International Journal of Environmental Research and Public Health

Oral health surveys are essential for assessing the dental caries experience and to influence national policies. This retrospective cross-sectional study aims to analyze dental caries experience for which dental treatment was sought in a reference university dental hospital at the Lisbon Metropolitan Area between January 2016 and March 2020. Full-mouth examination, and sociodemographic, behavior, and medical information were included. Descriptive analyses and logistic regression analysis were applied to ascertain risk indicators associated with dental caries experience. A final sample of 9349 participants (5592 females/3757 males) were included, aged 18 to 99 years old. In this population, caries experience was 91.1%, higher in female participants. Age (OR = 1.01, 95% CI [1.00–1.02], occupation (OR = 2.94, 95% CI [2.37–3.65], OR = 3.35, 95% CI [2.40–4.67], OR = 2.55, 95% CI [1.66–3.91], for employed, unemployed, and retired, respectively), overweight (OR = 1.52, 95% CI [1.18–1.96]), reporting to have never visited a dentist (OR = 0.38, 95% CI [0.23–0.64], and self-reported week teeth status (OR = 2.14, 95% CI [1.40–3.28]) were identified as risk indicators for the presence of dental caries, according to adjusted multivariable logistic analyses. These results highlight a substantial rate of dental experience in a Portuguese cohort and will pave the way for future tailored oral public health programs in Portugal. Full article

Environmental and occupational exposure to toxic metals has led many people around the world to have serious health problems. Mining activities contribute to an increased risk of exposure to these elements. In this work, a study of environmental biomonitoring and routes of exposure to toxic metals in a region of artisanal mining was performed. This study was carried out in the district of Taquaral de Minas, located in the Jequitinhonha Valley in the state of Minas Gerais. The valley is one of the wealthiest and highest gem-producing areas in Brazil. Five artisanal mines were sampled (Bode, Pirineu, Pinheira, Lajedo, and Marmita). Several potentially toxic metals (Be, Zn, Mn, Ba Cd, Hg, and U) were investigated in the soils and dust over the rocks and the soils. Samples from 22 individuals occupationally exposed and 17 unexposed persons, who formed the reference group, were analyzed for trace elements by an inductively coupled plasma mass spectrometer. The genotoxicity was evaluated by the micronucleus test in buccal mucosa epithelial cells, where the following changes were scored: micronuclei (MN) binucleate (BN) cells and kariolytic (KL) cells. The MN test showed significantly increased frequencies in all alterations of exposed individuals compared to the controls (p < 0.05, Student’s t-test). The urine analysis showed levels of Cr, Ni Ba, Pb, and As in the blood, which were higher than the ATSDR recommended levels. The association between the MN test and the trace element concentrations found in the blood and urine was significant (p < 0.05). The higher the number of years of working, the higher the concentrations in the blood were, due to chronic exposure. The results of the present study indicate environmental contamination and a potential risk to the health of miners, suggesting an intervention. Full article

Ship emissions contribute substantial air pollutants when at berth. However, the complexity and diversity of the marine fuels utilized hinder our understanding and mapping of the characteristics of ship emissions. Herein, we applied GC × GC-MS to analyze the components of marine fuel oils. Owing to the high separation capacity of GC × GC-MS, 11 classes of organic compounds, including b-alkanes, alkenes, and cyclo-alkanes, which can hardly be resolved by traditional one-dimensional GC-MS, were detected. Significant differences are observed between light (-10# and 0#) and heavy (120# and 180#) fuels. Notably, -10# and 0# diesel fuels are more abundant in b-alkanes (44~49%), while in 120# and 180#, heavy fuels b-alkanes only account for 8%. Significant enhancement of naphthalene proportions is observed in heavy fuels (20%) compared to diesel fuels (2~3%). Hopanes are detected in all marine fuels and are especially abundant in heavy marine fuels. The volatility bins, one-dimensional volatility-based set (VBS), and two-dimensional VBS (volatility-polarity distributions) of marine fuel oils are investigated. Although IVOCs still take dominance (62–66%), the proportion of SVOCs in heavy marine fuels is largely enhanced, accounting for ~30% compared to 6~12% in diesel fuels. Furthermore, the SVOC/IVOC ratio could be applied to distinguish light and heavy marine fuel oils. The SVOC/IVOC ratios for -10# diesel fuel, 0# diesel fuel, 120# heavy marine fuel, and 180# heavy marine fuel are 0.085 ± 0.046, 0.168 ± 0.159, 0.504, and 0.439 ± 0.021, respectively. Our work provides detailed information on marine fuel compositions and could be further implemented in estimating organic emissions and secondary organic aerosol (SOA) formation from marine fuel storage and evaporation processes. Full article

