ALBERT

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

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

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

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

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

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

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

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

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

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

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

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

Beschreibung: IJERPH, Vol. 15, Pages 1787: Psychological Coping with Job Loss. Empirical Study to Contribute to the Development of Unemployed People International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15081787 Authors: Yolanda Navarro-Abal José Antonio Climent-Rodríguez María José López-López Juan Gómez-Salgado Having a job is an essential part of people’s development. Unemployment, on the contrary, is one of the most frustrating experiences of life with greater psychological consequences for people’s lives. In this sense, psychology has contributed to an increase in knowledge about the personal and social experience of unemployment. This article discusses indicators of anxiety and depression in unemployed people, modulating socio-demographic variables, and coping strategies involved in the higher and lower levels of anxiety and depression. For this, a sample of 244 unemployed people who are users of the Career Service Centre of the Andalusian Public Employment Service of the city of Huelva is used for a descriptive and analytical cross-sectional study. The results show that only 5.7% of the participants do not have depressive symptoms. With regards to anxiety levels, 41.3% of participants have no anxiety. Unemployed people with high anxiety and depression scores have developed maladaptive coping strategies such as substance use, self-blaming, or denial. It is necessary to assess the importance of the unemployment process and the incorporation of appropriate coping strategies that facilitate new integration in the labour market, such as planification, emotional or social support and self-distraction between others.

Beschreibung: IJERPH, Vol. 15, Pages 1815: Evaluating the Coordination of Industrial-Economic Development Based on Anthropogenic Carbon Emissions in Henan Province, China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091815 Authors: Jianjian He Pengyan Zhang The mechanism of interaction between economic development, industrial structure and anthropogenic carbon emissions has become one of the focuses of climate change research. In this investigation, Henan Province was studied as an example, wherein the calculation model of carbon emissions in the primary, secondary and tertiary economic sectors was built using the ArcGIS 10.1 software. The spatiotemporal difference of carbon emissions between 2006 and 2015 from the three sectors was studied. The relation between economic development and environmental protection is discussed, based on the construction of a coordination degree model. Conclusions drawn from this analysis are: (1) In 2015, China’s total carbon emissions reached 10,291.93 × 107 t and Henan’s carbon emissions accounted for 1.96% of China’s total carbon emissions. The total carbon emissions in Henan Province increased more than 25.00% between 2006 and 2015. (2) Carbon emissions from different economic sectors demonstrated varied patterns. The primary sector presented a gradual decreasing trend in carbon emission, while the secondary sector showed a fluctuating pattern and the tertiary sector had an inclining trend in carbon emission. (3) There are also disparities in the spatial distribution of carbon emissions from different economic sectors. The primary and tertiary sectors had higher emissions in the southeast and lower emissions in the northwest regions, while the secondary sector showed higher emissions in the northwest and lower emissions in the southeast Between cities at different prefecture levels, differences do not only lie on the quantity of carbon emissions from the three sectors of economy but also a larger variation with regards to the change in quantity of carbon emissions. (4) The coordination degree of economic development was low among different prefecture-level cities. The economic and environmental development appeared coordinated among cities at the same prefecture level; however, coordination degrees among different prefecture-level cities varies significantly.

Beschreibung: IJERPH, Vol. 15, Pages 1814: Objectively Measured Neighborhood Walkability and Change in Physical Activity in Older Japanese Adults: A Five-Year Cohort Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091814 Authors: Hiroyuki Kikuchi Tomoki Nakaya Tomoya Hanibuchi Noritoshi Fukushima Shiho Amagasa Koichiro Oka James F. Sallis Shigeru Inoue Objectives: This study investigated the longitudinal association between changes in older adults’ physical activity and neighborhood walkability measured by geographic information systems (GISs, (ArcGIS, ESRI Inc., Redlands, CA, USA)). Methods: A mail survey was conducted for Japanese older adults who were randomly selected from three different settlement types. Data on walking, total moderate to vigorous physical activity (MVPA), and sociodemographic characteristics were collected at baseline (in 2010) and follow-up (in 2015). Multiple linear regression analyses were employed to assess the association between MVPA change and neighborhood walkability, adjusted for potential confounders. Effect sizes for independent variables on MVPA change were estimated. Results: Data from 731 community-dwelling older adults (43.7% women) were analyzed. During the follow-up, older adults’ MVPA was reduced by 94.4 min/week (−14.2%) on average (675.5 and 579.9 min/week in 2010 and 2015, respectively). Overall, older adults living in highly walkable areas showed a smaller reduction than those in low walkable areas (beta: 99.7 min/week, 95% confidence interval: 28.5–171.0). Similar associations were observed among those in the urban and suburban area, but not in the rural area. Walkability had larger effect sizes for explaining MVPA change than demographic characteristics. In addition, the findings for walking were similar to MVPA. Conclusion: Neighborhood walkability mitigated the 5-year reduction of walking and total MVPA among older adults, especially in urban areas.

Beschreibung: IJERPH, Vol. 15, Pages 1808: Labor Off-Farm Employment and Cropland Abandonment in Rural China: Spatial Distribution and Empirical Analysis International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091808 Authors: Xin Deng Dingde Xu Yanbin Qi Miao Zeng Alleviating cropland misallocation is helpful for the sustainable development of agriculture. Does off-farm employment inevitably result in cropland misallocation (e.g., cropland abandonment) and threaten the sustainable development of agriculture? This study differs from prior studies in its view that off-farm employment does not necessarily result in cropland abandonment. Specifically, the study employs survey data from 8031 peasant households from 27 provinces in rural China and spatial statistics to analyze the distribution of off-farm employment and cropland abandonment. Empirical models (i.e., IV-Probit and IV-Tobit) are used to examine the quantitative relation between off-farm employment and cropland abandonment. The results are as follows. (1) The spatial distribution of off-farm employment or cropland abandonment differs among regions. Regions with a higher rate of off-farm employment show more cropland abandonment but a lower average area of cropland abandonment. (2) Off-farm employment has a significant and positive correlation with cropland abandonment. However, its square has a significant and negative correlation with cropland abandonment; i.e., there is an inverted U-shaped relationship between off-farm employment and cropland abandonment, with the turning point occurring at 46.00% off-farm employment. (3) Off-farm employment has a significant and positive correlation with the area of cropland abandonment. However, its square has a significant and negative correlation with the area; i.e., there is an inverted U-shaped relationship between off-farm employment and area, with the turning point occurring at 44.50% off-farm employment. This study reveals the relationship between off-farm employment and cropland abandonment and provides policymakers with references for use in developing sustainable agriculture.

Beschreibung: IJERPH, Vol. 15, Pages 1801: Village-Scale Livelihood Change and the Response of Rural Settlement Land Use: Sihe Village of Tongwei County in Mid-Gansu Loess Hilly Region as an Example International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091801 Authors: Libang Ma Shichun Liu Yiwen Niu Meimei Chen Rural livelihood change has great influence on the scale, structure, and morphology of rural settlement land use, thus bringing new challenges to rural revitalization and settlement reconstruction. Sihe village of Tongwei County in mid-Gansu loess hilly region (China) was taken as an example here. Based on participatory rural appraisal data, we analyzed the structure and allocation of rural households’ livelihood assets as well as their livelihood diversity by using ecological asset, livelihood diversification index, and landscape pattern index models. We aimed to find a response mechanism between rural livelihood change and rural settlement land use change. The results might provide useful information for the selection of new village sites, reconstruction of rural settlements, and creation of livable rural environment. Results indicate that: (1) The total value of the average livelihood assets per household in the Sihe village increased significantly from 0.48 in 1988 to 1.288 in 2016. The four types of livelihood assets including natural, material, manpower, and financial assets changed with time. In 1988, the manpower asset was the most important type of livelihood assets, with value accounting for 76.67% of the total value of livelihood assets. With the extension of time, the proportions of the four types of assets in total livelihood assets became closer to each other. The livelihood diversification index of the Sihe village increased from 2.01 in 1988 to 3 in 2016, indicating the rural livelihoods became diverse; (2) Because of the dual influence of external environmental factors and the rural development policies of the country and the region, the livelihoods changed towards agricultural sector from 1988 to 2008, and the agricultural livelihoods tended to be diverse. The following trend of livelihood strategy change was observed: from diverse non-agricultural production group (IV) to agricultural and non-agricultural production group (III), then to diverse agricultural production group (II) and finally to agricultural production group (I). After 2008, the livelihoods changed towards non-agricultural sector, and the non-agricultural livelihoods tended to be diverse. This trend of livelihood change is opposite to that before 2008; (3) 2008 is the key year of livelihood change. Livelihood change caused changes in the scale, structure, and morphology of rural settlement land use, which eventually led to the change of rural residential land use.

Beschreibung: IJERPH, Vol. 15, Pages 1802: An Assessment of the Relationships between Extreme Weather Events, Vulnerability, and the Impacts on Human Wellbeing in Latin America International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091802 Authors: Gustavo J. Nagy Walter Leal Filho Ulisses M. Azeiteiro Johanna Heimfarth José E. Verocai Chunlan Li Climate change and variability are known to have an influence on human wellbeing in a variety of ways. In Latin America, such forces are especially conspicuous, particularly in respect of extreme climatological, hydrological, and weather events (EWEs) and climate-sensitive disasters (CSDs). Consistent with the need to study further such connections, this paper presents an analysis of some of the vulnerabilities of environmental health issues and climate-related impacts that are focusing on EWEs and CSDs in Latin American countries. The research includes an analysis of the (i) human and socio-economic development; (ii) geographical and socio-economic determinants of vulnerability and adaptability of environmental health issues (exposure, sensitivity, and adaptive capacity); (iii) occurrence of CSDs from 1988 to 2017 and their direct impacts on human wellbeing (Total death and Affected people); (iv) an online survey on the perceptions of the effects of EWEs on human wellbeing in a sample of countries in the region; and (v) discussion of possible solutions. The socio-economic and development indices, and the International Disaster Database (EM-DAT) and Climate-Risk Index (CRI) disaster statistics suggest that the impacts of CSDs are primarily related to socio-economic determinants of human wellbeing and health inequalities. Also, >80% respondents to the survey say that the leading causes of climate-related human impacts are the lack of (i) public awareness; (ii) investment and (iii) preparedness. The paper concludes by adding some suggestions that show how countries in Latin America may better cope with the impacts of Climate-sensitive Disasters.

Beschreibung: IJERPH, Vol. 15, Pages 1796: Reversing the Trends toward Shorter Lives and Poorer Health for U.S. Women: A Call for Innovative Interdisciplinary Research International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091796 Authors: April Schweinhart Janine Austin Clayton The United States (U.S.) is a leader and innovator in biomedicine, yet trails behind for many key health indicators, especially for women. This paper highlights key evidence indicating that not only is the state of women’s health in the U.S. lagging, but it is at risk for falling off the curve. Women’s health care remains fragmented; research in the field can be disconnected and difficult to integrate across disciplines—silos prevail. Structural obstacles contribute to this lack of cohesion, and innovative, interdisciplinary research approaches which integrate the multidimensional aspects of sex and gender, and race and ethnicity, with a life course perspective are sorely needed. Such synergistic, scientific strategies have the potential to reverse the trend towards shorter life expectancy and poorer health for women in the U.S. The National Institute for Health (NIH) seeks to raise the bar for the health of all women by tackling these issues through enhancing the relevance of biomedical research to the health of women and driving the sustained advancement of women in biomedical careers.

Beschreibung: IJERPH, Vol. 15, Pages 1797: Changes of Soil Microbiological Properties during Grass Litter Decomposition in Loess Hilly Region, China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091797 Authors: Yun Xiang Shaoshan An Man Cheng Lijun Liu Ying Xie Litter, the link between soil and plant, is an important part of nutrient return to soil. Deeply understanding the effect of litter decomposition on soil microbiological properties is important for the sustainable development of grasslands. Three plants (Thymus quinquecostatus Celak., Stipa bungeana Trin. and Artemisia sacrorum ledeb.) leaf litter were selected. A simulation experiment using the nylon bag method was conducted to measure the soil microbial biomass carbon and nitrogen, and soil enzyme activity during litter decomposition. The results showed that the decomposition of three leaf litter enhanced soil microbial carbon and nitrogen. The change rate of soil microbial carbon and nitrogen decreased as Ar.S > St.B > Th.Q. The activities of soil invertase, soil urease, and soil nitrate reductase were significantly improved by the coverage of leaf litter. After 741-day litter decomposition, the change rate of soil invertase was from 16.7% to 33.2%. The change rate of soil urease was highest in the Th.Q treatment; St.B treatment and Ar.S treatment followed, and lowest in the control. The change rates of soil nitrate reductase in the St.B and Ar.S treatment were >1000% higher than those of other treatments. The response of soil enzyme activity to litter decomposition “lagged” behind the change of soil microbial biomass. The significant increase of soil microbial biomass and enzyme activity demonstrated that litter decomposition played an important role in maintaining soil ecological function.

Beschreibung: IJERPH, Vol. 15, Pages 1792: Spatial Hurdle Models for Predicting the Number of Children with Lead Poisoning International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091792 Authors: Zhen Zhen Liyang Shao Lianjun Zhang Objective The purpose of this study is to identify the high-risk areas of children’s lead poisoning in Syracuse, NY, USA, using spatial modeling techniques. The relationships between the number of children’s lead poisoning cases and three socio-economic and environmental factors (i.e., building year and town taxable value of houses, and soil lead concentration) were investigated. Methods Spatial generalized linear models (including Poisson, negative binomial, Poisson Hurdle, and negative binomial Hurdle models) were used to model the number of children’s lead poisoning cases using the three predictor variables at the census block level in the inner city of Syracuse. Results The building year and town taxable value were strongly and positively associated with the elevated risk for lead poisoning, while soil lead concentration showed a weak relationship with lead poisoning. The negative binomial Hurdle model with spatial random effects was the appropriate model for the disease count data across the city neighborhood. Conclusions The spatial negative binomial Hurdle model best fitted the number of children with lead poisoning and provided better predictions over other models. It could be used to deal with complex spatial data of children with lead poisoning, and may be generalized to other cities.

Beschreibung: IJERPH, Vol. 15, Pages 1798: Differences in Metabolic Syndrome Prevalence by Employment Type and Sex International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091798 Authors: Duk Youn Cho Jung-Wan Koo Workers may sometimes do the same work, but differ in their risk of health-related problems depending on whether the employment type is standard or non-standard. Furthermore, even with similar job and employment types, there may be differences in risk factors for health-related problems depending on sex. This study aimed to determine the prevalence of metabolic syndrome (MetS) by employment type and sex using data from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES Ⅴ) (2010–2012) and KNHANES Ⅵ (2013–2015) conducted by the Korea Centers for Disease Control and Prevention. Overall, 9523 adult wage workers (5523 standard workers and 4000 non-standard workers) aged ≥ 19 years were analyzed. To determine MetS prevalence odds ratios according to employment type, logistic regression analysis was performed disaggregated by sex. The prevalence of MetS significantly increased with age (p < 0.001), being married (p < 0.05), current smoking status (p < 0.05), and high-risk drinking (p < 0.001) among male subjects. The prevalence of MetS significantly increased among female manual workers (p < 0.001), those with lower educational level and household income (p < 0.001). Non-standard workers of either sex showed higher MetS prevalence than standard workers; only females showed significant difference (p < 0.001). Female non-standard workers showed 1.44, 1.33, and 1.34 (all p < 0.001) times higher odds of MetS prevalence in Models 1, 2, and 3, respectively, compared to standard workers, suggesting a difference in risk factors of MetS according to sex. Also, that employment type affects MetS prevalence suggests that employment pattern is an important risk factor especially in females. Therefore, to manage MetS in female non-standard workers, individual health care as well as social effort may be necessary.

Beschreibung: IJERPH, Vol. 15, Pages 1795: The Influence of Adolescents’ Social Networks on Alcohol Consumption: A Descriptive Study of Spanish Adolescents Using Social Network Analysis International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091795 Authors: Enedina Quiroga Arrate Pinto-Carral Isaías García Antonio J. Molina Tania Fernández-Villa Vicente Martín In adolescence, friends are important due to their influence on the acquisition of habits such as alcohol consumption. However, there is a lack of studies that describe the structural context of adolescents, which would be useful to implement prevention strategies. Therefore, our research question was how adolescent friendship networks influence alcohol consumption. Our goal was to determine the structural profile of adolescent at-risk alcohol users and their relational context in the classroom. We designed a descriptive cross-sectional study based on social network analysis to analyze structural patterns. We recruited 195 students. Social-network and alcohol-consumption variables were analyzed using the UCINET and STATA programs. Some 86.67% of participants had consumed alcohol at some time in their lives and the prevalence of at-risk alcohol use was higher in females (50.48% vs. 49.52%; OR: 1.84; CI 95%: 0.99–3.43%; p = 0.036). The lower the intensity of friendship, the more contacts adolescent at-risk alcohol users had within the network, and the easier it was for them to access their peers. Consequently, we conclude that the structure of a class is a key factor that merits further research.

