ALBERT

Description: Poor public health is always associated with the mismanagement of municipal solid waste (MSW). Many cities are besieged by MSW in the world. It is essential to do a good job in MSW management (MSWM). In order to improve the efficiency of MSWM, the Chinese government has intensively implemented relevant policies. There are still few studies on MSWM efficiency in China. The research aims to comprehensively analyze MSWM efficiency, find high-efficiency MSWM policy implementation routes and the breakthrough on improving MSWM efficiency. To measure Chinese MSWM efficiency accurately, this paper introduced the three-stage data envelopment analysis (DEA) model into the research. According to the results of DEA, Fuzzy c-Means algorithm was used to the cluster analysis of 33 typical cities. After eliminating the interference of the external environment and random disturbance, the mean value of MSWM efficiency declined from 0.575 to 0.544. The mean of pure technical efficiency (PTE) was declined from 0.966 to 0.611, while the mean of scale efficiency (SE) increased from 0.600 to 0.907. The PTE of central and northeastern cities was relatively low. The SE of western cities was comparatively high and the efficiency distribution of the eastern region was relatively scattered. In general, MSWM efficiency is low and expected to be improved. Regional differences in MSWM efficiency have been shown. The management effectiveness of eight pilot cities (MSW classification) is affirmative but not that significant. To improve MSWM efficiency, differential management for four types of cities should be carried out.

Description: Purpose Biological age (BA) has recently emerged as a substitute for chronological age (CA), and many subjects seek to optimally control their BA. However, in South Korea, no study has adequately explored factors that affect BA, although individual health management is essential to preventing chronic diseases. In the present study, we focus on the use of health information, in particular nutrition facts, to control BA. Methods We used data from the Korea National Health and Nutrition Examination Surveys (2010–2015; 26,914 eligible participants) using BA and age differences as outcome variables. We used multiple linear regression to explore the relationship between the use of nutrition data and differences in BA after adjusting for covariates. In addition, we used multiple linear regression to examine subgroup differences in such relationships. Results 12.8% of males and 27.5% of females used nutrition facts when deciding which foods to purchase. The more attention paid to such facts, the lower the BA and BA differences in both males and females (males: β = −2.646, females: β = −2.787, p 〈 0.05, for BA; males: β = −1.181, females, β = −2.161, p 〈 0.05, for BA differences). However, BA differences were more significant in subjects with chronic disease, obesity, and/or a family history of chronic disease. Conclusion High-level awareness of and active use of nutrition facts permitted effective self-management in preventing chronic disease and improving BA, particularly in subjects at higher risk for chronic disease. Thus, considering nutrition facts when deciding what to purchase is important.

Description: Samples of wheat and soil were collected in the Lihe watershed in East China, the migration and accumulation processes of four common trace metals (Cu, Pb, Cd and Ni) in each part of the wheat plant (root, stem, leaf and grain) were analyzed, and a mechanistic model was proposed to simulate these processes based on wheat growth techniques. Model results show that Cu and Cd migrate more easily with wheat grains, while most Pb and Ni accumulate in roots. Modeling results were shown to be relatively good, with an error of 25.29% in value and 26.38% in fluctuation, and had smaller dispersion degree than actual measurement results. Monte Carlo simulation results also match quite well with actual measurement results, and modeling results are slightly smaller in the simulation of Leaf-Cu, Grain-Cu and Leaf-Ni. Trace metal pollution risk in wheat is evaluated based on this model; our results show that the northwest and northeast parts in the research area are not suitable for growing wheat. In general, this model is relatively accurate, and can evaluate the wheat pollution risk before seeding wheat, providing scientific references for the early selection of wheat safety sowing areas.

Description: African Americans have a disproportionately higher risk of chronic conditions such as cardiovascular disease (CVD), type 2 diabetes, and hypertension than other ethnic or racial groups. Data regarding CVD-related perceptions and beliefs among African Americans are limited, particularly in the Southwest US. Assessment of current views regarding health and health behaviors is needed to tailor interventions to meet the unique needs of specific populations. We sought to examine knowledge, attitudes, and perceptions of African Americans living in Arizona toward CVD and etiological factors associated with health behaviors and chronic disease development to inform state health agency program development. Transcripts from 14 focus groups (n = 103) were analyzed using Grounded Theory for perceived disease risk, knowledge of CVD risk factors, nutrition, preventative behaviors, and barriers and motivators to behavior change. Participants identified CVD, stroke, and diabetes as leading health concerns among African-Americans but were less certain about the physiological consequences of these diseases. Diet, stress, low physical activity, family history, hypertension, and stroke were described as key CVD risk factors, but overweight and obesity were mentioned rarely. Participants described low socio-economic status and limited access to healthy foods as contributors to disease risk. Focus group members were open to modifying health behaviors if changes incorporated their input and were culturally acceptable. Respondents were 41% male and 59% female with a mean age of 46 years. This study provides insight into CVD and associated disease-related perceptions, knowledge, and attitudes among African Americans in the Southwest and recommendations for interventions to reduce CVD risk.

Description: Background: Leptospirosis is a zoonotic disease with a worldwide distribution, especially in developing countries such as Malaysia. This study was designed to explore the knowledge, attitudes, beliefs and practices (KABP) toward leptospirosis among the communities in northeastern Malaysia and to determine the sociodemographic factors associated with the KABP toward leptospirosis. A cross-sectional study using a stratified sampling method was conducted among 214 individuals in four locales in northeastern Malaysia. Methods: A cross-sectional study was conducted among 214 respondents in northeastern Malaysia using a multi-stage stratified random sampling method. The study population was divided into two groups based on geographical locations: urban and rural. All data were entered and analyzed using the IBM Statistics for Social Sciences (SPSS) version 22.0 software for Windows (IBM, Armonk, NY, USA). The continuous variables were presented using mean and standard deviation (SD), whereas the categorical variables were described using frequency and percentage. Multiple logistic regression was performed to determine the associated factors for good KABP toward leptospirosis among the respondents. Results: It was found that 52.8% of respondents had good knowledge, 84.6% had positive attitudes, 59.8% had positive beliefs, and 53.7% had satisfactory practices. There were no significant sociodemographic factors associated with knowledge and practice, except for educational status, which was significant in the attitude and belief domains. Those with higher education exhibited better attitudes (Odds Ratio (OR) 3.329; 95% Coefficient Interval (CI): 1.140, 9.723; p = 0.028) and beliefs (OR 3.748; 95% CI: 1.485, 9.459; p = 0.005). The communities in northeastern Malaysia generally have good knowledge and a high level of positive attitude; however, this attitude cannot be transformed into practice as the number of people with satisfactory practice habits is much lower compared to those with positive attitudes. As for the belief domain, the communities must have positive beliefs to perceive the threat of the disease. Conclusions: Our current health program on preventing leptospirosis is good in creating awareness and a positive attitude among the communities, but is not sufficient in promoting satisfactory practice habits. In conclusion, more attention needs to be paid to promoting satisfactory practice habits among the communities, as they already possess good knowledge and positive attitudes and beliefs.

Description: Studies have demonstrated that, for urban children, dust represents the main exposure to sources of metals like lead (Pb) and manganese (Mn). We aimed to investigate the exposure to these metals and their association with intellectual deficit in children living in an industrial region. This cross-sectional study recruited volunteers from four elementary schools in the town of Simões Filho, Brazil. We evaluated 225 school-aged children (7–12 years) for blood lead (PbB) and manganese hair (MnH) and toenails (MnTn) by graphite furnace atomic absorption spectrometry. Child and maternal IQs were estimated using the Wechsler Abbreviated Scale for Intelligence (WASI). Median and range PbB were 1.2 (0.3–15.6) μg/dL. MnH and MnTn medians (ranges) were 0.74 (0.16–8.79) μg/g and 0.85 (0.15–13.30) μg/g, respectively. After adjusting for maternal IQ, age and Mn exposure, child IQ drops by 8.6 points for a 10-fold increase in PbB levels. Moreover, an effect modification of Mn co-exposure was observed. In children with low MnTn, association between Pb and child IQ was not significant (β = −6.780, p = 0.172). However, in those with high MnTn, the association was increased by 27.9% (β = −8.70, p = 0.036). Low Pb exposure is associated with intellectual deficit in children, especially in those with high MnTn.

Description: Antibiotic residues in the aquatic environment have the potential to induce resistance in environmental bacteria, which ultimately might get transferred to pathogens making treatment of diseases difficult and poses a serious threat to public health. If antibiotic residues in the environment could be eliminated or reduced, it could contribute to minimizing antibiotic resistance. Towards this objective, water containing ciprofloxacin was treated by sunlight-assisted photocatalysis using Fe- doped ZnO nanoparticles for assessing the degradation potential of this system. Parameters like pH, temperature, catalytic dosage were assessed for the optimum performance of the system. To evaluate degradation of ciprofloxacin, both spectrophotometric as well as microbiological (loss of antibiotic activity) methods were employed. 100 mg/L Fe-doped ZnO nanoparticle catalyst and sunlight intensity of 120,000–135,000 lux system gave optimum performance at pH 9 at 30 °C and 40 °C. Under these conditions spectrophotometric analysis showed complete degradation of ciprofloxacin (10 mg/L) at 210 min. Microbiological studies showed loss of antibacterial activity of the photocatalytically treated ciprofloxacin-containing water against Staphylococcus aureus (108 CFU) in 60 min and for Escherichia coli (108 CFU) in 75 min. The developed system, thus possess a potential for treatment of antibiotic contaminated waters for eliminating/reducing antibiotic residues from environment.

Description: Suicide is the leading cause of death among young men aged 15–29 in Greenland, but few epidemiological studies have described this problem. We aimed to summarise descriptive epidemiological studies of suicide in young men in Greenland compared with other demographic groups in Denmark and Greenland to inform future suicide prevention strategy. We searched PubMed, PsycINFO, and Embase using an agreed search strategy to identify English-language papers describing suicide epidemiology in Greenlandic men aged 15–29. We followed PRISMA guidelines in screening and appraising eligible publications. Eight articles fulfilled inclusion criteria of 64 meeting search criteria. Findings covering 1970–2011 supported a dramatic rise in suicide rates in Greenlandic men aged 15–24 from 1976, who remained the highest-ranking demographic group over 1976–2011 compared with men and women of all age groups in Denmark and Greenland. Highest rates recorded were almost 600 per 100,000 per year in men aged approximately 20–23 over 1977–1986. No studies described suicide epidemiology after 2011, and no studies described risk factors for suicide in young men. Given the very high suicide rates recorded for young men over 1976–2011, such studies will be essential for informing the development and evaluation of appropriate preventive interventions.

Description: (1) Background: Several researches have shown the relationship between healthy habits and physical and mental health. Thus, it is essential to study how some psychosocial factors can promote positive behaviours in university students, specifically in those who will be teachers of Physical Education. (2) Methods: This descriptive and cross-sectional research was conducted on 775 university students of Physical Education from Spain. This study aims to develop an explanatory model for the relationships between motivational climate, healthy habits (Mediterranean Diet (MD), Physical Activity (PA) and substance consumption) and some indicators of physical health (oxygen consumption (VO2MAX)) and mental health (self-concept) according to gender, using structural equations analysis. (3) Results: The motivational climate was positively associated with PA, showing a stronger relationship for ego-oriented climate in women. The adherence to MD showed a positive association with PA and self-concept, while it is negative for the consumption of tobacco in men. Likewise, PA was directly related to VO2MAX with a higher regression weight for women. The ego-oriented motivational climate was negatively related to tobacco consumption in women. (4) Conclusions: Task-oriented goals are related to more positive and healthy behaviours such as PA, although it was no association was found with MD. Therefore, we can conclude the importance of promoting task-oriented goals in educational contexts linked to Physical Education in order to avoid negative behaviours.

Description: The exploration of new food sources and natural products is the result of the increase in world population as well as the need for a healthier diet; in this context, microalgae are undoubtedly an interesting solution. With the intent to enhance their value in new commercial applications, this paper aims to characterize microalgae that have already been recognized as safe or authorized as additives for humans and animals (Chlorella vulgaris, Arthrospira platensis, Haematococcus pluvialis, Dunaliella salina) as well as those that have not yet been marketed (Scenedesmus almeriensis and Nannocholoropsis sp.). In this scope, the content of proteins, carbohydrates, lipids, total dietary fiber, humidity, ash, and carotenoids has been measured via standard methods. In addition, individual carotenoids (beta-carotene, astaxanthin, and lutein) as well as individual saturated, monounsaturated, and polyunsaturated fatty acids have been identified and quantified chromatographically. The results confirm the prerogative of some species to produce certain products such as carotenoids, polyunsaturated fatty acids, and proteins, but also show how their cellular content is rich and diverse. H. pluvialis green and red phases, and Nannochloropsis sp., in addition to producing astaxanthin and omega-3, contain about 25–33% w/w proteins on a dry basis. D. salina is rich in beta-carotene (3.45% w/w on a dry basis), S. Almeriensis is a source of lutein (0.30% w/w on a dry basis), and the C. vulgaris species is a protein-based microalgae (45% w/w on a dry basis). All, however, can also produce important fatty acids such as palmitic acid, γ-linolenic acid, and oleic acid. Considering their varied composition, these microalgae can find applications in multiple sectors. This is true for microalgae already on the market as well as for promising new sources of bioproducts such as S. almeriensis and Nannochloropsis sp.

Description: The study assessed changes in water quality between the water source and the tap of locally produced low cost ceramic water filters used by a community living in hygienically critical conditions in a remote mountainous area in Western Nepal. Data was collected from 42 rural households during two visits. The effectiveness of filter handling on its performance was assessed through microbiological analysis, structured household interviews and structured observations. Water quality decreased significantly when source water was filled into transport containers, while the use of the filters improved drinking water quality for about 40% of the households. Highly inadequate filter cleaning practices involving the use of contaminated raw water, hands (geo mean = 110 E. coli CFU/100 mL) and cleaning tools (geo mean = 80 E. coli CFU/100 mL) stained hygienic parts of the filter. The use of boiling water to disinfect the filters was significantly correlated with improved filter performance and should be further promoted. However, even disinfected filters achieved a very low average LRV for E. coli of 0.4 in the field and performed worse than during laboratory tests (LRV for E. coli of 1.5–2). Comprehensive training on adequate filter handling, as well as better filter products, are required to improve the impact of filter use.

