E-Mail Alert

Add your e-mail address to receive forthcoming issues of this journal:

Journal Browser

Journal Browser

Special Issue "IJERPH: 15th Anniversary"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 December 2018)

Special Issue Editor

Guest Editor
Prof. Dr. Paul B. Tchounwou

Department of Biology, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Box 18750, Jackson, MS 39217, USA
E-Mail
Phone: 6019690777
Fax: +1 601 979 2349

Special Issue Information

Dear Colleagues,

Next year (2018), we will be celebrating the 15th anniversary of the International Journal of Environmental Research and Public HealthIJERPH (ISSN 1660-4601). Hence, we are currently organizing a Special Issue to commemorate this important milestone. Founded in 2004, IJERPH has experienced a tremendous growth in terms of the number and quality of scientific publications. With a 2016 impact factor of 2.101, IJERPH now ranks among the top international journals in the emerging field of environmental research and public health. As described on our website (https://www.mdpi.com/journal/ijerph), IJERPH is a peer-reviewed journal that focuses on the publication of scientific and technical information on the impacts of natural phenomena and anthropogenic factors on the quality of our environment, the interrelationships between environmental health and the quality of life, as well as the socio-cultural, political, economic, and legal considerations related to environmental stewardship and public health. Its primary areas of research interests include:

  • Gene-environment interactions
  • Environmental genomics and proteomics
  • Environmental toxicology, mutagenesis and carcinogenesis
  • Environmental epidemiology and disease control
  • Health risk assessment and management
  • Ecotoxicology, and ecological risk assessment and management
  • Natural resources damage assessment
  • Environmental chemistry and computational modeling
  • Environmental policy and management
  • Environmental engineering and biotechnology
  • Emerging issues in environmental health and diseases
  • Environmental education and public health

To help celebrate the 15th anniversary, you are kindly invited to submit original articles, critical reviews, research notes, and short communications on any of the above-listed topics. Please also encourage any of our colleagues who may be interested to submit manuscripts.

We expect that this issue will attract considerable attention, as we prepare to celebrate the excellent scientific contributions and socio-economic impacts of IJERPH over the past 15 years.

Prof. Dr. Paul B. Tchounwou
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (48 papers)

View options order results:
result details:
Displaying articles 1-48
Export citation of selected articles as:

Research

Jump to: Review, Other

Open AccessArticle Association of Consecutive Influenza Vaccinations and Pneumonia: A Population-Based Case-Control Study
Int. J. Environ. Res. Public Health 2019, 16(6), 1078; https://doi.org/10.3390/ijerph16061078
Received: 14 February 2019 / Revised: 15 March 2019 / Accepted: 23 March 2019 / Published: 26 March 2019
PDF Full-text (436 KB) | HTML Full-text | XML Full-text
Abstract
The purpose of this study was to investigate whether individuals receiving influenza vaccines have a lower risk of pneumonia. A nationwide population-based case-control study was conducted using data from the National Health Insurance Research Database in Taiwan. We enrolled 7565 patients each in [...] Read more.
The purpose of this study was to investigate whether individuals receiving influenza vaccines have a lower risk of pneumonia. A nationwide population-based case-control study was conducted using data from the National Health Insurance Research Database in Taiwan. We enrolled 7565 patients each in pneumonia and non-pneumonia groups after diagnosis of patients with chronic pulmonary disease, and these patients were individually age and sex matched in a 1:1 ratio. Using conditional logistic regression analysis, adjusted odds ratios (aORs) were estimated in patients who received influenza vaccination and those who had not previously had pneumonia. Moreover, we also analyzed the interval between vaccination and the onset of pneumonia and the number of vaccinations received by patients. This was compared with patients who never received influenza vaccination. Patients who had received influenza vaccination and had been vaccinated for two consecutive years (aOR = 0.85, confidence interval (CI) = 0.79–0.93 and aOR = 0.75, CI = 0.67–0.85, respectively) showed lower rates of pneumonia occurrence by 15–25%. In conclusion, influenza vaccination significantly reduces the occurrence of pneumonia, especially in individuals who receive vaccination in consecutive years. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessFeature PaperArticle Measuring the Prevalence of Adverse Childhood Experiences by Survey Research Methods
Int. J. Environ. Res. Public Health 2019, 16(6), 1048; https://doi.org/10.3390/ijerph16061048
Received: 30 December 2018 / Revised: 6 March 2019 / Accepted: 20 March 2019 / Published: 22 March 2019
PDF Full-text (734 KB) | HTML Full-text | XML Full-text
Abstract
Background: Child maltreatment has been firmly established as a fundamental risk factor for adult health. However, its quantification poses many questions methodologically, psychologically, and culturally alike. We carried out the first nationally representative survey research in Hungary and in Central–Eastern Europe to [...] Read more.
Background: Child maltreatment has been firmly established as a fundamental risk factor for adult health. However, its quantification poses many questions methodologically, psychologically, and culturally alike. We carried out the first nationally representative survey research in Hungary and in Central–Eastern Europe to assess the prevalence of adverse childhood experiences (ACEs) among adults. Methods: Data were collected by an opinion research company using a screening tool of the Adverse Childhood Experiences study. Results: 25% (n = 293) of adults reported any childhood adversity; 5% (n = 59) of them had four or more ACEs. The most prevalent forms of child maltreatment were emotional (5%, n = 59) and physical abuse (5%, n = 59), sexual abuse (1%, n = 12) being the least prevalent. The most frequent dysfunctional household condition was parental divorce or separation (13%, n = 153), followed by household substance abuse (11%, n = 129). Conclusions: Nationally representative surveys on ACEs found a range of overall prevalence of various forms of child maltreatment between 14.1 and 35.2% into which our results fall. Nevertheless, our survey most likely underestimates the prevalence of child maltreatment in Hungary, reflecting the impact of a host of factors influencing awareness. Survey research methods are appropriate to obtain nationally representative data on child maltreatment that not only contribute to designing interventions but can also be used to monitor the effectiveness of interventions to improve child and adult health in the long run. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Pathologic Use of Video Games and Motivation: Can the Gaming Motivation Scale (GAMS) Predict Depression and Trait Anxiety?
Int. J. Environ. Res. Public Health 2019, 16(6), 1008; https://doi.org/10.3390/ijerph16061008
Received: 29 January 2019 / Revised: 6 March 2019 / Accepted: 17 March 2019 / Published: 20 March 2019
PDF Full-text (722 KB) | HTML Full-text | XML Full-text
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Youth Perspectives of Healthcare in Central Mexico: An Application of Massey’s Critical Health Literacy Framework
Int. J. Environ. Res. Public Health 2019, 16(5), 896; https://doi.org/10.3390/ijerph16050896
Received: 28 December 2018 / Revised: 27 February 2019 / Accepted: 1 March 2019 / Published: 12 March 2019
PDF Full-text (321 KB) | HTML Full-text | XML Full-text
Abstract
Attention to health literacy is essential more now than ever given the recognition, attention, and resources being dedicated to addressing health disparities throughout the world. Unfortunately, health literacy research is scarce in many parts of the world, particularly among youth. Using focus group [...] Read more.
Attention to health literacy is essential more now than ever given the recognition, attention, and resources being dedicated to addressing health disparities throughout the world. Unfortunately, health literacy research is scarce in many parts of the world, particularly among youth. Using focus group discussions with junior high school students (N = 98) in a rural town of Central Mexico, we sought to learn about their experiences utilizing healthcare services at a local health clinic. The themes that naturally emerged from focus group discussions aligned with Massey’s framework on critical health literacy among US youth, and included problems navigating the health system, embarrassment speaking to doctors about sensitive issues, and minimal importance being placed on preventative care. This suggests that Massey’s framework may be appropriate to use when seeking to understand and promote health literacy among youth in Mexico. Furthermore, the challenges faced by adolescent participants in this study suggest that additional research is needed to assess how youth in other areas of Mexico are faring in efforts to understand and access their new and evolving universal healthcare system. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Open AccessArticle Effects of Food Contamination on Gastrointestinal Morbidity: Comparison of Different Machine-Learning Methods
Int. J. Environ. Res. Public Health 2019, 16(5), 838; https://doi.org/10.3390/ijerph16050838
Received: 29 January 2019 / Revised: 2 March 2019 / Accepted: 3 March 2019 / Published: 7 March 2019
PDF Full-text (1328 KB) | HTML Full-text | XML Full-text
Abstract
Morbidity prediction can be useful in improving the effectiveness and efficiency of medical services, but accurate morbidity prediction is often difficult because of the complex relationships between diseases and their influencing factors. This study investigates the effects of food contamination on gastrointestinal-disease morbidities [...] Read more.
Morbidity prediction can be useful in improving the effectiveness and efficiency of medical services, but accurate morbidity prediction is often difficult because of the complex relationships between diseases and their influencing factors. This study investigates the effects of food contamination on gastrointestinal-disease morbidities using eight different machine-learning models, including multiple linear regression, a shallow neural network, and three deep neural networks and their improved versions trained by an evolutionary algorithm. Experiments on the datasets from ten cities/counties in central China demonstrate that deep neural networks achieve significantly higher accuracy than classical linear-regression and shallow neural-network models, and the deep denoising autoencoder model with evolutionary learning exhibits the best prediction performance. The results also indicate that the prediction accuracies on acute gastrointestinal diseases are generally higher than those on other diseases, but the models are difficult to predict the morbidities of gastrointestinal tumors. This study demonstrates that evolutionary deep-learning models can be utilized to accurately predict the morbidities of most gastrointestinal diseases from food contamination, and this approach can be extended for the morbidity prediction of many other diseases. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Start-Up of a Biofilter in a Full-Scale Groundwater Treatment Plant for Iron and Manganese Removal
Int. J. Environ. Res. Public Health 2019, 16(5), 698; https://doi.org/10.3390/ijerph16050698
Received: 28 December 2018 / Revised: 21 February 2019 / Accepted: 23 February 2019 / Published: 27 February 2019
PDF Full-text (1848 KB) | HTML Full-text | XML Full-text
Abstract
In recent years, biological purification technology has been widely developed in the process of iron and manganese removal from groundwater. The cultivation and maturation of the biological filter layer are key for biological iron and manganese removal processes. The time needed for maturation [...] Read more.
In recent years, biological purification technology has been widely developed in the process of iron and manganese removal from groundwater. The cultivation and maturation of the biological filter layer are key for biological iron and manganese removal processes. The time needed for maturation varies significantly with the water quality, filter and filter media conditions and operation parameters; sometimes it takes only one or two months, sometime more than half a year. In this paper, the feasibility of adopting an intermittent operation for the cultivation of biofilter was investigated with productive filters in a groundwater treatment plant, and the comparative test of the filter column was conducted. The results showed that the intermittent operation had little effect on the cultivation of the biofilter because dissolved oxygen would be gradually exhausted during the filter-suspension process, making the filter layer anaerobic, thus possibly inhibiting the growth and reproduction of IMOB (Iron and Manganese Oxidizing Bacteria). At the same time, the test shows that when the mature biological filter needs the suspension operation, the emptying method should be considered to avoid the destruction of the biological layer. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Social Capital and Mental Health in Rural and Urban China: A Composite Hypothesis Approach
Int. J. Environ. Res. Public Health 2019, 16(4), 665; https://doi.org/10.3390/ijerph16040665
Received: 15 January 2019 / Revised: 8 February 2019 / Accepted: 19 February 2019 / Published: 25 February 2019
Cited by 1 | PDF Full-text (553 KB) | HTML Full-text | XML Full-text
Abstract
The objective of this study is to follow the composite theory approach to analyze the effect of social capital on self-rated mental health in rural and urban China. Our nationally representative sample includes 10,968 respondents from 130 county-level communities. Two-level random-coefficient linear regressions, [...] Read more.
The objective of this study is to follow the composite theory approach to analyze the effect of social capital on self-rated mental health in rural and urban China. Our nationally representative sample includes 10,968 respondents from 130 county-level communities. Two-level random-coefficient linear regressions, which model individual and community variations in subjective mental health, were estimated by taking the hierarchical structure of the dataset into account. We found that a significant proportion of the total variations in self-rated mental health were explained at the community level. We also found an association between low contextual civic trust and poor self-rated mental health after adjusting for individual social capital and individual socioeconomic-demographic variables. The study also revealed that: (1) in rural areas a positive relationship between civic and political trust and mental health existed both at the individual and the community level, respectively; and (2) in urban areas, only political trust at the individual level contributed to better mental health. In addition, the individual and community level political participation exhibited a positive impact on mental health measures in both rural and urban China. The individual level civic participation was positively associated to the outcome variable. However, the community-level civic participation seemed to negatively impact mental health in urban area. Our findings emphasize the importance of both individual and community-level healthcare interventions in China. Finally, this study also found that human capital covariates remained important predictors of self-rated mental health status even after controlling social capital both at individual and community levels. This study suggested that the composite thesis could provide a more convincing narrative than other theories in explaining the effects of both human and social capital on health. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Risk Factors Associated with Dengue Virus Infection in Guangdong Province: A Community-Based Case-Control Study
Int. J. Environ. Res. Public Health 2019, 16(4), 617; https://doi.org/10.3390/ijerph16040617
Received: 26 December 2018 / Revised: 3 February 2019 / Accepted: 14 February 2019 / Published: 20 February 2019
PDF Full-text (550 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Dengue fever (DF) is a mosquito-borne infectious disease that is now an epidemic in China, Guangdong Province, in particular and presents high incidence rates of DF. Effective preventive measures are critical for controlling DF in China given the absence of a licensed vaccination [...] Read more.
Dengue fever (DF) is a mosquito-borne infectious disease that is now an epidemic in China, Guangdong Province, in particular and presents high incidence rates of DF. Effective preventive measures are critical for controlling DF in China given the absence of a licensed vaccination program in the country. This study aimed to explore the individual risk factors for the dengue virus infection in Guangdong Province and to provide a scientific basis for the future prevention and control of DF. A case-control study including 237 cases and 237 controls was performed. Cases were defined for samples who were IgG-antibody positive or IgM-antibody positive, and willing to participate in the questionnaire survey. Additionally, the controls were selected through frequency matching by age, gender and community information from individuals who tested negative for IgG and IgM and volunteered to become part of the samples. Data were collected from epidemiological questionnaires. Univariate analysis was performed for the preliminary screening of 28 variables that were potentially related to dengue virus infection, and multivariate analysis was performed through unconditioned logistic regression analysis to analyze statistically significant variables. Multivariate analysis revealed two independent risk factors: Participation in outdoor sports (odds ratio (OR) = 1.80, 95% confidence interval (CI) 1.17 to 2.78), and poor indoor daylight quality (OR = 2.27, 95% CI 1.03 to 5.03). Two protective factors were identified through multivariate analysis: 2 occupants per room (OR = 0.43, 95% CI 0.28 to 0.65) or ≥3 occupants per room (OR = 0.45, 95% CI 0.23 to 0.89) and air-conditioner use (OR = 0.46, 95% CI 0.22 to 0.97). The results of this study were conducive for investigating the risk factors for dengue virus infection in Guangdong Province. Effective and efficient strategies for improving environmental protection and anti-mosquito measures must be provided. In addition, additional systematic studies are needed to explore other potential risk factors for DF. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Design and Validation with Influenza A Virus of an Aerosol Transmission Chamber for Ferrets
Int. J. Environ. Res. Public Health 2019, 16(4), 609; https://doi.org/10.3390/ijerph16040609
Received: 18 January 2019 / Revised: 8 February 2019 / Accepted: 12 February 2019 / Published: 19 February 2019
PDF Full-text (4109 KB) | HTML Full-text | XML Full-text
Abstract
Background: The importance of aerosols in the spread of viruses like influenza is still a subject of debate. Indeed, most viruses can also be transmitted through direct contact and droplets. Therefore, the importance of the airborne route in a clinical context is [...] Read more.
Background: The importance of aerosols in the spread of viruses like influenza is still a subject of debate. Indeed, most viruses can also be transmitted through direct contact and droplets. Therefore, the importance of the airborne route in a clinical context is difficult to determine. The aim of this study was to design a chamber system to study the airborne transmission of viruses between ferrets. Methods: A system composed of three chambers connected in series, each one housing one ferret and preventing direct contact, was designed. The chambers were designed to house the ferrets for several days and to study the transmission of viruses from an infected (index) ferret to two naïve ferrets via aerosols and droplets or aerosols only. A particle separator was designed that can be used to modulate the size of the particles traveling between the chambers. The chamber system was validated using standard dust as well as with ferrets infected with influenza A virus. Conclusions: The 50% efficiency cut-off of the separator could be modulated between a 5-µm and an 8-µm aerodynamic diameter. In the described setup, influenza A virus was transmitted through the aerosol route in two out of three experiments, and through aerosols and droplets in all three experiments. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Evaluating Targeted Intervention on Coal Miners’ Unsafe Behavior
Int. J. Environ. Res. Public Health 2019, 16(3), 422; https://doi.org/10.3390/ijerph16030422
Received: 25 December 2018 / Revised: 24 January 2019 / Accepted: 30 January 2019 / Published: 1 February 2019
PDF Full-text (872 KB) | HTML Full-text | XML Full-text
Abstract
Miners’ unsafe behavior is the main cause of roof accidents in coal mines, and behavior intervention plays a significant role in reducing the occurrence of miners’ unsafe behavior. However, traditional behavior intervention methods lack pertinence. In order to improve the intervention effect and [...] Read more.
Miners’ unsafe behavior is the main cause of roof accidents in coal mines, and behavior intervention plays a significant role in reducing the occurrence of miners’ unsafe behavior. However, traditional behavior intervention methods lack pertinence. In order to improve the intervention effect and reduce the occurrence of coal mine roof accidents more effectively, this study proposed a targeted intervention method for unsafe behavior. The process of targeted intervention node locating was constructed, and based on the analysis of 331 coal mine roof accidents in China, three kinds of targeted intervention nodes were located. The effectiveness of targeted intervention nodes was evaluated by using structural equation model (SEM) through randomly distributing questionnaires to miners of Pingdingshan coal. The results show that, in preventing roof accidents of coal mines, the targeted intervention nodes have a significant positive impact on the intervention effect. The method can also be applied to the safety management of other industries by adjusting the node location and evaluation process. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Arbuscular Mycorrhizal Fungi Alter Plant and Soil C:N:P Stoichiometries Under Warming and Nitrogen Input in a Semiarid Meadow of China
Int. J. Environ. Res. Public Health 2019, 16(3), 397; https://doi.org/10.3390/ijerph16030397
Received: 28 December 2018 / Revised: 27 January 2019 / Accepted: 29 January 2019 / Published: 31 January 2019
PDF Full-text (870 KB) | HTML Full-text | XML Full-text
Abstract
Ecological stoichiometry has been widely used to determine how plant-soil systems respond to global change and to reveal which factors limit plant growth. Arbuscular mycorrhizal fungi (AMF) can increase plants’ uptake of nutrients such as nitrogen (N) and phosphorus (P), thereby altering plant [...] Read more.
Ecological stoichiometry has been widely used to determine how plant-soil systems respond to global change and to reveal which factors limit plant growth. Arbuscular mycorrhizal fungi (AMF) can increase plants’ uptake of nutrients such as nitrogen (N) and phosphorus (P), thereby altering plant and soil stoichiometries. To understand the regulatory effect of AMF feedback on plants and soil stoichiometry under global change, a microcosm experiment was conducted with warming and N input. The C4 grass Setaria viridis, C3 grass Leymus chinensis, and Chenopodiaceae species Suaeda corniculata were studied. The results showed that the mycorrhizal benefits for the C4 grass S. viridis were greater than those for the C3 grass L. chinensis, whereas for the Chenopodiaceae species S. corniculata, AMF symbiosis was antagonistic. Under N input and a combination of warming and N input, AMF significantly decreased the N:P ratios of all three species. Under N input, the soil N content and the N:P ratio were decreased significantly in the presence of AMF, whereas the soil C:N ratio was increased. These results showed that AMF can reduce the P limitation caused by N input and improve the efficiency of nutrient utilization, slow the negative influence of global change on plant growth, and promote grassland sustainability. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Graphical abstract

