International Journal of Environmental Research and Public Health

Obesity in childhood and adolescence represents a serious health problem worldwide. Similarly, eating disorders (EDs) are complex diseases that affect adolescents with an increasing prevalence and are an alarming health concern to both physical and mental health. Traditionally, obesity and EDs, particularly binge eating disorder (BED), have been considered separate conditions, but there is emerging evidence such as etiology, comorbidities, risk factors, psychosocial impairment, and prevention approaches, highlighting important overlaps among these conditions. In youth, the two conditions share risk factors and consequences at both the physical and psychological levels, requiring special care. Exercise, useful as strategy to prevent and treat overweight conditions, may have beneficial effects on BED symptoms, suggesting that it may be considered as one of the key factors in the treatment of individuals affected by obesity with BED. The purpose of this narrative review is to examine the bidirectional impact of obesity and BED in adolescents, in terms of risk factors, etiology and comorbid conditions. Specifically, we focused on the benefits of physical activity (PA) in the multidisciplinary treatment of subjects affected by obesity with BED. Even though additional research is needed to reach conclusions about the role of exercise in the treatment of obesity and comorbid BED, especially in adolescents, promising results have already suggested that closely monitored exercise is safe and, paired with cognitive behavioral therapy, may provide multiple benefits on both the physical and psychological levels. Tailored and integrated treatments for weight management and eating disorders are important to promptly and effectively treat obese subjects that have BED. Full article

Studies show that children spend considerable time engaged in informal learning outside of educational settings. Informal educational settings such as museums can provide a variety of opportunities to engage children in STEM learning and scientific discovery, which can increase school readiness. Research has also determined an achievement gap in students from low socio-economic backgrounds and in students who are dual language learners. The literature shows that this gap begins even before children enter formal schooling. This systematic review serves two purposes: to explore the impact of informal STEM learning (ISL) on school readiness and to examine the relationship between ISL and children’s social-emotional development, particularly in children who are dual language learners. Using PRISMA procedures, we identified 36 eligible studies in this systematic review. The findings illuminate the important role of parents and/or caregivers and the quality of design and interventions used at ISL sites, such as museums and zoos, on how ISL can impact school readiness for preschoolers. No research was found to specifically address the impact of ISL on school readiness for children who are dual language learners. The implications from the findings suggest that further research is needed on ISL for young children, particularly considering the dearth in research on young dual language learners. The implications further suggest that parents, ISL site designers, facilitators, and educators can benefit from learning about the impact of ISL on school readiness. Full article

The most important asset for a person is their health and wellbeing. While it is possible to keep one’s health at its best, it is common for people to have health shocks (HSs; negative shocks to an individual’s health). In this study, using Chinese Health and Nutrition Survey (CHNS) panel data, we studied the impact of different HSs on income using new modified methods. Thus, we considered the substantial links among different HSs, levels of education, and insurance types, as well as their impact on people’s wealth defined by their income. The core aim of this study is to help devise and guide new policies to reduce the effect of these HSs through the proper use of education and insurance channels. In this research, we used simple pooled OLS regression to measure the different causality estimates of HSs, education, and insurance, as well as their interactions. Obtained through the use of up-to-date panel data, the study results are consistent with previous research using different HS and education measures. The findings of this research suggest revising previous policies concerning education levels and health insurance schemes. Full article

The COVID-19 pandemic has created tremendous challenges for organizations’ corporate social responsibility (CSR), communication, and relationship management with internal stakeholders such as employees. This study conducted an online survey of 466 employees working for large Chinese corporations during the pandemic. A structural equation model based on insights from expectancy violation theory was used to examine how negative violation valence increases employees’ turnover intention as mediated by uncertainty, CSR cynicism, and distrust. The survey results showed that employees’ negative violation valence positively influenced their uncertainty about their organizations’ CSR activities, which fostered their cynicism about CSR and distrust of their organization. Employees’ CSR cynicism increased their distrust toward their organizations, which increased their turnover intention. The theoretical and practical implications of the study are discussed as well. Full article

eHealth interventions use information technology to provide attention to patients with chronic cardiovascular conditions, thereby supporting their self-management abilities. Objective: Identify barriers and aids to the implementation of eHealth interventions in people with chronic cardiovascular conditions from the perspectives of users, health professionals and institutions. Method: An integrative database review of WoS, Scopus, PubMed and Scielo of publications between 2016 and 2020 reporting eHealth interventions in people with chronic cardiovascular diseases. Keywords used were eHealth and chronic disease. Following inclusion and exclusion criteria application, 14 articles were identified. Results: Barriers and aids were identified from the viewpoints of users, health professionals and health institutions. Some notable barriers include users’ age and low technological literacy, perceived depersonalization in attention, limitations in technology access and usability, and associated costs. Aids included digital education and support from significant others. Conclusions: eHealth interventions are an alternative with wide potentiality for chronic disease management; however, their implementation must be actively managed. Full article