Description: The relationship between energy drink (ED) use and risky behaviours has not been explored in the Caribbean, where youth risky behaviours are prevalent. This paper examines the relationship between ED use and risky behaviours and the moderating effect of gender among 1994 undergraduate students in Trinidad and Tobago. Analyses examined the association between ED use and risky behaviours, and the significant predictors of risky behaviours. Analysis of variance determined whether there were differences in risky behaviours between those who used only alcohol or EDs, both alcohol and EDs, alcohol mixed with EDs and neither alcohol nor EDs; and the difference between those with high and low intensity of ED use. In both males and females current use of energy drinks was positively associated with harmful substance use, risky sexual behaviours, and risky non-sexual behaviours, more strongly for males. The strongest predictor of risky behaviours was gender. Males consuming both alcohol and EDs, independently or mixed, were most likely to have risky behaviours. Consistent with previous reports, harmful alcohol use and other risk taking health behaviours appear to be predicted by a combination of high intensity use of EDs and alcohol. In countries like Trinidad and Tobago where violence, alcohol use disorders, STI/HIV infection and teenaged pregnancy are prevalent, the assessment of consumption of EDs and alcohol may be an important potential predictor of health compromising behaviours.

Description: Background: People on long-term sick leave often have a long-lasting process back to work, where the individuals may be in multiple and recurrent states; i.e., receiving different social security benefits or working, and over time they may shift between these states. The purpose of this study was to evaluate the effects of two vocational rehabilitation programs, compared to a control, on return-to-work (RTW) or increased employability in patients on long-term sick leave due to mental illness and/or chronic pain. Methods: In this randomized controlled study, 427 women and men were allocated to either (1) multidisciplinary team management, i.e., multidisciplinary assessments and individual rehabilitation management, (2) acceptance and commitment therapy (ACT), or (3) control. A positive outcome was defined as RTW or increased employability. The outcome was considered negative if the (part-time) wage was reduced or ceased, or if there was an indication of decreased employability. The outcome was measured one year after entry in the project and analyzed using binary and multinomial logistic regressions. Results: Participants in the multidisciplinary team group reported having RTW odds ratio (OR) 3.31 (95% CI 1.39–7.87) compared to the control group in adjusted models. Participants in the ACT group reported having increased employability OR 3.22 (95% CI 1.13–9.15) compared to the control group in adjusted models. Conclusions: This study of vocational rehabilitation in mainly female patients on long-term sick leave due to mental illness and/or chronic pain suggests that multidisciplinary team assessments and individually adapted rehabilitation interventions increased RTW and employability. Solely receiving the ACT intervention also increased employability.

Description: Background: All of society is affected by mental health problems, not just a minor, isolated part. Mental health problems represent a major challenge to the global development of community health. This study examined the community health knowledge, perceived beliefs, and associated factors of mental distress (MD) in Mekelle city in Northern Ethiopia. Methods: The current study used a cross-sectional approach calculating a sample of 260 adults living in the two sub-cities of Mekelle city. To select the sample households in each sub-city, systematic random sampling was used. Self-reported questionnaire (SRQ-20 with a cutoff point of 7), and Mental Health Knowledge Schedule (MAKS) instruments were included within the structured questionnaire tool to clarify community occurrence and the level of health mental knowledge. Results: The likelihood of having MD was higher among the study participants who were female, employed, self-employed, and daily alcohol and khat users. The results also showed that the level of mental health knowledge among the participants was low. Conclusions: Factors such as being male, having a higher level of education, and having strong levels of social support were found to be the independent predictors of good mental health and community mental health knowledge.

Description: Current environmental impact analyses are mainly focused on land, soil, energy, and material consumption, while studies regarding blue water consumption are scarce. Based on the water footprint concept, this study evaluates the impacts of blue water consumption on human health, ecosystem quality, and water resources in China from the production and consumption perspective, respectively. The results indicate that environmental impacts due to blue water consumption in China were 15.82 × 106 DALY (disability-adjusted life years), 96.54 × 109 m2∙year, and 175.20 × 109 MJ, and provinces such as Xinjiang, Shandong, and Hebei could be targets for achieving smaller environmental impacts in the future. More than 80% of environmental impacts were related to the agricultural sector. In terms of agricultural production, about 70% of the environmental impacts were related to product export. Measures such as the shift of the agricultural production pattern from water-intensive crops and animal products toward less water-intensive ones, the increase of agricultural water use efficiency, and the adoption of water-saving technologies could contribute to smaller environmental impacts. In terms of agricultural consumption, more than 95% of the environmental impacts were related to agricultural products produced locally. The focus was on increasing awareness of the importance of saving water and whether products were imported from regions with relatively small environmental impacts.

Description: The prevalence of food allergy (FA) has not been estimated at a population level in Central American countries and, consequently, the magnitude and relevance of the problem in the Central American region remains unknown. Thus, our aim was to evaluate the parent-reported prevalence of FA in a population of schoolchildren from the Central American country El Salvador. A Spanish version of a structured questionnaire was utilized. Five hundred and eight (508) parents returned the questionnaire with valid responses (response rate, 32%). The estimated prevalence rates (95% CI) were: adverse food reactions 15.9 (13.0–19.3), “perceived FA, ever” 11.6 (9.1–14.6), “physician-diagnosed FA, ever” 5.7% (4.0–8.0), “immediate-type FA, ever” 8.8% (6.6–11.6), “immediate-type FA, current” 5.3% (3.6–7.6), and anaphylaxis 2.5% (1.5–4.3). The most common food allergens were milk (1.7%), shrimp (1.3), chili (0.7%), chocolate (0.7%), and nuts (0.3%). Most of the “food-dependent anaphylaxis” cases (60.5%) sought medical attention, but only one case reported the prescription of an epinephrine autoinjector. Mild and severe FA cases are not uncommon among Salvadoran schoolchildren and both the prescription of epinephrine autoinjectors by healthcare personnel and the use of the autoinjectors by anaphylactic individuals should be encouraged.

Description: Although radon is a well-established contributor to lung cancer mortality among uranium miners, the effects of radon decay products on different histopathologies of lung carcinoma are not well established. Using a retrospective cohort design, this study aims to examine the risks of lung cancer by histological subtypes associated with exposure to radon decay products among the Ontario Uranium Miners cohort. Cases were stratified by histological groups, and associated risks were estimated for cumulative radon exposure after adjustment for attained age and calendar period. Between 1969 and 2005, 1274 incident cases of primary lung cancer were identified. Of these, 1256 diagnoses (99%) contained information on histology. Squamous cell carcinoma was most common (31%), followed by adenocarcinoma (20%), large cells (18%), small cell lung carcinoma (14%), and other or unspecified cell types (17%). Of the histological sub-groups, small cell lung carcinoma had the strongest association with cumulative radon exposure; compared to the reference group (〈1 cumulative working level months (WLM)), the highest exposure category (〉60 cumulative WLM) had a relative risk (RR) of 2.76 (95% CI: 1.67–4.57). Adenocarcinoma had the lowest risk and was not significantly associated with exposure to radon decay products (RR = 1.49, 95% CI: 0.96–2.31). An increasing, linear trend in relative risk was noted with increasing cumulative WLM across small cell, squamous cell, and large cell lung carcinomas (Ptrend 〈 0.05). Similarly, the excess relative risk (ERR) per WLM was highest for small cell lung carcinoma (ERR/WLM = 0.15, p 〈 0.01), followed by squamous cell carcinoma (ERR/WLM = 0.12, p 〈 0.01). Non-statistically significant excess risk was observed for adenocarcinoma (ERR/WLM = 0.004, p = 0.07). Our analysis of the Ontario Uranium Miners cohort data shows differences in the magnitude of the risks across four histological subtypes of lung carcinoma; the strongest association was noted for small cell lung carcinoma, followed by squamous cell, large cell, and lastly adenocarcinoma, which showed no significant associations with exposure to radon decay products.

Description: There is an increase in the awareness of the importance of spatial data in epidemiology and exposure assessment (EA) studies. Most studies use governmental and ordnance surveys, which are often expensive and sparsely updated, while in most developing countries, there are often no official geo-spatial data sources. OpenStreetMap (OSM) is an open source Volunteered Geographic Information (VGI) mapping project. Yet very few environmental epidemiological and EA studies have used OSM as a source for road data. Since VGI data is either noncommercial or governmental, the validity of OSM is often questioned. We investigate the robustness and validity of OSM data for use in epidemiological and EA studies. We compared OSM and Governmental Major Road Data (GRD) in three different regions: Massachusetts, USA; Bern, Switzerland; and Beer-Sheva, South Israel. The comparison was done by calculating data completeness, positional accuracy, and EA using traditional exposure methods. We found that OSM data is fairly complete and accurate in all regions. The results in all regions were robust, with Massachusetts showing the best fits (R2 0.93). Results in Bern (R2 0.78) and Beer-Sheva (R2 0.77) were only slightly lower. We conclude by suggesting that OSM data can be used reliably in environmental assessment studies.

Description: Environmental changes significantly impact health behavior. Active travel behavior is mostly affected by increasing motorization, urban sprawl, and traffic safety. Especially for children, active and independent travel can contribute to physical activity, social and motor development, and other health-related outcomes. A reduced number of children engaging in independent mobility over the last 20 years demanded researchers to further examine the construct of children’s independent mobility. By examining relevant literature, this narrative review aims to provide the current state of knowledge on children’s independent mobility, and identify future directions in research, as well as practical implications. From a public health perspective, considering children’s independent mobility in intervention programs is recommended, since it is associated with numerous health and environmental benefits. To develop interventions, multilevel socio-ecological influences on children’s independent mobility are widely examined; however, evidence is limited due to heterogeneous measurements and a lack of high-quality prospective studies. To oppose the decline in children’s independent mobility, further analysis using comparable measures is needed to understand the determinants of children’s independent mobility and to enable international comparison.

Description: Swimming pool water ingestion volumes are necessary for assessing infection risk from swimming. Pool water ingestion volumes can be estimated by questionnaire or measuring a chemical tracer in swimmer urine. Questionnaires are often preferred to the chemical tracer method because surveys are less time consuming, but no research exists validating questionnaires accurately quantify pool water ingestion volumes. The objective of this study was to explore if questionnaires are a reliable tool for collecting pool water ingestion volumes. A questionnaire was issued at four pool sites in Tucson, Arizona to 46 swimmers who also submitted a urine sample for analyzing cyanuric acid, a chemical tracer. Perceived ingestion volumes reported on the questionnaire were compared with pool water ingestion volumes, quantified by analyzing cyanuric acid in swimmer urine. Swimmers were asked if they swallowed (1) no water or only a few drops, (2) one to two mouthfuls, (3) three to five mouthfuls, or (4) six to eight mouthfuls. One mouthful is the equivalent of 27 mL of water. The majority (81%) of swimmers ingested 〈27 mL of pool water but reported ingesting 〉27 mL (“one mouthful”) on the questionnaire. More than half (52%) of swimmers overestimated their ingestion volume. These findings suggest swimmers are over-estimating pool water ingestion because they perceive one mouthful is 〈27 mL. The questionnaire did not reliably collect pool water ingestion volumes and should be improved for future exposure assessment studies. Images of the ingestion volume categories should be included on the questionnaire to help swimmers visualize the response options.

Description: Recent assessments have found that a warming climate, with associated increases in extreme heat events, could profoundly affect human health. This paper describes a new modeling and analysis framework, built around the Benefits Mapping and Analysis Program—Community Edition (BenMAP), for estimating heat-related mortality as a function of changes in key factors that determine the health impacts of extreme heat. This new framework has the flexibility to integrate these factors within health risk assessments, and to sample across the uncertainties in them, to provide a more comprehensive picture of total health risk from climate-driven increases in extreme heat. We illustrate the framework’s potential with an updated set of projected heat-related mortality estimates for the United States. These projections combine downscaled Coupled Modeling Intercomparison Project 5 (CMIP5) climate model simulations for Representative Concentration Pathway (RCP)4.5 and RCP8.5, using the new Locating and Selecting Scenarios Online (LASSO) tool to select the most relevant downscaled climate realizations for the study, with new population projections from EPA’s Integrated Climate and Land Use Scenarios (ICLUS) project. Results suggest that future changes in climate could cause approximately from 3000 to more than 16,000 heat-related deaths nationally on an annual basis. This work demonstrates that uncertainties associated with both future population and future climate strongly influence projected heat-related mortality. This framework can be used to systematically evaluate the sensitivity of projected future heat-related mortality to the key driving factors and major sources of methodological uncertainty inherent in such calculations, improving the scientific foundations of risk-based assessments of climate change and human health.

Description: The Job Demand-Control and Job Demand-Control-Support (JDCS) models constitute the theoretical approaches used to analyze the relationship between the characteristics of labor and occupational health. Few studies have investigated the main effects and multiplicative model in relation to the perceived occupational health of professional accountants. Accountants are subject to various types of pressure in performing their work; this pressure influences their health and, ultimately, their ability to perform a job well. The objective of this study is to investigate the effects of job demands on the occupational health of 739 accountants, as well as the role of the moderator that internal resources (locus of control) and external resources (social support) have in occupational health. The proposed hypotheses are tested by applying different models of neural networks using the algorithm of the Extreme Learning Machine. The results confirm the relationship between certain stress factors that affect the health of the accountants, as well as the direct effect that the recognition of superiors in occupational health has. Additionally, the results highlight the moderating effect of professional development and the support of superiors on the job’s demands.

Description: Background: Vaccination hesitancy and skepticism among parents hinders progress in achieving full vaccination coverage. Swedish measles, mumps and rubella (MMR) vaccine coverage is high however some areas with low vaccination coverage risk outbreaks. This study aimed to explore factors influencing the decision of Somali parents living in the Rinkeby and Tensta districts of Stockholm, Sweden, on whether or not to vaccinate their children with the measles, mumps and rubella (MMR) vaccine. Method: Participants were 13 mothers of at least one child aged 18 months to 5 years, who were recruited using snowball sampling. In-depth interviews were conducted in Somali and Swedish languages and the data generated was analysed using qualitative content analysis. Both written and verbal informed consent were obtained from participants. Results: Seven of the mothers had not vaccinated their youngest child at the time of the study and decided to postpone the vaccination until their child became older (delayers). The other six mothers had vaccinated their child for MMR at the appointed time (timely vaccinators). The analysis of the data revealed two main themes: (1) barriers to vaccinate on time, included issues surrounding fear of the child not speaking and unpleasant encounters with nurses and (2) facilitating factors to vaccinate on time, included heeding vaccinating parents’ advice, trust in nurses and trust in God. The mothers who had vaccinated their children had a positive impact in influencing other mothers to also vaccinate. Conclusions: Fear, based on the perceived risk that vaccination will lead to autism, among Somali mothers in Tensta and Rinkeby is evident and influenced by the opinions of friends and relatives. Child Healthcare Center nurses are important in the decision-making process regarding acceptance of MMR vaccination. There is a need to address mothers’ concerns regarding vaccine safety while improving the approach of nurses as they address these concerns.