Open AccessArticle Incineration Kinetic Analysis of Upstream Oily Sludge and Sectionalized Modeling in Differential/Integral Method
Int. J. Environ. Res. Public Health 2019, 16(3), 384; https://doi.org/10.3390/ijerph16030384
Received: 27 December 2018 / Revised: 22 January 2019 / Accepted: 25 January 2019 / Published: 29 January 2019
PDF Full-text (10263 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
As the most significant solid residue generated in the oil production industry, upstream oily sludge was regarded as hazardous waste in China due to its toxicity and ignitability, and to date, the incineration process has been considered the most efficient method in practice. [...] Read more.
As the most significant solid residue generated in the oil production industry, upstream oily sludge was regarded as hazardous waste in China due to its toxicity and ignitability, and to date, the incineration process has been considered the most efficient method in practice. Due to the complicated components of oily sludge, a kinetic model of the incineration process was difficult to build, and is still absent in engineering use. In this study, multiple non-isothermal thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC) analysis were applied for the kinetic analysis of upstream oily sludge in air conditions. A viewpoint regarding the rules to sectionalize the reaction stages was raised, and a differential integral method to obtain the incineration kinetic model was provided. The results showed that four stages that were divided based on the weight-loss regions in the TGA curves and the endothermic/exothermic sections in the DSC curves were suitable to obtain an incineration kinetic model of oily sludge. The integral method was beneficial for obtaining the average activation energy of each stage, and the differential method was suitable for gaining the nth-order reaction rate equation and the pre-exponential factor before the operating temperature became lower than 635.968 °C. The average activation energies of stages one, two, three, and four were 60.87 KJ/mol, 78.11 KJ/mol, 98.82 KJ/mol, and 15.96 KJ/mol, respectively. The nth-order reaction rate equations and pre-exponential factors of stages one, two, and three were 0.82, 3.50, and 2.50, and e 13.32 min 1 , e 19.69 min 1 , and e 21.00 min 1 , respectively. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Roadside Exposure and Inflammation Biomarkers among a Cohort of Traffic Police in Kathmandu, Nepal
Int. J. Environ. Res. Public Health 2019, 16(3), 377; https://doi.org/10.3390/ijerph16030377
Received: 3 January 2019 / Revised: 25 January 2019 / Accepted: 25 January 2019 / Published: 29 January 2019
Cited by 1 | PDF Full-text (1024 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Air pollution is a major environmental problem in the Kathmandu Valley. Specifically, roadside and traffic-related air pollution exposure levels were found at very high levels exceeding Nepal air quality standards for daily PM2.5. In an exposure study involving traffic police officers, [...] Read more.
Air pollution is a major environmental problem in the Kathmandu Valley. Specifically, roadside and traffic-related air pollution exposure levels were found at very high levels exceeding Nepal air quality standards for daily PM2.5. In an exposure study involving traffic police officers, we collected 78 blood samples in a highly polluted spring season (16 February 2014–4 April 2014) and 63 blood samples in the less polluted summer season (20 July 2014–22 August 2014). Fourteen biomarkers, i.e., C-reactive protein (CRP), serum amyloid A (SAA), intracellular adhesion molecule (ICAM-1), vascular cell adhesion molecule (VCAM-1), interferon gamma (IFN-γ), interleukins (IL1-β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13), and tumor necrosis factor (TNF-α) were analyzed in collected blood samples using proinflammatory panel 1 kits and vascular injury panel 2 kits. All the inflammatory biomarker levels were higher in the summer season than in the spring season, while particulate levels were higher in the spring season than in the summer season. We did not find significant association between 24-hour average PM2.5 or black carbon (BC) exposure levels with most of analyzed biomarkers for the traffic volunteers working and residing near busy roads in Kathmandu, Nepal, during 2014. Inflammation and vascular injury marker concentrations were generally higher in females, suggesting the important role of gender in inflammation biomarkers. Because of the small sample size of female subjects, further investigation with a larger sample size is required to confirm the role of gender in inflammation biomarkers. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle The Influence of Physical Fitness on Reasons for Academy Separation in Law Enforcement Recruits
Int. J. Environ. Res. Public Health 2019, 16(3), 372; https://doi.org/10.3390/ijerph16030372
Received: 17 December 2018 / Revised: 23 January 2019 / Accepted: 27 January 2019 / Published: 29 January 2019
Cited by 3 | PDF Full-text (607 KB) | HTML Full-text | XML Full-text
Abstract
This study analyzed the effects physical fitness may have on reasons for academy separation in law enforcement recruits. A retrospective analysis was conducted on 401 recruits; 330 recruits graduated (GRAD), and 71 recruits separated at various times during academy. Twenty-eight recruits separated for [...] Read more.
This study analyzed the effects physical fitness may have on reasons for academy separation in law enforcement recruits. A retrospective analysis was conducted on 401 recruits; 330 recruits graduated (GRAD), and 71 recruits separated at various times during academy. Twenty-eight recruits separated for personal reasons (SEPPR); 18 due to physical training failures (i.e., poor fitness) or injury (SEPFI); and 25 due to academic or scenario failures (SEPAS). Fitness testing occurred prior to academy, and included: Push-ups and sit-ups in 60s; a 75-yard pursuit run (75PR); vertical jump; medicine ball throw; and multistage fitness test (MSFT). A one-way ANOVA with Bonferroni post hoc compared between-group fitness test performance. A multiple stepwise regression calculated whether recruit characteristics or fitness could predict separation. The GRAD group was younger than the SEPAS group (p < 0.01), faster in the 75PR than the SEPFI group (p = 0.02), and completed more MSFT shuttles than the SEPPR and SEPFI groups (p = 0.01). Age predicted GRAD and SEPAS group inclusion; MSFT predicted GRAD, SEPPR, and SEPFI group inclusion. Recruits who had superior high-intensity running capacity (75PR) and aerobic fitness (MSFT) should have a better chance of completing academy. However, this could be influenced by training practices adopted during academy. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessFeature PaperArticle Hydrophobic Organic Pollutants in Soils and Dusts at Electronic Waste Recycling Sites: Occurrence and Possible Impacts of Polybrominated Diphenyl Ethers
Int. J. Environ. Res. Public Health 2019, 16(3), 360; https://doi.org/10.3390/ijerph16030360
Received: 12 December 2018 / Revised: 24 January 2019 / Accepted: 25 January 2019 / Published: 28 January 2019
Cited by 1 | PDF Full-text (2800 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Concerns about the adverse consequences of informal electronic waste (e-waste) recycling is increasing, because e-waste contains some hazardous substances such as polybrominated diphenyl ethers (PBDEs) which is used as flame retardants in electronics. There is dearth of information on the concentrations of PBDEs [...] Read more.
Concerns about the adverse consequences of informal electronic waste (e-waste) recycling is increasing, because e-waste contains some hazardous substances such as polybrominated diphenyl ethers (PBDEs) which is used as flame retardants in electronics. There is dearth of information on the concentrations of PBDEs and the pattern of distribution at the various e-waste recycling sites in Nigeria. This study therefore measured the concentrations of 13 PBDE congeners, in top soils (0–10 cm) and in various dust samples from different e-waste recycling sites (burning, dismantling, repair). PBDE concentrations at e-waste sites were compared with the concentrations in samples from corresponding control sites in three study locations in Nigeria (Lagos, Ibadan, and Aba). There were significant differences in the level of PBDEs congeners between each of the e-waste recycling sites and the corresponding control sites. The levels of PBDEs at the e-waste recycling sites exceeded the levels at the controls sites by a factor of 100 s to 1000 s. In general, PBDE concentrations at the e-waste sites decreased with the intensity of the e-waste recycling activities: burning sites > dismantling sites > repair sites > control sites. Our results suggest that the informal e-waste recycling has negative impacts on the enviroment and human health. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Graphical abstract

