International Journal of Environmental Research and Public Health

The description of Medical Student Syndrome is based on the assumption that inexperienced medical students are prone to develop a pathological fear of medical conditions they are taught about. The aim of this study is to examine the sample of students (medical and non-medical) in order to assess and compare their level of hypochondriacal attitudes and health-related anxiety. We also examined other factors which might have had an influence on hypochondria and nosophobia attitudes among students. Methods: The study was conducted in two groups of students: 313 medical students at the Medical University of Silesia and 293 students at non-medical universities in Katowice, Poland. The study used the medical student syndrome self-explanatory questionnaire constructed for the study, taking into account the specificity of the group and the research problem. The research questionnaire was completed in an online survey by 606 students. Results: The results of the study showed that medical students obtained the same scores on a nosophobic scale as the non-medical students (p = 0.5). The analysis of hypochondriacal behavior showed significantly higher results in the non-medical student group (p = 0.02). In the entire study group, females and participants with mental disorders obtained higher scores in relation to nosophobia. Symptoms of depression and anxiety were more common in the group of medical students. Conclusions: Medical studies are not a risk factor for the occurrence of health anxiety and hypochondrial attitudes. Such factors are female gender and having a mental illness. Full article

Autistic adults have a high prevalence of sleep problems and psychiatric conditions. In the general population sleep problems have been associated with a range of demographic and lifestyle factors. Whether the same factors contribute to different types of disturbed sleep experienced by autistic adults is unknown and served as the main aim of this study. An online survey was conducted with 493 autistic adults. Demographic information (e.g., age, gender), about lifestyle (e.g., napping), and information about comorbid conditions was collected. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and the Epworth Sleepiness Scale (ESS) was used to assess daytime somnolence. Stepwise multiple regression analyses were used to examine predictors of each subscale score on the PSQI, as well as PSQI and ESS total scores. Results indicated that individuals who reported having a diagnosis of anxiety and insomnia were more likely to have poorer sleep quality outcomes overall. Furthermore, individuals who reported habitually napping had higher daytime dysfunction, increased sleep disturbances, and increased daytime sleepiness. These results provide novel insights into the demographic and lifestyle factors that influence sleep quality and daytime somnolence in autistic adults and can be used for targeted sleep interventions. Full article

Early integration of palliative care for terminally ill cancer and non-cancer patients improves quality of life. However, there are sparse data on results of palliative care consultation services (PCCS) between cancer and non-cancer patients. In this 9-year observational study, data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill cancer and non-cancer patients who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in outcomes of PCCS, including duration of PCCS, the awareness of disease of patients and families before and after PCCS, status of PCCS termination, and DNR declaration before and after PCCS among cancer and non-cancer patients throughout study period. In total, 5223 cancer patients and 536 non-cancer patients received PCCS from 2011 to 2019. The number of people who received PCCS increased stably over the decade, both for cancer and non-cancer patients. The average duration of PCCS for cancer and non-cancer patients was 21.4 days and 18.4 days, respectively. Compared with non-cancer patients, cancer patients had longer duration of PCCS, less DNR declaration (82% vs. 98%, respectively), and more transfers to the palliative care unit (17% vs. 11%, respectively), or for palliative home care (12% vs.8%, respectively). Determinants of late referral to PCCS includes age (OR 0.992, 95% CI 0.987–0.996), DNR declaration after PCCS (OR 1.967, 95% CI 1.574–2.458), patients’ awareness after PCCS (OR 0.754, 95% CI 0.635–0.895), and status of PCCS termination. This 9-year observational study showed that the trend of PCCS among cancer and non-cancer patients had changed over the duration of the study, and early integration of PCCS to all patients is essential for both cancer and non-cancer patients. Full article

Background: Sports university students are usually expected to lead an active life and have a lower risk of depression. Therefore, there are few studies on depression and its risk factors among this population. This study aimed to investigate depression and its association with sedentary behavior and physical activity in sports university students. Methods: A cross-sectional survey was conducted among undergraduates majoring in physical education in a sports university in Beijing in March 2021. Students were asked about sociodemographic information, domain-specific sedentary behavior, physical activity, and depression (using a nine-item Patient Health Questionnaire). Chi-squared test and logistic regression were carried out to analyze the data. Results: Among a total of 584 participants, the detection rate of depression was 49.1%. The median of total sedentary time was 7.29 h per day. After adjusting for covariates, recreational screen time (OR = 1.540, p = 0.035), sedentary time spent completing schoolwork (OR = 0.658, p = 0.038), and participation in vigorous physical activity everyday (OR = 0.415, p = 0.001) and a few times per week (OR = 0.423, p < 0.001) were significantly associated with depression. Conclusions: Sports university students are not immune to depression and inactive lifestyles. Excessive recreational screen time may have an adverse effect on depression, which is somewhat independent of physical activity. Full article

