ALBERT

Description: IJERPH, Vol. 15, Pages 1590: Research Trends and Hotspots Analysis Related to the Effects of Xenobiotics on Glucose Metabolism in Male Testes International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081590 Authors: Yongsheng Fan Guangxia Yu Jun Yu Jiantao Sun Yu Wu Xue Zhao Yu Meng Zhangdong He Chunhong Wang This study aimed to integrate and analyze the existing studies and to explore research trends and hotspots related to the effects of xenobiotics on glucose metabolism in male testes. All articles were retrieved from the PubMed database, from an inception date up to 10 June 2017. CiteSpace software (version 5.1.R8 SE) was used for the co-word cluster analysis. A total of 165 eligible publications were included in this study. In 1949–1959, only two articles were published. After 1960, the number of articles increased steadily. These articles were published in 97 journals, in particular, in the Indian Journal of Experimental Biology (11 articles, 6.7%). Most of the authors (87.0%) only published one article. Only a few established research teams, mostly from the USA, worked consistently in this field. The main xenobiotics that had been studied were medicine and common environmental pollutants, e.g., gossypol, cadmium, di-n-butyl phthalate, and alpha-chlorohydrin. The hotspot keywords were Sertoli cell, lactate dehydrogenase, 6-phosphate dehydrogenase, oxidative stress, and glucose metabolism. The focus of research had been changed overtime. This is the first bibliometric study between xenobiotics and glucose metabolism in the male testes. The findings suggest that environmental pollutants have become a huge concern, and related research should be strengthened.

Description: IJERPH, Vol. 15, Pages 1589: Estimation of Dietary Intake of Radionuclides and Effectiveness of Regulation after the Fukushima Accident and in Virtual Nuclear Power Plant Accident Scenarios International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081589 Authors: Michio Murakami Takao Nirasawa Takao Yoshikane Keisuke Sueki Kimikazu Sasa Kei Yoshimura Evaluation of radiation exposure from diet is necessary under the assumption of a virtual accident as a part of emergency preparedness. Here, we developed a model with complete consideration of the regional food trade using deposition data simulated by a transport model, and estimated the dietary intake of radionuclides and the effectiveness of regulation (e.g., restrictions on the distribution of foods) after the Fukushima accident and in virtual accident scenarios. We also evaluated the dilution factors (i.e., ratios of contaminated foods to consumed foods) and cost-effectiveness of regulation as basic information for setting regulatory values. The doses estimated under actual emission conditions were generally consistent with those observed in food-duplicate and market-basket surveys within a factor of three. Regulation of restricted food distribution resulted in reductions in the doses of 54–65% in the nearest large city to the nuclear power plant. The dilution factors under actual emission conditions were 4.4% for radioiodine and 2.7% for radiocesium, which are ~20 times lower than those used in the Japanese provisional regulation values after the Fukushima accident. Strict regulation worsened the cost-effectiveness for both radionuclides. This study highlights the significance and utility of the developed model for a risk analysis of emergency preparedness and regulation.

Description: IJERPH, Vol. 15, Pages 1587: Dental Scaling Decreases the Risk of Parkinson’s Disease: A Nationwide Population-Based Nested Case-Control Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081587 Authors: Chang-Kai Chen Jing-Yang Huang Yung-Tsan Wu Yu-Chao Chang The protective effect of dental scaling in Parkinson’s disease (PD) remains inconclusive. The aim of this study was to analyze the association between dental scaling and the development of PD. A retrospective nested case-control study was performed using the National Health Insurance Research Database of Taiwan. The authors identified 4765 patients with newly diagnosed PD from 2005 to 2013 and 19,060 individuals without PD by matching sex, age, and index year. In subgroup 1, with individuals aged 40–69 years, individuals without periodontal inflammatory disease (PID) showed a protective effect of dental scaling against PD development, especially for dental scaling over five consecutive years (adjusted odds ratio = 0.204, 95% CI = 0.047–0.886, p = 0.0399). In general, the protective effect of dental scaling showed greater benefit for individuals with PID than for those without PID, regardless of whether dental scaling was performed for five consecutive years. In subgroup 2, with patients aged ≥70 years, the discontinued (not five consecutive years) scaling showed increased risk of PD. This was the first study to show that patients without PID who underwent dental scaling over five consecutive years had a significantly lower risk of developing PD. These findings emphasize the value of early and consecutive dental scaling to prevent the development of PD.

Description: IJERPH, Vol. 15, Pages 1586: What Are the Net Benefits of Reducing the Ozone Standard to 65 ppb? An Alternative Analysis International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081586 Authors: Sabine S. Lange Sean E. Mulholland Michael E. Honeycutt In October 2015, the United States Environmental Protection Agency (EPA) lowered the level of the ozone National Ambient Air Quality Standard (NAAQS) from 0.075 ppm to 0.070 ppm (annual 4th highest daily maximum 8-h concentration, averaged over three years). The EPA estimated a 2025 annual national non-California net benefit of $1.5 to $4.5 billion (2011$, 7% discount rate) for a 0.070 ppm standard, and a −$1.0 to $14 billion net benefit for an alternative 0.065 ppm standard. The purpose of this work is to present a combined toxicological and economic assessment of the EPA’s benefit-cost analysis of the 2015 ozone NAAQS. Assessing the quality of the epidemiology studies based on considerations of bias, confounding, chance, integration of evidence, and application of the studies for future population risk estimates, we derived several alternative benefits estimates. We also considered the strengths and weaknesses of the EPA’s cost estimates (e.g., marginal abatement costs), as well as estimates completed by other authors, and provided our own alternative cost estimate. Based on our alternative benefits and cost calculations, we estimated an alternative net benefit of between −$0.3 and $1.8 billion for a 0.070 ppm standard (2011 $, 7% discount rate) and between −$23 and −$17 billion for a 0.065 ppm standard. This work demonstrates that alternative reasonable assumptions can generate very difference cost and benefits estimates that may impact how policy makers view the outcomes of a major rule.

Description: IJERPH, Vol. 15, Pages 1583: A Systematic Review of Sexual and Reproductive Health Knowledge, Experiences and Access to Services among Refugee, Migrant and Displaced Girls and Young Women in Africa International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081583 Authors: Olena Ivanova Masna Rai Elizabeth Kemigisha Adolescent girls and young women are an overlooked group within conflict- or disaster-affected populations, and their sexual and reproductive health (SRH) needs are often neglected. Existing evidence shows that forced migration and human mobility make girls and women more vulnerable to poor SRH outcomes such as high risk sexual behaviors, lack of contraception use, STIs and HIV/AIDS. We performed a systematic literature review to explore knowledge, experiences and access to SRH services in this population group across the African continent. Two databases (PubMed and Web of Science) were searched and from 896 identified publications, 15 peer-reviewed articles published in English met the inclusion criteria for this review. These consisted of eight applied qualitative, five quantitative and two mixed-method study designs. The quality of the studies was evaluated by the mixed-methods appraisal tool (MMAT) using scores in percentages (0–100%). Available evidence indicates that knowledge of young women and girls regarding contraceptive methods, STIs and HIV/AIDS are limited. This population group often experiences gender-based and sexual violence and abuse. The access and availability of SRH services are often limited due to distances, costs and stigma. This review demonstrates that there is still a dearth of peer-reviewed literature on SRH related aspects among refugee, migrant and displaced girls and young women in Africa. The data disaggregation by sex and age should be emphasized for future research in this field.

Description: IJERPH, Vol. 15, Pages 1592: Full-Scale Experimental Study of Groundwater Softening in a Circulating Pellet Fluidized Reactor International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081592 Authors: Ruizhu Hu Tinglin Huang Aofan Zhi Zhangcheng Tang The softening effect of a new type of circulating pellet fluidized bed (CPFB) reactor on groundwater was studied through a full-scale experiment. The operation of the CPFB reactor in the second water plant in Chang’an District in Xi’an China was monitored for one year, and the results were compared with those for the Amsterdam reactor in The Netherlands. The removal efficiency of Ca2+ in the CPFB reactor reached 90%; the removal rate of total hardness was higher than 60%; effluent pH was 9.5–9.8; the turbidity of the effluent and the turbidity after boiling were lower than 1.0 NTU; the unit cost was less than €0.064 per m3; and the softened effluent was stable. The pellets in the CPFB reactor were circulated, providing higher crystallization efficiency. The diameter of the discharged pellets reached between 3–5 mm, and the fluidized area height of the CPFB reactor was 4 m. The performance parameters of the CFPB reactor were optimized.

Description: IJERPH, Vol. 15, Pages 1596: Predicting Infectious Disease Using Deep Learning and Big Data International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081596 Authors: Sangwon Chae Sungjun Kwon Donghyun Lee Infectious disease occurs when a person is infected by a pathogen from another person or an animal. It is a problem that causes harm at both individual and macro scales. The Korea Center for Disease Control (KCDC) operates a surveillance system to minimize infectious disease contagions. However, in this system, it is difficult to immediately act against infectious disease because of missing and delayed reports. Moreover, infectious disease trends are not known, which means prediction is not easy. This study predicts infectious diseases by optimizing the parameters of deep learning algorithms while considering big data including social media data. The performance of the deep neural network (DNN) and long-short term memory (LSTM) learning models were compared with the autoregressive integrated moving average (ARIMA) when predicting three infectious diseases one week into the future. The results show that the DNN and LSTM models perform better than ARIMA. When predicting chickenpox, the top-10 DNN and LSTM models improved average performance by 24% and 19%, respectively. The DNN model performed stably and the LSTM model was more accurate when infectious disease was spreading. We believe that this study’s models can help eliminate reporting delays in existing surveillance systems and, therefore, minimize costs to society.

Description: IJERPH, Vol. 15, Pages 1597: Assessing Heat-Related Mortality Risks among Rural Populations: A Systematic Review and Meta-Analysis of Epidemiological Evidence International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081597 Authors: Emmanuel A. Odame Ying Li Shimin Zheng Ambarish Vaidyanathan Ken Silver Most epidemiological studies of high temperature effects on mortality have focused on urban settings, while heat-related health risks in rural areas remain underexplored. To date there has been no meta-analysis of epidemiologic literature concerning heat-related mortality in rural settings. This study aims to systematically review the current literature for assessing heat-related mortality risk among rural populations. We conducted a comprehensive literature search using PubMed, Web of Science, and Google Scholar to identify articles published up to April 2018. Key selection criteria included study location, health endpoints, and study design. Fourteen studies conducted in rural areas in seven countries on four continents met the selection criteria, and eleven were included in the meta-analysis. Using the random effects model, the pooled estimates of relative risks (RRs) for all-cause and cardiovascular mortality were 1.030 (95% CI: 1.013, 1.048) and 1.111 (95% CI: 1.045, 1.181) per 1 °C increase in daily mean temperature, respectively. We found excess risks in rural settings not to be smaller than risks in urban settings. Our results suggest that rural populations, like urban populations, are also vulnerable to heat-related mortality. Further evaluation of heat-related mortality among rural populations is warranted to develop public health interventions in rural communities.

Description: IJERPH, Vol. 15, Pages 1595: Does SuperPark Make Children Less Sedentary? How Visiting a Commercial Indoor Activity Park Affects 7 to 12 Years Old Children’s Daily Sitting and Physical Activity Time International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081595 Authors: Arto J. Pesola Martti Melin Anssi Vanhala Ying Gao Taija Finni Commercial indoor activity parks provide children with a variety of entertaining physical activities. This study examined whether visiting SuperPark affects total daily sitting and physical activity time. The participants (8 girls and 7 boys, aged 10.3 ± 1.9 years, height 144.5 ± 11.8 cm, body mass index (BMI) 19.3 ± 3.0 kg/m2) wore a thigh-worn accelerometer during a normal week and were provided free tickets to visit SuperPark on at least one day. On average, the children spent 3.3 ± 1.2 h in SuperPark. During the visits the children had 0.9 h less sitting (0.7 ± 0.3 h, p = 0.000) and 0.9 h more moderate-to-vigorous physical activity (MVPA; 1.4 ± 0.6 h, p = 0.002) as compared to the reference periods on days without a SuperPark visit (1.6 ± 0.3 h sitting and 0.5 ± 0.4 h MVPA). During the days when visiting SuperPark, sitting time decreased 1.0 h (5.8 ± 0.9 h, p = 0.008) and MVPA increased 0.8 h (3.0 ± 1.0 h, p = 0.017) as compared to the reference days (6.8 ± 1.1 h sitting and 2.2 ± 0.8 h MVPA). The effects were more pronounced during weekdays than weekends. The children spent more than three hours in SuperPark on one visit, of which almost a half was MVPA. During the whole day, one hour of sitting was replaced with MVPA, suggesting that visiting SuperPark has the potential to improve health. Whether children continue visiting SuperPark and gain health benefits merits investigation.

Description: IJERPH, Vol. 15, Pages 1593: Modeling Land Use Changes and their Impacts on Non-Point Source Pollution in a Southeast China Coastal Watershed International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081593 Authors: Xin Zhang Lin Zhou Yuqi Liu Changes in landscape patterns in a river basin play a crucial role in the change on load of non-point source pollution. The spatial distribution of various land use types affects the transmission of non-point source pollutants on the basis of source-sink theory in landscape ecology. Jiulong River basin in southeast of China was selected as the study area in this paper. Aiming to analyze the correlation between changing landscape patterns and load of non-point source pollution in this area, traditional landscape metrics and the improved location-weighted landscape contrast index based on the minimum hydrological response unit (HRULCI) were applied in this study, in combination with remote sensing and geographic information system (GIS) technique. The results of the landscape metrics showed the enhanced fragmentation extent and the decreasing polymerization degree of the overall landscape in the watershed. High values of HRULCI were concentrated in cultivated land, while low HRULCI values mostly appeared in forestland, indicating that cultivated land substantially enhanced non-point source pollution, while forestland inhibited the pollution process.

Description: IJERPH, Vol. 15, Pages 1605: An Analysis of Reported Dangerous Incidents, Exposures, and Near Misses amongst Army Soldiers International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081605 Authors: Ben Schram Robin Orr Timothy Rigby Rodney Pope Occupational health and safety incidents occurring in the military context are of great concern to personnel and commanders. Incidents such as “dangerous incidents”, “exposures”, and “near misses” (as distinct from injuries, illnesses, and fatalities) indicate serious health and safety risks faced by military personnel, even if they do not cause immediate harm. These risks may give rise to harm in the future, if not adequately addressed, and in some cases the incidents may cause latent harm. The purpose of this study was to ascertain the rates and patterns of incidents of these types reported by full time (ARA) and part time (ARES) Australian Army personnel. A retrospective cohort study was performed using self-reported incident data from the Workplace Health, Safety, Compensation and Reporting (WHSCAR) database over a two-year period. Data were analysed descriptively. Of 3791 such incidents, 3636 (96 percent) occurred in ARA and 155 (4 percent) in ARES personnel, somewhat consistent with the proportions of total army person-years served in each (ARA 93 percent; ARES 7 percent). In ARA, 84 percent of these incident types were exposures, 14 percent near misses, and 2 percent dangerous incidents. In ARES, 55 percent of incidents were exposures, 38 percent near misses, and 7 percent dangerous incidents. Soldiers at the rank of ‘private’ experienced the highest rates of these incident types, in both ARA and ARES. Driving gave rise to more near misses than any other activity, in both populations. Exposures to chemicals and sounds were more common in the ARA than ARES. The ARES reported higher proportions of vehicle near misses and multiple mechanism dangerous incidents than the ARA. The findings of this study can usefully inform development of risk mitigation strategies for dangerous incidents, exposures, and near misses in army personnel.

Description: IJERPH, Vol. 15, Pages 1604: Chronic Disease, Disability, Psychological Distress and Suicide Ideation among Rural Elderly: Results from a Population Survey in Shandong International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081604 Authors: Jing Zhu Lingzhong Xu Long Sun Jiajia Li Wenzhe Qin Gan Ding Qian Wang Jiao Zhang Su Xie Zihang Yu Objective: Suicide is a major public health and social problem in contemporary societies. Previous studies showed that the older the seniors were, the more likely it was that they would experience disability, chronic disease, or both. The objective of this study was to examine the joint effects of chronic disease and physical disability on suicide ideation while controlling for psychological distress among the rural elderly living in Shandong Province, China. Method: A total of 5514 rural elderly individuals (60+) living in Shandong Province, China were included in this study. Suicidal ideation was assessed by using questions from the National Comorbidity Survey (NCS). Multiple logistic analyses were performed to examine the factors associated with suicide ideation. A path analysis was conducted to test the direct and indirect effects of chronic disease and of activity of daily living (ADL) limitation on suicide ideation while controlling for psychological distress. Results: The prevalence of suicide ideation among the rural elderly in Shandong, China was 11.0%. Psychological distress had the strongest direct (β = 0.392) and total effect (β = 0.392), chronic disease (β = −0.034; β = −0.063) had both direct and indirect impacts, and ADL (β = 0.091) had indirect impacts on suicide ideation. Psychological distress was a mediator between chronic disease, ADL limitation, and suicide ideation. Conclusions: Psychological distress was the greatest influencing factor of suicide ideation among the rural elderly, followed by chronic disease and disability. Effective intervention measures should be taken to facilitate the early detection of psychological distress in clinical practice among the rural elderly.

Description: IJERPH, Vol. 15, Pages 1601: Risk of Appendicitis among Children with Different Piped Water Supply: A Nationwide Population-Based Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081601 Authors: Hao-Ming Li Shi-Zuo Liu Ying-Kai Huang Yuan-Chih Su Chia-Hung Kao Appendicitis is a common surgical condition for children. However, environmental effects, such as piped water supply, on pediatric appendicitis risk remain unclear. This longitudinal, nationwide, cohort study aimed to compare the risk of appendicitis among children with different levels of piped water supply. Using data from Taiwan Water Resource Agency and National Health Insurance Research Database, we identified 119,128 children born in 1996–2010 from areas of the lowest piped water supply (prevalence 51.21% to 63.06%) as the study cohort; additional 119,128 children of the same period in areas of the highest piped water supply (prevalence 98.97% to 99.63%) were selected as the controls. Both cohorts were propensity-score matched by baseline variables. We calculated the hazard ratios (HRs) and 95% confidence intervals (CIs) of appendicitis in the study cohort compared to the controls by Cox proportional hazards regression. The study cohort had a raised overall incidence rates of appendicitis compared to the control cohort (12.8 vs. 8.7 per 10,000 person-years). After covariate adjustment, the risk of appendicitis was significantly increased in the study cohort (adjusted HR = 1.46, 95% CI: 1.35, 1.58, p < 0.001). Subgroup and sensitivity analyses showed consistent results that children with low piped water supply had a higher risk of appendicitis than those with high piped water supply. This study demonstrated that children with low piped water supply were at an increased risk of appendicitis. Enhancement of piped water availability in areas lacking adequate, secure, and sanitized water supply may protect children against appendicitis.