Description: The presence of harmful algal blooms (HABs) can cause significant problems to the quality of the water, the marine ecosystems, and the human health, and economy worldwide. Biological remediation can inhibit harmful algal growth efficiently in an environmental-friendly manner. Therefore, the research conducted on biological remediation with regard to the inhibition of HABs is becoming a major focus in marine ecology. To date, no study has been reported with regard to the red tides occurring in mangrove wetlands. Therefore, the present study used two mangrove species, namely Bruguiera gymnorrhiza and Kandelia candel and one harmful algae species Phaeocystis globosa as experimental organisms. The present study determined the inhibitory effects and algae physiology of specific aqueous extracts from mangrove leaves on the viability of harmful algae, and analyzed the main chemical composition of the aqueous extracts by ultra-performance liquid chromatography coupled to high resolution mass spectrometry (UPLC-QTOF-MS). The results indicated that the aqueous extracts from different leaf ages of B. gymnorrhiza and K. candel leaves exhibited apparent inhibitory effects on the growth of P. globosa. The inhibitory effects of B. gymnorrhiza and K. candel leaves aqueous extracts on the growth of P. globosa were in the following order: senescent 〉 mature 〉 young leaves. The levels of the parameters superoxide dismutase (SOD) activity, glutathione (GSH), and malondialdehyde (MDA)content in P. globosa following treatment with B. gymnorrhiza and K. candel leaves aqueous extracts were increased as follows: senescent 〉 mature 〉 young leaves. Simultaneously, the intensity of the ion peaks of the specific secondary metabolites assigned 4 (No.: 4 Rt: 2.83 min), 7 (No.: 7 Rt: 3.14 min), 8 (No.: 8 Rt: 3.24 min), 9 (No.: 9 Rt: 3.82min) and 10 (No.: 10 Rt: 4.10 min) were increased. These metabolites were found in the aqueous extracts from B. gymnorrhiza leaves. The intensities of the ion peaks of the secondary metabolites 7, 8 in the aqueous extracts from the K. candel leaves were also increased. The majority of the substances that inhibited the algae found in the mangrove plants were secondary metabolites. Therefore, we considered that the norsesquiterpenes compounds 4, 8, 9, and 10 and a phenolic glycoside compound 7 were the active constituents in the aqueous extracts of the mangrove leaves responsible for the inhibition of algae growth. This evidence provided theoretical guidance for the development of biological methods to control red tides and for the further use of substances with antiproliferative activity against algae.

Description: Background: The incidences of typhoid and paratyphoid remain high and these diseases still pose a public health problem in China and in Zhejiang Province in particular. This study aimed to investigate the trend of typhoid and paratyphoid in Zhejiang Province from 1953 to 2014 and to provide a theoretical basis for the prevention and control of these diseases. Methods: Included in this study were compiled epidemiological data of typhoid and paratyphoid cases in Zhejiang from 1953 to 2003 and epidemiological data of those from 2004 to 2014 registered in the China Information System for Diseases Control and Prevention. Description methods were employed to explore the epidemiological characteristics, including long-term trend, gender distribution, age distribution, and occupation distribution. Incidence maps were made to represent the annual average incidences for each municipality. Spearman’s rank correlation was performed to detect the correlation between incidence and average elevation, and circular distribution was calculated to identify the seasonality and peak days of the diseases. A p-value of 〈0.05 was considered statistically significant. Results: A total of 182,602 typhoid and paratyphoid cases were reported in Zhejiang Province from 1953 to 2014, and the average annual incidence was 7.89 per 100,000 population. The incidence in 2014 decreased by 93.82% compared with that in 1953 and by 95.00% compared with the highest incidence rate. The average incidence before 2003 was negatively correlated with the average elevation of each region in Zhejiang province (r 〈 0, p 〈 0.05), but there was no statistically significant correlation from 2003. The peak period of diseases fell in the months from April to October every year. The incidence among the population group aged over 35 rose gradually but declined sharply among those between 20 and 34. Conclusions: The incidence of typhoid and paratyphoid decreased in Zhejiang Province from 1953 to 2014 but remained high in some regions. Proper measures for prevention and control are warranted in the southeast coast areas and for high-risk populations.

Description: The objective of the article is to present the slow sport movement as a phenomenon developing in the postmodern era in opposition to the idea of citius, altius, fortius (Eng. faster, higher, stronger). The theoretical part of the article describes the health repercussions of slow movement and its implications for the sports industry and sports tourism. It also points to new challenges in sports management and sports tourism implemented in the slow style. The empirical part of the article aims at determining what influence the achievement of a self-set sports goal has on the degree of satisfaction with participation in a running event among runners. Could runners who did not set themselves any sports goal and ran for pleasure (according to the idea of slow sport) achieve the same degree of satisfaction as runners who set themselves an ambitious sports goal and achieved it (according to the idea of citius, altius, fortius)? The case study is the 6th Poznan Half Marathon, a cyclical, popular running event taking place in Poland. A total of 560 runners (n = 560) took part in the diagnostic survey conducted using the interview technique. The ANOVA Rang Kruskal-Wallis test and Dunn’s test were used in the study. The results show that athletes who did not set a sporting goal (ran for pleasure, company, atmosphere, participation, etc.) experienced the same level of satisfaction as athletes who achieved their intended sporting goal. It turns out, therefore, that sport and physical activity done for pleasure in accordance with the slow sport idea can provide the same level of satisfaction as sport practiced in the spirit of citius, altius, fortius.

Description: Healthcare accessibility has become an issue of social equity. An accurate estimation of existing healthcare accessibility is vital to plan and allocate health resources. Healthcare capacity, population demand, and geographic impedance are three essential factors to measure spatial accessibility. Additionally, geographic impedance is usually represented with a function of travel time. In this paper, the three-step floating catchment area (3SFCA) method is improved from the perspectives of the temporal dimension and population demand. Specifically, the travel time from the population location to the service site is precisely calculated by introducing real-time traffic conditions instead of utilizing empirical speed in previous studies. Additionally, with the utilization of real-time traffic, a dynamic result of healthcare accessibility is derived during different time periods. In addition, since the medical needs of the elderly are higher than that of the young, a demand weight index of demand is introduced to adjust the population demand. A case study of healthcare accessibility in Wuhan shows that the proposed method is effective to measure healthcare accessibility during different time periods. The spatial accessibility disparities of communities and crowdedness of hospitals are identified as an important reference for the balance between the supply and demand of medical resources.

Description: Organized and ritual child sexual abuse (ORA) is often rooted in the child’s own family. Empirical evidence on possible associations between ORA and trauma-related symptoms in those who report this kind of extreme and prolonged violence is rare. The aim of our study was to explore socio-demographic and clinical characteristics of the individuals reporting ORA experiences, and to investigate protective as well as promotive factors in the link between ORA and trauma-related symptom severity. Within the framework of a project of the Independent Inquiry into Child Sexual Abuse in Germany, we recruited 165 adults who identified themselves as ORA victims via abuse- and trauma-specific networks and mailing lists, and they completed an anonymous online survey. We used variance analyses to examine correlations between several variables in the ORA context and PTSD symptoms (PCL-5) as well as somatoform dissociation (SDQ-5). Results revealed a high psychic strain combined with an adverse health care situation in individuals who report experiences with ORA. Ideological strategies used by perpetrators as well as Dissociative Identity Disorders experienced by those affected are associated with more severe symptoms (η2p = 0.11; η2p = 0.15), while an exit out of the ORA structures is associated with milder symptoms (η2p = 0.11). Efforts are needed to improve health care services for individuals who experience severe and complex psychiatric disorders due to ORA in their childhood.

Description: Social Network Analysis (SNA) is a set of techniques developed in the field of social and behavioral sciences research, in order to characterize and study the social relationships that are established among a set of individuals. When building a social network for performing an SNA analysis, an initial process of data gathering is achieved in order to extract the characteristics of the individuals and their relationships. This is usually done by completing a questionnaire containing different types of questions that will be later used to obtain the SNA measures needed to perform the study. There are, then, a great number of different possible network-generating questions and also many possibilities for mapping the responses to the corresponding characteristics and relationships. Many variations may be introduced into these questions (the way they are posed, the weights given to each of the responses, etc.) that may have an effect on the resulting networks. All these different variations are difficult to achieve manually, because the process is time-consuming and error-prone. The tool described in this paper uses semantic knowledge representation techniques in order to facilitate this kind of sensitivity studies. The base of the tool is a conceptual structure, called “ontology” that is able to represent the different concepts and their definitions. The tool is compared to other similar ones, and the advantages of the approach are highlighted, giving some particular examples from an ongoing SNA study about alcohol consumption habits in adolescents.

Description: Organisations may benefit from training champions to promote healthy workplace environments and initiatives. This study compared the perceived usefulness and relative effectiveness of an employee training course offered via online and face-to-face formats. Individuals who took part in the training course were assessed on their perceived competence and confidence to implement changes pre- and post-training. Repeated measures Analysis of Variance (ANOVA) and a t-test were conducted to test for significant differences between pre- and post-training scores and/or mode of training, respectively. Although the face-to-face training course was rated as slightly more useful, there were no significant differences between the two modes of training for the other dependent variables, and both modes led to significantly greater perceived competence and confidence post-training. These findings demonstrate the potential benefits of training employees to implement changes in their workplaces.

Description: Dust exposure is one of the major risk factors for respiratory health in many workplaces, including coffee factories. The aim of this study was to assess the prevalence of respiratory symptoms and lung function reduction among workers in Ethiopian primary coffee processing factories, compared to a control group of workers. A total of 115 coffee workers and 110 water bottling workers were involved in this study, from 12 coffee and 3 water bottling factories in Ethiopia, respectively. The chronic respiratory symptoms were assessed using a structured interview, using a standardized questionnaire adopted from the American Thoracic Society (ATS). The lung function tests were performed according to the ATS recommendation for spirometry. The coffee workers had a significantly higher prevalence of coughing, coughing with sputum, breathlessness, work-related shortness of breath, and wheezing compared with the controls. The prevalence ratio of work-related shortness of breath (PR = 3.7, 95% CI: 1.6–8.7) and wheezing (PR = 3.3, 95% CI: 1.3–8.4) was significantly higher for the coffee workers compared to the controls. The coffee workers in the age groups 28–39 years and ≥40 years, had a significantly lower forced vital capacity and forced expiratory volume in 1 s compared to the controls in the similar age groups. The findings indicated the need for longitudinal studies on the possible effect of coffee dust on respiratory health of coffee production workers.

Description: The aim of this study is to examine the efficiency of biobased Spanish broom (SB) surface modified cellulose fibers to remove bisphenol A (BPA), a well-known endocrine disruptor, from water. Spanish brooms are flowering plants, which are native and abundant to Mediterranean regions. The functionalized fibers (FF) were found to have the best adsorption efficiency at pH 5, due to the optimal hydrophobic interaction between the FF fiber and BPA. Adsorption kinetics of BPA was found to fit well a pseudo-second order reaction. Equilibrium isotherm data were fitted by Langmuir and Freundlich models. A very fast and simple regeneration method was developed and it was observed that adsorption capacity of the fibers was kept almost unchanged after 3 consecutive uses. Bottled water and synthetic wastewater were also tested to assess the efficiency of the process under more realistic water and wastewater treatment conditions. It was found that BPA removal was slightly decreased from 77% in ultrapure water to 64% in synthetic wastewater matrix, indicating that FF has a high selectivity toward BPA, even in the presence of other organic compounds. Overall, it was observed that SB-modified fibers can be a new promising green biotechnology for water purification.

Description: Total Worker Health® (TWH) frameworks call for attention to organizational leadership in the implementation and effectiveness of TWH approaches. It is especially important to study this within in the small business environment where employees face significant health, safety, and well-being concerns and employers face barriers to addressing these concerns. The purpose of this study was to gain a better understanding of how small business leaders perceive employee health, safety, and well-being in the context of their own actions. We conducted semi-structured interviews with 18 small business senior leaders and used a qualitative coding approach to analyze the transcripts to determine the frequency with which leaders discussed each code. When we asked leaders about their leadership practices for health, safety, and well-being, leaders reflected upon their business (65%), themselves (28%), and their employees (7%). Leaders rarely discussed the ways in which they integrate health, safety, and well-being. The interviews demonstrate that small business leaders care about the health of their employees, but because of the perceived value to their business, not to employees or themselves. Thus, they may lack the knowledge and skills to be successful TWH leaders. The present study supports a need for continued small business TWH leadership research.

Description: In this study, we identified the sources of trace metals, investigated their spatial distribution in topsoil and assessed their potential ecological risk in the area surrounding a typical manganese mining area in Xiangtan, Hunan Province, China. The concentrations of Mn, Cu, Pb, Zn, Cd, Ni, Cr and Hg in the topsoil of the study area were measured. Except for Cr and Hg, all trace metals exceeded the corresponding soil background values for Hunan Province. The spatial variation in trace metals was visualized by GIS, and the results show that trace metals in topsoil are enriched mainly around mines and smelters. Two groups of trace metals were identified using the spatial distribution, trend analysis, Pearson’s correlation and principal component analysis: Mn, Cu, Pb, Zn, Cd and Ni can be attributed to industrial and mining activities, whereas Cr and Hg are of natural origin. The results also revealed the extent of the influence of secondary processes such as the prevailing wind direction, erosion of mine tailings and rainwater runoff play significant roles in the wider dispersal and transfer of trace metals. In addition, the environmental risk of metal pollution was evaluated by applying the geoaccumulation index and potential ecological risk index (PERI) to the study area. The accumulated PERI for metals of concern is at highest risk level in the main manganese mine area. This decreases to a moderate risk around the manganese mine area, highlighting locations for further risk management concern. Furthermore, nearly 80% of the potential ecological risk was from Cd across the study area.