This study aimed to investigate the immediate and short-term impact of the pandemic on the psychological well-being of Italian children and adolescents with psychiatric disorders and their families. Overall, 56 patients aged 6–18 (M = 13.4 years, SD = 2.77) and their parents were evaluated during the COVID-19 lockdown (T0) and after 4 months (T1). An ad hoc data sheet, Youth Self-Report 11–18 (YSR), Child Behavior Checklist 6–18 (CBCL), and Depression Anxiety Stress Scale-21 (DASS-21) were administered. Patients, mainly suffering from internalizing disorders, overall demonstrated a good adaptation to the pandemic context. Moreover, patients with behavioral disorders showed a greater psychological discomfort at both T0 and T1 compared to patients with internalizing disorders. Over time, patients presented an improvement on the emotional side, as proven by a significant decrease in internalizing and post-traumatic stress problems. Finally, no significant differences were found in the emotional-behavioral profile of patients according to the means of conducting neuropsychiatric interventions during the lockdown (i.e., in person/remotely/interrupted), thus allowing us to exclude important negative effects caused by the transition to remote therapy. Concerning parents, an inverse relationship emerged between the DASS-21 scores and the level of resilience, which therefore represents a protective factor against psychological maladjustment. Over time, an improvement in the psychological well-being of parents was observed, as shown by a significant decrease in mothers’ anxiety and fathers’ stress. Full article

Advances in (bio)medicine and technological innovations make it possible to combine high-dimensional, heterogeneous health data to better understand causes of diseases and make them usable for predictive, preventive, and precision medicine. This study aimed to determine views on and expectations of “systems medicine” from the perspective of citizens and patients in six focus group interviews, all transcribed verbatim and content analyzed. A future vision of the use of systems medicine in healthcare served as a stimulus for the discussion. The results show that although certain aspects of systems medicine were seen positive (e.g., use of smart technology, digitalization, and networking in healthcare), the perceived risks dominated. The high degree of technification was perceived as emotionally burdensome (e.g., reduction of people to their data, loss of control, dehumanization). The risk-benefit balance for the use of risk-prediction models for disease events and trajectories was rated as rather negative. There were normative and ethical concerns about unwanted data use, discrimination, and restriction of fundamental rights. These concerns and needs of citizens and patients must be addressed in policy frameworks and health policy implementation strategies to reduce negative emotions and attitudes toward systems medicine and to take advantage of its opportunities. Full article

The sinonasal microbiota in human upper airway may play an important role in chronic rhinosinusitis (CRS). Thus, this study aimed to investigate the human upper airway microbiome in patients with unilateral CRS, and compare the sinonasal microbiome of the unilateral diseased site with that of a contralateral healthy site. Thirty samples, 15 each from the diseased and healthy sites, were collected from the middle meatus and/or anterior ethmoid region of 15 patients with unilateral CRS during endoscopic sinus surgery. DNA extraction and bacterial microbiome analysis via 16S rRNA gene sequencing were then performed. Corynebacterium showed the highest relative abundance, followed by Staphylococcus in samples from both the diseased and healthy sites. Further, the relative abundances of Staphylococcus and Pseudomonas were significantly lower in samples from diseased sites than in those from healthy sites. Conversely, anaerobes, including Fusobacterium, Bacteroides, and Propionibacterium, were abundantly present in samples from both sites, more so in samples from diseased sites. However, the sites showed no significant difference with respect to richness or diversity (p > 0.05). Our results indicate that CRS might be a polymicrobial infection, and also suggest that Corynebacterium and Staphylococcus may exist as commensals on the sinus mucosal surface in the upper respiratory tract. Full article

In 2018, the suicide rate in South Korea was the highest among the Organisation for Economic Co-operation and Development countries, and socioeconomic inequality has intensified. This study analyzes the impact relationship between suicidal impulses and economic inequality in South Korea. This study measures suicidal impulses thoughts National Health Survey Data and economic inequality based on the housing prices gap in the country. The primary analysis results were as follows: First, suicidal impulses were positively associated with the high index of housing price inequality; this correlation has become tight in recent years. Second, it was confirmed that the higher the income level, the higher the correlation between suicidal impulses with the index of housing price inequality. Third, the correlation between housing price inequality with suicidal impulse increased consistently in highly urbanized areas, but the statistical significance was low in non-urban areas. Full article