Description: IJERPH, Vol. 15, Pages 1600: Alternative Risk Assessment for Dangerous Chemicals in South Korea Regulation: Comparing Three Modeling Programs International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081600 Authors: Hyo Eun Lee Jong-Ryeul Sohn Sang-Hoon Byeon Seok J. Yoon Kyong Whan Moon Unlike other countries, the Korean chemical industry does not clearly distinguish between industrial sites and residential areas. The 2012 Gumi Hydrogen Fluoride Accident revealed that chemical accidents could cause damage to nearby residents. Accordingly, the Chemicals Control Act was enacted in 2015, which requested industrial sites using chemicals to perform a risk assessment for all chemical facilities and to distribute the results to the local residents and governments. Industrial businesses had the responsibility of warning the local residents. In this study, two programs (Areal Location of Hazardous Atmospheres (ALOHA), Process Hazard Analysis Software Tool (PHAST)) were compared with Korea Off-site Risk Assessment Supporting Tool (KORA), which is the current representative risk assessment program used in Korea Chemicals Control Act. The five chemical substances (nitric acid, hydrogen chloride, ammonia, sulfuric acid, and formaldehyde) most commonly involved in chemical accidents were selected. The range of influence of ERPG-2 (Emergency Response Planning Guideline) on chemical accidents was modeled and the results compared. ALOHA was found to be the most suitable program for the determination of toxicity for nitrate acid and ammonia, KORA for hydrogen chloride and sulfuric acid, and PHAST for formaldehyde. To maximize the safety of many local residents and to prepare for chemical accidents, risk assessments should be conducted using a variety of risk assessment programs, and the worst-case damage radius should be determined.

Description: IJERPH, Vol. 15, Pages 1611: Immunohistochemical Evaluation of Peri-Implant Soft Tissues around Machined and Direct Metal Laser Sintered (DMLS) Healing Abutments in Humans International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081611 Authors: Carlo Mangano Francesco Guido Mangano Jamil Awad Shibli Leandro Amadeu Roth Gianmaria d’ Addazio Adriano Piattelli Giovanna Iezzi Background: Direct metal laser Sintering (DMLS) is an additive manufacturing technique that allows fabrication of dental implants and related components with a highly porous surface. To date, no human studies have investigated the soft tissue adhesion and presence of inflammatory infiltrate with porous DMLS healing abutments (HAs), nor have they compared these with the classic machined ones. Purpose: To evaluate the degree of cell adhesion (integrin expression) and the quantity/quality of inflammatory infiltrate, on HAs with different surfaces; full DMLS, full machined, and hybrid (half DMLS and half machined). Methods: Fifty implant patients were randomly assigned to receive one of these different Has: T1, full DMLS (11 subjects); T2, machined in the upper portion and DMLS in the lower one (10 subjects); T3, DMLS in the upper portion and machined in the lower one (19 subjects); T4, full machined (10 patients). Thirty days after placement, circular sections of soft tissues around HAs were retrieved for immunohistochemical evaluation. Results: With regard to the adhesion molecules, the samples showed different intensity of integrin expression, with a statistically significant difference (p < 0.001) between T1 and the other groups. All the samples were positive for the different clusters related to the inflammatory infiltrate (T lymphocytes, CD3; B lymphocytes, CD20; and macrophages, CD68), but a lower infiltrate was found in T1, with statistically significant differences (p < 0.001) among the groups. Conclusions: The HA surface seems to influence the degree of cell adhesion and the inflammatory infiltrate of the surrounding soft tissues.

Description: IJERPH, Vol. 15, Pages 1614: Effects of Bisphenol A and 4-tert-Octylphenol on Embryo Implantation Failure in Mouse International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081614 Authors: Dinh Nam Tran Eui-Man Jung Changhwan Ahn Jae-Hwan Lee Yeong-Min Yoo Eui-Bae Jeung Miscarriage due to blastocyst implantation failure occurs in up to two-thirds of all human miscarriage cases. Calcium ion has been shown to be involved in many cellular signal transduction pathways as well as in the regulation of cell adhesion, which is necessary for the embryo implantation process. Exposure to endocrine-disrupting chemicals (EDs) during early gestation results in disruption of intrauterine implantation and uterine reception, leading to implantation failure. In this study, ovarian estrogen (E2), bisphenol A (BPA), or 4-tert-octylphenol (OP), with or without ICI 182,780 (ICI) were injected subcutaneously from gestation day 1 to gestation day 3 post-coitus. The expression levels of the calcium transport genes were assessed in maternal uteri and implantation sites. The number of implantation sites was significantly low in the OP group, and implantation sites were absent in the E2, ICI and EDs + ICI groups. There were different calcium transient transport channel expression levels in uterus and implantation site samples. The levels of TRPV5 and TRPV6 gene expression were significantly increased by EDs with/without ICI treatment in utero. Meanwhile, TRPV5 and TRPV6 gene expression were significantly lower in implantation sites samples. NCX1 and PMCA1 mRNA levels were significantly decreased by OP and BPA in the implantation site samples. Compared to vehicle treatment in the uterus, both the MUC1 mRNA and protein levels were markedly high in all but the BPA group. Taken together, these results suggest that both BPA and OP can impair embryo implantation through alteration of calcium transport gene expressions and by affecting uterine receptivity.

Description: IJERPH, Vol. 15, Pages 1609: A Comparison of Dependence across Different Types of Nicotine Containing Products and Coffee International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081609 Authors: Karl Fagerstrom Introduction: Few studies have compared the dependence to different tobacco and nicotine products. Even less is known about how it relates to dependence on other common drugs, e.g., caffeine. In this study degree of dependence was compared between snus, cigarettes, nicotine replacement (NR), electronic cigarettes and coffee. Methods: A random sample of Swedish citizens belonging to an internet panel were contacted from September to October 2017. The responders were asked among other related things about their use of snus, NR, traditional cigarette or e-cigarette use and coffee consumption. The indicators of dependence used were: (A) the Heavy Smoking Index, (B) The proportions that used within 30 min after raising in the morning, (C) rating the first use in the morning as the most important and (D) Stating that it would be very hard to give up entirely. Results: Significantly fewer coffee drinkers started use within 30 min of awakening compared with all other products. The first use of the day was found to be more important for snus users compared with other products. On HSI there was no difference between snus and cigarettes. Snus and cigarettes were rated as being more difficult to give up than NR and coffee. Conclusion: Dependence to traditional cigarettes and snus seem to be relatively similar while NR was rated lower and coffee lowest. Since the prevalence of caffeine use in all forms is so much more prevalent than nicotine there might be more persons in the society heavily dependent on caffeine. Implication: Tobacco products are likely more dependence forming than NR products and coffee although there might be more people dependent on caffeine. The addiction to coffee or caffeine is seldom discussed in the society probably because of the little or no harm it causes. Funding: The Snus Commission in Sweden (snuskommissionen) funded the data collection. No funding used for the analysis and writing of manuscript.

Description: IJERPH, Vol. 15, Pages 1613: Sexual Violence against Women in Germany: Prevalence and Risk Markers International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081613 Authors: Deborah F. Hellmann Max W. Kinninger Sören Kliem Previous research has repeatedly shown that gender-based violence affects a considerable proportion of women in any given population. Apart from providing current estimates of the prevalence of sexual violence against women in Germany, we identified specific risk markers applying an advanced statistical method. We analyzed data from a survey of N = 4450 women representative of the German population, conducted by the Criminological Research Institute of Lower Saxony in 2011. Lifetime prevalence for experiencing sexual violence was 5.4% for women aged 21−40 years (five-year prevalence: 2.5%). Non-parametric conditional inference tree (C-Tree) analyses revealed that physical and sexual abuse during childhood as well as being divorced, separated, or widowed was the most informative constellation of risk markers, increasing the five-year prevalence rate of experienced sexual violence victimizations up to 17.0%. Furthermore, knowing about the official penalization of marital rape was related to a lower victimization risk for women without a history of parental violence. Possible explanations for these findings as well as implications for future research are critically discussed.

Description: IJERPH, Vol. 15, Pages 1612: Legionellosis Associated with Recreational Waters: A Systematic Review of Cases and Outbreaks in Swimming Pools, Spa Pools, and Similar Environments International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081612 Authors: Erica Leoni Federica Catalani Sofia Marini Laura Dallolio Legionella spp. is widespread in many natural and artificial water systems, such as hot water distribution networks, cooling towers, and spas. A particular risk factor has been identified in the use of whirlpools and hot tubs in spa facilities and public baths. However, there has been no systematic synthesis of the published literature reporting legionellosis cases or outbreaks related to swimming/spa pools or similar environments used for recreational purposes (hot springs, hot tubs, whirlpools, natural spas). This study presents the results of a systematic review of the literature on cases and outbreaks associated with these environments. Data were extracted from 47 articles, including 42 events (17 sporadic cases and 25 outbreaks) and 1079 cases, 57.5% of which were diagnosed as Pontiac fever, without any deaths, and 42.5% were of Legionnaires’ disease, with a fatality rate of 6.3%. The results are presented in relation to the distribution of Legionella species involved in the events, clinical manifestations and diagnosis, predisposing conditions in the patients, favourable environmental factors, and quality of the epidemiological investigation, as well as in relation to the different types of recreational water sources involved. Based on the epidemiological and microbiological criteria, the strength of evidence linking a case/outbreak of legionellosis with a recreational water system was classified as strong, probable, and possible; in more than half of the events the resulting association was strong.

Description: IJERPH, Vol. 15, Pages 1639: Sexual Function of Postmenopausal Women Addicted to Alcohol International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081639 Authors: Anna Jenczura Mariola Czajkowska Agnieszka Skrzypulec-Frankel Violetta Skrzypulec-Plinta Agnieszka Drosdzol-Cop Introduction: Alcoholism impairs female sexual functions (decreased sex drive, reduced vaginal fluid, difficulty to experience orgasm). Aim: The aim of this study was to evaluate the course of perimenopausal period and sexual life of female alcoholics. Methods: 97 women at the age of 40–60 years were qualified with a diagnosed history of alcoholism (studied group). For the control group, 92 women at the age of 40–60 without a history of alcoholism were qualified. Questionnaires assessing female sexual function (Female Sexual Function Index—FSFI), the severity of perimenopausal symptoms (Menopause Rating Scale—MRS) and the degree of alcohol addiction (Michigan Alcoholism Screening Test—MAST) were obtained from each participant. Main outcome measures: To assess the sexual function of perimenopausal women addicted to alcohol. Results: The studied and control groups were significantly different (p = 0.00) in terms of severity of menopausal symptoms (MRS). The research showed lower quality of sexual life (FSFI) of women from the studied group. Conclusions: Population of women with diagnosed alcohol dependence enter the menopausal stage at the similar age as the population of female non-drinkers. The time of alcohol abuse is an important factor having an impact on both the course of menopause and the dynamics of the perimenopause period, leading to symptom escalation. The population of female alcoholics shows a decrease in sexual activity and the prevalence of sexual disorders.

Description: IJERPH, Vol. 15, Pages 1634: Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081634 Authors: Angela Koverech Valeriano Soldati Vittoria Polidori Leda Marina Pomes Luana Lionetto Matilde Capi Andrea Negro Maurizio Simmaco Paolo Martelletti The ageing of the world population has resulted in an increase in the number of older patients with multimorbid conditions receiving multiple therapies. This emerging clinical scenario poses new challenges, which are mostly related to the increased incidence of adverse effects. This translates into poor clinical care, reduced cost-effectiveness of drug therapies, and social isolation of multimorbid patients due to reduced autonomy. A strategy to address these emerging challenges could involve the personalization of therapies based on the clinical, molecular, and genetic characterization of multimorbid patients. Anticoagulation therapy is a feasible model to implement personalized medicine since it generally involves older multimorbid patients receiving multiple drugs. In this study, in patients with atrial fibrillation, the use of the new generation of anticoagulation therapy, i.e., direct oral anti-coagulants (DOACs), is based on a preliminary assessment of the molecular targets of DOACS and any possible drug–drug interactions. Then, the genetic polymorphism of enzymes metabolizing DOACs is studied. After DOAC prescription, its circulating levels are measured. Clinical data are being collected to assess whether this personalized approach improves the safety and efficacy profiles of anticoagulation therapy using DOACs, thereby reducing the costs of healthcare for ageing multimorbid patients.

Description: IJERPH, Vol. 15, Pages 1648: Transcriptomic Profiles in Zebrafish Liver Permit the Discrimination of Surface Water with Pollution Gradient and Different Discharges International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081648 Authors: Zhou Zhang Wei Liu Yuanyuan Qu Xie Quan Ping Zeng Mengchang He Yanmei Zhou Ruixia Liu The present study aims to evaluate the potential of transcriptomic profiles in evaluating the impacts of complex mixtures of pollutants at environmentally relevant concentrations on aquatic vertebrates. The changes in gene expression were determined using microarray in the liver of male zebrafish (Danio rerio) exposed to surface water collected from selected locations on the Hun River, China. The numbers of differentially expressed genes (DEGs) in each treatment ranged from 728 to 3292, which were positively correlated with chemical oxygen demand (COD). Predominant transcriptomic responses included peroxisome proliferator-activated receptors (PPAR) signaling and steroid biosynthesis. Key pathways in immune system were also affected. Notably, two human diseases related pathways, insulin resistance and Salmonella infection were enriched. Clustering analysis and principle component analysis with DEGs differentiated the upstream and downstream site of Shenyang City, and the mainstream and the tributary sites near the junction. Comparison the gene expression profiles of zebrafish exposed to river surface water with those to individual chemicals found higher similarity of the river water with estradiol than several other organic pollutants and metals. Results suggested that the transcriptomic profiles of zebrafish is promising in differentiating surface water with pollution gradient and different discharges and in providing valuable information to support discharge management.

Description: IJERPH, Vol. 15, Pages 1650: Pesticides Are an Occupational and Public Health Issue International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081650 Authors: Hans-Peter Hutter Hanns Moshammer n/a

Description: IJERPH, Vol. 15, Pages 1641: Cytotoxic and Genotoxic Effects of Pesticide Exposure in Male Coffee Farmworkers of the Jarabacoa Region, Dominican Republic International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081641 Authors: Hans-Peter Hutter Abdul Wali Khan Kathrin Lemmerer Peter Wallner Michael Kundi Hanns Moshammer Intensive agrochemical use in coffee production in the Global South has been documented. The aim of this study was to investigate cytotoxic and genotoxic effects of pesticide exposure in male farmworkers in the Dominican Republic comparing conventional farming using pesticides to organic farming. Furthermore, feasibility of the buccal micronucleus cytome assay (BMCA) for field studies under difficult local conditions was tested. In a cross-sectional field study, pesticide exposed (sprayers) and non-exposed male workers on coffee plantations were interviewed about exposure history, and pesticide application practices. Buccal cells were sampled, and BMCA was applied to assess potential effects on cell integrity. In total, 38 pesticide-exposed and 33 non-exposed workers participated. Eighty-four and 87%, respectively, of the pesticide-exposed respondents did not use masks or gloves at all. All biomarkers from the BMCA were significantly more frequent among exposed workers—odds ratio for micronucleated cells: 3.1 (95% confidence interval: 1.3–7.4) or karyolysis: 1.3 (1.1–1.5). Buccal cells as sensitive markers of toxic oral or respiratory exposures proved feasible for challenging field studies. Our findings indicate that the impact of pesticide use is not restricted to acute effects on health and wellbeing, but also points to long-term health risks. Therefore, occupational safety measures including training and protective clothing are needed, as well as encouragement towards minimal application of pesticides and more widespread use of organic farming.

Description: IJERPH, Vol. 15, Pages 1644: Recommendations for Improving the Quality of Rare Disease Registries International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081644 Authors: Yllka Kodra Jérôme Weinbach Manuel Posada-de-la-Paz Alessio Coi S. Lydie Lemonnier David van Enckevort Marco Roos Annika Jacobsen Ronald Cornet S. Faisal Ahmed Virginie Bros-Facer Veronica Popa Marieke Van Meel Daniel Renault Rainald von Gizycki Michele Santoro Paul Landais Paola Torreri Claudio Carta Deborah Mascalzoni Sabina Gainotti Estrella Lopez Anna Ambrosini Heimo Müller Robert Reis Fabrizio Bianchi Yaffa R. Rubinstein Hanns Lochmüller Domenica Taruscio Rare diseases (RD) patient registries are powerful instruments that help develop clinical research, facilitate the planning of appropriate clinical trials, improve patient care, and support healthcare management. They constitute a key information system that supports the activities of European Reference Networks (ERNs) on rare diseases. A rapid proliferation of RD registries has occurred during the last years and there is a need to develop guidance for the minimum requirements, recommendations and standards necessary to maintain a high-quality registry. In response to these heterogeneities, in the framework of RD-Connect, a European platform connecting databases, registries, biobanks and clinical bioinformatics for rare disease research, we report on a list of recommendations, developed by a group of experts, including members of patient organizations, to be used as a framework for improving the quality of RD registries. This list includes aspects of governance, Findable, Accessible, Interoperable and Reusable (FAIR) data and information, infrastructure, documentation, training, and quality audit. The list is intended to be used by established as well as new RD registries. Further work includes the development of a toolkit to enable continuous assessment and improvement of their organizational and data quality.

