Subjects -> HEALTH AND SAFETY (Total: 1562 journals)
    - CIVIL DEFENSE (22 journals)
    - DRUG ABUSE AND ALCOHOLISM (86 journals)
    - HEALTH AND SAFETY (740 journals)
    - WOMEN'S HEALTH (82 journals)

HEALTH FACILITIES AND ADMINISTRATION (390 journals)                  1 2 | Last

Showing 1 - 200 of 397 Journals sorted alphabetically
ACI Open     Open Access  
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Administration and Policy in Mental Health and Mental Health Services Research     Partially Free   (Followers: 22)
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi     Open Access   (Followers: 1)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 17)
Advances in Dual Diagnosis     Hybrid Journal   (Followers: 48)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Medical Education and Practice     Open Access   (Followers: 34)
Advances in Mental Health and Intellectual Disabilities     Hybrid Journal   (Followers: 89)
Advances in Nursing Science     Hybrid Journal   (Followers: 43)
Advances in Simulation     Open Access   (Followers: 7)
African Journal of Primary Health Care & Family Medicine     Open Access   (Followers: 6)
AIDS and Behavior     Hybrid Journal   (Followers: 18)
American Journal of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 48)
American Journal of Managed Care     Full-text available via subscription   (Followers: 13)
Analytical Methods     Full-text available via subscription   (Followers: 14)
Anthropologie et santé     Open Access   (Followers: 5)
Applied Clinical Informatics     Hybrid Journal   (Followers: 5)
Applied Health Economics and Health Policy     Full-text available via subscription   (Followers: 24)
Applied Research in Quality of Life     Hybrid Journal   (Followers: 13)
Archives of Public Health     Open Access   (Followers: 13)
Asian Journal of Health     Open Access   (Followers: 4)
Australasian Journal of Paramedicine     Open Access   (Followers: 7)
Australian and New Zealand Journal of Public Health     Hybrid Journal   (Followers: 17)
Australian Health Review     Hybrid Journal   (Followers: 7)
Australian Journal of Primary Health     Hybrid Journal  
Australian Journal of Rural Health     Hybrid Journal   (Followers: 18)
Autism     Hybrid Journal   (Followers: 350)
Avicenna     Open Access   (Followers: 3)
Balint Journal     Hybrid Journal   (Followers: 2)
Bereavement Care     Hybrid Journal   (Followers: 13)
BJR     Hybrid Journal   (Followers: 21)
BMC Medical Informatics and Decision Making     Open Access   (Followers: 25)
BMC Oral Health     Open Access   (Followers: 7)
BMJ Leader     Hybrid Journal  
BMJ Quality & Safety     Hybrid Journal   (Followers: 69)
BMJ Supportive & Palliative Care     Hybrid Journal   (Followers: 50)
British Journal of Healthcare Assistants     Full-text available via subscription   (Followers: 33)
British Journal of Healthcare Management     Full-text available via subscription   (Followers: 19)
British Journal of Hospital Medicine     Full-text available via subscription   (Followers: 18)
British Journal of Nursing     Full-text available via subscription   (Followers: 297)
British Journal of School Nursing     Full-text available via subscription   (Followers: 14)
Bruce R Hopkins' Nonprofit Counsel     Hybrid Journal   (Followers: 2)
Building Better Healthcare     Full-text available via subscription   (Followers: 1)
Canadian Nurse     Full-text available via subscription   (Followers: 8)
Cardiac Electrophysiology Clinics     Full-text available via subscription   (Followers: 1)
Children and Schools     Hybrid Journal   (Followers: 8)
Chinese Medical Record English Edition     Hybrid Journal  
CIN : Computers Informatics Nursing     Hybrid Journal   (Followers: 11)
Clinical Audit     Open Access   (Followers: 4)
Clinics and Practice     Open Access  
Cognition, Technology & Work     Hybrid Journal   (Followers: 14)
Communication & Medicine     Hybrid Journal   (Followers: 5)
Community Based Medical Journal     Open Access  
Conflict and Health     Open Access   (Followers: 8)
Contemporary Nurse : A Journal for the Australian Nursing Profession     Hybrid Journal   (Followers: 7)
Critical Public Health     Hybrid Journal   (Followers: 26)
Culture, Health & Sexuality: An International Journal for Research, Intervention and Care     Hybrid Journal   (Followers: 17)
Current Opinion in Supportive and Palliative Care     Hybrid Journal   (Followers: 28)
Das Gesundheitswesen     Hybrid Journal   (Followers: 10)
Death Studies     Hybrid Journal   (Followers: 22)
Dental Nursing     Full-text available via subscription   (Followers: 3)
Disaster Health     Hybrid Journal   (Followers: 1)
DoctorConsult - The Journal. Wissen für Klinik und Praxis     Full-text available via subscription  
Droit, Déontologie & Soin     Full-text available via subscription   (Followers: 3)
E-Health Telecommunication Systems and Networks     Open Access   (Followers: 2)
East and Central African Journal of Surgery     Open Access  
Éducation thérapeutique du patient     Full-text available via subscription   (Followers: 1)
eGEMs     Open Access  
Emergency Radiology     Hybrid Journal   (Followers: 10)
Enfermería Clínica     Full-text available via subscription   (Followers: 3)
Epidemiologic Methods     Hybrid Journal   (Followers: 4)
Ergonomics     Hybrid Journal   (Followers: 24)
Escola Anna Nery     Open Access   (Followers: 1)
Ethnicity & Health     Hybrid Journal   (Followers: 15)
European Journal of Public Health     Hybrid Journal   (Followers: 27)
European Journal of Work and Organizational Psychology     Hybrid Journal   (Followers: 35)
European Research in Telemedicine / La Recherche Européenne en Télémédecine     Full-text available via subscription   (Followers: 2)
Evaluation & the Health Professions     Hybrid Journal   (Followers: 11)
Evidence-Based Nursing     Hybrid Journal   (Followers: 74)
Evolution, Medicine, and Public Health     Open Access   (Followers: 12)
Expert Opinion on Therapeutic Patents     Hybrid Journal   (Followers: 12)
Families, Systems, & Health     Full-text available via subscription   (Followers: 9)
Family Practice Management     Full-text available via subscription   (Followers: 5)
Focus on Health Professional Education : A Multi-disciplinary Journal     Full-text available via subscription   (Followers: 7)
Frontiers in Public Health Services and Systems Research     Open Access   (Followers: 5)
Future Hospital Journal     Full-text available via subscription   (Followers: 2)
Gastrointestinal Nursing     Full-text available via subscription   (Followers: 5)
Geron     Full-text available via subscription  
Global & Regional Health Technology Assessment     Open Access   (Followers: 1)
Global Health Action     Open Access   (Followers: 12)
Global Health Management Journal (GHMJ)     Open Access   (Followers: 1)
Global Health Research and Policy     Open Access   (Followers: 4)
Global Journal of Hospital Administration     Open Access   (Followers: 1)
Global Public Health: An International Journal for Research, Policy and Practice     Hybrid Journal   (Followers: 21)
Globalization and Health     Open Access   (Followers: 9)
Handbook of Practice Management     Hybrid Journal   (Followers: 2)
Health     Open Access   (Followers: 5)
Health & Social Care In the Community     Hybrid Journal   (Followers: 54)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 16)
Health and Interprofessional Practice     Open Access   (Followers: 6)
Health and Technology     Hybrid Journal   (Followers: 4)
Health Care Analysis     Hybrid Journal   (Followers: 17)
Health Care Management Review     Hybrid Journal   (Followers: 16)
Health Economics     Hybrid Journal   (Followers: 59)
Health Expectations     Open Access   (Followers: 16)
Health Facilities Management     Free   (Followers: 10)
Health Informatics Journal     Hybrid Journal   (Followers: 28)
Health Information : Jurnal Penelitian     Open Access   (Followers: 5)
Health Information Science and Systems     Open Access   (Followers: 4)
Health Policy and Management     Open Access   (Followers: 7)
Health Policy and Planning     Hybrid Journal   (Followers: 27)
Health Professions Education     Open Access   (Followers: 3)
Health Promotion International     Hybrid Journal   (Followers: 28)
Health Promotion Practice     Hybrid Journal   (Followers: 18)
Health Psychology     Full-text available via subscription   (Followers: 62)
Health Psychology Review     Hybrid Journal   (Followers: 46)
Health Reform Observer : Observatoire des Réformes de Santé     Open Access   (Followers: 2)
Health Research Policy and Systems     Open Access   (Followers: 16)
Health Science Journal of Indonesia     Open Access   (Followers: 2)
Health Services Research and Managerial Epidemiology     Open Access   (Followers: 3)
Health, Risk & Society     Hybrid Journal   (Followers: 14)
Healthcare : The Journal of Delivery Science and Innovation     Full-text available via subscription   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Management Forum     Hybrid Journal   (Followers: 8)
Healthcare Policy / Politiques de Santé     Full-text available via subscription   (Followers: 5)
Healthcare Quarterly     Full-text available via subscription   (Followers: 10)
Healthcare Risk Management     Full-text available via subscription   (Followers: 5)
HealthcarePapers     Full-text available via subscription   (Followers: 2)
Hispanic Health Care International     Full-text available via subscription  
História, Ciências, Saúde - Manguinhos     Open Access   (Followers: 2)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 3)
Hospital     Open Access   (Followers: 3)
Hospital a Domicilio     Open Access  
Hospital Medicine Clinics     Full-text available via subscription   (Followers: 2)
Hospital Peer Review     Full-text available via subscription   (Followers: 1)
Hospital Pharmacy     Partially Free   (Followers: 18)
Hospital Practice     Hybrid Journal   (Followers: 2)
Hospital Practices and Research     Open Access  
Housing, Care and Support     Hybrid Journal   (Followers: 9)
Human Factors : The Journal of the Human Factors and Ergonomics Society     Full-text available via subscription   (Followers: 39)
Human Resources for Health     Open Access   (Followers: 12)
ICU Director     Hybrid Journal  
Ids Practice Papers     Hybrid Journal  
IEEE Pulse     Hybrid Journal   (Followers: 5)
IISE Transactions on Healthcare Systems Engineering     Hybrid Journal   (Followers: 2)
Independent Nurse     Full-text available via subscription   (Followers: 3)
Index de Enfermeria     Open Access   (Followers: 7)
Indian Journal of Public Health     Open Access   (Followers: 1)
Informatics for Health and Social Care     Hybrid Journal   (Followers: 10)
Innovation and Entrepreneurship in Health     Open Access   (Followers: 1)
INQUIRY : The Journal of Health Care Organization, Provision, and Financing     Open Access   (Followers: 1)
Interface - Comunicação, Saúde, Educação     Open Access   (Followers: 1)
International Archives of Health Sciences     Open Access  
International Journal for Equity in Health     Open Access   (Followers: 9)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 41)
International Journal of Care Coordination     Hybrid Journal   (Followers: 7)
International Journal of Computers in Healthcare     Hybrid Journal   (Followers: 3)
International Journal of Electronic Healthcare     Hybrid Journal   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 27)
International Journal of Health Administration and Education Congress (Sanitas Magisterium)     Open Access  
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 15)
International Journal of Health Economics and Management     Hybrid Journal   (Followers: 12)
International Journal of Health Governance     Hybrid Journal   (Followers: 27)
International Journal of Health Planning and Management     Hybrid Journal   (Followers: 6)
International Journal of Health Sciences Education     Open Access   (Followers: 2)
International Journal of Health Services Research and Policy     Open Access   (Followers: 1)
International Journal of Health System and Disaster Management     Open Access   (Followers: 3)
International Journal of Healthcare     Open Access   (Followers: 1)
International Journal of Healthcare Technology and Management     Hybrid Journal   (Followers: 7)
International Journal of Hospital Research     Open Access  
International Journal of Human Factors and Ergonomics     Hybrid Journal   (Followers: 20)
International Journal of Human Rights in Healthcare     Hybrid Journal   (Followers: 5)
International Journal of Medicine and Public Health     Open Access   (Followers: 6)
International Journal of Migration, Health and Social Care     Hybrid Journal   (Followers: 12)
International Journal of Occupational and Environmental Medicine, The     Open Access   (Followers: 16)
International Journal of Palliative Nursing     Full-text available via subscription   (Followers: 32)
International Journal of Positive Behavioural Support     Full-text available via subscription   (Followers: 38)
International Journal of Prisoner Health     Hybrid Journal   (Followers: 14)
International Journal of Privacy and Health Information Management     Full-text available via subscription   (Followers: 3)
International Journal of Public and Private Healthcare Management and Economics     Full-text available via subscription   (Followers: 4)
International Journal of Qualitative Studies on Health and Well-Being     Open Access   (Followers: 22)
International Journal of Reliable and Quality E-Healthcare     Full-text available via subscription   (Followers: 1)
International Journal of Research in Nursing     Open Access   (Followers: 12)
International Journal of Technology Assessment in Health Care     Hybrid Journal   (Followers: 16)
International Journal of Telemedicine and Clinical Practices     Hybrid Journal   (Followers: 5)
International Journal of Telework and Telecommuting Technologies     Full-text available via subscription  
International Journal of Therapy and Rehabilitation     Full-text available via subscription   (Followers: 42)
International Journal of User-Driven Healthcare     Full-text available via subscription   (Followers: 1)
International Journal on Disability and Human Development     Hybrid Journal   (Followers: 23)
Irish Journal of Paramedicine     Open Access   (Followers: 3)
JAAPA     Hybrid Journal   (Followers: 3)
Jaffna Medical Journal     Open Access  
Joint Commission Journal on Quality and Patient Safety     Hybrid Journal   (Followers: 41)
Journal for Healthcare Quality     Hybrid Journal   (Followers: 28)
Journal of Advanced Nursing     Hybrid Journal   (Followers: 251)
Journal of Advances in Medical Education & Professionalism     Open Access   (Followers: 10)
Journal of Aging and Health     Hybrid Journal   (Followers: 27)
Journal of Ambulatory Care Management, The     Hybrid Journal   (Followers: 4)
Journal of Applied Arts and Health     Hybrid Journal   (Followers: 1)