Open AccessArticle The Effectiveness of Laser-Assisted Surgical Excision of Leukoplakias and Hyperkeratosis of Oral Mucosa: A Case Series in A Group of Patients
Int. J. Environ. Res. Public Health 2019, 16(2), 210; https://doi.org/10.3390/ijerph16020210
Received: 24 November 2018 / Revised: 26 December 2018 / Accepted: 9 January 2019 / Published: 13 January 2019
PDF Full-text (9049 KB) | HTML Full-text | XML Full-text
Abstract
Introduction: In the different branches of dentistry, the use of laser to solve different clinical situations is increasing due to numerous advantages that have been studied in literature since the 70s. Leucoplakia and hyperkeratosis can benefit from laser-assisted treatment. In most cases [...] Read more.
Introduction: In the different branches of dentistry, the use of laser to solve different clinical situations is increasing due to numerous advantages that have been studied in literature since the 70s. Leucoplakia and hyperkeratosis can benefit from laser-assisted treatment. In most cases biopsy sampling, histological examination and, if no malignant cells are present, the follow-up is needed. However, even if the lesion is free of dysplasia patients often ask to eliminate these white spots that are always a cause of concern. Aim: From these numerous requests comes the idea of setting up a laser-assisted protocol as less invasive as possible to be offered to patients. The aim of the study is to find a laser-assisted protocol for the surgical excision of leucoplakia and hyperkeratosis that can both improve the clinical aspect of the lesion and be sustainable for patients. The null hypothesis has been identified in the following statement: the treatment is effective and efficient at the same time; where effectiveness was tested with the following criteria: size of the lesion, tactile perception, discomfort, pain; and efficiency with the following criteria: pain and discomfort perceived during the treatment. Materials and methods: To collect all data, a specially designed medical record was used. The diode laser was used with a pulsed mode and the maximum power corresponds to 1.8 W. No anaesthesia was used. Before laser-assisted treatment, the fibre was activated and was used with a contact overflowing. Results: Our results show a decrease in the size of the lesion statistically significant. No pain was referred during treatment, except for a slight burning sensation. Conclusion: In conclusion we can state that the treatment is both efficient and effective. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Estimation of the Spatial Suitability of Winter Tourism Destinations Based on Copula Functions
Int. J. Environ. Res. Public Health 2019, 16(2), 186; https://doi.org/10.3390/ijerph16020186
Received: 4 December 2018 / Revised: 6 January 2019 / Accepted: 7 January 2019 / Published: 10 January 2019
Cited by 1 | PDF Full-text (3371 KB) | HTML Full-text | XML Full-text
Abstract
Climate and weather are important factors that determine winter tourism destinations and snow resources and temperature affect the income of the winter tourism industry. Against the background of climate change, abnormal fluctuations in climate elements bring a series of challenges for winter tourism [...] Read more.
Climate and weather are important factors that determine winter tourism destinations and snow resources and temperature affect the income of the winter tourism industry. Against the background of climate change, abnormal fluctuations in climate elements bring a series of challenges for winter tourism and cause potential losses to the tourism industry. To effectively assess and plan winter tourism destinations, this study establishes the snow abundance and meteorological suitability indices from snow resource and weather conditions to express winter tourism resources, respectively. The coupling relationship of the two indices was used to analyze the spatial suitability of winter tourism destinations based on the copula function. By case analysis, it was found that the Frank copula one is the best fitting function for winter tourism suitability analysis. The Yushu–Jiutai–Yitong–Dongliao line is the boundary of spatial suitability in the study area. The eastern areas of the boundary have great potential for winter tourism and could strive to develop ice-snow projects, whereas the western regions are relatively weak. This study has guiding significance for winter tourism destination development and resource spatial layout. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Elimination of Schistosoma japonicum Transmission in China: A Case of Schistosomiasis Control in the Severe Epidemic Area of Anhui Province
Int. J. Environ. Res. Public Health 2019, 16(1), 138; https://doi.org/10.3390/ijerph16010138
Received: 30 November 2018 / Revised: 30 December 2018 / Accepted: 2 January 2019 / Published: 7 January 2019
PDF Full-text (1404 KB) | HTML Full-text | XML Full-text
Abstract
Over the several decades, China has been incessantly optimizing control strategies in response to the varying epidemic situations of schistosomiasis. We evaluated continuously the changing prevalence under different control strategies of two villages, Sanlian and Guifan, in China through five phases lasting 37 [...] Read more.
Over the several decades, China has been incessantly optimizing control strategies in response to the varying epidemic situations of schistosomiasis. We evaluated continuously the changing prevalence under different control strategies of two villages, Sanlian and Guifan, in China through five phases lasting 37 years. We tested residents, calculated prevalence and discussed change causes. We found the prevalence in Sanlian did not differ significant from that of Guifan (p = 0.18) in 1981, but decreased to 2.66%, much lower than Guifan’s 11.25%, in 1984 (p = 0). Besides, prevalence in Guifan increased to 21.25% in 1987, while in Sanlian it rose to 20.78% until 1989. Those data confirmed that praziquantel combined with snail control could better reduce the prevalence. From 1992 to 1994, the prevalence in the two villages displayed downtrends, which showed the World Bank Loan Project worked. From 1995 to 2004, repeated oscillations with no obvious change trend was seen. Since 2005, the prevalence in both villages has shown a significant downtrend (p < 0.05), which suggests the integrated strategy is effective. We considered the control strategies were implemented suitably in the study area under changing social circumstances. Adjusting the strategy in consideration of social transformations is necessary and vital. The experience may be useful for policy making of other epidemic areas with an analogous situation. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Beyond Commuting: Ignoring Individuals’ Activity-Travel Patterns May Lead to Inaccurate Assessments of Their Exposure to Traffic Congestion
Int. J. Environ. Res. Public Health 2019, 16(1), 89; https://doi.org/10.3390/ijerph16010089
Received: 3 December 2018 / Revised: 25 December 2018 / Accepted: 28 December 2018 / Published: 30 December 2018
PDF Full-text (20846 KB) | HTML Full-text | XML Full-text
Abstract
This research examines whether individual exposures to traffic congestion are significantly different between assessments obtained with and without considering individuals’ activity-travel patterns in addition to commuting trips. We used crowdsourced real-time traffic congestion data and the activity-travel data of 250 individuals in Los [...] Read more.
This research examines whether individual exposures to traffic congestion are significantly different between assessments obtained with and without considering individuals’ activity-travel patterns in addition to commuting trips. We used crowdsourced real-time traffic congestion data and the activity-travel data of 250 individuals in Los Angeles to compare these two assessments of individual exposures to traffic congestion. The results revealed that individual exposures to traffic congestion are significantly underestimated when their activity-travel patterns are ignored, which has been postulated as a manifestation of the uncertain geographic context problem (UGCoP). The results also highlighted that the probability distribution function of exposures is heavily skewed but tends to converge to its average when individuals’ activity-travel patterns are considered when compared to one obtained when those patterns are not considered, which indicates the existence of the neighborhood effect averaging problem (NEAP). Lastly, space-time visualizations of individual exposures illustrated that people’s exposures to traffic congestion vary significantly even if they live at the same residential location due to their idiosyncratic activity-travel patterns. The results corroborate the claims in previous studies that using data aggregated over areas (e.g., census tracts) or focusing only on commuting trips (and thus ignoring individuals’ activity-travel patterns) may lead to erroneous assessments of individual exposures to traffic congestion or other environmental influences. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Premature Adult Death and Equity Impact of a Reduction of NO2, PM10, and PM2.5 Levels in Paris—A Health Impact Assessment Study Conducted at the Census Block Level
Int. J. Environ. Res. Public Health 2019, 16(1), 38; https://doi.org/10.3390/ijerph16010038
Received: 20 November 2018 / Revised: 19 December 2018 / Accepted: 21 December 2018 / Published: 24 December 2018
PDF Full-text (6748 KB) | HTML Full-text | XML Full-text
Abstract
Background: To support environmental policies aiming to tackle air pollution, quantitative health impact assessments (HIAs) stand out as one of the best decision-making tools. However, no risk assessment studies have quantified or mapped the health and equity impact of air pollution reduction [...] Read more.
Background: To support environmental policies aiming to tackle air pollution, quantitative health impact assessments (HIAs) stand out as one of the best decision-making tools. However, no risk assessment studies have quantified or mapped the health and equity impact of air pollution reduction at a small spatial scale. Objectives: We developed a small-area analysis of the impact of air pollution on “premature” death among an adult population over 30 years of age to quantify and map the health and equity impact related to a reduction of air pollution. Methods: All-cause mortality data of an adult population (>30 years) from January 2004 to December 2009 were geocoded at the residential census block level in Paris. Each census block was assigned socioeconomic deprivation levels and annual average ambient concentrations of NO2, PM10, and PM2.5. HIAs were used to estimate, at a small-area level, the number of “premature” deaths associated with a hypothetical reduction of NO2, PM10, and PM2.5 exposure. In total, considering global dose response function for the three pollutants and socioeconomic deprivation specific dose response function, nine HIAs were performed for NO2 and six and four HIAs for PM10 and PM2.5, respectively. Finally, a clustering approach was used to quantify how the number of “premature” deaths could vary according to deprivation level. Results: The number of deaths attributable to NO2, PM10, and PM2.5 exposure were equal to 4301, 3209, and 2662 deaths, respectively. The most deprived census blocks always appeared as one of the groups most impacted by air pollution. Our findings showed that “premature” deaths attributable to NO2 were not randomly distributed over the study area, with a cluster of excess “premature” deaths located in the northeastern area of Paris. Discussion: This study showed the importance of stratifying an environmental burden of disease study on the socioeconomic level, in order to take into consideration the modifier effect of socioeconomic status on the air pollution-mortality relationship. In addition, we demonstrated the value of spatial analysis to guide decision-making. This shows the need for tools to support priority-setting and to guide policymakers in their choice of environmental initiatives that would maximize health gains and reduce social inequalities in health. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Compliance with Tuberculosis Screening in Irregular Immigrants
Int. J. Environ. Res. Public Health 2019, 16(1), 28; https://doi.org/10.3390/ijerph16010028
Received: 23 November 2018 / Revised: 19 December 2018 / Accepted: 21 December 2018 / Published: 23 December 2018
PDF Full-text (588 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Tuberculosis (TB) is a serious public health problem in many regions of the world, especially in the poorest areas. For this reason, screening for active and latent forms must be considered when dealing with high-risk groups such as irregular immigrants in Western countries. [...] Read more.
Tuberculosis (TB) is a serious public health problem in many regions of the world, especially in the poorest areas. For this reason, screening for active and latent forms must be considered when dealing with high-risk groups such as irregular immigrants in Western countries. We conducted a retrospective cohort study by recruiting subjects aged ≥15 years who underwent a tuberculin skin test at a dedicated National Health Service Centre in a northern Italian province between 1 January 2012 and 31 December 2013. These participants were followed up until 31 December 2016. We aimed at evaluating an experimental protocol for active and latent tuberculosis screening, focusing on patient compliance, feasibility, and capability to detect clinical forms of the disease. We enrolled 368 irregular immigrants, i.e., immigrants not having a valid residence permit and who were therefore not entitled to choose a general practitioner. In total, 90.22% of these completed all the steps for the screening of active TB, while 87.33% also undertook screening for the latent form of the disease. Homelessness, self-reported prostitution, female sex, and employment status adversely affected compliance. Chronic alcohol consumption was associated with increased risk of no beginning or interruption of the procedures. All of the five patients with active TB successfully completed the treatment. Overall, adherence to the screening program was high compared to other studies in immigrants, possibly owing to organizational factors such as the availability of cultural mediators, the network between the different health services, the presence of dedicated nursing staff and a free-of-charge service. In addition, selected vulnerable subgroups should be targeted using tailored screening and follow-up programs. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Concentrations, Distribution, Sources and Ecological Risk Assessment of Trace Elements in Soils from Wuhan, Central China
Int. J. Environ. Res. Public Health 2018, 15(12), 2873; https://doi.org/10.3390/ijerph15122873
Received: 20 November 2018 / Revised: 7 December 2018 / Accepted: 11 December 2018 / Published: 14 December 2018
PDF Full-text (1255 KB) | HTML Full-text | XML Full-text
Abstract
This study aimed to determine the concentration levels, potential sources and ecological risks of eleven trace elements, namely Cr, Fe, Co, Ni, Cu, As, Sb, Cd, Zn, Hg and Pb, in the soil from Huangpi district, Wuhan, Central China. Soil samples were collected [...] Read more.
This study aimed to determine the concentration levels, potential sources and ecological risks of eleven trace elements, namely Cr, Fe, Co, Ni, Cu, As, Sb, Cd, Zn, Hg and Pb, in the soil from Huangpi district, Wuhan, Central China. Soil samples were collected from eighteen sites at soil depths of 1–10 and 10–20 cm and analyzed using Inductively Coupled Plasma-Mass Spectrometer ICP-MS (Thermo X SERIES 2, Scientific and Innovative Technology Co. Ltd., Beijing, China). The recorded mean concentration of the elements were in a decreasing order of Fe > Co > Cr > Ni > Pb > Cu > As > Cd > Sb > Zn > Hg. The mean concentration of trace elements, soil pH and total organic carbon (TOC) were higher at a soil depth of 1–10 cm. The obtained mean concentration of Cr, Co, As, Cd, Ni, Cu, Hg and Pb were above the soil background values of Wuhan and Hubei Province. The mean concentration values of Co, Ni and Cd, exceeded the recommended FAO (Food and Agriculture Organization)/ISRIC (International Soil Reference and Information Centre) (2004) and WHO/FAO (2001) values. Pearson’s correlation analysis illustrated that there was a strong and significant correlation between trace elements, whereas, a weak positive and negative correlation between elements and soil properties (pH and TOC). The principal component analysis (PCA) and cluster analysis (CA) result indicated that the concentration of trace elements in Huangpi soil were originated from anthropogenic sources. Potential ecological risk index (RI) of this study revealed that there is a high ecological risk of trace elements in the soil. Enrichment factor (EF) and geo-accumulation index (Igeo) of trace elements for this study indicated that the study area is strongly contaminated with Cd and Co. Generally, the finding of this research showed that Huangpi soil is contaminated. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Relative Density of Away from Home Food Establishments and Food Spend for 24,047 Households in England: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2018, 15(12), 2821; https://doi.org/10.3390/ijerph15122821