Description: IJERPH, Vol. 15, Pages 1662: Cost and Threshold Analysis of the FinishIt Campaign to Prevent Youth Smoking in the United States International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081662 Authors: Brian W. Weir Jennifer Cantrell David R. Holtgrave Marisa S. Greenberg Ryan D. Kennedy Jessica M. Rath Elizabeth C. Hair Donna Vallone In 2014, Truth Initiative launched the national FinishIt campaign to prevent smoking initiation among youth and young adults. The significant changes in the communications landscape requires further analysis to determine resource requirements for public education campaigns relative to their impact. This analysis estimates the cost of the FinishIt campaign based on data from expenditure records and uses published estimates of the lifetime treatment costs and quality-adjusted life years associated with smoking. The total cost of the FinishIt campaign for 2014–2016 was $162 million. Under assumptions associated with the pessimistic base-case (no medical care costs saved through prevention), 917 smoking careers would need to be averted for the campaign to be cost-effective. Assuming smoking leads to increased medical care costs, 7186 smoking careers would need to be averted for the campaign to be cost-saving. Given these thresholds (917 and 7186) and the estimate of the impact of the previous truth campaign, the investments in the Truth Initiative’s FinishIt campaign are likely warranted for preventing smoking careers among youth and young adults.

Description: IJERPH, Vol. 15, Pages 1664: Predicting the Time Spent Playing Computer and Mobile Games among Medical Undergraduate Students Using Interpersonal Relations and Social Cognitive Theory: A Cross-Sectional Survey in Chongqing, China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081664 Authors: Li Chen Ruiyi Liu Huan Zeng Xianglong Xu Rui Zhu Manoj Sharma Yong Zhao Background: Computer and mobile games are widely used among undergraduate students worldwide, especially in China. Our objective was to predict the time spent playing computer and mobile games based on interpersonal relations and social cognitive theory constructs (i.e., expectation, self-efficacy, and self-control). Methods: The cross-sectional survey was conducted in two medical universities using a sample of 1557 undergraduate students recruited by cluster sampling. The five-point Likert questionnaire was jointly developed by researchers from Chongqing Medical University and Jackson State University. Results: Approximately 30% and 70% of the students played computer and mobile games, respectively. The daily times spent by participants on computer games were 25.61 ± 73.60 min (weekdays) and 49.96 ± 128.60 min (weekends), and 66.07 ± 154.65 min (weekdays) and 91.82 ± 172.94 min (weekends) on mobile games. Students with high scores of interpersonal relations but low scores of self-efficacy spent prolonged time playing computer games on weekdays and weekends (p < 0.05 for all). Students with low scores of expectation spent prolonged time playing computer games on weekdays (p < 0.05). Students with high scores of interpersonal relations but low scores of self-efficacy and self-control spent prolonged time playing mobile games on weekdays and weekends (p < 0.05 for all). Conclusions: The prevalence and duration of playing mobile games were higher than those of playing computer games among medical undergraduate students in Chongqing, China. This study determined the interpersonal relations, self-efficacy, self-control, and expectation of the students at the time of playing computer and mobile games. Future studies may consider studying the interaction among game-related behaviours, environments, and personality characteristics.

Description: IJERPH, Vol. 15, Pages 1688: EcoHealth and the Determinants of Health: Perspectives of a Small Subset of Canadian Academics in the EcoHealth Community International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081688 Authors: Aryn Lisitza Gregor Wolbring EcoHealth is an emerging field that examines the complex relationships among humans, animals, and the environment, and how these relationships affect the health of each of these domains. The different types of determinants of health greatly influence human health and well-being. Therefore, EcoHealth’s ability to improve human, animal, and environmental health and well-being is, in part, influenced by its ability to acknowledge and integrate the determinants of health. However, our previous research demonstrates that the academic EcoHealth literature had a low, uneven engagement with the determinants of health. Accordingly, to make sense of this gap, our research aim is to better understand the views of a small subset of the Canadian EcoHealth community about EcoHealth and the determinants of health relative to EcoHealth. We used a qualitative research design involving seven semi-structured interviews, which were analyzed using thematic analysis. Our findings suggest a tension across themes and a lack of conceptual engagement with the determinants of health. As we consider a future with rapid, unsustainable changes, we expect the identification and integration of the different types of determinants of health within EcoHealth to be imperative for EcoHealth to attain its goal of improving the health and well-being of humans, animals, and the environment.

Description: IJERPH, Vol. 15, Pages 1693: An Exploration of Psychosocial Pathways of Parks’ Effects on Health: A Qualitative Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081693 Authors: Ewelina M. Swierad Terry T. K. Huang Urban green space has been positively associated with psychological and physical health. However, the linkage between exposure to parks and health outcomes remains unclear. The current study examined the meanings that people assign to city parks, as a way to understand the pathways by which parks exert their effects on health. We conducted qualitative interviews with twenty culturally diverse residents in New York City. Thematic analysis was performed on the qualitative data. Results showed that all themes identified were related to parks fulfilling a basic human need for connection to (1) family, loved ones, and friends; (2) community and neighborhood; (3) self; and (4) nature. Based on these data, we proposed a human-centered framework for future research and interventions aimed at catalyzing parks as a vehicle to improve health and wellbeing. A human-centered approach emphasizes targeting the deep-seated needs and values of those we seek to engage and for whom health promotion and disease prevention efforts are designed. Our study shows that park transformations need to incorporate careful considerations of the human need for connection on multiple levels, so that park usage and its consequent health benefits may be optimized.

Description: IJERPH, Vol. 15, Pages 1691: Evolution of Landscape Ecological Risk at the Optimal Scale: A Case Study of the Open Coastal Wetlands in Jiangsu, China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081691 Authors: Yongchao Liu Yongxue Liu Jialin Li Wanyun Lu Xianglin Wei Chao Sun Detailed analysis of the evolution characteristics of landscape ecological risk is crucial for coastal sustainable management and for understanding the potential environmental impacts of a man-made landform landscapes (MMLL). As a typical open coastal wetland, large-scale human activities (e.g., tidal reclamation, fishery activities, wind farm construction, and port construction) have substantially affected the evolution of the coastal ecological environment. Previous landscape ecological risk assessment studies have documented the effectiveness of assessing the quality of ecological environment processes. However, these studies have either focused on the noncoastal zone, or they have not considered the evolution of the spatial characteristics and ecological risk evolution of the landscape at an optimal scale. Here, we present a landscape ecological risk pattern (LERP) evolution model, based on two successive steps: first, we constructed an optimal scale method with an appropriate extent and grain using multi–temporal Landsat TM/OLI images acquired in the years 2000, 2004, 2008, 2013 and 2017, and then we calculated landscape ecological risk indices. Based on this model, the entire process of the spatiotemporal evolution of ecological risk patterns of the open coastal wetlands in Jiangsu, China, was determined. The principal findings are as follows: (1) The main landscape types in the study area are tidal flats and farmland, and the main features of the landscape evolution are a significant increase in aquafarming and a substantial decrease in the tidal flat area, while the landscape heterogeneity increased; (2) In the past 20 years, the areas of low and relatively low ecological risk in the study region were greatly reduced, while the areas of medium, relatively high, and high ecological risk greatly increased; the areas of high-grade ecological risk areas are mainly around Dongtai and Dafeng; (3) The area of ecological risk from low-grade to high-grade occupied 71.75% of the study area during 2000–2017. During the previous periods (2000–2004 and 2004–2008), the areas of low-grade ecological risk were transformed to areas of middle-grade ecological risk area, while during the later periods (2008–2013 and 2013–2017) there was a substantial increase in the proportion of areas of high-grade ecological risk. Our results complement the official database of coastal landscape planning, and provide important information for assessing the potential effects of MMLL processes on coastal environments.

Description: IJERPH, Vol. 15, Pages 1689: Predicting Condom Use among Undergraduate Students Based on the Theory of Planned Behaviour, Coquimbo, Chile, 2016 International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081689 Authors: Patricio Ramírez-Correa Muriel Ramírez-Santana Background: Sexually transmitted infections and pregnancy in adolescents are acknowledged public health problems in many countries. Although it is known that the proper use of condoms allows avoiding these health problems, their use in Chile is still limited, for unknown reasons. Objective: Based on planned behavioural theory, the aim was to validate a behaviour model regarding condom use by measuring the influence of the variables that predict this use among Chilean university students. Methods: A cross-sectional descriptive study was carried out in October 2016 among 151 Chilean university students belonging to the health and engineering areas. The information was collected through a self-administered survey. The sample was divided into two groups: stable and not stable relationships. Partial least squares (PLS) regression was used for the analysis. Results: It was possible to explain the condom use of the students by 57%. The attitude was the main variable related to the intention of using condoms, together with the perceived behavioural control. Additionally, there are statistically significant differences in the variables that predict condom use among students with stable relations compared to those without a stable relationship. Conclusions: The planned behavioural theory is useful for predicting condom use behaviour when students have a stable partner.

Description: IJERPH, Vol. 15, Pages 1687: A Framework of Industrialized Building Assessment in China Based on the Structural Equation Model International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081687 Authors: Lei Jiang Zhongfu Li Long Li Tiankun Li Yunli Gao Compared with the conventional building, the industrialized building (IB) promotes the sustainable development of the construction industry, which will become a growth trend in the future. Nevertheless, the progress of industrialized building is intimately affected through the scientific evaluating mechanism, which still requires more research. Thus, this study establishes a conceptual framework of industrialized building assessment (IBA), which is validated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The impact between efficiency and the other five dimensions are studied by the structural equations model (SEM). The findings indicated that the conceptual framework is valid, and the efficiency has a positive impact on economic factors, livability, safety, environmental factors, and social benefits. Consequently, the improvement of efficiency has turned out to be the primary issue for improving the growth of the industrialized building. This research explores the basic framework of industrialized building assessment and provides a basis to establish a comprehensive and precise industrial building evaluation mechanism in the near future.

Description: IJERPH, Vol. 15, Pages 1232: Prevalence of Smoking among Men in Ethiopia and Kenya: A Cross-Sectional Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061232 Authors: Shangfeng Tang Ghose Bishwajit Tegene Regassa Luba Sanni Yaya While tobacco use remains the largest single cause of premature death in the industrialized countries, low-and-middle income countries are also experiencing a rising burden of the tobacco epidemic and are making various programmatic efforts to tackle the issue. Evidence-based policy making is critical to the long-term success of tobacco intervention programs and is reliant on regular monitoring of the trends and prevalence rates of tobacco use though population-based surveys, which are sparse for countries in eastern Africa. Therefore, in the present study we aimed to (1) estimate the trends in the prevalence of self-reported smoking status; and (2) explore the sociodemographic factors associated with smoking among adult men in Ethiopia and Kenya. Methods: Subjects were 26,919 adult men aged between 15 and 59 years from Ethiopia and Kenya. Nationally representative cross-sectional data on self-reported smoking and relevant sociodemographic indicators were collected from the Demographic and Health Surveys (DHS) conducted in these two countries. Data analysis was performed by descriptive, bivariate, and multivariable methods. Results: In Ethiopia, the prevalence rate of smoking increased from 8.5% in 2005 to 11.7% in 2011. While in Kenya, the rate declined albeit slowly from 22.9% in 2003 to 18.8% in 2008–2009 and 17% in 2014. The prevalence was significantly different in urban and rural areas. In majority of the surveys, prevalence of smoking was highest in the age group of 25–34 years. The prevalence of smoking varied widely across several socioeconomic characteristics. Conclusions: The findings indicate a high rate of smoking among men especially in urban areas, and call for policy actions to address the socioeconomic factors as a part of the policy to strengthen tobacco-control efforts.

Description: IJERPH, Vol. 15, Pages 1166: Effect of Intermittent Energy Restriction on Flow Mediated Dilatation, a Measure of Endothelial Function: A Short Report International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061166 Authors: Michelle L. Headland Peter M. Clifton Jennifer B. Keogh Intermittent energy restriction is a popular alternative to daily energy restriction for weight loss; however, it is unknown if endothelial function, a risk factor for cardiovascular disease, is altered by periods of severe energy restriction. The objective of the study was to determine the impact of two consecutive very low energy intake days, which is the core component of the 5:2 intermittent energy restriction diet strategy, on endothelial function compared to consecutive ad libitum eating days. The secondary objective was to explore the effects of these dietary conditions on fasting glucose concentrations. This was a 4-week randomized, single-blinded, crossover study of 35 participants. Participants consumed a very low energy diet (500 calories for women, 600 calories for men) on two consecutive days per week and 5 days of habitual eating. In weeks 3 and 4 of the trial, participants had measurements of flow mediated dilatation (FMD) and blood samples taken following either 2 habitual eating days or 2 energy restricted days in a randomized order. FMD values were not different after the two eating states (8.6% vs. 8.3%, p = 0.7). All other outcome variables were unchanged. Endothelial function, as measured by flow mediated dilatation, was not altered by two consecutive very low energy intake days. Further investigations assessing the impact in specific population groups as well as different testing conditions would be beneficial.

Description: IJERPH, Vol. 15, Pages 1225: Effect of Time and Mixing in Thermal Pretreatment on Faecal Indicator Bacteria Inactivation International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061225 Authors: Fubin Yin Hongmin Dong Bin Shang Wanqin Zhang Faecal indicator bacteria of faecal coliform, Salmonella spp., and faecal Streptococcus are present at high levels in faecal sludge and affect human health. Mesophilic anaerobic digestion cannot reduce faecal indicator bacteria to meet the standards for biosolids; therefore, the thermal pretreatment of faecal sludge is essential. The main objectives of this research were to evaluate the effect of thermal (70 °C) pretreatment time (20, 40, 60, 80, 100, and 120 min) and mixing velocity gradient (no mixing, 133, 191, and 238 s−1) on faecal indicator bacteria inactivation and determine the kinetics of the inactivation. The results showed that mixing has a more positive effect on pretreatment; thermal pretreatment with mixing was able to completely inactivate faecal indicator bacteria within 80 min, and inactivation followed first-order kinetics. In addition, under optimal mixing at a velocity gradient 191 s−1, the thermal pretreatment with mixing had a positive effect on the sludge solubilisation. Soluble chemical oxygen demand (SCOD, 71,430 mg L−1) and soluble protein (7.96 g L−1) were higher than the values obtained with thermal pretreatment without mixing, which were a SCOD value of 63,600 mg L−1 and soluble protein of 6.78 g L−1.

Description: IJERPH, Vol. 15, Pages 1257: Impacts of Water Stress on Forest Recovery and Its Interaction with Canopy Height International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061257 Authors: Peipei Xu Tao Zhou Chuixiang Yi Hui Luo Xiang Zhao Wei Fang Shan Gao Xia Liu Global climate change is leading to an increase in the frequency, intensity, and duration of drought events, which can affect the functioning of forest ecosystems. Because human activities such as afforestation and forest attributes such as canopy height may exhibit considerable spatial differences, such differences may alter the recovery paths of drought-impacted forests. To accurately assess how climate affects forest recovery, a quantitative evaluation on the effects of forest attributes and their possible interaction with the intensity of water stress is required. Here, forest recovery following extreme drought events was analyzed for Yunnan Province, southwest China. The variation in the recovery of forests with different water availability and canopy heights was quantitatively assessed at the regional scale by using canopy height data based on light detection and ranging (LiDAR) measurements, enhanced vegetation index data, and standardized precipitation evapotranspiration index (SPEI) data. Our results indicated that forest recovery was affected by water availability and canopy height. Based on the enhanced vegetation index measures, shorter trees were more likely to recover than taller ones after drought. Further analyses demonstrated that the effect of canopy height on recovery rates after drought also depends on water availability—the effect of canopy height on recovery diminished as water availability increased after drought. Additional analyses revealed that when the water availability exceeded a threshold (SPEI > 0.85), no significant difference in the recovery was found between short and tall trees (p > 0.05). In the context of global climate change, future climate scenarios of RCP2.6 and RCP8.5 showed more frequent water stress in Yunnan by the end of the 21st century. In summary, our results indicated that canopy height casts an important influence on forest recovery and tall trees have greater vulnerability and risk to dieback and mortality from drought. These results may have broad implications for policies and practices of forest management.

Description: IJERPH, Vol. 15, Pages 1255: Cost and Affordability of Diets Modelled on Current Eating Patterns and on Dietary Guidelines, for New Zealand Total Population, Māori and Pacific Households International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061255 Authors: Sally Mackay Tina Buch Stefanie Vandevijvere Rawinia Goodwin Erina Korohina Mafi Funaki-Tahifote Amanda Lee Boyd Swinburn The affordability of diets modelled on the current (less healthy) diet compared to a healthy diet based on Dietary Guidelines was calculated for population groups in New Zealand. Diets using common foods were developed for a household of four for the total population, Māori and Pacific groups. Māori and Pacific nutrition expert panels ensured the diets were appropriate. Each current (less healthy) diet was based on eating patterns identified from national nutrition surveys. Food prices were collected from retail outlets. Only the current diets contained alcohol, takeaways and discretionary foods. The modelled healthy diet was cheaper than the current diet for the total population (3.5% difference) and Pacific households (4.5% difference) and similar in cost for Māori households (0.57% difference). When the diets were equivalent in energy, the healthy diet was more expensive than the current diet for all population groups (by 8.5% to 15.6%). For households on the minimum wage, the diets required 27% to 34% of household income, and if receiving income support, required 41–52% of household income. Expert panels were invaluable in guiding the process for specific populations. Both the modelled healthy and current diets are unaffordable for some households as a considerable portion of income was required to purchase either diet. Policies are required to improve food security by lowering the cost of healthy food or improving household income.

Description: IJERPH, Vol. 15, Pages 1253: Reducing Food Poverty and Vulnerability among the Rural Elderly with Chronic Diseases: The Role of the New Rural Pension Scheme in China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061253 Authors: Zhaohua Zhang Yuxi Luo Derrick Robinson Vulnerability to food poverty is the probability of an individual falling below the food poverty line in the near future, which provides a forward-looking welfare analysis. Applying a nationally representative survey dataset, this study investigates the role of the New Rural Pension Scheme (NRPS) in reducing food poverty and vulnerability among the rural elderly with chronic diseases. By designing province-specific food poverty lines to account for variations in the elderly’s needs, as well as the prices across provinces using a least-cost linear programming approach, the food poverty incidences among the elderly with chronic diseases are calculated. Applying a three-stage feasible generalized least squares (FGLS) procedure, the vulnerability to food poverty is estimated. Our results show that food poverty incidence and vulnerability of the elderly with chronic diseases in rural China is 41.9% and 35% respectively, which is 8% and 6% higher, respectively, than the elderly that are in good health. To address the potential endogeneity of pension payment, a fuzzy regression discontinuity (RD) regression is employed to investigate the effects of pension income on food poverty and vulnerability for different population groups. We found that pension income decreases the probability of being food poor and the vulnerability to food poverty among the elderly with chronic diseases by 12.9% and 16.8% respectively, while it has no significant effect on the elderly in good health.