        1 2 | Last

Similar Journals
Journal Cover
International Journal of Environmental Research and Public Health
Journal Prestige (SJR): 0.735
Citation Impact (citeScore): 2
Number of Followers: 27  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1660-4601 - ISSN (Online) 1661-7827
Published by MDPI Homepage  [233 journals]
  • IJERPH, Vol. 17, Pages 4454: Eye Injuries Epidemiology Description in a
           Working Population over 10 Years in Spain

    • Authors: Sergio Martín-Prieto, Cristina Álvarez-Peregrina, Israel Thuissard-Vassallo, Carlos Catalina-Romero, Eva Calvo-Bonacho, César Villa-Collar, Miguel Ángel Sánchez-Tena
      First page: 4454
      Abstract: Background: Several studies show a high percentage of eye injuries related to work compared to other origins. However, there are few studies that describe work-related eye injuries. Methods: A descriptive, retrospective, and longitudinal study that describes the characteristics of work-related eye injuries in a group of insured workers. Eye injuries were classified according to the International Classification of Diseases (ICD-10) and analyzed over 10 years (2008–2018). Results: Keratitis and conjunctivitis were the most prevalent injuries (26,674 (53.1%) and 15,906 (31.6%)). Keratitis and conjunctivitis also show the highest percentage of injury incidence per 100,000 insured workers in both sexes, any age group, and any occupation. The analysis of the cumulative percentage change and average annual percent change in incidences over ten years shows a decrease in the incidences of all injuries, except for other disorders of the eye and anexa. Conclusions: Most of the work-related eye injuries affect the most exposed eye structures in any line of work: the cornea and conjunctiva. Suitable protection of these eye structures will decrease the number of cases of work-related eye injuries.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124454
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4455: Measurement of Factors Affecting the
           Perception of People with Disabilities in the Workplace

    • Authors: Urszula Załuska, Alicja Grześkowiak, Cyprian Kozyra, Dorota Kwiatkowska-Ciotucha
      First page: 4455
      Abstract: The issue of employing people with disabilities is crucial from both a social and economic perspective, and is often influenced by the social perception of this group of people. In this article, we attempted to examine attitudes towards the disabled in eight European countries by using one of the most popular tools that measures the perception of such people in everyday life—the Attitudes to Disability Scale (ADS) developed by the WHOQOL Group. We checked the general attitude towards disability according to the ADS scale and the specific perception of disability in the workplace using a scale created ad hoc. The research was conducted in 2019 using the CAWI (computer-assisted web interview) method on representative samples of Internet users, whereas the analysis methods included the measurement reliability analysis, confirmatory factor analysis (CFA) and structural equation modelling (SEM). The obtained results allow for the acceptance of the measurement model of the ADS scale in the societies of the analyzed countries. No significant differences were found between models created for people with a disability experience (a group from the WHOQOL Group research) and without such experience. The measurement using the original ADS scale factor structure is of good reliability, whereas CFA is of good fit. We also examined the impact of ADS scale factors on the perception of people with disabilities in the workplace using the SEM model, and obtained good fit of the model. The results show that the dimensions of perception, such as inclusion, discrimination and prospects, affect the evaluation of people with disabilities in the workplace.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124455
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4456: An Exploratory Research of 18 Years on the
           Economic Burden of Diabetes for the Romanian National Health Insurance

