International Journal of Environmental Research and Public Health

This study investigated the association between a healthy lifestyle with all-cause, cause-specific mortality, and cancer incidence among individuals with metabolic syndrome (MetS). Healthy lifestyle scores were created based on MetS management guidelines, including never/quitting smoking, moderate drinking, good sleep, healthy diet, sufficient exercise, social support, and less sedentary behaviour. Weighted healthy lifestyle scores were further constructed and classified into three groups: unfavourable (lowest quintile), intermediate (quintiles 2–4), and favourable (highest quintile) lifestyles. We included 87,342 MetS participants from the UK Biobank. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using multivariate-adjusted Cox proportional hazards regression. During a median follow-up of 12.54 years, 6739 deaths were reported; during a median follow-up of 10.69 years, 10,802 new cancer cases were documented. We found a favourable lifestyle was inversely associated with all-cause mortality (HR: 0.57; 95%CI: 0.53–0.62), cause-specific mortality from respiratory disease, cancer, digestive disease, cardiovascular disease (HR < 1; p-trend < 0.001), and overall cancer incidence (HR: 0.84; 95% CI: 0.79–0.90). Our results indicate that adherence to healthy lifestyles is associated with lower overall cancer incidence and all-cause mortality risk among MetS individuals. However, causality cannot be made due to the nature of observational studies. Full article

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease globally in tandem with the growing obesity epidemic. However, there is a lack of data on the relationship between historical weight changes 10 years ago and at present on NAFLD prevalence at the population level. Therefore, we sought to evaluate the relationship between weight classes and the prevalence of NAFLD. Methods: Data were used from the United States National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Univariate and multivariate general linear model analyses were used to obtain risk ratio (RR) estimations of NAFLD events. Results: In total, 34,486 individuals were analysed, with those who were lean at both time points as the control group. Overweight (RR: 14.73, 95%CI: 11.94 to 18.18, p < 0.01) or obese (RR: 31.51, 95%CI: 25.30 to 39.25, p < 0.01) individuals at both timepoints were more likely to develop NAFLD. Residual risk exists where previously obese individuals became overweight (RR: 14.72, 95%CI: 12.36 to 17.52, p < 0.01) or lean (RR: 2.46, 95%CI: 1.40 to 4.31, p = 0.02), and previously overweight individuals who became lean (RR 2.24, 95%CI 1.42 to 3.54, p = 0.01) had persistent elevated risk of developing NAFLD despite weight regression. Sensitivity analysis identified that a higher proportion of individuals with regression in weight class were diabetics and Mexican Americans, while fewer African Americans saw weight-class regression. Conclusions: Residual risk exists in patients who lost weight despite the smaller magnitude of effect, and targeted weight reductions should still be used to mitigate the risk of NAFLD at the population level. Full article

Introduction: The COVID-19 pandemic has affected the mental health of the population. This study aims to assess the prevalence of subjective depressive and anxiety symptoms as well as assess the quality of life in different waves of the COVID-19 pandemic based on an online survey. Methods: The study was conducted based on an original and anonymous questionnaire, consisting of a section assessing sociodemographic status and psychometric tools: Beck Depression Inventory (BDI), Generalised Anxiety Disorder Assessment (GAD-7) and Manchester Short Assessment of Quality of Life (MANSA). A total of 6739 people participated in the survey, with the largest number from the first wave of the pandemic (2467—36.6%), followed by 1627 (24.1%) for the second wave, 1696 (25.2%) for wave three and 949 (14.1%) for wave four. The mean age of the study group was 28.19 ± 9.94. Results: There was an initial, gradual increase in depressive and anxiety symptoms over the three waves. There were no significant differences in the quality-of-life scores, except for the second and third waves (−0.0846; p = 0.013. It was found that women, residents of big cities and people with psychiatric history showed higher BDI and GAD-7 scores. Conclusions: The impact of the pandemic on mental health was not homogeneous, with the first three waves of the COVID-19 pandemic having more of an impact compared to the fourth wave. Female respondents’ sex, history of mental disease and reduced earning capacity exacerbated psychiatric symptoms. Full article