Description: IJERPH, Vol. 15, Pages 1262: Research on the Relationship between Water Diversion and Water Quality of Xuanwu Lake, China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061262 Authors: Weiwei Song Qing Xu Xingqian Fu Peng Zhang Yong Pang Dahao Song Water diversion is often used to improve water quality to reach the standard of China in the short term. However, this large amount of water diversion can not only improve the water quality, but also lead to a decline in the water quality (total phosphorus, total nitrogen) of Xuanwu Lake. Through theoretical analysis, the relationship between water quality and water diversion is established. We also found that the multiplication of the pollutant degradation coefficient (K) and the water residence time (T) is a constant (N), K⋅T=N. The water quality changed better at first, with the increase of inflow discharge, and then became worse, and the optimal water quality inflow discharge is 180,000 m3/day. By constructing two-dimensional hydrodynamic and water quality models, the optimal diversion water plan is calculated. Through model calculations, it can be seen that reducing the inflow discharge makes the water residence time longer (15.3 days changed to 23.8 days). Thereby, increasing the degradation of pollutants, and thus improving water quality. Compared with other wind directions, the southwest wind makes the water quality of Xuanwu Lake the most uniform. The concentration of water quality first became smaller and then became larger, as the wind speed increased, and eventually became constant. Implementing these results for water quality improvement in small and medium lakes will significantly reduce the cost of water diversion.

Description: IJERPH, Vol. 15, Pages 1266: Vibrio Species in Wastewater Final Effluents and Receiving Watershed in South Africa: Implications for Public Health International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061266 Authors: Allisen N. Okeyo Nolonwabo Nontongana Taiwo O. Fadare Anthony I. Okoh Wastewater treatment facilities in South Africa are obliged to make provision for wastewater effluent quality management, with the aim of securing the integrity of the surrounding watersheds and environments. The Department of Water Affairs has documented regulatory parameters that have, over the years, served as a guideline for quality monitoring/management purposes. However, these guidelines have not been regularly updated and this may have contributed to some of the water quality anomalies. Studies have shown that promoting the monitoring of the current routinely monitored parameters (both microbial and physicochemical) may not be sufficient. Organisms causing illnesses or even outbreaks, such as Vibrio pathogens with their characteristic environmental resilience, are not included in the guidelines. In South Africa, studies that have been conducted on the occurrence of Vibrio pathogens in domestic and wastewater effluent have made it apparent that these pathogens should also be monitored. The importance of effective wastewater management as one of the key aspects towards protecting surrounding environments and receiving watersheds, as well as protecting public health, is highlighted in this review. Emphasis on the significance of the Vibrio pathogen in wastewater is a particular focus.

Description: IJERPH, Vol. 15, Pages 1271: The Impact of Road Construction on Subjective Well-Being in Communities in Madre de Dios, Peru International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061271 Authors: Amy R. Riley-Powell Gwenyth O. Lee Nehal S. Naik Kelly E. Jensen Christina O’Neal Gabriela Salmón-Mulanovich Stella M. Hartinger Daniel G. Bausch Valerie A. Paz-Soldan The interoceanic highway (IOH) in Madre de Dios, Peru has driven dramatic change in the Peruvian Amazon basin. We conducted a mixed methods study to examine the impact of these changes on the subjective well-being (SWB) of four communities on the IOH. Themes that emerged qualitatively included changing health threats, environmental degradation, and the impact of increased migration. To achieve a higher level of SWB, respondents emphasized the need for higher incomes, opportunities to learn new skills, and a better education for their children. Potential threats to SWB included marital problems and poorer health. Quantitative analyses suggested that social support and a sense of security impacted reported SWB scores based on life satisfaction, and the impact of income on life satisfaction was mediated by food security. Although long-term residents felt that specific determinants of SWB had both increased (food variety, transport and access to work) and decreased (access to natural resources and hunting), the majority reported that their lives had improved overall. Health had been affected by the IOH in both negative ways (increased dengue and road accidents) and positive ways (improved access to health services). Our results suggest that the rapidly-changing communities near the IOH link well-being to health, income, community, and the environment.

Description: IJERPH, Vol. 15, Pages 1265: Comparison of Wearable Trackers’ Ability to Estimate Sleep International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061265 Authors: Jung-Min Lee Wonwoo Byun Alyssa Keill Danae Dinkel Yaewon Seo Tracking physical activity and sleep patterns using wearable trackers has become a current trend. However, little information exists about the comparability of wearable trackers measuring sleep. This study examined the comparability of wearable trackers for estimating sleep measurement with a sleep diary (SD) for three full nights. A convenience sample of 78 adults were recruited in this research with a mean age of 27.6 ± 11.0 years. Comparisons between wearable trackers and sleep outcomes were analyzed using the mean absolute percentage errors, Pearson correlations, Bland–Altman Plots, and equivalent testing. Trackers that showed the greatest equivalence with the SD for total sleep time were the Jawbone UP3 and Fitbit Charge Heart Rate (effect size = 0.09 and 0.23, respectively). The greatest equivalence with the SD for time in bed was seen with the SenseWear Armband, Garmin Vivosmart, and Jawbone UP3 (effect size = 0.09, 0.16, and 0.07, respectively). Some of the wearable trackers resulted in closer approximations to self-reported sleep outcomes than a previously sleep research-grade device, these trackers offer a lower-cost alternative to tracking sleep in healthy populations.

Description: IJERPH, Vol. 15, Pages 1268: Moving towards a Comprehensive Approach for Health Literacy Interventions: The Development of a Health Literacy Intervention Model International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061268 Authors: Bas Geboers Sijmen A. Reijneveld Jaap A. R. Koot Andrea F. de Winter Low health literacy (HL) is associated with many negative health outcomes, and is a major challenge in public health and healthcare. Interventions to improve outcomes associated with HL are needed. In this paper, we aim to develop a comprehensive HL intervention model. We used a multimethod approach, consisting of (1) a literature review of articles listed in MEDLINE, presenting HL intervention models, (2) online consultation of international HL experts, and (3) two consensus meetings with members (n = 36 and 27) of a consortium studying HL among older adults (50+) in Europe. In our literature review, we identified twenty-two HL models, only a few of which focused explicitly on interventions. Sixty-eight health literacy experts took part in the online survey. The results from all three methods came together in a comprehensive HL intervention model. This model conceptualized interventions as potentially targeting five factors affecting HL outcomes: (1) individuals’ personal characteristics, (2) individuals’ social context, (3) communication between individuals and health professionals, (4) health professionals’ HL capacities, and (5) health systems. Our model is the first comprehensive HL model focused specifically on interventions. The model can support the further development of HL interventions to improve the health outcomes of people with low HL.

Description: IJERPH, Vol. 15, Pages 1275: Screen Time, Physical Activity and Self-Esteem in Children: The Ulm Birth Cohort Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061275 Authors: Stefanie Braig Jon Genuneit Viola Walter Stephanie Brandt Martin Wabitsch Lutz Goldbeck Hermann Brenner Dietrich Rothenbacher Screen time is a central activity of children’s daily life and jeopardizes mental health. However, results appear inconclusive and are often based on small cross-sectional studies. We aimed to investigate the temporal sequence of the association between screen time and self-esteem taking into account further indirect effects through family or friendship relationship. In our population-based birth cohort study (baseline November 2000–November 2001, Ulm, Germany), these relationships were explored in n = 519 11- and 13-year-old children and their parents who both provided information on children’s screen time: time spent watching television or videos (TV), time spent on computers, video game consoles, mobile devices, or cell phones; so called “other screen time”, and children’s self-esteem (KINDL-R). Time watching TV (self-reported) at age 11 was negatively associated with girls’ self-esteem at the same age but positively with an increase of self-esteem between age 11 and 13. However, the latter association was restricted to low to moderate TV viewers. In boys, a higher increase of other screen time between age 11 and age 13 was associated with lower self-reported self-esteem at age 13. Additionally, friendship relationship mediated the association between watching TV and self-esteem in girls. For parental reports similar associations were observed. These findings indicate that time sequence and potential mediators need further investigation in cohort studies with multiple assessments of screen time and self-esteem.

Description: IJERPH, Vol. 15, Pages 1288: Differences in the Perception of Social Support Among Rural Area Seniors—A Cross-Sectional Survey of Polish Population International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061288 Authors: Paweł Chruściel Teresa Kulik Klaudia Jakubowska Dorota Nalepa Introduction and objective: Social support constitutes an important determinant of an elderly person’s health and of functioning in his or her living environment. It depends on available support networks and the type of help received. Measurement of social support should encompass both its structure and the functions it fulfills, which enables detailed assessment of the phenomenon. The aim of the study was to compare the perception of social support among rural area seniors provided with institutional care with those living in a home setting. Material and method: Using the diagnostic survey method and the technique of the distribution of a direct questionnaire, 364 respondents from rural areas were examined: those living in an institutional environment (n = 190) and those living in their home (natural) environment (n = 174). The respondents were selected on the basis of a combined sampling method: proportionate, stratified, and systematic. Variables were measured with the following questionnaires: Courage Social Network Index (CSNI) and Social Support Scale (SSS). Results: The living environment has been proved to differentiate average values of support both in the structural and functional dimensions in a statistically significant way (p < 0.001). An untypical phenomenon was higher average values pertaining to emotional bonds, frequency of direct contacts, and help received in the group of respondents living in an institutional environment. Conclusions: The living environment and demographic variables affect the perception of social support among elderly people. Full-time institutional care of a senior citizen leads to the deterioration of social support; therefore, keeping an elderly person in a home environment should be one of the primary goals of the senior policy.

Description: IJERPH, Vol. 15, Pages 1287: Trends and Knowledge Gaps in the Study of Nature-Based Participation by Latinos in the United States International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061287 Authors: Pooja S. Tandon Lauren M. Kuehne Julian D. Olden Mounting evidence supports health and well-being benefits associated with nature experiences, while also highlighting race- and class-based inequalities in access and exposure. We synthesized the literature on nature contact by Latinos in the United States to assess the state of knowledge and strategically identify research needs to improve outcomes and reduce health disparities for this rapidly growing ethnic group. Our systematic review revealed 108 articles with a notable increase in number of papers over the past 3 decades. We noted that the body of research is focused on certain demographic targets (adults in urban areas) with a relative dearth of knowledge for others (children, seniors, and rural areas). Our analysis also revealed strong compartmentalizing of studies into research “clusters” based on nonoverlapping topics and types of outcomes that are measured. Although one-third of studies explored health outcomes, these studies rarely examined other outcomes or research topics. Moreover, less than 7% of studies reported on interventions. Given the potential for nature contact to enhance health and well-being, there is substantial need for multidisciplinary research that explores interactions between social, cultural, and economic factors, and how those ultimately relate to nature contact and outcomes for Latinos in the United States.

Description: IJERPH, Vol. 15, Pages 1301: Changes of Ecosystem Service Value in a Coastal Zone of Zhejiang Province, China, during Rapid Urbanization International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071301 Authors: Luodan Cao Jialin Li Mengyao Ye Ruiliang Pu Yongchao Liu Qiandong Guo Baixiang Feng Xiayun Song Gains and losses in ecosystem service values (ESV) in coastal zones in Zhejiang Province during rapid urbanization were analyzed in terms of land-use changes. Decision-making on coastal development based on ESV estimation is significant for the sustainable utilization of coastal resource. In this study, coastal land-use changes in Zhejiang Province during rapid urbanization were discussed based on remote-sensing derived land-use maps created in the years 1990, 2000 and 2010. The ESV changes in coastal zones in Zhejiang Province from 1990 to 2010 were estimated by using the established ESV estimation model. The analysis results demonstrate the following: (1) with the continuous acceleration of urbanization, land-use types in coastal zones in Zhejiang Province changed significantly from 1990 to 2010, demonstrated by considerable growth of urban construction land and reduction of forest land and farmland; (2) in the study period, the total ESV in coastal zones in Zhejiang Province continuously decreased in value from RMB 35.278 billion to 29.964 billion, a reduction of 15.06%; (3) in terms of the spatial distribution of ESV, the ESVs in coastal zones in Zhejiang Province were generally converted from a higher ESV to a lower ESV; (4) estimates of ESV for the three years 1990, 2000 and 2010 appear to be relatively stable; and (5) land-use intensity in coastal zones in Zhejiang Province continuously increased during the 20 years. The spatial distribution of land-use intensity was consistent with that of the ESV change rate. Disordered land-use changes from forestland and farmland to urban construction land was a major cause of ESV loss.

Description: IJERPH, Vol. 15, Pages 1311: Sexual Health Help-Seeking Behavior among Migrants from Sub-Saharan Africa and South East Asia living in High Income Countries: A Systematic Review International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071311 Authors: Donna Angelina Rade Gemma Crawford Roanna Lobo Corie Gray Graham Brown The number of migrants has increased globally. This phenomenon has contributed to increasing health problems amongst migrants in high-income countries, including vulnerability for HIV acquisition and other sexual health issues. Adaptation processes in destination countries can present difficulties for migrants to seek help from and gain access to health services. This study examined migrants’ from sub-Saharan Africa (SSA) and South East Asia (SEA) sexual health help-seeking behavior in high-income countries with universal health coverage. The systematic review followed PRISMA guidelines and was registered with PROSPERO. Several databases were searched from 2000 to 2017. Of 2824 studies, 15 met the inclusion criteria. These consisted of 12 qualitative and three quantitative studies conducted in Australia, Spain, the United Kingdom, Belgium, Scotland, Ireland, and Sweden. Migrants experienced a range of difficulties accessing health services, specifically those related to sexual health, in high-income countries. Few studies described sources of sexual health help-seeking or facilitators to help-seeking. Barriers to access were numerous, including: stigma, direct and indirect costs, difficulty navigating health systems in destination countries and lack of cultural competency within health services. More culturally secure health services, increased health service literacy and policy support to mitigate costs, will improve health service access for migrants from SSA and SEA. Addressing the structural drivers for stigma and discrimination remains an ongoing and critical challenge.

Description: IJERPH, Vol. 15, Pages 1310: Integrating Refined Kano Model and QFD for Service Quality Improvement in Healthy Fast-Food Chain Restaurants International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071310 Authors: Kai-Jung Chen Tsu-Ming Yeh Fan-Yun Pai Der-Fa Chen People are paying greater attention to health. To maintain a good health status and obtain food fast, customers may go to healthy fast-food chain restaurants such as Subway more often than before in China and Taiwan. Healthy fast-food chain restaurants come with a healthy spin, seeking to differentiate themselves from other fast-food restaurants. This paper combined the refined Kano model and the quality function deployment (QFD) method. The refined Kano model was used to understand how customers perceive service attributes developed based on DINESERV measurements. QFD was employed to describe the relationships among the critical service attributes and corresponding improvements as well as to identify the priority for these improvements. The analysis results revealed that providing limited offers (due to periods, seasons, and regions) should be at the top of their improvement list, followed by staff suggestions for ingredients, and a temperature display to enhance the image of fresh ingredients. Other improvement actions include providing regular launches of new flavors/products, designing new and attractive slogans, and providing restaurant apps.

Description: IJERPH, Vol. 15, Pages 1313: Weather and Suicide: A Decade Analysis in the Five Largest Capital Cities of Colombia International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071313 Authors: Julián Fernández-Niño Víctor Flórez-García Claudia Astudillo-García Laura Rodríguez-Villamizar Historically, seasonal variations in suicide rates were thought to be associated with changes in weather. Most of this evidence however, is based on studies that were conducted in developed countries that are located outside the tropics. As such, it is necessary to examine this association in developing countries, such as Colombia, which do not experience marked seasons. In addition, it is important to adjust for the effect of holidays when analyzing this association as they have been reported to be a relevant confounding factor. Our objective was to estimate the association between daily suicide incidence among men and women in five major Colombian cities (Bogotá, Medellin, Cali, Barranquilla, and Bucaramanga) and daily temperature and rainfall. For this purpose, we conducted a multi-city, multi-temporal ecological study from 2005 to 2015, using data from the suicide mortality registries (provided by the National Administrative Department of Statistics). Daily measurements of the two weather variables were obtained from the official historical registry of the meteorological station at each city airport. We used these data to estimate conditional Poisson models for daily suicide counts, stratifying by sex and adjusting for holidays. Although we found that none of the weather variable estimators could reject the null hypothesis, we uncovered an association between suicide incidence and long weekends in the total suicide model (Incidence Rate Ratio (IRR): 1.19, 95% confidence interval (CI): 1.04–1.23). We found no evidence of association between weather variables and suicide in Colombia. Our study is based on daily observations and it provides evidence of absence of this association in a tropical country that does not experience marked seasons.

Description: IJERPH, Vol. 15, Pages 1308: A Method for Developing Rapid Screening Values for Active Pharmaceutical Ingredients (APIs) in Water and Results of Initial Application for 119 APIs International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071308 Authors: Ashley Suchomel Helen Goeden Julia Dady Americans fill upward of four billion prescriptions for pharmaceuticals each year, and many of those pharmaceuticals eventually make their way into the environment. Hundreds of different active pharmaceutical ingredients (APIs) are detected in ambient waters and source water used for drinking water in the U.S. Very few of these drugs have health-based guidance values that suggest a safe level for individuals exposed in the ambient environment through drinking water. The Minnesota Department of Health (MDH) has developed a novel method to derive screening-level human health guidance values for APIs. This method was designed for rapid evaluation and relies on Food and Drug Administration (FDA)-approved drug labels and limited additional public data resources for necessary information. MDH developed an analytical framework using traditional and novel uncertainty and adjustment factors specific to the information available for APIs. This framework, along with an estimated lowest therapeutic dose (LTD), was used to derive screening reference dose (sRfD) values. Water screening values (WSV) were then derived using the sRfD, a relative source contribution factor (RSC), and a water intake rate for infants to represent a highly exposed population. MDH used this new method to derive water screening values for 119 APIs that are commonly prescribed and/or commonly monitored in Minnesota waters, including antibiotics, antidepressants, steroids, and other classes of drugs. The derived WSVs can be used to provide context to environmental detections, prioritize APIs for further health-based guidance development, prioritize APIs for future environmental monitoring studies, and inform the development or refinement of analytical methods.