Description: Mining activities make important contributions to economic growth, but they can also produce massive amounts of solid waste, such as tailings and metal accumulations. Taking the Urad Houqi mining area in Inner Mongolia as the study area, this study systematically assessed the contamination risk of arsenic and heavy metals in the soils of the study area and explored the contamination characteristics in a key polymetallic mining area. For the whole study area, based on the Nemerow comprehensive pollution method, almost half of the investigated sites were contaminated, and the most contaminated site was Urad Houqi Qianzhen Mineral Concentration Co., Ltd. (Bayannaoer, China), a cooperation between the lead and zinc mining industry. The assessment results indicated that Cd and As were the elements of greatest concern, followed by Pb, Cr and Hg. Particularly, for the typical Dongshengmiao mining area, when compared with the GB15618-1995 standard values, As, Zn and Cd posed the most serious contamination threat, while Cr and Ni exhibited clean conditions. In addition, the vertical distribution maps demonstrated that the contents of arsenic and metals in some soil profiles were correlated with sampling depth. Therefore, arsenic and heavy metals pose high threat to soil ecosystems in this area, there is encouragement for some control and remediation measures to be taken into effect.

Description: Young women in their late teens and early 20s are at the highest risk for depression onset. The present study aimed to assess depressive symptoms among female college students in Fukushima. More specifically, it aimed to clarify factors predicting possible symptom profiles, with an emphasis on determining how nuclear radiation risks affect the reporting of depression symptoms. A cross-sectional survey was conducted of 310 female students at a college in the Fukushima prefecture, Japan, in December 2015, and 288 participants submitted valid questionnaires. In total, 222 (77.1%) participants lived in Fukushima at the time of the Great East Japan Earthquake. The measures included the World Health Organization-Five Well-Being Index, the Fukushima Future Parents Attitude Measure, and risk perception of radiation health effects. A total of 46.5% of participants reported depressive symptoms. Path analysis revealed that higher radiation risk perceptions and reduced efficacy with reproduction related to a decline in self-esteem and self-efficacy, which was subsequently associated with increased depressive symptoms. These findings highlight the importance of radiation education among children and young adults, both after a nuclear accident and during disaster preparation, particularly in the context of reproductive and mental health.

Description: Job stress is considered one of the critical causes of construction workers’ unsafe behaviors. As a mainstay industry in many countries, the construction industry has a considerable number of employees and the research on how job stress affects workers’ unsafe behaviors has important theoretical and practical significance to improve construction safety performance through better job stress management. In this study, the authors thoroughly reviewed the literature and conducted semi-structured interviews to identify the dimensions of job stress, designed the job stress scale and cited the safety behavior measurement scale. After that, a questionnaire survey was developed using the proposed measurement scale and distributed to the construction employees from a project in Beijing. One hundred fifty responses were collected and analyzed using reliability analysis to validate the scale’s internal consistency. Results from factor analysis indicate that the scales of job stress measurement can be grouped into six dimensions. To demonstrate the applicability of the developed scale on construction safety management research, the collected data was used to test the hypothesis that job stress has a negative correlation with safety behavior. Results show that the hypothesis is valid, and there is a negative correlation between job stress and safety behavior. In addition, finer results of the relationship between the six dimensions of job stress and safety behavior can be obtained. In summary, this study developed an improved stress scale for construction workers in China, and the proposed scale was validated by analyzing the data from an empirical study in Beijing.

Description: The objective of this study was to gain a better understanding of the mechanisms underlying falls in the elderly. The results were based on a group of 28 women in a control group (CON) and 16 women in an experimental group (EXP), aged 60–70. Participants took part in the six-weeks Elderly Recreation Movement Program (ERMP) with the only difference that the EXP group practiced twice as often as the CON group. The measurement of variations in the index called limits of stability (LOS) was performed by application of Kistler force plate and the coactivation index (CI) was registered by means of sEMG. The results demonstrate the existence of statistically significant differences in terms of the principal outcome of the exercise time in the measurements of LOS (F(1.42) = 10.0, p = 0.003), and CI (F(1.42) = 10.5, p = 0.002). The effect of the program was associated with an increase the level of the maximum LOS, and a decrease of the CI level, especially in the experimental group. Hence, the implementation of an innovative ERMP exercise program results in the improvement of the physical capabilities of senior subjects.

Description: As modern workplace environments are becoming increasingly diverse, the experiences of disenfranchised employees have become a topic of great interest to scholars and business professionals alike. While the experiences of individuals with singular stigmatized identities have been well-established, a dearth of research has assessed how intersectionality, i.e., holding multiple stigmatized identities, combine and intertwine to shape workplace experiences. We contribute to a growing literature on intersectionality by assessing the extent to which employees identifying with multiple stigmatized identities may constitute a risk factor for the experience of job insecurity, a prevalent and potent economic stressor. Additionally, we propose that job insecurity will partially mediate the relationship between intersectionality and a variety of adverse workplace outcomes associated with increased job insecurity perceptions. In order to test these hypotheses, we collected survey data from 449 employed individuals within the United States over two timepoints. Results of the tests of our direct and indirect hypotheses revealed that individuals with more stigmatized identities reported greater perceptions of job insecurity, and intersectionality indirectly affected workplace outcomes via this heightened job insecurity. Our results highlight a new antecedent of job insecurity for consideration and is meant to motivate others to approach diversity-related research questions with multiple identities in mind, in an effort to encapsulate the full spectrum of one’s experience based on their identity makeup.

Description: The prevalence of overweight and obesity has been increasing globally. Recent studies suggest that eating frequency (EF) might be a factor influencing the development of overweight and obesity. This study aims to explore the association between eating frequency and obesity in Chinese adults. A cross-sectional study was conducted in Wuhan, China, from March to June 2016. A self-administered questionnaire and 24-h dietary recall were used to collect data on sociodemographic variables, lifestyle factors, nutrition knowledge, and eating frequency. Participants were divided into four groups according to eating frequency and meal timing: traditional time pattern (TTP), traditional time plus late snack pattern (TTLSP), irregular time pattern (ITP), and all-day pattern (ADP). We performed the chi-squared test and multiple logistic regression to assess associations among variables using JMP statistical software version 14.0.0 (SAS Institute Inc., Cary, NC, USA). Respondents were Chinese adults (N = 2290; range 29–74 years; 1162 men). Lower education level, higher food budget, and lower nutrition knowledge were associated with higher likelihood of irregular EF patterns (TTLSP, ITP, or ADP). Men, non-smokers, and participants with less physical activity, lower education level, or lower nutrition knowledge were more likely to be obese. Body mass index (BMI) categorization was significantly different among EF pattern groups (χ2 = 25.40, p = 0.003); however, this association was no longer significant in the regression model after adjustment for age, sex, education, smoking, food budget, nutrition knowledge, and physical activity. Thus, EF is not associated with obesity in Chinese adults.

Description: Little is known about the respiratory health damage related to household air pollution (HAP) in survivors of pulmonary tuberculosis (PTB). In a population-based cross-sectional study, we determined the prevalence and associated predictors of chronic cough and hemoptysis in 441 randomly selected PTB survivors living in 13 remote health zones with high TB burden in the South Kivu province of the Democratic Republic of Congo (DRC). Trained community and health-care workers administered a validated questionnaire. In a multivariate logistic regression, chronic cough was independently associated with HAP (adjusted odds ratios (aOR) 2.10, 95% CI: 1.10–4.00) and PTB treatment 〉6 months (aOR 3.80, 95% CI: 1.62–8.96). Among women, chronic cough was associated with cooking ≥3 h daily (aOR 2.74, 95% CI: 1.25–6.07) and with HAP (aOR 3.93, 95% CI: 1.15–13.43). Independent predictors of hemoptysis were PTB retreatment (aOR 3.04, 95% CI: 1.04–5.09) and ignorance of treatment outcome (aOR 2.24, 95% CI: 1.09–4.58) but not HAP (aOR 1.86, 95% CI: 0.61–5.62). Exposure to HAP proved a major risk factor for chronic cough in PTB survivors, especially in women. This factor is amenable to intervention.

Description: Inhalation of fungal spores can cause various spectrums of fungal diseases in immunocompromised hosts. The aim of this study was to evaluate the concentrations and profiles of fungal species in air collected at different locations in hematology wards and outside of the hospital in Seoul St. Mary’s Hospital over the course of a year. Air sampling was performed at four locations—outside the hospital (O), in the general ward (GW), in the lounge in the cleanroom (CRL), and in the patients’ room in the cleanroom (CRR)—by using Andersen single-stage air sampler at every two weeks between May 2017 and May 2018. The results showed higher mean fungal density in summer, and the concentrations of fungi decreased as follows: O (954.8 colony-forming units, CFU/m3) 〉 GW (4.2 CFU/m3) 〉 CRL (0.7 CFU/m3) 〉 CRR (0 CFU/m3). Aspergillus was most prevalent both inside (47%) and outside (62%) of the hospital. However, the outdoor fungal profile was more diverse than the indoor profile. Within the hospital, Penicillium was the second most dominant species. In conclusion, the outdoor fungal profile is diverse even in Seoul, a highly urbanized area in Korea. The distribution of indoor air fungi is significantly different from outdoor due to air quality systems. Heating, ventilation, and air conditioning (HVAC), as well as high-efficiency particulate air (HEPA)-filtered systems should be established to effectively reduce levels of indoor fungi.

Description: Menstrual hygiene management (MHM) has gained some attention and several literature reviews have been published. However, both original papers and reviews tend to focus on absorbent access and use and not on the disposal of menstrual waste. This review aims to fill a gap in the water, sanitation and hygiene (WASH) sector by bringing a focus specifically on menstrual hygiene safe disposal in low- and middle-income countries (LMIC). We reviewed published literature since 2002 on menstrual hygiene with a focus on menstrual waste management and menstrual absorbent disposal in LMIC. Database searches were conducted of both peer reviewed literature and grey literature, in addition to hand searching of references of relevant earlier literature reviews. In total 152 articles and reports were identified and 75 met the inclusion criteria and was included in the final review. Existing polices on MHM was also reviewed with a focus on India and South Africa. The review showed that disposal of menstrual waste is often neglected MHM and sanitation value chains, leading to improper disposal and negative impacts on users, the sanitation systems and the environment. Findings call for further research to gain better understandings of MHM waste streams, disposal behaviors, absorbent materials and waste management technologies to deliver health, safety, mobility and dignity for women and girls.

Description: Excess weight status may increase the risk of suicidality among sexual minority females, but few studies have examined this suicidality disparity in sexual minority males. This study examined the association between sexual minority status and suicide attempts in Chinese male adolescents and tested whether body mass index (BMI) had a moderating effect on that association. Data were collected from 7th to 12th graders from seven randomly selected provinces of China in the 2015 School-Based Chinese Adolescents Health Survey. In total, 72,409 male students completed the questionnaires regarding sexual attraction, self-reported weight and height, and suicide attempts. After adjustment for covariates, sexual minority status was associated with suicide attempts among male students (AOR = 1.74, 95% CI = 1.57–1.93). Stratification analyses showed that BMI category moderated this association; compared with the results before stratification analyses, sexual minority males who were obese had increased risk of suicide attempts (AOR = 2.15, 95% CI = 1.09–4.24), sexual minority males who were overweight had reduced odds of suicide attempts (AOR = 1.40, 95% CI = 1.01–1.92), and no significant association change was found in sexual minority males who were underweight (AOR = 1.82, 95% CI = 1.43–2.33). Our study indicated that BMI moderated the risk of suicide attempts in sexual minority males. Suicide prevention targeting sexual minority males should be focused on weight status disparity and the creation of a positive climate to reduce minority stressors due to body image.

Description: Biological and psychosocial factors are recognized contributors to the worldwide burden of asthma. However, the relationship between psychosocial factors and asthma symptoms among students in low- and middle-income countries remains underexplored. We aimed to identify socioeconomic, environmental, psychosocial, family-related and lifestyle factors associated with the self-reporting of asthma symptoms in Brazilian adolescents. This is a cross-sectional study using data from the 2012 PeNSE survey (n = 109,104). We analyzed the following variables: socioeconomic conditions, demographic characteristics, lifestyle, family context and dynamics, psychosocial indicators, smoking, and exposure to violence. Our outcome variable was the self-report of asthma symptoms in the past 12 months. The prevalence of wheezing was 22.7% (21.5–23.9). After adjusting for sex, age and the variables from higher hierarchical levels, exposure to violence (feeling unsafe at school, being frequently bullied, being exposed to fights with firearms) and physical aggression by an adult in the family were the environmental factors that showed the strongest associations with self-reporting of asthma symptoms. For psychosocial indicators of mental health and social integration, feelings of loneliness and sleeping problems were the strongest factors, and among individual behavioral factors, the largest associations were found for tobacco consumption. Our findings were consistent with previous studies, showing an association between self-reported asthma symptoms and socio-economic status, family context and dynamics, psychosocial indicators of mental health, exposure to violence and social integration, as well as a sedentary lifestyle and tobacco use.

Description: This study investigated barriers towards health behaviours (physical activity, limiting sedentary behaviour and healthy dietary habits) experienced by young European families living in vulnerable areas, from multiple perspectives (parents, teachers, local community workers). Focus groups were conducted in six European countries (Belgium, Bulgaria, Finland, Hungary, Greece and Spain). In each country, three focus groups were conducted with parents, one with teachers and one with local community workers. Data were analysed using a deductive framework approach with a manifest content analysis using the software NVivo. The present study identified barriers on four levels (individual, interpersonal, organisational and macro level) of a socio-ecological model of health behaviour. From parents’ perspectives, both general barriers (e.g., financial limitations and lack of time) and country-specific barriers (e.g., organisational difficulties and inappropriate work environment) were identified. Additional barriers (e.g., lack of parental knowledge and lack of parental skills) were provided by other stakeholders (i.e., teachers and local community workers). The results of this study demonstrate the additional value of including multiple perspectives when developing a lifestyle intervention aiming to prevent type 2 diabetes in vulnerable groups. Future lifestyle interventions are recommended to include multiple components (family, school, and community) and could be implemented across European countries if country-specific adaptations are allowed.