Street trees are crucial for air pollutant reduction in urban areas. Herein, we used computational fluid dynamics (CFD) simulation to identify changes in airborne particulate matter (PM_2.5) concentration based on wind characteristics (direction and velocity) and the green network of street trees. The green network was assessed based on composition of the green area of street trees in the central reserve area and between the motor and pedestrian roads. The PM_2.5 concentration varied according to the presence or absence of major reserve planting and the planting structure of the street trees, but not according to the wind direction or velocity. The concentration was lower when the wind direction was 45° (than when the wind direction was 0°), whereas it showed a more significant decrease as the wind velocity increased. Despite variation at each measurement site, the PM_2.5 reduction was generally higher when the central reserve and street trees had a multi-planting structure. Hence, to ensure an effective reduction in the PM_2.5 concentration on motor roads and reduce its negative impact on pedestrians, both arbors and shrubs should be planted in the central reserve area. The study results will serve as reference for managing the green area network and linear green infrastructure in terms of improving the atmospheric environment. Full article

Background: Several environmental factors seem to be involved in childhood leukaemia incidence. Traffic exposure could increase the risk while urban green spaces (UGS) exposure could reduce it. However, there is no evidence how these two factors interact on this infant pathology. Objectives: to evaluate how residential proximity to UGS could be an environmental protective factor against traffic exposure on childhood leukaemia incidence. Methods: A population-based case control study was conducted across thirty Spanish regions during the period 2000–2018. It included 2526 incident cases and 15,156, individually matched by sex, year-of-birth, and place-of-residence. Using the geographical coordinates of the participants’ home residences, a 500 m proxy for exposure to UGS was built. Annual average daily traffic (AADT) was estimated for all types of roads 100 m near the children’s residence. Odds ratios (ORs) and 95% confidence intervals (95% CIs), UGS, traffic exposure, and their possible interactions were calculated for overall childhood leukaemia, and the acute lymphoblastic (ALL) and acute myeloblastic leukaemia (AML) subtypes, with adjustment for socio-demographic covariates. Results: We found an increment of childhood leukaemia incidence related to traffic exposure, for every 100 AADT increase the incidence raised 1.1% (95% CI: 0.58–1.61%). UGS exposure showed an incidence reduction for the highest exposure level, Q5 (OR = 0.63; 95% CI = 0.54–0.72). Regression models with both traffic exposure and UGS exposure variables showed similar results but the interaction was not significant. Conclusions: Despite their opposite effects on childhood leukaemia incidence individually, our results do not suggest a possible interaction between both exposures. This is the first study about the interaction of these two environmental factors; consequently, it is necessary to continue taking into account more individualized data and other possible environmental risk factors involved. Full article

Increasing cultural and linguistic diversities of populations have created a challenge for medical educators to provide authentic learning experiences fostering cross-cultural understanding and interprofessional attitudes of students. Simulations with actors portraying patients (commonly referred to as simulated patients) are effective learning modalities to teach students to provide culturally competent care and influence the quality of patient-centered care. The aim of this systematic review was to identify and synthesize available evidence on the use of simulations with simulated patients as a learning intervention to teach cultural competence to the students of healthcare professions. The PubMed, Medline Complete, and CINAHL databases were searched for articles, which resulted in 27 papers being included in the review. Results revealed that engaging students in cross-cultural interactions with patients increases their level of cultural competence, confidence, and learning satisfaction, and therefore, simulations with simulated patients can serve as a powerful reinforcement of cross-cultural education. Full article

Previous research has already shown the negative impact of the COVID-19 pandemic on college students’ well-being and mental health. Eating problems and weight gain due to changes in eating habits and physical activity experienced during this period have also been noticed. However, few studies have explored the role of students’ resources as used during the COVID-19 pandemic, such as coping strategies. This study aimed to (1) explore the associations among psychological distress, disordered eating, coping strategies, and weight changes; (2) examine the moderating role of coping strategies in the process of weight gain and weight loss; and (3) study the mediating role of coping strategies in the process of weight gain and weight loss. The participants in this study were 772 students at a Portuguese university. The data collected included sociodemographic data and three self-reported questionnaires (Depression, Anxiety, and Stress Scale; Eating Disorder Examination Questionnaire; Brief COPE) during the first few months of the pandemic, which included a 72-day full national lockdown. The results showed that depression, anxiety, stress, and disordered eating were related to increased weight. Guilt, denial, self-distraction, use of substances, and behavior disinvestment were also related to increased weight. Behavioral disinvestment had a strong mediating effect on weight gain. Additionally, planning, positive reframing, and acceptance all showed a moderating effect between psychological distress and weight changes. In conclusion, coping strategies allow for a better understanding of the mechanisms by which psychological distress and disordered eating were related to weight changes during the pandemic. Full article