Description: IJERPH, Vol. 15, Pages 1319: Rural Households’ Livelihood Capital, Risk Perception, and Willingness to Purchase Earthquake Disaster Insurance: Evidence from Southwestern China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071319 Authors: Xu Liu Wang Tang Liu Earthquake disaster insurance can effectively reduce the impact of earthquake disasters on rural households. Exploring rural households’ willingness to purchase earthquake disaster insurance in earthquake disaster areas provides an understanding of the motivations underlying the implementation of an insurance policy. However, few studies have examined the perspectives of rural households, in order to explore the correlations between the rural households’ livelihood capital, their disaster risk perception, and their willingness to purchase earthquake disaster insurance. A cross-sectional survey data including 241 rural households from the most severe disaster counties (cities) during the 5 • 12 Wenchuan earthquake was examined with regard to rural households’ livelihood and disaster risk perception, and ordinal logistic regression models were constructed to explore rural households’ willingness to purchase earthquake disaster insurance, as well as the driving mechanism behind this willingness. The results showed that 34.44% of rural households were very willing to purchase earthquake disaster insurance, and 7.05% of rural households were very reluctant to purchase earthquake insurance. Rural households’ livelihood capital and risk perceptions were the most important factors affecting their willingness to purchase earthquake disaster insurance. Rural households with higher scores on natural capital, physical capital, possibility, and worry were more likely to purchase earthquake disaster insurance. Specifically, keeping all other variables constant, every one unit increase in nature capital and physical capital corresponded to an increase in the odds of willingness to purchase earthquake disaster insurance by a factor of 0.14 and 0.06, respectively; every one unit increase in possibility and worry corresponded to an increase in the odds of willingness to purchase earthquake disaster insurance by a factor of 0.03 and 0.04, respectively. This study contributes to the current literature by increasing the understanding of the relationships between Chinese rural households’ livelihood capital and risk perceptions, and their willingness to purchase earthquake disaster insurance.

Description: IJERPH, Vol. 15, Pages 1316: A Dual-Channel Supply Chain Coordination under Carbon Cap-and-Trade Regulation International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071316 Authors: Qi Qi Jing Wang Jianteng Xu We consider a dual-channel supply chain coordination under a carbon cap-and-trade regulation. The dual-channel refers to the traditional retail channel and the network direct channel, and both two channels’ selling prices can affect the market demand. We formulate the problem as a supplier-Stackelberg game model and obtain the optimal pricing decisions and corresponding profits in centralized and decentralized systems. We explore the effects of cap-and-trade regulation on optimal decisions and profits. To improve the performance of the decentralized system, we propose online channel price discount and offline channel price discount contracts to coordinate dual-channel supply chain and provide a transfer payment mechanism to make win-win of both sides. Moreover, we investigate how carbon regulation affects the coordination performance. Numerical examples illustrate the process to find the appropriate price discount coefficient and show the coordination effects of two contracts.

Description: IJERPH, Vol. 15, Pages 1315: A Review of Methods for Assessing the Environmental Health Impacts of an Agricultural System International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071315 Authors: Leah Grout Simon Hales Nigel French Michael G. Baker (1) Background: Global agricultural production is projected to increase substantially in the coming decades. Agricultural production provides food and materials crucial to human survival and well-being and is a critical source of livelihood, providing employment opportunities and economic benefits. However, industrialized or intensified agricultural systems, in particular, can have adverse effects on public health, place pressure on natural resources, and reduce environmental sustainability. This review attempts to identify and characterize key environmental health assessment methods for examining a broad array of potential impacts; (2) Methods: Electronic databases Medline, Scopus, Web of Science, and GreenLINE were searched for published literature that presented methods for conducting an environmental health assessment of an agricultural system; (3) Results: Fifty-three sources were included in the review. Eight methods were selected to illustrate the wide range of approaches currently available: health risk assessment methods, health impact assessment, environmental impact assessment methods, environmental burden of disease, lifecycle methods, integrated assessment modeling, trade-off analysis, and economic assessment; (4) Conclusions: This review can provide guidance for selecting an existing method or for designing a new method for assessing the environmental health impacts of an agricultural system.

Description: IJERPH, Vol. 15, Pages 1317: An Environmental Management Maturity Model of Construction Programs Using the AHP-Entropy Approach International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071317 Authors: Libiao Bai Hailing Wang Ning Huang Qiang Du Youdan Huang The accelerating process of urbanization in China has led to considerable opportunities for the development of construction projects, however, environmental issues have become an important constraint on the implementation of these projects. To quantitatively describe the environmental management capabilities of such projects, this paper proposes a 2-dimensional Environmental Management Maturity Model of Construction Program (EMMMCP) based on an analysis of existing projects, group management theory and a management maturity model. In this model, a synergetic process was included to compensate for the lack of consideration of synergies in previous studies, and it was involved in the construction of the first dimension, i.e., the environmental management index system. The second dimension, i.e., the maturity level of environment management, was then constructed by redefining the hierarchical characteristics of construction program (CP) environmental management maturity. Additionally, a mathematical solution to this proposed model was derived via the Analytic Hierarchy Process (AHP)-entropy approach. To verify the effectiveness and feasibility of this proposed model, a computational experiment was conducted, and the results show that this approach could not only measure the individual levels of different processes, but also achieve the most important objective of providing a reference for stakeholders when making decisions on the environmental management of construction program, which reflects this model is reasonable for evaluating the level of environmental management maturity in CP. To our knowledge, this paper is the first study to evaluate the environmental management maturity levels of CP, which would fill the gap between project program management and environmental management and provide a reference for relevant management personnel to enhance their environmental management capabilities.

Description: IJERPH, Vol. 15, Pages 1323: Social Risk Factors of Transportation PPP Projects in China: A Sustainable Development Perspective International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071323 Authors: Jingfeng Yuan Wei Li Jiyue Guo Xianbo Zhao Mirosław J. Skibniewski Public-private partnerships (PPPs) have become increasingly important in improving the sustainability of society in China, with transportation being the largest investment area. However, the Social Risk Factors (SRFs) of transportation PPPs in China, which serve as a useful tool for distinguishing strengths and weaknesses for effective social risk management (SRM), have not been clearly identified. A conceptual model including 3 risk dimensions and 15 SRFs was proposed to mitigate social risks and improve the social sustainability of transportation PPP projects. A questionnaire survey conducted to investigate stakeholders’ opinions on the proposed SRFs demonstrated that all the SRFs were important. The SRFs can be used to evaluate social risks from economic, environmental, and social dimensions. Confirmatory factor analysis (CFA) verified the classification of the SRFs and indicated that all the risk dimensions contributed to social risks. The social and environmental impacts on social sustainability may contribute more to the generation of social risks. Furthermore, the concept of people-first PPPs was proposed to reduce social risks from the perspective of different stakeholders, with the interactions among different stakeholders being prioritized. The identified SRFs and their relationships can improve our understanding of SRM in the delivery of social sustainability and improve social resilience.

Description: IJERPH, Vol. 15, Pages 1327: Daily Intake Estimation for Young Children’s Ingestion of Residential Dust and Soils Contaminated with Chlorpyrifos and Cypermethrin in Taiwan International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071327 Authors: Ya-Qing Yang Lih-Ming Yiin We estimated the daily intakes of chlorpyrifos and cypermethrin via ingestion of indoor dust and outdoor soils using the Stochastic Human Exposure and Dose Simulation Model on a probabilistic approach for Taiwanese young children. Variables for the estimation, such as concentration, ingestion rate, and body weight, were adopted from previous studies. Monte Carlo simulation was performed with 1,000,000 iterations to simulate a single daily intake, which was shown in terms of percentage of the Acceptable Daily Intake (ADI) of either insecticide. The daily intakes are minimal with a 99% probability, but go up steeply at the 99.9th percentile (13.1% and 20.0% of the ADIs of chlorpyrifos and cypermethrin, respectively). The sensitivity analysis indicates that concentration is the most determinant variable for daily intake estimation, suggesting that high intakes may occur when insecticide concentrations are elevated. Compared to the data of daily intakes via dietary ingestion of vegetables derived from a previous study, the estimated non-dietary intakes are negligible until reaching the highest percentile. Consequently, the non-dietary ingestion exposure to either insecticide is commonly low for young children in Taiwan’s homes, unless high contamination (e.g., indoor insecticide application) occurs in the environment. Care has to be taken to avoid high contamination indoors.

Description: IJERPH, Vol. 15, Pages 1328: Ventilation and Air Quality in Student Dormitories in China: A Case Study during Summer in Nanjing International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071328 Authors: Zhe Yang Jialei Shen Zhi Gao The Air quality in student dormitories can have a major impact on the health of millions of students in China. This study aims to investigate the ventilation and air quality in student dormitories. Questionnaire survey was conducted in eight dormitory buildings and field measurements were conducted in one dormitory during the summer in Nanjing. The survey result reveals that most students thought the indoor and outdoor air quality was neutral and the correlation between indoor and outdoor perceived air quality is statistically significant. There are few indoor PM2.5 and ozone sources in dormitories and natural ventilation is the most common form of ventilation. However, there is no statistically significant correlation between window opening behaviors and the perceptions of indoor and outdoor air quality. The field measurement result shows the measured I/O ratios of PM2.5 and ozone over 37 days are in the range of 0.42–0.79 and 0.21–1.00, respectively. The I/O ratios for PM2.5 and ozone are 0.49 ± 0.05 and 0.26 ± 0.05 in the case of the window being closed, and the I/O ratios for PM2.5 and ozone are 0.65 ± 0.08 and 0.50 ± 0.15 in the case of the window being open. The outdoor and indoor ozone concentrations show pronounced diurnal periodic variations, while the PM2.5 concentrations do not. Finally, recommended open/close window strategies are discussed to reduce indoor pollutant levels. Understanding the indoor/outdoor PM2.5 and ozone concentrations in different window patterns can be a guidance to preventing high indoor PM2.5 and ozone exposure in student dormitories.

Description: IJERPH, Vol. 15, Pages 1347: Human Exposure to Ferret Badger Rabies in Taiwan International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071347 Authors: Tai-Hwa Shih Jeng-Tung Chiang Hung-Yi Wu Satoshi Inoue Cheng-Ta Tsai Shih-Chiang Kuo Cheng-Yao Yang Chang-Young Fei On 17 July 2013, Taiwan confirmed multiple cases of the rabies virus (RABV) in the wild Taiwan Ferret badger (TFB) (Melogale moschata) member of the family Mustelidae. This study aims at investigating the risk factors for human exposure to rabid TFBs. Statistical inference based on Pearson correlation showed that there was a strong positive correlation between the total number of positive TFB rabies cases and the number of rabid TFBs involved with human activities in 81 enzootic townships (r = 0.91; p < 0.001). A logistic regression analysis indicated that the risk probability of a human being bitten by rabid TFBs was significantly higher when there were no dogs around (35.55% versus 6.17% (indoors, n = 171, p = 0.0001), and 52.00% versus 5.26% (outdoors, n = 44, p = 0.021)), and whether or not there was a dog around was the only crucial covariate that was statistically significantly related to the risk of a human being bitten. In conclusion, this study showed the value of having vaccinated pets as a deterrent to TFB encounters and as a buffer to prevent human exposure to rabid TFBs. The presence of unvaccinated pets could become a significant risk factor in the longer term if rabies isn’t controlled in TFBs because of the spillover between the sylvatic and urban cycles of rabies. Consequently, raising dogs, as well as keeping rabies vaccinations up-to-date for them, can be considered an effective preventive strategy to reduce the risk for human exposure to rabid TFBs.

Description: IJERPH, Vol. 15, Pages 1351: Upstream-Downstream Joint Carbon Reduction Strategies Based on Low-Carbon Promotion International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071351 Authors: Xiqiang Xia Junhu Ruan Zhiru Juan Yan Shi Xuping Wang Felix T. S. Chan A differential game model is established to analyze the impact of emissions reduction efforts and low-carbon product promotion on the reduction strategies of low-carbon product manufacturers (subsequently referred to as manufacturers) and the retailers of such products in a dynamic environment. Based on this model, changes in emissions reduction efforts and promotional efforts are comparatively analyzed under three scenarios (retailers bearing the promotional cost, manufacturers bearing the promotional cost, and centralized decision-making). The results are as follows: (1) the trajectory of carbon emissions reduction per product unit is the highest when the supply chain is under centralized decision-making, followed by when manufacturers bear the promotional cost, and lastly when retailers bear the cost; (2) when manufacturers bear the promotional cost, the market demand, emissions reduction effort, and promotional effort are higher, although the unit retail price is higher than when retailers bear the promotional cost; and (3) under centralized decision-making, the unit retail price is the lowest; however, sales volume, the emissions reduction effort, and the promotional effort are all higher than those in the other scenarios.

Description: IJERPH, Vol. 15, Pages 1359: Using Interpretative Structural Modeling to Identify Critical Success Factors for Safety Management in Subway Construction: A China Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071359 Authors: Ping Liu Qiming Li Jing Bian Liangliang Song Xiaer Xiahou With the rapid development of urbanization in China, a vast number of subway projects are under construction and planned in many cities. However, the complexities of the environment in subway construction inherently bring about many uncertainties and risk factors. Understanding the inherent properties of the critical success factors (CSFs) will contribute significantly to the subway construction. From this perspective, this paper aims to identify the CSFs for safety management in subway construction. This study screened preliminary CSFs through a literature review and in-depth interviews with experts in China. Based on the data gathered and subsequently analyzed from the questionnaire surveys, a final total of 24 CSFs were identified. Then, interpretative structural modeling was employed to ascertain the interrelations among them. The result showed that the factors concerning the engineering survey and design not only occupy relatively higher scores in the questionnaire survey but also contribute significantly latent impacts on other factors. In addition, the creation of a reasonable schedule and the investment of the safety measures were also found to have a fundamental impact on the safety management of subway construction. This research guided the safety managers in determining the most important safety factors they must face and provided them valuable information that could promote safety performance and decrease the number of accidents over the course of subway construction.

Description: IJERPH, Vol. 15, Pages 1357: Self-Reported Sleep Duration and Its Correlates with Sociodemographics, Health Behaviours, Poor Mental Health, and Chronic Conditions in Rural Persons 40 Years and Older in South Africa International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071357 Authors: Karl Peltzer Supa Pengpid This study aims to investigate sleep duration and its association with sociodemographic, health behaviour, mental health, and chronic disease factors among rural individuals 40 years and older in South Africa. Cross-sectional data from the “Health and Aging in Africa: A Longitudinal Study of an INDEPTH community in South Africa” (HAALSI) baseline survey were analysed. Socio-demographic, clinical, health, and sleep duration data were collected. The total sample included 4725 persons 40 years and older (mean age 61.5 years, SD = 13.0, age range of 40–111 years) in one sub-district in rural South Africa. The mean sleep duration was 8.28 ± 1.93 h. Short (<7 h) and long (≥9 h) sleepers accounted for 13.1% and 40.0% of the sample, respectively. In adjusted multinomial logistic regression, greater wealth status (p < 0.05), inadequate fruit and vegetable consumption (p < 0.001), and depressive symptoms (p < 0.05) were associated with a higher odds and physical inactivity (p < 0.05) with a lower odds of short sleep duration. Being male (p < 0.001) and depressive symptoms (p < 0.001) were associated with a higher odds and being 50 to 69 years old (p < 0.01), having Grade 1 to 11 education (p < 0.05), and greater wealth status (p < 0.001) were associated with a lower odds of long sleep duration. In adjusted multinomial logistic regression, compared to normal sleepers, long sleepers were more likely to have myocardial infarction (p < 0.05). In unadjusted analysis, compared to normal sleepers, short sleepers were more likely to have cataracts (p < 0.05). This study found that a significant proportion of rural dwellers 40 years and older in South Africa had a short sleep duration and a high proportion had a long sleep duration. Some associations, such as depression and myocardial infarction, with short and/or long sleep duration were confirmed, while no associations were found for many chronic conditions.

Description: IJERPH, Vol. 15, Pages 1356: Physical Activity and Outdoor Play of Children in Public Playgrounds—Do Gender and Social Environment Matter? International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15071356 Authors: Anne Kerstin Reimers Stephanie Schoeppe Yolanda Demetriou Guido Knapp Background: Few studies have delved into the relationship of the social environment with children’s physical activity and outdoor play in public playgrounds by considering gender differences. The aim of the present study was to examine gender differences and the relationship of the social environment with children’s physical activity and outdoor play in public playgrounds. Methods: A quantitative, observational study was conducted at ten playgrounds in one district of a middle-sized town in Germany. The social environment, physical activity levels, and outdoor play were measured using a modified version of the System for Observing Play and Leisure Activity in Youth. Results: In total, 266 observations of children (117 girls/149 boys) between four and 12 years old were used in this analysis. Significant gender differences were found in relation to activity types, but not in moderate-to-vigorous physical activity (MVPA). The presence of active children was the main explanatory variable for MVPA. In the models stratified by gender, the presence of opposite-sex children was a significant negative predictor of MVPA in girls but not in boys. Conclusions: The presence of active children contributes to children’s physical activity levels in public playgrounds. Girls’ physical activity seems to be suppressed in the presence of boys.

Description: IJERPH, Vol. 15, Pages 1581: The Effect of an Automated Phone Warning and Health Advisory System on Adaptation to High Heat Episodes and Health Services Use in Vulnerable Groups—Evidence from a Randomized Controlled Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081581 Authors: Kaddour Mehiriz Pierre Gosselin Isabelle Tardif Marc-André Lemieux Automated phone warning systems are increasingly used by public health authorities to protect the population from the adverse effects of extreme heat but little is known about their performance. To fill this gap, this article reports the result of a study on the impact of an automated phone heat warning system on adaptation behaviours and health services use. A sample of 1328 individuals vulnerable to heat was constituted for this purpose and participants were randomly assigned to treatment and control groups. The day before a heat episode, a phone heat warning was sent to the treatment group. Data were obtained through two surveys before and one survey after the heat warning issuance. The results show that members of the treatment group were more aware of how to protect themselves from heat and more likely to adopt the recommended behaviours. Moreover, a much smaller proportion of women in this group used the health-care system compared to the control group. Thus, the exposure to an automated phone warning seems to improve the adaptation to heat and reduce the use of health services by some important at-risk groups. This method can thus be used to complement public health interventions aimed at reducing heat-related health risks.