Received: 11 September 2018 / Revised: 19 November 2018 / Accepted: 26 November 2018 / Published: 11 December 2018
PDF Full-text (1353 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Eating away from home is a risk factor for poor diet quality and obesity. With an ever-increasing proportion of household food spend directed toward eating out, the proliferation of these food establishments may contribute to their use, a potential precursor to less healthy [...] Read more.
Eating away from home is a risk factor for poor diet quality and obesity. With an ever-increasing proportion of household food spend directed toward eating out, the proliferation of these food establishments may contribute to their use, a potential precursor to less healthy food choices and low overall diet quality. However few studies are conducted at the national level and across a range of away from home food sources. The purpose of this study was to examine the association between the density of away from home food establishments (e.g., restaurants, fast food outlets and cafés) and household spend on away from home food within a nationally representative sample for England, UK. A cross-sectional analysis of data from Wave 1 of the UK Household Longitudinal Survey (n = 24,047 adults aged ≥19y) was conducted. Exposure was characterised as the density of away from home food establishments to all other food sources within 1 mile of the home, divided into quintiles (Q1 as lowest exposure and Q5 as highest exposure). The primary outcome included households with a high away from home equivalised monthly food spend (≥25% of total food spend). Logistic regression was used to estimate associations between away from home food establishment exposure and high away from home food spend. Away from home food establishment density was significantly associated with a greater odds of high monthly food spend (Q3: OR = 1.18, 95% CI = 1.07, 1.30; Q4: OR = 1.30, 95% CI = 1.18, 1.43; and Q5: OR = 1.52, 95% CI = 1.37, 1.68) with attenuation after controlling for known socioeconomic confounders (Q4: OR = 1.13, 95% CI = 1.02, 1.25; and Q5: OR = 1.16, 95% CI = 1.04, 1.30) compared to those least exposed (Q1). Those most exposed to away from home food establishments had a 16% greater odds of allocating more than 25% of household food spend on away from home food sources. This study provides one of the first analyses at the national level to examine the role of the local food environment in relation to household food spend, a potential precursor to diet quality and health. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Relationships between Physical Activity and Quality of Life in Pregnant Women in the Second and Third Trimester
Int. J. Environ. Res. Public Health 2018, 15(12), 2745; https://doi.org/10.3390/ijerph15122745
Received: 26 October 2018 / Revised: 1 December 2018 / Accepted: 3 December 2018 / Published: 5 December 2018
Cited by 1 | PDF Full-text (342 KB) | HTML Full-text | XML Full-text
Abstract
Background: The problem of an inadequate level of physical activity (PA) is important in the context of its relationship with the quality of life (QoL) of pregnant women. The aim of this study was to analyze the relationships between PA and QoL among [...] Read more.
Background: The problem of an inadequate level of physical activity (PA) is important in the context of its relationship with the quality of life (QoL) of pregnant women. The aim of this study was to analyze the relationships between PA and QoL among pregnant women. Methods: The study analyzed 346 questionnaires filled in by pregnant women (157 in the second trimester and 189 in the third). The tool used for assessment of PA was the Pregnancy Physical Activity Questionnaire-Polish version (PPAQ-PL). The quality of life (QoL) was assessed by the World Health Organization Quality of Life Questionnaire-short form (WHOQoL-Bref). The results obtained from the PPAQ-PL and WHOQoL-Bref questionnaires for women in the second and third trimesters of pregnancy and intergroup differences were analyzed. Results: There was a significant correlation in the group of women in the second trimester of pregnancy between quality of life in the physical health domain and the intensity and type of physical activity. The women who rated their quality of life higher in this domain declared higher energy expenditures (EE) associated with vigorous activity (R = 0.159, p ≤ 0.05), as well as with occupational activity (R = 0.166; p ≤ 0.05) and sport/exercise activity (R = 0.187; p ≤ 0.05). In women in the third trimester, higher EE related to sport/exercise activity coincided with higher assessments of the overall quality of life (R = 0.149, p ≤ 0.05) and general health (R = 0.170, p ≤ 0.05). In the case of the psychological domain (R = 0.161, p ≤ 0.05) and social relationship domain (R = 0.188; p ≤ 0.05) of QoL, positive correlations occurred with EE related to vigorous activity. In contrast, high assessment of physical health domain coincided with higher EE related to occupational activity (R = 0.174; p ≤ 0.05). Conclusions: Our study makes an important contribution to knowledge concerning the correlations between PA and QoL in pregnancy. The results suggest the need for improvement in prenatal care and promotion of PA programs for pregnant women. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Open AccessArticle Utilization of Formal and Informal Care by Community-Living People with Dementia: A Comparative Study between Sweden and Italy
Int. J. Environ. Res. Public Health 2018, 15(12), 2679; https://doi.org/10.3390/ijerph15122679
Received: 13 October 2018 / Revised: 21 November 2018 / Accepted: 22 November 2018 / Published: 28 November 2018
Cited by 1 | PDF Full-text (347 KB) | HTML Full-text | XML Full-text
Abstract
Background: Dementia is a public health priority with a dramatic social and economic impact on people with dementia (PwD), their caregivers and societies. The aim of this study was to contribute to the knowledge on how utilization of formal and informal care varies [...] Read more.
Background: Dementia is a public health priority with a dramatic social and economic impact on people with dementia (PwD), their caregivers and societies. The aim of this study was to contribute to the knowledge on how utilization of formal and informal care varies between Sweden and Italy. Methods: Data were retrieved from two trials: [email protected] (Sweden) and UP-TECH (Italy). The sample consisted of 89 Swedish and 317 Italian dyads (PwD and caregivers). Using bivariate analysis, we compared demographic characteristics and informal resource utilization. Multiple linear regression was performed to analyze factors associated with time spent on care by the informal caregivers. Results: Swedish participants utilized more frequently health care and social services. Informal caregivers in Italy spent more time in caregiving than the Swedish ones (6.3 and 3.7 h per day, respectively). Factors associated with an increased time were country of origin, PwD level of dependency, living situation, use of formal care services and occupation. Conclusions: Care and service utilization significantly varies between Sweden and Italy. The level of formal care support received by the caregivers has a significant impact on time spent on informal care. Knowledge on the factors triggering formal care resources utilization by PwD and their caregivers might further support care services planning and delivery across different countries. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Open AccessArticle Healthy Lifestyle: Relationship between Mediterranean Diet, Body Composition and Physical Fitness in 13 to 16-Years Old Icelandic Students
Int. J. Environ. Res. Public Health 2018, 15(12), 2632; https://doi.org/10.3390/ijerph15122632
Received: 27 September 2018 / Revised: 11 November 2018 / Accepted: 21 November 2018 / Published: 24 November 2018
Cited by 1 | PDF Full-text (2202 KB) | HTML Full-text | XML Full-text
Abstract
Childhood and adolescent obesity are currently among the greatest challenges for public health. Physical activity, physical fitness, and adherence to the Mediterranean diet (MD), representing powerful indicators of healthy lifestyles, are shown as determinant factors in the prevention and treatment of obesity. The [...] Read more.
Childhood and adolescent obesity are currently among the greatest challenges for public health. Physical activity, physical fitness, and adherence to the Mediterranean diet (MD), representing powerful indicators of healthy lifestyles, are shown as determinant factors in the prevention and treatment of obesity. The aim of the present study has been to analyse the relationship between health-related physical fitness components, body composition, and adherence to MD in 387 Icelandic adolescents of 13–16-years old (54% boys). The ALPHA Fitness Test was used to measure physical fitness and body composition. The KIDMED questionnaire was used to assess the adherence to MD among participants. Associations between variables were tested according to gender and age using linear regression models and analysis of variance. Participants with high/medium adherence to MD showed significantly higher endurance scores in both the boys and the girls. Gender differences were found. The boys in high/medium MD categories had significantly lower fat percentages and ran a 4 × 10 m sprint faster than the girls. The girls scored higher than the boys in endurance and speed-agility tests. It can be concluded that a high and medium adherence to MD is associated with high and very high endurance in both the girls and the boys. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle A Fuzzy Comprehensive Assessment and Hierarchical Management System for Urban Lake Health: A Case Study on the Lakes in Wuhan City, Hubei Province, China
Int. J. Environ. Res. Public Health 2018, 15(12), 2617; https://doi.org/10.3390/ijerph15122617
Received: 13 October 2018 / Revised: 6 November 2018 / Accepted: 18 November 2018 / Published: 22 November 2018
PDF Full-text (1607 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Environmental assessment of eutrophication or heavy metals in urban lakes is an important reference for identifying the pollution degree and formulating pollution prevention strategies. At present, the most research on lake health states is often evaluated from a single angle for toxic metals [...] Read more.
Environmental assessment of eutrophication or heavy metals in urban lakes is an important reference for identifying the pollution degree and formulating pollution prevention strategies. At present, the most research on lake health states is often evaluated from a single angle for toxic metals pollution or eutrophication using the standard comparison method for both, the comprehensive trophic level index (TLI), and the health risk assessment for toxic metals. Moreover, the above deterministic methods probably lead to biased or unreliable assessment due to the randomness and fuzziness in environment system caused by natural change and human activities. In this paper, a fuzzy comprehensive lake health assessment method (FCLHAM) was established to evaluate comprehensive lake health states more comprehensively and accurately, which integrates quantitative eutrophication and health risk considerations. To test and verify FCLHAM, 21 lakes, scientifically selected from the total 143 lakes in the Chinese Wuhan city as study case, were investigated and analyzed for their state of eutrophication and the health risk posed by heavy metals. According to the FCLHAM, the average comprehensive lake health state decreased in the sequence of L20 (considerate risk level) > L1–L17, L19, L21 (moderate risk level) > L18 (low risk level). Based on the result, lakes were classified into three categories: general management (L18), enhanced management (L1–L17, L19, L21), and priority management (L20). If the 143 lakes in Wuhan were classified by the “area-region-function” classification, they would be assigned to the same category as the representative lakes of the same type. At this point, we will attribute all of Wuhan’s lakes to the three types. Depending on the characteristics of each type, a targeted approach to different types of management for each type of lake is a more efficient way to manage many of Wuhan’s lakes. This management mode also serves as an effective reference for the environmental management of urban lakes both at home and abroad. In other words, according to the FCLHAM, a hierarchical management system based on lake characteristics classification was obtained. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Body Mass Index and Helicobacter pylori among Obese and Non-Obese Patients in Najran, Saudi Arabia: A Case-Control Study
Int. J. Environ. Res. Public Health 2018, 15(11), 2586; https://doi.org/10.3390/ijerph15112586
Received: 12 October 2018 / Revised: 13 November 2018 / Accepted: 16 November 2018 / Published: 19 November 2018
PDF Full-text (312 KB) | HTML Full-text | XML Full-text
Abstract
Objective: We examine obese and non-obese patients with respect to Helicobacter pylori (H. pylori) positive-infection (HPPI) and associated factors, specifically body mass index (BMI). Methods: This study took place in the Department of Endoscopy of a central hospital in [...] Read more.
Objective: We examine obese and non-obese patients with respect to Helicobacter pylori (H. pylori) positive-infection (HPPI) and associated factors, specifically body mass index (BMI). Methods: This study took place in the Department of Endoscopy of a central hospital in the Najran region of Saudi Arabia (SA). A total of 340 obese Saudi patients (BMI ≥ 30 kg/m2) who had undergone diagnostic upper endoscopy before sleeve gastrectomy, were compared with 340 age and gender-matched control patients (BMI < 30 kg/m2) who had undergone diagnostic upper endoscopy for other reasons. Data collected included diagnosis of HPPI. Descriptive and multivariable binary logistic regression was conducted. Results: Mean patient age was 31.22 ± 8.10 years, and 65% were males. The total prevalence of HPPI was 58% (95% CI = 54–61%) with obese patients presenting significantly more HPPI than non-obese patients (66% vs. 50%, OR = 1.98, 95% CI = 1.45–2.70, p < 0.0005). Age and gender did not associate significantly with HPPI (p = 0.659, 0.200, respectively) and increases in BMI associated significantly with increases in HPPI (p < 0.0005). BMI remained a significant factor in HPPI when modelled with both age and gender (OR = 1.022, 95% CI = 1.01–1.03, p < 0.0005). Conclusions: Within the limitations of this study, the significance of HPPI in obese Saudi patients residing in the Najran region in SA was demonstrated alongside the significance role of BMI in HPPI. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Open AccessArticle Aircraft-Assisted Pilot Suicides in the General Aviation Increased for One-Year Period after 11 September 2001 Attack in the United States
Int. J. Environ. Res. Public Health 2018, 15(11), 2525; https://doi.org/10.3390/ijerph15112525
Received: 13 September 2018 / Revised: 15 October 2018 / Accepted: 6 November 2018 / Published: 12 November 2018
PDF Full-text (456 KB) | HTML Full-text | XML Full-text
Abstract
Pilot aircraft-assisted suicides (AAS) are rare, and there is limited understanding of copycat phenomenon among aviators. The aim of this study was to evaluate the possible effect the 11 September 2001, terrorist attacks had on pilot AASs in the U.S. Fatal aviation accidents [...] Read more.