    • Authors: Claudiu Morgovan, Smaranda Adina Cosma, Madalina Valeanu, Anca Maria Juncan, Luca Liviu Rus, Felicia Gabriela Gligor, Anca Butuca, Delia Mirela Tit, Simona Bungau, Steliana Ghibu
      First page: 4456
      Abstract: The prevalence of diabetes mellitus (DM) rises constantly each year worldwide. Because of that, the funds allocated for the DM treatment have increased over time. Regarding the number of DM cases, Romania is among the top ten countries in Europe. Based on the National Diabetes Programme (NDP), antidiabetic drugs and other expenditures (Self-monitoring blood glucose (SMBG) test, HbA1c, insulin pumps/insulin pumps supplies) are free of charge. This programme has undergone many changes in drugs supply, in the last two decades: re-organizing the NDP, authorization of new molecules with high prices (e.g., SGLT-2 inhibitors, etc.) or new devices (e.g., insulin pumps, etc.) The main purpose of this study is to identify and analyse the impact of the DM costs on the Romanian health budget and to highlight the evolution of these costs. A retrospective longitudinal research on the official data regarding the DM costs from 2000 to 2017 was performed. The DM funds (DMF) were adjusted with the inflation rate. In this period, the average share of DMF in the total funds allocated for health programmes was 21.3 ± 3.4%, and DMF average growth rate was 25.4% (r = 0.488, p = 0.047). On the other hand, the DMF increased more than 14 times, in spite of the patients’ number having increased only about 2.5 times. Referring to the structure of DMF, the mean value of the antidiabetic drugs cost was of 96,045 ± 67,889 thousand EUR while for other expenditures it was of 11,530 ± 7922 thousand EUR (r = 0.945, p < 0.001). Between 2008 and 2017, the total DMF was 181,252 ± 74,278 thousand EUR/year. Moreover, the average patients’ number was 667,384 ± 94,938 (r = 0.73, p = 0.016), and the cost of treatment was 215 ± 36 EUR/patient/year. Even if the cost is rising, the correct and optimal treatment is a main condition for the diabetic patient’s health and for the prevention of its complications, which have multiple socio-economic repercussions.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124456
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4457: Positive Youth Development and Adolescent
           Depression: A Longitudinal Study Based on Mainland Chinese High School

    • Authors: Zheng Zhou, Daniel T.L. Shek, Xiaoqin Zhu, Diya Dou
      First page: 4457
      Abstract: There are several limitations of the scientific literature on the linkage between positive youth development (PYD) attributes and adolescent psychological morbidity. First, longitudinal studies in the field are limited. Second, few studies have used validated PYD measures to explore the related issues. Third, few studies have used large samples. Fourth, limited studies have been conducted in mainland China. In this study, we conducted a longitudinal study using two waves of data collected from 2648 junior high school students in mainland China. In each wave, participants responded to a validated PYD scale (Chinese Positive Youth Development Scale: CPYDS) and other measures of well-being, including the 20-item Centre for Epidemiologic Studies Depression Scale (CES-D). After controlling for the background demographic variables, different measures of CPYDS (cognitive–behavioral competence, prosocial attributes, general positive youth development qualities, positive identity, and overall PYD qualities) were negatively associated with CES-D scores in Wave 1 and Wave 2. Longitudinal analyses also revealed that PYD measures in Wave 1 negatively predicted Wave 2 depression scores and the changes over time. The present findings highlight the protective role of PYD attributes in protecting adolescents from depression.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124457
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4458: Biomarkers Facilitate the Assessment of
           Prognosis in Critically Ill Patients with Primary Brain Injury: A Cohort

    • Authors: Izabela Duda, Agnieszka Wiórek, Łukasz J. Krzych
      First page: 4458
      Abstract: Primary injuries to the brain are common causes of hospitalization of patients in intensive care units (ICU). The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system is widely used for prognostication among critically ill subjects. Biomarkers help to monitor the severity of neurological status. This study aimed to identify the best biomarker, along with APACHE II score, in mortality prediction among patients admitted to the ICU with the primary brain injury. This cohort study covered 58 patients. APACHE II scores were assessed 24 h post ICU admission. The concentrations of six biomarkers were determined, including the C-reactive protein (CRP), the S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase 9 (MMP-9), and tissue inhibitor of metalloproteinase 1 (TIMP-1), using commercially available ELISA kits. The biomarkers were specifically chosen for this study due to their established connection to the pathophysiology of brain injury. In-hospital mortality was the outcome. Median APACHE II was 18 (IQR 13–22). Mortality reached 40%. Median concentrations of the CRP, NGAL, S100B, and NSE were significantly higher in deceased patients. S100B (AUC = 0.854), NGAL (AUC = 0.833), NSE (AUC = 0.777), and APACHE II (AUC = 0.766) were the best independent predictors of mortality. Combination of APACHE II with S100B, NSE, NGAL, and CRP increased the diagnostic accuracy of mortality prediction. MMP and TIMP-1 were impractical in prognostication, even after adjustment for APACHE II score. S100B protein and NSE seem to be the best predictors of compromised outcome among critically ill patients with primary brain injuries and should be assessed along with the APACHE II calculation after ICU admission.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124458
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4459: Relation between Perceived Barrier Profiles,
           Physical Literacy, Motivation and Physical Activity Behaviors among
           Parents with a Young Child

    • Authors: Amy S. Ha, Wai Chan, Johan Y. Y. Ng
      First page: 4459
      Abstract: Objectives: to reveal distinct subgroups of parents by their perception of 6 types of physical activity barriers and challenges (i.e., lack of time, poor health, lack of company, lack of facilities, childcare responsibility, lack of motivation), and examine its relation with related constructs. Design: cross-sectional survey data. Method: the sample consisted of 424 parents who had at least 1 child of primary school age. Latent profile analysis was conducted to identify latent subgroups within participants. Group differences on physical literacy, autonomous motivation, and self-report physical activity (PA) levels were explored. Results: a four-profile solution was obtained from latent profile analysis, labelled as: “Struggling” (29.0%), “Family burden” (41.3%), “Lazy” (13.0%), and “Barriers free” (16.7%). The “Barriers free” profile experienced the least difficulties with physical activity, but the “Struggling” profile suffered the most severe barriers and challenges. “Family burden” and “Lazy” profiles demonstrated qualitative differences on one or two given challenges. Significant group differences on physical literacy, autonomous motivation, and PA levels were found, showing the “Barriers free” profile as the most robust and adaptive group of parents. Conclusions: the findings suggest that it is common for a substantial portion of parents to experience multiple barriers and challenges to a relatively high degree. Intervention on raising parent’s physical literacy to reduce barriers and sustain their motivation may be a target for intervention.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124459
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4460: Daily and Seasonal Variation in Light
           Exposure among the Old Order Amish

    • Authors: Ellen E. Lee, Ameya Amritwar, L. Elliot Hong, Iqra Mohyuddin, Timothy Brown, Teodor T. Postolache
      First page: 4460
      Abstract: Exposure to artificial bright light in the late evening and early night, common in modern society, triggers phase delay of circadian rhythms, contributing to delayed sleep phase syndrome and seasonal affective disorder. Studying a unique population like the Old Order Amish (OOA), whose lifestyles resemble pre-industrial societies, may increase understanding of light’s relationship with health. Thirty-three participants (aged 25–74, mean age 53.5; without physical or psychiatric illnesses) from an OOA community in Lancaster, PA, were assessed with wrist-worn actimeters/light loggers for at least 2 consecutive days during winter/spring (15 January–16 April) and spring/summer (14 May–10 September). Daily activity, sleep–wake cycles, and their relationship with light exposure were analyzed. Overall activity levels and light exposure increased with longer photoperiod length. While seasonal variations in the amount and spectral content of light exposure were equivalent to those reported previously for non-Amish groups, the OOA experienced a substantially (~10-fold) higher amplitude of diurnal variation in light exposure (darker nights and brighter days) throughout the year than reported for the general population. This pattern may be contributing to lower rates of SAD, short sleep, delayed sleep phase, eveningness, and metabolic dysregulation, previously reported among the OOA population.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124460
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4461: Who or What Influences the Individuals’
           Decision-Making Process Regarding Vaccinations'

    • Authors: Hanna Czajka, Szymon Czajka, Paweł Biłas, Paulina Pałka, Szczepan Jędrusik, Anna Czapkiewicz
      First page: 4461
      Abstract: Thanks to vaccines, many people are not exposed to the risks associated with vaccine-preventable diseases (VPDs). This, however, results in growing popularity of antivaccine movements and affects global and local epidemiological situation. Vaccine hesitancy has become a significant problem not only for epidemiologists but also for practitioners. Fortunately, the hesitant group seems to be vulnerable to intervention, and studies indicate that these patients can be persuaded to undergo vaccinations. The aim of the present study was to determine the factors most strongly affecting vaccination-related attitudes and decisions. An anonymous, self-administered survey consisting of demographic data and single select multiple-choice questions regarding vaccination was conducted. The voluntary study included secondary school pupils, medical and nonmedical students, healthcare professionals, hospital and clinic patients as well as parents. A total of 7950 survey forms were distributed between January 2018 and June 2019 in south-eastern Poland. A total of 6432 respondents (80.2%) completed a questionnaire that was eligible for analysis. The positive attitude toward vaccination was significantly affected by older age, by the fact of obtaining information on vaccinations from a physician, this information’s higher quality (assessed in school grade scale), higher level of knowledge on vaccines and by the fact of denying the association between vaccination and autism in children (p < 0.001). The probability of supporting vaccinations was almost eight-fold lower among respondents believing the vaccine–autism relationship. Chance of supporting vaccination doubled in the group with a higher knowledge level. The individuals not provided with expert information on vaccination were twice as often unconvinced. Age, education and having children significantly affected the attitude toward influenza immunization (p < 0.001). Older, better educated respondents and those having children were more positive about vaccinations. The medical community still exert decisive effects on attitudes toward vaccinations. High-quality information provided by them is of great importance. Skillful and competent provision of evidence-based information disproving the myth about vaccine–autism connection and proper education of medical staff is essential in molding positive attitudes toward vaccinations.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124461
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4462: Identifying Who Improves or Maintains Their
           Food Literacy Behaviours after Completing an Adult Program