Food safety has always been a public health challenge. Globally, food safety control is supported by laws and preventive measures, such as inspections conducted from primary production to market, “from farm to fork” as emphasized by the European Union and training of Food Handlers (FHs). This latter preventive measure plays a very important role, and for this reason a review of training courses regulations provided in the different Italian regions was conducted. Analysis of the results shows that the Italian regions approach this issue in different ways: some regions provide only general guidelines, while others offer detailed instructions. The most significant differences concern the topics dealt with, the stakeholders, the staff training and the verification of results; topics such as allergens and gluten are often absent. More detailed guidelines tailored to fit the local scenario could provide better support to FHs, thus leading to real changes in their behaviors and mindsets and promoting the development of an actual “prevention culture”. Full article

Bipolar disorder is associated with suicidal behavior. The risk of suicide for individuals with bipolar disorder is up to 20–30 times larger than that of the general population. Considerable evidence suggests that testosterone may play a role in the pathophysiology of suicidal behavior in both men and women with bipolar disorder and other psychiatric conditions. Testosterone has complex effects on psychological traits. It affects mood and behavior, including interactions with other people. Testosterone regulates pro-active and re-active aspects of aggression. Probably, both high and low levels of testosterone may contribute to the neurobiology of suicide in various patient populations. The effects of endogenous and exogenous testosterone on suicidality in patients with bipolar disorder need further investigation. The aim of this commentary article is to provide a commentary on the author’s work on the topic, summarize the literature on testosterone, bipolar disorder, and suicide, and encourage future research on this poorly studied topic. Full article

The COVID-19 pandemic affects women’s mental health, because they are more predisposed to vulnerabilities and adverse impacts. Therefore, is important to find strategies for preventing and treating these mental health consequences in the female population. The main purposes of our study were to determine the level of social support received by peri- and postmenopausal women during the SARS-CoV-2 pandemic, as well as factors related to this level with reference to health status and sociodemographic variables. A total of 218 women in peri- and postmenopausal status participated in the study. The study assessed depression (Beck Depression Inventory), anxiety (the Spielberg State-Trait Anxiety Scale), climacteric symptoms (the Blatt–Kupperman Index), social support (the Inventory of Social Supportive Behaviors). The majority of the respondents had a moderate level of anxiety as a state (40.8%), a low level of anxiety as a trait (51.4%), no depressive symptoms (75.2%) and no climacteric symptoms (52.3%). Age was found to significantly correlate with anxiety as a state (p = 0.036). The anxiety as state was significantly stronger in people with higher education than in people with secondary education (p = 0.019). Professionally inactive women had more emotional (p = 0.05) and appraisal (p = 0.014) support than women who work. The analysis demonstrated no statistically significant correlation between social support and depression, anxiety or climacteric symptoms (p > 0.05). The majority of peri- and postmenopausal women had no depressive symptoms and/or anxiety symptoms. Professionally inactive women had more emotional and appraisal support than women who work. The analysis demonstrated no statistically significant correlation between social support and depression, anxiety or climacteric symptoms. Full article

Rural veterans have poorer health, use healthcare services less often than their urban counterparts, and have more prevalent food insecurity than average U.S. households. Food insecurity and resource use may be influenced by modifiable psychological attributes such as grit and help-seeking behaviors, which may be improved through interventions. Grit and help-seeking have not been previously evaluated among rural veterans. Thus, this cross-sectional study evaluated the hypothesis that grit and help-seeking were associated with food insecurity and the use of resources. Food security, resource use, grit, and help-seeking behavior were assessed among rural veterans (≥18 years) from five food pantries in southern Illinois counties (n = 177) from March 2021 to November 2021. Adjusted multiple regression was used to estimate the relationship between the odds of food insecurity and the use of resources with grit and help-seeking scores. Higher grit scores were significantly associated with lower odds of food insecurity (OR = 0.5, p = 0.009). No other associations were detected. The results provided evidence to inform the content of future educational interventions to improve food insecurity and address health disparities among rural veterans by addressing grit. The enhancement of psychological traits such as grit is related to food security and has the potential to benefit other aspects of well-being. Full article