Pilot aircraft-assisted suicides (AAS) are rare, and there is limited understanding of copycat phenomenon among aviators. The aim of this study was to evaluate the possible effect the 11 September 2001, terrorist attacks had on pilot AASs in the U.S. Fatal aviation accidents in the National Transportation Safety Board (NTSB) database were searched using the following search words: “suicide”, “murder-suicide” and “homicide-suicide”. The timeline between 11 September 1996, and 11 September 2004, was analyzed. Only those accidents in which NTSB judged that the cause of the accident was suicide were included in the final analysis. The relative risk (RR) of the pilot AASs in all fatal accidents in the U.S. was calculated in order to compare the one, two, and three-year periods after the September 11 terrorist attacks with five years preceding the event. The RR of a fatal general aviation aircraft accident being due to pilot suicide was 3.68-fold (95% confidence interval 1.04–12.98) during the first year after 11 September 2001, but there was not a statistically significant increase in the later years. This study showed an association, albeit not determinate causal effect, of a very specific series of simultaneous terrorist murder-suicides with subsequent pilot AASs. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Generalized Self-Efficacy, Dispositional Optimism, and Illness Acceptance in Women with Polycystic Ovary Syndrome
Int. J. Environ. Res. Public Health 2018, 15(11), 2484; https://doi.org/10.3390/ijerph15112484
Received: 12 October 2018 / Revised: 2 November 2018 / Accepted: 4 November 2018 / Published: 7 November 2018
PDF Full-text (322 KB) | HTML Full-text | XML Full-text
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common chronic endocrinopathies affecting between 5 and 10% of reproductive age women. A diagnosis of PCOS very often causes a deterioration in the woman’s self-esteem and self-image, and consequently her quality of life (QoL). [...] Read more.
Polycystic ovary syndrome (PCOS) is one of the most common chronic endocrinopathies affecting between 5 and 10% of reproductive age women. A diagnosis of PCOS very often causes a deterioration in the woman’s self-esteem and self-image, and consequently her quality of life (QoL). The purpose of the study was to investigate generalized self-efficacy, dispositional optimism and acceptance of illness in women with PCOS and to explore factors that affect these variables. The study was performed between January and November 2016 among women with PCOS using health care services. The study used a diagnostic survey with questionnaires. The research instruments included the Generalized Self-Efficacy Scale (GSES), the Life Orientation Test-Revised (LOT-R), the Acceptance of Illness Scale (AIS), and a standardized interview questionnaire. Among the PCOS patients studied, the mean score for generalized self-efficacy was 28.74 (±5.16), dispositional optimism—13.56 (±4.28), and acceptance of illness—27.90 (±7.74). The respondents’ generalized self-efficacy was determined by their residence, education, socio-economic standing, BMI, and time from diagnosis (p < 0.05), while socio-economic standing was a determinant of dispositional optimism (p < 0.05). Determinants of illness acceptance in women with PCOS included their residence, socio-economic standing, and time from diagnosis (p < 0.05). Increased generalized self-efficacy and dispositional optimism contributed to more illness acceptance in PCOS patients. The present study, compared with others on the subject, will enable specialists providing care to women with PCOS to gain a deeper and more comprehensive understanding of the situation and condition of their patients. It will also allow for a better response to the needs of PCOS patients, and provide them with individualized, holistic specialist care, diagnostics, and treatment. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Open AccessArticle An Epidemiological Analysis of Head Injuries in Taiwan
Int. J. Environ. Res. Public Health 2018, 15(11), 2457; https://doi.org/10.3390/ijerph15112457
Received: 30 September 2018 / Revised: 25 October 2018 / Accepted: 1 November 2018 / Published: 4 November 2018
PDF Full-text (1311 KB) | HTML Full-text | XML Full-text
Abstract
Traumatic head injuries occur frequently in Taiwan, having catastrophic consequences for the victims, their families, and society as a whole. However, little is known about the risk factors at the population level in Taiwan. The primary aim of this study was to obtain [...] Read more.
Traumatic head injuries occur frequently in Taiwan, having catastrophic consequences for the victims, their families, and society as a whole. However, little is known about the risk factors at the population level in Taiwan. The primary aim of this study was to obtain more information on these variables and their relationships. Another aim was to analyze the effects of independent variables such as sex, age, residency, pre-existing conditions, mechanisms of injury, associated injuries, and severity on the probability of in-hospital death. Using the 2007–2008 total admissions claim dataset from Taiwan’s National Health Insurance system, total admissions due to acute head injury were selected for further analysis. The obtained data included patient demographics and trauma hospitalization rate. A total of 99,391 patients were admitted with head injury, 48,792 of which had moderate-to-severe head injury. There were 4935 cases recorded as in-hospital mortality and the standardized in-hospital mortality rate was 10.7 deaths per 100,000 person-years. The mortality rate increased with age. After adjustments, male sex, age older than 54 years, living in a rural area, lower monthly income, a Charlson comorbidity index greater than one, being a pedestrian hit by a motor vehicle, fall from a height, and having significant chest, abdominal, or lower extremity injury increased the risk of death during admission. This population-based analysis provides information about the incidence rate and death rate for admissions in Taiwan due to acute head injury and the factors that affect in-hospital mortality. Our results that highlight the risk factors for adverse outcome can help us prevent or improve rural area trauma care of head injury patients in the future. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Spatial Analysis of Socio-Economic and Demographic Factors Associated with Contraceptive Use among Women of Childbearing Age in Rwanda
Int. J. Environ. Res. Public Health 2018, 15(11), 2383; https://doi.org/10.3390/ijerph15112383
Received: 7 August 2018 / Revised: 19 October 2018 / Accepted: 25 October 2018 / Published: 27 October 2018
PDF Full-text (960 KB) | HTML Full-text | XML Full-text
Abstract
Contraceptive use is considered as essential for protecting women’s health and rights, influencing fertility and population growth, and helping to promote economic development. The main objective of this study was to analysis the factors and spatial correlates of contraceptive use among women of [...] Read more.
Contraceptive use is considered as essential for protecting women’s health and rights, influencing fertility and population growth, and helping to promote economic development. The main objective of this study was to analysis the factors and spatial correlates of contraceptive use among women of childbearing age. The 2015 Rwanda Demographic and Health Survey (RDHS) data were used to identify the factors associated with contraceptive use in Rwanda. A Bayesian geo-additive model was used in order to account for fixed effects, nonlinear effects, spatial and random effects inherent in the data. The overall prevalence of use of any contraceptive method among married women of childbearing age in Rwanda was 52.7%. A woman’s age, wealth quintile, level of education, working status, number of living children, and exposure to the media was found to increase contraceptive use. The findings from the study also found disparities in contraceptive use at provincial and district level, where prevalence was higher in districts of Northern provinces and lower in districts of western provinces. The findings of this study suggest that exposure to information on contraceptive use in health centres, empowerment of women to access quality contraceptive-use services and religions to play an important role in explaining and informing their adherents on the importance of using a contraceptive method. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Depression and Its Association with Health-Related Quality of Life in Postmenopausal Women in Korea
Int. J. Environ. Res. Public Health 2018, 15(11), 2327; https://doi.org/10.3390/ijerph15112327
Received: 28 September 2018 / Revised: 19 October 2018 / Accepted: 21 October 2018 / Published: 23 October 2018
Cited by 1 | PDF Full-text (290 KB) | HTML Full-text | XML Full-text
Abstract
Menopause is associated with depressive symptoms that can significantly affect a woman’s quality of life. The objective of this study was to evaluate the association between depression and health-related quality of life (HRQoL) in postmenopausal women. In this cross-sectional descriptive study, participants ( [...] Read more.
Menopause is associated with depressive symptoms that can significantly affect a woman’s quality of life. The objective of this study was to evaluate the association between depression and health-related quality of life (HRQoL) in postmenopausal women. In this cross-sectional descriptive study, participants (n = 3860) were selected from the 2013–2015 Korea National Health and Nutrition Examination Survey (KNHANES). The sociodemographic characteristics, medical history of depression, and EQ-5D scores of the participants were obtained from the KNHANES dataset. Age, educational level, and income were associated with HRQoL in these participants. Moreover, depression exerted a considerable influence on HRQoL in postmenopausal women. The adjusted odds ratios in participants with depression for the EQ-5D dimensions were as follows: 5.52 (95% CI = 4.04–7.55, p < 0.001) for anxiety/depression, 3.86 (95% CI = 2.78–5.36, p < 0.001) for usual activities, and 2.52 (95% CI = 1.68–3.78, p < 0.001) for self-care. Our findings suggest a strong association between depression and HRQoL. Hence, preventing the onset or exacerbation of depression may significantly improve quality of life in postmenopausal women. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Open AccessArticle Parenting Desire and Minority Stress in Lesbians and Gay Men: A Mediation Framework
Int. J. Environ. Res. Public Health 2018, 15(10), 2318; https://doi.org/10.3390/ijerph15102318
Received: 26 September 2018 / Revised: 17 October 2018 / Accepted: 19 October 2018 / Published: 22 October 2018
PDF Full-text (1044 KB) | HTML Full-text | XML Full-text
Abstract
Despite the rapid increase in lesbian and gay (LG) people who desire and decide to become parents, LG childless individuals may encounter serious obstacles in the parenthood process, such as minority stress. Notwithstanding, the psychological processes by which prejudice events might affect the [...] Read more.
Despite the rapid increase in lesbian and gay (LG) people who desire and decide to become parents, LG childless individuals may encounter serious obstacles in the parenthood process, such as minority stress. Notwithstanding, the psychological processes by which prejudice events might affect the desire to become parents are still understudied. As an extension of the minority stress theory, the psychological mediation framework sheds light on these psychological processes, as it encompasses a more clinical view of stress. Within this framework, the current study aimed at assessing the role of prejudice events in affecting parenting desire in 290 childless Italian LG individuals (120 lesbians and 170 gay men), as well as the role of internalized heterosexism and sexual orientation concealment in mediating the relationship between prejudice events and parenting desire. The results suggest that only in lesbians prejudice events were negatively associated with parenting desire, and that sexual orientation concealment and internalized heterosexism were also negatively associated with parenting desire. Furthermore, sexual orientation concealment, and not internalized heterosexism, mediated the relationship between prejudice events and parenting desire in lesbians, but not gay men. The findings have important implications for clinical practice. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Health-Related Quality of Life among People Applying for Housing Adaptations: Associated Factors
Int. J. Environ. Res. Public Health 2018, 15(10), 2130; https://doi.org/10.3390/ijerph15102130
Received: 30 August 2018 / Revised: 24 September 2018 / Accepted: 25 September 2018 / Published: 27 September 2018
PDF Full-text (338 KB) | HTML Full-text | XML Full-text
Abstract
Housing adaptations (HA) clients are a heterogeneous group of people with disabilities experiencing restricted performance and participation in everyday life. While health-related quality of life is a common and relevant outcome in health care research, associated factors among HA clients are largely unknown. [...] Read more.
Housing adaptations (HA) clients are a heterogeneous group of people with disabilities experiencing restricted performance and participation in everyday life. While health-related quality of life is a common and relevant outcome in health care research, associated factors among HA clients are largely unknown. Thus, the aim of this study was to investigate which factors are associated with health-related quality of life among HA clients in Sweden. The study has a cross-sectional design, using baseline data collected among 224 participants in three municipalities in Sweden. The main outcome was health-related quality of life measured by the EQ-5D. Factors investigated as potentially associated were age, sex, living conditions, cognitive impairment, usability of the home, activities of daily living (ADL) dependence, participation, and fear of falling. The associations were explored using multiple linear regression analysis. Younger age and higher dependence in ADL were associated with lower scores on the EQ-5D. The social aspect of usability in the home had a positive association with the EQ VAS. Results suggest that certain groups of HA clients might be at risk for low health-related quality of life. Knowledge of their characteristics can potentially improve development and implementation of tailored interventions aiming at increasing their health-related quality of life. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Open AccessArticle Oral Microbiota of the Snake Bothrops lanceolatus in Martinique
Int. J. Environ. Res. Public Health 2018, 15(10), 2122; https://doi.org/10.3390/ijerph15102122
Received: 17 August 2018 / Revised: 17 September 2018 / Accepted: 19 September 2018 / Published: 27 September 2018
PDF Full-text (713 KB) | HTML Full-text | XML Full-text
Abstract
In Martinique, Bothrops lanceolatus snakebite, although relatively uncommon (~30 cases/year), may result in serious complications such as systemic thrombosis and local infections. Infections have been hypothesized to be related to bacteria present in the snake’s oral cavity. In this investigation, we isolated, identified, [...] Read more.
In Martinique, Bothrops lanceolatus snakebite, although relatively uncommon (~30 cases/year), may result in serious complications such as systemic thrombosis and local infections. Infections have been hypothesized to be related to bacteria present in the snake’s oral cavity. In this investigation, we isolated, identified, and studied the susceptibility to beta-lactams of bacteria sampled from the oral cavity of twenty-six B. lanceolatus specimens collected from various areas in Martinique. Microbiota from B. lanceolatus oral cavity was polymicrobial. Isolated bacteria belonged to fifteen different taxa; the most frequent being Aeromonas hydrophyla (present in 50% of the samples), Morganella morganii, Klebsiella pneumoniae, Bacillus spp., and Enterococcus spp. Analysis of antibiotic susceptibility revealed that 66.7% of the isolated bacteria were resistant to amoxicillin/clavulanate. In contrast, the majority of isolated bacteria were susceptible to the third-generation cephalosporins (i.e., 73.3% with cefotaxime and 80.0% with ceftazidime). Microbiota from B. lanceolatus oral cavity is polymicrobial with bacteria mostly susceptible to third-generation cephalosporins but rarely to amoxicillin/clavulanate. In conclusion, our findings clearly support that first-line antibiotic therapy in the B. lanceolatus-bitten patients, when there is evidence of infection, should include a third-generation cephalosporin rather than amoxicillin/clavulanate. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessFeature PaperArticle Diagnosis on Transport Risk Based on a Combined Assessment of Road Accidents and Watershed Vulnerability to Spills of Hazardous Substances