(1) Background: While previous studies revealed how underground mining might adversely affect the cardiopulmonary functions of workers, this study further investigated the differences between under- and aboveground mining at both high and low altitudes, which has received little attention in the literature. (2) Methods: Seventy-one healthy male coal mine workers were recruited, who had worked at least 5 years at the mining sites located above the ground at high (>3900 m; n = 19) and low (<120 m; n = 16) altitudes as well as under the ground at high (n = 20) and low (n = 16) altitudes. Participants’ heart rates, pulmonary functions, total energy expenditure and metabolism were measured over a 5-consecutive-day session at health clinics. (3) Results: Combining the results for both above- and underground locations, workers at high-altitude mining sites had significantly higher peak heart rate (HR), minimum average HR and training impulse as well as energy expenditure due to all substances and due to fat than those at low-altitude sites. They also had significantly higher uric acid, total cholesterol, creatine kinase and N-osteocalcin in their blood samples than the workers at low-altitude mining sites. At underground worksites, the participants working at high-altitude had a significantly higher average respiratory rate than those at low-altitude regions. (4) Conclusion: In addition to underground mining, attention should be paid to high-altitude mining as working under a hypoxia condition at such altitude likely presents physiological challenges. Full article

The internet’s convenience and anonymity have facilitated different types of covert fraud, resulting in economic, mental, and social harm to victims. Understanding why people are deceived and implementing appropriate interventions is critical for fraud reduction. Based on the Bayesian brain theory, individuals’ mental states may be a key point in scam compliance and warning compliance. Fraud victims with different mental states may construct various hypotheses and explanations about the fraud they are exposed to, causing different cognition and behavior patterns. Therefore, we first conducted a semi-structured in-depth interview with online fraud victims to investigate the individual and social factors that affect victims’ mental states. Grounded theory analysis showed five core factors influencing scam compliance: psychological traits, empirical factors, motivation, cognitive biases, and emotional imbalance. Based on our findings of psychological processes and deception’s influential factors, we then designed warnings to inform victims of fraud, particularly for those involving novel types of scams. Tested on a real-life setting, our designed warnings effectively enhanced warning compliance, allowing more fraud victims to avoid financial losses. Full article

Although discrete maternal exercise and polyunsaturated fatty acid (PUFA) supplementation individually are beneficial for infant body composition, the effects of exercise and PUFA during pregnancy on infant body composition have not been studied. This study evaluated the body composition of infants born to women participating in a randomized control exercise intervention study. Participants were randomized to aerobic exercise (n = 25) or control (stretching and breathing) groups (n = 10). From 16 weeks of gestation until delivery, the groups met 3×/week. At 16 and 36 weeks of gestation, maternal blood was collected and analyzed for Docosahexaenoic Acid (DHA) and Eicosapentaenoic Acid (EPA). At 1 month postnatal, infant body composition was assessed via skinfolds (SFs) and circumferences. Data from 35 pregnant women and infants were analyzed via t-tests, correlations, and regression. In a per protocol analysis, infants born to aerobic exercisers exhibited lower SF thicknesses of triceps (p = 0.008), subscapular (p = 0.04), SF sum (p = 0.01), and body fat (BF) percentage (%) (p = 0.006) compared with controls. After controlling for 36-week DHA and EPA levels, exercise dose was determined to be a negative predictor for infant skinfolds of triceps (p = 0.001, r² = 0.27), subscapular (p = 0.008, r² = 0.19), SF sum (p = 0.001, r² = 0.28), mid-upper arm circumference (p = 0.049, r² = 0.11), and BF% (p = 0.001, r² = 0.32). There were no significant findings for PUFAs and infant measures: during pregnancy, exercise dose, but not blood DHA or EPA levels, reduces infant adiposity. Full article

Pharmaceutical products, including active pharmaceutical ingredients and inactive ingredients such as packaging materials, have raised significant concerns due to their persistent input and potential threats to human and environmental health. Discourse on reducing pharmaceutical waste and subsequent pollution is often limited, as information about the toxicity of pharmaceuticals in humans is yet to be fully established. Nevertheless, there is growing awareness about ecotoxicity, and efforts to curb pharmaceutical pollution in the European Union (EU), United States (US), and Canada have emerged along with waste disposal and treatment procedures, as well as growing concerns about impacts on human and animal health, such as through antimicrobial resistance. Yet, the outcomes of such endeavors are often disparate and involve multiple agencies, organizations, and departments with little evidence of cooperation, collaboration, or oversight. Environmental health disparities occur when communities exposed to a combination of poor environmental quality and social inequities experience more sickness and disease than wealthier, less polluted communities. In this paper, we discuss pharmaceutical environmental pollution in the context of health disparities and examine policies across the US, EU, and Canada in minimizing environmental pollution. Full article