The distribution of heavy metal pollution in cultivated land is closely related to the quality of the cultivated land. In this study, 533 soil samples were collected from cultivated land in the Yangtze River delta region in China for Cd, Pb, and Hg analyses. Spatial statistical analysis was used to study the heavy metal pollution in the cultivated land, and the driving forces of heavy metal distribution in different cultivated land quality subdivisions were analyzed with GeogDetector. The conclusions are as follows: (1) Among the three heavy metals in the study area, the coefficient of variation of Cd is the largest, and that of Pb is the smallest. The proportion of Cd and Hg exceeding the standard value (the standard of level two in GB 15618—2018) is relatively large, both of which are 5%; (2) From the perspective of the spatial distribution of soil heavy metal pollution, only four counties (CX, HN, WY, and LH) were free of heavy metal pollution. Soil heavy metal pollution in AJ, SY, QJ, and DS counties is relatively serious, and the pollution may come from agricultural activities, manufacturing, and prevalent coastal shipping industries in these counties; (3) The heavy metal pollution levels of cultivated land with different quality levels are different. The high-quality cultivated land has no high contamination, while the medium and the general cultivated land both have high contamination. High contamination is related to Cd for medium and general cultivated lands, and to Hg in only general cultivated land; (4) The main driving factors of heavy metal concentration in cultivated soil were GDP, followed by soil organic matter, and pH. These results indicate that the spatial distribution of heavy metal concentration in cultivated soil was affected by the level of economic development, followed by the ecological environment, indicating that human activities had a critical impact on the ecological environment of cultivated land. Full article

This paper examines the impact of retirement on people’s subjective quality of life, as expressed by their levels of happiness and loneliness, in Poland. We analysed five waves of the Social Diagnosis panel survey conducted between 2007 and 2015. To account for unobserved individual heterogeneity, we employed fixed effects ordered logit models and fixed effect logistic models for the panel data. We found that the respondents’ happiness levels did not change after they retired, and that the introduction of interactions between retirement and employment did not alter these findings. However, the results of the loneliness model showed that the probability of being lonely increased among males after retirement. Second, the outcomes of interactions between retirement and employment suggested that not working after retirement increased the likelihood of being lonely among men, whereas engaging in bridge employment decreased the chances of being lonely among men. These findings may indicate that combining retirement with employment may be a source of social interaction, which can provide protection against loneliness, and which may, in turn, be positively related to other factors (i.e., subjective quality of life, health status, and mortality). Full article

Amino acids are now recognised as having multiple cellular functions in addition to their traditional role as constituents of proteins. This is well-illustrated in the early mammalian embryo where amino acids are now known to be involved in intermediary metabolism, as energy substrates, in signal transduction, osmoregulation and as intermediaries in numerous pathways which involve nitrogen metabolism, e.g., the biosynthesis of purines, pyrimidines, creatine and glutathione. The amino acid derivative S-adenosylmethionine has emerged as a universal methylating agent with a fundamental role in epigenetic regulation. Amino acids are now added routinely to preimplantation embryo culture media. This review examines the routes by which amino acids are supplied to the early embryo, focusing on the role of the oviduct epithelium, followed by an outline of their general fate and function within the embryo. Functions specific to individual amino acids are then considered. The importance of amino acids during the preimplantation period for maternal health and that of the conceptus long term, which has come from the developmental origins of health and disease concept of David Barker, is discussed and the review concludes by considering the potential utility of amino acid profiles as diagnostic of embryo health. Full article

Background: Machine translation (MT) technologies have increasing applications in healthcare. Despite their convenience, cost-effectiveness, and constantly improved accuracy, research shows that the use of MT tools in medical or healthcare settings poses risks to vulnerable populations. Objectives: We aimed to develop machine learning classifiers (MNB and RVM) to forecast nuanced yet significant MT errors of clinical symptoms in Chinese neural MT outputs. Methods: We screened human translations of MSD Manuals for information on self-diagnosis of infectious diseases and produced their matching neural MT outputs for subsequent pairwise quality assessment by trained bilingual health researchers. Different feature optimisation and normalisation techniques were used to identify the best feature set. Results: The RVM classifier using optimised, normalised (L₂ normalisation) semantic features achieved the highest sensitivity, specificity, AUC, and accuracy. MNB achieved similar high performance using the same optimised semantic feature set. The best probability threshold of the best performing RVM classifier was found at 0.6, with a very high positive likelihood ratio (LR+) of 27.82 (95% CI: 3.99, 193.76), and a low negative likelihood ratio (LR−) of 0.19 (95% CI: 0.08, 046), suggesting the high diagnostic utility of our model to predict the probabilities of erroneous MT of disease symptoms to help reverse potential inaccurate self-diagnosis of diseases among vulnerable people without adequate medical knowledge or an ability to ascertain the reliability of MT outputs. Conclusion: Our study demonstrated the viability, flexibility, and efficiency of introducing machine learning models to help promote risk-aware use of MT technologies to achieve optimal, safer digital health outcomes for vulnerable people. Full article