Plant-based ecological protection is one of the effective methods to improve the stability of slope soils. However, plants need a stable growth environment and water supply. Although it has been demonstrated that polymer materials can effectively enhance the stability and water retention of soils, their improvement mechanism and long-term effects are yet to be clear. In this paper, we use a new polymer composite material (ADNB), an optimized compound of nano-aqueous binder (NAB) and super absorption resin (SAR), to conduct outdoor model tests to study the effects of different ADNB ratios on soil compactness, biochemical properties, and plant growth at longer time scales, and to explore its action law and mechanism of enhancing the ecological self-repairing ability of surface slope soil. The results show that ADNB can effectively improve the soil structure, increase the compactness of the soil, increase the organic matter content, microbial population and available nutrient content in the soil, thus promoting plant growth. The adsorption and agglomeration effect of the NAB in ADNB on soil particles and its degradation in natural environment can be observed by SEM. In summary, ADNB can not only effectively enhance the ecological self-repairing ability of surface slope soil, but also has good environmental friendliness and can be completely degraded under natural conditions without additional adverse effects on soil and environment. Full article

Young carers are children and adolescents who provide care to other family members or friends, taking over responsibilities that are usually associated with adulthood. There is emerging but still scarce knowledge worldwide about the phenomenon of young carers and the impact of a caring role on their health, social and personal development spheres. This paper provides an overview of the main results from the ME-WE project, which is the first European research and innovation project dedicated to adolescent young carers (AYCs) (15–17 years). The project methods relied on three main activities: (1) a systematization of knowledge (by means of a survey to AYCs, country case studies, Delphi study, literature review); (2) the co-design, implementation and evaluation of a primary prevention intervention addressing AYCs’ mental health (by means of Blended Learning Networks and a clinical trial in six European countries); (3) the implementation of knowledge translation actions for dissemination, awareness, advocacy and lobbying (by means of national and international stakeholder networks, as well as traditional and new media). Project results substantially contributed to a better understanding of AYCs’ conditions, needs and preferences, defined tailored support intervention (resilient to COVID-19 related restrictions), and significant improvements in national and European policies for AYCs. Full article

The aim of this study was to cross-culturally adapt and validate the psychosocial impact of dental esthetics questionnaire (PIDAQ) to the Portuguese language. The PIDAQ was culturally translated and adapted according to international guidelines. In this cross-sectional study, we enrolled 501 subjects in a population-based epidemiological survey conducted at the Egas Moniz Dental Clinic (Almada, Portugal) in June 2022. The participants answered the Portuguese version of the PIDAQ (PIDAQ-PT), which was a 23-item scale with four conceptual domains (self-confidence, social impact, psychological impact and esthetic concern factor). Psychometric properties were estimated using content validity, construct validity, internal consistency and test–retest reliability. The PIDAQ-PT presented an intraclass correlation coefficient (ICC) of 0.84, and a 95% confidence interval (0.73–0.90, p < 0.001), with values for the Cronbach’s alpha coefficient of the subconstructs ranging from 0.93 to 0.98. In the confirmatory factor analysis (CFA), the final models presented a good fit, with the comparative fit indices (CFIs) ranging from 0.905 to 0.921 and the root mean squared error of approximation (RMSEA) ranging between 0.088 and 0.090. The PIDAQ-PT was shown to be a valid and reliable tool to assess oral health values in a Portuguese population. Further studies should evaluate the psychometric properties of the oral personal representation on dental specialties and its impact on dental appointments and procedures. Full article

Background: This study aimed to estimate the impact of the COVID-19 lockdown on fitness performance among Chinese college men during the pandemic period and to explore how fitness changed with a different college grade. Methods: We conducted repeated measures of 1000 m running and pull-up testing on students from one university in China before and after the lockdown. A total of 7107 (age 19.21 ± 1.17 yr.) male students who completed the same 1000 m running and pull-up testing in 2019 and 2020 were included in the analysis. Results: The paired t-test result indicates a reduction in 1000 m running and pull-up performance by 10.91% (95% CI = 0.89, 0.95) and 23.89% (95% CI = −0.36, −0.31), respectively. Interestingly, college men in the 2017 grade (the third-year college men) had more decreases than in the 2019 grade (the first-year college men). The 1000 m running performance was decreased by 14.43% and 6.48% in the third- and the first-year college men, respectively. The pull-up performance was decreased by 39.11 % in the third-year college men while increased by 10.98% in the first-year college men. Conclusions: The COVID-19 lockdown reduced 1000 m running and pull-up performances among Chinese college men. The reduction varies by grade and it seems to be particularly seriously decreased for the third-year college men while being modest for the first-year college men. Public policy was urgently needed to improve Chinese college men’s fitness performance after the lockdown. Full article