Description: IJERPH, Vol. 15, Pages 1618: Mumps in the Vaccination Age: Global Epidemiology and the Situation in Germany International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081618 Authors: Andrea-Ioana Beleni Stefan Borgmann Vaccination against mumps virus (MuV) (mostly measles-mumps-rubella) is routinely performed in more than 120 countries and has resulted in a distinct decrease of mumps incidence. However, alteration of mumps epidemiology has been observed in several countries after implementation of the vaccine but is sparsely documented. Moreover, outbreaks have occurred after starting vaccination, even in highly vaccinated populations. In the former German Democratic Republic (DDR) mumps was a notifiable disease but vaccination against mumps was not implemented. In the five eastern German states forming the DDR until 1990, mumps was not notifiable until 2001. Except for the lack of reporting between 1990–2000, data from Eastern Germany allow analysis of mumps epidemiology after initiating the vaccination campaign. For the period from 2001 to 2016 the data show that the incidence of mumps dropped notably after initiating vaccines, and was accompanied by an increase of the median age of patients with mumps. In Eastern Germany, no outbreaks were noted, while several outbreaks occurred in Western Germany, possibly due to a lower vaccination rate. Further literature analysis revealed that outbreaks were facilitated by waning immunity and crowding. Nevertheless, although vaccination prevented infection, the course of illness, once infected, was sometimes more complicated. In comparison to non-vaccinated populations, high rates of complicated courses occurred and were marked by orchitis, due to higher age of mumps patients. Therefore, refusing vaccination against mumps increases the risk of severe courses when living in a vaccinated population.

Description: IJERPH, Vol. 15, Pages 1617: Changing Neighborhoods and Residents’ Health Perceptions: The Heart Healthy Hoods Qualitative Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081617 Authors: Paloma Conde Marta Gutiérrez María Sandín Julia Díez Luisa N. Borrell Jesús Rivera-Navarro Manuel Franco Cities, and therefore neighborhoods, are under constant change. Neighborhood changes may affect residents’ health in multiple ways. The Heart Healthy Hoods (HHH) project studies the association between neighborhood and residents’ health. Focusing on a middle–low-socioeconomic neighborhood in Madrid (Spain), our aim was to describe qualitatively its residents’ perceptions on the urban changes and their impacts on health. We designed a qualitative study using 16 semi-structured interviews including adult residents and professionals living or working in the area. Firstly, we described the perceived main social and neighborhood changes. Secondly, we studied how these neighborhood changes connected to residents’ health perceptions. Perceived major social changes were new demographic composition, new socio–cultural values and economic changes. Residents’ negative health perceptions were the reduction of social relationships, increase of stress and labor precariousness. Positive health perceptions were the creation of supportive links, assimilation of self-care activities and the change in traditional roles. Neighborhood changes yielded both negative and positive effects on residents’ health. These effects would be the result of the interrelation of different elements such as the existence or absence of social ties, family responsibilities, time availability, economic resources and access and awareness to health-promoting programs. These qualitative research results provide important insight into crafting urban health policies that may ultimately improve health outcomes in communities undergoing change.

Description: IJERPH, Vol. 15, Pages 1620: Obesity Inequalities According to Place of Birth: The Role of Education International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081620 Authors: Elena Rodriguez-Alvarez Nerea Lanborena Luisa N. Borrell This study examined obesity inequalities according to place of birth and educational attainment in men and in women in Spain. A cross-sectional study was conducted using data from the Spanish National Health Survey 2011–2012 and from the European Health Survey in Spain 2014. We used data for 27,720 adults aged 18–64 years of whom 2431 were immigrants. We used log-binomial regression to quantify the association of place of birth with obesity before and after adjusting for the selected characteristics in women and in men. We found a greater probability of obesity in immigrant women (PR: 1.42; 95% CI: 1.22–1.64) and a lower probability of obesity in immigrant men (PR: 0.73; 95% CI: 0.59–0.89) relative to natives after adjustment. Significant heterogeneity was observed for the association of place of birth and obesity according to education in men (p-interactions = 0.002): Men with lower educational levels (PR: 0.47; 95% CI: 0.26–0.83) have a protective effect against obesity compared with their native counterparts. This study suggests that place of birth may affect obesity in women and in men. However, this effect may be compounded with education differently for women and men.

Description: IJERPH, Vol. 15, Pages 1615: Questionnaires for Lung Health in Africa across the Life Course International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081615 Authors: Sepeedeh Saleh Richard van Zyl-Smit Brian Allwood Herve Lawin Bertrand Hugo Mbatchou Ngahane Irene Ayakaka Elvis Moyo Asma El-Sony Kevin Mortimer Jamie Rylance Respiratory infections remain a leading cause of morbidity and mortality in many low and middle-income countries but non-communicable disease rates are rising fast. Prevalence studies have been primarily symptom-focused, with tools developed in countries in the Global North such as the United States and the United Kingdom. Systematic study in sub-Saharan African populations is necessary to accurately reflect disease risk factors present in these populations. We present tools for such studies, developed as part of the International Multidisciplinary Programme to Address Lung Health and TB in Africa (‘IMPALA’), which includes lay representatives. At a preliminary meeting, the adequacy and suitability of existing tools was discussed and a new questionnaire set proposed. Individual questionnaires were developed, and an expert panel considered content and criterion validity. Questionnaires underwent a cross-cultural adaptation process, incorporating translation and contextual ‘sense-checking’, through the use of pre-established lay focus groups in Malawi, before consensus-approval by project collaborators. The complete set of research questionnaires, providing information on lung health symptoms and a relevant range of potential risk factors for lung disease, is now available online. In developing the tools, cultural and contextual insights were important, as were translational considerations. The process benefitted from a foundation in expert knowledge, starting with validated tools and internationally respected research groups, and from a coordinated collaborative approach. We present and discuss a newly devised, contextually appropriate set of questionnaires for non-communicable lung disease research in Africa that are now available in open access for all to use.

Description: IJERPH, Vol. 15, Pages 1619: Ovarian Cancer Incidence in the U.S. and Toxic Emissions from Pulp and Paper Plants: A Geospatial Analysis International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081619 Authors: Carol Hanchette Charlie H. Zhang Gary G. Schwartz Ovarian cancer is the fifth leading cause of female cancer mortality in the U.S. and accounts for five percent of all cancer deaths among women. No environmental risk factors for ovarian cancer have been confirmed. We previously reported that ovarian cancer incidence rates at the state level were significantly correlated with the extent of pulp and paper manufacturing. We evaluated that association using county-level data and advanced geospatial methods. Specifically, we investigated the relationship of spatial patterns of ovarian cancer incidence rates with toxic emissions from pulp and paper facilities using data from the Environmental Protection Agency’s Toxic Release Inventory (TRI). Geospatial analysis identified clusters of counties with high ovarian cancer incidence rates in south-central Iowa, Wisconsin, New York, Pennsylvania, Alabama, and Georgia. A bivariate local indicator of spatial autocorrelation (LISA) analysis confirmed that counties with high ovarian cancer rates were associated with counties with large numbers of pulp and paper mills. Regression analysis of state level data indicated a positive correlation between ovarian cancer and water pollutant emissions. A similar relationship was identified from the analysis of county-level data. These data support a possible role of water-borne pollutants from pulp and paper mills in the etiology of ovarian cancer.

Description: IJERPH, Vol. 15, Pages 1621: The Transition from Occupational Safety and Health (OSH) Interventions to OSH Outcomes: An Empirical Analysis of Mechanisms and Contextual Factors within Small and Medium-Sized Enterprises International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081621 Authors: Guido J. L. Micheli Enrico Cagno Antonio Calabrese Many Occupational Safety and Health (OSH) interventions have proven to be effective only under controlled conditions; during the implementation in practice, the interventions may not work as expected, especially in small and medium-sized enterprises (SMEs). SMEs are affected by different contextual factors than larger enterprises and these factors can influence the outcome of the OSH programs. Three different phases of an OSH intervention (design, implementation, and control) have been considered. The aim of this research is to understand what are the mechanisms by which an OSH intervention works or does not work as expected, together with barriers and drivers, and the related contextual factors. The research was designed following multiple case study research, which enables an in depth understanding of the intervention process and the identification of the most relevant factors for OSH. Data were collected through interviews with owner-managers or OSH managers of SMEs. Finally, the data were analysed through an analytical research framework that enabled the identification of the main mechanisms and contextual factors for the interventions that had an expected outcome and for those which had an unexpected outcome.

Description: IJERPH, Vol. 15, Pages 1616: Assessing the Impact of a Risk-Based Intervention on Piped Water Quality in Rural Communities: The Case of Mid-Western Nepal International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081616 Authors: Dorian Tosi Robinson Ariane Schertenleib Bal Mukunda Kunwar Rubika Shrestha Madan Bhatta Sara J. Marks Ensuring universal access to safe drinking water is a global challenge, especially in rural areas. This research aimed to assess the effectiveness of a risk-based strategy to improve drinking water safety for five gravity-fed piped schemes in rural communities of the Mid-Western Region of Nepal. The strategy was based on establishing community-led monitoring of the microbial water quality and the sanitary status of the schemes. The interventions examined included field-robust laboratories, centralized data management, targeted infrastructure improvements, household hygiene and filter promotion, and community training. The results indicate a statistically significant improvement in the microbial water quality eight months after intervention implementation, with the share of taps and household stored water containers meeting the international guidelines increasing from 7% to 50% and from 17% to 53%, respectively. At the study endline, all taps had a concentration of <10 CFU Escherichia coli/100 mL. These water quality improvements were driven by scheme-level chlorination, improved hygiene behavior, and the universal uptake of household water treatment. Sanitary inspection tools did not predict microbial water quality and, alone, are not sufficient for decision making. Implementation of this risk-based water safety strategy in remote rural communities can support efforts towards achieving universal water safety.

Description: IJERPH, Vol. 15, Pages 1628: Do Challenge Stress and Hindrance Stress Affect Quality of Health Care? Empirical Evidence from China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081628 Authors: Tengyang Ma Tianan Yang Yilun Guo Yifei Wang Jianwei Deng Severe job stress has adverse effects on the health of Chinese healthcare workers. We investigated associations between job stress, health, and quality of health care among Chinese healthcare workers. To analyze associations between stress, health, and quality of health care among healthcare workers in 74 Chinese hospitals, we surveyed 2426 healthcare workers of primary, secondary, and tertiary hospitals in Western, Central, and Eastern China in 2017. Structural equation modelling was used to examine relationships between job stress, health, and quality of health care. The mediating effect of health on the association between job stress and quality of health care was examined with the Sobel test. In the final model, health had a moderate direct positive effect on the quality of health care (β = 0.24; p < 0.001). Challenge stress had a direct inverse effect on health (β = −0.05; p < 0.05) and a significant direct positive effect on the quality of health care (β = 0.26; p < 0.001). Hindrance stress had a significant inverse effect on health (β = −0.37; p < 0.001) and a moderate inverse effect on the quality of health care (β = −0.19; p < 0.001). The correlation between challenge stress and hindrance stress was significant and positive (β = 0.59; p < 0.001). A partial mediation effect was in the final model. The health status of healthcare workers is an important concern at all levels of Chinese hospitals. To improve quality of healthcare, appropriate challenge stress is recommended among young staff, and interventions targeting hindrance stress should be developed and implemented in all hospital departments.

Description: IJERPH, Vol. 15, Pages 1625: A Closer Look at the Bivariate Association between Ambient Air Pollution and Allergic Diseases: The Role of Spatial Analysis International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081625 Authors: Dohyeong Kim SungChul Seo Soojin Min Zachary Simoni Seunghyun Kim Myoungkon Kim Although previous ecological studies investigating the association between air pollution and allergic diseases accounted for temporal or seasonal relationships, few studies address spatial non-stationarity or autocorrelation explicitly. Our objective was to examine bivariate correlation between outdoor air pollutants and the prevalence of allergic diseases, highlighting the limitation of a non-spatial correlation measure, and suggesting an alternative to address spatial autocorrelation. The 5-year prevalence data (2011–2015) of allergic rhinitis, atopic dermatitis, and asthma were integrated with the measures of four major air pollutants (SO2, NO2, CO, and PM10) for each of the 423 sub-districts of Seoul. Lee’s L statistics, which captures how much bivariate associations are spatially clustered, was calculated and compared with Pearson’s correlation coefficient for each pair of the air pollutants and allergic diseases. A series of maps showing spatiotemporal patterns of allergic diseases at the sub-district level reveals a substantial degree of spatial heterogeneity. A high spatial autocorrelation was observed for all pollutants and diseases, leading to significant dissimilarities between the two bivariate association measures. The local L statistics identifies the areas where a specific air pollutant is considered to be contributing to a type of allergic disease. This study suggests that a bivariate correlation measure between air pollutants and allergic diseases should capture spatially-clustered phenomenon of the association, and detect the local instability in their relationships. It highlights the role of spatial analysis in investigating the contribution of the local-level spatiotemporal dynamics of air pollution to trends and the distribution of allergic diseases.

Description: IJERPH, Vol. 15, Pages 1622: Tetanus Vaccination and Extra-Immunization among Adult Populations: Eight-Year Follow Up Cohort Study of 771,443 Adults in Taiwan, 2006–2013 International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081622 Authors: Shih-Wei Liu Liang-Chung Huang Wu-Fu Chung Jauching Wu Li-Fu Chen Yu-Chun Chen Under-and extra-immunization of tetanus boosters are important issues to consider in reducing the burden of vaccine-preventable disease in adults. The present study aimed to analyze the trend of vaccination coverage (VC) and risk factors associated with extra-immunization of tetanus during an 8-year period using a national-scale cohort database. Taiwan’s one-million representative research database, the Longitudinal Health Insurance Database (LHID2005) was used. A total of 771,443 adults aged between 20 and 79 years were enrolled and followed from 1 January 2006 to 31 December 2013. VC at the beginning was as low as 35.1%, declining gradually and dropping to 33.9% at the end of follow-up. While a total of 303,480 tetanus boosters were used during the study period, more than half (55.5%) of these boosters were considered as extra-immunized. Both individual characteristics and visit characteristics were strongly associated with extra-immunization. Males, young and older adults, and those with a higher number of comorbidities were more likely to receive extra-immunization boosters, especially when they had more severe symptoms, visited an emergency room, or visited a hospital with lower accreditation levels located in a less urbanized area. This information could enhance implementation of evidence-based programs for tetanus boosters.

Description: IJERPH, Vol. 15, Pages 1642: Aircraft Noise and Psychological Ill-Health: The Results of a Cross-Sectional Study in France International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081642 Authors: Clémence Baudin Marie Lefèvre Patricia Champelovier Jacques Lambert Bernard Laumon Anne-Sophie Evrard Background: The effects of aircraft noise on psychological ill-health have not been largely investigated and remain to be discussed. No study has been performed in France on the health effects of aircraft noise. Objectives: The present study aimed to investigate the relationship between aircraft noise in dB and in terms of annoyance and psychological ill-health in populations living near airports in France. Methods: A total of 1244 individuals older than 18 and living near three French airports (Paris–Charles de Gaulle, Lyon–Saint-Exupéry and Toulouse–Blagnac) were randomly selected to participate in the study. Information about their personal medical history and socioeconomic and lifestyle factors was collected by means of a face-to-face questionnaire performed at their place of residence by an interviewer. Psychological ill-health was evaluated with the 12-item version of the General Heath Questionnaire (GHQ-12). For each participant, outdoor aircraft noise exposure in dB was estimated by linking their home address to noise maps. Objective noise exposure in dB was considered to be the primary exposure of interest. Four noise indicators referring to three different periods of the day were derived and used for the statistical analyses: Lden, LAeq,24hr, LAeq,6hr–22hr, and Lnight. Noise annoyance and noise sensitivity were the secondary risk factors of interest. Logistic regression models were used with adjustment for potential confounders. Results: The participation rate in the study was 30%. Approximately 22% of the participants were considered to have psychological ill-health according to the GHQ-12. No direct association was found between exposure to aircraft noise in dB and psychological ill-health. However, annoyance due to aircraft noise and noise sensitivity were both significantly associated with psychological ill-health. Moreover, a gradient was evidenced between annoyance and psychological ill-health, with increasing ORs from 1.79 (95% CI 1.06–3.03) for people who were not all annoyed to 4.00 (95% CI 1.67–9.55) for extremely annoyed people.Conclusions: These findings confirm the results of previous studies, suggesting there is no direct association between aircraft noise exposure in dB and psychological ill-health, but there is a significant relationship between noise sensitivity or annoyance due to aircraft noise and psychological ill-health. This supports the hypothesis that psychological aspects, such as noise annoyance and noise sensitivity, play important roles in the association between environmental noise and adverse effects on health. However, further studies are necessary in order to better understand the links between these variables.

Description: IJERPH, Vol. 15, Pages 1682: Do Water, Sanitation and Hygiene Conditions in Primary Schools Consistently Support Schoolgirls’ Menstrual Needs? A Longitudinal Study in Rural Western Kenya International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081682 Authors: Kelly T. Alexander Garazi Zulaika Elizabeth Nyothach Clifford Oduor Linda Mason David Obor Alie Eleveld Kayla F. Laserson Penelope A. Phillips-Howard Many females lack access to water, privacy and basic sanitation—felt acutely when menstruating. Water, sanitation and hygiene (WASH) conditions in schools, such as access to latrines, water, and soap, are essential for the comfort, equity, and dignity of menstruating girls. Our study was nested within a cluster randomized controlled pilot feasibility study where nurses provided menstrual items to schoolgirls. We observed the WASH conditions of 30 schools from June 2012–October 2013 to see if there were any changes in conditions, to compare differences between study arms and to examine agreement between observed and teacher-reported conditions. Data came from study staff observed, and school head teacher reported, WASH conditions. We developed scores for the condition of school facilities to report any changes in conditions and compare outcomes across study arms. Results demonstrated that soap availability for students increased significantly between baseline and follow-up while there was a significant decrease in the number of “acceptable” latrines. During the study follow-up period, individual WASH indicators supporting menstruating girls, such as locks on latrine doors or water availability in latrines did not significantly improve. Advances in WASH conditions for all students, and menstrual hygiene facilities for schoolgirls, needs further support, a defined budget, and regular monitoring of WASH facilities to maintain standards.