    • Authors: Andrea Begley, Ellen Paynter, Lucy Butcher, Vanessa Bobongie, Satvinder S. Dhaliwal
      First page: 4462
      Abstract: Food Sensations for Adults is a free four-week nutrition and cooking program that teaches low- to middle-income individuals food literacy. This research aimed to compare demographic characteristics of participants who completed the program’s follow-up questionnaire three months after program completion and assess whether food literacy and dietary behaviour changes were improved or maintained. Statistical analysis methods used factor scores of the plan and manage, selection, and preparation domains to examine mean self-reported changes in food literacy. Tertile stratification methods calculated changes in participants who had low, middle, and high end-of-program food literacy scores, and multivariable regression analysis explored the associations. The follow-up results (n = 621) demonstrated a statistically significant factor score increase in plan and manage (3%) and selection (7.2%) domain scores, and a decrease in the preparation score (3.1%), and serves of consumed vegetables (7.9%), but were still significantly higher than at the start of the program. At follow-up, participants with low food literacy at the program end significantly improved their follow-up domain scores for plan and manage (60%) and selection (73.3%), and participants with moderate or high food literacy at the program end maintained their follow-up scores. A food literacy program can support adults to improve and maintain their food literacy behaviours and maintain dietary behaviour change; therefore, strategies to support this continued change must be considered.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124462
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4463: Children Witnessing Domestic Violence in the
           Voice of Health and Social Professionals Dealing with Contrasting Gender

    • Authors: Stefania Carnevale, Immacolata Di Napoli, Ciro Esposito, Caterina Arcidiacono, Fortuna Procentese
      First page: 4463
      Abstract: Witnessing domestic violence (WDV) is recognized by the Istanbul Convention as psychological abuse that has dramatic consequences on the psychophysical health of children. Therefore, professionals who form the support network for WDV victims play a very fundamental role. In order to draw up useful guidelines for services dealing with WDV, and to give children more awareness of supportive settings, this study analyzes WDV in the perception of health and welfare professionals to enhance their skills and strategies for contrasting gender violence. Sixteen Neapolitan specialists dealing with WDV children were interviewed. A theoretical intentional sampling was used. Narrative focused interviews were carried out, transcribed verbatim and analyzed through the grounded theory methodology, using the ATLAS.ti 8 software (Scientific Software Development GmbH, Berlin, Germany). We assigned 319 codes and grouped these into 10 categories and 4 macro-categories. The analysis of the texts led to the definition of the core category as “The Crystal Fortress”. It summarizes the image of the WDV children as described by the professionals working in contrasting domestic violence. In this structure the parental roles of protection and care (fortress) are suspended and everything is extremely rigid, fragile and always at risk of a catastrophe. It also symbolizes the difficult role of health professionals in dealing with such children and their families. For WDV children, protective factors guarantee solid development and supportive settings help them to learn proper emotional responsiveness and expressiveness and to develop their skills in talking with adults while avoiding negative consequences.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124463
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4464: Urgent Need for Adolescent Physical Activity
           Policies and Promotion: Lessons from “Jeeluna”

    • Authors: Omar J. Baqal, Hassan Saleheen, Fadia S. AlBuhairan
      First page: 4464
      Abstract: Physical inactivity is a growing concern in Kingdom of Saudi Arabia (KSA) and globally. Data on physical activity (PA) trends, barriers, and facilitators among adolescents in KSA are scarce. This study aims to identify PA trends amongst adolescents in KSA and associated health and lifestyle behaviors. Data from “Jeeluna”, a national study in KSA involving around 12,500 adolescents, were utilized. School students were invited to participate, and a multistage sampling procedure was used. Data collection included a self-administered questionnaire, anthropometric measurements, and blood sampling. Adolescents who performed PA for at least one day per week for >30 min each day were considered to “engage in PA”. Mean age of the participants was 15.8 ± 0.8 years, and 51.3% were male. Forty-four percent did not engage in PA regularly. Only 35% engaged in PA at school, while 40% were not offered PA at school. Significantly more 10–14-year old than 15–19-year-old adolescents and more males than females engaged in PA (<0.01). Mental health was better in adolescents who engaged in PA (<0.01). Adolescents who engaged in PA were more likely to eat healthy food and less likely to live a sedentary lifestyle (<0.01). It is imperative that socio-cultural and demographic factors be taken into consideration during program and policy development. This study highlights the urgent need for promoting PA among adolescents in KSA and addressing perceived barriers, while offering a treasure of information to policy and decision makers.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124464
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4465: Gamification in Physical Education:
           Evaluation of Impact on Motivation and Academic Performance within Higher

    • Authors: Alberto Ferriz-Valero, Ove Østerlie, Salvador García Martínez, Miguel García-Jaén
      First page: 4465
      Abstract: Gamification is an innovative pedagogical approach to addressing problems related to social behaviour, student motivation and academic performance at different educational stages. Therefore, this research aimed to analyse its impact on the motivations and academic performances of university students. The research was carried out in the training of future teachers specialising in physical education during two academic courses. In total, 127 students participated in the study, divided into a gamified experimental group (n = 62) and a control group (n = 65). The participants completed a questionnaire to assess motivation in physical education before and after the intervention and performed a final exam to assess academic performance. The results indicated an increase in external regulation in the experimental group only. Furthermore, this group achieved significantly better academic performance. The findings of this study suggest that gamified implementation is beneficial for academic performance at the university stage, even though intrinsic motivation does not change. Furthermore, the nature of rewards or punishments, as characteristic of this pedagogical approach, could play an important role in the expected results, since external regulation increased significantly after the intervention.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124465
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4466: Challenges Affecting Access to Health and
           Social Care Resources and Time Management among Parents of Children with
           Rett Syndrome: A Qualitative Case Study

    • Authors: Javier Güeita-Rodriguez, Pilar Famoso-Pérez, Jaime Salom-Moreno, Pilar Carrasco-Garrido, Jorge Pérez-Corrales, Domingo Palacios-Ceña
      First page: 4466
      Abstract: Rare diseases face serious sustainability challenges regarding the distribution of resources geared at health and social needs. Our aim was to describe the barriers experienced by parents of children with Rett Syndrome for accessing care resources. A qualitative case study was conducted among 31 parents of children with Rett syndrome. Data were collected through in-depth interviews, focus groups, researchers’ field notes and parents’ personal documents. A thematic analysis was performed and the Standards for Reporting Qualitative Research (SRQR) guidelines were followed. Three main themes emerged from the data: (a) essential health resources; (b) bureaucracy and social care; and (c) time management constraints. Parents have difficulties accessing appropriate health services for their children. Administrative obstacles exist for accessing public health services, forcing parents to bear the financial cost of specialized care. Time is an essential factor, which conditions the organization of activities for the entire family. Qualitative research offers insight into how parents of children with Rett syndrome experience access to resources and may help improve understanding of how Rett syndrome impacts the lives of both the children and their parents.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-21
      DOI: 10.3390/ijerph17124466
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4467: Mutation in ROBO3 Gene in Patients with
           Horizontal Gaze Palsy with Progressive Scoliosis Syndrome: A Systematic

    • Authors: Elena Pinero-Pinto, Verónica Pérez-Cabezas, Cristina Tous-Rivera, José-María Sánchez-González, Carmen Ruiz-Molinero, José-Jesús Jiménez-Rejano, María-Luisa Benítez-Lugo, María Carmen Sánchez-González
      First page: 4467
      Abstract: Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare, inherited disorder characterized by a congenital absence of conjugate horizontal eye movements with progressive scoliosis developing in childhood and adolescence. Mutations in the Roundabout (ROBO3) gene located on chromosome 11q23–25 are responsible for the development of horizontal gaze palsy and progressive scoliosis. However, some studies redefined the locus responsible for this pathology to a 9-cM region. This study carried out a systematic review in which 25 documents were analyzed, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The search was made in the following electronic databases from January 1995 to October 2019: PubMed, Scopus, Web of Science, PEDRO, SPORT Discus, and CINAHL. HGPPS requires a multidisciplinary diagnostic approach, in which magnetic resonance imaging might be the first technique to suggest the diagnosis, which should be verified by an analysis of the ROBO3 gene. This is important to allow for adequate ocular follow up, apply supportive therapies to prevent the rapid progression of scoliosis, and lead to appropriate genetic counseling.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124467
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4468: Sexual Dysfunction in Young Women with Type 1