The ‘Planning Health in School’ programme (PHS-pro) is a behavioural change intervention to assess and improve the eating habits of children, particularly the intake of fruit and vegetables, and to guide them towards healthy choices. The programme and its educational components are based on the Transtheoretical Model of stages of change to integrate nutritional literacy and build up problem-solving and decision-making skills. Children (n = 240, ages 10–12) of one large suburban school in Porto’s metropolitan area (Portugal) were evaluated throughout PHS-pro implementation during one school year in a repeated time–series design. Children’s outcome evaluations were conducted through seven 3-day food records for nine eating behaviour, documented after each learning module and through participatory activities which analysed attitudes, preferences and expectations. Changes were observed in children’s eating behaviour, supported by changes in motivation as perceived in their attitudes and expectations. Significant changes were found in a higher consumption of vegetable soup (p = 0.003), milk products (p = 0.024), and fruit (p = 0.008), while the consumption of high-energy dense food (p = 0.048) and soft drinks (p = 0.042) significantly decreased. No positive effects on fried food, water, vegetables and bread consumption were found. The PHS-pro intervention proved to be effective in developing healthy eating behaviour in young people. Full article

Physical education (PE) is acknowledged as a relevant context for holistic child and youth development promotion. However, interventional research mostly builds on individual theories focused on specific outcome domains. This study presents a multisport enriched PE intervention that capitalizes on the intersection of different theory-based approaches to motor, cognitive and socio-emotional skills development promotion. With a cross-over design, 181 fifth graders, coming from a past class-randomized trial of enriched or traditional PE in their 1st–3rd grade, were stratified (based on their previous PE experience) and class-randomized to multisport enriched PE or control group. They completed pre-post assessments in motor and sport skills, cool (inhibition, working memory) and hot (decision making) executive functions, prosocial (empathy, cooperation) and antisocial (quick-temperedness, disruptiveness) behaviors. Children in the enriched PE group showed advantages in motor and prosocial skills after the intervention, which were linked by a mediation path, and an interactive effect of past and actual PE experience on decision making but no differential effects on other variables. The results suggest that a PE intervention designed with an integrative theory base, although not allowing disentangling the contribution of individual components to its efficacy, may help pursue benefits in motor and non-motor domains relevant to whole-child development. Full article

When a study population is relatively healthy, such as an occupational population, epidemiological studies are likely to underestimate risk. We used a case study on the cancer risk of workers with exposure to acid mists, a well-documented carcinogen, to demonstrate that using proportional mortality ratios (PMRs) is more appropriate than mortality ratios in assessing risk in terms of mortality. The study included 10,229 employees of a telecommunication company who worked in buildings with battery rooms. In these buildings, the battery rooms had the highest levels of sulfuric acid in the air (geometric mean = 10.7 μg/m³). With the general population in Taiwan as a reference, a decreased standardized mortality ratio (0.42, p < 0.01) from all causes combined, between 1 January 1985 and 31 December 1996, was observed, indicating a healthy worker effect. When we reanalyzed the data using standardized PMR, elevated risks were observed for all cancers combined (1.46, p = 0.01) and cancers of the digestive organs and peritoneum (1.61, p = 0.02), especially stomach cancer (2.94, p = 0.01). The results showed that PMR can detect increases in mortality when a study population is generally healthier than the comparison population and call for further studies on the possible carcinogenic effects of low-level acid mist exposures on the stomach. Full article

