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

There is an increasing body of evidence showing the impact of air pollutants on human health such as on the respiratory, and cardio- and cerebrovascular systems. In China, as people begin to pay more attention to air quality, recent research focused on the quantitative assessment of the effects of air pollutants on human health. To assess the health effects of air pollutants and to construct an indicator placing emphasis on health impact, a generalized additive model was selected to assess the health burden caused by air pollution. We obtained Baidu indices (an evaluation indicator launched by Baidu Corporation to reflect the search popularity of keywords from its search engine) to assess daily query frequencies of 25 keywords considered associated with air pollution-related diseases. Moreover, we also calculated the daily concentrations of major air pollutants (including PM₁₀, PM_2.5, SO₂, O₃, NO₂, and CO) and the daily air quality index (AQI) values, and three meteorological factors: daily mean wind level, daily mean air temperature, and daily mean relative humidity. These data cover the area of Beijing from 1 March 2015 to 30 April 2017. Through the analysis, we produced the relative risks (RRs) of the six main air pollutants for respiratory, and cardio- and cerebrovascular diseases. The results showed that O₃ and NO₂ have the highest health impact, followed by PM₁₀ and PM_2.5. The effects of any pollutant on cardiovascular diseases was consistently higher than on respiratory diseases. Furthermore, we evaluated the currently used AQI in China and proposed an RR-based index (health AQI, HAQI) that is intended for better indicating the effects of air pollutants on respiratory, and cardio- and cerebrovascular diseases than AQI. A higher Pearson correlation coefficient between HAQI and RR_Total than that between AQI and RR_Total endorsed our efforts. Full article

Effort to control dengue transmission requires community participation to ensure its sustainability. We carried out a knowledge attitude and practice (KAP) survey of dengue prevention to inform the design of a vector control intervention. A cross-sectional survey was conducted in June–August 2014 among 521 households in two villages of Yogyakarta, Indonesia. Demographic characteristics and KAP questions were asked using a self-managed questionnaire. Knowledge, attitudes and practice scores were summarized for the population according to sex, age, occupation and education. The average knowledge score was rather poor—3.7 out of 8—although both attitude and practice scores were good: 25.5 out of 32 and 9.2 out of 11 respectively. The best knowledge within the different groups were found among women, the age group 30–44 years, people with a university degree and government employees. Best practice scores were found among retired people and housewives. There were several significant gaps in knowledge with respect to basic dengue symptoms, preventive practices and biting and breeding habits of the Aedes mosquito. In contrast, people’s practices were considered good, although many respondents failed to recognize outdoor containers as mosquito breeding sites. Accordingly, we developed a vector control card to support people’s container cleaning practices. The card was assessed for eight consecutive weeks in 2015, with pre-post larvae positive houses and containers as primary outcome measures. The use of control cards reached a low engagement of the community. Despite ongoing campaigns aiming to engage the community in dengue prevention, knowledge levels were meagre and adherence to taught routines poor in many societal groups. To increase motivation levels, bottom-up strategies are needed to involve all community members in dengue control, not only those that already comply with best practices. Full article