Beschreibung: IJERPH, Vol. 15, Pages 1794: Exogenous Glycinebetaine Promotes Soil Cadmium Uptake by Edible Amaranth Grown during Subtropical Hot Season International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091794 Authors: Wei-Qing Yao Yong-Kang Lei Ping Yang Qu-Sheng Li Li-Li Wang Bao-Yan He Zhi-Min Xu Chu Zhou Han-Jie Ye Exogenous glycinebetaine treatment is an effective measure for preventing crops from being exposed to drought and high temperature; however, the effects of this approach on the soil Cd uptake and accumulation by crops remain unclear. Pot experiments were conducted in this study to analyze the effect of glycinebetaine on the soil Cd uptake and accumulation by edible amaranth cultivated in Cd-contaminated soil. Results revealed that after exogenous glycinebetaine treatment on amaranth leaves during the vigorous growth period, the plant biomass, the Cd concentrations in the roots and shoots, and the Cd translocation factor (TF) were significantly higher than those of the control group. The highest Cd concentrations in the roots and shoots and the TF were higher by 91%, 96% and 23.8%, respectively, than the corresponding values in the control group. In addition, exogenous glycinebetaine treatment significantly increased leaf chlorophyll content and promoted the photosynthesis of edible amaranth. Consequently, the contents of soluble sugar, dissolved organic carbon, and low-molecular-weight organic acids significantly increased in the rhizosphere, resulting in Cd mobilization. Significant positive correlations were observed among the contents of leaf chlorophyll, Mg, Fe, pectin and Ca. Given that Cd shares absorption and translocation channels with these elements, we speculated that the increased leaf chlorophyll and pectin contents promoted the absorption and accumulation of Mg, Fe and Ca, which further promoted the absorption and translocation of Cd. These results indicated that exogenous glycinebetaine treatment during hot season would aggravate the health risks of crops grown in Cd-contaminated soils.

Beschreibung: IJERPH, Vol. 15, Pages 1817: Child- and Parent-Related Correlates of Total and Prolonged Sedentary Time in 5- to 6-Year-Old Children International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091817 Authors: Evi van Ekris Emma Solomon-Moore Mai J. M. Chinapaw Russell Jago Teatske M. Altenburg The primary aim was to examine child- and parent-related correlates of accelerometer-assessed overall total and prolonged (i.e., accumulated in bouts of ≥10 consecutive minutes) sedentary time (SED) in 5- to 6-year-old children. Second, child- and parent-related correlates of total and prolonged SED during weekend days and the after school period were examined, as associations with parent-related correlates may be stronger during these periods. SED and moderate-to-vigorous-intensity physical activity (MVPA) were assessed by ActiGraph accelerometers in children (n = 836) and one of their parents/carers. Parents completed a questionnaire examining potential parent-related correlates. Multilevel models examined associations between potential correlates and children’s total and prolonged SED. Children’s MVPA was the only correlate that was consistently negatively associated with both total and prolonged SED across the different time periods (overall, after school, and weekend days). Higher total SED in parents was associated with higher overall total SED and weekend total SED in children. Higher body mass index z-scores of children were associated with lower overall total and prolonged SED. Girls had lower prolonged SED after school than boys. Older children had lower total SED during the weekend. In conclusion, few potential correlates were associated with young children’s total or prolonged SED and most associations differed by time period.

Beschreibung: IJERPH, Vol. 15, Pages 1816: The Blocking Effect of Clay in Groundwater Systems: A Case Study in an Inland Plain Area International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091816 Authors: Liting Xing Linxian Huang Yi Yang Junxiang Xu Wenjing Zhang Guangyao Chi Xinyu Hou In order to increase understanding of the hydrogeochemical effects that influence changes in the quality of salt water, we investigated the distribution of saline and fresh water in an inland plain area and, in particular, the scarcity of fresh water resources. Taking the inland plain in Jiyang County as a specific case study, samples of undisturbed clay and underground saline water from different depths were collected to examine hydrogeological changes. A wide variety of methods was used to analyze the blocking effect of clay on the chemical characteristics of the groundwater. These include real-time monitoring for field water quality, tests for isothermal adsorption, a factor analysis model, physiochemical analysis, and correlation analysis. Our results show that the optimal adsorption isotherm of clay for Na+, Ca2+ and Mg2+ in groundwater conform to the established Henry and Langmuir equations for adsorption isotherms. The influence of clay mineral types and content on the blockage of Na+, Ca2+ and Mg2+ in groundwater samples were evident at different depths, with the clay adsorption capacity increasing in line with increases in the clay mineral content. Clay at different depths was found to have the strongest blocking effect on Na+ in groundwater, being systematically greater than its effect on Ca2+ and Mg2+. It is believed that the blocking effect of clay has an important influence on the hydrochemical zoning of groundwater in inland plains and the formation of saline water in groundwater systems. This study therefore provides concrete evidence in support of this supposed effect.

Beschreibung: IJERPH, Vol. 15, Pages 1837: The Concentration of BTEX in the Air of Tehran: A Systematic Review-Meta Analysis and Risk Assessment International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091837 Authors: Mehrnoosh Abtahi Yadolah Fakhri Gea Oliveri Conti Margherita Ferrante Mahmoud Taghavi Javad Tavakoli Ali Heshmati Hassan Keramati Bigard Moradi Nazak Amanidaz Amin Mousavi Khaneghah In the current study, the concentration of some pollutants which are categorized as volatile organic compounds (VOCs), including benzene (B), toluene (T), ethylbenzene (E), and o-xylenes (o-X), in the air of Tehran was evaluated by the aid of a systematic review and meta-analysis approach. Also, the health risk for the exposed population was estimated using the recommended methods by the Environmental Protection Agency (EPA). The rank order based on their concentration in BTEX was benzene (149.18 µg/m3: 31%) > o-xylene (127.16 µg/m3: 27%) > ethylbenzene (110.15 µg/m3: 23%) > toluene (87.97 µg/m3: 19%). The ratio B/T in this study was calculated as 1.69, repressing that both stationary and mobile sources of emission can be considered as the main sources for benzene and toluene. Moreover, strong photochemical activity in Tehran was demonstrated by the high ratio of E/o-X. Meta-regression indicates that the concentration of BTEX has insignificantly (p-value > 0.05) increased over time. The BTEX compounds based on the target hazard quotient (THQ) were ordered as benzene > o-xylene > ethylbenzene > toluene. Percentile 95% of THQ due to benzene (4.973) and o-xylene (1.272) was higher than a value of 1. Percentile 95% excessive cancer risk (ECR) for benzene (1.25 × 106) and ethylbenzene (1.11 × 106) was higher than a value of 1.00 × 106. The health risk assessment indicated that the population of Tehran are at considerable non-carcinogenic and carcinogenic risks.

Beschreibung: IJERPH, Vol. 15, Pages 1833: European Web-Based Platform for Recording International Health Regulations Ship Sanitation Certificates: Results and Perspectives International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091833 Authors: Varvara Mouchtouri Diederik Van Reusel Nikolaos Bitsolas Antonis Katsioulis Raf Van den Bogaert Björn Helewaut Inge Steenhout Dion Damman Miguel Dávila Cornejo Christos Hadjichristodoulou the EU SHIPSAN ACT Joint Action Partnership The purpose of this study was to report the data analysis results from the International Health Regulations (2005) Ship Sanitation Certificates (SSCs), recorded in the European Information System (EIS). International sea trade and population movements by ships can contribute to the global spread of diseases. SSCs are issued to ensure the implementation of control measures if a public health risk exists on board. EIS designed according to the World Health Organization (WHO) “Handbook for Inspection of Ships and Issuance of SSC”. Inspection data were recorded and SSCs issued by inspectors working at European ports were analysed. From July 2011–February 2017, 107 inspectors working at 54 ports in 11 countries inspected 5579 ships. Of these, there were 29 types under 85 flags (including 19 EU Member States flags). As per IHR (2005) 10,281 Ship Sanitation Control Exception Certificates (SSCECs) and 296 Ship Sanitation Control Certificates (SSCCs) were issued, 74 extensions to existing SSCs were given, 7565 inspection findings were recorded, and 47 inspections were recorded without issuing an SSC. The most frequent inspection findings were the lack of potable water quality monitoring reports (23%). Ships aged ≥12 years (odds ratio, OR = 1.77, 95% confidence intervals, CI = 1.37–2.29) with an absence of cargo at time of inspection (OR = 3.36, 95% CI = 2.51–4.50) had a higher probability of receiving an SSCC, while ships under the EU MS flag had a lower probability of having inspection findings (OR = 0.72, 95% CI = 0.66–0.79). Risk factors to prioritise the inspections according to IHR were identified by using the EIS. A global information system, or connection of national or regional information systems and data exchange, could help to better implement SSCs using common standards and procedures.

Beschreibung: IJERPH, Vol. 15, Pages 1834: The Role of Polybrominated Diphenyl Ethers in Thyroid Carcinogenesis: Is It a Weak Hypothesis or a Hidden Reality? From Facts to New Perspectives International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091834 Authors: Francesca Gorini Giorgio Iervasi Alessio Coi Letizia Pitto Fabrizio Bianchi In the last decades, the incidence of thyroid cancer has increased faster than that of any other malignant tumor type. The cause of thyroid cancer is likely multifactorial and a variety of both exogenous and endogenous has been identified as potential risk factors. Polybrominated diphenyl ethers (PBDEs), used since the 1970s as flame retardants, are still widespread and persistent pollutants today, although their production was definitely phased out in the western countries several years ago. Polybrominated diphenyl ethers are known endocrine disruptors, and the endocrine system is their primary target. Whereas animal studies have ascertained the ability of PBDEs to affect the normal functionality of the thyroid, evidence in humans remains inconclusive, and only a few epidemiological studies investigated the association between exposure to PBDEs and thyroid cancer. However, a number of clues suggest that a prolonged exposure to these chemicals might act a trigger of the most common malignancy of the endocrine system, whereas further studies with an advanced design are suggested.

Beschreibung: IJERPH, Vol. 15, Pages 1835: Healthcare Utilization and All-Cause Premature Mortality in Hungarian Segregated Roma Settlements: Evaluation of Specific Indicators in a Cross-Sectional Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091835 Authors: János Sándor Anita Pálinkás Ferenc Vincze Nóra Kovács Valéria Sipos László Kőrösi Zsófia Falusi László Pál Gergely Fürjes Magor Papp Róza Ádány Roma is the largest ethnic minority of Europe with deprived health status, which is poorly explored due to legal constrains of ethnicity assessment. We aimed to elaborate health indicators for adults living in segregated Roma settlements (SRS), representing the most vulnerable Roma subpopulation. SRSs were mapped in a study area populated by 54,682 adults. Records of all adults living in the study area were processed in the National Institute of Health Insurance Fund Management. Aggregated, age-sex standardized SRS-specific and non-SRS-specific indicators on healthcare utilization and all-cause premature death along with the ratio of them (RR) were computed with 95% confidence intervals. The rate of GP appointments was significantly higher among SRS inhabitants (RR = 1.152, 95% CI: 1.136–1.167). The proportion of subjects hospitalized (RR = 1.286, 95% CI: 1.177–1.405) and the reimbursement for inpatient care (RR = 1.060, 95% CI: 1.057–1.064) were elevated for SRS. All-cause premature mortality was significantly higher in SRSs (RR = 1.711, 1.085–2.696). Our study demonstrated that it is possible to compute the SRS-specific version of routine healthcare indicators without violating the protection of personal data by converting a sensitive ethical issue into a non-sensitive small-area geographical analysis; there is an SRS-specific healthcare utilization pattern, which is associated with elevated costs and increased risk of all-cause premature death.

Beschreibung: IJERPH, Vol. 15, Pages 1832: Prenatal Exposure to Perfluoroalkyl Substances and Birth Outcomes; An Updated Analysis from the Danish National Birth Cohort International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091832 Authors: Meng Inoue Ritz Olsen Liew Perfluoroalkyl substances (PFASs) are widespread industrial pollutants that are extremely persistent in the environment. A previous study in the Danish National Birth Cohort (DNBC) found prenatal perfluorooctanoate (PFOA) exposure was associated with decreased birth weight, but had insufficient statistical power to evaluate adverse birth outcomes. Here, we conducted additional analyses in three samples originating from the DNBC for 3535 mothers and infant pairs to evaluate associations between prenatal PFASs exposures and low birth weight and preterm birth. Maternal plasma concentrations were measured for six types of PFASs in early pregnancy. Several PFASs were associated with a reduction in birth weight and gestational age. We estimated a nearly 2-fold increase in risks of preterm birth for the higher quartiles of PFOA and perflourooctanesulfonate (PFOS) exposure. In spline models, risk of preterm birth was increased for perfluorononanoic acid (PFNA), perfluoroheptane sulfonate (PFHpS) and perfluorodecanoic acid (PFDA) in higher exposure ranges. We also observed some elevated risks for low birth weight but these estimates were less precise. Our findings strengthen the evidence that in-utero PFASs exposures affect fetal growth. Future studies are needed to evaluate whether these associations persist with the decline of PFOA and PFOS in populations and should also investigate newer types of fluorinated compounds introduced more recently.

Beschreibung: IJERPH, Vol. 15, Pages 1830: Mind–Body (Baduanjin) Exercise Prescription for Chronic Obstructive Pulmonary Disease: A Systematic Review with Meta-Analysis International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091830 Authors: Shi-Jie Liu Zhanbing Ren Lin Wang Gao-Xia Wei Liye Zou Baduanjin exercise is a traditional Chinese health Qigong routine created by an ancient physician for health promotion. Its mild-to-moderate exercise intensity is suitable for individuals with medical conditions. Recently, a large number of trials have been conducted to investigate the effects of Baduanjin exercise in patients with chronic obstructive pulmonary disease (COPD). It remains to be determined whether Baduanjin exercise prescription is beneficial for the management of COPD patients. Thus, we conducted a systematic review to objectively evaluate the existing literature on this topic. We searched six databases (PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure, and Wanfang) from inception until early May 2018. The adapted Physical Therapy Evidence Database (PEDro) scale was used for study quality assessment of all randomized controlled trials (RCTs). Based on 95% confidence interval (CI), the pooled effect size (Hedge’s g) of exercise capability (6-Minute Walking Test, 6-MWT), lung function parameters (forced expiratory volume in one second, FEV1; forced volume vital capacity, FVC; FEV1/FVC ratio), and quality of life were calculated based on the random-effects model. Twenty RCTs (n = 1975 COPD patients) were included in this review, with sum scores of the adapted PEDro scale between 5 and 9. Study results of the meta-analysis indicate that Baduanjin is effective in improving exercise capability (Hedge’s g = 0.69, CI 0.44 to 0.94, p < 0.001, I2 = 66%), FEV1 (Hedge’s g = 0.47, CI 0.22 to 0.73, p < 0.001, I2 = 68.01%), FEV1% (Hedge’s g = 0.38, CI 0.21 to 0.56, p < 0.001, I2 = 54.74%), FVC (Hedge’s g = 0.39, CI 0.22 to 0.56, p < 0.001, I2 = 14.57%), FEV1/FVC (Hedge’s g = 0.5, CI 0.33 to 0.68, p < 0.001, I2 = 53.49%), and the quality of life of COPD patients (Hedge’s g = −0.45, CI −0.77 to −0.12, p < 0.05, I2 = 77.02%), as compared to control groups. Baduanjin exercise as an adjunctive treatment may potentially improve exercise capability and pulmonary function of COPD patients as well as quality of life. Baduanjin exercise could be tentatively prescribed for COPD in combination with the conventional rehabilitation program to quicken the process of recovery. To confirm the positive effects of Baduanjin exercise for COPD patients, future researchers need to consider our suggestions mentioned in this article.