Environmental governance is related to the healthy living standard of human beings and the sustainable development of an economic society. It is of great significance to explore the influence of government trust and environmental pollution perception on environmental governance satisfaction to improve the performance of government environmental governance. Based on the CSS2019 survey data, 3872 survey samples were statistically analyzed, and the optimal scale regression model was used to analyze the relationship between government trust, environmental pollution perception, and environmental governance satisfaction. The results showed that 52.27% of the respondents believed that the satisfaction of environmental governance was good, and both government trust and environmental pollution perception had significant positive effects on the satisfaction of environmental governance. The trust level of the central government, district and county governments, and township governments shows a “differential government trust” state, which is pyramidal. However, the impact of government trust on environmental governance satisfaction shows an inverted pyramid structure, and the township government has the largest effect, which is not matched with the distribution of government trust level. The influence effect of air pollution perception is relatively large, and the public is sensitive to air pollution. Government trust has an impact on the satisfaction of environmental governance through the “expectation-response” path. People are close to the township government and have the opportunity to contact and interact with the township government and its staff. They can directly observe the governance performance and share the public goods of environmental governance. Therefore, it is necessary to further improve the trust level of township governments, strengthen the control of air pollution and improve the township government's environmental governance ability. Full article

Awareness of indoor air quality (IAQ) in crowded places such as schools and offices has increased since 2020 due to the COVID-19 pandemic. In addition, countries’ shifting away from containment and towards living with COVID-19 is expected to increase demand for risk mitigation via air-purification devices. In this work, we use Computational Fluid Dynamics (CFD) analysis to investigate the impact of adding an air-purification technology on airflow in an enclosed space. We model a Polyester Filter and UV light (PFUV) dehumidifier in an office with two occupants: one infected with an airborne infectious disease, such as COVID-19; and the other uninfected. We compare three cases where the infected occupant coughs: with no device, and with the device at two different orientations. We construct a CFD model using ANSYS^® 2021 Fluent and the Discrete Phase Model (DPM) for the particle treatment. Thermal comfort is assessed using the Testo 400 IAQ and comfort kit. We find that both the device operation and the placement alter the airflow contours, significantly reducing the potential for the uninfected occupant to inhale the vapour expelled by the infected occupant, potentially impacting the likelihood of disease transmission. The device improved thermal comfort measured by Predicted Mean Vote (PMV), Predicted Percentage Dissatisfied (PPD). Full article

This paper analyzes, from a bibliometric viewpoint, those publications that relate COVID-19 and eye indexed in Scopus since the beginning of the pandemic, and it identifies the resulting main research lines. A bibliographic search in the Scopus database was conducted for publications that simultaneously include ocular and visual manifestations and aspects with COVID-19, from 1 January 2020 to 16 March 2021, and the obtained bibliographic information was processed with VOSviewer (v. 1.6.16). A total of 2206 documents were retrieved, and 60% were original articles. The USA published the most studies (24.6%). The retrieved documents had a total of 18,634 citations. The h index of the set of retrieved documents was 58. The Indian Journal of Ophthalmology was the most productive journal, while JAMA Neurology and The Lancet accounted for 20% of citations. Three keyword clusters representing hotspots in this field were identified. Eye-related COVID-19 research is an emerging field with plenty of scientific evidence whose growth is expected to increase as the aspects and manifestations of the disease, its treatment and the effect of vaccination on it become known. Full article