Int. J. Environ. Res. Public Health 2018, 15(9), 2011; https://doi.org/10.3390/ijerph15092011
Received: 13 August 2018 / Revised: 8 September 2018 / Accepted: 9 September 2018 / Published: 14 September 2018
PDF Full-text (2204 KB) | HTML Full-text | XML Full-text
Abstract
Roads play an important role in the economic development of cities and regions, but the transport of cargo along highways may represent a serious environmental problem because a large portion of transported goods is composed of dangerous products. In this context, the development [...] Read more.
Roads play an important role in the economic development of cities and regions, but the transport of cargo along highways may represent a serious environmental problem because a large portion of transported goods is composed of dangerous products. In this context, the development and validation of risk management tools becomes extremely important to support the decision-making of people and agencies responsible for the management of road enterprises. In the present study, a method for determination of environmental vulnerability to road spills of hazardous substances is coupled with accident occurrence data in a highway, with the purpose to achieve a diagnosis on soil and water contamination risk and propose prevention measures and emergency alerts. The data on accident occurrences involving hazardous and potentially harmful products refer to the highway BR 050, namely the segment between the Brazilian municipalities of Uberaba and Uberlândia. The results show that many accidents occurred where vulnerability is high, especially in the southern sector of the segment, justifying the implementation of prevention and alert systems. The coupling of vulnerability and road accident data in a geographic information system proved efficient in the preparation of quick risk management maps, which are essential for alert systems and immediate environmental protection. Overall, the present study contributes with an example on how the management of risk can be conducted in practice when the transport of dangerous substances along roads is the focus problem. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Impact of the Regional Network for AMI in the Management of STEMI on Care Processes, Outcomes and Health Inequities in the Veneto Region, Italy
Int. J. Environ. Res. Public Health 2018, 15(9), 1980; https://doi.org/10.3390/ijerph15091980
Received: 13 August 2018 / Revised: 7 September 2018 / Accepted: 9 September 2018 / Published: 11 September 2018
PDF Full-text (1354 KB) | HTML Full-text | XML Full-text
Abstract
Cardiovascular diseases are a leading cause of death in Europe. Outcomes in terms of mortality and health equity in the management of patients with ST-Elevation Myocardial Infarction (STEMI) are influenced by health care service organization. The main aim of the present study was [...] Read more.
Cardiovascular diseases are a leading cause of death in Europe. Outcomes in terms of mortality and health equity in the management of patients with ST-Elevation Myocardial Infarction (STEMI) are influenced by health care service organization. The main aim of the present study was to examine the impact of the new organizational model of the Veneto Region’s network for Acute Myocardial Infarction (AMI) to facilitate primary percutaneous coronary intervention (PCI) on STEMI, and its efficacy in reducing health inequities. A retrospective cohort study was conducted on HDRs in the Veneto Region for the period 2007–2016, analyzing 65,261 hospitalizations for AMI. The proportion of patients with STEMI treated with PCI within 24 h increased significantly for men and women, and was statistically much higher for patients over 75 years of age (APC, 75–84: 9.8; >85: 12.5) than for younger patients (APC, <45: 3.3; 45–64: 4.9), with no difference relating to citizenship. The reduction in in-hospital, STEMI-related mortality was only statistically significant for patients aged 75–84 (APC: −3.0 [−4.5;−1.6]), and for Italians (APC: −1.9 [−3.2;−0.6]). Multivariate analyses confirmed a reduction in the disparities between socio-demographic categories. Although the new network improved the care process and reduced health care disparities in all subgroups, these efforts did not result in the expected survival benefit in all patient subgroups. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Developing an Awareness Campaign to Reduce Second Hand Smoke Among Disadvantaged Families—A Participatory M-Health Approach
Int. J. Environ. Res. Public Health 2018, 15(9), 1945; https://doi.org/10.3390/ijerph15091945
Received: 14 August 2018 / Revised: 3 September 2018 / Accepted: 5 September 2018 / Published: 6 September 2018
PDF Full-text (1545 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Children from disadvantaged families are particularly exposed to second hand smoke in their home environment. Using a mixed methods participatory approach, we aimed at identifying suitable media channels and appropriate content for a campaign increasing caregivers’ knowledge about the risks of second hand [...] Read more.
Children from disadvantaged families are particularly exposed to second hand smoke in their home environment. Using a mixed methods participatory approach, we aimed at identifying suitable media channels and appropriate content for a campaign increasing caregivers’ knowledge about the risks of second hand smoke (SHS) exposure for their children and appropriate measures for exposure reduction. In the first phase of the mixed method design, we evaluated knowledge and norms about children’s SHS and perceived barriers for avoiding it. To this end, we conducted 26 one-to-one interviews with smoking caregivers of children below the age of six years. Subsequently, we developed and illustrated core messages and identified appropriate communication channels. These were evaluated in focus group discussions by 20 of the 26 interview participants. After a final revision, 121 caregivers evaluated the campaign via an online questionnaire. Online social networks were identified as the most suitable media channel. For these, we developed animated photos with voiceovers addressing the potential consequences of SHS for children. The overall rating of the campaign messages was promising. Participants confirmed that it was important to address the issue in social media. However, sharing the pictures was considered unlikely due to the sensitive topic of the campaign, while the importance of doctors or scientists being recognizable as a source was highlighted. Employing a participatory approach, we developed an m-health campaign, which can now be disseminated in social networks to reach the target population. The effectiveness of the campaign should be evaluated. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Using a Clustering Approach to Investigate Socio-Environmental Inequality in Preterm Birth—A Study Conducted at Fine Spatial Scale in Paris (France)
Int. J. Environ. Res. Public Health 2018, 15(9), 1895; https://doi.org/10.3390/ijerph15091895
Received: 19 July 2018 / Revised: 23 August 2018 / Accepted: 29 August 2018 / Published: 31 August 2018
PDF Full-text (1314 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Background & Objectives: Today, to support public policies aiming to tackle environmental and health inequality, identification and monitoring of the spatial pattern of adverse birth outcomes are crucial. Spatial identification of the more vulnerable population to air pollution may orient health interventions. [...] Read more.
Background & Objectives: Today, to support public policies aiming to tackle environmental and health inequality, identification and monitoring of the spatial pattern of adverse birth outcomes are crucial. Spatial identification of the more vulnerable population to air pollution may orient health interventions. In this context, the objective of this study is to investigate the geographical distribution of the risk of preterm birth (PTB, gestational age ≤36 weeks) at the census block level in in city of Paris, France. We also aimed to assess the implication of neighborhood characteristics including air pollution and socio-economic deprivation. Material & Methods: Newborn health data are available from the first birth certificate registered by the Maternal and Child Care department of Paris. All PTB from January 2008 to December 2011 were geocoded at the mother residential census block. Each census block was assigned a socioeconomic deprivation level and annual average ambient concentrations of NO2. A spatial clustering approach was used to investigate the spatial distribution of PTB. Results: Our results highlight that PTB is non-randomly spatially distributed, with a cluster of high risk in the northeastern area of Paris (RR = 1.15; p = 0.06). After adjustment for socio-economic deprivation and NO2 concentrations, this cluster becomes not statistically significant or shifts suggesting that these characteristics explain the spatial distribution of PTB; further, their combination shows an interaction in comparison with SES or NO2 levels alone. Conclusions: Our results may inform the decision makers about the areas where public health efforts should be strengthened to tackle the risk of PTB and to choose the most appropriate and specific community-oriented health interventions. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Comparative Evaluation of Arabin Pessary and Cervical Cerclage for the Prevention of Preterm Labor in Asymptomatic Women with High Risk Factors
Int. J. Environ. Res. Public Health 2018, 15(4), 791; https://doi.org/10.3390/ijerph15040791
Received: 17 March 2018 / Revised: 11 April 2018 / Accepted: 12 April 2018 / Published: 18 April 2018
PDF Full-text (1264 KB) | HTML Full-text | XML Full-text
Abstract
Objective: Preterm labor is one of the most significant obstetric problems associated with high rate of actual and long-term perinatal complications. Despite the creation of scoring systems, uterine activity monitoring, cervical ultrasound and several biochemical markers, the prediction and prevention of preterm labor [...] Read more.
Objective: Preterm labor is one of the most significant obstetric problems associated with high rate of actual and long-term perinatal complications. Despite the creation of scoring systems, uterine activity monitoring, cervical ultrasound and several biochemical markers, the prediction and prevention of preterm labor is still a matter of concern. The aim of this study was to examine cervical findings for the prediction and the comparative use of Arabin pessary or cerclage for the prevention of preterm birth in asymptomatic women with high risk factors for preterm labor. Material and methods: The study group was composed of singleton pregnancies (spontaneously conceived) with high risk factors for preterm labor. Cervical length, dilatation of the internal cervical os and funneling, were estimated with transvaginal ultrasound during the first and the second trimesters of pregnancy. Results: Cervical funneling, during the second trimester of pregnancy, was the most significant factor for the prediction of preterm labor. The use of Arabin cervical pessary was found to be more effective than cerclage in the prolongation of pregnancy. Conclusion: In women at risk for preterm labor, the detection of cervical funneling in the second trimester of pregnancy may help to predict preterm labor and to apply the appropriate treatment for its prevention. Although the use of cervical pessary was found to be more effective than cerclage, more studies are needed to classify the effectiveness of different methods for such prevention. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessArticle Medical and Legal Aspects of Child Sexual Abuse: A Population-Based Study in a Hungarian County
Int. J. Environ. Res. Public Health 2018, 15(4), 701; https://doi.org/10.3390/ijerph15040701
Received: 1 March 2018 / Revised: 5 April 2018 / Accepted: 5 April 2018 / Published: 9 April 2018
PDF Full-text (299 KB) | HTML Full-text | XML Full-text
Abstract
Background: Very few studies focus on childhood sexual abuse in middle European countries. Aim: The purpose of our study is to describe the medical and legal characteristics of children who experience sexual abuse and explore common features that may result in strategies for [...] Read more.
Background: Very few studies focus on childhood sexual abuse in middle European countries. Aim: The purpose of our study is to describe the medical and legal characteristics of children who experience sexual abuse and explore common features that may result in strategies for prevention. Methods: Between 2000 and 2015, 400 girls and 26 boys under the age of 18, suspected of being sexually abused, visited one of the four hospitals in a Hungarian county. Results: Mean age at onset was 10.81 years for boys, 13.46 years for girls. In 278 cases (65.3%), the perpetrator was known to the victim, and a stranger was suspected in 148 cases (34.7%). In 79 cases (30.7% of boys and 17.7% of girls), a family member was the accused perpetrator. In more than one-third (boys) and in one-fifth (girls) of cases, sexual abuse had occurred on multiple occasions. In the case of boys, child and adolescent sexual abuse (CSA) included oral genital, genital touching and genital to genital contact in 14 cases (53.8%) and anal intercourse in 12 (46.2%) cases. In case of girls, sexual abuse included coitus in 219 (54.8%), oral genital, genital touching, genital to genital contact in 164 (41.0%), anal abuse in 14 (3.5%) cases, physical injury was incurred in 15 cases. Legal proceedings followed the CSA in 205 (48.1%) cases. Conclusion: The results highlight the urgent need to address the issue of sexual abuse in Hungary and minimize its impact. Prevention requires a systematic and lifelong approach to educating children about personal space safety and privacy to reduce vulnerability and is the responsibility of parents and professionals. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Open AccessArticle Ethylenediamine-N,N′-Disuccinic Acid (EDDS)—Enhanced Flushing Optimization for Contaminated Agricultural Soil Remediation and Assessment of Prospective Cu and Zn Transport
Int. J. Environ. Res. Public Health 2018, 15(3), 543; https://doi.org/10.3390/ijerph15030543
Received: 7 February 2018 / Revised: 12 March 2018 / Accepted: 15 March 2018 / Published: 18 March 2018
Cited by 11 | PDF Full-text (12732 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
This paper presents the results of an experimental study aimed at investigating the effect of operative parameters on the efficiency of a soil flushing process, conducted on real contaminated soil containing high amounts of Cu and Zn. Soil flushing tests were carried out [...] Read more.
This paper presents the results of an experimental study aimed at investigating the effect of operative parameters on the efficiency of a soil flushing process, conducted on real contaminated soil containing high amounts of Cu and Zn. Soil flushing tests were carried out with Ethylenediamine-N,N′-disuccinic acid (EDDS) as a flushing agent due to its high biodegradability and environmentally friendly characteristics. Process parameters such as Empty-Bed Contact Time (EBCT) and EDDS solution molarity were varied from 21–33 h and from 0.36–3.6 mM, respectively. Effects on the mobility of cations such as Fe and Mn were also investigated. Results showed that very high performances can be obtained at [EDDS] = 3.6 mM and EBCT = 33 h. In these conditions, in fact, the amount of removed Cu was 53%, and the amount of removed Zn was 46%. Metal distribution at different depths from the top surface revealed that Cu has higher mobility than Zn. The process results were strongly dependent on the exchange of metals due to the different stability constants of the EDDS complexes. Finally, results from a comparative study showed that soil washing treatment reached the same removal efficiency of the flushing process in a shorter time but required a larger amount of the EDDS solution. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Graphical abstract

