International Journal of Environmental Research and Public Health

Exercise in different settings has become a fundamental part of Huntington’s disease (HD) management. The aim of this systematic review and meta-analysis was to investigate the effectiveness of home-based exercises (HBE) in HD. Randomized controlled trials (RCTs) investigating the effect of HBE on motor, cognitive, or health-related quality of life (QoL) outcomes in HD were included. Standardized mean difference (SMD), the 95% confidence interval, and p-values were calculated by comparing the outcomes change between HBE and control groups. Seven RCTs met the inclusion criteria. The included RCTs prescribed different types of HBEs, i.e., aerobic strengthening, walking, balance, and fine motor exercises. The HBE protocol length was between 6 and 36 weeks. The meta-analyses showed a significant effect of HBE intervention on motor function measure by Unified Huntington Disease Rating and overall QoL measure by Short Form−36 post-treatment respectively, [SMD = 0.481, p = 0.048], [SMD = 0.378, p = 0.003]. The pooled analysis did not detect significant changes in cognition, gait characteristics, or functional balance scales. The current study shows the positive effect of HBE in HD, especially on motor function and QoL. No significant adverse events were reported. The current results support the clinical effect of HBE intervention on motor function and QoL in HD patients. However, these results should be taken with caution due to the limited available evidence. Well-designed clinical studies that consider the disease severity and stages are required in the future. Full article

Polycystic ovary syndrome (PCOS) is a prevalent condition that not only has the potential to impede conception but also represents the most common endocrine dysfunction in fertile women. It is considered a heterogeneous and multifaceted disorder, with multiple reproductive and metabolic phenotypes which differently affect the early- and long-term syndrome’s risks. Undoubtedly, the impact of PCOS on infertility has attracted most of the attention of healthcare providers and investigators. However, there is growing evidence that even after conception is achieved, PCOS predisposes the parturient to several adverse pregnancy outcomes including a high risk of pregnancy-induced hypertension, spontaneous abortion, gestational diabetes, preeclampsia, and preterm birth, which increase the risks of stillbirth and neonatal death. Fetal growth abnormalities may also be more common, but the relationship is less well defined. This narrative review aims to summarize current knowledge regarding these conditions as they interplay with PCOS and concludes that although there appears to be an increase in these complications during the pregnancy of women with PCOS, there is a need for further research to clarify the possible confounding impact of obesity. Implications for clinical practice and future research are outlined. Full article

The purpose of this research was to investigate the degree of agreement between data from the International Physical Activity Questionnaire—Short Form (IPAQ) and accelerometer (ActiGraph^®) readings for physical activity (PA), classified as moderate, vigorous, and moderate–vigorous PA, and sedentary behavior (SB) in participants with major depressive or bipolar disorder. Following a cross-sectional observational design (n = 30), participants used an accelerometer for 4 to 7 days (minimum of 10 h per day) and answered the IPAQ (for the same period as accelerometer use). Our results suggest significant differences (p < 0.05) when comparing the ActiGraph^® and IPAQ data: for moderate PA, 155 min vs. 25 min per week; for moderate–vigorous PA, 157 min vs. 50 min per week; and for SB, 8 h vs. 3 h per day. Spearman’s correlation coefficients (ActiGraph^® and IPAQ) were low for moderate PA, vigorous PA, and moderate–vigorous PA (rho = 0.03 to 0.13). The Bland–Altman plot showed a bias of −75 min for moderate PA, 9 min for vigorous PA, −66 min for moderate–vigorous PA, and −5 h for SB. Considering the differences observed and the objectivity of the ActiGraph^® measurements, whenever possible, we recommend ActiGraph^® measurements of PA and SB for these clinical groups. Full article

The aim of this study is to assess factors associated with the number of prenatal visits of women who delivered in a public maternity hospital in northeastern Brazil. This cross-sectional study focused on 380 puerperal women who gave birth at a public maternity hospital in northeastern Brazil. Prenatal and perinatal data were collected in the immediate postpartum period by interviewing mothers and using medical records. Chi-square/Fisher exact test compared the data, and a logistic regression model estimated the association between birth weight and number of prenatal visits. As a result, the sample was composed of 175 women with <37 weeks of gestational age and 205 women with ≥37 weeks of gestational age. Women with less than four prenatal visits were more likely to give birth to low birth weight (<2500 g) and preterm infants (<37 weeks of gestational age) than those with more than four prenatal visits (p = 0.001). The subjects with less than four prenatal visits had a 2.76-fold higher odds of giving birth to infants weighing less than 2500 g (p = 0.03; 95%CI = 1.05–7.30), without relation to maternal and gestational ages. In conclusion, women with less than four prenatal visits had higher odds of giving birth to low birth infants, independently of maternal and gestational ages, and were more likely to give birth to premature babies. Full article