A more scientific green economy efficiency indicator is constructed based on OH (2010), and a multiperiod spatial DID model is used to examine the impact of national credit demonstration policies on urban green economy efficiency in a sample of cities above the prefecture level in the Yangtze River Delta. The study confirms the following: (1) The national credit demonstration policy makes a significant contribution to the green economic efficiency of cities, and it is conducive to strengthening awareness of the rule of law in the market to regulate market order. (2) The demand for credit regulation in coastal areas has increased under the new development pattern, and the national credit demonstration policy has effectively enhanced green economy efficiency through institutional supply. (3) Under the national credit demonstration policy, the subprovincial level and above can mobilise more resources for policy refinement and support, reducing transaction costs and improving the efficiency of the green economy. (4) The impact of the national credit demonstration policy on the efficiency of Zhejiang’s green economy is more obvious; but, under the overall framework of the Yangtze River Delta, the policy has a more prominent role in promoting green economy efficiency in other provinces. Policy insights are as follows: (1) Different cities have different degrees of impact on the efficiency of the green economy from the national credit demonstration policy, and they should implement differentiated measures based on regional heterogeneity; (2) regulating the use of administrative resources and avoiding undue administrative intervention are important prerequisites for promoting regional integration to enhance the efficiency of the green economy; and (3) strengthening interprovincial credit policy synergies can help to alleviate administrative distortions of policy implementation and enhance the efficiency of the regional green economy. Full article

Background: The objective was to analyze the factors that influence reactions to confinement situations, such as personality, humor, coping with stressors, and resilience, and to compare this population with a normal situation of exposure to an intense academic stressor such as a partial test, and with the confinement situation caused by the COVID-19 pandemic. Methods: A longitudinal study was performed involving 116 health sciences students from Spain. Three situations were evaluated: a basal situation of normality at the beginning of the course, situation facing an academic stressor (partial test), and confinement situation due to COVID-19. The Positive and Negative Affect Schedule (PANAS), Coping Orientation to Problems Experienced (COPE), Connor–Davidson Resilience Scale, and NEO-FFI scale were used. Results: Significant differences were observed in the increase in negative humor and decrease in positive one, as well as decrease in “Focus on and Venting of Emotions”. Personality factors that better predict humor at confinement were “conscientiousness” for having positive humor and low “extraversion” for negative humor. Conclusions: The confinement situation due to COVID-19 has caused changes in predominant humor, as well as in coping strategies. Personality factors positively or negatively influence the situation. Full article

Background: Patients who are post-COVID-19 will require more treatment soon. Therefore, it is important to understand the root cause of their psychological and somatic conditions. Previous studies showed contradictory results on the influence of pre-existing mental conditions. The present study examines the influence of these pre-existing conditions and their pre-treatment on the severity of post-COVID-19 symptoms. Methods: This analysis employs questionnaire data from a large study sample in Germany. Overall, 801 participants were included. All participants rated their health status on a scale from 0 to 100. Fatigue, depression, and anxiety were measured using the FAS, PHQ-9, and GAD-7 scales. Results: All pre-pandemic values showed no significant differences between the groups. The current health status was rated similarly by the recovered patients (μ = 80.5 ± 17.0) and the control group (μ = 81.2 ± 18.0) but significantly worse by acutely infected (μ = 59.0 ± 21.5) and post-COVID-19 patients (μ = 54.2 ± 21.1). Fatigue, depression, and anxiety were similar for recovered patients and the control group. By contrast, there were significant differences between the control and the post-COVID-19 groups concerning fatigue (45.9% vs. 93.1%), depression (19.3% vs. 53.8%), and anxiety (19.3% vs. 22.3%). Conclusion: Fatigue and psychological conditions of post-COVID-19 patients are not associated with pre-existing conditions. Full article