    • Authors: Edyta Cichocka, Michał Jagusiewicz, Janusz Gumprecht
      First page: 4468
      Abstract: Introduction: Sexual dysfunctions (SD) are chronic complications that can develop due to vascular complications or autonomic neuropathy. Additionally, such complications can be of hormonal, infectious or psychogenic etiology. Objectives: The aim of study was to assess the sexual function and acceptance of the chronic disease in young sexually active women with type 1 diabetes (T1DM). Materials and methods: A total of 169 female patients with T1DM completed two standardized questionnaires, the Female Sexual Function Index (FSFI) and the Acceptance of Illness Scale (AIS). Other medical data were collected from medical history. Results: The mean FSFI score was 27.96 ± 5.00, and the mean AIS score was 29.67 ± 8.28. The score < 26 points in FSFI was obtained by 28.7% of patients. Analysis of correlation between the FSFI and the AIS showed that the higher the score on the FSFI, the higher the score on the AIS. Patients who underwent regular physical activity (55%) had a significantly higher acceptance of the disease (p = 0.0026) and reported painful intercourse significantly less frequently (p = 0.01). The value of HbA1c in the study group was 7.31 ± 1.25%. Patients with poorer glycemic control (HbA1c > 8%) obtained significantly lower scores on the FSFI (p = 0.03), whereas no differences were found on the AIS. Diabetes-related complications were observed in 25.5% of patients. The presence of chronic complications did not affect the results of the FSFI or the AIS. Patients with diabetes and hypertension had poorer functioning in the sexual sphere and had significantly lower scores on the FSFI. Past or present history of depression was reported by 36% of patients and also negatively affected acceptance of diabetes (p = 0.0015). Patients who reported recurrent urinary tract infections (17%) achieved significantly lower scores on the FSFI (p = 0.03) and showed that sex-related pain was significantly more prevalent (p = 0.02). In the case of the statement related to the embarrassment of people around the patient due to diabetes, patients with lower scores complained of SD significantly more often (p = 0.0033). Past deliveries, the type of labor, the use of contraceptives or the number of sexual partners had no influence on the overall assessment in both scales. However, in terms of desire, women who had delivered obtained higher scores (p = 0.0021). Conclusion: SD in women with T1DM may result from diabetes-related complications, hormonal disorders or recurrent genital or urinary tract infections. However, they usually have a psychological basis due to the lack of acceptance of the problems related to the treatment of diabetes.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124468
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4469: Understanding the Phenomenon of
           Binge-Watching—A Systematic Review

    • Authors: Jolanta A. Starosta, Bernadetta Izydorczyk
      First page: 4469
      Abstract: Binge-watching is a relatively new behaviour pattern whose popularity has been increasing since 2013, ultimately to become one of the most popular ways of spending free time, especially among young people. However, there is still a dearth of research on this phenomenon. The aim of this study is to present the current understanding and psychological conditions of binge-watching, as provided in the research papers published between 2013 and 2020. This systematic review, including 28 articles, addresses different approaches to defining this behaviour, diverse motivations, personality traits, and risks of excessive binge-watching. Its results imply that there are two perspectives in understanding binge-watching. The first is related to entertainment, positive emotions, cognition, and spending free time. However, the second perspective emphasises the negative outcomes of excessive binge-watching and symptoms of behavioural addiction. There is undoubtedly a need for further research to be conducted on diversified populations to reach more profound understanding of binge-watching behaviour patterns.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124469
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4470: The Impact of Internet Usage and
           Knowledge-Intensive Activities on Households’ Healthcare Expenditures

    • Authors: Marco Benvenuto, Alexandru Avram, Francesco Vincenzo Sambati, Marioara Avram, Carmine Viola
      First page: 4470
      Abstract: This paper examines the impact of the internet usage and knowledge intensive activities on households’ healthcare expenditures Similarly, the paper aims to recognize and understand, from a value-creation perspective, the correlation between: internet access of households (IA), individuals frequently using the internet (IU), individuals searching on internet for health-related information (HI), payments made by households for healthcare (PHH), expressed as euro per inhabitant and employment in knowledge-intensive activities (KIA). The approach utilized in the present study consists of two steps. First, a theoretical framework was conducted to determine the existing relationship between major variables. Next, the Vector Autoregressive (VAR) approach was applied in a case study at European level to prove the three hypothesis we consider. By analyzing the connection between the major variables, a positive and long- lasting impulse response function was revealed, followed by an ascending trend. This suggests that a self-multiplying effect is being generated; and it reasonable to assume that the more individuals use the Internet, the more electronic acquisitions occur. We can thus reasonably conclude that the improvement of the internet usage and knowledge intensive activities on households’ healthcare expenditures process is strongly dependent on people’s capability. Improving IU and KIA is the new reading key in the decision-making process in health system approach.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124470
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4471: Bone Mineral Density of Femur and Lumbar and
           the Relation between Fat Mass and Lean Mass of Adolescents: Based on Korea
           National Health and Nutrition Examination Survey (KNHNES) from 2008 to

    • Authors: Aram Kim, Seunghui Baek, Seyeon Park, Jieun Shin
      First page: 4471
      Abstract: It is most important to reach the maximum bone density in the childhood period to prevent developing osteoporosis; it is widely known that increased body weight has a positive correlation with bone density and that even though both the fat mass and lean mass have a significant impact on bone density, the latter mass has more importance for adults. Therefore, the study analyzed to identify the relationship between bone density and both fat mass and lean mass of Korean adolescents. Subjects were chosen among 21,303 people from the Korea National Health and Nutrition Examination Survey (KNHNES) between 2008 and 2011 that took a bone density checkup; as a result, 1454 teenagers aged between 12 and 18 were selected. Data analysis was performed in SAS ver. 9.4 (SAS Institute Inc., Cary, NC, USA) following the KNHNES and the weighted complex sample analysis was conducted; body fat mass and lean mass were divided into quintile groups, and to figure out the differences in bone density that were analyzed in six models adjusted by body weight (kg) and walking (yes/no), muscle strengthening exercises (yes/no), nutrition (intake of ca (g), and serum vitamin D (ng/mL)). Then, the generalized linear model (GLM) and trend test were conducted for each gender with a significance level of 0.05. The bone density differences of fat mass and lean mass were analyzed. The result of Model 6 considering all correction variables is as follows; in the case of male adolescents, the total femur and lumbar spine showed a significant difference (F = 13.120, p < 0.001; F = 12.900, p < 0.001) for fat mass, and the trend test showed that the figures significantly decreased (β = −0.030, p < 0.001; −0.035, p < 0.001). Meanwhile, for lean mass, the total femur and lumbar spine had a significant difference (F = 16.740, p < 0.001; F = 20.590, p < 0.001) too, but the trend test showed a significant increase (β = 0.054, p < 0.001; 0.057, p < 0.001). In the case of female adolescents, the lumbar spine (F = 3.600, p < 0.05) for lean mass showed a significant difference, and it also significantly rose in the trend test too (β = 0.020, p < 0.01). To sum up the results, for male adolescents, the bone density differences for fat mass (FM) and lean mass (LM) all had significant differences, but for female adolescents, only the lumbar spine for LM showed such a result. Meanwhile, both genders showed that LM had a more positive impact on bone density than FM.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124471
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4472: Community Perceptions of a Multilevel
           Sanitation Behavior Change Intervention in Rural Odisha, India

    • Authors: Renee De Shay, Dawn L. Comeau, Gloria D. Sclar, Parimita Routray, Bethany A. Caruso
      First page: 4472
      Abstract: While latrine coverage is increasing in India, not all household members use their latrines. Cost-effective, culturally appropriate, and theory-informed behavior change interventions are necessary to encourage sustained latrine use by all household members. We qualitatively examined community perceptions of sanitation interventions broadly, along with specific impressions and spillover of community-level activities of the Sundara Grama latrine use behavior change intervention in rural Odisha, India. We conducted sixteen sex-segregated focus group discussions (n = 152) in three intervention and three nonintervention villages and thematically analyzed the data. We found Sundara Grama was well-received by community members and considered educative, but perceptions of impact on latrine use were mixed and varied by activity. Intervention recruitment challenges prevented some, such as women and households belonging to lower castes, from attending activities. Spillover occurred in one of two nonintervention villages, potentially due to positive relations within and between the nonintervention village and nearby intervention village. Community-level sanitation initiatives can be hindered by community divisions, prioritization of household sanitation over community cleanliness, and perceptions of latrine use as a household and individual issue, rather than common good. Community-centered sanitation interventions should assess underlying social divisions, norms, and perceptions of collective efficacy to adapt intervention delivery and activities.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124472
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4473: Development of a Prediction Model for
           Short-Term Success of Functional Treatment of Class II Malocclusion

    • Authors: Elisabetta Cretella Lombardo, Lorenzo Franchi, Giorgio Gastaldi, Veronica Giuntini, Roberta Lione, Paola Cozza, Chiara Pavoni
      First page: 4473
      Abstract: (1) Background: The nature of the changes that contribute to Class II correction with functional appliances is still controversial. A broad variation in treatment responses has been reported. The purpose of this study was to find cephalometric predictors for individual patient responsiveness to twin-block treatment in patients with Class II Division 1 malocclusion; (2) Methods: The study was performed on a sample of 39 pubertal patients (21 females, 18 males) treated with the twin block appliance. Lateral cephalograms were available at the start of the treatment (T1) and at the end of functional therapy (T2). The outcome variable was the T2–T1 change in the sagittal position of the soft tissue pogonion with respect to the vertical line perpendicular to the Frankfort plane and passing through point subnasale. The predictive variables were age, gender at T1, and all the cephalometric parameters measured T1. Forward stepwise linear regression with p value to enter 0.05 and p value to leave 0.10 was applied; (3) Results: The only significant predictive variable that was selected was the Co–Go–Me angle (p = 0.000); (4) Conclusions: A greater advancement of the soft tissue chin on the profile is expected with smaller pretreatment values of Co–Go–Me angle.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124473
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4474: Benefits of Physical Activity and Its
           Associations with Resilience, Emotional Intelligence, and Psychological
           Distress in University Students from Southern Spain