Globally, adolescents living with HIV (ALHIV) experience poor health outcomes such as low retention in care, ART non-adherence and viral non-suppression. These outcomes coincide with the period during and after their transition from pediatric to adult healthcare. This study aimed to systematically describe the compendium of transition interventions and synthesize the effects of such transition interventions on adherence to ART, retention in care and viral load suppression. Seven databases and Google Scholar were searched and the review findings were reported according to the Preferred Reporting Items Stipulated for Systematic Reviews and Meta-Analyses. The risk of bias and the strength of evidence were assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. Seven studies (two cross-sectional, two retrospective cohort and three prospective cohort studies), with sample sizes ranging from 13 to 192, were included in the narrative synthesis. There was high-quality evidence that these interventions—Individualized care plans, communication, psychological support, and health and sexual education and mHealth—improved adherence, retention in care and viral load suppression at post-transition over the short and long term. In contrast, group transition intervention produced weak quality evidence. Hence, transition interventions including a combination of the high-quality evidenced interventions mentioned above can improve treatment outcomes for adolescents on ART. Full article

The findings of longitudinal studies on traumatized refugees have shown that factors related to premigration, migration, and post-migration experiences determine changes in mental health over time. The primary aim of this follow-up study was to examine the potential change in the prevalence rates of probable PTSD and depression among Syrian refugees in Iraq. An unselected group of N = 92 Syrian adult refugees was recruited from Arbat camps in Sulaymaniyah Governorate in Iraq’s Kurdistan Region, and then interviewed at two different time points between July 2017 and January 2019. Locally validated instruments were used to assess traumatic events and mental health symptoms. The primary results showed no significant change in the mean scores of PTSD and depression symptoms from the first measurement to the second measurement over the course of 18 months. On the individual level, no reliable change was found for either PTSD or depression symptoms in more than three-quarters of the participants (78.3% and 77.2%, respectively). New adversities and traumatic events that occurred over the 18 months between the interviews were a significant predictor of increasing trauma-related symptoms. After the flight from conflict settings, trauma-related disorders seem to be chronic for the majority of Syrian refugees. Further longitudinal studies are needed in order to identify specific risk factors that lead to maintaining or worsening mental health symptoms over time, and to explore effective therapeutic intervention methods for this traumatized population. Full article

The process of urban development in China is that cities retain independent administrative divisions, realize inter-regional urban integration, and then establish metropolitan areas; this process has high requirements for the coordinated development of cities. China’s cities still need to receive approximately 300 million people in the future, and these urban populations are mainly planned in the emerging metropolitan area. In order to clarify the problems and development of the direction of China’s emerging megalopolis in the process of building a framework for carrying urban population, and to provide reference for China’s urbanization process, the entropy weight method–coupling coordination degree model–panel vector autoregression model (EWM-CCDM-PVAR) is constructed to measure the development level, coupling coordination degree and dynamic response relationship of NTU-UI-UE in the Jiaodong Economic Circle. First, the development level of new-type urbanization and urban infrastructure in the Jiaodong Economic Circle has been steadily improved, but regional differences have been expanding year by year. The urban environment of most cities in the Jiaodong Economic Circle is deteriorating. Second, the CCD level of NTU-UI-UE in the Jiaodong Economic Circle is on the rise, but the CCD level of NTU-UI-UE in Weifang and Yantai is only a Moderate-coupling coordination type, and the development within the region is uneven. Third, both NTU-UI and UI-UE in the Jiaodong Economic Circle have established a dynamic response relationship of mutual promotion, but NTU-UE has a dynamic response relationship of mutual inhibition. Fourth, despite different problems, the Jiaodong Economic Circle has made certain achievements in the process of regional integration and has initially formed a metropolitan circle pattern with Qingdao as its core, Weifang as its west center, Yantai and Weihai as its north center and Rizhao as its south center. Full article