Biochar (BC)-supported sulfide-modified nanoscale zerovalent iron (S-nZVI/BC) was prepared using the liquid-phase reduction method for the application of the removal of sulfamethazine (SMZ) from water. The reaction conditions were optimized by the Box–Behnken response surface method (RSM). A model was constructed based on the influence factors of the removal rate, i.e., the carbon-to-iron ratio (C/Fe), iron-sulfur ratio (Fe/S), pH, and hydrogen peroxide (H₂O₂) concentration, and the influence of each factor on the removal efficiency was investigated. The optimal removal process parameters were determined based on theoretical and experimental results. The results showed that the removal efficiency was significantly affected by the C/Fe ratio and pH (p < 0.0001) but relatively weakly affected by the Fe/S ratio (p = 0.0973) and H₂O₂ concentration (p = 0.022). The optimal removal process parameters were as follows: 0.1 mol/L H₂O₂, a pH of 3.18, a C/Fe ratio of 0.411, and a Fe/S ratio of 59.75. The removal rate of SMZ by S-nZVI/BC was 100% under these conditions. Therefore, it is feasible to use the Box–Behnken RSM to optimize the removal of emerging pollutants in water bodies by S-nZVI/BC. Full article

Purpose: The current study is intended to assess the effects of a multicomponent social support intervention program on grip strength, sprinting, jumping, agility, flexibility, core strength and exercise attitude among children over a period of twelve weeks. Method: This study followed a randomized parallel design in which 366 children (age: 9.35 ± 1.12 years) in the 3rd–5th grade at an elementary school in China were allocated to an intervention group (n = 183) or a control group (n = 183). Participants were assessed twice (baseline and postintervention) for the following tests: (i) grip strength, (ii) 50 m dash, (iii) rope skipping, (iv) sit-ups, (v) sit-and-reach, and (vi) exercise attitude. The intervention group received the “Exercise Methods and Wellness Knowledge Guide (EMWKG)” leaflet three times a week. The control group was not required to make any changes. Results: Significant increases in pre–post left-hand grip strength (Cohen’s d = 0.10, p < 0.001), right-hand grip strength (Cohen’s d = 0.09, p < 0.001), and behavioral intention (Cohen’s d = 0.17, p < 0.01) were observed in the intervention group. Students in the control group showed significant decreases in three indicators: both 50 m (Cohen’s d = 0.19, p < 0.01) and sit-ups (Cohen’s d = 0.14, p < 0.05) as well as sit-and-reach (Cohen’s d = 0.46, p < 0.001). Significant differences (p < 0.001) were found between the two groups in right-hand grip strength (F = 7.109, η_p² = 0.020), sit-and-reach (F = 11.255, η_p² = 0.031), and subjective standards (F = 15.461, η_p² = 0.043). A comparison of the post hoc test results showed that the intervention group scored 0.519 kg (95% CI: 0.136–0.901, Cohen’s d = 0.27), 0.944 cm (95% CI: 0.0391–1.497, Cohen’s d = 0.35), and 2.535 points (95% CI: 1.267–3.803, Cohen’s d = 0.41) higher than the control group in right-hand grip strength, sit-and-reach, and subjective standards, respectively. Conclusion: This combined social support theory-based intervention was effective in improving exercise attitude and fitness among children in 12 weeks. Full article

This study investigated the interactions between self-perceived weight status and lifestyle behaviors, and their associations with childhood obesity among school children. Methods: Cross-sectional study data from a nationwide sample of 3258 participants (aged 8–15 years old) during 2015–2017 were used. Self-perceived weight status and lifestyle factors (dietary intake and physical activity) were assessed using self-administered questionnaires. Multivariable mixed-effects models tested the effect of interactions between weight self-perception and behavioral factors on overweight and obesity (ow/ob). Results: Overall ow/ob prevalence based on BMI was 30.9% (38.5% for boys, 23.0% for girls). Based on self-perceived weight status, ow/ob prevalence was 37.7% (35.8% for boys, 39.7% for girls). 41.2% of boys and 25.9% of girls underestimated their actual weight status. The interaction between self-perceived weight status and meat consumption was associated with ow/ob in boys, while the interaction between self-assessed weight status and protein foods and sedentary lifestyle were associated with ow/ob in girls. The attributable proportions of these three factors were 39.8%, 48.2%, and 34.6%, respectively. Conclusions: The self-perceived weight status was different from their actual weight status in children. The interactions between self-perceived weight status and lifestyle behaviors were associated with ow/ob. Health promotion programs that empower children to have appropriate self-awareness of weight status, eating, and physical activity behaviors need to be developed and implemented. Full article