A set of exposure–response coefficients between fine particulate matter (PM_2.5) pollution and different health endpoints were determined through the meta-analysis method based on 2254 studies collected from the Web of Science database. With data including remotely-sensed PM_2.5 concentration, demographic data, health data, and survey data, a Poisson regression model was used to assess the health losses and their economic value caused by PM_2.5 pollution in cities of atmospheric pollution transmission channel in the Beijing–Tianjin–Hebei region, China. The results showed the following: (1) Significant exposure–response relationships existed between PM_2.5 pollution and a set of health endpoints, including all-cause death, death from circulatory disease, death from respiratory disease, death from lung cancer, hospitalization for circulatory disease, hospitalization for respiratory disease, and outpatient emergency treatment. Each increase of 10 μg/m³ in PM_2.5 concentration led to an increase of 5.69% (95% CI (confidence interval): 4.12%, 7.85%), 6.88% (95% CI: 4.94%, 9.58%), 4.71% (95% CI: 2.93%, 7.57%), 9.53% (95% CI: 6.84%, 13.28%), 5.33% (95% CI: 3.90%, 7.27%), 5.50% (95% CI: 4.09%, 7.38%), and 6.35% (95% CI: 4.71%, 8.56%) for above-mentioned health endpoints, respectively. (2) PM_2.5 pollution posed a serious threat to residents’ health. In 2016, the number of deaths, hospitalizations, and outpatient emergency visits induced by PM_2.5 pollution in cities of atmospheric pollution transmission channel in the Beijing–Tianjin–Hebei region reached 309,643, 1,867,240, and 47,655,405, respectively, accounting for 28.36%, 27.02% and 30.13% of the total number of deaths, hospitalizations, and outpatient emergency visits, respectively. (3) The economic value of health losses due to PM_2.5 pollution in the study area was approximately $28.1 billion, accounting for 1.52% of the gross domestic product. The economic value of health losses was higher in Beijing, Tianjin, Shijiazhuang, Zhengzhou, Handan, Baoding, and Cangzhou, but lower in Taiyuan, Yangquan, Changzhi, Jincheng, and Hebi. Full article

Environmental noise is an important public health problem, being among the top environmental risks to health. The burden of noise exposure seems to be unequally distributed in societies. Up to now there is fragmentary evidence regarding which social groups are most affected. The aim of this review was to systematically assess published evidence on social inequalities in environmental noise exposure in the WHO European Region, taking different sociodemographic and socioeconomic dimensions as well as subjective and objective measures of environmental noise exposure into account. Articles published in English in a peer reviewed journal between 2010 and 2017 were included in the review. Eight studies were finally included in the review, four of them analysed aggregated data and four analysed individual data. Though results of social inequalities in noise exposures were mixed between and within studies, there was a trend that studies using indicators of material deprivation and deprivation indices showed higher environmental noise exposures in groups with lower socioeconomic position. More research on the social distribution of environmental noise exposure on a small spatial scale is needed, taking into account aspects of vulnerability and procedural justice. Full article

Background: This paper is a summary of the findings from an ethnographic study on child developmental disabilities conducted partly in Nairobi and Kiambu Counties in Kenya. Methods: Quantitative and qualitative data collection methods were applied for the period between mid August and mid November 2018. The study was conducted through the Kenya Institute of Special Education (KISE) situated in Nairobi County. Results: There are parents who are willing to migrate in search of better education and healthcare options for their children who have developmental disabilities (DDs). However, there are also government reforms taking place in the field of disability that may help to support the caregiving role for children with special needs. The challenges, bargaining position and power play between parents or guardians and other actors implicated in the debates on inclusion and integration of persons with developmental disabilities in Kenya has been brought to the forefront. Conclusions: In Kenya, more needs to be done to change the attitude towards disability from the medical and moral (religious/cultural) models to an approach leaning towards the social model, so that developmental disabilities are not viewed negatively. Full article

In recent years, migrant workers, defined as people who move from Chinese rural areas to cities in other parts of the country to find work, have experienced slowed wage growth. An important question that has emerged is whether depressive symptoms have a significant relationship with migrant worker wages. This paper uses a nationally representative panel dataset to examine the overall association of depressive symptoms and migrant worker wages in China and explores the indirect mechanisms through which these impacts occur. Using the Coarsened Exact Matching method, our results show that depressive symptoms have a significant direct negative relationship with migrant worker wages, and that this relationship is consistent. Furthermore, we also find that depressive symptoms can reduce migrant worker wages indirectly by increasing the frequency of job conversion or by shortening work duration. Full article