The regular practice of physical activity helps in the prevention and control of several non-communicable diseases. However, evidence on the role of physical activity in mitigating worsening clinical outcomes in people with COVID-19 is still unclear. The aim of this study was to verify whether different levels of physical activity provide protection for clinical outcomes caused by SARS-CoV-2 infection. A cross-sectional study was conducted with 509 adults (43.8 ± 15.71 years; 61.1% female) with a positive diagnosis of COVID-19 residing in Ribeirão Preto, São Paulo, Brazil. Participants were interviewed by telephone to determine the severity of the infection and the physical activity performed. Binary logistic regression was used to indicate the odds ratio (OR) of active people reporting less harmful clinical outcomes from COVID-19. Active people had a lower chance of hospitalization, fewer hospitalization days, less respiratory difficulty and needed less oxygen support. The results suggest that active people, compared to sedentary people, have a lower frequency of hospitalization, length of stay, breathing difficulty and need for oxygen support. These results corroborate the importance of public policies to promote the practice of physical activity, in order to mitigate the severity of the clinical outcomes of COVID-19. Full article

Hotel room cleaners frequently report job-related pain, with high rates of work-related musculoskeletal disorder injuries established for this group of workers. Surprisingly, there is limited published research documenting the impact of interventions to reduce ergonomic-related injury risks specific to hotel room cleaners’ job tasks. In this study focused on hotel bathroom-cleaning and furniture-dusting tasks, twelve experienced hotel room cleaners used their standard method and a risk-reduction method—a tool with a handle that could extend, to perform these tasks. The female study participants’ average age was 45.3 (SD 8.7) years with an average of 10 years of work experience as cleaners (range: 0.8–26.0 years). Trunk kinematics and a low back injury risk assessment were measured using the Lumbar Motion Monitor. All study metrics were significantly reduced when cleaning tasks involved use of adjustable, long-handled tools (p < 0.05). This study demonstrated that commonly available cleaning and dusting tools with extendable handles can significantly reduce low back injury risk among hotel room cleaners and potentially reduce injury risk to other body parts known to be the site of musculoskeletal disorders in this workforce. The study findings suggest that cleaning or housekeeping jobs in other industries where these same tasks are performed could benefit from use of extended-handle tools like those investigated here. Full article

Nature-based solutions (NbS), including green social prescribing (GSP), are sustainable ways to address health and wellbeing, especially since the COVID-19 pandemic exacerbated the strain on healthcare. NbS require national and local cross-sector coordination across complex, interrelated systems, but little is known about the specific challenges this poses for community-led NbS. We carried out a traditional literature review to establish the context and knowledge base for this study and interviewed 26 stakeholders. These came from environment, health and social care sectors at national and local levels, with local-level stakeholders from Bradford and Walsall: English cities significantly affected by the pandemic, with high levels of deprivation and health inequality. The interviews explored experiences of implementing NbS, both pre- and post-pandemic and the resulting renewed interest in the salutogenic effects of engaging with natural environments. We coded the interview transcriptions using NVivo to identify the challenges existing in the systems within which these stakeholders operate to create and manage NbS. By synthesizing what is known about the challenges from existing literature with findings from the interviews, we developed eight categories of challenges (perception and knowledge, political, financial, access to natural spaces, engagement, institutional and organisational, coordination, GSP referral and services) faced by multiple sectors in implementing community-led NbS in England. Furthermore, this study highlights the new challenges related to the pandemic. Identifying these challenges helps stakeholders in existing complex systems recognise what is needed to support and mainstream NbS in England. Full article