    • Authors: Silvia San Román-Mata, Pilar Puertas-Molero, José Luis Ubago-Jiménez, Gabriel González-Valero
      First page: 4474
      Abstract: This is a descriptive and cross-sectional study in a sample of 1095 university students from southern Spain. The aim was to identify the frequency of health-fulfilling physical activity engagement reported by participants. Sufficient physical activity was categorized according to whether participants ‘achieved minimum recommendations’ (≥150 min of moderate physical activity) or ‘did not achieve minimum recommendations’ (≤150 min of moderate physical activity). Participants were further categorized as: inactive (does not engage in physical activity or sport), engaging in physical activity that is not beneficial to health (≤300 min of moderate physical activity per week) and engaging in physical activity that is beneficial to health (≥300 min of moderate physical activity per week). Possible relationships with psychosocial factors and perceived psychological distress were explored. An ad hoc questionnaire was used to record the time in minutes of physical activity engagement per week. The Connor–Davidson Resilience Scale, the Trait Meta-mood Scale, and Kessler Psychological Distress Scale were also administered. Statically significant differences are shown between the three examined groups: physical inactivity and non-beneficial physical activity; physical inactivity and beneficial physical activity, and; non-beneficial physical activity and beneficial physical activity. Positive and direct correlations were seen with respect to resilience and understanding, and emotional regulation, in addition to negative associations with respect to psychological distress. In conclusion, the more individuals engage in beneficial physical activity, the greater their resilience and emotional management, and the lower their rates of psychological distress.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124474
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4475: Gratitude and Emotional Intelligence as
           Protective Factors against Cyber-Aggression: Analysis of a Mediation Model

    • Authors: Chamizo-Nieto, Rey, Pellitteri
      First page: 4475
      Abstract: Cyber-bullying is becoming an increasing school and health problem affecting adolescents worldwide. A number of studies have examined risk factors and protective factors in cyber-bullying situations and their consequences on the psychological well-being of adolescents. Gratitude and Emotional Intelligence (EI) are two personal resources that have been shown to have beneficial effects on the health and the social, personal and psychological functioning of young people. Nevertheless, little is known about these two variables in the context of cyber-bullying. The main purpose of this study was to examine the roles of gratitude and EI in cyber-aggression. Specifically, we hypothesised a mediational effect of gratitude in emotional intelligence-cyber-aggression link. A total of 1157 students aged 12–18 years (54.4% females) completed several questionnaires assessing gratitude (Gratitude Questionnaire; GQ-5), EI (Wong and Law’s Emotional Intelligence Scale; WLEIS-S) and cyber-bullying (European Cyberbullying Intervention Project Questionnaire; ECIPQ). The results showed expected significant associations between the studied variables. Moreover, the structural equation model analysis confirmed that EI dimensions were indirectly associated with cyber-aggression via gratitude, even when controlling for the effects of socio-demographic variables. These findings provide evidence on why those adolescents high in emotional intelligence are less aggressive in cyber-bullying context and suggest possibilities for gratitude interventions to reduce aggressive actions by electronic means among adolescents. The theoretical and practical implications are discussed.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124475
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4476: Examining the Moderation Effect of Political
           Trust on the Linkage between Civic Morality and Support for Environmental

    • Authors: Jae Young Lim, Kuk-Kyoung Moon
      First page: 4476
      Abstract: Climate change and pollution are threatening sustainable environments and human life. To mitigate and adapt to the effects of such threats, governments around the world need significant financial resources. Accordingly, this study focuses on which factors are associated with individuals’ support for taxation to protect the environment and pays special attention to the direct effects of civic morality and political trust, as well as their joint effects on support for environmental taxation. Ordered probit results with a sample size of 760 demonstrate that civic morality is positively associated with individuals’ support for environmental taxation; political trust works in the same way. More importantly, political trust moderates and enhances the linkage between civic morality and support for environmental taxation, demonstrating that it can serve as a powerful tool in a government’s efforts to protect the environment.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124476
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4477: Using Mind–Body Modalities via Telemedicine
           during the COVID-19 Crisis: Cases in the Republic of Korea

    • Authors: Chan-Young Kwon, Hui-Yong Kwak, Jong Woo Kim
      First page: 4477
      Abstract: The coronavirus disease 2019 (COVID-19) pandemic affected the world, and its deleterious effects on human domestic life, society, economics, and especially on human mental health are expected to continue. Mental health experts highlighted health issues this pandemic may cause, such as depression, anxiety, obsessive compulsive disorder, and post-traumatic stress disorder. Mind–body intervention, such as mindfulness meditation, has accumulated sufficient empirical evidence supporting the efficacy in improving human mental health states and the use for this purpose has been increasing. Notably, some of these interventions have already been tried in the form of telemedicine or eHealth. Korea, located adjacent to China, was exposed to COVID-19 from a relatively early stage, and today it is evaluated to have been successful in controlling this disease. “The COVID-19 telemedicine center of Korean medicine” has treated more than 20% of the confirmed COVID-19 patients in Korea with telemedicine since 9 March 2020. The center used telemedicine and mind–body modalities (including mindfulness meditation) to improve the mental health of patients diagnosed with COVID-19. In this paper, the telemedicine manual is introduced to provide insights into the development of mental health interventions for COVID-19 and other large-scale disasters in the upcoming new-normal era.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124477
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4478: Association of Pain, Severe Pain, and
           Multisite Pain with the Level of Physical Activity and Sedentary Behavior
           in Severely Obese Adults: Baseline Data from the DieTBra Trial

    • Authors: Carolina Rodrigues Mendonça, Matias Noll, Ana Paula dos Santos Rodrigues, Priscila Valverde de Oliveira Vitorino, Márcio de Almeida Mendes, Erika Aparecida Silveira
      First page: 4478
      Abstract: The study aimed to assess the prevalence of pain, severe pain, and pain in four or more regions associated with physical activity and sedentary behavior, as well as other associated factors in severely obese adults (Body Mass Index ≥ 35 kg/m2). Baseline data from the DieTBra Trial were analyzed. The outcome variables were pain (yes/no) and pain in four or more sites (yes/no), as identified by the Brazilian version of the Nordic Musculoskeletal Questionnaire, along with the presence of severe pain (yes/no), identified based on the Numerical Pain Rating Scale (≥8). The main independent variables were moderate to vigorous physical activity (MVPA), light physical activity, and sedentary behavior, assessed by triaxial accelerometry. The variables were analyzed using multiple hierarchical Poisson regression. In 150 individuals (men, 14.67%; and women, 85.33%), with a mean age of 39.6 ± 0.7 years, there was a high prevalence of pain (89.33%), severe pain (69.33%), and pain in four or more regions (53.33%). The associated factors were shorter MVPA time with pain (p = 0.010); arthritis/arthrosis (p = 0.007) and the use of muscle relaxants (p = 0.026) with severe pain; and economic class C (p = 0.033), and economic class D (p = 0.003), along with arthritis and arthrosis (p = 0.025) with pain in four or more sites. There were no significant associations between sedentary behavior and any of the three outcomes analyzed. These findings indicate that, in severely obese individuals, shorter MVPA time is associated with a higher prevalence of pain. Future studies on physical activity intervention may contribute to the reduction in the prevalence and severity of pain in adults with severe obesity.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124478
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4479: COVID-19-Related Factors Associated with
           Sleep Disturbance and Suicidal Thoughts among the Taiwanese Public: A
           Facebook Survey

    • Authors: Dian-Jeng Li, Nai-Ying Ko, Yi-Lung Chen, Peng-Wei Wang, Yu-Ping Chang, Cheng-Fang Yen, Wei-Hsin Lu
      First page: 4479
      Abstract: Coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of people’s lives all over the world. This Facebook survey study aimed to investigate the COVID-19-related factors that were associated with sleep disturbance and suicidal thoughts among members of the public during the COVID-19 pandemic in Taiwan. The online survey recruited 1970 participants through a Facebook advertisement. Their self-reported experience of sleep disturbance and suicidal thoughts in the previous week were collected along with a number of COVID-19-related factors, including level of worry, change in social interaction and daily lives, any academic/occupational interference, levels of social and specific support, and self-reported physical health. In total, 55.8% of the participants reported sleep disturbance, and 10.8% reported having suicidal thoughts in the previous week. Multiple COVID-19-related factors were associated with sleep disturbance and suicidal thoughts in the COVID-19 pandemic. Increased worry about COVID-19, more severe impact of COVID-19 on social interaction, lower perceived social support, more severe academic/occupational interference due to COVID-19, lower COVID-19-specified support, and poorer self-reported physical health were significantly associated with sleep disturbance. Less handwashing, lower perceived social support, lower COVID-19-specified support, poorer self-reported physical health, and younger age were significantly associated with suicidal thoughts. Further investigation is needed to understand the changes in mental health among the public since the mitigation of the COVID-19 pandemic.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124479
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4480: Sekentei as a Socio-Cultural Determinant of
           Cognitive Function among Older Japanese People: Findings from the NEIGE