Videogaming is an increasingly prevalent activity among adolescents worldwide. The present study aimed at adapting the Gaming Motivation Scale (GAMS) to the Italian context, assessing its psychometric properties and verifying its sensitivity to predict depression and anxiety levels. From a sample of 1899 participants, a group of 388 adolescents who participated in the survey was divided into two subgroups of Heavy (HG, N = 188) and Light Gamers (LG, N = 200). A sub-sample of N = 172 adolescents also filled-in CESD and STAI to assess, respectively, depression and trait anxiety. Internal consistency and factorial structure of the Italian version of GAMS (GAMS-it) have been evaluated. Moreover, a latent regression structural equation model by predicting the CES-D and STAI scores with the GAMS-it factors has been carried out. GAMS-it has adequate validity and reliability levels, showing a very similar factorial structure to the original version. Therefore, this scale can be used to evaluate gaming motivation, which is useful for gaming motivation screening. Finally, it has been found that lower gaming motivation can be related to high level of depression and anxiety. The present findings provide a coherent picture, supporting the reliability and validity of the GAMS-it, that appears potentially useful in predicting anxiety and depression levels in a population of adolescents. Full article

Exposure to maternal depressive symptoms in the peri-pregnancy periods may be associated with poorer child development, but research is often limited to only maternal assessments of behavior and cognition. This study investigates the specific periods of prenatal and postnatal exposure to maternal depressive symptoms in association with child development using reports from teachers and mothers. This study is based on 1225 mother–child pairs from Project Viva, a prospective pre-birth cohort study. Mothers reported depressive symptoms on the Edinburgh Postpartum Depression Scale (EPDS) in mid-pregnancy as well as at 6 months and 12 months postpartum. Teachers and mothers reported child executive functions using the Behavioral Rating Inventory of Executive Function (BRIEF) and behavior using the Strengths and Difficulties Questionnaire (SDQ). Children completed the Kaufman Brief Intelligence Test (KBIT-2), the Wide Range Assessment of Visual Motor Abilities (WRAVMA), and the Visual Memory Index of the Wide Range Assessment of Memory and Learning (WRAML). We used multivariable linear regression models to examine associations of prenatal and postpartum depressive symptoms with outcomes. Many of the crude associations observed were attenuated after adjusting for demographic factors and maternal IQ, yet some remained significant. For example, high prenatal maternal depressive symptoms were associated with poorer scores on the BRIEF Behavior Regulation Index and some SDQ scales based on reports from teachers and mothers. High prenatal maternal depressive symptoms were associated with poorer behavioral development. Postpartum symptoms did not show strong associations with outcomes once we adjusted for the prenatal period. Full article

Background: The purpose of our investigation was to analyze the relationship between the serum levels of inflammatory mediators (HETE, HODE) and the levels of selected metabolic and hormonal parameters in patients with benign prostatic hyperplasia (BPH) with regard to concomitant metabolic syndrome (MetS). Methods: The study involved 151 men with BPH. Blood samples were taken for laboratory analysis of the serum levels of metabolic and hormonal parameters. Gas chromatography was performed using an Agilent Technologies 7890A GC System. Results: We found that waist circumference was the only parameter related to the levels of fatty acids, namely: 13(S)-HODE, 9(S)-HODE, 15(S)-HETE, 12(S)-HETE, and 5-HETE. In the patients with BPH and MetS, triglycerides correlated with 9(S)-HODE, 15(S)-HETE, 12(S)-HETE, and 5-HETE, which was not observed in the patients without MetS. Similarly, total cholesterol correlated with 9(S)-HODE, and 15(S)-HETE in the patients with BPH and MetS, but not in those without MetS. In the group of BPH patients with MetS, total testosterone positively correlated with 13(S)-HODE, and free testosterone with 9(S)-HODE. Conclusions: Based on this study, it can be concluded that lipid mediators of inflammation can influence the levels of biochemical and hormonal parameters, depending on the presence of MetS in BPH patients. Full article