Background: Long-COVID affects over 144 million people globally. In the absence of treatments, there is a need to establish the efficacy of therapies that improve patient outcomes. Forest bathing has been demonstrated to improve physical and mental outcomes but there is no evidence in Long-COVID patients. Accordingly, this pilot study sought to determine the feasibility and effectiveness of online forest bathing in adults with Long-COVID. Methods: Feasibility was assessed by monitoring retention rates and participant feedback. In a waitlist controlled, repeated measures design, 22 Long-COVID patients completed weekly online surveys during a four-week waitlist control period, before engaging in four weekly online forest bathing sessions, completing post-intervention surveys following each session. Results: In terms of retention, 27% did not provide post-intervention data, reasons for non-adherence were: feeling too ill, having medical appointments, or having career responsibilities. Compared with the waitlist control period, there were statistically significant improvements in Anxiety (49% decrease), Rumination (48% decrease), Social Connection (78% increase), and Long-COVID symptoms (22% decrease). Written qualitative comments indicated that participants experienced feelings of calm and joy, felt more connected socially and with nature, and experienced a break from the pain and rumination surrounding their illness. Conclusions: Online Forest bathing resulted in significant improvements in well-being and symptom severity and could be considered an accessible and inexpensive adjunct therapy for Long-COVID patients. Where people have limited access to in-person nature, virtual nature may offer an alternative to improve health and well-being outcomes. Full article

Maternal satisfaction is essential for women. Extant research has focused on how a practical delivery method effects maternal satisfaction. This article tried to explore the effect of the consistency of delivery mode between mothers’ expectations and their experience of maternal satisfaction and proposed the mediating effect of the perception of support from medical staff and the moderated mediation effect of maternal self-efficacy. Based on two studies, this article found that the consistency of the delivery mode has a positive effect on maternal satisfaction, and women’s perception of support from medical staff mediated the above relationship. The maternal perception of self-efficacy has a moderated mediation effect; specifically, for women with a high level of self-efficacy, the positive effect of the consistency of the delivery mode on maternal satisfaction through perception support from medical staff is stronger. This article highlights the importance of the consistency of the delivery mode between women’s expectations and the experience of maternal satisfaction and the psychological mechanisms involved. The results extend the theoretical research on ethics in childbirth and provide implications for improving women’s maternal satisfaction from medical staff and themselves. Full article

Personalized medicine requires an understanding of treatment effect heterogeneity. Evolving toward causal evidence for scenarios not studied in randomized trials necessitates a methodology using real-world evidence. Herein, we demonstrate a methodology that generates causal effects, assesses the heterogeneity of the effects and adjusts for the clustered nature of the data. This study uses a state-of-the-art machine learning survival model, riAFT-BART, to draw causal inferences about individual survival treatment effects, while accounting for the variability in institutional effects; further, it proposes a data-driven approach to agnostically (as opposed to a priori hypotheses) ascertain which subgroups exhibit an enhanced treatment effect from which intervention, relative to global evidence—average treatment effects measured at the population level. Comprehensive simulations show the advantages of the proposed method in terms of bias, efficiency and precision in estimating heterogeneous causal effects. The empirically validated method was then used to analyze the National Cancer Database. Full article

Disasters such as rock bursts and mine earthquakes became increasingly serious with the increase in mining depth in Erdos Coal Field and became serious problems that restrict high-strength continuous mining of coal mines. In this study, strata movement and energy polling distribution of ultrathick weak-bonding sandstone layers were controlled by the local filling–caving multi-faces coordinated mining technique, which was based on the analysis of subsidence and overlying structural characteristics in the Yingpanhao mining area. Moreover, the influencing factors and the control effect laws were investigated. Surface subsidence and energy polling distribution control effects of different mining modes were compared, which confirmed the superiority of local filling based on the main key stratum. According to the results, the maximum surface subsidence velocity of the first mining face was 1.24 mm/d, which indicates the presence of a logistic functional relationship between the mining degree and subsidence factors. When the mining degree was close to full mining, the practical surface subsidence was smaller than the corresponding logistic functional value. The largest influencing factor for the strata movement control effect of partial filling mining based on the main key stratum was the width of the caving face, followed by the filling ratio, section pillar width, and width of the filling face, successively. With respect to the influencing degree on the energy polling distribution of partial filling mining based on the main key stratum, the order followed as section pillar width > filling ratio > caving working face > width of backfilling working face. Additionally, the comparative analysis from the perspectives of control effect, resource utilization, and cost-effectiveness demonstrated that partial filling mining based on the main key stratum was one of the techniques with high cost-effectiveness in controlling strata movement and relieving rock bursts, mining earthquakes, and subsidence disasters. Full article

