16, especially its BBR degradation capability. Methods: The identification of strain B16 was conducted by visual observation, as well as biochemical and phylogenetic analysis. The degradation kinetics of strain B16 was tentatively described by Haldane model. Results: The strain B16 was 100% determined as a Sphingopyxis sp. The kinetic parameters of BBR degradation by strain B16 were as follows: Vmax 54.73 ± 5.54 mg (g MLSS · h)⁻¹, Km 66.68 ± 8.95 mg L⁻¹, and Ki 43.16 ± 5.92 mg L⁻¹, with an R² of 0.996. Stain B16 exhibited considerable capability of BBR degradation. BBR of initial concentration 40 mg L⁻¹ could be completely degraded in 48 h under optimal conditions. Conclusions: strain B16 was the first pure culture found with the ability to totally mineralize BBR, indicating the potential of B16 application in real industrial processes. Full article

Alongside the growing number of older persons, the prevalence of chronic diseases is increasing, leading to higher pressure on health care services. eHealth is considered a solution for better and more efficient health care. However, not every patient is able to use eHealth, for several reasons. This study aims to provide an overview of: (1) sociodemographic factors that influence the use of eHealth; and (2) suggest directions for interventions that will improve the use of eHealth in patients with chronic disease. A structured literature review of PubMed, ScienceDirect, Association for Computing Machinery Digital Library (ACMDL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was conducted using four sets of keywords: “chronic disease”, “eHealth”, “factors”, and “suggested interventions”. Qualitative, quantitative, and mixed-method studies were included. Four researchers each assessed quality and extracted data. Twenty-two out of 1639 articles were included. Higher age and lower income, lower education, living alone, and living in rural areas were found to be associated with lower eHealth use. Ethnicity revealed mixed outcomes. Suggested solutions were personalized support, social support, use of different types of Internet devices to deliver eHealth, and involvement of patients in the development of eHealth interventions. It is concluded that eHealth is least used by persons who need it most. Tailored delivery of eHealth is recommended. Full article

Depression is associated with absenteeism and presentism, problems in workplace relationships and loss of productivity and quality. The present work describes the validation of a web-based system for the assessment of depression in the university work context. The basis of the system is the Spanish version of the Beck Depression Inventory (BDI-II). A total of 185 participants completed the BDI-II web-based assessment, including 88 males and 97 females, 70 faculty members and 115 staff members. A high level of internal consistency reliability was confirmed. Based on the results of our web-based BDI-II, no significant differences were found in depression severity between gender, age or workers’ groups. The main depression risk factors reported were: “Changes in sleep”, “Loss of energy”, “Tiredness or fatigue” and “Loss of interest”. However significant differences were found by gender in “Changes in appetite”, “Difficulty of concentration” and “Loss of interest in sex”; males expressed less loss of interest in sex than females with a statistically significant difference. Our results indicate that the data collected is coherent with previous BDI-II studies. We conclude that the web-based system based on the BDI-II is psychometrically robust and can be used to assess depression in the university working community. Full article

To assess different impacts of land, population and economy factors on the lexicographic minimax optimal allocation of blue and green water footprints, a comprehensive discriminant rule is constructed in this paper based on the Gini coefficient and Theil entropy index. The proposed rule is employed to estimate the influence of the aforesaid factors (land, population and economy) on the corresponding allocation schemes from a fairness perspective. To demonstrate its applicability, the proposed approach is applied to a water resources allocation study for 11 provinces in the Yangtze River Economic Belt (YREB). The results indicate that: (1) the economy-based lexicographic allocation of water footprints (LAWF) is more equalitarian for the provinces with high water footprint quotas. The land area-based LAWF is more equalitarian for the provinces with low water footprint quotas. The population-based LAWF is more equalitarian for the provinces with medium water footprint quotas. (2) The contribution of intra-regional variation in the population-based LAWF scheme is the largest of the three schemes. The inter-regional variation contributed the largest in the land area-based LAWF scheme. (3) Two synthetic schemes which integrate multiple factors among land area, economy and population are more equalitarian than the three single-factor schemes. Compared with the original situation which is an equalitarian but ineffective allocation, the two synthetic schemes have greater effect on the improvement of the supply-demand balance of water resources carrying capacity. Therefore, the defect of the population, economy and land area factors acting alone should be resolved by designing a weighting system, in order to optimize the allocation of water resources. Full article