This study aimed to develop and validate an instrument to evaluate Brazilian home kitchens’ good practices. We elaborated on the preliminary version of the check-list based on the Brazilian resolution for food safety Collegiate Board Resolution 216 (RDC 216), Collegiate Board Resolution 275 (RDC 275), the standard 22000 from the International Organization for Standardization (ISO 22000) and Codex Alimentarius. Seven experts with experience in the area participated in the check-list validation and semantic evaluation. The criteria used for the approval of the items, as to their importance for the prevention of food contamination and clarity of the wording, was the achievement of a minimum of five out of seven of agreement among the experts (W-values ≥ 0.7). Moreover, items should have a mean ≥3 for the evaluation of importance (content validation) and clarity (semantic evaluation) to be maintained in the instrument. After the expert phase, we conducted another semantic evaluation of the check-list with a focus group composed of 13 undergraduate students, one moderator, and one observer of the process, to evaluate each item regarding its clarity, considering their level of understanding of the item. The final version of the check-list was composed of 77 items, divided into four blocks. The check-list developed was validated with respect to content with a W-value of 0.86 and approved in the semantic evaluation. Full article

The aim of the work is to evaluate the effectiveness of the risk communication strategies in cases of unsafe drinking water supply in Sardinia, the Italian context with the highest population distrust in drinking water safety. During the period 2010–2015, the ordinances published on the institutional websites were analyzed, and the population risk perception was evaluated by applying, for the first time in public health threats, the “OUTRAGE Prediction & Management” software released by Sandman. Overall, 417 ordinances issued by the Sardinian Municipalities were found. Only 1.5% of the ordinances reported information about parameters, concentrations, and risks to health, whereas 4.8% indicated only the parameters and non-standard levels. By contrast, 53.2% specified only the non-standard parameter, and 40.5% indicated a generic non-drinking motivation. The outrage assessment showed values exceeding the threshold of risk acceptance, attributable to the lack and low clarity of the information reported by the ordinances. The present study allowed us to highlight critical issues in risk communication of the quality of drinking water. Full article

Purpose: To examine the effect of acute moderate-intensity continuous exercise performed under normobaric severe hypoxia on cognition, compared to sea-level normoxia. Methods: Thirty healthy inactive women randomly performed two experimental trials separated by at least three days but at approximately the same time of day. Executive functions were measured during the follicular stage via an interference control task before (rest) and during exercise with 45% peak power output under normobaric normoxia (PIO₂ = 150 mmHg, FIO₂ = 0.21), and (2) hypoxia (PIO₂ = 87 mmHg, FIO₂ = 0.12, simulated at an altitude of 4000 m). Reaction time (RT), accuracy rate (AC), heart rate, ratings of perceived exertion, and peripheral oxygen saturation (SpO₂) were collected before and during exercise. Results: RT (p < 0.05, η²_p = 0.203) decreased during moderate exercise when compared at rest, while a short bout of severe hypoxia improved RT (p < 0.05, η²_p = 0.134). Exercise and hypoxia had no effects on AC (p > 0.05). No significant associations were found between the changes of RT and SpO₂ under the conditions of normoxia and hypoxia (p > 0.05). Conclusions: At the same phase of the menstrual cycle, a short bout of severe hypoxia simulated at 4000 m altitude caused no impairment at rest. RT during moderate exercise ameliorated in normoxia and severe hypoxia, suggesting that both exercise and short-term severe hypoxia have benefits on cognitive function in sedentary young women. Full article