There is a growing number of children affected by HIV in Africa. Research on HIV-exposed uninfected children (HEU) is also growing. This systematic review focuses on the psychological well-being of HEU and its association with school intervention, outcomes, and enrollment in the African context, which is where the rate of HIV reaches its highest levels. Research on public databases was conducted according to PRISMA standards. Only studies on HEU primary school children in Africa, both quantitative and qualitative, were included. Out of 1510 papers retrieved, 50 met the inclusion criteria. These studies demonstrate that HEU children are more likely to perform worse in school compared to their counterparts who were not exposed to HIV and to show poorer concentration in the classroom. Children with parents suffering from AIDS are worried for them and have to take household responsibility, resulting in school dropouts, juvenile work, and risky behaviors. Few interventions have been conducted in the school environment with some of them being successful; therefore, future research should involve schools to create an inclusive environment where HEU children could enhance their potential and improve their psychological health. Full article

The COVID-19 pandemic has had a negative impact on the mental health of the population such as increased levels of anxiety, psychological distress, isolation, etc. Access to mental health services has been limited due to the “overflow” of demands. The Recovery College (RC) model, an education-based approach, has addressed this challenge and provided online well-being and mental health courses to at-risk populations. The RC model proposes a co-learning space in an adult education program where learners from diverse backgrounds collectively learn and empower themselves to better address psychological well-being and mental health issues. The aim of this study was to document the experience of learners who participated in online RC courses during the COVID-19 pandemic and the perceived impact of these courses on their mental health. A qualitative interpretative descriptive study design was employed, and Miles and Huberman’s stepwise content analysis method was used to mine the data for themes. Fourteen structured online interviews were conducted with a sample representative of the diversity of learners. Five categories of themes emerged: (1) updating and validating your mental health knowledge, (2) taking care of yourself and your mental health, (3) improving and modifying your behaviors and practices, (4) changing how you look at yourself and others, and (5) interacting and connecting with others. Results suggest that online RC courses can be an effective strategy for supporting individual self-regulation and empowerment, breaking social isolation, and reducing the effects of stress in times of social confinement measures and limited access to care. Full article

People with autism spectrum disorder (ASD) present several different characteristics that predispose them to greater difficulties with intimate emotional and sexual relationships. This qualitative study uncovers the perspective of education and healthcare professionals on the affective and sexual needs of young people with ASD by analysing their narratives in semi-structured focus group sessions. Professionals highlight the inadequate training they receive in this aspect of health. They consider it should be commonplace for professionals working with autistic people as it would aid their collaborative efforts when treating children and adolescents with ASD. They show that, by working together with the families to establish joint objectives, these professionals can appropriately address sex and affective education, preventing risky behaviours among young people with ASD, and improving the interactions these individuals have with others. Sex and affective education is described as an indispensable tool at this stage of development and should be specially adapted for those with ASD. Full article

Occupational exposure assessment is important in preventing occupational coal worker’s diseases. Methods have been proposed to assess compliance with exposure limits which aim to protect workers from developing diseases. A Bayesian framework with informative prior distribution obtained from historical or expert judgements has been highly recommended for compliance testing. The compliance testing is assessed against the occupational exposure limits (OEL) and categorization of the exposure, ranging from very highly controlled to very poorly controlled exposure groups. This study used a Bayesian framework from historical and expert elicitation data to compare the posterior probabilities of the 95th percentile (P95) of the coal dust exposures to improve compliance assessment and decision-making. A total of 10 job titles were included in this study. Bayesian framework with Markov chain Monte Carlo (MCMC) simulation was used to draw a full posterior probability of finding a job title to an exposure category. A modified IDEA (“Investigate”, “Discuss”, “Estimate”, and “Aggregate”) technique was used to conduct expert elicitation. The experts were asked to give their subjective probabilities of finding coal dust exposure of a job title in each of the exposure categories. Sensitivity analysis was done for parameter space to check for misclassification of exposures. There were more than 98% probabilities of the P95 exposure being found in the poorly controlled exposure group when using expert judgments. Historical data and non-informative prior tend to show a lower probability of finding the P95 in higher exposure categories in some titles unlike expert judgments. Expert judgements tend to show some similarity in findings with historical data. We recommend the use of expert judgements in occupational risk assessment as prior information before a decision is made on current exposure when historical data are unavailable or scarce. Full article