The objective of the current study was to evaluate young Canadians’ exposure to caffeinated energy drink marketing and educational messages that warn about the potential health risks of energy drinks. An online survey was conducted in 2015 with youth and young adults aged 12–24 years recruited from a national online panel (n = 2023). Respondents were asked about their exposure to energy drink marketing and educational messages that warn about the potential health risks of energy drinks. Regression models were fitted to examine correlates of exposure to marketing and to educational messages. Over 80% of respondents reported ever seeing energy drink marketing through at least one channel, most commonly television (58.8%), posters or signs in a convenience or grocery store (48.5%), and online ads (45.7%). The mean number of marketing channels selected was 3.4 (SD = 2.9) out of ten. Respondents aged 18–19 (vs. 12–14 and 15–17) and 20–24 (vs. 12–14 and 15–17) reported significantly more channels of exposure to marketing. Overall, 32% of respondents reporting ever seeing an educational message about energy drinks. The most frequently reported sources of exposure were at school (16.2%), online (15.0%), and on television (12.6%). Respondents aged 18–19 (vs. 12–14, 15–17 and 20–24) and 20–24 (vs. 15–17) were significantly more likely to report having seen an educational message. Exposure to energy drink marketing was common among youth and young adults and was significantly more prevalent than exposure to educational messages that warn about the potential health risks of energy drinks. A comprehensive policy approach, including enforcing responsible marketing and increasing education surrounding the risks of consuming energy drinks, may be an effective approach in promoting lower-risk consumption of CEDs. Full article

Anterior cervical discectomy and fusion (ACDF) is the standard surgical management for disc herniation and spondylosis worldwide and reportedly performed with short hospitalization and early discharge (ED). However, it is unknown if ED improves the outcomes of ACDF including among older adults. This cohort study included patients who underwent ACDF surgery in Taiwan over two years analyzed in two groups: the ED group (discharged within 48 hours), and the comparison group (hospitalized for more than 48 h). Both groups were followed-up for at least 180 days. Pre- and post-operative comorbidities, re-admissions and re-operations were analyzed using a multivariate cox-regression model, with bootstrapping, and Kaplan–Meier analysis. Among 5565 ACDF patients, the ED group (n = 405) had a higher chance (crude and adjusted hazard ratio = 2.33 and 2.39, both p < 0.001) of re-admission than the comparison group (n = 5160). The ED group had an insignificant trend toward more re-admissions for spinal problems and re-operations within 180 days. In the ED group, older age (≥60) and hypertension were predictive of re-admission. For ACDF surgery, the ED group had higher rates of re-admission within 180 days of post-op, suggesting that the current approach to ED requires modification or more cautious selection criteria be adopted, particularly for older adults. Full article

Background: The integration of animals into healthcare, referred to as animal-assisted intervention, is a rapidly growing research field and was previously related to One Health. However, the assessment of synergistic effects of animal-assisted interventions (AAI) has been poorly addressed to date. Method: We discuss experiences in integrated human and animal assessments in AAI and provide a methodical framework for One Health approaches in AAI research. We propose theoretical consideration of an integrated human and animal health assessment, as well as the use of such an integrated approach in research. Based on the existing research, we argue that, for a deeper understanding of AAI mechanisms, parallel research designs are needed. Results and Conclusion: Our paper shows that a One Health study design is necessary to ensure that a tradeoff in health of animals is prevented and that an added value, or synergistic benefit, can be achieved on both sides during animal-assisted interventions. Full article