This study aimed to compare the screening and diagnosis of maternal syphilis in Shanghai between the national and municipal prevent mother-to-child transmission (PMTCT) of syphilis policies, and then to assess whether PMTCT programs and enhancing healthcare infrastructure could bring about an early detection of maternal syphilis. Detection of maternal syphilis was initiated in 2001 and then scaled-up in 2011 along with the enhancement of antenatal healthcare infrastructure. The initial five-year periods of municipal and national PMTCT policies were defined as the “exploring period” (2002–2006) and the “comprehensive period” (2011–2015). The demographic and gestational weeks (GW) of syphilis screening and diagnosis were analyzed to identify the factors affecting early detection. During the study period, maternal syphilis screening increased from 83,718 in 2002 to 243,432 in 2015. Of the 1,894,062 pregnant women screened, 1526 and 2714 participants were diagnosed with maternal syphilis in 2002–2006 and 2011–2015, respectively. The average age of diagnosis was 28.36 years and non-residents accounted for 71.1%. In the comprehensive period, more women received early syphilis screening (14.0% vs. 10.8%) and diagnosis (13.3% vs. 7.3%) within 12 GWs compared with the exploring period. Significantly, early detection grew during 2011–2015, which was not seen in the exploring period. Multivariate analysis revealed a greater possibility for infected women to be diagnosed within 16 GWs (OR = 2.76) in the comprehensive period, but those who were non-residents and unemployed were less likely to receive early detection. In conclusion, early detection of maternal syphilis has been remarkably improved. More emphasis is required on the development of pro-vulnerable policies and the implementation of tailored health education to improve the accessibility of routine antenatal care and awareness of syphilis prevention. Full article

Evidence suggests that socioeconomically disadvantaged children may experience a greater increase in overweight risk during macroeconomic downturns. We examined whether inequalities in the risk of overweight between Japanese children from single- and two-parent households increased after the 2008 global financial crisis. We used data from ten waves (2001 to 2011) of a nationwide longitudinal survey following all Japanese children born within 2 weeks in 2001 (boys: n = 15,417, girls: n = 14,245). Child overweight was defined according to age- and sex-specific cut-offs for Body Mass Index (BMI). Interaction between a binary measure of crisis onset (September 2008) and single-parent status was assessed using generalized estimating equation models. Covariates included baseline household income and income loss during the crisis. Girls from single-parent households showed a greater increase in the odds of overweight after crisis onset (adjusted odds ratio (AOR), 1.23; 95% confidence interval (CI), 1.04–1.46) compared to girls from households with two parents, regardless of household financial status. A similar though statistically non-significant trend was observed among boys (AOR, 1.10; 95% CI, 0.92–1.30). Child overweight risk by single-parent status may increase during macroeconomic downturns, at least among girls. Financial aid to single-parent households may not suffice to redress this gap. Full article

Older people living in residential aged care facilities tend to be physically as well as socially inactive, which leads to poorer health and reduced wellbeing. A lack of recognition of the importance of social support, limited resources, lack of training and task-oriented work routines leave little time for staff to meet the social needs of residents. Through qualitative ethnographic fieldwork, this study investigates the potential for new technologies to enhance quality of life and facilitate meaningful engagement in physical and social activities among culturally and linguistically diverse residents and staff in care facilities. A continuum from nonparticipation to full participation among residents was observed when Touch Screen Technology activities were implemented. Data indicate that resident’s engagement is impacted by five interdependent factors, including environmental, organisational, caregiver, patient, and management- &government-related. Findings show that new technologies can be used to increase meaningful physical and social engagement, including transcending language and cultural barriers. However, the successful application of new technologies to enhance quality of life is dependent on their integration into the daily routine and social relationships of staff and residents, with the full support of management. Guidelines governing the use of new technologies to support meaningful engagement of older people in residential care are lacking: this project highlights the importance of attention to the social relational dimensions of technology interventions to support best practice in their use. Full article

In order to reduce the noise level of wheel loaders caused by gear pumps and realize environmentally sustainable development, the noise generation mechanism of a gear pump was studied, and the influence of flow pulsation and gear impact on noise was analyzed. In order to reduce the interference of other noise sources on the noise level of the gear pump, a noise test rig was established. The mixed noise signals obtained from the rig test were separated using the ICA model. The ICA model includes the following algorithms: The fast Fourier transform (FFT), independent component analysis (ICA) and inverse fast Fourier transform (IFFT). Some theories about the influence of the teeth number and teeth profile on noise were analyzed by theory and simulation. A noise reduction strategy was proposed by increasing the teeth numbers and modifying the teeth profile of the gear pump. The tests results showed that the noise values of the external and the driver’s ear of the wheel loader were reduced to 1 and 2.2 dB (A), respectively. This proves the effectiveness of the optimization scheme of gear pump noise reduction. Full article