    • Authors: Hiroshi Murayama, Shigeru Inoue, Takeo Fujiwara, Naoki Fukui, Yuichi Yokoyama, Yugo Shobugawa
      First page: 4480
      Abstract: Sekentei (social appearance) is a Japanese concept that describes a person’s sense of implicit societal pressure to conform to social norms. However, evidence of a relationship between sekentei and health outcomes is sparse. This study examined the association between sekentei and cognitive function among community-dwelling older Japanese people. Baseline data were obtained from the Neuron to Environmental Impact across Generations (NEIGE) study conducted in 2017; 526 randomly sampled community-dwelling individuals aged 65–84 years living in Tokamachi, Niigata Prefecture, Japan were analyzed. The 12-item Sekentei Scale was used to assess sekentei. Cognitive function levels were evaluated with the Japanese version of Mini-Mental State Examination (MMSE-J; ranging from 0–30). Approximately 10% and 25% had cognitive decline and mild cognitive impairment, respectively (MMSE-J scores of ≤23 and 24–26, respectively). Multinomial logistic regression analysis showed that both high and low levels of sekentei were associated with lower cognitive function, particularly mild cognitive impairment, after adjusting for sociodemographic factors, health behaviors, health conditions, and genetic factors. The current findings suggest that a moderate level of sekentei consciousness is beneficial for cognitive health, and that sekentei could be an important socio-cultural factor affecting cognitive function.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124480
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4481: Prevalence of Preoperative Anxiety and Its
           Relationship with Postoperative Pain in Foot Nail Surgery: A
           Cross-Sectional Study

    • Authors: Navarro-Gastón, Munuera-Martínez
      First page: 4481
      Abstract: Preoperative anxiety has been studied in different medical disciplines, but it is unknown in minor surgical procedures such as foot nail surgery. This study aimed to determine the prevalence of preoperative anxiety and postoperative pain in foot nail surgery. The validated Amsterdam preoperative anxiety and information scale (APAIS) was used to evaluate preoperative anxiety and the need for information in 155 patients undergoing foot nail surgery. In addition, a questionnaire was used to collect other variables such as age, sex and educational level. The verbal numeric scale was employed to value the postoperative pain after 24 h. Age and sex influenced (p < 0.05) preoperative anxiety, which had a prevalence of 22.6%. More than 43% of patients needed more information and this was correlated with anxiety (r = 0.629; p < 0.001). There was a significant difference when comparing the total anxiety between the group of participants who had more pain and that who had less pain (p < 0.001). The prevalence of anxiety was high in the participants of this study, being greater in young patients and in women. There was a deficit of information, increasing the level of preoperative anxiety, which in turn was related with greater postoperative pain.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124481
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4482: Effects of Gender and Age on Dietary Intake
           and Body Mass Index in Hypertensive Patients: Analysis of the Korea
           National Health and Nutrition Examination

    • Authors: Hyunju Dan, Jiyoung Kim, Oksoo Kim
      First page: 4482
      Abstract: Controlling weight and dietary intake are important for hypertensive patients to manage their blood pressure. However, the interaction effect of gender and age on weight and dietary intake is not well known. The aim of this study was to examine the main and interaction effects of age and gender on body mass index (BMI) and dietary intake in hypertensive patients. We analyzed data from 4287 participants with hypertension (1600 participants 45–64 years old and 2687 participants 65 years or older) who participated in the Korea National Health and Nutrition Examination Survey (2013–2016). Two-way ANOVAs were conducted to examine the main and interaction effects of age and gender on BMI and dietary intake. Gender and age had significant main effects on BMI, intake of energy, cholesterol, sodium, and potassium. However, both gender and age illustrated interaction effects on BMI (F = 8.398, p = 0.004), energy intake (F = 12.882, p < 0.001), and cholesterol intake (F = 6.107, p = 0.014), while not showing any significant interaction effects on sodium (F = 3.547, p = 0.060) and potassium (F = 3.396, p = 0.066). Compared to the middle-aged group, BMI, energy intake, and cholesterol intake decreased in the older-aged group. However, the declines were steeper in men than in women. Therefore, both gender and age need to be considered for weight and dietary intake management for hypertensive patients.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124482
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4483: Functional and Clinical Characteristics for
           Predicting Sarcopenia in Institutionalised Older Adults: Identifying Tools
           for Clinical Screening

    • Authors: Maria A. Cebrià i Iranzo, Anna Arnal-Gómez, Maria A. Tortosa-Chuliá, Mercè Balasch-Bernat, Silvia Forcano, Trinidad Sentandreu-Mañó, Jose M. Tomas, Natalia Cezón-Serrano
      First page: 4483
      Abstract: Background: Recently, the European Working Group on Sarcopenia in Older People (EWGSOP2) has updated the sarcopenia definition based on objective evaluation of muscle strength, mass and physical performance. The aim of this study was to analyse the relationship between sarcopenia and clinical aspects such as functionality, comorbidity, polypharmacy, hospitalisations and falls in order to support sarcopenia screening in institutionalised older adults, as well as to estimate the prevalence of sarcopenia in this population using the EWGSOP2 new algorithm. Methods: A multicentre cross-sectional study was conducted on institutionalised older adults (n = 132, 77.7% female, mean age 82 years). Application of the EWGSOP2 algorithm consisted of the SARC-F questionnaire, handgrip strength (HG), appendicular skeletal muscle mass index (ASMI) and Short Physical Performance Battery (SPPB). Clinical study variables were: Barthel Index (BI), Abbreviated Charlson’s Comorbidity Index (ACCI), number of medications, hospital stays and falls. Results: Age, BI and ACCI were shown to be predictors of the EWGSOP2 sarcopenia definition (Nagelkerke’s R-square = 0.34), highlighting the ACCI. Sarcopenia was more prevalent in older adults aged over 85 (p = 0.005), but no differences were found according to gender (p = 0.512). Conclusion: BI and the ACCI can be considered predictors that guide healthcare professionals in early sarcopenia identification and therapeutic approach.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124483
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4484: Environments, Behaviors, and Inequalities:
           Reflecting on the Impacts of the Influenza and Coronavirus Pandemics in
           the United States

    • Authors: Roberts, Tehrani
      First page: 4484
      Abstract: In the past century, dramatic shifts in demographics, globalization and urbanization have facilitated the rapid spread and transmission of infectious diseases across continents and countries. In a matter of weeks, the 2019 coronavirus pandemic devastated communities worldwide and reinforced the human perception of frailty and mortality. Even though the end of this pandemic story has yet to unfold, there is one parallel that is undeniable when a comparison is drawn between the 2019 coronavirus and the 1918 influenza pandemics. The public health response to disease outbreaks has remained nearly unchanged in the last 101 years. Furthermore, the role of environments and human behaviors on the effect and response to the coronavirus pandemic has brought to light many of the historic and contemporaneous inequalities and injustices that plague the United States. Through a reflection of these pandemic experiences, the American burden of disparity and disproportionality on morbidity, mortality and overall social determinants of health has been examined. Finally, a reimagination of a post-coronavirus existence has also been presented along with a discussion of possible solutions and considerations for moving forward to a new and better normal.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124484
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4485: Center-Line Velocity Change Regime in a
           Parallel-Flow Square Exhaust Hood

    • Authors: Jianwu Chen, Longzhe Jin, Zhenfang Chen, Bin Yang, Yanqiu Sun, Shulin Zhou
      First page: 4485
      Abstract: A parallel-flow exhaust hood is an effective ventilation device to control dust and toxic pollutants and protect the occupational health of workers, whether it is used alone or combined with a uniform air supply hood in a push–pull ventilation system. Some scholars have studied the outside air flow characteristics of the conventional exhaust hood with non-uniform air speed at the hood face, but the law of velocity variation outside the parallel-flow exhaust hood is not clear at present. Therefore, this paper uses the dimensionless method to study the center-line velocity change regime in a parallel-flow square exhaust hood based on simulation and experimental data. The results show that the dimensionless center-line velocity has a good change law with the characteristic length of exhaust hood in a parallel-flow square exhaust hood, which can eliminate the influence of hood face velocity and the hood size on the velocity change regime; and the experimental data is basically consistent with the calculated data, which shows that the regression equation method is reliable.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124485
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4486: Evaluation of Stoffenmanager and a New
           Exposure Model for Estimating Occupational Exposure to Styrene in the
           Fiberglass Reinforced Plastics Lamination Process

    • Authors: Seokwon Lee, Sangjun Choi, Kyoungho Lee
      First page: 4486
      Abstract: This study aims to evaluate occupational exposure models by comparing model estimations of Stoffenmanager, version 8.2, and exposure scores calculated using a new exposure model with personal exposure measurements for styrene used in the fiberglass-reinforced plastic (FRP) lamination processes in Korea. Using the collected exposure measurements (n = 160) with detailed contextual information about the type of process, working conditions, local exhaust ventilation, respiratory protections, and task descriptions, we developed a new model algorithm to estimate the score for occupational exposures on situation level. We assumed that the source of exposure originates from the near field only (within the breathing zone of workers). The new model is designed as a simple formula of multiplying scores for job classification, exposure potential, engineering controls, chemical hazard, and exposure probability and then dividing the score for workplace size. The final score is log-transformed, ranging from 1 to 14, and the exposure category is divided into four ratings: no exposure (1), low (2), medium (3), and high (4) exposures. Using the contextual information, all the parameters and modifying factors are similarly entered into the two models through direct translation and coding processes with expert judgement, and the exposure estimations and scores using the two models are calculated for each situation. Overall bias and precision for Stoffenmanager are −1.00 ± 2.07 (50th) and −0.32 ± 2.32 (90th) for all situations (n = 36), indicating that Stoffenmanager slightly underestimated styrene exposures. Pearson’s correlation coefficients are significantly high for Stoffenmanager (r = 0.87) and the new model (r = 0.88), and the correlation between the two models is significantly high (r = 0.93) (p < 0.01). Therefore, the model estimations using Stoffenmanager and the new model are significantly correlated with the styrene exposures in the FRP lamination process. Further studies are needed to validate and calibrate the models using a larger number of exposure measurements for various substances in the future.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124486
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4487: Air Pollution and Covid-19: The Role of
           Particulate Matter in the Spread and Increase of Covid-19's Morbidity
           and Mortality