Beschreibung: IJERPH, Vol. 15, Pages 1827: Can Urban-Rural Patterns of Hospital Selection Be Changed Using a Report Card Program? A Nationwide Observational Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091827 Authors: Tsung-Hsien Yu Nikolas Matthes Chung-Jen Wei Background: Guiding patients to choose high-quality healthcare providers helps ensure that patients receive excellent care and helps reduce health disparities among patients of different socioeconomic backgrounds. The purpose of this study was to examine and compare the effect of implementing a report-card program on the patterns of hospital selection in patients from different socioeconomic subgroups. Patients undergoing total knee replacement (TKR) surgery were used as the sample population. Methods: A patient-level, retrospective, observational and cross-sectional study design was conducted. Taiwan National Health Insurance claims data were used and all patients in this database who had received TKR between April 2007–March 2008 (prior to report-card program implementation) and between April 2009–March 2010 (after program implementation) were included. Those patients who were under 18 years of age or who lacked area-of-residence or National Health Insurance premium information were excluded. Travelling distance to the hospital and level of hospital performance were used to evaluate the effect of the report-card program. Results: A total of 32,821 patients were included in this study. The results showed that patterns of hospital selection varied based on the socioeconomic characteristics of patients. In terms of travelling distance and hospital selection, the performance of urban and higher income patients was shorter and better, respectively, than their rural and lower-income peers both before and after report-card-program implementation. Moreover, although the results of multivariate analysis showed that the urban-rural difference in travelling distance enlarged (by 4.75 km) after implementation of the report-card program, this increase was shown to not be significantly related to this program. Furthermore, the results revealed that implementation of the report-card program did not significantly affect the urban-rural difference in terms of level of hospital performance. Conclusions: A successful report-card program should ensure that patients in all socioeconomic groups obtain comprehensive information. However, the results of this study indicate that those in higher socioeconomic subgroups attained more benefits from the program than their lower-subgroup peers. Ensuring that all have equal opportunity to access high-quality healthcare providers may therefore be the next issue that needs to be addressed and resolved.

Beschreibung: IJERPH, Vol. 15, Pages 1839: A Randomized Controlled Trial of a Theory-Informed School-Based Intervention to Prevent Waterpipe Tobacco Smoking: Changes in Knowledge, Attitude, and Behaviors in 6th and 7th Graders in Lebanon International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091839 Authors: Rima Nakkash Tamara Lotfi Dima Bteddini Pascale Haddad Hala Najm Lina Jbara Hala Alaouie Lama Al Aridi Ahmad Al Mulla Ziyad Mahfoud Rima A. Afifi Waterpipe tobacco smoking (WTS) is spreading worldwide. Research has indicated health consequences of WTS similar to cigarettes. Prevalence of WTS is high among young people. In Lebanon, current use rates of 35% have been documented among 13–15 year olds. We evaluated a school-based intervention. Method: We conducted a randomized-controlled-trial of a theory-informed WTS intervention. The intervention consisted of ten sessions based on social cognitive theory and the social influences approach. Thirty-one schools participated: 14 intervention and 17 control; a total of 1279 students completed pre and post assessments. We measured knowledge, attitudes and self-reported behaviors related to WTS using Chi-square tests and regression analyses to compare results between the two study arms. Results: The intervention increased knowledge of intervention group compared to control group participants—about WTS constituents and health consequences; and shifted attitudes of intervention group participants to be even more unfavorable towards WTS. We found no impact of the intervention on WTS behaviors. Discussion: The effectiveness of the intervention on knowledge and attitudes supports previous research. The lack of intervention effect on behavior is not surprising given the timing of the post assessment immediately after the intervention, and the social context that was supportive of waterpipe use.

Beschreibung: IJERPH, Vol. 15, Pages 1840: Exploring Neighborhood Environments and Active Commuting in Chennai, India International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091840 Authors: Deepti Adlakha J. Hipp James Sallis Ross Brownson Few studies assess built environment correlates of active commuting in low-and-middle-income countries (LMICs), but the different context could yield distinct findings. Policies and investments to promote active commuting remain under-developed in LMICs like India, which grapples with traffic congestion, lack of activity-supportive infrastructure, poor enforcement of traffic rules and regulations, air pollution, and overcrowding. This cross-sectional study investigated associations between home neighborhood environment characteristics and active commuting in Chennai, India. Adults (N = 370, 47.2% female, mean age =37.9 years) were recruited from 155 wards in the metropolitan area of Chennai in southern India between January and June 2015. Participants self-reported their usual mode of commute to work, with responses recoded into three categories: (1) multi-modal or active commuting (walking and bicycling; n = 56); (2) public transit (n = 52); and (3) private transport (n = 111). Environmental attributes around participants’ homes were assessed using the Neighborhood Environment Walkability Scale for India (NEWS-India). Associations between environmental characteristics and likelihood of active commuting and public transit use were modeled using logistic regression with private transport (driving alone or carpool) as the reference category, adjusting for age, gender, and household car ownership. Consistent with other international studies, participants living in neighborhoods with a mix of land uses and a transit stop within a 10-minute walk from home were more likely to use active commuting (both p < 0.01). Land-use mix was significantly associated with the use of public transit compared to private transport (adjusted odds ratio (aOR) =5.2, p = 0.002). Contrary to findings in high-income countries, the odds of active commuting were reduced with improved safety from crime (aOR =0.2, p = 0.003), aesthetics (aOR =0.2, p = 0.05), and street connectivity (aOR =0.2, p = 0.003). Different environmental attributes were associated with active commuting, suggesting that these relationships are complex and may distinctly differ from those in high-income countries. Unexpected inverse associations of perceived safety from crime and aesthetics with active commuting emphasize the need for high-quality epidemiologic studies with greater context specificity in the study of physical activity in LMICs. Findings have public health implications for India and suggest that caution should be taken when translating evidence across countries.

Beschreibung: Diversity, Vol. 10, Pages 96: Assessment of Structural and Functional Diversity of Mollusc Assemblages within Vermetid Bioconstructions Diversity doi: 10.3390/d10030096 Authors: Luigia Donnarumma Roberto Sandulli Luca Appolloni José Luis Sánchez-Lizaso Giovanni Fulvio Russo Dendropoma lebeche is a prosobranch gastropod belonging to the family Vermetidae, which calcifies its shell on hard substrates in dense aggregates, forming biogenic constructions along the western Mediterranean intertidal habitat. It is an important ecosystem engineer and, due to its ecological value, is protected by international convention. The aim of this study is to investigate the mollusc composition and diversity occurring within Spanish vermetid bioconstructions. During the late summer 2013, three distant sites along the Mediterranean coast of Spain were sampled by scraping off the vermetid shells to study their associated assemblages. A total of 600 molluscs were identified within the classes of Polyplacophora (four species), Gastropoda (35 spp.) and Bivalvia (18 spp.). Multivariate analyses revealed significant differences in composition and trophic diversity of mollusc assemblages among the three sites, highlighting a clear geographical gradient. Overall, both herbivores (grazers and deposit feeders) and omnivores were the quantitatively dominant trophic groups, while carnivores (predators and ectoparasites) were very scarce. Our results point out that mollusc assemblages associated with vermetid bioconstructions are rich and diversified, both in populations structure and trophic diversity, confirming the important role of vermetid gastropods as ecosystem engineers and biodiversity enhancers in shallow coastal waters.

Beschreibung: IJERPH, Vol. 15, Pages 1861: Truck and Multivehicle Truck Accidents with Injuries Near Colorado Oil and Gas Operations International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091861 Authors: Benjamin D. Blair John Hughes William B. Allshouse Lisa M. McKenzie John L. Adgate Unconventional and conventional oil and gas (O&G) operations raise public health concerns, such as the potential impacts from trucking activity in communities that host these operations. In this work, we used two approaches to evaluate accidents in relation to O&G activities in the State of Colorado. First, we calculated the rate of truck accidents by computing the ratio of accident count and county population. When comparing counties with increased O&G operations to counties with less activity, we found that counties with more activity have greater rates of truck traffic accidents per capita (Rate Ratio = 1.07, p < 0.05, 95% CI: 1.01–1.13). Second, we laid a grid over the eleven counties of interest and counted, for each cell, the number of truck accidents, the number of multivehicle accidents with injuries, the number of homes, and the number of O&G wells. We then applied hurdle count models, using the accident counts as the outcomes and the number of homes and number of wells as independent variables. We found that both independent variables are significant predictors of truck accidents and multivehicle truck accidents. These accidents are of concern since they can have an impact on the people who live near O&G operations.

Beschreibung: IJERPH, Vol. 15, Pages 1862: Learning and Action in Community Health: Using the Health Belief Model to Assess and Educate African American Community Residents about Participation in Clinical Research International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091862 Authors: Latrice Rollins Angela Sy Nicole Crowell Desiree Rivers Assia Miller Pamela Cooper Debra Teague Cassandra Jackson Tabia Henry Akintobi Elizabeth Ofili The Learning and Action in Community Health project was implemented to gather preliminary data needed to inform community-engaged educational approaches to increase clinical research participation among racial minorities. The Health Belief Model was the theoretical framework utilized to develop the intervention and assessment tools. An educational session about clinical research and biorepository participation was designed using clinicaltrials.gov information and administered to adult, African American community residents (n = 60) in Atlanta, Georgia. Pre- and post-tests were collected and analyzed to assess changes in participants’ knowledge, perceptions, and willingness to participate in clinical studies and biorepositories. There were statistically significant changes in knowledge about joining a clinical study (p < 0.001) and registry or biorepository (p < 0.001). There was no statistically significant change in willingness to participate in clinical research or biorepositories after the educational session. Focus groups were conducted to gather feedback on the educational session and perceived barriers and benefits to participating in clinical research. Perceived benefits were improving health, receiving incentives, early detection of health issues, and access to care. Perceived barriers included fear, lack of knowledge, historical mistrust of research, and time constraints. Results have implications for subsequent community-engaged approaches to increasing minority participation in clinical research.

Beschreibung: IJERPH, Vol. 15, Pages 1859: A Portfolio Analysis of Culturally Tailored Trials to Address Health and Healthcare Disparities International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091859 Authors: Marisa Torres-Ruiz Kaitlynn Robinson-Ector Dionna Attinson Jamie Trotter Ayodola Anise Steven Clauser In 2010, Patient-Centered Outcomes Research Institute (PCORI) was authorized by Congress to improve the quality and relevance of evidence available to help patients, caregivers, employers, insurers, and policy makers make better-informed health decisions. We conducted a qualitative analysis of behavioral health trials in the PCORI Addressing Disparities portfolio to examine cultural tailoring strategies across the following priority populations: racial and ethnic minorities, rural populations, people with low-income or low socioeconomic status, individuals with disabilities, people with low health literacy, and lesbian, gay, bisexual, and transgender (LGBT) communities. The Common Strategies for Enhancing Cultural Appropriateness model was used to examine cultural tailoring strategies within trials. We hypothesized increased intersectionality within a patient population at risk for disparities would correlate with the dosage and type of cultural tailoring strategies applied. Thirty-three behavioral health trials applied cultural tailoring strategies and a majority of trials (n = 30) used three or more strategies. Trends in cultural tailoring were associated with certain racial and ethnic groups; however, increased use of tailoring was not associated with the number of priority populations included in a trial. The PCORI Addressing Disparities portfolio demonstrates how a range of cultural tailoring strategies are used, within comparative clinical effectiveness research trials, to address the needs and intersectionality of patients to reduce health and healthcare disparities.

Beschreibung: IJERPH, Vol. 15, Pages 1845: School Nurses’ Perceptions, Knowledge, and Related Factors Associated with Evidence-Based Practice in Taiwan International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091845 Authors: Pei-Lin Hsieh Sue-Hsien Chen Li-Chun Chang The implementation of evidence-based practice (EBP) in health care has been focused mainly on hospital settings and there is little research on EBP adoption and implementation among school nurses in Taiwan. This study aimed to determine primary school nurses’ perceptions regarding EBP and to explore the factors that influence EBP in Taiwan. A cross-sectional design was used and the School Nurse Evidence-Based Practice Questionnaire was developed to collect data. A total of 2679 elementary school nurses in Taiwan were invited to participate in this study, and 1200 completed questionnaires were returned, with a 45% response rate. Participants’ mean age was 37.5 (range: 31–62) years and the mean duration of employment as a school nurse was 8.4 (range: 1–20) years. The majority of participants had a Bachelor’s degree (56%). The results revealed that participants had insufficient EBP knowledge and skills. However, they had a positive attitude toward and moderate self-efficacy in EBP. The demographic data positively correlated with knowledge, attitudes, skills, self-efficacy, and influencing factors. Certain influencing factors were highlighted. As school nurses play a crucial role in promoting children’s health, they ought to embrace EBP so as to provide more effective services. School organization should play a supportive role with regard to EBP implementation.

Beschreibung: IJERPH, Vol. 15, Pages 1841: The Neighborhood Effect Averaging Problem (NEAP): An Elusive Confounder of the Neighborhood Effect International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091841 Authors: Mei-Po Kwan Ignoring people’s daily mobility and exposures to nonresidential contexts may lead to erroneous results in epidemiological studies of people’s exposures to and the health impact of environmental factors. This paper identifies and describes a phenomenon called neighborhood effect averaging, which may significantly confound the neighborhood effect as a result of such neglect when examining the health impact of mobility-dependent exposures (e.g., air pollution). Several recent studies that provide strong evidence for the neighborhood effect averaging problem (NEAP) are discussed. The paper concludes that, due to the observed attenuation of the neighborhood effect associated with people’s daily mobility, increasing the mobility of those who live in disadvantaged neighborhoods may be helpful for improving their health outcomes.

Beschreibung: IJERPH, Vol. 15, Pages 1854: Perceived Neighbourhood Problems over Time and Associations with Adiposity International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091854 Authors: Anne Ellaway Ruth Dundas Jonathan R. Olsen Paul G. Shiels There is growing interest in understanding which aspects of the local environment influence obesity. Using data from the longitudinal West of Scotland Twenty-07 study (n = 2040) we examined associations between residents’ self-reported neighbourhood problems, measured over a 13-year period, and nurse-measured body weight and size (body mass index, waist circumference, waist–hip ratio) and percentage body fat. We also explored whether particular measures such as abdominal obesity, postulated as a marker for stress, were more strongly related to neighbourhood conditions. Using life course models adjusted for sex, cohort, household social class, and health behaviours, we found that the accumulation of perceived neighbourhood problems was associated with percentage body fat. In cross-sectional analyses, the strongest relationships were found for contemporaneous measures of neighbourhood conditions and adiposity. When analyses were conducted separately by gender, perceived neighbourhood stressors were strongly associated with central obesity measures (waist circumference, waist–hip ratio) among both men and women. Our findings indicate that chronic neighbourhood stressors are associated with obesity. Neighbourhood environments are modifiable, and efforts should be directed towards improving deleterious local environments to reduce the prevalence of obesity.

Beschreibung: IJERPH, Vol. 15, Pages 1853: Influence of Coil Power Ranges on the E-Liquid Consumption in Vaping Devices International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091853 Authors: S´ebastien Soulet Marie Duquesne Jean Toutain Charly Pairaud H´elène Lalo As electronic cigarettes (e-cigarettes) represent a new constantly evolving product category, the systematic analysis of the developed devices and the e-liquid vaporization is challenging. Indeed, understanding how e-cigarettes work and the role of key parameters in the process are major issues. This work focuses on an experimental study of how the power supplied by the battery to the atomizer coil influences e-liquid consumption. The reproducibility and the repeatability of e-liquid consumption were investigated over 20 series of 20 puffs for one of the tested atomizers. Then, the reproducibility and the repeatability of the e-liquid consumption was investigated over five series of 20 puffs for each tested atomizer. The wire behavior according to the supplied power could be separated into three regimes: under-heating (insufficient power to generate an aerosol), optimal vaporization characterized by a linear trend (vaporization of the e-liquid proportional to the supplied energy) and over-heating (dry-burn occurs). Using a controllable and repeatable energy supply, the reproducibility of the quantity of vaporized e-liquid was verified for each of the five series of 20 puffs programed for all the atomizers except one. Finally, the influence of the supplied power on the vaporization and the consumption of the e-liquid as well as the optimal power ranges were investigated and discussed. The results showed that atomizers with resistance ranging from 1 Ω to 1.8 Ω are efficient using all the energy supplied by the battery to vaporize the e-liquid and reducing the energy lost in the cotton or in the metal part of atomizer coil.