The positive effects of e-bikes on physical activity, health, and the environment have been confirmed in many studies. Their choice, as well as of cycling in general, was previously considered from, among others, the socio-psychological aspect (often by use of the theory of planned behavior (TPB)) or the financial aspect (in the context of financial incentives). In addition, the question of physical activity can be especially relevant for the student population, since their level of physical activity usually declines. Starting from the previous framework, the aim of this research was to consider the intention to use e-bikes by the student population in the context of their attitudes, subjective norms, perceived behavioral control, and financial incentives. It is, according to the authors’ knowledge, the first research that combines all those variables when studying e-bikes. The research was conducted in 2022 on a convenience sample of 332 students from the University of Novi Sad (Republic of Serbia). The results show that the strongest predictor of the intention to use e-bikes can be attributed to financial incentives, followed by attitudes and subjective norms, while perceived behavioral control is not significant. Besides considerations in the context of previous research, additional recommendations for increasing e-bikes’ use were provided. Full article

Uncontrolled external bleeding is a common cause of preventable death, and due to the environment in which these events often occur, e.g., in hostile environments, the state security forces are usually the first responders, and in many cases, if they are injured their partners provide the initial assistance. The tourniquet is a fast, effective, and easy-to-learn intervention, although there is a knowledge gap concerning training techniques. The objective is to evaluate the effectiveness of a bleeding control training program on a high-fidelity mannequin in a simulated critical situation in a law enforcement training environment. A quasi-experimental study was carried out with 27 members of the state security forces. They underwent brief theoretical–practical training and were evaluated via a scenario involving a critically ill patient in a hostile environment. The results showed that no member of the state security forces completed all the tourniquet placement steps, 26 (96%) prepared the tourniquet correctly, 21 (77.8%) placed it on the leg, and all the participants adjusted the band to the thickness of the injured limb and secured the windlass to the triangular flange of the device. However, only 23 (85.2%) of the participants placed it effectively. The participants, who were members of the state security forces, were able to effectively resolve a critical situation with active bleeding in a simulation scenario with a high-fidelity mannequin after completing theoretical–practical training. Full article

This study aimed to determine whether prehospital visits to other medical institutions before admission are associated with prolonged hospital stay, readmission, or mortality rates in acute stroke patients. Using the claims data from the Korean Health Insurance Service, a cross-sectional study was conducted on 58,418 newly diagnosed stroke patients aged ≥ 20 years from 1 January 2019 to 31 December 2019. Extended hospital stay (≥7 days; median value) following initial admission, readmission within 180 days after discharge, and all-cause mortality within 30 days were measured as health outcomes using multiple logistic regression analysis after adjusting for age, sex, income, residential area, and medical history. Stroke patients with a prehospital visit (10,992 patients, 18.8%) had a higher risk of long hospitalization (odds ratio = 1.06; 95% confidence interval = 1.02–1.10), readmission (1.19; 1.14–1.25), and mortality (1.23; 1.13–1.33) compared with patients without a prehospital visit. Female patients and those under 65 years of age had increased unfavorable outcomes (p < 0.05). Prehospital visits were associated with unfavorable health outcomes. Full article

Since the outbreak of the COVID-19 pandemic in December 2019 and the associated restrictions, mental health in children and adolescents has been increasingly discussed in the media. Negative impacts of the pandemic, including a sharp increase in psychopathology and, consequently, reduced quality of life, appear to have particularly affected children and young people, who may be especially vulnerable to the adverse effects of isolation. Nevertheless, many children and adolescents have managed to cope well with the restrictions, without deterioration of their mental health. The present study therefore explored the links between COVID-19 infection (in oneself or a family member, as well as the death of a family member due to the virus), protective factors such as self-efficacy, resilience, self-esteem, and health-related quality of life, and measures of psychopathology such as depression scores, internalizing/externalizing problems, emotion dysregulation, and victimization. For this purpose, we examined data from 2129 adolescents (mean age = 12.31, SD = 0.67; 51% male; 6% born outside of Germany) using a structural equation model. We found medium to high loadings of the manifest variables with the latent variables (COVID-19, protective factors, and psychopathology). Protective factors showed a significant negative correlation with psychopathology. However, COVID-19 had a weak connection with psychopathology in our sample. External pandemic-related factors (e.g., restrictions) and their interaction with existing psychopathology or individual protective factors appear to have a greater influence on young people’s mental health than the impact of the virus per se. Sociopolitical efforts should be undertaken to foster prevention and promote individual resilience, especially in adolescence. Full article