Description: Background: As the principal means of reimbursing medical institutions, the effects of case payment still need to be evaluated due to special environments and short exploration periods, especially in rural China. Methods: Xi County was chosen as the intervention group, with 36,104, 48,316, and 59,087 inpatients from the years 2011 to 2013, respectively. Huaibin County acted as the control group, with 33,073, 48,122, and 51,325 inpatients, respectively, from the same period. The inpatients’ information was collected from local insurance agencies. After controlling for age, gender, institution level, season fixed effects, disease severity, and compensation type, the generalised additive models (GAMs) and difference-in-differences approach (DID) were used to measure the changing trends and policy net effects from two levels (the whole county level and each institution level) and three dimensions (cost, quality and efficiency). Results: At the whole-county level, the cost-related indicators of the intervention group showed downward trends compared to the control group. Total spending, reimbursement fee and out-of-pocket expense declined by ¥346.59 (p 〈 0.001), ¥105.39 (p 〈 0.001) and ¥241.2 (p 〈 0.001), respectively (the symbol ¥ represents Chinese yuan). Actual compensation ratio, length of stay, and readmission rates exhibited ascending trends, with increases of 7% (p 〈 0.001), 2.18 days (p 〈 0.001), and 1.5% (p 〈 0.001), respectively. The intervention group at county level hospital had greater length of stay reduction (¥792.97 p 〈 0.001) and readmission rate growth (3.3% p 〈 0.001) and lower reimbursement fee reduction (¥150.16 p 〈 0.001) and length of stay growth (1.24 days p 〈 0.001) than those at the township level. Conclusions: Upgraded case payment is more reasonable and suitable for rural areas than simple quota payment or cap payment. It has successfully curbed the growth of medical expenses, improved the efficiency of medical insurance fund utilisation, and alleviated patients’ economic burden of disease. However, no positive effects on service quality and efficiency were observed. The increase in readmission rate and potential hidden dangers for primary health care institutions should be given attention.

Description: Environmental protection has been increasingly emphasized by stakeholders, including social organizations, the government, and the public. As a result, building a sustainable supply chain has now become a part of social corporate responsibility as well as a challenge for firms, including small and medium-sized enterprises (SMEs). Taking a chemical enterprise (called enterprise C, in this paper) as an example, this paper uses quality function deployment (QFD) techniques and sets up a house of quality (HOQ) to investigate how a SME can achieve sustainable supply chain management. Specifically, in this paper we build a performance measurement system focusing on economic performance, environmental performance, and social performance. These three types of performance measure, in turn, include fifty-nine secondary indicators. Furthermore, an analytic hierarchy process (AHP) has been adopted to calculate the weight of each indicator. Benchmarking has also been used, to determine how much the enterprise should improve on each indicator. Based on the HOQ model, we conclude that avoiding waste, recycling resources, and sustainable exploitation are most important internal abilities of enterprise C.

Description: In this study, models were used for the first time to investigate the fate and transport of rare earth elements (REE) in the presence of hydrous manganese and ferric oxides in groundwaters from the coastal Bohai Bay (China). Results showed that REE sorption is strongly dependent on pH, as well as hydrous manganese and ferric oxide content. Higher proportions of REE were sorbed by hydrous manganese oxide as compared to hydrous ferric oxides, for example in the presence of neodymium. In this case, a mean 28% of this element was sorbed by hydrous manganese oxide, whereas an average 7% sorption was observed with hydrous ferric oxides. A contrasting REE sorption behavior was observed with hydrous manganese and ferric oxide for all investigated groundwaters. Specifically, REE bound to hydrous manganese oxides showed decreasing sorption patterns with increasing atomic number. The opposite trend was observed in the presence of hydrous ferric oxides. In addition, these results suggested that light REE (from La to Sm) rather than heavy REE (from Eu to Lu) are preferentially scavenged by hydrous manganese oxide. However, the heavy REE showed a greater affinity for hydrous ferric oxides compared to light REE. Therefore, both hydrous manganese and ferric oxide are important scavengers of REE. This study shows the implication of hydrous manganese and ferric oxide sorption for the sink of REE in groundwater.

Description: IJERPH is proud to announce that it is adopting a new policy concerning the publication of research funded by tobacco companies. [...]

Description: Socioeconomic status has shown to be associated with subjective health, well-being, satisfaction with overall life and estimation of happiness. The body of research concerning the question of whether higher economic status leads to better health and well-being are mostly from developed countries. The present study was therefore conducted among women in Nepal with an aim to investigate whether household wealth status is associated with satisfaction about (1) self-reported health, (2) happiness, and (3) life overall. Methods: Subjects were 5226 Nepalese women aged between 15 and 24 years. Cross-sectional data were extracted from round 5 of the Nepal Multiple Indicator Cluster Survey (NMICS), conducted in 2014, and analyzed using chi-square tests of association, bivariate and multivariable regression methods. Results: Wealth status was significantly associated with satisfaction about health, estimation of happiness and satisfaction. Compared with women in the poorest households, the odds of positive estimation about overall happiness were respectively 30% higher for poorer (p 〈 0.0001; 95% CI = 1.653–3.190), 80% higher for middle (p = 0.001; 95% CI = 1.294–2.522), 64% higher for richer (p = 0.006; 95% CI = 1.155–2.326), and 40% higher for richest households. The odds of reporting satisfaction about life were respectively 97% higher for poorer (p 〈 0.0001; 95% CI = 1.680–2.317), 41% higher for middle (p 〈 0.0001; 95% CI = 1.165–1.715), 62% higher for richer (p 〈 0.0001; 95% CI = 1.313–2.003), and 31% higher for richest households (p = 0.043; 95% CI = 1.008–1.700). Conclusion: Our results conclude that women in households with lower wealth status report poorer subjective health, quality of life and happiness. However, the findings need to be interpreted in light of the existing sociocultural conditions mediating the role of household wealth status on women’s lives.

Description: Background: Air pollution in large Chinese cities has led to recent studies that highlighted the relationship between particulate matters (PM) and elevated risk of cardio-cerebrovascular mortality. However, it is unclear as to whether: (1) The same adverse relations exist in cities with relatively low levels of air pollution; and (2) the relationship between the two are similar across ethnic groups. Methods: We collected data of PM2.5 (PM with an aerodynamic diameter ≤ 2.5 µm) and PM10 (aerodynamic diameter ≤ 10 µm) in the Yanbian Korean Autonomous Prefecture between 1 January 2015 and 31 December 2016. Using a time-stratified case-crossover design, we investigated whether levels of particulate pollutants influence the risk of cardio-cerebrovascular disease mortality among ethnic Korean vs. ethnic Han residents residing in the Yanbian Korean Autonomous Prefecture. Results: Under the single air pollutant model, the odds ratios (ORs) of cardio-cerebrovascular disease were 1.025 (1.024–1.026) for each 10 μg/m3 increase in PM2.5 at lag0 day, 1.012 (1.011–1.013) for each 10 μg/m3 increase in PM10 at lag1 day. In the multi-pollutant model adjusted by PM10, SO2, and NO2, the ORs of cardio-cerebrovascular disease were 1.150 (1.145–1.155) for ethnic Koreans and 1.154 (1.149–1.158) for ethnic Hans for each 10 μg/m3 increase in PM2.5. In the multi-pollutant model adjusted by PM2.5, SO2, and NO2, the ORs of cardio-cerebrovascular disease were 1.050 (1.047–1.053) for ethnic Koreans and 1.041 (1.039–1.043) for ethnic Hans for each 10 μg/m3 increase in PM10. Conclusion: This study showed that PM2.5 and PM10 were associated with increased risks of acute death events in residential cardio-cerebrovascular disease in Yanbian, China.

Description: Diarrheal disease is a critical health condition in urban areas of developing countries due to increasing urbanization and its associated problems of sanitation and poor access to good drinking water. Increasing floods in cities have been linked to the risk of diarrheal disease. There are few studies that specifically link flooding with diarrhea diseases. This may be due to the fact that secondary data mainly hospital recorded cases, and not individual cases at the household level are used. Furthermore, of the few papers that consider the flood-diarrheal diseases nexus, none have considered risk perceptions in general, and more specifically, whether households that have experienced floods which resulted in a reported case of diarrhea, have higher perceived risks of future occurrences of the two phenomena compared to households that had different experiences. Yet, this is critical for the development of interventions that seek to increase protective behaviors and reduce the risk of contracting diarrhea. We surveyed 401 households in some selected urban poor communities in Accra, the capital of Ghana. Results show that households that experienced floods which resulted in a reported case of diarrhea, have higher perceived risk of future occurrence of the two phenomena compared to other households. We recommend public education that reduces the risk of exposure to flood and diarrhea through flood mitigation measures, including the construction of drains in communities and educating communities on good sanitation.

Description: Anthropogenic activities have weakened the invasion of ruderals and increased the number of non-native species in urban areas. Ruderals are an important component of urban plant diversity and are of great significance to the sustainable development of urban green space. We used the tessellation–randomized plot method to examine the composition and biodiversity of ruderal species among urban land use types (LUTs) in the built-up areas of Beijing. Soil samples from the surface to a depth of 10 cm were taken from each site to examine the impact of soil characteristics on ruderal species diversity. Results showed that a total of 120 ruderal species were observed, including 71 native and 49 non-native species. Among them, 90% were identified as Cosmopolitan. Native species accounted for the majority of ruderals across all the eight LUTs. Institutional, residential, and woodlot areas with coarser management had higher ruderal species richness than did commercial areas and roadside lawns. Allergenic species showed the highest proportions in municipal parks, and invasive species accounted for 20% of all ruderal species. Ruderal species diversity was related to distance from the urban center, pruning intensity, and soil characteristics. These results suggest that with ruderals playing an important role in urban grass species diversity, there is tremendous potential for more native species in Beijing lawns, which would contribute substantially to increasing the ecological system’s functional benefits. Ruderal species accustomed to the causal processes and environmental conditions of different LUTs should be used and conserved properly to improve the harsh conditions of different LUTs and to sustain ecosystem health.

Description: Insufficient fruit intake is observed worldwide despite the generally higher preference for consumption of fruits than vegetables. For children, the determinants of consumption, such as at-home accessibility and parental consumption patterns, may especially influence fruit intake. The aim of this study was to analyze the association between fruit consumption behaviors and the preferences of mothers and their declared behaviors and preferences of children. The study was conducted in national samples of Polish (n = 1200) and Romanian (n = 1157) mothers of children aged 3–10 years (random quota sampling; quotas: age, education and place of residence) by using Computer-Assisted Telephone Interviewing (CATI). Mothers were asked about their general frequency of fruit consumption and their and their children’s most preferred fruits. A 24-h dietary recall of fruit intake was conducted for mothers and children. Significant associations were observed for (1) fruit consumption behaviors of mothers and children, (2) fruit consumption preferences of mothers and their declared preferences of their children, and (3) fruit consumption preferences of mothers and behaviors of their children. The associations were very strong for all fruits, both for Polish and Romanian samples. In order to increase the fruit intake of children, it is necessary to influence the fruit consumption preferences and behaviors of mothers.

Description: Performing arts used as a method of spreading health information dates back to the origins of storytelling. However, interventions in developing, non-Western countries typically utilize Western entertainment forms. This qualitative investigation assesses responses to an intervention designed around traditional Javanese shadow puppetry (wayang kulit). Semi-structured interviews provided in-depth responses from a sample (N = 12) of villagers. Responses analyzed both cross-case and within-case, focused on perceptions of the music and storyline, responses to the intervention, and the perceived appropriateness of wayang kulit for disseminating a health message. Wayang kulit was considered to be interesting and easy to remember, but concerns remained regarding the reliability of information provided through the drama. The fusion of traditional and modern music and story elements were perceived positively. Some participants were inspired to improve their hygiene practices, although the lack of motivation, or belief that they were unable to change was noted. The performance was generally received positively in terms of the nature of the intervention, the fusion of traditional and Western music and story elements, as well as the use of wayang kulit to spread health information. The study provides guidance for modifications to the production, prior to scaling up.

Description: Physical activity has numerous associated benefits for cancer survivors. Compared to their urban counterparts, rural and remote Australians experience a health disadvantage, including poorer survival rate after the diagnosis of cancer. The purpose of this qualitative study was to (a) investigate factors that motivated or inhibited walking in rural participants during a 12-week intervention and (b) to investigate factors that motivated or inhibited physical activity behavior change three months post-intervention. Ten cancer survivors living in rural areas of South Australia participated in a 12-week computer-delivered walking-based intervention during which they reported daily steps, daily affect, and ratings of perceived exertion. Based on this information, individualized daily step goals were sent to them to increase walking. Following the intervention, participants engaged in face-to-face semi-structured interviews. Interviews were recorded, transcribed and coded using thematic analysis. Participants identified a range of physical, psychological, social, environmental, and organizational motivators and barriers. Participants appreciated the monitoring and support from the research team, but some voiced a need for better transition to post-program and many desired ongoing support to maintain their motivation. Future studies should incorporate strategies to help walking behavior to become more intrinsically motivated and therefore sustained.

Description: (1) Medical doctors and medical students show increased psychological stress levels. International medical students seem to be particularly vulnerable. (2) We compared different methods of assessing stress levels in international and local first year medical students. First, study participants completed questionnaires related to stress, depression, empathy, and self-efficacy (MBI, PSQ, PHQ-9, JSPE-S, and GSE) at three separate points in time (T1 to T3). Second, their heart rate variabilities (HRVs) were recorded in an oral examination, a seminar, and in a relaxing situation. Third, hair samples were collected at the beginning and at the end of the semester to assess the cortisol concentration. (3) Included were 20 international and 20 local first semester medical students. At T1, we found considerable differences between international and local students in the JSPE-S; at T2 in the MBI factor “professional efficacy”, the PHQ-9, and in the JSPE-S; and at T3 in the MBI factors “cynicism” and “professional efficacy”, the PHQ-9, and in the JSPE-S. International and local students also differed concerning their HRVs during relaxation. Over the course of the semester, international students showed changes in the MBI factors “emotional exhaustion” and “professional efficacy”, the PHQ-9, and the GSE. Local students showed changes in the GSE. No effects were found for students’ hair cortisol concentrations. (4) All participants showed low levels of stress. However, while international students experienced their stress levels to decrease over the course of the semester, local students found their stress levels to increase.

Description: This research aimed to identify systemic housing-level contributions to infectious disease transmission for Indigenous Australians, in response to the Government program to ‘close the gap’ of health and other inequalities. A narrative literature review was performed in accordance to PRISMA guidelines. The findings revealed a lack of housing maintenance was associated with gastrointestinal infections, and skin-related diseases were associated with crowding. Diarrhoea was associated with the state of food preparation and storage areas, and viral conditions such as influenza were associated with crowding. Gastrointestinal, skin, ear, eye, and respiratory illnesses are related in various ways to health hardware functionality, removal and treatment of sewage, crowding, presence of pests and vermin, and the growth of mould and mildew. The research concluded that infectious disease transmission can be reduced by improving housing conditions, including adequate and timely housing repair and maintenance, and the enabling environment to perform healthy behaviours.