Beschreibung: IJERPH, Vol. 15, Pages 1857: Increased Urgent Care Center Visits by Southeast European Migrants: A Retrospective, Controlled Trial from Switzerland International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091857 Authors: Jolanta Klukowska-Röetzler Maria Eracleous Martin Müller David S. Srivastava Gert Krummrey Osnat Keidar Aristomenis K. Exadaktylos We investigated whether immigrants from Southeast Europe (SE) and Swiss patients have different reasons for visiting the emergency department (ED). Our retrospective data analysis for the years 2013–2017 describes the pattern of ED consultations for immigrants from SE living in Switzerland (Canton Bern), in comparison with Swiss nationals, with a focus on type of referral and reason for admission. A total of 153,320 Swiss citizens and 12,852 immigrants from SE were included in the study. The mean age was 51.30 (SD = 21.13) years for the Swiss patients and 39.70 (SD = 15.87) years for the SE patients. For some countries of origin (Albania, Bosnia and Herzegovina, and Turkey), there were highly statistically significant differences in sex distribution, with a predominance of males. SE immigrants had a greater proportion of patients in the lower triage level (level 3: SE: 67.3% vs. Swiss: 56.0%) and a greater proportion of patients in the high triage level than the Swiss population (level 1: SE: 3.4% vs. Swiss: 8.8%). SE patients of working age (16–65 years) were six times more often admitted by ambulance than older (≥65 years) SE patients, whereas this ratio was similar in the Swiss population. In both groups, the fast track service was primarily used for patients of working age (<65) and more than three times more often in the SE than the Swiss group (SE: 39.1%, Swiss: 12.6%). We identified some indications for access to primary care in emergency departments for immigrants and highlighted the need for attention to the role of organizational characteristics of primary health care in Switzerland. We highlighted the need for professional support to improve the quality of healthcare for immigrants. In the future, we will need more primary care services and general practitioners with a migrant background.

Beschreibung: IJERPH, Vol. 15, Pages 1858: The Human Right to Water and Unconventional Energy International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091858 Authors: Robert C Palmer Damien Short Walter E. Ted Auch Access to water, in sufficient quantities and of sufficient quality is vital for human health. The United Nations Committee on Economic, Social and Cultural Rights (in General Comment 15, drafted 2002) argued that access to water was a condition for the enjoyment of the right to an adequate standard of living, inextricably related to the right to the highest attainable standard of health, and thus a human right. On 28 July 2010 the United Nations General Assembly declared safe and clean drinking water and sanitation a human right essential to the full enjoyment of life and all other human rights. This paper charts the international legal development of the right to water and its relevance to discussions surrounding the growth of unconventional energy and its heavy reliance on water. We consider key data from the country with arguably the most mature and extensive industry, the USA, and highlight the implications for water usage and water rights. We conclude that, given the weight of testimony of local people from our research, along with data from scientific literature, non-governmental organization (NGO) and other policy reports, that the right to water for residents living near fracking sites is likely to be severely curtailed. Even so, from the data presented here, we argue that the major issue regarding water use is the shifting of the resource from society to industry and the demonstrable lack of supply-side price signal that would demand that the industry reduce or stabilize its water demand per unit of energy produced. Thus, in the US context alone, there is considerable evidence that the human right to water will be seriously undermined by the growth of the unconventional oil and gas industry, and given its spread around the globe this could soon become a global human rights issue.

Beschreibung: IJERPH, Vol. 15, Pages 1860: Affordable Care Act and Disparities in Health Services Utilization among Ethnic Minority Breast Cancer Survivors: Evidence from Longitudinal Medical Expenditure Panel Surveys 2008–2015 International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091860 Authors: Shelley I. White-Means Ahmad Reshad Osmani Breast cancer is the most prevalent female cancer in the US. Incidence rates are similar for white and black women but mortality rates are higher for black women. This study draws on rich, nationally representative data, the 2008–2015 Medical Expenditure Panel Surveys, to estimate effects of the Affordable Care Act (ACA) on reducing disparities in and access to use of diagnostic and medical services for black and Hispanic breast cancer survivors. Random effects multinomial logit, flexible hurdle and Box-Cox estimation techniques are used. The robust estimates indicate that the ACA narrowed the racial/ethnic disparity in health insurance coverage, health care utilization and out-of-pocket prescription drug expenditures among breast cancer survivors. Gaps in uninsurance significantly declined for black and Hispanic survivors. Hispanic women generally and black breast cancer survivors specifically increased use of mammography services post-ACA. The ACA did not significantly impact disparities in physician utilization or out-of-pocket prescription drug expenditures for Hispanic survivors, while there were substantive improvements for black breast cancer survivors. The paper concludes with a discussion of the strengths and limitations of the ACA for reducing disparities and improving health outcomes for a growing population of breast cancer survivors in the US.

Beschreibung: IJERPH, Vol. 15, Pages 1881: Hyperspectral Data and Machine Learning for Estimating CDOM, Chlorophyll a, Diatoms, Green Algae and Turbidity International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091881 Authors: Sina Keller Philipp M. Maier Felix M. Riese Stefan Norra Andreas Holbach Nicolas Börsig Andre Wilhelms Christian Moldaenke André Zaake Stefan Hinz Inland waters are of great importance for scientists as well as authorities since they are essential ecosystems and well known for their biodiversity. When monitoring their respective water quality, in situ measurements of water quality parameters are spatially limited, costly and time-consuming. In this paper, we propose a combination of hyperspectral data and machine learning methods to estimate and therefore to monitor different parameters for water quality. In contrast to commonly-applied techniques such as band ratios, this approach is data-driven and does not rely on any domain knowledge. We focus on CDOM, chlorophyll a and turbidity as well as the concentrations of the two algae types, diatoms and green algae. In order to investigate the potential of our proposal, we rely on measured data, which we sampled with three different sensors on the river Elbe in Germany from 24 June–12 July 2017. The measurement setup with two probe sensors and a hyperspectral sensor is described in detail. To estimate the five mentioned variables, we present an appropriate regression framework involving ten machine learning models and two preprocessing methods. This allows the regression performance of each model and variable to be evaluated. The best performing model for each variable results in a coefficient of determination R 2 in the range of 89.9% to 94.6%. That clearly reveals the potential of the machine learning approaches with hyperspectral data. In further investigations, we focus on the generalization of the regression framework to prepare its application to different types of inland waters.

Beschreibung: IJERPH, Vol. 15, Pages 1882: Water Quality of Inflows to the Everglades National Park over Three Decades (1985–2014) Analyzed by Multivariate Statistical Methods International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091882 Authors: Lei Wan Xiaohui Fan The Everglades, a vast subtropical wetland, dominates the landscape of south Florida and is widely recognized as an ecosystem of great ecological importance. Data from seven inflow sites to the Everglades National Park (ENP) were analyzed over three decades (1985–2014) for temporal trends by the STL (integrated seasonal-trend decomposition using LOESS) method. A cluster analysis (CA) and principal component analysis (PCA) were applied for the evaluation of spatial variation. The results indicate that the water quality change trend is closely associated with rainfall. Increasing rainfall results in increasing flow and thus, decreasing concentrations of nitrogen and phosphorus. Based on 10 variables, the seven sampling stations were classified by CA into four distinct clusters: A, B, C, and D. The PCA analysis indicated that total nitrogen (TN) and total phosphorus (TP) are the main pollution factors, especially TN. The results suggest that non-point sources are the main pollution sources and best management practices (BMPs) effectively reduce organic nitrogen. However, TN and TP control is still the focus of future work in this area. Increasing the transfer water quantity can improve the water quality temporarily and planting submersed macrophytes can absorb nitrogen and phosphorus and increase the dissolved oxygen (DO) concentration in water, continuously improving the water quality.

Beschreibung: IJERPH, Vol. 15, Pages 1877: Mining Facebook Data of People with Rare Diseases: A Content-Based and Temporal Analysis International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091877 Authors: Laia Subirats Natalia Reguera Antonio Miguel Bañón Beni Gómez-Zúñiga Julià Minguillón Manuel Armayones This research characterized how Facebook deals with rare diseases. This characterization included a content-based and temporal analysis, and its purpose was to help users interested in rare diseases to maximize the engagement of their posts and to help rare diseases organizations to align their priorities with the interests expressed in social networks. This research used Netvizz to download Facebook data, word clouds in R for text mining, a log-likelihood measure in R to compare texts and TextBlob Python library for sentiment analysis. The Facebook analysis shows that posts with photos and positive comments have the highest engagement. We also observed that words related to diseases, attention, disability and services have a lot of presence in the decalogue of priorities (which serves for all associations to work on the same objectives and provides the lines of action to be followed by political decision makers) and little on Facebook, and words of gratitude are more present on Facebook than in the decalogue. Finally, the temporal analysis shows that there is a high variation between the polarity average and the hour of the day.

Beschreibung: IJERPH, Vol. 15, Pages 1878: Evaluating the Impact of the Dementia Care in Hospitals Program (DCHP) on Hospital-Acquired Complications: Study Protocol International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091878 Authors: Mark Yates Jennifer J. Watts Kasia Bail Mohammadreza Mohebbi Sean MacDermott Jessica C. Jebramek Henry Brodaty Despite the increasing number of older people, many with cognitive impairment (CI), in hospitals, there is yet to be an evaluation of hospital-wide interventions improving the management of those with CI. In hospitalized patients with CI, there are likely to be associations between increased complications that impact on outcomes, length of stay, and costs. This prospective study will evaluate the effectiveness of an established hospital CI support program on patient outcomes, patient quality of life, staff awareness of CI, and carer satisfaction. Using a stepped-wedge, continuous-recruitment method, the pre-intervention patient data will provide the control data for usual hospital care. The intervention, the Dementia Care in Hospitals Program, provides hospital-wide CI awareness and support education, and screening for all patients aged 65+, along with a bedside alert, the Cognitive Impairment Identifier. The primary outcome is a reduction in hospital-acquired complications: urinary tract infections, pressure injuries, pneumonia and delirium. Secondary outcome measures include cost effectiveness, patient quality of life, carer satisfaction, staff awareness of CI, and staff perceived impact of care. This large-sample study across four sites offers an opportunity for research evaluation of health service functioning at a whole-of-hospital level, which is important for sustainable change in hospital practice.

Beschreibung: IJERPH, Vol. 15, Pages 1875: Which School Community Agents Influence Adolescents’ Motivational Outcomes and Physical Activity? Are More Autonomy-Supportive Relationships Necessarily Better? International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091875 Authors: Javier Sevil Luis García-González Ángel Abós Eduardo Generelo Lanaspa Alberto Aibar Solana The first aim of this work was to examine the independent influence of students’ perceived autonomy support for leisure-time physical activity (LTPA), from different school community agents, on motivational outcomes in a LTPA context and objective PA levels. Using both a variable- and person-centered approach, the second aim was to examine how different combinations of autonomy-support were associated with students’ motivational outcomes in a LTPA context and PA levels. A sample of 178 secondary students (M = 13.26 ± 0.64) participated in the study. Autonomy support for LTPA from the PE teacher, mother, father, and peers were the only agents that significantly and positively predicted motivational outcomes in a LTPA context and PA levels. While the two- and three-way interactions of some of these four significant sources significantly increased the explained variance of some motivational outcomes, the plots revealed that the lowest values of motivational outcomes were associated with low values of perceived autonomy support. A cluster analysis revealed five profiles. The “high autonomy support” group reported the most optimal outcomes, whereas the “low autonomy support” group showed the opposite pattern. However, mixed autonomy support profiles did not differ in any of the outcomes. The adoption of a whole-of-school approach seems decisive to empower adolescents to be active in and out of school.

Beschreibung: IJERPH, Vol. 15, Pages 1879: A Systematic Review of Access to General Healthcare Services for People with Disabilities in Low and Middle Income Countries International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091879 Authors: Tess Bright Hannah Kuper Background: A systematic review was undertaken to explore access to general healthcare services for people with disabilities in low and middle-income countries (LMICs). Methods: Six electronic databases were searched in February 2017. Studies comparing access to general healthcare services by people with disabilities to those without disabilities from LMICs were included. Eligible measures of healthcare access included: utilisation, coverage, adherence, expenditure, and quality. Studies measuring disability using self-reported or clinical assessments were eligible. Title, abstract and full-text screening and data extraction was undertaken by the two authors. Results: Searches returned 13,048 studies, of which 50 studies were eligible. Studies were predominantly conducted in sub-Saharan Africa (30%), Latin America (24%), and East Asia/Pacific (12%). 74% of studies used cross-sectional designs and the remaining used case-control designs. There was evidence that utilisation of healthcare services was higher for people with disabilities, and healthcare expenditure was higher. There was less consistent differences between people with and without disabilities in other access measures. However, the wide variation in type and measurement of disability, and access outcomes, made comparisons across studies difficult. Conclusions: Developing common metrics for measuring disability and healthcare access will improve the availability of high quality, comparable data, so that healthcare access for people with disabilities can be monitored and improved.

Beschreibung: IJERPH, Vol. 15, Pages 1873: Developments in the Research Base on Reducing Exposure to Second-Hand Smoke International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091873 Authors: Olivia Wynne Billie Bonevski n/a

Beschreibung: IJERPH, Vol. 15, Pages 1876: The Potential Implications of Autonomous Vehicles in and around the Workplace International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091876 Authors: Simone Pettigrew Lin Fritschi Richard Norman The advent of autonomous vehicles is forecast to bring enormous changes to the workplace as positions primarily involving driving become progressively redundant. Little is known about public awareness of these impending changes and the potential impacts on society and individuals. This study involved a national survey of Australians and interviews with key stakeholders across multiple countries to identify major potential issues associated with vehicle automation, including in and around the workplace. Most survey respondents had concerns relating to job losses in driving occupations, while almost half anticipated increased employment in technology-related areas. Three primary themes were evident in the data from the stakeholder interviews: (1) the inevitability of the universal use of AVs and hence the immediate need for labour market planning, (2) associated potential effects on occupations that are not primarily structured around driving, and (3) the possibility of increased worker safety and enhanced commuting opportunities.

Beschreibung: IJERPH, Vol. 15, Pages 1874: Healthy Indoor Environments: The Need for a Holistic Approach International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091874 Authors: Aneta Wierzbicka Eja Pedersen Roger Persson Birgitta Nordquist Kristian Stålne Chuansi Gao Lars-Erik Harderup Jonas Borell Héctor Caltenco Barry Ness Emilie Stroh Yujing Li Mats Dahlblom Karin Lundgren-Kownacki Christina Isaxon Anders Gudmundsson Pawel Wargocki Indoor environments have a large impact on health and well-being, so it is important to understand what makes them healthy and sustainable. There is substantial knowledge on individual factors and their effects, though understanding how factors interact and what role occupants play in these interactions (both causative and receptive) is lacking. We aimed to: (i) explore interactions between factors and potential risks if these are not considered from holistic perspective; and (ii) identify components needed to advance research on indoor environments. The paper is based on collaboration between researchers from disciplines covering technical, behavioural, and medical perspectives. Outcomes were identified through literature reviews, discussions and workshops with invited experts and representatives from various stakeholder groups. Four themes emerged and were discussed with an emphasis on occupant health: (a) the bio-psycho-social aspects of health; (b) interaction between occupants, buildings and indoor environment; (c) climate change and its impact on indoor environment quality, thermal comfort and health; and (d) energy efficiency measures and indoor environment. To advance the relevant research, the indoor environment must be considered a dynamic and complex system with multiple interactions. This calls for a transdisciplinary and holistic approach and effective collaboration with various stakeholders.

Beschreibung: IJERPH, Vol. 15, Pages 1872: The Impacts of Land Use Patterns on Water Quality in a Trans-Boundary River Basin in Northeast China Based on Eco-Functional Regionalization International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091872 Authors: Peixuan Cheng Fansheng Meng Yeyao Wang Lingsong Zhang Qi Yang Mingcen Jiang The relationships between land use patterns and water quality in trans-boundary watersheds remain elusive due to the heterogeneous natural environment. We assess the impact of land use patterns on water quality at different eco-functional regions in the Songhua River basin during two hydrological seasons in 2016. The partial least square regression indicated that agricultural activities associated with most water quality pollutants in the region with a relative higher runoff depth and lower altitude. Intensive grazing had negative impacts on water quality in plain areas with low runoff depth. Forest was related negatively with degraded water quality in mountainous high flow region. Patch density and edge density had major impacts on water quality contaminants especially in mountainous high flow region; Contagion was related with non-point source pollutants in mountainous normal flow region; landscape shape index was an effective indicator for anions in some eco-regions in high flow season; Shannon’s diversity index contributed to degraded water quality in each eco-region, indicating the variation of landscape heterogeneity influenced water quality regardless of natural environment. The results provide a regional based approach of identifying the impact of land use patterns on water quality in order to improve water pollution control and land use management.