Description: IJERPH, Vol. 15, Pages 1679: Rebuilding the Gut Microbiota Ecosystem International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081679 Authors: Antonella Gagliardi Valentina Totino Fatima Cacciotti Valerio Iebba Bruna Neroni Giulia Bonfiglio Maria Trancassini Claudio Passariello Fabrizio Pantanella Serena Schippa A microbial ecosystem in which bacteria no longer live in a mutualistic association is called dysbiotic. Gut microbiota dysbiosis is a condition related with the pathogenesis of intestinal illnesses (irritable bowel syndrome, celiac disease, and inflammatory bowel disease) and extra-intestinal illnesses (obesity, metabolic disorder, cardiovascular syndrome, allergy, and asthma). Dysbiosis status has been related to various important pathologies, and many therapeutic strategies aimed at restoring the balance of the intestinal ecosystem have been implemented. These strategies include the administration of probiotics, prebiotics, and synbiotics; phage therapy; fecal transplantation; bacterial consortium transplantation; and a still poorly investigated approach based on predatory bacteria. This review discusses the various aspects of these strategies to counteract intestinal dysbiosis.

Description: IJERPH, Vol. 15, Pages 1685: Early Infant Feeding of Formula or Solid Foods and Risk of Childhood Overweight or Obesity in a Socioeconomically Disadvantaged Region of Australia: A Longitudinal Cohort Analysis International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081685 Authors: Haider Mannan In southwestern Sydney the timing of introduction of formula and solids may be associated with risk of childhood overweight or obesity, and this may vary by age at breastfeeding cessation during first year. We included 346 infants from southwestern Sydney using the longitudinal study for Australian children (LSAC), who at baseline were singleton, full term, and normal weight births. The outcome risk of overweight or obesity was measured at every two-year interval of children aged 0 or 1 year at baseline until they reached age 10 or 11, defined by body mass index (BMI) ≥ 85th percentile, using the Centre for Disease Control and Prevention growth charts. Age at introduction to formula or solids was dichotomized at four months. We used mixed effects logistic regression for performing all analyses with and without adjusting for mother’s BMI, age during pregnancy, and social disadvantage index. Missing data were estimated using multivariate normal imputation having 25 imputations. The odds of overweight or obesity were significantly higher among infants introduced to formula or solids at ≤4 months compared to those introduced at >4 months in both unadjusted (odds ratio = 2.3262, p = 0.023) and adjusted (odds ratio = 1.9543, p = 0.0475) analyses. The odds of overweight or obesity when age at formula or solids introduction was held fixed at ≤4 months, increased significantly (odds ratio = 2.0856, p = 0.0215) for children stopping breastfeeding at age ≤4 months compared to >4 months. Thus, increasing the prevalence of breast-feeding without any formula or solids to 4–6 months in southwest Sydney should be a worthwhile public health measure.

Description: IJERPH, Vol. 15, Pages 1683: Community Resilience Learning Collaborative and Research Network (C-LEARN): Study Protocol with Participatory Planning for a Randomized, Comparative Effectiveness Trial International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081683 Authors: Benjamin F. Springgate Armen C. Arevian Ashley Wennerstrom Arthur J. Johnson David P. Eisenman Olivia K. Sugarman Catherine G. Haywood Edward J. Trapido Cathy D. Sherbourne Ashley Everett Michael McCreary Diana Meyers Sheryl Kataoka Lingqi Tang Jennifer Sato Kenneth B. Wells This manuscript presents the protocol and participatory planning process for implementing the Community Resilience Learning Collaborative and Research Network (C-LEARN) study. C-LEARN is designed to determine how to build a service program and individual client capacity to improve mental health-related quality of life among individuals at risk for depression, with exposure to social risk factors or concerns about environmental hazards in areas of Southern Louisiana at risk for events such as hurricanes and storms. The study uses a Community Partnered Participatory Research (CPPR) framework to incorporate community priorities into study design and implementation. The first phase of C-LEARN is assessment of community priorities, assets, and opportunities for building resilience through key informant interviews and community agency outreach. Findings from this phase will inform the implementation of a two-level (program-level and individual client level) randomized study in up to four South Louisiana communities. Within communities, health and social-community service programs will be randomized to Community Engagement and Planning (CEP) for multi-sector coalition support or Technical Assistance (TA) for individual program support to implement evidence-based and community-prioritized intervention toolkits, including an expanded version of depression collaborative care and resources (referrals, manuals) to address social risk factors such as financial or housing instability and for a community resilience approach to disaster preparedness and response. Within each arm, the study will randomize individual adult clients to one of two mobile applications that provide informational resources on services for depression, social risk factors, and disaster response or also provide psychoeducation on Cognitive Behavioral Therapy to enhance coping with stress and mood. Planned data collection includes baseline, six-month and brief monthly surveys for clients, and baseline and 12-month surveys for administrators and staff.

Description: IJERPH, Vol. 15, Pages 1680: Dissipation Dynamic and Final Residues of Oxadiargyl in Paddy Fields Using High-Performance Liquid Chromatography-Tandem Mass Spectrometry Coupled with Modified QuEChERS Method International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081680 Authors: Xile Deng Yong Zhou Wenna Zheng Lianyang Bai Xiaomao Zhou Oxadiargyl, which binds to the protoporphyrinogen oxidase IX to exhibit herbicide activity, is mainly used in the prevention of certain perennial broadleaved and grass weeds during the preemergence of rice in paddy fields. However, oxadiargyl affects the germination and seedling growth of rice, causing damage to the plant and reducing rice yield. Hence, monitoring fate and behaviour of oxadiargyl in rice paddy fields is of great significance. A modified quick, easy, cheap, effective, rugged, and safe (QuEChERS) sample preparation method coupled with high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was established in paddy water, paddy soil, rice straw, paddy hull, and brown rice. We validated this method for the first time in the analysis of the dissipation dynamic and residues of oxadiargyl over two years (2015–2016) at three sites in China. The average recoveries of oxadiargyl ranged from 76.0 to 98.8%, with relative standard deviations of 3.5–14.0%. The dissipation curves for paddy soil fit to a first-order kinetic equation, revealing that oxadiargyl degraded rapidly in paddy soil with half-lives (t1/2) of 4.5–7.6 days. The final oxadiargyl residues in all samples remained below the detection limit and the maximum residue limit in China (0.02 mg kg−1) and Japan (0.05 mg kg−1) during the harvesting dates and were not detected in rice straw.

Description: IJERPH, Vol. 15, Pages 1684: The Overlooked Burden of Food Insecurity among Asian Americans: Results from the California Health Interview Survey International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081684 Authors: Monideepa B. Becerra Salome Kapella Mshigeni Benjamin J. Becerra Objective: Food insecurity remains a major public health issue in the United States, though lack of research among Asian Americans continue to underreport the issue. The purpose of this study was to evaluate the prevalence and burden of food insecurity among disaggregated Asian American populations. Methods: The California Health Interview Survey, the largest state health survey, was used to assess the prevalence of food insecurity among Asian American subgroups with primary exposure variable of interest being acculturation. Survey-weighted descriptive, bivariate, and multivariable robust Poisson regression analyses, were conducted and alpha less than 0.05 was used to denote significance. Results: The highest prevalence of food insecurity was found among Vietnamese (16.42%) and the lowest prevalence was among Japanese (2.28%). A significant relationship was noted between prevalence of food insecurity and low acculturation for Chinese, Korean, and Vietnamese subgroups. Language spoken at home was significant associated with food insecurity. For example, among Chinese, being food insecure was associated with being bilingual (prevalence ratio [PR] = 2.51) or speaking a non-English language at home (PR = 7.24), while among South Asians, it was associated with speaking a non-English language at home was also related to higher prevalence (PR = 3.62), as compared to English speakers only. Likewise, being foreign-born also related to being food insecure among Chinese (PR = 2.31), Filipino (PR = 1.75), South Asian (PR = 3.35), Japanese (PR = 2.11), and Vietnamese (PR = 3.70) subgroups, when compared to their US-born counterparts. Conclusion: There is an imperative need to address food insecurity burden among Asian Americans, especially those who have low acculturation.

Description: IJERPH, Vol. 15, Pages 1690: Human Papillomavirus-16 DNA Quantitation Differentiates High-Grade Anal Neoplasia International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081690 Authors: Melissa Agsalda-Garcia Tiffany Shieh Eleanore Chuang Nicholas Loi Cris Milne Rui Fang Eunjung Lim Jeffrey Killeen Bruce Shiramizu Background: Due to their higher rates of anal dysplasia/cancer, human immunodeficiency virus (HIV)-positive individuals are recommended to undergo anal dysplasia screening, which consists of anal cytology (AC) and high resolution anoscopy (HRA) with anal biopsy (AB) after abnormal AC result. However, AC variability limits its usefulness. Our objective was to evaluate human papillomavirus (HPV)-16 DNA quantitation as part of the screening algorithm. Methods: HPV-16 was detected in AC specimens from 75 HIV-positive participants using quantitative real-time polymerase chain reaction. AB results were available from 18/44 patients who had abnormal AC. Statistical tests included Mann-Whitney U, Kruskal-Wallis, receiver operating characteristic (ROC) analysis and Kappa coefficient tests. Results: HPV-16 copy numbers differed significantly across AC (p = 0.001) and AB grades (p = 0.009). HPV-16 ≥ 65 copies/cell predicted high-grade AB (p = 0.04). Using this cut-off in comparison to AB, it had better specificity (1.00) than AC (0.75) and specificity (0.77) than qualitative HPV-16 detection (0.38). Also, the Kappa coefficient of the cut-off (κ = 0.649) was higher than AC (κ = 0.557) and qualitative HPV-16 detection (κ = 0.258) to AB. Conclusion: Higher HPV-16 copy numbers corresponded to higher AC and AB grades, suggesting the importance of HPV burden on disease stage. Furthermore, HPV-16 ≥ 65 copies/cell distinguished high-grade disease and demonstrated better sensitivity, specificity, and agreement with AB than AC or qualitative HPV-16 detection. These results support the potential use of HPV quantitation in conjunction with AC in anal dysplasia screening.

Description: IJERPH, Vol. 15, Pages 1699: Transmission of Influenza A in a Student Office Based on Realistic Person-to-Person Contact and Surface Touch Behaviour International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081699 Authors: Nan Zhang Yuguo Li Influenza A viruses result in the deaths of hundreds of thousands of individuals worldwide each year. In this study, influenza A transmission in a graduate student office is simulated via long-range airborne, fomite, and close contact routes based on real data from more than 3500 person-to-person contacts and 127,000 surface touches obtained by video-camera. The long-range airborne, fomite and close contact routes contribute to 54.3%, 4.2% and 44.5% of influenza A infections, respectively. For the fomite route, 59.8%, 38.1% and 2.1% of viruses are transmitted to the hands of students from private surfaces around the infected students, the students themselves and other susceptible students, respectively. The intranasal dose via fomites of the students’ bodies, belongings, computers, desks, chairs and public facilities are 8.0%, 6.8%, 13.2%, 57.8%, 9.3% and 4.9%, respectively. The intranasal dose does not monotonously increase or decrease with the virus transfer rate between hands and surfaces. Mask wearing is much more useful than hand washing for control of influenza A in the tested office setting. Regular cleaning of high-touch surfaces, which can reduce the infection risk by 2.14%, is recommended and is much more efficient than hand-washing.

Description: IJERPH, Vol. 15, Pages 1707: Road Traffic Noise, Air Pollutants, and the Prevalence of Cardiovascular Disease in Taichung, Taiwan International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081707 Authors: Wei-Ting Yang Ven-Shing Wang Li-Te Chang Kai-Jen Chuang Hsiao-Chi Chuang Chiu-Shong Liu Bo-Ying Bao Ta-Yuan Chang Background: A few studies have investigated the interaction between exposure to road traffic noise, air pollutants, and cardiovascular disease (CVD), but their results were inconsistent. This cross-sectional study investigated whether road traffic noise, particulate matter with dynamic diameter less than 10 μm (PM10) and nitrogen dioxides (NO2) exposure were independently associated with the risk of CVD. Methods: We recruited 663 volunteers who had been living near main roads for more than three years in 2008. Information concerning the subjects’ home addresses was combined with noise measurements at 42 locations and annual average of air pollutants from 2 monitoring stations to estimate individual exposure. Multivariate logistic regression was used to calculate the odds ratio (OR) for diagnosed CVD, adjusting for potential confounders and co-exposure. Results: Only per 5-dBA increase in road traffic noise was significantly associated with elevated risk of CVD (adjusted OR = 2.23, 95% confidence interval (CI) = 1.26–3.93) in the single-exposure models. Such association was aggravated (adjusted OR = 2.96, 95% CI = 1.41–6.23) after adjustment for total traffic and PM10 or NO2 in the two-exposure models. Conclusions: Road traffic noise exposure may be associated with the increasing prevalence of CVD. No synergistic association was observed between co-exposure to noise and air pollutants and the risk of CVD.

Description: IJERPH, Vol. 15, Pages 1704: Exposure to Environmental and Occupational Particulate Air Pollution as a Potential Contributor to Neurodegeneration and Diabetes: A Systematic Review of Epidemiological Research International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081704 Authors: Eirini Dimakakou Helinor J. Johnston George Streftaris John W. Cherrie It has been hypothesised that environmental air pollution, especially airborne particles, is a risk factor for type 2 diabetes mellitus (T2DM) and neurodegenerative conditions. However, epidemiological evidence is inconsistent and has not been previously evaluated as part of a systematic review. Our objectives were to carry out a systematic review of the epidemiological evidence on the association between long-term exposure to ambient air pollution and T2DM and neurodegenerative diseases in adults and to identify if workplace exposures to particles are associated with an increased risk of T2DM and neurodegenerative diseases. Assessment of the quality of the evidence was carried out using the GRADE system, which considers the quality of the studies, consistency, directness, effect size, and publication bias. Available evidence indicates a consistent positive association between ambient air pollution and both T2DM and neurodegeneration risk, such as dementia and a general decline in cognition. However, corresponding evidence for workplace exposures are lacking. Further research is required to identify the link and mechanisms associated with particulate exposure and disease pathogenesis and to investigate the risks in occupational populations. Additional steps are needed to reduce air pollution levels and possibly also in the workplace environment to decrease the incidence of T2DM and cognitive decline.

Description: IJERPH, Vol. 15, Pages 1736: Grief and Avoidant Death Attitudes Combine to Predict the Fading Affect Bias International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081736 Authors: Jeffrey A. Gibbons Sherman A. Lee Ashley M.A. Fehr Kalli J. Wilson Timothy R. Marshall The fading affect bias (FAB) occurs when unpleasant affect fades faster than pleasant affect. To detect mechanisms that influence the FAB in the context of death, we measured neuroticism, depression, anxiety, negative religious coping, death attitudes, and complicated grief as potential predictors of FAB for unpleasant/death and pleasant events at 2 points in time. The FAB was robust across older and newer events, which supported the mobilization-minimization hypothesis. Unexpectedly, complicated grief positively predicted FAB, and death avoidant attitudes moderated this relation, such that the Initial Event Affect by Grief interaction was only significant at the highest 3 quintiles of death avoidant attitudes. These results were likely due to moderate grief ratings, which were, along with avoidant death attitudes, related to healthy outcomes in past research. These results implicate complicated grief and death avoidant attitudes as resiliency mechanisms that are mobilized during bereavement to minimize its unpleasant effects.

Description: IJERPH, Vol. 15, Pages 1732: Association between Oral Health-Related Quality of Life in People with Rare Diseases and Their Satisfaction with Dental Care in the Health System of the Federal Republic of Germany International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081732 Authors: Marcel Hanisch Sabrina Wiemann Lauren Bohner Johannes Kleinheinz Susanne Jung Background: The aim of this study was to examine the current dental care situation in Germany from the perspective of those affected by a rare disease, especially concerning their satisfaction with the German dental health care system, and thus assess the relationship between their perspective and their oral health-related quality of life (OHRQoL). Methods: A questionnaire regarding their experiences with the dental assistance and the health care system, such as the OHIP-14, was sent to the member associations of the organization of self-help groups for rare diseases ACHSE e.V. The correlation between OHIP-14 values and patient’s perspective was statistically analyzed by the non-parametric Tau de Kendall test (p < 0.05). Results: There was a statistically significant correlation between the OHIP score and the patient’s perspective regarding dental assistance and health care system (p < 0.05). For those surveyed who were satisfied with the support of the health care system, an average OHIP score of 8.54 ± 10.45 points (range: 0–48) was determined. The group that did not feel sufficiently supported by the health care system had an average OHIP score of 16.07 ± 13.43 points (range: 0–56). Discussion: The majority of respondents with rare diseases are dissatisfied with the German health care system and its support with regard to dental care.

Description: IJERPH, Vol. 15, Pages 1741: Asbestos Exposure and the Mesothelioma Incidence in Poland International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081741 Authors: Małgorzata Krówczyńska Ewa Wilk Asbestos is carcinogenic to humans; the exposure to asbestos causes a wide range of diseases. Aim: Malignant mesothelioma (MM) is unique for asbestos exposure. Methods: Based on the physical inventory of asbestos-cement roofing, the social-economic situation of communes, the proximity of asbestos manufacturing plants, the land use data referring to the surface of the built-up area, and the historical data on the annexations, the amount of asbestos-containing products in use was estimated by computing best Random Forest models. Per capita asbestos use is an indicator to compare the state of asbestos use among countries. MM cases in the local administrative units (provinces) were tested by the application of Moran’s I and Getis and Ord statistic. Results: The total amount of asbestos roofing in Poland was estimated at 738,068,000 m2 (8.2 million tons). In total there were 28 plants in Poland located in 11 provinces throughout the country. The amount of asbestos-cement roofing in use is correlated primarily with the measurements of asbestos concentration fibers (rs = 0.597). MM raw morbidity rate was calculated, stratified by province, and classified into five groups with respect to incidence. Hotspots of MM cases are in the southern part of Poland. Conclusions: MM cases are concentrated in the same geographical areas, which may indicate an increasing impact of environmental exposure. The results of the local and global autocorrelation clearly indicate a statistically significant relationship between incidences of MM in provinces. Poland and other Eastern European countries are among countries with low MM incidence rate. Detailed investigation is desirable since the current MM morbidity rate in Poland seems to be underestimated.