Description: Background: We examined the effects of lead on kidney function in occupationally and environmentally exposed adults from a Dallas lead smelter community that was the site of an Environmental Protection Agency (EPA) Superfund clean-up. All subjects were African Americans—a racial group that bears a disproportionate burden of kidney disease. Methods: A two-phase health screening was conducted. Phase II included a physical examination and laboratory tests. Study subjects were African Americans residents, aged ≥19 years to ≤89 years. Of 778 subjects, 726 were environmentally exposed and 52 were both occupationally and environmentally exposed. The effects of lead exposure on estimated glomerular filtration rate (eGFR) were examined in three groups: male and female smelter-community residents, as well as males with both occupational and environmental exposure. Multiple linear regression was used to analyze the dependence of eGFR on log (blood lead level), duration of residence in the community, type 2 diabetes, and hypertension. Results: There was a statistically significant negative effect on kidney function for all three groups. Comparison of female and male residents showed a slightly larger negative effect of blood lead level on eGFR in females versus males, with the largest effect seen in male smelter-working residents. For each unit increase (log10 10 µg/dL = 1) in blood lead level, age-adjusted eGFR was reduced 21.2 mL/min/1.73 m2 in male residents, 25.3 mL/min/1.73 m2 in female residents and 59.2 mL/min/1.73 m2 in male smelter-working residents. Conclusions: Chronic lead exposure is associated with worsening kidney function in both African American male and female residents, as well as male workers in Dallas smelter communities. This effect is slightly, but not statistically significantly, worse in female residents than male residents, and significantly worse in males that both worked and resided in the smelter community.

Description: The epidemiology of occupational injuries is reported worldwide, but suspicions of under-reporting prevail, probably associated with free press. We examined the association between freedom of the press and lethality rate of occupational injuries based on the most comprehensive International Labour Organization database on labour statistics (ILOSTAT) among 39 countries. The occupational injury indices, national indicators, and information on freedom of the press in 2015 were sourced from ILOSTAT, World Bank open data, World Health Organization and Freedom House. The lethality rate was the number of fatal occupational injuries per 10,000 total occupational injuries. The relationship among fatal and total occupation injury rates, lethality rate, and national statistics were analysed using Spearman’s rank correlation coefficients. Multivariable linear regression models with bootstrap estimation to manage non-normality determined freedom of the press associated with lethality rate. Freedom of the press was significantly correlated with fatal and total occupational injury rate and lethality rate of occupational injuries. Adjusting for national indicators, only freedom of the press was associated with lethality rate per 10,000 occupational injuries in the report of ILOSTAT. The lethality rate of occupational injury reported by each country might not reflect the actual lethality, but under-reported nonfatal occupational injuries, probably relating to freedom of the press.

Description: Construction professionals are prone to work-family conflict and job burnout, which in turn can affect project performance during implementation of delivery. To cope with this, a questionnaire survey was undertaken with construction professionals in the Chinese construction industry and 373 valid responses were received. A theoretical model introducing organizational support as a moderating variable was developed and tested with structural equation modeling. The results showed that there is a positive correlation between work-family conflict and job burnout for construction professionals. Involving organizational support can alleviate the impact of work-family conflict on professionals’ job burnout. Meanwhile, both work-family conflict and job burnout have negative effects on project performance. Therefore, an atmosphere and culture of humanized management should be established within the construction enterprises. Additionally, organizational incentives such as regulations and rules should be formulated assisting employees achieve work-family balance. Such incentives could contribute to the construction industry and improve project performance. Furthermore, this study provides a new theoretical perspective for the management of job burnout and work-family conflict in the construction industry, complementing the existing body of knowledge.

Description: Exposures to toxic metals such as mercury have been suggested to be risk factors for amyotrophic lateral sclerosis (ALS). Human intake of mercury commonly occurs via consumption of seafood or from mercury-containing amalgam dental restorations (‘mercury fillings’). We therefore compared mercury exposures from these sources in 401 ALS and 452 non-ALS respondents, using an internationally-available online questionnaire that asked respondents how often they ate seafood and what their favourite types of seafoods were. Respondents were also asked to record numbers of current or former mercury fillings. ALS and non-ALS respondents did not differ in their frequency of seafood consumption or in monthly mercury intake from favourite seafoods. Both groups had similar numbers of current, as well as former, mercury fillings. In conclusion, this study found no evidence that mercury exposure from eating seafood, or from mercury dental fillings, was associated with the risk of developing ALS. Therefore, if mercury does play a role in the pathogenesis of ALS, other sources of exposure to mercury in the environment or workplace need to be considered. Alternatively, a susceptibility to mercury toxicity in ALS, such as genetic or epigenetic variations, multiple toxic metal interactions, or selenium deficiency, may be present.

Description: We argue that a Nash bargaining model with behavioral factors (i.e., fairness concern and risk aversion) should be introduced to the price strategizing process in the context of a closed-loop supply chain. We consider three different pricing models: The first is when both the manufacturer and the retailer have fairness concerns; the second is when both the manufacturer and the retailer have risk aversion; and the final is when the manufacturer has risk aversion but the retailer has both risk aversion and fairness concern. Then we examine the model with game theory. The results have shown that fairness and risk aversion change the optimal pricing strategy, which affects the expected profits of retailers and manufacturers. The impacts of two (relatively irrational) behavioral factors on the wholesale and retail prices of new products, the recycle price and recycle transfer price of the waste products, are not the same. For new products, the wholesale price is most affected by behavioral factors and the sales price scores second. For waste recycling products, the transfer price is most affected by behavioral factors and the recycle price scores second. When considering fairness and risk aversion in retail, fairness concern is good for both manufacturers and retailers. This innovative pricing strategy model adds implications for sustainability in supply chain operations.

Description: The purpose of this study was to develop and validate the ICT Self-Efficacy Scale and the association of cyberbullying and victimization with ICT self-efficacy. Sample 1 (436 university students) was used to identify the factor structure of the Scale, and sample 2 (1115 university students) provided the data to confirm the factor structure (CFA), and to compute the internal consistency reliability, and convergent validity of the scale. Findings demonstrate that the new scale is a reliable and valid domain-specific measure to assess ICT Self-Efficacy for university students. Suggestions for further research with the scale are provided.

Description: Falls incidence rates and associated injuries are projected to increase among rural-dwelling older adults, which highlights the need for effective interventions to prevent falls and manage fall-related risks. The purpose of this descriptive study was to identify the geospatial dissemination of eight evidence-based fall prevention programs (e.g., A Matter of Balance, Stepping On, Tai Chi, Otago Exercise Program) across the United States (U.S.) in terms of participants enrolled, workshops delivered, and geospatial reach. These dissemination characteristics were compared across three rurality designations (i.e., metro areas; non-metro areas adjacent to metro areas; and, non-metro areas not adjacent to metro areas). Data were analyzed from a national repository of 39 Administration for Community Living (ACL) grantees from 2014–2017 (spanning 22 states). Descriptive statistics were used to assess program reach, delivery-site type, and completion rate by rurality. Geographic information systems (GIS) geospatially represented the collective reach of the eight interventions. Of the 45,812 participants who attended a fall prevention program, 12.7% attended workshops in non-metro adjacent areas and 6.6% attended workshops in non-metro non-adjacent areas. Of the 3755 workshops delivered (in over 550 unique counties), most were delivered in senior centers (26%), residential facilities (20%), healthcare organizations (13%), and faith-based organizations (9%). On average, the workshop attendance/retention rates were consistent across rurality (~70%). Findings highlight the need to diversify the delivery infrastructure for fall prevention programs to adequately serve older adults in rural areas. Ongoing efforts are needed to offer sustainable technical assistance and to develop scalable clinical-community referral systems to increase fall prevention program participation among rural-dwelling older adults.

Description: The aim of this paper is to evaluate the link between the history of exposure to tuberculosis (TB) in the household and diagnosed TB cases at school, and to compare the detection rate of active TB among household contacts and classroom contacts of adolescent TB cases with the rates among contacts of healthy controls. From November 2016 to December 2017, a prospective matched case-control study was conducted using passively identified index adolescent student cases from the TB surveillance system and healthy controls (matched by county, school type, sex, age and ethnicity). Contacts in households and classrooms of index cases and of controls were investigated. Matched tabulation of 117 case-control pairs revealed exposure to TB in the household as a strong risk factor (odds ratio (OR) = 21.0, 95% confidence interval (CI): 3.4, 868.6). Forty-five (case detection rate 0.69%) and two (case detection rate 0.03%) new active TB cases were detected among 6512 and 6480 classroom contacts of the index cases and controls, respectively. Having an index case in the classroom significantly increased the risk of classmates contracting active TB (OR = 22.5, 95% CI: 5.9, 191.4). Our findings suggested that previous exposure to TB in the household could lead a child to catch TB at school, then spread TB to classmates.

Description: The rise of food trucks as an eating out option requires knowledge of this sector. Balancing the reality of the food truck sector with access to safe food should guide actions and public policies to cater to its peculiarities. Therefore, this study aimed to characterize the Brazilian food truck vendors’ profile regarding their socioeconomic status and compliance with food safety rules. From the 118 food truck vendors registered in the Brazilian Federal District, 30% (n = 35) participated in the study. We conducted structured interviews from December 2017 to April 2018. We ranked compliance levels according to a five-point Likert scale based on calculated compliance scores. The interviews revealed that food truck vendors were mostly married males, who had completed at least a tertiary education level, and wanted to start up their own businesses. The compliance levels depict good compliance with food safety rules (overall compliance (OC)-score = 0.69, on a 0 to 1 scale). The food trucks assessed in this study distinguished themselves from the street food and food retail sectors due to their operational structure and the complexity of food production processes. Those particular features should be considered to ensure adequate and effective sanitary control and inspections, as well as to reduce the probability of microbial growth and food contamination and the consequent risk of foodborne illnesses.

Description: This study examined the prevalence and factors associated with inconsistent condom use among men who have sex with men (MSM) who use gay mobile geo-social networking applications (gay mobile apps) in Greater Tokyo. Among a sample of 1657 MSM recruited through advertisements on gay mobile apps, inconsistent condom use was reported by over one-third (37%) of participants with regular male partners, 18% with casual male partners, and 20% with female partners. In multiple regression analysis, inconsistent condom use with both regular and casual male partners was more commonly reported among participants without a university education, and among participants reporting lower self-efficacy for safer sex. Inconsistent condom use with casual male partners was more commonly reported among participants living in the central 23 wards of Tokyo. Inconsistent condom use with regular male partners was more commonly reported among participants who identified as a member of the gay community, and who only had male partners. These results indicate that a substantial proportion of Greater Tokyo gay mobile app users use condoms inconsistently, particularly with regular partners, and may be at risk for HIV. This paper provides useful information to help design tailored strategies to reduce inconsistent condom use.

Description: Cumulative risk assessment (CRA) has been proposed as a means of evaluating possible additive and synergistic effects of multiple chemical, physical and social stressors on human health, with the goal of informing policy and decision-making, and protecting public health. Routine application of CRA to environmental regulatory and policy decision making, however, has been limited due to a perceived lack of appropriate quantitative approaches for assessing combined effects of chemical and nonchemical exposures. Seven research projects, which represented a variety of disciplines, including population health science, laboratory science, social sciences, geography, statistics and mathematics, were funded by the US Environmental Protection Agency (EPA) to help address this knowledge gap. We synthesize key insights from these unique studies to determine the implications for CRA practice and priorities for further research. Our analyses of these seven projects demonstrate that the necessary analytical methods to support CRA are available but are ultimately context-dependent. These projects collectively provided advancements for CRA in the areas of community engagement, characterization of exposures to nonchemical stressors, and assessment of health effects associated with joint exposures to chemical and psychosocial stressors.

Description: There have been many public health recommendations for avoiding UV radiation exposures. This is primarily due to concerns about skin cancer and especially melanoma, the most serious type of skin cancer. However, UV radiation is also known as the primary source of vitamin D and other compounds needed for good health. This brief commentary lists several of the many important recent studies of adverse health effects associated with low sun exposure, including some specific cancers, multiple sclerosis, diabetes, cardiovascular disease, autism, Alzheimer’s disease, and age-related macular degeneration. Our conclusion is that non-burning UV exposure is a health benefit and—in moderation—should be recommended as such.

Description: Macao, China’s only city with legalized casinos, has maintained a high prevalence of gambling participation and gambling disorder (GD) over the past decade. The mental health risks associated with such high levels have been overlooked. In order to estimate the comorbid prevalence of GD with depression, anxiety, and Internet gaming disorder (IGD) and to explore the potential buffering effect of psychological resilience and purpose in life, this study obtained a representative adult Chinese sample (N = 1000, 44% male, aged 18–97 years) from a telephone survey conducted between October and November of 2016. As hypothesized, the highest psychiatric comorbid prevalence was observed in the GD subgroup (n = 19, 21.1% probable IGD, 26.3% probable depression, and 37.0% probable anxiety). All these mental health problems could increase one’s proclivity to GD, and vice versa. Psychological resilience was found to buffer the association between anxiety symptoms and probable GD (χ2(1) = 4.30, p = 0.04/GD symptoms, Fchange (1,162) = 6.29, p = 0.01), whereas purpose in life did not display any hypothesized moderating effect. These results indicate the usefulness of mental health screening for GD, taking into consideration its associated risks, and of fostering psychological resilience in prevention and treatment programs.

Description: Inventory management of deteriorating drugs has attracted considerable attention recently in hospitals. Drugs are a kind of special product. Two characteristics of some drugs are the shorter shelf life and high service level. This causes hospitals a great deal of difficulty in inventory management of perishable drugs. On one hand, hospitals should increase the drug inventory to achieve a higher service level. On the other hand, hospitals should decrease the drug inventory because of the short shelf life of drugs. An effective management of pharmaceuticals is required to ensure 100% product availability at the right time, at the right cost, in good conditions to the right customers. This requires a trade-off between shelf-life and service level. In addition, many uncontrollable factors can lead to random lead time of drugs. This paper focuses on deteriorating drugs with stochastic lead time. We have established a stochastic lead time inventory model for deteriorating drugs with fixed demand. The lead time obeyed a certain distribution function and shortages were allowed. This model also considered constraints on service level, stock space and drug shelf life. Through the analysis of the model, the shelf life of drugs and service level were weighted in different lead time distributions. Empirical analysis and sensitivity analysis were given to get reach important conclusions and enlightenment.