Beschreibung: IJERPH, Vol. 15, Pages 1870: Relationship between Problematic Internet Use, Sleep Problems, and Oral Health in Korean Adolescents: A National Survey International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091870 Authors: Kyung-Yi Do Kang-Sook Lee We examined the relationship between Problematic Internet Use (PIU), sleep (sleep satisfaction, sleep duration), and experience of oral disease symptoms in Korean adolescents by gender. This cross-sectional study utilized the 6th (2010) Korean Youth Risk Behavior Web-based Survey. Participants comprised 74,980 students from 400 middle schools and 400 high schools nationwide. Among these, 73,238 students from 799 schools (38,391 boys, 34,847 girls, aged 13–18 years) were included in the analysis (inclusion rate = 97.7%). Multiple logistic regression and analysis of moment structures (AMOS) analyses were performed to identify meaningful relationships between the three factors. The “high risk group” of problematic internet usage had increased experience of oral disease symptoms (boys: adjusted odds ratio (AOR) = 1.92, 95% confidence interval (CI) = 1.63–2.28, girls: AOR = 1.98, 95% CI = 1.50–2.63) compared to the general group. Boys who used the Internet for “5–6 h” had a higher risk of oral disease symptoms compared to those who used it for “less than 1 h” (OR = 1.24, 95% CI = 1.01–1.53); however, this difference was not significant in Models II and III. For girls, the risk of 5–6 h of use (Model I: OR = 1.69, 95% CI = 1.40–2.04) was higher than that of the boys. In addition, the difference was significant in Models II and III for girl students who used the Internet for 5–6 h. In subgroup analysis, the high-risk group had a higher odds ratio for mild symptoms of bad breath to severe symptoms such as sore and bleeding gums. In addition, in the path analysis, PIU affected sleep and indirectly affected oral health. Direct and indirect causal relationships between the three factors were confirmed. Therefore, it is important to recognize that PIU can have a detrimental effect on mental, physical, and oral health.

Beschreibung: IJERPH, Vol. 15, Pages 1871: Changes in Urinary Hydrogen Peroxide and 8-Hydroxy-2′-Deoxyguanosine Levels after a Forest Walk: A Pilot Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091871 Authors: Da-Hong Wang Ai Yamada Masamitsu Miyanaga Some studies have shown that exposure to forests has positive effects on human health, although the mechanisms underlying the health benefits of a forest environment have not been elucidated yet. The current study was aimed at examining how the levels of urinary hydrogen peroxide (H2O2) and 8-hydroxy-2’deoxyguanosine (8-OHdG) change after a forest or urban walk in healthy subjects. Twenty-eight volunteers (19 men and 9 women) participated in the study. The forest walks were carried out in a forest in Okayama Prefecture, Japan, and the urban walks (15 men and 7 women) were carried out in the downtown area of Okayama city, each for two hours. Spot urine samples were collected before the walk, the next day and one week after the forest or urban walk. Compared with pre-forest walk levels, urinary H2O2 (p < 0.1) and 8-OHdG (p < 0.1) concentrations significantly decreased in the participants the day after the forest walk; furthermore, urinary 8-OHdG remained at a low level even at one week after the forest walk (p < 0.05). However, there were no significant changes in the concentrations of these oxidative biomarkers after the urban walk. These findings suggest the possibility that exposure to forests may alleviate oxidative stress in the body.

Beschreibung: IJERPH, Vol. 15, Pages 1869: Spatial Clustering of Dengue Fever Incidence and Its Association with Surrounding Greenness International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091869 Authors: Chi-Chieh Huang Tuen Yee Tiffany Tam Yinq-Rong Chern Shih-Chun Candice Lung Nai-Tzu Chen Chih-Da Wu With more than 58,000 cases reported by the country’s Centers for Disease Control, the dengue outbreaks from 2014 to 2015 seriously impacted the southern part of Taiwan. This study aims to assess the spatial autocorrelation of the dengue fever (DF) outbreak in southern Taiwan in 2014 and 2015, and to further understand the effects of green space (such as forests, farms, grass, and parks) allocation on DF. In this study, two different greenness indexes were used. The first green metric, the normalized difference vegetation index (NDVI), was provided by the long-term NASA MODIS satellite NDVI database, which quantifies and represents the overall vegetation greenness. The latest 2013 land use survey GIS database completed by the National Land Surveying and Mapping Center was obtained to access another green metric, green land use in Taiwan. We first used Spearman’s rho to find out the relationship between DF and green space, and then three spatial autocorrelation methods, including Global Moran’s I, high/low clustering, and Hot Spot were employed to assess the spatial autocorrelation of DF outbreak. In considering the impact of social and environmental factors in DF, we used generalized linear mixed models (GLMM) to further clarify the relationship between different types of green land use and dengue cases. Results of spatial autocorrelation analysis showed a high aggregation of dengue epidemic in southern Taiwan, and the metropolitan areas were the main hotspots. Results of correlation analysis and GLMM showed a positive correlation between parks and dengue fever, and the other five green space metrics and land types revealed a negative association with DF. Our findings may be an important asset for improving surveillance and control interventions for dengue.

Beschreibung: IJERPH, Vol. 15, Pages 1867: The Role of Psychosocial Stress on a Family-Based Treatment for Adolescents with Problematic Behaviors International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091867 Authors: Jesús Maya Bárbara Lorence Victoria Hidalgo Lucía Jiménez The stressful life events experienced by adolescents with problematic behaviors, should be considered for implementing effective interventions. This study aimed to examine the adjustment of adolescents with problematic behaviors, and to assess the effectiveness of a family-based treatment, namely Scene-Based Psychodramatic Family Therapy (SB-PFT), according to different stress profiles. Ten SB-PFT sessions, over 17 trials were implemented. Stressful life events and adolescent adjustment were evaluated at pretest and posttest, for the SB-PFT participants (n = 104 adolescents) and a control group (n = 106). The adolescents were categorized into three profiles depending on the nature of the stressors: family stress profile, individual and family stress profile, and low stress profile. The individual and family stress group showed worse adjustment. Effectiveness analyses revealed improvements in SB-PFT participants’ emotional intelligence, but not in anger and hostility. Furthermore, adolescents with low and family-related stress profiles showed enhancements in parent attachment. In conclusion, interventions involving adolescents with problematic behaviors must be tailored to the stressful life events experienced. Specific treatments should be used alongside SB-PFT, when adolescents are met with individual-related stress. Nevertheless, SB-PFT seemed to promote emotional intelligence and parent attachment, particularly in adolescents with problematic behaviors that experienced only family stressors.

Beschreibung: IJERPH, Vol. 15, Pages 1868: Exploring the Influence of Built Environment on Car Ownership and Use with a Spatial Multilevel Model: A Case Study of Changchun, China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091868 Authors: Xiaoquan Wang Chunfu Shao Chaoying Yin Chengxiang Zhuge Although the impacts of built environment on car ownership and use have been extensively studied, limited evidence has been offered for the role of spatial effects in influencing the interaction between built environment and travel behavior. Ignoring the spatial effects may lead to misunderstanding the role of the built environment and providing inconsistent transportation policies. In response to this, we try to employ a two-step modeling approach to investigate the impacts of built environment on car ownership and use by combining multilevel Bayesian model and conditional autocorrelation (CAR) model to control for spatial autocorrelation. In the two-step model, the predicting car ownership status in the first-step model is used as a mediating variable in the second-step car use model. Taking Changchun as a case study, this paper identifies the presence of spatial effects in influencing the effects of built environment on car ownership and use. Meanwhile, the direct and cascading effects of built environment on car ownership and use are revealed. The results show that the spatial autocorrelation exists in influencing the interaction between built environment and car dependency. The results suggest that it is necessary for urban planners to pay attention to the spatial effects and make targeted policy according to local land use characteristics.

Beschreibung: IJERPH, Vol. 15, Pages 1866: An Explanatory Model for the Relationship between Motivation in Sport, Victimization, and Video Game Use in Schoolchildren International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091866 Authors: Manuel Castro-Sánchez Ramón Chacón-Cuberos José Luis Ubago-Jiménez Edson Zafra-Santos Félix Zurita-Ortega (1) Background: Society is changing amazingly fast, and this is bringing about changes in the way that people spend their free time. In the 21st century, free time is increasingly spent using technological devices such as video games, thus increasing levels of sedentariness. The aim of the present study was to define an explanatory model for the problematic use of video games, physical activity, motivational climate in sports, and victimization in schoolchildren, and to analyze the relationships between these variables according to gender; (2) Methods: A total of 734 schoolchildren, of both sexes, participated in this research study. They were aged from 10 to 12 and lived in the province of Granada (Spain). The main instruments used were the questionnaires PMCSQ-2, PAQ-C, QERV, and SVS. A multigroup structural equation model was used, which had an excellent fit (χ2 = 319.472; df = 72; p < 0.001; CFI = 0.962; NFI = 0.952; IFI = 0.962; RMSEA = 0.048); (3) Results: The practice of physical activity was related negatively and indirectly to the problematic use of video games ((r = −0.085, boys); (r = −0.081, girls)), and this in turn was related positively and directly to victimization ((r = 0.094, boys); (r = 0.174, girls)). Additionally, task climate was inversely related to the problematic use of video games for girls (r = −0.133), and ego climate was directly related to the use of these devices only with regard to boys (r = 0.250). (4) Conclusions: It must be noted that schoolchildren’s pathological use of video games is closely related to lower levels of physical activity. In addition, those motivational climates in sports that are oriented towards performance exacerbate this pathological behavior, which accentuates the importance of promoting motivational climates that are oriented towards tasks in schoolchildren.

Beschreibung: IJERPH, Vol. 15, Pages 1865: Loneliness at Universities: Determinants of Emotional and Social Loneliness among Students International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091865 Authors: Katharina Diehl Charlotte Jansen Kamila Ishchanova Jennifer Hilger-Kolb The transition from school to university is associated with social, structural, and behavioral changes. These changes may be related to feelings of loneliness, which are in turn related to morbidity. The authors’ aim was to quantify loneliness among students and to identify its determinants and its relation to transition-related variables (e.g., changes in weight, diet, or physical activity since the transition from high school to university). Coming from across Germany, 689 students participated in the Nutrition and Physical Activity in Adolescence (NuPhA) survey (16–29 years; 69.5% female). Associations of loneliness with the above-mentioned aspects were analyzed using descriptive statistics and linear regressions. Altogether, 32.4% felt moderately lonely and 3.2%, severely lonely. Emotional loneliness was more common than social loneliness (severe loneliness: 7.7% vs. 3.2%). Both were positively associated with feelings of depression and anxiety. Being married or in a committed relationship seemed to be protective factors for emotional loneliness. Physical inactivity, an immigrant background, and studying social sciences were related to higher social loneliness. Transition-related variables produced mixed results. In conclusion, this study’s findings indicated that loneliness seemed to be prevalent in university students. The authors identified important starting points for interventions to prevent loneliness. Such interventions may help reduce the disease burden in the students’ future professional life.

Beschreibung: IJERPH, Vol. 15, Pages 1864: Selenium, Mercury, and Their Molar Ratio in Sportfish from Drinking Water Reservoirs International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091864 Authors: Tara K. B. Johnson Catherine E. LePrevost Thomas J. Kwak W. Gregory Cope Mercury (Hg) bioaccumulates in aquatic ecosystems and may pose a risk to humans who consume fish. Selenium (Se) has the ability to reduce Hg toxicity, but the current guidance for human consumption of fish is based on Hg concentration alone. The purpose of the present study was to examine the relationship between Se and Hg in freshwater sportfish, for which there is a paucity of existing data. We collected three species of fish from different trophic positions from two drinking water reservoirs in central North Carolina, USA, to assess Hg and Se concentrations in relation to fish total length and to compare two measures of the protective ability of Se, the Se:Hg molar ratio and Se health benefit value (HBVSe), to current guidance for Hg. According to the Se:Hg molar ratio, all of the low trophic position fish sampled and the middle trophic position fish sampled from one of the reservoirs were safe for consumption. The same number of fish were considered safe using the HBVSe. More fish were deemed unsafe when using the Se:Hg molar ratio and HBVSe than were considered unsafe when using the U.S. Environmental Protection Agency (USEPA) Hg threshold. These findings suggest that the measures of Se protection may be unnecessarily conservative or that the USEPA Hg threshold may not be sufficiently protective of human health, especially the health of sensitive populations like pregnant or nursing mothers and young children. Future examination of the Se:Hg molar ratio and HBVSe from a variety of fish tissue samples would help refine the accuracy of these measures so that they may be appropriately utilized in ecological and human health risk assessment.

Beschreibung: IJERPH, Vol. 15, Pages 1897: Spatial Distribution and Contamination Assessment of Surface Heavy Metals off the Western Guangdong Province and Northeastern Hainan Island International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091897 Authors: Qian Ge Zuo George Xue Fengyou Chu Surface sediments collected from the continental shelf off the western Guangdong Province and northeastern Hainan Island are analyzed for selected heavy metals contents including Cd, Cr, Cu, Pb, Zn, and As to determine spatial distribution, potential ecological risks, and sources. In addition, some of the controlling factors of heavy metals distribution are also discussed. The average heavy metals contents decrease in the order of Zn > Cr > Pb > Cu > As > Cd. The averaged pollution degree, as shown by the index of geo-accumulation (Igeo), decreases in the order of Zn > Cu > Pb > Cr > Cd > As. Due to the barrier of islands, the Igeo values of Zn, Pb, Cr, Cu, and Cd near the Hailing and Xiachuan Islands are larger than those in other areas. Meanwhile, the Igeo value of As near the coastal area off the estuary of Wanquan River is clearly larger than that in other areas. Based on the results of potential ecological risk index, Cd, Cu, and As should be paid more attention for the contamination risk in future. The results of Pearson correlation analysis and principal component analysis indicate that Zn, Cr, Pb, Cu, and Cd are mainly from the Pearl River and surrounding small rivers, whereas As originates from the Hainan Island. The grain size is one of the main controlling factors for heavy metals distribution, and the anthropogenic activity also plays an important role.

Beschreibung: IJERPH, Vol. 15, Pages 1896: Physical Activity and Fundamental Motor Skill Performance of 5–10 Year Old Children in Three Different Playgrounds International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091896 Authors: Jessie Adams Jenny Veitch Lisa Barnett Playgrounds provide opportunities for children to engage in physical activity and develop their fundamental motor skills. The aim of this descriptive pilot study was to examine whether playground design facilitated different levels of physical activity and fundamental motor skills. Children aged 5 to 10 (n = 57) were recruited from three independent playgrounds located in Melbourne (Australia). Whilst playing, children wore accelerometers which measured time spent in physical activity and direct observations recorded fundamental motor skills and play equipment use. A general linear model with playground type as the predictor and adjusting for monitor wear-time identified whether mean time in physical activity was different for the three playgrounds. Frequencies and a one-way ANOVA assessed whether the observed mean number of fundamental motor skills varied between playgrounds. On average, 38.1% of time (12.0 min) was spent in moderate- vigorous-intensity physical activity. Children in the traditional playground (n = 16) engaged in more moderate-intensity physical activity (9.4 min) than children in the adventure playground (n = 21), (5.6 min) (p = 0.027). There were no significant associations with vigorous-intensity physical activity or fundamental motor skills between playgrounds. Children performed few fundamental motor skills but used a wider variety of equipment in the contemporary and adventure playgrounds. Playgrounds need to maximise opportunities for children to engage in physical activity and develop fundamental motor skills.

Beschreibung: IJERPH, Vol. 15, Pages 1894: The Combined Process of Paper Filtration and Ultrafiltration for the Pretreatment of the Biogas Slurry from Swine Manure International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091894 Authors: Yuanhang Zhan Hongmin Dong Fubin Yin Caide Yue The membrane process had been applied for the advanced treatment of pig farm biogas slurry. As studied, this physical pretreatment, with low cost and high efficiency of the suspended solids removal and nutrient retention, is required to control membrane fouling. The combined process of paper filtration and ultrafiltration in a pilot scale was applied in the present study. The main objective was to explore and identify the feasibility of the new process for the pretreatment of the separation liquid of pig farm biogas slurry. A precision identification experiment of paper filtration and the multi-batch repetitive experiments of the combined process were designed. The results showed, at the identified paper filtration precision of 50μm and an operating pressure of 0.3 bar of the ultrafiltration process, that the flux rate at the stable stage of the multi-batch operation was around 295.00 L/h. The combined process achieved an overall processing rate of 345.41 ± 18.81 L/h and a volume permeation proportion of 82.45% ± 0.85%. The TSS was removed by 95.71%, but total nitrogen (TN) and ammonia nitrogen (NH3-N) were retained by 76.29% ± 2.04% and 73.74% ± 2.10%, respectively. Comprehensively, the requirement for the pretreatment was obtained.