Open AccessArticle Exposure to Night-Time Traffic Noise, Melatonin-Regulating Gene Variants and Change in Glycemia in Adults
Int. J. Environ. Res. Public Health 2017, 14(12), 1492; https://doi.org/10.3390/ijerph14121492
Received: 8 November 2017 / Revised: 24 November 2017 / Accepted: 29 November 2017 / Published: 1 December 2017
Cited by 5 | PDF Full-text (837 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Traffic noise has been linked to diabetes, with limited understanding of its mechanisms. We hypothesize that night-time road traffic noise (RTN) may impair glucose homeostasis through circadian rhythm disturbances. We prospectively investigated the relationship between residential night-time RTN and subsequent eight-year change in [...] Read more.
Traffic noise has been linked to diabetes, with limited understanding of its mechanisms. We hypothesize that night-time road traffic noise (RTN) may impair glucose homeostasis through circadian rhythm disturbances. We prospectively investigated the relationship between residential night-time RTN and subsequent eight-year change in glycosylated hemoglobin (ΔHbA1c) in 3350 participants of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA), adjusting for diabetes risk factors and air pollution levels. Annual average RTN (Lnight) was assigned to participants in 2001 using validated Swiss noise models. HbA1c was measured in 2002 and 2011 using liquid chromatography. We applied mixed linear models to explore RTN–ΔHbA1c association and its modification by a genetic risk score of six common circadian-related MTNR1B variants (MGRS). A 10 dB difference in RTN was associated with a 0.02% (0.003–0.04%) increase in mean ΔHbA1c in 2142 non-movers. RTN–ΔHbA1c association was modified by MGRS among diabetic participants (Pinteraction = 0.001). A similar trend in non-diabetic participants was non-significant. Among the single variants, we observed strongest interactions with rs10830963, an acknowledged diabetes risk variant also implicated in melatonin profile dysregulation. Night-time RTN may impair glycemic control, especially in diabetic individuals, through circadian rhythm disturbances. Experimental sleep studies are needed to test whether noise control may help individuals to attain optimal glycemic levels. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Review