Description: The purpose of this study was to examine the impact of summer breaks on the body composition and cardiovascular fitness of elementary school children who participated in a multi-year school-based physical activity intervention. Participants were 404 children who had their height and weight measured and completed the Progressive Aerobic Cardiovascular Endurance Run (PACER) during physical education classes at the beginning and end of the school year for three consecutive years. To examine the effects of time on health-related fitness data, general linear mixed effects models were employed. The results indicate that there was a trend toward an increase in body mass index (BMI) after the summer of 2015 (p = 0.958), and a significant increase in BMI after the summer of 2016 compared to time point 1 (p 〈 0.001). For PACER laps, there were trends toward decreases in PACER laps after the summers of 2015 (p = 0.515) and 2016 (p = 0.073). Summer breaks tended to attenuate the BMI and PACER lap improvements that were observed during the intervention. While school-based physical activity programming has had some successes in improving health-related fitness markers, the loss of these improvements over the summer is of concern to both practitioners and researchers. It is clear that additional efforts are needed to limit obesogenic behaviors during the summer months.

Description: Background Very little research has been done to simultaneously investigate the effects of Tai Chi (TC) on depression and heart rate variability (HRV). This study, therefore, attempted to explore the effects of TC on depression and on HRV parameters. Methods Sixty older individuals with depression score of 10 or above (the Geriatric Depression Scale, GDS) were randomly assigned into two groups: TC (n = 30) and control group (n = 30). Participants in the experimental group participated in a 24-week TC training program (three 60-min sessions per week), whereas individuals in the control group maintained their unaltered lifestyle. Depression and HRV were measured using the GDS and digital electrocardiogram at baseline and after the 24-week intervention. Results The TC had produced significant positive chances in depression and some HRV parameters (mean heart rate, RMSSD, HF, LFnorm, and HFnorm) (p 〈 0.05), whereas these positive results were not observed in the control group. Conclusions The results of this study indicated that TC may alleviate depression of the elderly through modulating autonomous nervous system or HRV parameters. This study adds to a growing body of research showing that TC may be effective in treating depression of the elderly. Tai Chi as a mild to moderate mind-body exercise is suitable for older individuals who suffer from depression.

Description: In this study, the results of an airflow investigation conducted on 7 June 2015 as part of a series of epidemiologic investigations at Pyeongtaek St. Mary’s Hospital, South Korea, were investigated. The study involved 38 individuals who were infected directly and indirectly with Middle East Respiratory Syndrome (MERS), by a super-spreader patient. Tracer gas experiments conducted on the eighth floor, where the initial patient was hospitalized, confirmed that the tracer gas spread to adjacent patient rooms and rooms across corridors. In particular, the experiment with an external wind direction and speed similar to those during the hospitalization of the initial patient revealed that the air change rate was 17–20 air changes per hour (ACH), with air introduced through the window in the room of the infected patient (room 8104). The tracer gas concentration of room 8110, which was the farthest room, was 7.56% of room 8104, indicating that a high concentration of gas has spread from room 8104 to rooms across the corridor. In contrast, the tracer gas was barely detected in a maternity ward to the south of room 8104, where there was no secondary infected patient. Moreover, MERS is known to spread mainly by droplets through close contact, but long-distance dispersion is probable in certain environments, such as that of a super-spreader patient hospitalized in a room without ventilation, hospitals with a central corridor type, and indoor airflow dispersion due to external wind.

Description: Limited evidence exists about how to design interventions to improve access to health care for people with disabilities in low and middle-income countries (LMICs). This paper documents the development of two behaviour change interventions. Case study one outlines the design of an intervention to improve uptake of referral for ear and hearing services for children in Malawi. Case study two describes the design of an intervention to improve menstrual hygiene management for people with intellectual impairments in Nepal. Both followed existing approaches—Medical Research Council Guidance for developing and evaluating complex interventions and Behaviour Centred Design. The purpose is to demonstrate how these frameworks can be applied, to document the interventions developed, and encourage further initiatives to advance health services targeting people with disabilities. Important components of the intervention design process were: (1) systematic reviews and formative research ensure that interventions designed are relevant to current discourse, practice and context; (2) people with disabilities and their family/carers must be at the heart of the process; (3) applying the theory of change approach and testing it helps understand links between inputs and required behaviour change, as well as ensuring that the interventions are relevant to local contexts; (4) involving creative experts may lead to the development of more engaging and appealing interventions. Further evidence is needed on the effectiveness of these types of interventions for people with disabilities to ensure that no one is left behind.

Description: If children with common vision problems receive and use eyeglasses, their educational performance rises. Without proper treatment, visually impaired children may not achieve educational gains and could suffer from poor mental health. We use a randomized controlled trial to study the impact of an eyeglasses promotion program in rural China on the mental health of myopic primary school students. Three measures of mental health are used: learning anxiety, physical anxiety, and scores on the Mental Health Test (MHT). Our empirical analysis showed that on average, the treatment has small and insignificant for learning anxiety and MHT, and a small but significant reduction in physical anxiety. However, subgroup analysis reveals that myopic students who study more intensively see their learning anxiety and physical anxiety reduced after being provided with eyeglasses. In contrast, students with the lower study intensity suffer a rise in learning anxiety after receiving eyeglasses. A potential mechanism for the differing impacts is the increase in teasing reported among low study-intensity students that does not occur for high study-intensity students. Care should be taken to maximize the benefits and minimize the costs of in-school vision programs.

Description: This study investigates whether class-level school performance affects students’ life satisfaction and if there are differential effects for high- and low-performing students. Data were derived from the National Educational Panel Study, including n = 5196 students (49.6% girls), nested in 478 classes and 250 secondary schools. School performance in class was measured by aggregating individual grade point average in Mathematics and German. The study could not reveal the “big-fish-little-pond”-effect regarding students’ life satisfaction but found differential effects for high- vs. low performing students. There was no significant association for low-performing students attending classes with higher class-level performance However, low-performing students revealed the lowest life satisfaction. High-performing students placed in classes with higher average performance reported lower life satisfaction compared to high-performing students in classes with lower average performance. This study provides evidence for the impact of the learning environment in class on school-aged children’s life satisfaction, by highlighting the differential sensitivity of high-performing students when placed in classes with higher or lower average performance.

Description: Polycyclic aromatic hydrocarbons are large groups of ubiquitous environmental pollutants composed of two or more fused aromatic rings. This study was designed to evaluate the distribution, potential sources, and ecological and cancer risks of eleven polycyclic aromatic hydrocarbons from Huangpi soils in Wuhan, central China. The soil samples for this study were taken from 0–10 cm and 10–20 cm soil depths. A modified matrix solid-phase dispersion extraction method was applied to extract analytes from the soil samples. A gas chromatograph equipped with a flame ionization detector was used to determine the concentrations of the compounds. The sum mean concentrations of the polycyclic aromatic hydrocarbons were 138.93 and 154.99 µg kg−1 in the 0–10 cm and 10–20 cm soil depths, respectively. Benzo[a]pyrene and fluorene were the most abundant compounds in the 0–10 cm and 10–20 cm soil depths, respectively. The quantitative values of the pyrogenic index, total index, and diagnostic ratio used in this study showed that the polycyclic aromatic hydrocarbons have a pyrogenic origin. The negligible and maximum permissible concentrations values for naphthalene, acenaphthylene, acenaphthene, phenanthrene, anthracene, pyrene, benz[a]anthracene, and benzo[a]pyrene indicated a moderate ecological risk. The incremental lifetime cancer risk values for adults and children showed a low and moderate cancer risk, respectively.

Description: Work-related tuberculosis (TB) remains a public health concern in low- and middle-income countries. The use of vital registration data for monitoring TB deaths by occupation has been unexplored in South Africa. Using underlying cause of death and occupation data for 2011 to 2015 from Statistics South Africa, age-standardised mortality rates (ASMRs) were calculated for all persons of working age (15 to 64 years) by the direct method using the World Health Organization (WHO) standard population. Multivariate logistic regression analysis was performed to calculate mortality odds ratios (MORs) for occupation groups, adjusting for age, sex, year of death, province of death, and smoking status. Of the 221,058 deaths recorded with occupation data, 13% were due to TB. ASMR for TB mortality decreased from 165.9 to 88.8 per 100,000 population from 2011 to 2015. An increased risk of death by TB was observed among elementary occupations: agricultural labourers (MORadj = 3.58, 95% Confidence Interval (CI) 2.96–4.32), cleaners (MORadj = 3.44, 95% CI 2.91–4.09), and refuse workers (MORadj = 3.41, 95% CI 2.88–4.03); among workers exposed to silica dust (MORadj = 3.37, 95% CI 2.83–4.02); and among skilled agricultural workers (MORadj = 3.31, 95% CI 2.65–4.19). High-risk TB occupations can be identified from mortality data. Therefore, TB prevention and treatment policies should be prioritised in these occupations.

Description: Objective: Sarcoidosis is thought to be an aberrant immune response to environmental agents, with rural living as a risk factor. We aimed to determine if farm living, consumption of farm (untreated) milk, or untreated water increased the risk of sarcoidosis. Methods: In a case-referent design, patients aged 18–60 with pulmonary sarcoidosis together with referents with other chronic respiratory disease, diagnosed 1999–2005 in Alberta, Canada, were approached through their specialist physician. Participants completed a telephone questionnaire about farm living, use of untreated water and farm milk for each residence from birth to diagnosis. Exposures at birth, up to age five, and up to diagnosis were calculated. Results: The study included 615 cases and 1334 referents. The consumption of farm milk, but not of unpiped water or farm living overall, appeared to be consistently associated with sarcoidosis in a fully adjusted analysis. The association was present for farm milk used in the residence of birth (odds ratios (OR): 1.59, 95% confidence intervals (CI): 1.08–2.34) and persisted for those drinking farm milk to age five years (OR: 1.52, 95% CI: 1.04–2.21), and for those drinking farm milk for 〉16 years to diagnosis (OR: 1.50, 95% CI: 1.04–2.15). The association with sarcoidosis was stronger when the referent was in the subgroup diagnosed with asthma but was present also with referents with other chronic respiratory disease. Among those whose family used farm milk at birth and to age 5 years, continued use of farm milk into adulthood increased the risk of sarcoidosis. Conclusion: We observed evidence of positive association between consumption of farm milk and sarcoidosis.

Description: Previous research found that weight-related behaviors and body weight tends to be similar between individuals and peers. Rather little is known how different domains of weight-related behaviors co-evolve in peer networks. Hence, this study explores how young adults’ self-reported dieting relates to perceived body weight and weight control behaviors of their peers. A Swedish two-wave panel survey with ego-centric network data was analyzed with negative binomial regression models. Nineteen-year-old men and women in the first wave, and 23-year-olds in the follow-up sample were examined. Men at age 19 showed an increased dieting propensity when being exposed to underweight peers. Compared to men, women’s dieting at age 19 was more strongly related to their own body image concerns, and peers’ weight-related behaviors like physical exercising and unhealthy eating. The associations between dieting and peers’ weight-related characteristics for men and women deteriorated from age 19 to age 23. The findings suggest that women’s dieting—in comparison to dieting in men—is more strongly related to the peer context. The decrease in associations between men’s and women’s dieting and peers’ weight-related characteristics from age 19 to age 23 may reflect a weakened importance of the peer context in early adulthood.

Description: Cardiovascular disease (CVD) burden is several-fold higher in patients with chronic kidney disease (CKD). Although statins have been shown to provide significant CVD benefits in both the general population and patients with CKD, this has not translated into survival advantage in patients with advanced CKD or on dialysis. It has been reported that CVD risk continues to escalate as CKD progresses to end-stage kidney disease (ESKD); however, the CVD risk reduction by statins appears to decline as patients’ progress from the early to later stages of CKD. Statins have also been associated with a higher incidence of stroke in ESKD patients. Thus, the CVD benefits of statins in ESKD remain questionable.

Description: Over one billion of the world’s population are smokers, with increasing tobacco use in low- and middle-income countries. However, information about the methodology of studies on tobacco control is limited. We conducted a literature search to examine and evaluate the methodological designs of published tobacco research in Sub-Saharan Africa (SSA) over the past 50 years. The first phase was completed in 2015 using PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. An additional search was completed in February 2017 using PubMed. Only tobacco/smoking research in SSA countries with human subjects and published in English was selected. Out of 1796 articles, 447 met the inclusion criteria and were from 26 countries, 11 of which had one study each. Over half of the publications were from South Africa and Nigeria. The earliest publication was in 1968 and the highest number of publications was in 2014 (n = 46). The majority of publications used quantitative methods (91.28%) and were cross-sectional (80.98%). The commonest data collection methods were self-administered questionnaires (38.53%), interviews (32.57%), and observation (20.41%). Around half of the studies were among adults and in urban settings. We conclud that SSA remains a “research desert” and needs more investment in tobacco control research and training.

Description: Older Worker Identity consists of the internalization of negative beliefs and attitudes towards aged employees by these same people. This research aims to explore the moderator role both of subjective age and self-efficacy in the relationship between older worker identity and job performance. The study was conducted with a panel design, including a sample of +40 Spanish workers (n = 200), with two waves (4-months interval). The findings supported the moderator role of subjective age in the relationship, while it failed to support the moderator role of self-efficacy. These findings underline that workers who actively manage their subjective age perceptions could age successfully at work. The implications of this study for counseling practices are discussed.

Description: To determine the relationships between exposure to environmental contaminants in water and chronic kidney disease (CKD), we investigated the associations of 61 water attributes with the prevalence of CKD and End-Stage Renal Disease (ESRD) using data from 2005 to 2011 from all 22 counties and cities in the main island of Taiwan. We acquired patient information from the Taiwan Longitudinal Health Insurance Database to calculate the age-standardized CKD and ESRD prevalence rates and linked the patients’ residences to the water quality monitoring data, which were sampled periodically for a total of over 45,000 observations obtained from the Taiwan Environmental Water Quality Information Database. The association analysis adjusting for gender, age, and annual effects showed that the zinc (Zn), ammonia, chemical oxygen demand (COD), and dissolved oxygen in rivers were weakly correlated with CKD (τ = 0.268/0.250/0.238/−0.267, p = 6.01×10−6/2.52×10−5/6.05×10−5/3.30×10−5, respectively), but none for ESRD. The importances of Zn and COD in rivers were also demonstrated in a CKD regression model. Moreover, an unusually high CKD prevalence was related to arsenic contamination in groundwater. A further prospective cohort study would improve our understanding of what level of environmental water with risky properties could affect the development of CKD.