Beschreibung: IJERPH, Vol. 15, Pages 1895: Using a Clustering Approach to Investigate Socio-Environmental Inequality in Preterm Birth—A Study Conducted at Fine Spatial Scale in Paris (France) International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091895 Authors: Severine Deguen Nina Ahlers Morgane Gilles Arlette Danzon Marion Carayol Denis Zmirou-Navier Wahida Kihal-Talantikite Background & Objectives: Today, to support public policies aiming to tackle environmental and health inequality, identification and monitoring of the spatial pattern of adverse birth outcomes are crucial. Spatial identification of the more vulnerable population to air pollution may orient health interventions. In this context, the objective of this study is to investigate the geographical distribution of the risk of preterm birth (PTB, gestational age ≤36 weeks) at the census block level in in city of Paris, France. We also aimed to assess the implication of neighborhood characteristics including air pollution and socio-economic deprivation. Material & Methods: Newborn health data are available from the first birth certificate registered by the Maternal and Child Care department of Paris. All PTB from January 2008 to December 2011 were geocoded at the mother residential census block. Each census block was assigned a socioeconomic deprivation level and annual average ambient concentrations of NO2. A spatial clustering approach was used to investigate the spatial distribution of PTB. Results: Our results highlight that PTB is non-randomly spatially distributed, with a cluster of high risk in the northeastern area of Paris (RR = 1.15; p = 0.06). After adjustment for socio-economic deprivation and NO2 concentrations, this cluster becomes not statistically significant or shifts suggesting that these characteristics explain the spatial distribution of PTB; further, their combination shows an interaction in comparison with SES or NO2 levels alone. Conclusions: Our results may inform the decision makers about the areas where public health efforts should be strengthened to tackle the risk of PTB and to choose the most appropriate and specific community-oriented health interventions.

Beschreibung: IJERPH, Vol. 15, Pages 1891: Evaluation of Hand–Dug Wells in Rural Haiti International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091891 Authors: Hayley E. Schram Peter J. Wampler Water resources, especially safe, potable water, are limited for many Haitians. In areas where shallow groundwater is available, many household water needs such as laundry, bathing, and cooking are supplied by hand–dug wells. In order to better understand the water quality and prevalence of these household wells, 35 hand–dug wells were surveyed and sampled near the Hôpital Albert Schweitzer in Deschapelles, Haiti. Water samples were collected and tested for fecal coliform and Escherichia coli using the IDEXX Colilert–18 method. Of the samples collected, 89 percent were determined unsafe to use as a drinking water source based on the World Health Organization standard of 1.0 colony–forming unit (cfu) E. coli per 100 mL. Sixty–six percent of the wells exceeded recreational/body contact standards for the state of Michigan (130 cfu/100 mL). Some of these wells were deemed suitable for conversion to a new well type called in situ filtration (ISF) wells. In situ filtration wells are installed with an internal sand filter pack, PVC casing, pump, and cap which seals the well from surface contamination and provides additional water treatment as water is pumped. Previous ISF installations have reduced E. coli to safe drinking water levels within 90 days.

Beschreibung: IJERPH, Vol. 15, Pages 1892: Spatial Patterns of Urban Wastewater Discharge and Treatment Plants Efficiency in China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091892 Authors: Min An Weijun He Dagmawi Mulugeta Degefu Zaiyi Liao Zhaofang Zhang Liang Yuan With the rapid economic development, water pollution has become a major concern in China. Understanding the spatial variation of urban wastewater discharge and measuring the efficiency of wastewater treatment plants are prerequisites for rationally designing schemes and infrastructures to control water pollution. Based on the input and output urban wastewater treatment data of the 31 provinces of mainland China for the period 2011–2015, the spatial variation of urban water pollution and the efficiency of wastewater treatment plants were measured and mapped. The exploratory spatial data analysis (ESDA) model and super-efficiency data envelopment analysis (DEA) combined Malmquist index were used to achieve this goal. The following insight was obtained from the results. (1) The intensity of urban wastewater discharge increased, and the urban wastewater discharge showed a spatial agglomeration trend for the period 2011 to 2015. (2) The average inefficiency of wastewater treatment plants (WWTPs) for the study period was 39.2%. The plants’ efficiencies worsened from the eastern to western parts of the country. (3) The main reasons for the low efficiency were the lack of technological upgrade and scale-up. The technological upgrade rate was −4.8%, while the scale efficiency increases as a result of scaling up was −0.2%. Therefore, to improve the wastewater treatment efficiency of the country, the provinces should work together to increase capital investment and technological advancement.

Beschreibung: IJERPH, Vol. 15, Pages 1886: About One in Five Novice Vapers Buying Their First E-Cigarette in a Vape Shop Are Smoking Abstinent after Six Months International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091886 Authors: Karolien Adriaens Dinska Van Gucht Frank Baeyens Background: E-cigarette use is rising with the majority of vapers purchasing their e-cigarettes in vape shops. We investigated the smoking/vaping trajectories and quit-smoking success rates of smokers deciding to start vaping for the first time and buying their e-cigarette in brick-and-mortar vape shops in Flanders. Methods: Participants filled out questionnaires assessing smoking/vaping behaviour at three moments (intake, after three and six months) and smoking status was biochemically verified using eCO measurements. Results: Participants (n = 71) were regular smokers (MeCO-intake = 22 ppm), half of whom reported a motivation to quit smoking in the near future. Participants bought 3rd/4th generation e-cigarettes and e-liquid with a nicotine concentration averaging 7 mg/mL. A smoking reduction of 53% (17 cigarettes per day (CPD) at intake to 8 CPD after six months) was observed, whereas eCO decreased to 15 ppm. Eighteen percent of participants had quit smoking completely (eCO = 2 ppm), another 25% had at least halved CPD, whereas 57% had failed to reduce CPD by at least 50% (including 13% lost to follow-up). Quitters consumed more e-liquid than reducers and those who continued to smoke. Conclusions: Around one in five smoking customers buying their first e-cigarette in a brick-and-mortar vape shop had quit smoking completely after six months.

Beschreibung: IJERPH, Vol. 15, Pages 1905: Seroprevalence of Markers of Hepatitis B Virus Infection, Associated Factors, and Vaccination Status in Young Adults in Arkhangelsk, Northwest Russia: A Population-Based Cross-Sectional Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091905 Authors: Balaeva Grjibovski Samodova Sannikov Klouman Russia had a high incidence of hepatitis B virus (HBV) infection before the vaccination campaigns of 1997, 2001, 2007, which targeted newborns, adolescents, and adults, respectively. The aim of our study was to assess the prevalence of serological markers of HBV infection, associated factors, and vaccination status among young adults in Arkhangelsk, Northwest Russia. In this cross-sectional, population-based study, we used a quota sampling method to recruit 1243 adults aged 18–39 years. Participants completed a self-administrated questionnaire and were tested for hepatitis B markers. Associations between positivity for markers and selected sociodemographic and behavioral factors were studied by logistic regression. 10.9% of our participants were positive for at least one marker of hepatitis B, 1.2% were positive for HBsAg, and 42.1% were negative for all markers. In multivariable logistic regression analyses, age 30–34 years; lack of self-reported vaccination; and having ≥2 sexual partners in the last 6 months were associated with positivity for markers of hepatitis B. Hepatitis B vaccination was confirmed in 46.9% of participants. Although half of our study sample was vaccinated, four in 10 were still susceptible to infection and more than one participant in 100 showed evidence of an active infection.

Beschreibung: IJERPH, Vol. 15, Pages 1904: Impact of Antidepressant Use on Healthcare Utilization among Individuals with Type 2 Diabetes and Depression Symptoms in the United States: Sociodemographic, Clinical, and Behavioral Factors Matter International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091904 Authors: Ammena Y. Binsaleh Alexandra Perez Ioana Popovici Silvia E. Rabionet Individuals with diabetes are twice as likely to struggle from depressive symptoms than individuals without diabetes. However, this joint condition is undertreated in nearly two-thirds of patients. Failure to monitor the comorbidity may lead to suboptimal therapy. This study evaluated the association of antidepressant use with healthcare utilization in a national sample of patients with type 2 diabetes and depression symptoms in the United States. It further assessed the differences in sociodemographic, clinical, and behavioral factors between those who use antidepressants and those who do not. This study was a secondary data analysis using the National Health and Nutrition Examination Survey (NHANES) for the period 2005–2014. To assess if there were significant differences in sociodemographic, clinical, and behavioral factors between those who were taking antidepressants or not, Chi Square and independent t-tests were used. To assess if there was a significant association between antidepressant use and healthcare utilization, univariate and multivariate regression analyses were conducted. Of the 955 participants, only 33% were on antidepressants. There were significant differences in sociodemographic, clinical, and behavioral factors among those who used antidepressants and those who did not. Regardless of antidepressant use, the study population had access to health care. Those on antidepressants had fewer diabetes specialists’ visits and more mental health care. There might be underlying health care disparities related to the use of, and access to, antidepressants. Further studies are needed to comprehensively explore the management of these comorbidities.

Beschreibung: IJERPH, Vol. 15, Pages 1899: Implementation of the International Classification of Functioning, Disability, and Health (ICF) Core Sets for Children and Youth with Cerebral Palsy: Global Initiatives Promoting Optimal Functioning International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091899 Authors: Verónica Schiariti Egmar Longo Alexander Shoshmin Ludmila Kozhushko Yanina Besstrashnova Maria Król Taynah Neri Correia Campos Haryelle Náryma Confessor Ferreira Cláudia Verissimo Daniel Shaba Matilda Mwale Sandra Amado Background: The International Classification of Functioning, Disability, and Health (ICF) Core Sets for children and youth with cerebral palsy (CP) offer service providers and stakeholders a specific framework to explore functioning and disability for assessment, treatment, evaluation, and policy purposes in a global context. Objective: Describe global initiatives applying the ICF Core Sets for children and youth with CP, with a focus on contributions to clinical practice and challenges in their implementation. Methods: This is a descriptive cross-sectional study. Ongoing initiatives applying the ICF Core Sets for CP in Russia, Poland, Malawi, and Brazil are included. Results: The main contributions of applying the ICF Core Sets for children and youth with CP include: (1) an objective description of abilities and limitations in everyday activities; (2) a consistent identification of facilitators and barriers influencing functioning; (3) a practical communication tool promoting client-centered care and multidisciplinary teamwork; and, (4) a useful guideline for measurement selection. The main challenges of adopting the ICF Core Sets are related to lack of ICF knowledge requiring intense training and translating results from standardized measures into the ICF qualifiers in a consistent way. Conclusions: Global initiatives include research and clinical applications at the program, service and system levels. The ICF Core Sets for CP are useful tools to guide service provision and build profiles of functioning and disability. Global interprofessional collaboration, capacity training, and informatics (e-records) will maximize their applications and accelerate adoption.

Beschreibung: IJERPH, Vol. 15, Pages 1901: Does Physical Fitness Affect Academic Achievement among Japanese Adolescents? A Hybrid Approach for Decomposing Within-Person and Between-Persons Effects International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091901 Authors: Akira Kyan Minoru Takakura Masaya Miyagi Positive association between physical fitness and academic achievement in adolescents has been suggested yet the causal effect of physical fitness on academic achievement remains unclear. This study examined if longitudinal changes in physical fitness were associated with changes in academic achievement among junior high school students. Analyses were based on a two-year with three time-point data of 567 students (aged 12–13 years old at the baseline-point; 303 boys) who entered in five Japanese junior high schools in 2015. Academic achievement was evaluated using the student’s overall grade point average. Comprehensive physical fitness score was summed up from eight fitness tests: 50-m sprint, standing broad jump, repeated side-steps, sit and reach, sit-ups, hand-grip strength, handball throw, and 20-m shuttle run or endurance run. The hybrid regression model was applied to examine the impact of change in physical fitness on change in academic achievement using multiple imputation to account for non-response at follow-up. The changes in fitness score within-person and the differences in average of fitness score of three-time points between-person were associated with change in overall grade point average for boys. No significant association between fitness score and overall grade point average was observed in girls. Opportunities for increased physical fitness may be important to support academic achievement, particularly in junior high school boys.

Beschreibung: Diversity, Vol. 10, Pages 99: Beyond Capricornia: Tropical Sea Slugs (Gastropoda, Heterobranchia) Extend Their Distributions into the Tasman Sea Diversity doi: 10.3390/d10030099 Authors: Matt J. Nimbs Stephen D. A. Smith There is increasing evidence of poleward migration of a broad range of taxa under the influence of a warming ocean. However, patchy research effort, the lack of pre-existing baseline data, and taxonomic uncertainty for some taxa means that unambiguous interpretation of observations is often difficult. Here, we propose that heterobranch sea slugs provide a useful target group for monitoring shifts in distribution. As many sea slugs are highly colourful, popular with underwater photographers and rock-pool ramblers, and found in accessible habitats, they provide an ideal target for citizen scientist programs, such as the Sea Slug Census. This maximises our ability to rapidly gain usable diversity and distributional data. Here, we review records of recent range extensions by tropical species into the subtropical and temperate waters of eastern Australia and document, for the first time in Australian waters, observations of three tropical species of sea slug as well as range extensions for a further six to various locations in the Tasman Sea.

Beschreibung: Diversity, Vol. 10, Pages 98: cpDNA Barcoding by Combined End-Point and Real-Time PCR Analyses to Identify and Quantify the Main Contaminants of Oregano (Origanum vulgare L.) in Commercial Batches Diversity doi: 10.3390/d10030098 Authors: Alessandro Vannozzi Margherita Lucchin Gianni Barcaccia Oregano (Origanum vulgare L.) is a flowering plant that belongs to the mint family (Lamiaceae). It is used as a culinary herb and is often commercialized as a fine powder or a mixture of small fragments of dried leaves, which makes morphological recognition difficult. Like other commercial preparations of drugs and spices, the contamination of oregano mixtures with vegetable matter of lower quality, or the use of generic misleading names, are frequent and stress the need to develop a molecular traceability system to easily, quickly, and cheaply unveil these scams. The DNA-based analytical approach known as cpDNA barcoding is particularly suited for fraud identification in crop plant species (fresh products and food derivatives), and it represents a promising traceability tool as an alternative or complement to traditional detection methods. In the present study, we used a combined approach based on both qualitative and quantitative cpDNA barcoding with end-point and real-time polymerase chain reaction (PCR) analyses to assess the type and degree of contamination in commercial batches of common oregano. In a preliminary qualitative screening, we amplified, cloned, and sequenced a number of universal trnH-psbA- and trnL-barcoded regions, to identify the main contaminants in the samples under investigation. On the basis of these findings, we then developed and validated a species-specific and sequence-targeted method of testing for the quantitative assessment of contaminants, using trnL gene intron assays. Surprisingly, the results obtained in our case study indicated an almost total absence of O. vulgare in the commercial batches analyzed, but a high presence of group I contaminants (Satureja pilosa Velen.), and a moderate presence of group II contaminants (Cistus lanidifer L./Cistus albidus).

Beschreibung: IJERPH, Vol. 15, Pages 1926: Hands-On Experience of Crowdsourcing for Flood Risks. An Android Mobile Application Tested in Frederikssund, Denmark International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091926 Authors: Simone Frigerio Luca Schenato Giulia Bossi Matteo Mantovani Gianluca Marcato Alessandro Pasuto There is evidence that the toll of death and destruction caused by natural hazards is rising. This is often ascribed to the impact of climate change that resulted in an increased frequency of extreme meteorological events. As a consequence, it is realistic to expect that the casualties and damages caused by floods will increase in the near future. Advanced weather forecast is a fundamental tool to predict the occurrence of floods and structural mitigation measures are crucial for flood protection. However, these strategies should be associate with tools to promote and increase natural-disaster awareness and nonstructural mitigation measures in the exposed population. To bridge this gap, we coupled innovative, ICT-based technologies with crowdsourcing. The idea is to exploit geospatial data gathered by citizens and volunteers with their own devices such as mobile phones to provide authorities with relevant information in case of flood emergencies. This paper describes the design and testing of an Android application named MAppERS (Mobile Applications for Emergency Response and Support), thought to enhance active participation and response of the population in territorial and flood-risk mitigation in Frederikssund, Denmark. The results of the piloting fully validate MAppERS as an effective tool to support the decision-making process during a crisis and to improve the awareness of the community and their disaster resilience.