Description: IJERPH, Vol. 15, Pages 1739: Molecular Verification of Bloom-forming Aphanizomenon flos-aquae and Their Secondary Metabolites in the Nakdong River International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081739 Authors: Hae-Kyung Park Mi-Ae Kwon Hae-Jin Lee Jonghee Oh Su-Heon Lee In-Soo Kim Aphanizomenon spp. have formed harmful cyanobacterial blooms in the Nakdong River during spring, autumn, and now in winter, and the expansion of blooming period and area, associated with the global warming is predicted. The genus Aphanizomenon has been described to produce harmful secondary metabolites such as off-flavors and cyanotoxins. Therefore, the production of harmful secondary metabolites from the Aphanizomenon blooms in the Nakdong River needs to be monitored to minimize the risk to both water quality and public health. Here, we sampled the cyanobacterial blooms in the Nakdong River and isolated ten Aphanizomenon strains, morphologically classified as Aphanizomenon flos-aquae Ralfs ex Bornet et Flahault 1888. Phylogenetic analysis using 16S rRNA and internal transcribed spacer (ITS) region nucleotide sequences confirmed this classification. We further verified the harmful secondary metabolites-producing potential of A. flos-aquae isolates and water samples containing cyanobacterial blooms using PCR with specific primer sets for genes involved in biosynthesis of off-flavor metabolites (geosmin) and toxins (microcystins, saxitoxins and cylindrospermopsins). It was confirmed that these metabolite biosynthesis genes were not identified in all isolates and water samples containing only Aphanizomenon spp. Thus, it is likely that there is a low potential for the production of off-flavor metabolites and cyanotoxins in Aphanizomenon blooms in the Nakdong River.

Description: IJERPH, Vol. 15, Pages 1727: A Review of Knowledge, Belief and Practice Regarding Osteoporosis among Adolescents and Young Adults International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081727 Authors: Chin Yi Chan Norazlina Mohamed Soelaiman Ima-Nirwana Kok-Yong Chin Osteoporosis is a major public health problem affecting millions of people worldwide. Increasing knowledge, correcting health belief and promoting osteoprotective practices are effective measures for building and maintaining strong bone throughout ones’ life-span. This review aims to summarize the contemporary evidence on the knowledge, beliefs and practice of adolescents and young adults on bone health. We performed literature searches using the PubMed and Scopus databases to identify original studies from 2008 to May 2018 using the search terms “(knowledge OR beliefs OR attitude OR practice OR behaviours OR physical activity OR exercise OR diet OR nutrition) AND (young OR youth OR adolescents OR children OR young adults OR students OR teenager) AND (osteoporosis OR bone health)”. Of the 3206 articles found, 34 met the inclusion criteria. Studies showed that most adolescents and young adults had poor knowledge and expressed disinterest in osteoporosis. They believed that other diseases were more serious than osteoporosis, contributing to low perceived susceptibility and seriousness towards this disease. Popular media emerged as a platform to obtain information regarding osteoporosis. The lack of knowledge and misconceptions about osteoporosis led to poor osteoprotective practices. As a conclusion, the current evidence revealed a lack of awareness about osteoporosis among adolescents and young adults. Educational interventions may be useful to improve the awareness of osteoporosis among this population.

Description: IJERPH, Vol. 15, Pages 1774: Live and Let Die? Life Cycle Human Health Impacts from the Use of Tire Studs International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081774 Authors: Anna Furberg Rickard Arvidsson Sverker Molander Studded tires are used in a number of countries during winter in order to prevent accidents. The use of tire studs is controversial and debated because of human health impacts from increased road particle emissions. The aims of this study are to assess whether the use of tire studs in a Scandinavian studded passenger car actually avoids or causes health impacts from a broader life cycle perspective, and to assess the distribution of these impacts over the life cycle. Life cycle assessment is applied and the disability-adjusted life years indicator is used to quantify the following five types of health impacts: (1) impacts saved in the use phase, (2) particle emissions in the use phase, (3) production system emissions, (4) occupational accidents in the production system, and (5) conflict casualties from revenues of cobalt mining. The results show that the health benefits in the use phase in general are outweighed by the negative impacts during the life cycle. The largest contribution to these negative human health impacts are from use phase particle emissions (67–77%) and occupational accidents during artisanal cobalt mining (8–18%). About 23–33% of the negative impacts occur outside Scandinavia, where the benefits occur. The results inform the current debate and highlight the need for research on alternatives to tire studs with a positive net health balance.

Description: IJERPH, Vol. 15, Pages 1769: Effect of Hypothermia in the Emergency Department on the Outcome of Trauma Patients: A Cross-Sectional Analysis International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081769 Authors: Ting-Min Hsieh Pao-Jen Kuo Shiun-Yuan Hsu Peng-Chen Chien Hsiao-Yun Hsieh Ching-Hua Hsieh This study aimed to assess whether hypothermia is an independent predictor of mortality in trauma patients in the condition of defining hypothermia as body temperatures of <36 °C. Data of all hospitalized adult trauma patients recorded in the Trauma Registry System at a level I trauma center between 1 January 2009 and 12 December 2015 were retrospectively reviewed. A multivariate logistic regression analysis was performed in order to identify factors related to mortality. In addition, hypothermia and normothermia were defined as temperatures <36 °C and from 36 °C to 38 °C, respectively. Propensity score-matched study groups of hypothermia and normothermia patients in a 1:1 ratio were grouped for mortality assessment after adjusting for potential confounders such as age, sex, preexisting comorbidities, and injury severity score (ISS). Of 23,705 enrolled patients, a total of 401 hypothermic patients and 13,368 normothermic patients were included in this study. Only 3.0% of patients had hypothermia upon arrival at the emergency department (ED). Compared to normothermic patients, hypothermic patients had a significantly higher rate of abbreviated injury scale (AIS) scores of ≥3 in the head/neck, thorax, and abdomen and higher ISS. The mortality rate in hypothermic patients was significantly higher than that in normothermic patients (13.5% vs. 2.3%, odds ratio (OR): 6.6, 95% confidence interval (CI): 4.86–9.01, p < 0.001). Of the 399 well-balanced propensity score-matched pairs, there was no significant difference in mortality (13.0% vs. 9.3%, OR: 1.5, 95% CI: 0.94–2.29, p = 0.115). However, multivariate logistic regression analysis revealed that patients with low body temperature were significantly associated with the mortality outcome. This study revealed that low body temperature is associated with the mortality outcome in the multivariate logistic regression analysis but not in the propensity score matching (PSM) model that compared patients with hypothermia defined as body temperatures of <36 °C to those who had normothermia. These contradicting observations indicated the limitation of the traditional definition of body temperature for the diagnosis of hypothermia. Prospective randomized control trials are needed to determine the relationship between hypothermia following trauma and the clinical outcome.

Description: IJERPH, Vol. 15, Pages 1771: Short-Term Effects of Heat on Mortality and Effect Modification by Air Pollution in 25 Italian Cities International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081771 Authors: Matteo Scortichini Manuela De Sario Francesca K. de’Donato Marina Davoli Paola Michelozzi Massimo Stafoggia Evidence on the health effects of extreme temperatures and air pollution is copious. However few studies focused on their interaction. The aim of this study is to evaluate daily PM10 and ozone as potential effect modifiers of the relationship between temperature and natural mortality in 25 Italian cities. Time-series analysis was run for each city. To evaluate interaction, a tensor product between mean air temperature (lag 0–3) and either PM10 or ozone (both lag 0–5) was defined and temperature estimates were extrapolated at low, medium, and high levels of pollutants. Heat effects were estimated as percent change in mortality for increases in temperature between 75th and 99th percentiles. Results were pooled by geographical area. Differential temperature-mortality risks by air pollutants were found. For PM10, estimates ranged from 3.9% (low PM10) to 14.1% (high PM10) in the North, from 3.6% to 24.4% in the Center, and from 7.5% to 21.6% in the South. Temperature-related mortality was similarly modified by ozone in northern and central Italy, while no effect modification was observed in the South. This study underlines the synergistic effects of heat and air pollution on mortality. Considering the predicted increase in heat waves and stagnation events in the Mediterranean countries such as Italy, it is time to enclose air pollution within public health heat prevention plans.

Description: IJERPH, Vol. 15, Pages 1781: Eat or Skip Breakfast? The Important Role of Breakfast Quality for Health-Related Quality of Life, Stress and Depression in Spanish Adolescents International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081781 Authors: Rosario Ferrer-Cascales Miriam Sánchez-SanSegundo Nicolás Ruiz-Robledillo Natalia Albaladejo-Blázquez Ana Laguna-Pérez Ana Zaragoza-Martí This study examined the associations between eating or skipping breakfast and the quality of breakfast eaten on health-related quality of life (HRQOL), perceived stress and depression in 527 Spanish adolescents. Results showed differences in stress and two domains of HRQOL; Moods and Emotions and Parent Relations and Home Life between adolescent breakfast skippers and eaters, those having breakfast showing higher levels of stress and poor HRQOL. When breakfast quality was analyzed in breakfast eaters, adolescents who ate a good quality breakfast showed better HRQOL and lower levels of stress and depression than those who ate a poor or very poor quality breakfast. Further, breakfast skippers showed better HRQOL and lower levels of stress and depression than breakfast eaters who ate a poor or very poor quality breakfast. These findings indicate the importance of eating a good quality breakfast, rather than just having or not having breakfast. The conclusions of the present study are especially relevant for clinicians and nutritional educators, given the significant impact of breakfast quality on health-related quality of life, stress and depression observed in the adolescents studied.

Description: IJERPH, Vol. 15, Pages 1780: Post Vaccinal Temporary Sensorineural Hearing Loss International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081780 Authors: Federica De Marco Donato Pompeo De Cesare Francesco Di Folco Francesco Massoni Gianfranco Tomei Natale Mario Di Luca Carmina Sacco Francesco Tomei Ricci Serafino In our systematic research we identified four studies concerning the onset of neurological adverse events following vaccination and two excluding this association. A 33-year-old Italian man, belonging to the Italian Army was hospitalized because he suffered from vertigo, nausea and sudden right hearing loss not classified (NDD), that set in 24 h after the administration of tetanus-diphtheria and meningococcal vaccines. Some neurological events arising after vaccination are very difficult to treat. In our case, the functional recovery on low and medium frequencies was possible about 6 months after the morbid event.

Description: IJERPH, Vol. 15, Pages 1791: Environmental Carcinogenesis and Transgenerational Transmission of Carcinogenic Risk: From Genetics to Epigenetics International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081791 Authors: Ernesto Burgio Prisco Piscitelli Annamaria Colao The dominant pathogenic model, somatic mutation theory (SMT), considers carcinogenesis as a ‘genetic accident’ due to the accumulation of ‘stochastic’ DNA mutations. This model was proposed and accepted by the scientific community when cancer mainly affected the elderly, but it does not explain the epidemiological observation of the continuous increase in cancer incidence among children and young adults. Somatic mutation theory has been proposed for a revision based on the emerging experimental evidence, as it does not fully address some issues that have proven to be crucial for carcinogenesis, namely: the inflammatory context of cancer; the key role played by the stroma, microenvironment, endothelial cells, activated macrophages, and surrounding tissues; and the distorted developmental course followed by the neoplastic tissue. Furthermore, SMT is often not able to consider either the existence of specific mutations resulting in a well-defined cancer type, or a clear relationship between mutations and tumor progression. Moreover, it does not explain the mechanism of action of the non-mutagenic and environmental carcinogens. In the last decade, cancer research has highlighted the prominent role of an altered regulation of gene expression, suggesting that cancer should be considered as a result of a polyclonal epigenetic disruption of stem/progenitor cells, mediated by tumour-inducing genes. The maternal and fetal exposure to a wide range of chemicals and environmental contaminants is raising the attention of the scientific community. Indeed, the most powerful procarcinogenic mechanisms of endocrine disruptors and other pollutants is linked to their potential to interfere epigenetically with the embryo-fetal programming of tissues and organs, altering the regulation of the genes involved in the cell cycle, cell proliferation, apoptosis, and other key signaling pathways. The embryo-fetal exposure to environmental, stressful, and proinflammatory triggers (first hit), seems to act as a ‘disease primer’, making fetal cells and tissues more susceptible to the subsequent environmental exposures (second hit), triggering the carcinogenic pathways. Furthermore, even at the molecular level, in carcinogenesis, ‘epigenetics precedes genetics’ as global DNA hypomethylation, and the hypermethylation of tumor suppressor genes are common both in cancerous and in precancerous cells, and generally precede mutations. These epigenetic models may better explain the increase of cancer and chronic/degenerative diseases in the last decades and could be useful to adopt appropriate primary prevention measures, essentially based on the reduction of maternal-fetal and child exposure to several procarcinogenic agents and factors dispersed in the environment and in the food-chains, as recently suggested by the World Health Organization.

Description: IJERPH, Vol. 15, Pages 1785: Concentration and Potential Ecological Risk of PAHs in Different Layers of Soil in the Petroleum-Contaminated Areas of the Loess Plateau, China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081785 Authors: Di Wang Jing Ma Hao Li Xingchang Zhang The three most representative areas of petroleum pollution on the Loess Plateau are the research subjects of this study. In this study, 16 priority polycyclic aromatic hydrocarbons (PAHs) were determined by the QuEChERS method combined with gas chromatography-tandem mass spectrometry (GC-MS/MS). The total concentrations of ∑16PAHs in top layer soils (0–10 cm), middle layer soils (10–30 cm), and bottom layer soils (30–50 cm) ranged from 1010.67 to 18,068.80, 495.85 to 9868.56 and 213.16 to 12,552.53 μg/kg, with an average of 5502.44, 2296.94 and 2203.88 μg/kg, respectively. The 3-ring and 4-ring PAHs were the most prominent components in all soil samples. Meanwhile, the average value of ∑16PAHs decreased with the depth, from 5502.44 μg/kg (0–10 cm) to 2203.88 μg/kg (30–50 cm). The PAHs levels in the studied soils were heavily polluted (over 1000 μg/kg) according to the Soils Quality Guidelines and 95% of PAHs come from petroleum sources. Moreover, the total of PAHs in petroleum-contaminated soils was assigned a high ecological risk level. Toxic equivalency quantities (TEQs) indicated that PAHs in petroleum-contaminated soils presented relatively high toxicity.

Description: IJERPH, Vol. 15, Pages 1786: The Importance of Using Public Health Impact Criteria to Develop Environmental Health Indicators: The Example of the Indoor Environment in New Zealand International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081786 Authors: Kylie Mason Kirstin Lindberg Deborah Read Barry Borman Developing environmental health indicators is challenging and applying a conceptual framework and indicator selection criteria may not be sufficient to prioritise potential indicators to monitor. This study developed a new approach for prioritising potential environmental health indicators, using the example of the indoor environment for New Zealand. A three-stage process of scoping, selection, and design was implemented. A set of potential indicators (including 4 exposure indicators and 20 health indicators) were initially identified and evaluated against indicator selection criteria. The health indicators were then further prioritised according to their public health impact and assessed by the five following sub-criteria: number of people affected (based on environmental burden of disease statistics); severity of health impact; whether vulnerable populations were affected and/or large inequalities were apparent; whether the indicator related to multiple environmental exposures; and policy relevance. Eight core indicators were ultimately selected, as follows: living in crowded households, second-hand smoke exposure, maternal smoking at two weeks post-natal, asthma prevalence, asthma hospitalisations, lower respiratory tract infection hospitalisations, meningococcal disease notifications, and sudden unexpected death in infancy (SUDI). Additionally, indicators on living in damp and mouldy housing and children’s injuries in the home, were identified as potential indicators, along with attributable burden indicators. Using public health impact criteria and an environmental burden of disease approach was valuable in prioritising and selecting the most important health impacts to monitor, using robust evidence and objective criteria.

Description: IJERPH, Vol. 15, Pages 1788: Situational Use of Child Restraint Systems and Carpooling Behaviors in Parents and Caregivers International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081788 Authors: Catherine C. McDonald Erin Kennedy Linda Fleisher Mark R. Zonfrillo Suboptimal compliance with child restraint system (CRS) recommendations can increase risk for injury or death in a motor vehicle crash. The purpose of this study was to examine scenarios associated with incomplete CRS use and non-use in children ages 4–10 years. We used a cross-sectional online survey with a convenience sample of parent/caregivers from the United States, age ≥18 years, with a child age 4–10 years in their home, who could read and spoke English, and drove child ≥6 times in previous three months. We used descriptive statistics and Mann-Whitney U to describe and compare the distribution of responses to situational use of CRSs among car seat users and booster seat users. We also used descriptive statistics and the Mann-Whitney U to describe and compare the distribution of responses to carpooling items among booster seat users and non-booster seat users. There were significant differences among those who reported most often using booster seats (n = 282) and car seats (n = 127) in situations involving rental cars, driving just around the corner, car too crowded to fit the CRS, not enough CRSs in the vehicle, the CRS is missing from the car, or the child is in someone else’s car without a CRS (p < 0.05). Among those who reported most often using booster seats and who carpooled other children (n = 159), 71.7% (n = 114) always used a booster seat for their own child. When carpooling other children, booster seat users were significantly more likely to use booster seats for other children ages 4–10 than the non-booster seat users (p < 0.01). Continued education and programs surrounding CRS use is critical, particularly for children who should be in booster seats.

Description: IJERPH, Vol. 15, Pages 1784: 6 Hz Active Anticonvulsant Fluorinated N-Benzamide Enaminones and Their Inhibitory Neuronal Activity International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081784 Authors: Isis J. Amaye Thomas Heinbockel Julia Woods Zejun Wang Miguel Martin-Caraballo Patrice Jackson-Ayotunde A small library of novel fluorinated N-benzamide enaminones were synthesized and evaluated in a battery of acute preclinical seizure models. Three compounds (GSA 62, TTA 35, and WWB 67) were found to have good anticonvulsant activity in the 6-Hz ‘psychomotor’ 44-mA rodent model. The focus of this study was to elucidate the active analogs’ mode of action on seizure-related molecular targets. Electrophysiology studies were employed to evaluate the compounds’ ability to inhibit neuronal activity in central olfactory neurons, mitral cells, and sensory-like ND7/23 cells, which express an assortment of voltage and ligand-gated ion channels. We did not find any significant effects of the three compounds on action potential generation in mitral cells. The treatment of ND7/23 cells with 50 µM of GSA 62, TTA 35, and WWB 67 generated a significant reduction in the amplitude of whole-cell sodium currents. Similar treatment of ND7/23 cells with these compounds had no effect on T-type calcium currents, indicating that fluorinated N-benzamide enaminone analogs may have a selective effect on voltage-gated sodium channels, but not calcium channels.