Description: A growing number of people undertake international travel, and yet faster growth of such travel is expected in the tropics. Information on the hazards presented by pool and hot spring waters in tropical countries is very limited. This review aims to collate available information on pool water quality, alongside data on cases and outbreaks associated with swimming in pools in tropical regions affecting both local populations and travellers. Bacteria species commonly causing cases and outbreaks in the tropics as well as elsewhere in the world were excluded, and the review focuses on studies related to pathogens that, with the exception of Cryptosporidium, are unusual in more temperate climates. Studies concerning subtropical countries were included in the light of climate change. Diseases transmitted by vectors breeding in poorly maintained, neglected or abandoned pools were also included. 83 studies dealing with Microsporidia, Leptospira spp., Schistosomas spp., Cryptosporidium spp., Acanthamoeba spp., Naegleria spp., Clostridium trachomatis, viruses, and vectors breeding in swimming pool and hot tub waters, and fulfilling predefined criteria, have been included in our survey of the literature. In conclusion, prevention strategies for pool safety in the tropics are imperative. Public health authorities need to provide guidance to westerners travelling to exotic destinations on how to protect their health in swimming pools.

Description: Improved quality of life has led to a growing demand for better indoor air quality (IAQ). Buildings are becoming more airtight and insulated in order to minimize energy consumption. The importance of both energy conservation and IAQ improvement has been recognized and addressed by many studies. Bake-out is the process of using indoor heating to remove volatile compounds present in building materials and furnishings so that they can be vented out into the atmosphere. Indiscriminate use of heating to increase the surface temperature of materials during this process can result in significant loss of energy. Therefore, energy-efficient bake-out should be performed by considering both the floor temperature and the emission amount of pollutants. This study aims to investigate an effective and economical bake-out implementation strategy via experimentation and computational fluid dynamics analysis. The results showed weak direct correlation between the heating energy consumption and the amount of pollutants emitted. The study also highlights the passive option of installing sorptive building materials for improving IAQ economically.

Description: This study describes pastoralism practiced in the Karakul village, Northeast of Tajikistan, and discusses its sustainability. Tajikistan introduced a market economy at independence in 1991, and pastoralism is now practiced on a family-unit basis. The families in Karakul graze livestock in their summer pastureland (jailoo) and move their livestock to winter pastureland around the village (kyshtoo). They make groups for pasturage with several families in jailoo and also in kyshtoo. Each group pastures their livestock every day, using a system called novad. In addition to jailoo and kyshtoo, they also practice pastoralism on two additional kinds of pastureland: küzdöö (spring pastureland) and bäärlöö (autumn pastureland). Still, now, the Karakul villagers use their pastureland as the commons: the Karakul village has not established private possession of pastureland even after a law enabled the division of common pastureland among individual families. Using the pastureland as the commons would be preferred by the local pastoralists. However, the free pasture access as the commons may result in a loss of sustainability as a trade-off. Regardless of privatization or the continued use of the commons, the possible development of the uneven use of the pastureland is inferred and should be avoided, and the introduction of a local management structure is urgently needed.

Description: Desiccation cracking is a very common surface soil phenomenon of saline-sodic land. The objective of this study was to investigate the effects of salt content on the spectral reflectance of soil with and without desiccation cracks. To achieve our objective, a cracking test was performed using 17 soil samples. Following the tests, crack parameters were extracted, and correlation analysis was then performed between crack parameters and four soil properties: Na+, salinity (total concentration of ions), pH, and electric conductivity (EC). In order to select the optimum spectral measurement method and develop prediction models, spectral response to different soil properties were compared between the cracked soil samples and the comparative soil samples composed of the 2 mm particle size fraction processed by traditional methods. The results indicate that soil salinity dominated cracking propagation with a positive correlation. Since area and volume scattering are closer to what occurs in the field, a greater spectral response to soil properties was found for cracked soil samples relative to the comparative soil samples in the near-infrared and shortwave-infrared regions. The R2 of optimal linear prediction models based on the cracked soil samples were 0.74, 0.67, 0.58, and 0.67 for Na+, salinity, pH, and EC, respectively.

Description: The new WHO Environmental Noise Guidelines for the European Region have recommendations for limiting noise exposure associated with adverse health effects. The limits are said to be based on a systematic review of existing evidence. This paper gives a systematic assessment of the presented evidence with respect to annoyance from aircraft noise. The new guidelines have been based on the results from a selection of existing aircraft noise studies. This paper demonstrates that a similar selection of other existing post-2000 studies will yield very different results. In addition, the validity of the presented evidence has been questioned as some of the referenced studies have not been conducted according to standardized methods, and the selection of respondents is not representative of the general airport population.

Description: Background Daytime sleepiness can be assessed by the Epworth Sleepiness Scale (ESS), which is widely used in the field of sleep medicine as a subjective measure of a patient’s sleepiness. Also, health utility assessed by the mean Short-Form Six-Dimension (SF-6D) score, one of several preference-based utility measures, is an important measure in health care. We aimed to examine age-related differences in daytime sleepiness and health utility and their relationship in patients 5 months after cardiac surgery. Methods; This cross-sectional study assessed 51 consecutive cardiac surgery patients who were divided into a middle-aged (〈65 years, n = 29) and older-age group (≥65 years, n = 22). The mean ESS and SF-6D utility scores were measured at 5 months after cardiac surgery and compared. In addition, the relationship between ESS and SF-6D utility scores were assessed. Results; There were no significant differences between the middle-aged and older-aged groups in either the mean ESS (5.14 ± 2.96 vs. 4.05 ± 3.23, p = 0.22) or SF-6D utility (0.72 ± 0.14 vs. 0.71 ± 0.10, p = 0.76) scores. However, there was a negative correlation between both values in all of the patients after cardiac surgery (r = −0.41, p = 0.003). Conclusions; Although there were no age-related differences in the ESS and SF-6D utility values between the two groups, there was a negative correlation between these values in all patients at 5 months after cardiac surgery. This suggested that sleepiness is associated with decreased utility scores in patients at 5 months after cardiac surgery.

Description: Health care personnel are considered one of the worker sectors most exposed to heavier workloads and work stress. One of the consequences associated with the exposure to chronic stress is the development of burnout syndrome. Given that evaluating this syndrome requires addressing the context in which they are to be used, the purpose of this work was to analyze the psychometric properties and structure of the Burnout Brief Questionnaire (CBB), and to propose a more suitable version for its application to health professionals, and more specifically nurses. The final study sample was made up of 1236 working nursing professionals. An exploratory factorial analysis was carried out and a new model was proposed through a confirmatory factorial analysis. Thus, validation of the CBB questionnaire for nursing health care personnel showed an adequate discrimination of the items and a high internal consistency of the scale. With respect to the factorial analysis, four factors were extracted from the revised model. Specifically, these new factors, called job dissatisfaction, social climate, personal impact, and motivational abandonment, showed an adequate index of adjustment. Thus, the Brief Burnout Questionnaire Revised for nursing staff has favorable psychometric properties, and this model can be applied to all health care professionals.

Description: The authors would like to extend their thanks for the fruitful comments and suggestions, which are useful for conducting deeper analyses of the ethical concerns related to occupational health. [...]

Description: Mild cognitive impairment (MCI) is an early stage of Alzheimer’s disease or other forms of dementia that occurs mainly in older adults. The MCI phase could be considered as an observational period for the secondary prevention of dementia. This study aims to assess potential differences in the risk of MCI among different elderly groups in Wuhan, China, and to further identify the most vulnerable populations using logistic regression models. A total of 622 older adults participated in this study, and the prevalence of MCI was 34.1%. We found that individuals aged 80–84 (odds ratio, OR = 1.908, 95% confidence interval, 95% CI 1.026 to 3.549) or above (OR = 2.529, 95% CI 1.249 to 5.122), and those with two chronic diseases (OR = 1.982, 95% CI 1.153 to 3.407) or more (OR = 2.466, 95% CI 1.419 to 4.286) were more likely to be diagnosed with MCI. Those with high school degrees (OR = 0.451, 95% CI 0.230 to 0.883) or above (OR = 0.318, 95% CI 0.129 to 0.783) and those with a family per-capita monthly income of 3001–4500 yuan (OR = 0.320, 95% CI 0.137 to 0.750) or above (OR = 0.335, 95% CI 0.135 to 0.830) were less likely to experience MCI. The results also showed that those aged 80 or above were more likely to present with cognitive decline and/or reduced activities of daily living (ADL) function, with the odds ratios being 1.874 and 3.782, respectively. Individuals with two, or three or more chronic diseases were more likely to experience cognitive decline and/or reduced ADL function, with odds ratios of 2.423 and 2.631, respectively. Increased risk of suffering from either MCI and/or decline in ADL functioning is strongly positively associated with older age, lower educational levels, poorer family economic status, and multiple chronic diseases. Our findings highlight that the local, regional, and even national specific MCI-related health promotion measures and interventions must target these vulnerable populations.

Description: This study aimed to assess the colonization of hotel water systems in central Greece and Corfu by Legionella, and to investigate the association between physicochemical parameters and Legionella colonization. Standardized hygiene inspection was conducted in 51 hotels, and 556 water samples were analyzed for Legionella spp. Free chlorine concentration, pH, hardness, conductivity, and trace metals were defined in cold water samples. The results of inspections and chemical analyses were associated with the microbiological results using univariate and logistic regression analysis. According to the score of the checklist used for the inspections, 17.6% of the hotels were classified as satisfactory, 15.7% as adequate, and 66.7% as unsatisfactory. Moreover, 74.5% of the hotels were colonized by Legionella spp. and 31.4% required remedial measures according to the European guidelines. Legionella spp. were isolated in 28% of the samples. Unsatisfactory results of inspections were associated with Legionella presence (relative risk (RR) = 7.67, p-value = 0.043). In hot-water systems, 〈50 °C temperatures increased the risk of Legionella colonization (RR = 5.36, p-value 〈 0.001). In cold-water systems, free chlorine concentration 〈0.375 mg/L (odds ratio (OR) = 9.76, p-value = 0.001), pH ≥ 7.45 (OR = 4.05, p-value = 0.007), and hardness ≥321 mgCaCO3/L (OR = 5.63, p-value = 0.003) increased the risk, whereas copper pipes demonstrated a protective role (OR = 0.29, p-value = 0.0024). The majority of the hotels inspected were colonized with Legionella. Supplementary monitoring of the risk factors that were identified should be considered.

Description: Environments are shifting rapidly in the Circumpolar Arctic and Subarctic regions as a result of climate change and other external stressors, and this has a substantial impact on the health of northern populations. Thus, there is a need for integrated surveillance systems designed to monitor the impacts of climate change on human health outcomes as part of broader adaptation strategies in these regions. This review aimed to identify, describe, and synthesize literature on integrated surveillance systems in Circumpolar Arctic and Subarctic regions, that are used for research or practice. Following a systematic realist review approach, relevant articles were identified using search strings developed for MEDLINE® and Web of Science™ databases, and screened by two independent reviewers. Articles that met the inclusion criteria were retained for descriptive quantitative analysis, as well as thematic qualitative analysis, using a realist lens. Of the 3431 articles retrieved in the database searches, 85 met the inclusion criteria and were analyzed. Thematic analysis identified components of integrated surveillance systems that were categorized into three main groups: structural, processual, and relational components. These components were linked to surveillance attributes and activities that supported the operations and management of integrated surveillance. This review advances understandings of the distinct contributions of integrated surveillance systems and data to discerning the nature of changes in climate and environmental conditions that affect population health outcomes and determinants in the Circumpolar North. Findings from this review can be used to inform the planning, design, and evaluation of integrated surveillance systems that support evidence-based public health research and practice in the context of increasing climate change and the need for adaptation.

Description: Active commuting to and from school (ACS) could help to increase daily physical activity levels in youth; however, this association remains unknown in Ecuadorian youth. Thus, the aims of this study were (1) to determine the patterns of commuting to and from school and (2) to analyze the associations between ACS, physical activity (PA), and sedentary habits in Ecuadorian youth. A total of 732 students (65.3% males), aged 10–18 years (children = 246, young adolescents = 310, older adolescents = 162) from the central region of Ecuador participated in this study. A self-report questionnaire, including the usual mode and frequency of commuting, distance from home to school (PACO-Questionnaire), and PA and sedentary habits (YAP-Questionnaire), was used. Most of the sample lived ≤2 km from school; however, they were mainly passive commuters (96%). The most common mode of commuting was by car (to school = 43.4%, from school = 31.6%; p 〈 0.001). Children presented significantly higher scores (0–4) in PA outside school and total PA compared with older adolescents (2.20 ± 0.97 vs. 1.97 ± 0.96; p = 0.013 and 2.30 ± 0.76 vs. 2.09 ± 0.74, p = 0.019, respectively), as well as the lowest scores in sedentary habits (1.51 ± 0.65, p 〈 0.001). PA at school and total PA were positively associated with ACS (OR 3.137; 95% CI, 1.918 to 5.131; p 〈 0.001, and OR 2.543; 95% CI, 1.428 to 4.527; p = 0.002, respectively). In conclusion, passive modes of transportation were the most frequently used to commute to and from school in young Ecuadorians. PA at school and total PA were positively associated with ACS. Thus, interventions at school setting could be an opportunity to improve PA levels and additionally ACS in youth from the central region of Ecuador.

Description: It is essential to establish a pattern to detect the strengths and weaknesses of working groups publishing on malaria, to promote coordination to facilitate the eradication of the disease. Given the complexity of the scientific network of groups and institutions studying malaria, it is necessary to use a mathematical algorithm that allows us to know the real structure of research on the disease in the world. In this work, articles with the word “malaria” in the title or author keywords gathered from Elsevier Scopus database were analyzed. By means of specific software, graphs were created. The analysis of the data allowed established different scientific communities, among which two were very diverse: one formed by those groups concerned about the vector transmission and control, and another one focused on the drug resistance of the parasite. Basic, applied, and operational research to eradicate malaria is an ambitious goal of the international institutions and the scientific community. The combination of effort and the establishment of a worldwide-scientific network that allows an effective interconnection (exchange) of knowledge, infrastructure technology, collaborators, financial resources, and datasets will contribute more effectively to end the disease.