Beschreibung: IJERPH, Vol. 15, Pages 1924: Characteristics of PM2.5 Chemical Compositions and Their Effect on Atmospheric Visibility in Urban Beijing, China during the Heating Season International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091924 Authors: Xing Li Shanshan Li Qiulin Xiong Xingchuan Yang Mengxi Qi Wenji Zhao Xinlong Wang Beijing, which is the capital of China, suffers from severe Fine Particles (PM2.5) pollution during the heating season. In order to take measures to control the PM2.5 pollution and improve the atmospheric environmental quality, daily PM2.5 samples were collected at an urban site from 15 November to 31 December 2016, characteristics of PM2.5 chemical compositions and their effect on atmospheric visibility were analyzed. It was found that the daily average mass concentrations of PM2.5 ranged from 7.64 to 383.00 μg m−3, with an average concentration of 114.17 μg m−3. On average, the Organic Carbon (OC) and Elemental Carbon (EC) contributed 21.39% and 5.21% to PM2.5, respectively. Secondary inorganic ions (SNA: SO42− + NO3− + NH4+) dominated the Water-Soluble Inorganic Ions (WSIIs) and they accounted for 47.09% of PM2.5. The mass concentrations of NH4+, NO3− and SO42− during the highly polluted period were 8.08, 8.88 and 6.85 times greater, respectively, than during the clean period, which contributed most to the serious PM2.5 pollution through the secondary transformation of NO2, SO2 and NH3. During the highly polluted period, NH4NO3 contributed most to the reconstruction extinction coefficient (b′ext), accounting for 35.7%, followed by (NH4)2SO4 (34.44%) and Organic Matter (OM: 15.24%). The acidity of PM2.5 in Beijing was weakly acid. Acidity of PM2.5 and relatively high humidity could aggravate PM2.5 pollution and visibility impairment by promoting the generation of secondary aerosol. Local motor vehicles contributed the most to NO3−, OC, and visibility impairment in urban Beijing. Other sources of pollution in the area surrounding urban Beijing, including coal burning, agricultural sources, and industrial sources in the Hebei, Shandong, and Henan provinces, released large amounts of SO2, NH3, and NO2. These, which were transformed into SO42−, NH4+, and NO3− during the transmission process, respectively, and had a great impact on atmospheric visibility impairment.

Beschreibung: IJERPH, Vol. 15, Pages 1922: The Impact of Innovative Smoking Reduction Education at Hospital Entrances: A Prospective Pre- and Post-Test Study Design International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091922 Authors: Tusi-Ping Chu Min-Li Chen Yu-Chen Lin Mei-Yen Chen Background: Nurses are expected to play an important role in smoking reduction education. Although the smoking ban was enacted in Taiwan in 1997, which included the introduction of smoking-free areas around the entrances of hospitals, many smokers are still found near hospitals. Few smoking reduction programs have been initiated around hospital entrances. The aim of this study was to examine the impacts of an innovative smoking reduction education program, which was conducted by nursing students around the entrances of a teaching hospital. Methods: A prospective pre- and post-test study design was used. The smoking reduction education program consisted of posters, audio broadcasts, and dramatic performances that provided information and resources related to smoking reduction. Outcome variables included the number of smokers, number of cigarette butts on the ground, and the experiences from nursing students after conducting the program. Results: After adjusting for weather and temperature, the number of smokers decreased significantly in the afternoon and during the whole day after the implementation of the program. The number of cigarette butts significantly decreased during the implementation of the program. Conclusion: The findings reveal that alternative smoking reduction programs initiated around hospital entrances significantly reduced both the number of smokers and cigarette butts on the ground. Nursing students shared their positive experiences in conducting this study.

Beschreibung: IJERPH, Vol. 15, Pages 1923: Exploring Brazilian Immigrant Mothers’ Beliefs, Attitudes, and Practices Related to Their Preschool-Age Children’s Sleep and Bedtime Routines: A Qualitative Study Conducted in the United States International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091923 Authors: Ana Cristina Lindsay Carlos André Moura Arruda Márcia M. Tavares Machado Gabriela P. De Andrade Mary L. Greaney In the United States (US), racial/ethnic minority children, low-income children, and children of immigrant families are at increased risk of childhood obesity. Mounting evidence documents that sleep duration and sleep quality are important modifiable factors associated with increased risk of obesity among preschool-aged children. The number of Brazilian immigrants in the US is increasing, yet no existing research, to our knowledge, has examined factors affecting sleep and bedtime routines of children of Brazilian immigrant families. Therefore, the purpose of this qualitative study was to explore Brazilian immigrant mothers’ beliefs, attitudes, and practices related to sleep and bedtime routines among preschool-aged children. Seven focus group discussions (FGDs) were conducted with 37 Brazilian immigrant mothers of preschool-age children living in the US. The audio-recordings of the FGDs were transcribed verbatim in Portuguese without identifiers and analyzed using thematic analyses. Mothers also completed a brief questionnaire assessing socio-demographic and acculturation. Analyses revealed that most mothers were aware of the importance of sleep and sleep duration for their children’s healthy growth and development. Mothers also spoke of children needing consistent bedtime routines. Nevertheless, many mothers reported inconsistent and suboptimal bedtime routines (e.g., lack of predictable and orderly bedtime activities such as bath, reading, etc. and use of electronics in bed). These suboptimal routines appeared to be influenced by day-to-day social contextual and environmental factors that are part of Brazilian immigrant families’ lives such as parents’ work schedule, living with extended family, living in multi-family housing, neighborhood noise, etc. Analyses identified several modifiable parenting practices related to young children’s sleep and bedtime routines (e.g., irregular bedtime, late bedtime, inconsistent bedtime routines, use of electronics in bed, etc.) that can be addressed in parenting- and family-based obesity prevention interventions. Interventions should consider the social context of the home/family (e.g., parents’ work schedules) and the environment (e.g., multi-family housing; neighborhood noise, etc.) faced by Brazilian immigrant families when developing health promotion messages and parenting interventions tailored to this ethnic group.

Beschreibung: IJERPH, Vol. 15, Pages 1920: Daily Effect of Recovery on Exhaustion: A Cross-Level Interaction Effect of Workaholism International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091920 Authors: Monica Molino Claudio G. Cortese Chiara Ghislieri Workaholics generally allocate an excessive amount of time and energy to their work at the expense of having time for recovery from work. Nevertheless, a complete recovery is an essential prerequisite for well-being. This study examines the moderating role of workaholism in the relationship between daily recovery and daily exhaustion. Data were collected among 95 participants who completed a general questionnaire and a diary booklet for five consecutive working days. Multilevel analysis results confirmed a cross-level interaction effect of workaholism, showing that the negative relationship between recovery and exhaustion at the daily level is weaker for those with a high (versus low) level of workaholism. These insights suggest the promotion of interventions aimed at addressing workaholism among workers, and the design of projects able to stimulate recovery from work, particularly for workaholics.

Beschreibung: IJERPH, Vol. 15, Pages 1909: How Does Emotional Intelligence Make One Feel Better at Work? The Mediational Role of Work Engagement International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091909 Authors: Natalio Extremera Sergio Mérida-López Nicolás Sánchez-Álvarez Cirenia Quintana-Orts Although previous research has highlighted the association between emotional intelligence (EI) and job satisfaction, the underlying mechanisms remain relatively unexplored. To address this gap, this study examined employee engagement as a potential mediator of the association. A multi-occupational sample of 405 Spanish professionals completed the Wong Law Emotional Intelligence Scale, the Utrecht Work Engagement Scale and an Overall Job Satisfaction Scale as well as providing socio-demographic data. As expected, employees’ EI was positively related to engagement dimensions (vigour, dedication and absorption) as well as overall job satisfaction. Bootstrap estimates from multiple mediation analysis confirmed that employees’ perceived EI was indirectly associated with job satisfaction via vigour and dedication scores, even when controlling for the effects of socio-demographic variables. Similarly, the same pattern was found when multiple mediation was conducted for each EI dimension. Our study contributes to understanding of the processes involved in maintaining and enhancing positive attitudes at work, providing the first, encouraging evidence that work engagement play a role in the EI-job satisfaction link. Our results extend the EI literature by elucidating the pathways through which EI is linked to positive employee attitudes and suggests that intervention programs designed to bolster EI might prove effective at increasing job satisfaction.

Beschreibung: IJERPH, Vol. 15, Pages 1908: Pre-Service Teachers’ Intervention in School Bullying Episodes with Special Education Needs Students: A Research in Italian and Greek Samples International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091908 Authors: Tatiana Begotti Maurizio Tirassa Daniela Acquadro Maran Background: The aim of the study was to compare the level of self-confidence in dealing with problems at school, the attitude towards bullying situations and the recommended strategies to cope with bullying in two samples of pre-service teachers (PSTs). The PSTs were in training to become teachers with special education needs students (SEN) and came from two different countries (Italy and Greece). Methods: A questionnaire survey was made involving 110 Italian and 84 Greek PSTs. Results: The results about self-confidence showed that Greek PSTs had lower outcome expectations and a higher external locus of causality than Italian PSTs. Teachers’ training programs and school preventive intervention were also discussed. Conclusions: Because the participants in this investigation will be teachers in the near future, they require specific training on bullying in general and in students with SEN in particular.

Beschreibung: IJERPH, Vol. 15, Pages 1906: Knowledge, Attitudes and Practices Regarding Diabetes in the General Population: A Cross-Sectional Study from Pakistan International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091906 Authors: Ali Hassan Gillani Fakir Muhammad Amirul Islam Khezer Hayat Naveel Atif Caijun Yang Jie Chang Zhan Qu Yu Fang Background: Low knowledge about diabetes risk factors coupled with high disease prevalence is common in low-resource countries. This study evaluated diabetes-related knowledge, attitudes, and practices in the general population in Punjab (Pakistan). Methods: A cross-sectional study was conducted in five districts in Punjab from January to March 2017. Data were collected from 2019 adults aged 18–90 years through face-to-face interviews using a semi-structured questionnaire. The total knowledge score ranged from 0–9; a score ≥6 was considered adequate diabetes awareness. Descriptive statistics, chi-square tests, and linear and binary logistic regression were used for the analyses. Results: Respondents’ mean age was 32.92 ± 11.4 years. In total, 85.9% of respondents had heard of diabetes, and 30.1% knew about the glucose tolerance test. We found 2.3% of respondents scored zero for diabetes knowledge, 11.3% scored 9, and 47.4% scored ≥6 (adequate awareness). Being female (β = 0.37, 95% confidence interval [CI]: 0.16, 0.05; p = 0.001), socioeconomic status (β = 0.24, 95% CI: 0.12, 0.36; p < 0.001), being diabetic (β = 0.82, 95% CI: 0.53, 1.10; p < 0.001), and higher education (β = 0.25, 95% CI: 0.17, 0.33; p < 0.001) were significantly associated with knowledge score. Respondents with high socioeconomic status showed significantly higher positive attitudes compared with those with low socioeconomic status (adjusted odds ratio 1.57, 95% CI: 1.12, 2.24). Only 8.7% (30/343) of those diagnosed with diabetes had never undergone blood glucose screening since diagnosis. Conclusions: Knowledge of diabetes risk factors, management, and care is low in Pakistan’s general population. Targeted public education programs should be instigated at a national level to increase understanding of diabetes prevention and treatment.

Beschreibung: IJERPH, Vol. 15, Pages 1913: Study of Hybrid PVA/MA/TEOS Pervaporation Membrane and Evaluation of Energy Requirement for Desalination by Pervaporation International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091913 Authors: Zongli Xie Derrick Ng Manh Hoang Jianhua Zhang Stephen Gray Desalination by pervaporation is a membrane process that is yet to be realized for commercial application. To investigate the feasibility and viability of scaling up, a process engineering model was developed to evaluate the energy requirement based on the experimental study of a hybrid polyvinyl alcohol/maleic acid/tetraethyl orthosilicate (PVA/MA/TEOS) Pervaporation Membrane. The energy consumption includes the external heating and cooling required for the feed and permeate streams, as well as the electrical power associated with pumps for re-circulating feed and maintaining vacuum. The thermal energy requirement is significant (e.g., up to 2609 MJ/m3 of thermal energy) and is required to maintain the feed stream at 65 °C in recirculation mode. The electrical energy requirement is very small (<0.2 kWh/m3 of required at 65 °C feed temperature at steady state) with the vacuum pump contributing to the majority of the electrical energy. The energy required for the pervaporation process was also compared to other desalination processes such as Reverse Osmosis (RO), Multi-stage Flash (MSF), and Multiple Effect Distillation (MED). The electrical energy requirement for pervaporation is the lowest among these desalination technologies. However, the thermal energy needed for pervaporation is significant. Pervaporation may be attractive when the process is integrated with waste heat and heat recovery option and used in niche applications such as RO brine concentration or salt recovery.

Beschreibung: IJERPH, Vol. 15, Pages 1912: A School-Based Educational Intervention for School-Aged Children and Caregivers about Rational Use of Antibiotics in Urban Areas of Shaanxi Province: A Study Protocol for a Randomized Controlled Research International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091912 Authors: Yu Zhang John Kabba Jie Chang Wenjing Ji Shan Zhu Jiale Yu Sen Xu Yu Fang (1) Background: Antibiotic resistance is an imperative public health issue globally. Major factors that are resulting in this trend are the irrational and excessive use of antibiotics. Children account for a greater population of antibiotics use, therefore, an educational intervention on the rational use of antibiotics for children and caregivers will be beneficial. (2) Methods: A randomized controlled and parallel group study of fifth grade children and their caregivers will be evaluated in four primary schools in Baoji and Weinan of the Shaanxi Province. Two primary schools will be randomly selected for the educational intervention and two schools will serve as a control group. In the intervention arm, educational interventions will be conducted among caregivers and their children. The intervention measures include interactive training sessions, booklets, and printed or electronic educational materials that will be given to the caregivers or the school-aged children. In the control arm, no interventions will be implemented. Baseline data collected from June, 2018 and the intervention will last for three months. Knowledge-Attitude-Practice (KAP) questionnaires will be used to evaluate the caregivers’ knowledge, their attitude, and their practice. Knowledge-Retention questionnaires will be used to assess the children’s knowledge about microbes, antibiotics, and hygiene. (3) Discussion: This study is a unique comprehensive intervention targeting both children and their caregivers. We hypothesize a decrease in the irrational use of antibiotics among the studied population. Hence, this result would provide evidence for policy makers and educational departments for the implementation of similar interventions on the rational use of antibiotics.

Beschreibung: IJERPH, Vol. 15, Pages 1947: Lead in Air in Bangladesh: Exposure in a Rural Community with Elevated Blood Lead Concentrations among Young Children International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091947 Authors: May K. Woo Elisabeth S. Young Md Golam Mostofa Sakila Afroz Md Omar Sharif Ibne Hasan Quazi Quamruzzaman David C. Bellinger David C. Christiani Maitreyi Mazumdar Previous evaluations of a birth cohort in the Munshiganj District of Bangladesh had found that over 85% of 397 children aged 2–3 years had blood lead concentrations above the United States Centers for Disease Control and Prevention’s reference level of 5 μg/dL. Studies in urban areas of Bangladesh have found elevated levels of lead in the air due to industries and remaining contamination from the historic use of leaded gasoline. Sources of lead in rural areas of Bangladesh remain unknown. We conducted air sampling in both residential and industrial sites in Munshiganj to determine whether children are exposed to elevated lead concentrations in the air and study the association between the children’s blood lead levels and sampled air lead concentrations. Residential and industrial air samples in Munshiganj were found to have elevated lead concentrations (mean 1.22 μg/m3) but were not found to be associated with the observed blood lead concentrations. Lead in air is an important environmental health exposure risk to the for children in Munshiganj, and further research may shed light on specific sources to inform exposure prevention and mitigation programs.

Beschreibung: IJERPH, Vol. 15, Pages 1946: Dietary Patterns and Breast Cancer Risk: A Multi-Centre Case Control Study among North Indian Women International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091946 Authors: Krithiga Shridhar Gurpreet Singh Subhojit Dey Sarvdeep Singh Dhatt Jatinder Paul Singh Gill Michael Goodman Melina Samar Magsumbol Neil Pearce Sandeep Singh Archna Singh Preeti Singh Jarnail Singh Thakur Preet Kaur Dhillon Evidence from India, a country with unique and distinct food intake patterns often characterized by lifelong adherence, may offer important insight into the role of diet in breast cancer etiology. We evaluated the association between Indian dietary patterns and breast cancer risk in a multi-centre case-control study conducted in the North Indian states of Punjab and Haryana. Eligible cases were women 30–69 years of age, with newly diagnosed, biopsy-confirmed breast cancer recruited from hospitals or population-based cancer registries. Controls (hospital- or population-based) were frequency matched to the cases on age and region (Punjab or Haryana). Information about diet, lifestyle, reproductive and socio-demographic factors was collected using a structured interviewer-administered questionnaire. All participants were characterized as non-vegetarians, lacto-vegetarians (those who consumed no animal products except dairy) or lacto-ovo-vegetarians (persons whose diet also included eggs). The study population included 400 breast cancer cases and 354 controls. Most (62%) were lacto-ovo-vegetarians. Breast cancer risk was lower in lacto-ovo-vegetarians compared to both non-vegetarians and lacto-vegetarians with odds ratios (95% confidence intervals) of 0.6 (0.3–0.9) and 0.4 (0.3–0.7), respectively. The unexpected difference between lacto-ovo-vegetarian and lacto-vegetarian dietary patterns could be due to egg-consumption patterns which requires confirmation and further investigation.