In the WHO European Region the topic of contaminated sites is considered a priority among environment and health themes. Communities living in or close to contaminated sites tend to be characterized by a high prevalence of ethnic minorities and by an unfavorable socioeconomic status so rising issues of environmental justice. A structured review was undertaken to describe the contents of original scientific studies analyzing distributive and procedural justice in industrially contaminated sites carried out in the WHO European Region in the period 2010–2017. A systematic search of the literature was performed. In total, 14 articles were identified. Wherever assessments on environmental inequalities were carried out, an overburden of socioeconomic deprivation or vulnerability, with very few exemptions, was observed. The combined effects of environmental and socioeconomic pressures on health were rarely addressed. Results show that the studies on environmental and health inequalities and mechanisms of their generation in areas affected by industrially contaminated sites in the WHO European Region are in their early stages, with exemption of UK. Future efforts should be directed to improve study strategies with national and local assessments in order to provide evidence for equity-oriented interventions to reduce environmental exposure and related health risks caused by industrial contamination. Full article

:Hawai’i Island often receives extreme (UV Index ≥ 11) solar ultraviolet radiation (UVR). While the UV Index (UVI) has been measured since 1997 at Hawai’i’s high-altitude Mauna Loa Observatory (MLO), measurements where people live and recreate are rare. We measured UVI on the face of a rotating mannequin head with UVR sensors at its eyes, ears and cheeks while simultaneously measuring the UVI with a zenith-facing sensor at MLO and seven sites at or near sea level from 19 July to 14 August 2018. The mannequin sensors received higher UVR at midmorning and midafternoon than at noon. For example, at sea level the peak UVI at the left cheek was 5.2 at midmorning and 2.9 at noon, while the horizontal UVI at noon was 12.7. Our measurements were supplemented with wide-angle (190° and 360°) sky photographs and UV images of the mannequin head. Because the UVI applies to horizontal surfaces, people in tropical and temperate latitudes should be informed that their face may be more vulnerable to UVR at midmorning and midafternoon than at noon. Finally, our instruments provided opportunities to measure unexpected UVR-altering events, including rare biomass smoke over MLO and spectroscopic measurements of substantial UVR-absorbing sulfur dioxide in the eruption plume of the Kilauea volcano. Full article

Flocculation can remove large amounts of nitrogen and phosphorus from wastewater, and the resulting nitrogen- and phosphorus-rich floc can be used to produce organic fertilizer. For biogas slurries containing high levels of nitrogen and phosphorus, ordinary flocculants can no longer meet the flocculation requirements. In this study, to fully utilize the advantages of the two flocculants and achieve efficient removal rates of nitrogen and phosphorus from a biogas slurry, chitosan (CTS) and polyaluminum chloride (PAC) were used as a composite flocculation agent to flocculate pig biogas slurries. The response surface method was used to study the effect of PAC added (PAC_added) to the composite flocculant (CF), composite flocculant added (CF_added) to the biogas slurry and the pH on flocculation performance, and optimize these three parameters. In the tests, when the PAC_added was 6.79 g·100 mL⁻¹_CF, the CF_added was 20.05 mL·L⁻¹ biogas slurry and the pH was 7.50, the flocculation performance was the best, with an absorbance of 0.132 at a wavelength of 420 nm. The total phosphorus (TP) concentration was reduced from 214.10 mg·L⁻¹ to 1.38 mg·L⁻¹ for a removal rate of 99.4%. The total ammonia nitrogen (TAN) concentration was reduced from 1568.25 mg·L⁻¹ to 150.27 mg·L⁻¹ for a removal rate of 90.4%. The results showed that the CF could form larger flocs, and had greater adsorption capacity and more stable flocculation performance than ordinary flocculants. Furthermore, the CF could exhibit better chelation, electrical neutralization and bridge adsorption. Full article