This study aims to empirically examine the mediating effects of psychological safety and leadership identification on the relationship between inclusive leadership and pro-social rule breaking among hospitality employees. This study analyzes the survey data collected in three waves from 589 employees working in different hotels and restaurants operating in the Northern areas of Khyber Pakhtunkhwa, Pakistan. The scale validity, composite reliability, and hypotheses were assessed through PLS-SEM. The study found that inclusive leadership significantly impacts employees’ pro-social rule-breaking. The study also found that leadership identification and psychological safety partially mediate the relationship between inclusive leadership and pro-social rule-breaking. Hospitality leaders can practice inclusive leadership characteristics because it may significantly enhance employee engagement in pro-social rule-breaking. Through their inclusive features, hospitality leaders can improve employees’ psychological safety and leadership identification, enhancing frontline employees’ pro-social rule-breaking. Full article

This work developed an environmentally-friendly soil remediation method based on BC and g-C₃N₄, and demonstrated the technical feasibility of remediating petroleum-contaminated soil with biochar/graphite carbon nitride (BC/g-C₃N₄). The synthesis of BC/g-C₃N₄ composites was used for the removal of TPH in soil via adsorption and photocatalysis. BC, g-C₃N₄, and BC/g-C₃N₄ have been characterized by scanning electron microscopy (SEM), Brunauer–Emmett–Teller surface area analyzer (BET), FT-IR, and X-ray diffraction (XRD). BC/g-C₃N₄ facilitates the degradation due to reducing recombination and better electron-hole pair separation. BC, g-C₃N₄, and BC/g-C₃N₄ were tested for their adsorption and photocatalytic degradation capacities. Excellent and promising results are brought out by an apparent synergism between adsorption and photocatalysis. The optimum doping ratio of 1:3 between BC and g-C₃N₄ was determined by single-factor experiments. The removal rate of total petroleum hydrocarbons (TPH) by BC/g-C₃N₄ reached 54.5% by adding BC/g-C₃N₄ at a dosing rate of 0.08 g/g in a neutral soil with 10% moisture content, which was 2.12 and 1.95 times of BC and g-C₃N₄, respectively. The removal process of TPH by BC/g-C₃N₄ conformed to the pseudo-second-order kinetic model. In addition, the removal rates of different petroleum components in soil were analyzed in terms of gas chromatography–mass spectrometry (GC-MS), and the removal rates of nC₁₃-nC₃₅ were above 90% with the contaminated soil treated by BC/g-C₃N₄. The radical scavenger experiments indicated that superoxide radical played the major role in the photocatalytic degradation of TPH. This work definitely demonstrates that the BC/g-C₃N₄ composites have great potential for application in the remediation of organic pollutant contaminated soil. Full article

In March 2020, the COVID-19 pandemic led to restricted vocational (Voc-PA) and recreational physical activity (Rec-PA) outside of the home. We conducted a nation-wide survey in the United States (US) during the mitigation peak of the pandemic (June 2020) to assess health-related changes from the previous year. A diet quality (DQ) assessment tool weighted the relative healthfulness of eating occasions from foods prepared-at-home (Home) and away-from-home (Away). Previously-validated instruments assessed PA and demographic variables; height/weight were self-reported to calculate body mass index (BMI). T-tests explored longitudinal, between-sex, and obesity status differences in DQ, PA, and BMI; Pearson correlations explored associations. Of 1648 respondents, 814 valid responses (56.8% female, 81.7% white) were analyzed. Overall and Home DQ was higher for females than males in 2020 (p < 0.001 for both). Respondents increased DQ from 2019 to 2020, primarily from Away (p < 0.001 for both sexes). Total Rec-PA and Voc-PA was higher in males (p = 0.002, p < 0.001) than females in 2020; females reported higher other PA (p = 0.001). Change in BMI was inversely associated with change in both DQ and PA (p < 0.001 for both). In this sample of US adults, early adaptations to the COVID-19 pandemic included improved DQ and BMI. Whether these short-term improvements were maintained warrant further investigation. Full article