Background: Even though chronic knee pain is common in volleyball, neuromuscular imbalance as a potential risk factor has not been investigated in volleyball-specific tasks. The aim of the study was to compare neuromuscular control between healthy and injured players in a clinical jump test and a volleyball-specific jump task in real field conditions. Methods: Six athletes with knee pain and nine controls were included. Surface electromyographic data were recorded from the mm. vastus medialis (VM) and lateralis (VL) of both legs. VM/VL activation ratio was calculated from countermovement jump (CMJ) and volleyball spike indoors and on two beach surfaces. Results: All subjects had pain in the leading leg. Mann–Whitney U Test (M-W-U Test) revealed a significantly lower VM/VL ratio of the leading leg (always affected) of the injured compared with that of the healthy control group for the CMJ and spike jump on all three grounds. Bland–Altman analysis revealed low bias and low difference in standard deviation for the injured leg but high values for the uninvolved leg and healthy controls between tasks and grounds. These results could indicate that neuromuscular control might not adapt too well to different movement tasks and grounds in the injured leg. Conclusion: Athletes with chronic knee pain might have lower VM/VL ratios than controls independent from movement task and ground. Neuromuscular control in injured athletes might be less adaptable to new circumstances. The results of neuromuscular control in laboratory settings might be applicable to field conditions in injured legs but not healthy ones. Full article

Individuals who are prelingually deaf and have intellectual disabilities experience great challenges in their language, cognitive and social development, leading to heterogeneous profiles of intellectual and adaptive functioning. The present study describes these profiles, paying particular attention to domain discrepancies, and explores their associations with quality of life and maladaptive behavior. Twenty-nine adults with prelingual deafness (31% female) and mild intellectual functioning deficits (mean IQ = 67.3, SD = 6.5) were administered the Vineland Adaptive Behavior Scales-II (VABS-II) and an adapted sign language version of a quality of life scale (EUROHIS-QOL 8). Intellectual disability domain discrepancies were characterized as at least one standard deviation difference between the social domain and IQ and the practical domain and IQ, and a significant difference, according to the VABS-II manual, between the social and practical domains. Domain discrepancies were found between intellectual functioning and both the practical (58.6%) and social domain (65.5%). A discrepancy between intellectual and social functioning was significantly associated with a higher level of internalizing maladaptive behavior (T = 1.89, p < 0.05). The heterogeneous profiles highlight the importance of comprehensive assessments for adequate service provision. Full article

An ageing population brings with it the need for public policy to respond to the demands and health needs of this group of people. The ageing process has been shown to be associated with changes in body composition. These mainly concern a decrease in muscle mass and an increase in body fat. Body composition and other indicators of nutritional status are important factors differentiating carbohydrate management. Glycaemic index (GI) values may be affected by differences resulting from individual metabolism. The rate of carbohydrate digestion is also influenced by a number of factors, including the degree to which the product is processed, the structure of the starch, and the presence of protein, fat and dietary fibre. Available studies do not provide information on the glycaemic response following the consumption of specific products by older people with varying BMI and body composition. Therefore, the aim of this study was to evaluate the effect of the body mass index (BMI) values of women aged 50–80 years on the glycaemic response after eating vegetarian meals and the influence of selected indices of nutritional status on their GI values. It has been shown that the areas under the glycaemic curves after the consumption of the tested foods, both traditional and modified, are higher in the group of overweight and obese women. Nevertheless, the GI of meals consumed by those with a BMI ≥ 25.0 kg/m² is lower than that of foods consumed by women with normal values of this index. In the group of women with BMI 18.5–24.9 kg/m², on the basis of an analysis of the obtained correlations, it was observed that the GI value of modified products depends on the percentage of body fat (FM%) (p = 0.0363) and the percentage of fat free mass (FFM%) (p = 0.0363), and, in the case of traditional products, also on the percentage of total body water (%) (p = 0.0133). In the group of women with a BMI ≥ 25.0 kg/m², significant correlations were only found between the GI of modified foods and the waist-to-hip ratio (WHR) (p = 0.0363) and the ratio of waist circumference to height (WHtR) (p = 0.0369) indices. The GI values of food set solely with the participation of young, healthy people should not be the basis for the nutrition planning of all groups of people. Full article