Willingness to get a vaccine was important during the COVID-19 pandemic. Previous studies suggest that vaccine hesitation during the pandemic could have been related to truth discernment, belief in information, exposure to misinformation, attitudes to vaccines, and conspiracy beliefs. Previous studies were mostly with younger adults, and studies with older adults are lacking. This study aimed to analyze the relationship between the trust or belief in fake online news (print news was not included), truth discernment, attitudes, and willingness to be vaccinated during the COVID-19 pandemic while controlling for some significant factors/variables that could affect vaccination in a sample of older adults. There were 504 pre-retirees and retirees participating in this study. Participants from Lithuania age ranged from 50 to 90 years old (M = 64.37, SD = 9.10), 58.3 percent were females. Results from several path models predicting the participants willingness to get a vaccine suggested that stronger conspiracy beliefs and skeptical attitudes toward vaccination would be related to lower willingness to get vaccinated. Participants who disbelieved in the headlines were already vaccinated. Therefore, it seems that discernment (the ability to distinguish which information is true and which is not) is not related to the willingness to vaccinate. Full article

The eighth edition of the TNM classification officially introduced “depth of invasion” (DOI) as a criterion for determining the T stage in tongue squamous cell carcinoma. The DOI is a well-known independent risk factor for nodal metastases. In fact, several experts strongly suggest elective neck dissection for tongue cancer with a DOI > 4 mm due to the high risk of early and occult nodal metastases. Imaging plays a pivotal role in preoperative assessments of the DOI and, hence, in planning the surgical approach. Intraoral ultrasound (IOUS) has been proposed for early-stage SCC of the oral tongue as an alternative to magnetic resonance imaging (MRI) for local staging. The aim of this work is to investigate the accuracy of IOUS in the assessment of the DOI in early oral SCC (CIS, pT1, and pT2). A total of 41 patients with tongue SCCs (CIS-T2) underwent a preoperative high-frequency IOUS. An IOUS was performed using a small-size, high-frequency hockey-stick linear probe. The ultrasonographic DOI (usDOI) was retrospectively compared to the pathological DOI (pDOI) as the standard reference. In patients who underwent a preoperative MRI, their usDOI, magnetic resonance DOI (mriDOI), and pDOI were compared. Specificity and sensitivity for the IOUS to predict a pDOI > 4 mm and to differentiate invasive and noninvasive tumors were also evaluated. A high correlation was found between the pDOI and usDOI, pDOI and mriDOI, and usDOI and mriDOI (Spearman’s ρ = 0.84, p < 0.0001, Spearman’s ρ = 0.79, p < 0.0001, and Spearman’s ρ = 0.91, p < 0.0001, respectively). A Bland–Altman plot showed a high agreement between the usDOI and pDOI, even though a mean systematic error was found between the usDOI and pDOI (0.7 mm), mriDOI and pDOI (1.6 mm), and usDOI and mriDOI (−0.7 mm). The IOUS was accurate at determining the T stage (p < 0.0001). The sensitivity and specificity for the IOUS to predict a pDOI ≥4 mm were 92.31% and 82.14%, respectively, with an AUC of 0.87 (p < 0.0001). The specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) for the IOUS to predict an invasive cancer were 100%, 94.7%, 60%, and 100%, respectively. The AUC was 0.8 (95% CI 0.646–0.908, p < 0.0001). The IOUS was accurate in a preoperative assessment of a pDOI and T stage, and can be proposed as an alternative to MRI in the preoperative staging of tongue SCC. Full article