Jump to: Research, Other

Open AccessReview “Back to the Future”: Time for a Renaissance of Public Health Engineering
Int. J. Environ. Res. Public Health 2019, 16(3), 387; https://doi.org/10.3390/ijerph16030387
Received: 21 December 2018 / Revised: 23 January 2019 / Accepted: 26 January 2019 / Published: 29 January 2019
PDF Full-text (664 KB) | HTML Full-text | XML Full-text
Abstract
Public health has always been, and remains, an interdisciplinary field, and engineering was closely aligned with public health for many years. Indeed, the branch of engineering that has been known at various times as sanitary engineering, public health engineering, or environmental engineering was [...] Read more.
Public health has always been, and remains, an interdisciplinary field, and engineering was closely aligned with public health for many years. Indeed, the branch of engineering that has been known at various times as sanitary engineering, public health engineering, or environmental engineering was integral to the emergence of public health as a distinct discipline. However, in the United States (U.S.) during the 20th century, the academic preparation and practice of this branch of engineering became largely separated from public health. Various factors contributed to this separation, including an evolution in leadership roles within public health; increasing specialization within public health; and the emerging environmental movement, which led to the creation of the U.S. Environmental Protection Agency (EPA), with its emphasis on the natural environment. In this paper, we consider these factors in turn. We also present a case study example of public health engineering in current practice in the U.S. that has had large-scale positive health impacts through improving water and sanitation services in Native American and Alaska Native communities. We also consider briefly how to educate engineers to work in public health in the modern world, and the benefits and challenges associated with that process. We close by discussing the global implications of public health engineering and the need to re-integrate engineering into public health practice and strengthen the connection between the two fields. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessReview The Epidemiology of Suicide in Young Men in Greenland: A Systematic Review
Int. J. Environ. Res. Public Health 2018, 15(11), 2442; https://doi.org/10.3390/ijerph15112442
Received: 30 September 2018 / Revised: 25 October 2018 / Accepted: 27 October 2018 / Published: 1 November 2018
PDF Full-text (841 KB) | HTML Full-text | XML Full-text
Abstract
Suicide is the leading cause of death among young men aged 15–29 in Greenland, but few epidemiological studies have described this problem. We aimed to summarise descriptive epidemiological studies of suicide in young men in Greenland compared with other demographic groups in Denmark [...] Read more.
Suicide is the leading cause of death among young men aged 15–29 in Greenland, but few epidemiological studies have described this problem. We aimed to summarise descriptive epidemiological studies of suicide in young men in Greenland compared with other demographic groups in Denmark and Greenland to inform future suicide prevention strategy. We searched PubMed, PsycINFO, and Embase using an agreed search strategy to identify English-language papers describing suicide epidemiology in Greenlandic men aged 15–29. We followed PRISMA guidelines in screening and appraising eligible publications. Eight articles fulfilled inclusion criteria of 64 meeting search criteria. Findings covering 1970–2011 supported a dramatic rise in suicide rates in Greenlandic men aged 15–24 from 1976, who remained the highest-ranking demographic group over 1976–2011 compared with men and women of all age groups in Denmark and Greenland. Highest rates recorded were almost 600 per 100,000 per year in men aged approximately 20–23 over 1977–1986. No studies described suicide epidemiology after 2011, and no studies described risk factors for suicide in young men. Given the very high suicide rates recorded for young men over 1976–2011, such studies will be essential for informing the development and evaluation of appropriate preventive interventions. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Open AccessReview Sepiolite-Based Adsorbents for the Removal of Potentially Toxic Elements from Water: A Strategic Review for the Case of Environmental Contamination in Hunan, China
Int. J. Environ. Res. Public Health 2018, 15(8), 1653; https://doi.org/10.3390/ijerph15081653
Received: 4 July 2018 / Revised: 1 August 2018 / Accepted: 2 August 2018 / Published: 3 August 2018
PDF Full-text (1512 KB) | HTML Full-text | XML Full-text
Abstract
The last few decades have seen rapid industrialization and urban development in many regions globally; with associated pollution by potentially toxic elements; which have become a threat to human health and the food chain. This is particularly prevalent in a number of regions [...] Read more.
The last few decades have seen rapid industrialization and urban development in many regions globally; with associated pollution by potentially toxic elements; which have become a threat to human health and the food chain. This is particularly prevalent in a number of regions in China that host multiple mineral resources and are important agricultural locations. Solutions to protect contamination of the food chain are more effective and sustainable if locally sourced materials are available; and in this context; we review the potential of local (sepiolite) mineral deposits to treat water contamination in the Hunan Municipality; central south China; widely recognized for significant environmental pollution issues (particularly by Hg; Cd; Pb; and Cr) and the high agricultural productivity of the region. Sepiolite is an abundant fibrous clay mineral with modest to good adsorption properties and extensive industrial process applications. It shows reasonable performance as an adsorbent for element removal. In addition; a number of surface modification strategies are available that improve this capability. We review these studies; focused on sorption reaction mechanisms and regeneration potential; with a view to present options for a localized and effective economic strategy for future application. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Other

Jump to: Research, Review

Open AccessBrief Report Associations between Bystanders and Perpetrators of Online Hate: The Moderating Role of Toxic Online Disinhibition
Int. J. Environ. Res. Public Health 2018, 15(9), 2030; https://doi.org/10.3390/ijerph15092030
Received: 29 August 2018 / Revised: 12 September 2018 / Accepted: 15 September 2018 / Published: 17 September 2018
Cited by 1 | PDF Full-text (450 KB) | HTML Full-text | XML Full-text
Abstract
Hatred directed at members of groups due to their origin, race, gender, religion, or sexual orientation is not new, but it has taken on a new dimension in the online world. To date, very little is known about online hate among adolescents. It [...] Read more.
Hatred directed at members of groups due to their origin, race, gender, religion, or sexual orientation is not new, but it has taken on a new dimension in the online world. To date, very little is known about online hate among adolescents. It is also unknown how online disinhibition might influence the association between being bystanders and being perpetrators of online hate. Thus, the present study focused on examining the associations among being bystanders of online hate, being perpetrators of online hate, and the moderating role of toxic online disinhibition in the relationship between being bystanders and perpetrators of online hate. In total, 1480 students aged between 12 and 17 years old were included in this study. Results revealed positive associations between being online hate bystanders and perpetrators, regardless of whether adolescents had or had not been victims of online hate themselves. The results also showed an association between toxic online disinhibition and online hate perpetration. Further, toxic online disinhibition moderated the relationship between being bystanders of online hate and being perpetrators of online hate. Implications for prevention programs and future research are discussed. Full article
(This article belongs to the Special Issue IJERPH: 15th Anniversary)
Figures

Figure 1

Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top