The main objective of this research work was to explore the healthcare professionals’ perspectives of type 2 diabetes patients’ experiences of self-management of diabetes in the rural area of Pakistan. In this study, we have carried out a methodological approach to use a self-management framework to direct the interview guide for healthcare professionals to examine their perceptions and expectations of their diabetes patients’ adherence to the medications prescribed. Twenty healthcare professionals were recruited in this study consisting of ten general practitioners and ten nurses from various clinics (medical centres) of Al-Rehman Hospital at Abbottabad, Pakistan. This qualitative study explored the feelings and opinions of general practitioners on patients’ compliance and adherence by using the semi-structured interview guide using a methodological framework. All interviews of participants were audiotaped and transcribed for content analysis. Six major themes were identified: patient–doctor relationship; patient’s non-adherence to diet and exercise; conflicts with the patients; low self-efficacy and feeling of “resignation with poor care”; the influence of culture on patients’ self-management activities and lack of support for patients by health care providers, patients, and their families. We have derived relevant solutions from qualitative studies and considered that communication, tailored, and shared care is the best approach for patient adherence to treatment. GPs felt that a structured consultation and follow-up in a multidisciplinary team might help to increase adherence. The results of this qualitative health research highlighted the challenges healthcare professionals are facing in rural Pakistan in managing patients with type 2 diabetes and supporting their management activities. Healthcare professionals and patients may benefit by adopting a methodological framework approach to ensure meaningful participation and adjusting the patient–doctor relationship, and setting up achievable management and self-management goals. Full article

To address existing gaps in public health practice, we used data from a 2014 internet panel survey of 954 Los Angeles County adults to investigate the relationships between psychosocial community characteristics (PCCs) and two key chronic disease-related dietary behaviors: fruit and vegetable (F+V) and soda consumption. Negative binomial regression models estimated the associations between ‘neighborhood risks and resources’ and ‘sense of community’ factors for each dietary outcome of interest. While high perceived neighborhood violence (p < 0.001) and perceived community-level collective efficacy (p < 0.001) were associated with higher F+V consumption, no PCCs were directly associated with soda consumption overall. However, moderation analyses by race/ethnicity showed a more varied pattern. High perceived violence was associated with lower F+V consumption among White and Asian/Native Hawaiian/Other Pacific Islander (ANHOPI) groups (p < 0.01). Inadequate park access and walking as the primary mode of transportation to the grocery store were associated with higher soda consumption among the ANHOPI group only (p < 0.05). Study findings suggest that current and future chronic disease prevention efforts should consider how social and psychological dynamics of communities influence dietary behaviors, especially among racially/ethnically diverse groups in urban settings. Intervention design and implementation planning could benefit from and be optimized based on these considerations. Full article

Heavy metal pollution of soil, particularly by mercury (Hg), is a problem that can seriously affect the environment and human health. For this reason, it is necessary to take steps to remediate these environments, prevent potential adverse effects, and restore these areas for subsequent use in agriculture, industry, ranching, and forestry. The present study has selected 40 bacterial strains from rhizosphere and bulk soil that grow naturally in high Hg-contaminated soils from the Almadén mining district in Ciudad Real, Spain. With the objective of evaluating the potential use of these strains in phyto-rhizoremediation, an evaluation and statistical analysis of their PGPR (Plant-Growth-Promoting Rhizobacteria) activity at different levels of Hg was carried out as the first condition of selection for their potential use in bioremediation. In addition, a Hg MBC (Maximum Bactericidal Concentration) was performed with the aim of selecting the strains with high Hg tolerance. Finally, strains with potential biotechnological use have been proposed according to the Bio-Mercury Remediation Suitability Index (BMRSI) criteria, which consider indole-3-acetic acid (IAA) production, acid 1- aminocyclopropane-1-carboxylic deaminase (ACCd) activity, phosphates solubilization, and siderophore production measured in the presence of Hg, as well as its MBC to Hg. The strains selected for further in vivo and in situ processes must reach at least an MBC (Hg) > 100 μg/mL and BMRSI ≥ 6.5. Full article

The rapid transmission of highly contagious infectious diseases within communities can yield potential hotspots or clusters across geographies. For COVID-19, the impact of population density on transmission models demonstrates mixed findings. This study aims to determine the correlations between population density, clusters, and COVID-19 incidence across districts and regions in Malaysia. This countrywide ecological study was conducted between 22 January 2021 and 4 February 2021 involving 51,476 active COVID-19 cases during Malaysia’s third wave of the pandemic, prior to the reimplementation of lockdowns. Population data from multiple sources was aggregated and spatial analytics were performed to visualize distributional choropleths of COVID-19 cases in relation to population density. Hierarchical cluster analysis was used to synthesize dendrograms to demarcate potential clusters against population density. Region-wise correlations and simple linear regression models were deduced to observe the strength of the correlations and the propagation effects of COVID-19 infections relative to population density. Distributional heats in choropleths and cluster analysis showed that districts with a high number of inhabitants and a high population density had a greater number of cases in proportion to the population in that area. The Central region had the strongest correlation between COVID-19 cases and population density (r = 0.912; 95% CI 0.911, 0.913; p < 0.001). The propagation effect and the spread of disease was greater in urbanized districts or cities. Population density is an important factor for the spread of COVID-19 in Malaysia. Full article