Antioxidant activity can be analyzed by various methods, both in vitro and in vivo. The widely used colorimetric method using the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging reaction has many limitations, such as interference from photosynthetic pigments naturally found in plant extracts. The DPPH-HPLC eliminates these troubles by enabling the separation of the DPPH free radical (DPPH-R) peak and its reduced form (DPPH-H) from other extract components. However, simultaneous analysis of antioxidants and evaluation of their activity is more complicated. To date, a post-column reaction with DPPH has been used for this purpose. The aim of the current study was the elaboration on a DPPH-RP-HPLC in gradient elution mode for simultaneous evaluation of the antioxidant activity of standards on the basis of DPPH-R peak inhibition, together with the identification of standards, as well as the products of redox reactions. The following antioxidants (AOs) were used as standards: quercetin, resveratrol, Trolox, chlorogenic acid, hesperetin, and coumarin. Flavone was used as the control chemical without antioxidant activity. The separation of the DPPH-R/DPPH-H pair, together with standards and reaction products, was studied on a C18 column using a gradient of acetonitrile from 5 to 60% within 20 min. The stability of DPPH was evaluated with different gradient profiles. The influence of the addition of acetic acid in concentrations of 0.05 to 1%, the duration of the analysis, and the radiation emitted by the UV lamp of a diode array detector on the induction of DPPH decomposition processes were investigated. The most significant parameter affecting DPPH stability appeared to be the acidic environment and water content in the mobile phase. An increase in the water content from 70 to 95% worsened the LOD of DPPH-R from 31.64 nM to 107.31 nM, as measured at 517 nm, and from 189.41 to 1677.05 nM at 330 nm. Each gradient profile provided good linearity (R² = 0.9790–0.9977) of the relationship between the DPPH-R as well as DPPH-H peak areas, and a wide concentration range from 0.5 to 2.5 mM for UV-vis detection. Free radical scavenging activity was expressed by the percentage of DPPH-R peak inhibition at 517 nm. This simple method is suitable for monitoring DPPH radical scavenging by AO standards. Full article

Introduction: Using digital technology to provide support, medical consultations, healthcare services, and to track the spread of the coronavirus has been identified as an important solution to curb the transmission of the virus. This research paper aims to (1) summarize the digital technologies used during the COVID-19 pandemic to mitigate the transmission of the COVID-19; (2) establish the extent to which digital technology applications have facilitated mitigation of the spread of COVID-19; and (3) explore the facilitators and barriers that impact the usability of digital technologies throughout the pandemic. Methods: A rapid electronic search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted of available records up to June 2022 on the medical databases PubMed, Ovid, Embase, CINHAIL, the Cochrane Library, Web of Science, and Google Scholar. Results: An increasing number and variety of digital health applications have been available throughout the pandemic, such as telehealth, smartphone mobile health apps, machine learning, and artificial intelligence. Each technology has played a particular role in curbing COVID-19 transmission. Different users have gained benefits from using digital technology during the COVID-19 pandemic and different determinants have contributed to accelerating the wheel of digital technology implementation during the pandemic. Conclusion: Digital health during the COVID-19 pandemic has evolved very rapidly, with different applications and roles aimed at curbing the pandemic. Full article

“I remember when sex was safe and skydiving was dangerous” read a popular bumper sticker during the HIV crisis. Popular perceptions of extreme sport (ES) often include the descriptor ‘dangerous’. Therefore, why is the popularity of ES increasing exponentially with “dedicated TV channels, internet sites, high-rating competitions, and high-profile sponsors drawing more participants”? More importantly, how should health practitioners respond to the influx of ES athletes with novel injuries, enquiries and attitudes. This paper describes the results of a collaborative auto-ethnographic approach to answering “what is an extreme sports medicine health care provider and what are the components of an effective Extreme Sports Medicine (ESM) training program?” The study was conducted following the first ESM university course offered in Australia with the intention of assessing the learning design and reflecting on the development and practice of ES health practitioners. We explicated three overarching themes common to both the ES health practitioner and for the effective training of healthcare providers in the support of ES endeavors and athletes. These themes were individual, task and environmental factors. The impacts of these findings confirm that ESM courses are vital and should be designed specifically to ensure that practitioners are effectively supported to develop the unique skills necessary for practice in real world extreme sports events. Full article