Background: Patients affected by COVID-19 may develop an impaired lung function, with reduced lung capacities and volumes, respiratory muscle weakness, changes in radiographic and tomographic findings, limitations in exercising, decreased functional capacity, depression, anxiety and reduced quality of life. Thus, we aimed to analyze the effects of a pulmonary and functional rehabilitation program on the functional capacity, lung function and respiratory muscle strength in patients who were affected by COVID-19 syndrome. Methods: This is a pilot clinical trial, composed of post-COVID-19 patients with mild, moderate or severe involvement, in which, they underwent a pulmonary and functional rehabilitation program. Patients were evaluated for functional capacity by the 6 min walk test, pulmonary function by spirometry, respiratory muscle strength by manovacuometry, handgrip strength by dynamometry, quality of life by the COPD Assessment Test and functional status by the PCFS. After the initial assessments, the patients performed the rehabilitation protocol in 16 sessions (inspiratory muscle training, aerobic exercise and peripheral muscle strength) and, at the end, they were evaluated again. Results: A total of 29 patients completed the program (12.7 ± 2.7 sessions). The functional capacity increased in meters walked from 326.3 ± 140.6 to 445.4 ± 151.1 (p < 0.001), with an increase in the predicted value from 59.7% to 82.6% (p < 0.001). The lung function increased in liters from 2.9 ± 0.8 to 3.2 ± 0.8 (p = 0.004) for forced vital capacity and from 2.5 ± 0.7 to 2.7 ± 0.7 (p = 0.001) for forced expiratory volume in the first second. The respiratory muscle strength increased in cmH₂O from 101.4 ± 46.3 to 115.8 ± 38.3 (p = 0.117) for inspiratory pressure and from 85.8 ± 32.8 to 106.7 ± 36.8 (p < 0.001) for expiratory pressure. Conclusions: The pulmonary and functional rehabilitation program provided an improvement in the functional capacity, pulmonary function and respiratory muscle strength in post-COVID-19 patients, restoring their quality of life. Full article

This study was conducted in order to assess the chemistry (41 metalloids and heavy metals and 16 physico-chemical indicators) of groundwater sampled from the protected area of the Tisa River Basin during the months of 2021. Pollution indices were used in order to determine the potential metal pollution level. Consequently, a non-carcinogenic risk assessment of metal through the ingestion of water was done. The results indicated general contamination with ammonium, chloride, iron, and manganese. The samples were rich in Cu, Mg, and Pb, but lower than the maximum limits. Significant correlations were noticed between Al-Fe, Mn-Fe, Mn-Ni, and Cr-Zn, as well as the metal content and pollution index scores. The metal pollution indices indicated three pollution levels (low, medium, and high) based on the metal content and standards regarding the water quality used for drinking purposes. The pollution indices scores ranged from 1.52–41.2. A human health risk assessment indicated no potential non-carcinogenic risk for the studied metals through the consumption of groundwater. The results of three different tools (chronic daily intake, hazard quotient, and hazard index) were below the critical value, except for the aluminium in two samples. This study is one of the first attempts to evaluate the quality of groundwater sources associated with the human health risks of the studied metals from the Tisa River Basin protected area. Based on this research, strategies for managing and controlling the risks can be developed. Full article

Cyanobacteria dominate lakes under diverse trophic conditions. Of these, two harmful filamentous cyanobacterial species, namely Planktothrix agardhii and P. rubescens, occupy completely different ecological niches in which they can form dense populations. In the present study, we investigated the effects of environmental conditions on the growth and vertical distribution of these species in lakes of different trophic statuses. Moreover, we underscored certain inconveniences in the assessment of the ecological status of lakes according to the European Union Water Framework Directive. The highest biomass of P. agardhii was recorded in eutrophic lake at a depth of 0.5–1 m, under high light intensity. Meanwhile, the highest biomass of P. rubescens, at which the deep chlorophyll maximum was recorded, was observed in mesotrophic lakes at a depth of 11–12 m, often below the euphotic zone under very low light intensity. P. rubescens, but not P. agardhii, exerted a strong allelopathic effect on the diversity and biomass of phytoplankton. Moreover, both species utilised different dissolved nitrogen fractions for their growth; specifically, P. agardhii used ammonium nitrogen, whilst P. rubescens used nitrate nitrogen. Furthermore, dissolved phosphorus produced a potentially limiting effect on P. rubescens growth. Overall, the tested Polish PMPL, German PSI, and Estonian phytoplankton indices were indeed useful in the assessment of the ecological status of lakes, albeit limited to the eutrophic lake with a high biomass of cyanobacteria (P. agardhii) in the upper water layers. However, problems arose in the proper assessment of lakes with a high biomass of cyanobacteria (P. rubescens) with a deep chlorophyll maximum outside the range of the euphotic zone. In such cases, two of the tested indices, namely the Polish and German indices, allowed sample collection from the euphotic layers, which significantly affected the number of samples included in the calculation. Consequently, the correct calculation of the ecological status of the lake was uncertain. Only the Estonian index allowed for a sample collection from two to three thermal layers of water, including the bloom layer of P. rubescens. Hence, the Estonian index offered the best fit for calculations. Full article