Beschreibung: IJERPH, Vol. 15, Pages 1950: Temporal Trends of Urinary Phthalate Concentrations in Two Populations: Effects of REACH Authorization after Five Years International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091950 Authors: Giovanna Tranfo Lidia Caporossi Daniela Pigini Silvia Capanna Bruno Papaleo Enrico Paci Phthalates are widely used in the industrial manufacture of many products. Some phthalates have shown reproductive toxicity in humans, acting as endocrine disruptors, so they were included in the authorization process defined in Reg. CE 1907/2006 (REACH). Two groups of population were recruited, before and after the inclusion of some phthalates in the authorization list in REACH: the first group of 157 volunteers was studied in 2011 and the second, 171 volunteers, in 2016. Each subject completed a questionnaire about personal lifestyle, working activities and use of chemical products. The main urinary metabolites of five phthalates were analyzed by HPLC/MS/MS: mono(2-ethylhexyl)phthalate (MEHP) and mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) for di(2-ethylhexyl)phthalate (DEHP) exposure; monoethylphthalate (MEP) for diethylphtahate (DEP); monobenzylphthalate (MBzP) for butylbenzylphtahalate (BBP) and dibenzylphthalate (DBzP), mono-n-butylphthalate (MnBP) for butylbenzylphtahalate (BBP) and di-n-butylphthalate (DnBP). The results show a significant difference for all metabolites between the two periods, with the exception of MEP in women. The comparison of the two sets of results shows a decrease in urinary metabolites excretion from 2011 to 2016, statistically significant for the three phthalates included in Annex XIV of REACH. DEP, not currently included in the list for authorization, maintains a constant presence in the daily life of the population, particularly for women.

Beschreibung: IJERPH, Vol. 15, Pages 1945: Developing an Awareness Campaign to Reduce Second Hand Smoke Among Disadvantaged Families—A Participatory M-Health Approach International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091945 Authors: Tobias Weinmann Katja Radon Freya Sukalla Jessica Gerlich Swaantje Barth Dennis Nowak Veronika Karnowski Children from disadvantaged families are particularly exposed to second hand smoke in their home environment. Using a mixed methods participatory approach, we aimed at identifying suitable media channels and appropriate content for a campaign increasing caregivers’ knowledge about the risks of second hand smoke (SHS) exposure for their children and appropriate measures for exposure reduction. In the first phase of the mixed method design, we evaluated knowledge and norms about children’s SHS and perceived barriers for avoiding it. To this end, we conducted 26 one-to-one interviews with smoking caregivers of children below the age of six years. Subsequently, we developed and illustrated core messages and identified appropriate communication channels. These were evaluated in focus group discussions by 20 of the 26 interview participants. After a final revision, 121 caregivers evaluated the campaign via an online questionnaire. Online social networks were identified as the most suitable media channel. For these, we developed animated photos with voiceovers addressing the potential consequences of SHS for children. The overall rating of the campaign messages was promising. Participants confirmed that it was important to address the issue in social media. However, sharing the pictures was considered unlikely due to the sensitive topic of the campaign, while the importance of doctors or scientists being recognizable as a source was highlighted. Employing a participatory approach, we developed an m-health campaign, which can now be disseminated in social networks to reach the target population. The effectiveness of the campaign should be evaluated.

Beschreibung: IJERPH, Vol. 15, Pages 1944: Serum Lipid Profile and Its Association with Diabetes and Prediabetes in a Rural Bangladeshi Population International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091944 Authors: Bishwajit Bhowmik Tasnima Siddiquee Anindita Mujumder Faria Afsana Tareen Ahmed Ibrahimu A. Mdala Nayla Cristina do V. Moreira Abul Kalam Azad Khan Akhtar Hussain Gerd Holmboe-Ottesen Tone Kristin Omsland Dyslipidemia is commonly associated with diabetes (T2DM). This has been demonstrated for the Caucasian population, but few data are available for Asian Indians. The paper aims to investigate serum lipids (separately or in combination) and their association with glucose intolerance status (T2DM and prediabetes) in a rural Bangladeshi population. A sample of 2293 adults (≥20 years) were included in a community based cross-sectional survey in 2009. Anthropometric measures, blood pressure, blood glucose (fasting and 2-h oral glucose tolerance test) and fasting serum lipids (total cholesterol, T-Chol; triglycerides, Tg; low density lipoprotein cholesterol, LDL-C and high density lipoprotein cholesterol, HDL-C) were registered. Analysis of covariance (ANCOVA) and regression analysis were performed. High Tg levels were seen in 26% to 64% of the participants, depending on glucose tolerance status. Low HDL-C levels were seen in all groups (>90%). Significant linear trends were observed for high T-Chol, high Tg and low HDL-C with increasing glucose intolerance (p for trend <0.001). T2DM was significantly associated with high T-Chol (Odds ratio (OR): 2.43, p < 0.001), high Tg (OR: 3.91, p < 0.001) and low HDL-C (OR: 2.17, p = 0.044). Prediabetes showed a significant association with high Tg (OR: 1.96, p < 0.001) and low HDL-C (OR: 2.93, p = 0.011). Participants with combined high Tg and low HDL-C levels had a 12.75-fold higher OR for T2DM and 4.89 OR for prediabetes. In Asian Indian populations an assessment of serum lipids is warranted not only for T2DM patients, but also for those with prediabetes.

Beschreibung: IJERPH, Vol. 15, Pages 1943: Monitoring and Evaluation Indicators for Climate Change-Related Health Impacts, Risks, Adaptation, and Resilience International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091943 Authors: Kristie L. Ebi Christopher Boyer Kathryn J. Bowen Howard Frumkin Jeremy Hess Climate change poses a range of current and future health risks that health professionals need to understand, track, and manage. However, conventional monitoring and evaluation (M&E) as practiced in the health sector, including the use of indicators, does not adequately serve this purpose. Improved indicators are needed in three broad categories: (1) vulnerability and exposure to climate-related hazards; (2) current impacts and projected risks; and (3) adaptation processes and health system resilience. These indicators are needed at the population level and at the health systems level (including clinical care and public health). Selected indicators must be sensitive, valid, and useful. And they must account for uncertainties about the magnitude and pattern of climate change; the broad range of upstream drivers of climate-sensitive health outcomes; and the complexities of adaptation itself, including institutional learning and knowledge management to inform iterative risk management. Barriers and constraints to implementing such indicators must be addressed, and lessons learned need to be added to the evidence base. This paper describes an approach to climate and health indicators, including characteristics of the indicators, implementation, and research needs.

Beschreibung: IJERPH, Vol. 15, Pages 1949: Ecohydraulogical Characteristic Index System of Schizopygopsis younghusbandi during Spawning Periods in the Yarlung Tsangpo River International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091949 Authors: Qing-Yuan Liu Jia Li Rui-Dong An Yong Li To address the species decline in aboriginal fish in the Yarlung Tsangpo River Basin and the lack of research on the habitat characteristics of fish spawning grounds, this paper studied the changing trends in runoff in spawning grounds and the habitat conditions characteristics of Schizopygopsis younghusbandi during the spawning period. In conventional approaches, inaccurate statistical results are obtained when a full river section is taken as the region to be assessed, so a new method for determining the statistical boundaries of characteristic indexes was proposed. By combining hydrological analyses, mathematical statistics, and numerical simulations, the statistical boundary of the index was determined, and a suitable range for the habitat characteristic indexes for the spawning field was finally obtained. The results showed that (1) the maximum percentage of the statistical boundary for the spawning grounds was 39% near the banks on both sides of the river; (2) the flow during the spawning period exhibited small variations, a short duration and a fluctuation cycle and was dominated by water rising events, and the interannual growth trend in the daily flow was obvious; and (3) during the spawning period, the flow velocity of the fish habitat was small, the turbulence level of the fluid was low, and the flow regime was stable. A suitable range for the habitat characteristic index of the target fish provided the basic data for the protection of aboriginal fish and was beneficial to maintain the balance of aquatic ecological system in the Yarlung Tsangpo River. The results of this study contribute to the rational development of water resources in the basin and the protection of species diversity and water environment.

Beschreibung: IJERPH, Vol. 15, Pages 1948: Associations among Elder Abuse, Depression and PTSD in South Korean Older Adults International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091948 Authors: Yun-Jung Choi Meaghan O’Donnell Hwa-Bok Choi Hae-Sun Jung Sean Cowlishaw Increasing attention is being placed on the prevalence of elder abuse and its impact on mental health. This study conducted a survey of 172 elderly people in South Korea to determine the prevalence of elder abuse and the relationships involving elder abuse, depression and posttraumatic stress disorder (PTSD). Participants completed a battery of self-report questionnaires, which included the Korean Geriatric Depression Screening Scale (KGDS) and Impact of Event Scale-Revised Korean version (IES-R-K). Descriptive analyses were conducted to examine the frequency of specific forms of abuse. Logistic regression models were estimated to identify the factors that contributed to risk of abuse exposure and the relationship between exposure and PTSD or depression. The results indicated around 22% of the participants reported abuse exposure, which most commonly included being refused physical contact, verbal threats, and/or being excluded from decision-making about personal issues. Low education and being unmarried, separated or divorced was associated with an increased risk of abuse exposure. There were strong associations between elder abuse and PTSD symptoms, while comparable relationships with depression were weaker and were not robust to the inclusion of control variables. The findings provided empirical support for the relationship between abuse experiences of the elderly and poor mental health and raise important issues for the mental health care of the elderly.

Beschreibung: IJERPH, Vol. 15, Pages 1934: Pregnancy Related Health Care Needs in Refugees—A Current Three Center Experience in Europe International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091934 Authors: Christian Dopfer Annabelle Vakilzadeh Christine Happle Evelyn Kleinert Frank Müller Diana Ernst Reinhold E. Schmidt Georg M. N. Behrens Sonja Merkesdal Martin Wetzke Alexandra Jablonka Background: Immigration into Europe has reached an all-time high. Provision of coordinated healthcare, especially to refugee women that are at increased risk for adverse pregnancy outcomes, is a challenge for receiving health care systems. Methods: We assessed pregnancy rates and associated primary healthcare needs in three refugee cohorts in Northern Germany during the current crisis. Results: Out of n = 2911 refugees, 18.0% were women of reproductive age, and 9.1% of these were pregnant. Pregnancy was associated with a significant, 3.7-fold increase in primary health care utilization. Language barrier and cultural customs impeded healthcare to some refugee pregnant women. The most common complaints were demand for pregnancy checkup without specific symptoms (48.6%), followed by abdominal pain or urinary tract infections (in 11.4% of cases each). In 4.2% of pregnancies, severe complications such as syphilis or suicide attempts occurred. Discussion: We present data on pregnancy rates and pregnancy associated medical need in three current refugee cohorts upon arrival in Germany. Healthcare providers should be particularly aware of the requirements of pregnant migrants and should adapt primary caretaking strategies accordingly.

Beschreibung: IJERPH, Vol. 15, Pages 1932: Reducing the Future Risk of Trauma: On the Integration of Global Disaster Policy within Specific Health Domains and Established Fields of Practice International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091932 Authors: Lennart Reifels The global increase in the frequency and severity of natural hazards and extreme climatic events necessitates more efficient global and national strategies to reduce the likelihood and impact of traumatic consequences for disaster-affected populations. The recent inclusion of mental health in the Sendai Framework for Disaster Risk Reduction marks a pivotal point in the recognition of the significant burden of disasters on mental health, and a global commitment to reducing its impacts. Nevertheless, effective agreement implementation and efforts to reduce disaster mental health risks are facing significant challenges. These include a lack of clarity about the conceptual interlinkages and place of disaster risk reduction principles within the field of disaster mental health, which is traditionally marked by a prevailing recovery orientation, and the need for effective translation into disaster mental health policy and practice. Therefore, this study drew on data from interviews with European disaster mental health and risk reduction experts in order to appraise the merit and implications of a global disaster risk reduction policy for advancing population mental health in the context of disaster. Study findings outline existing opportunities, challenges, and key strategies for the integration of disaster risk reduction within disaster mental health policy and practice.

Beschreibung: IJERPH, Vol. 15, Pages 1931: The Association between US Adolescents’ Weight Status, Weight Perception, Weight Satisfaction, and Their Physical Activity and Dietary Behaviors International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091931 Authors: Furong Xu Steven A. Cohen Mary L. Greaney Geoffrey W. Greene Background: It remain unclear that the association between weight status, weight perception, weight satisfaction and the clustering of physical activity (PA) and dietary behaviors in adolescents. Method: A cross-sectional analysis of National Health and Nutrition Examination Survey and the US Department of Agriculture’s Food Patterns Equivalents 2007–2014 data from adolescents aged 12–17 years (n = 2965) was conducted. Multivariable logistic regression models adjusted for demographic characteristics examined the association between weight status, weight perception, weight satisfaction, and the four created lifestyle groups (healthier behaviors, healthier diet only, physically active only, unhealthier behaviors). Results: Males with obesity were more likely to be in the healthier diet only group than males with a normal weight (OR = 1.90, 95% CI: 1.02, 3.52). Similar patterns were found in males who perceived themselves as being overweight or having obesity (OR = 2.09, 95% CI: 1.09, 3.99) and males with obesity who perceived their weight status accurately (OR = 2.33, 95% CI: 1.12, 4.88). Female respondents who were satisfied with their weight were 59% less likely to be in the healthier diet only group than healthier behaviors group compared with females who were weight dissatisfied (OR = 0.41, 95% CI: 0.23, 0.75). This pattern was not observed in males. Conclusions: Clustering PA and dietary behaviors were associated with weight status and weight perception for males but not females. Weight satisfaction was associated with clustered PA and dietary behaviors for females. These findings are important for obesity prevention policies and programs to better address adolescents’ obesity and reduce health disparities in this population.

Beschreibung: IJERPH, Vol. 15, Pages 1928: Key Factors Influencing the Incidence of West Nile Virus in Burleigh County, North Dakota International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091928 Authors: Hiroko Mori Joshua Wu Motomu Ibaraki Franklin W. Schwartz The city of Bismarck, North Dakota has one of the highest numbers of West Nile Virus (WNV) cases per population in the U.S. Although the city conducts extensive mosquito surveillance, the mosquito abundance alone may not fully explain the occurrence of WNV. Here, we developed models to predict mosquito abundance and the number of WNV cases, independently, by statistically analyzing the most important climate and virus transmission factors. An analysis with the mosquito model indicated that the mosquito numbers increase during a warm and humid summer or after a severely cold winter. In addition, river flooding decreased the mosquito numbers. The number of WNV cases was best predicted by including the virus transmission rate, the mosquito numbers, and the mosquito feeding pattern. This virus transmission rate is a function of temperature and increases significantly above 20 °C. The correlation coefficients (r) were 0.910 with the mosquito-population model and 0.620 with the disease case model. Our findings confirmed the conclusions of other work on the importance of climatic variables in controlling the mosquito numbers and contributed new insights into disease dynamics, especially in relation to extreme flooding. It also suggested a new prevention strategy of initiating insecticides not only based on mosquito numbers but also 10-day forecasts of unusually hot weather.

Beschreibung: IJERPH, Vol. 15, Pages 1958: Field Evaluation of N95 Filtering Facepiece Respirators on Construction Jobsites for Protection against Airborne Ultrafine Particles International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15091958 Authors: Atin Adhikari Aniruddha Mitra Abbas Rashidi Imaobong Ekpo Jacob Schwartz Jefferson Doehling Exposure to high concentrations of airborne ultrafine particles in construction jobsites may play an important role in the adverse health effects among construction workers, therefore adequate respiratory protection is required. The performance of particulate respirators has never been evaluated in field conditions against ultrafine particles on construction jobsites. In this study, respiratory protection levels against ultrafine particles of different size ranges were assessed during three common construction related jobs using a manikin-based set-up at 85 L/min air flow rate. Two NanoScan SMPS nanoparticle counters were utilized for measuring ultrafine particles in two sampling lines of the test filtering facepiece respirator—one from inside the respirator and one from outside the respirator. Particle size distributions were characterized using the NanoScan data collected from outside of the respirator. Two models of N95 respirators were tested—foldable and pleated. Collected data indicate that penetration of all categories of ultrafine particles can exceed 5% and smaller ultrafine particles of <36.5 nm size generally penetrated least. Foldable N95 filtering facepiece respirators were found to be less efficient than pleated N95 respirators in filtering nanoparticles mostly at the soil moving site and the wooden building frameworks construction site. Upon charge neutralization by isopropanol treatment, the ultrafine particles of larger sizes penetrated more compared to particles of smaller sizes. Our findings, therefore, indicate that N95 filtering facepiece respirators may not provide desirable 95% protection for most categories of ultrafine particles and generally, 95% protection is achievable for smaller particles of 11.5 to 20.5 nm sizes. We also conclude that foldable N95 respirators are less efficient than pleated N95 respirators in filtering ultrafine particles, mostly in the soil moving site and the wooden building framework construction site.