Background: Cancer patients’ experiences of the healthcare system, care, and treatment are increasingly viewed as important in order to inform and improve quality of care, patient safety, and treatment efficacy. Understanding patient experience is a key step in moving toward patient-centred care. The aims of this study were to determine the experience of cancer patients in Central and Eastern European countries and to identify the needs and perspectives of oncological patients during the cancer treatment. In this paper, results from Croatia are presented. Methods: A sixty-nine item online survey was translated by native-language participating countries. Only registered members (subjects with confirmed cancer diagnosis) of the national patient oncology associations in each participating country were allowed to access and complete the online questionnaire (n = 16,458). Data were collected between October 2018 to February 2019. The Croatian Coalition of Health Associations enabled the authors of this paper to use the collected data from a sample of the Croatian participants (n = 2460) for the purposes of publication. Results: Two-thirds (67.3%) of the respondents reported satisfaction with the length of time needed for getting tests done. Bad news was delivered sensitively to 52.97% of the participants, and 52.76% received a cancer treatment plan. During the hospitalisation, 45.93% responded that they did not find someone from the hospital staff whom they could talk to about their worries and fears, and 57.48% were not given any contact information in case of concerns about their condition or treatment following the discharge. Regarding the patients’ preferences, needs, and values, 60.81% of the respondents felt that the greatest improvement would be to perform all services in one place, and 55.28% felt that improvement would be achieved through a multidisciplinary team coordinated by one person. Conclusions: The study reveals domains that need to be addressed in the overall Croatian healthcare system for oncology patients. Based on the obtained data, we can conclude that there is a large need for improvement in patient experience on the oncology pathway. Full article

In preparation for the PRO B study which aims to examine the effects of an app-based intensified patient-reported outcome (PRO) monitoring for metastatic breast cancer patients, prior assessment of its feasibility was carried out. Sixteen breast cancer patients visiting the breast cancer unit at Charité were recruited and downloaded an app connected to an ePRO system. They received electronic questionnaires on two occasions (baseline and the following week) and were subsequently contacted for a semi-structured phone interview for evaluation. Eleven participants answered at least one questionnaire. Some participants did not receive any or only a part of the questionnaires due to technical problems with the app. Participants who completed the evaluation questionnaire (n = 6) were overall satisfied with the weekly PRO questionnaire. All interviewed (n = 11) participants thought it was feasible to answer the PRO questionnaires on a weekly basis for one year, as planned in the PRO B study. The pretest revealed a need for major technical adjustments to the app because push notifications about the receipt of new questionnaires were not displayed on some smartphone models. Due to the low number of participants, generalization of the findings is limited to our specific context and study. Nevertheless, we could conclude that if technical aspects of the app were improved, the PRO B study could be implemented as planned. The ePRO questionnaire was considered feasible and adequate from the patients’ perspectives. Full article

This study introduces a socio-ecological perspective of differences in psychological distress between the Palestinian minority and Jewish majority citizens of Israel during lockdown due to COVID-19. The study examines the association between COVID-19-related stress and psychological distress, and the moderating effect of parenthood. Online questionnaires, completed by 1934 participants (1391 Jews, 552 Palestinians; 1306 parents, 637 without children; 54.86% female, 45.13% male; M age = 40.38, SD = 13.77) assessed COVID-19-related stressors and depression, anxiety, and stress. The Palestinian minority showed a higher level of COVID-19-related stress and psychological distress than the Jewish majority. Parenthood showed a moderating effect on the association between COVID-19-related stress and distress for the Jewish majority but not the Palestinian minority. The results emphasize the significance of considering social status when seeking to understand the differences between minorities and majorities in terms of distress and resilience during pandemic events, and the need for cultural sensitivity and awareness when issuing instructions in such circumstances. Additionally, the results highlight the potential role of parenthood as a resilience factor, depending upon social status. Full article

The risk of developing cardiovascular diseases (CVDs) arises from the interaction of prenatal factors; epigenetic regulation; neonatal factors; and factors that affect childhood and adolescence, such as early adiposity rebound (AR) and social and environmental influences. Thus, CVD risk varies between the group of low-risk metabolically healthy normal-weight subjects (MHNW); the intermediate-risk group, which includes metabolically healthy obese (MHO) and metabolically unhealthy normal-weight subjects (MUHNW); and the high-risk group of metabolically unhealthy obese (MUHO) subjects. In this continuum, several risk factors come into play and contribute to endothelial damage, vascular and myocardial remodeling, and atherosclerotic processes. These pathologies can occur both in prenatal life and in early childhood and contribute to significantly increasing CVD risk in young adults over time. Early intervention in the pediatric MUHO population to reduce the CVD risk during adulthood remains a challenge. In this review, we focus on CVD risk factors arising at different stages of life by performing a search of the recent literature. It is urgent to focus on preventive or early therapeutic strategies to stop this disturbing negative metabolic trend, which manifests as a continuum from prenatal life to adulthood. Full article