    • Authors: Comunian, Dongo, Milani, Palestini
      First page: 4487
      Abstract: Sars-cov-2 virus (Covid-19) is a member of the coronavirus family and is responsible for the pandemic recently declared by the World Health Organization. A positive correlation has been observed between the spread of the virus and air pollution, one of the greatest challenges of our millennium. Covid-19 could have an air transmission and atmospheric particulate matter (PM) could create a suitable environment for transporting the virus at greater distances than those considered for close contact. Moreover, PM induces inflammation in lung cells and exposure to PM could increase the susceptibility and severity of the Covid-19 patient symptoms. The new coronavirus has been shown to trigger an inflammatory storm that would be sustained in the case of pre-exposure to polluting agents. In this review, we highlight the potential role of PM in the spread of Covid-19, focusing on Italian cities whose PM daily concentrations were found to be higher than the annual average allowed during the months preceding the epidemic. Furthermore, we analyze the positive correlation between the virus spread, PM, and angiotensin-converting enzyme 2 (ACE2), a receptor involved in the entry of the virus into pulmonary cells and inflammation.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124487
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4488: Proposal of Sustainability Indicators for the
           Design of Small-Span Bridges

    • Authors: Cleovir José Milani, Víctor Yepes, Moacir Kripka
      First page: 4488
      Abstract: The application of techniques to analyze sustainability in the life cycle of small-span bridge superstructures is presented in this work. The objective was to obtain environmental and economic indicators for integration into the decision-making process to minimize the environmental impact, reduce resource consumption and minimize life cycle costs. Twenty-seven configurations of small-span bridges (6 to 20 m) of the following types were analyzed: steel–concrete composite bridges, cast in situ reinforced concrete bridges, precast bridges and prestressed concrete bridges, comprising a total of 405 structures. Environmental impacts and costs were quantified via life cycle environmental assessment and life cycle cost analysis following the boundaries of systems from the extraction of materials to the end of bridge life (“from cradle to grave”). In general, the results indicated that the environmental performance of the bridges was significantly linked to the material selection and bridge configuration. In addition, the study enabled the identification of the products and processes with the greatest impact in order to subsidize the design of more sustainable structures and government policies.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124488
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4489: Characterization of Silica Exposure during
           Manufacturing of Artificial Stone Countertops

    • Authors: Carrieri, Guzzardo, Farcas, Cena
      First page: 4489
      Abstract: Artificial stone is increasing in popularity in construction applications, including commercial and residential countertops. Eco-friendliness, durability, and resistance to staining, make artificial stone attractive to consumers. Health concerns have arisen during manufacturing of artificial stone due to increased incidence of silicosis after relatively short exposure. Three artificial stone samples (A, B, and C) and one natural granite sample were subjected to cutting and grinding in a controlled environment. Gravimetric analysis, X-Ray diffraction, and scanning electron microscopy with energy dispersive spectroscopy were employed to determine crystalline silica concentrations and particle morphology of bulk and respirable particles. Silica content of bulk dust from artificial samples A and B was 91%, sample C was <10%, while granite was 31%. Silica percent in the respirable fraction for samples A and B was 53% and 54%, respectively, while sample C was <5% and granite was 8%. Number concentrations for samples A and B were mainly in the nano-fraction, indicating potential for translocation of silica particles to other organs outside of the lungs. Respirable dust concentrations inside the chamber were well above Occupational Safety and Health Administration standards for all materials, indicating that confined-space exposures require ventilation to lower risks of acute silicosis regardless of the nature of the stone.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124489
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4490: Effectiveness of the Muscle Energy Technique
           versus Osteopathic Manipulation in the Treatment of Sacroiliac Joint
           Dysfunction in Athletes

    • Authors: Urko José García-Peñalver, María Victoria Palop-Montoro, David Manzano-Sánchez
      First page: 4490
      Abstract: Background: The study of injuries stemming from sacroiliac dysfunction in athletes has been discussed in many papers. However, the treatment of this issue through thrust and muscle-energy techniques has hardly been researched. The objective of our research is to compare the effectiveness of thrust technique to that of energy muscle techniques in the resolution of sacroiliac joint blockage or dysfunction in middle-distance running athletes. Methods: A quasi-experimental design with three measures in time (pre-intervention, intervention 1, final intervention after one month from the first intervention) was made. The sample consisted of 60 adult athletes from an Athletic club, who were dealing with sacroiliac joint dysfunction. The sample was randomly divided into three groups of 20 participants (43 men and 17 women). One intervention group was treated with the thrust technique, another intervention group was treated with the muscle–energy technique, and the control group received treatment by means of a simulated technique. A prior assessment of the range of motion was performed by means of a seated forward flexion test, a standing forward flexion test, and the Gillet test. After observing the dysfunction, the corresponding technique was performed on each intervention group. The control group underwent a simulated technique. A second intervention took place a month later, in order to ascertain possible increased effectiveness. Results: Statistically significant differences were found between the muscle energy technique (MET) and muscle energy groups compared with the placebo group in both interventions (p = 0.000), with a significant reduction in positive dysfunction (initially 20 in all groups, eight in MET group, and two in thrust group in the final intervention). Comparing the changes in time, only the thrust group obtained statistically significant differences (p = 0.000, with a reduction of positive dysfunction, starting at 20 positives, five positive in the initial intervention and two positive in the final intervention) and when comparing both techniques, it was observed that between the first intervention and the final intervention, the thrust technique was significantly higher than the MET technique (p = 0.032). Conclusions: The thrust manipulation technique is more effective in the treatment of sacroiliac dysfunction than the energy muscle technique, in both cases obtaining satisfactory results with far middle-distance running athletes. Finally, the thrust technique showed positive results in the first intervention and also in the long term, in contrast to the MET technique that only obtained changes after the first intervention.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124490
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4491: Socioeconomic and Familial Factors Associated
           with Gross Motor Skills among US Children Aged 3–5 Years: The 2012
           NHANES National Youth Fitness Survey

    • Authors: Soyang Kwon, Meghan O’Neill
      First page: 4491
      Abstract: The first aim of this study was to examine the prevalence of below average gross motor skills in a representative sample of US children aged 3 to 5 years. The second aim was to identify socioeconomic and familial characteristics that are associated with below average gross motor skills. Secondary analysis was conducted using the datasets from the 2012 National Health and Examination Survey National Youth Fitness Survey (NNYFS). The NNYFS assessed gross motor skills among 329 children aged 3–5 years, using the Test of Gross Motor Development-Second Edition (TGMD-2). Socioeconomic and familial characteristics of interest, such as family income and family structure, were asked in an in-person interview. This study estimated that one in three US children age 3 to 5 years old (33.9%) scored below average for gross motor quotient. In the gross motor subsets, one in four (24.4%) scored below average for locomotion and two in five (39.9%) scored below average for object control. Children living below the poverty threshold were more likely to have a higher gross motor quotient (odds ratio, OR = 2.76; 95% confidence interval, CI = 1.09–7.00). Girls were more likely to have a higher locomotor score (OR = 2.17; 95% CI = 1.10–4.25). Those living with other child(ren) aged ≤5 years were more likely to have a higher locomotor score (OR = 2.36; 95% CI = 1.01–5.54), while those living with child(ren) aged 6–17 years were more likely to have a higher object control score (OR = 1.83; 95% CI = 1.24–2.69). This study revealed risk factors associated with poor gross motor development, furthering our understanding of gross motor development in early childhood.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124491
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4492: The Analysis of Green Areas’ Accessibility
           in Comparison with Statistical Data in Poland

    • Authors: Wysmułek, Hełdak, Kucher
      First page: 4492
      Abstract: The study discusses the problem of public green areas’ accessibility for the residents of large cities in Poland. The purpose of the research is to assess the possibility of applying the British Accessible Natural Greenspace Standard (ANGSt) method in determining the amount of natural green space available to residents in Polish conditions including, in particular, the assessment of accessibility using data collected by the Central Statistical Office and the verification of results based on detailed research. The identification of green areas for 18 voivodeship cities in Poland was prepared using the GIS programme, taking into account public green space, provided for general access and free of change. The verification of the ANGSt method consisted of mapping spatial barriers extending the route of access either on foot or by roads as well as closed private areas. The conducted research revealed that, after taking into account the access routes to selected areas, the distance to public green areas increased, on average, from 50 m in the smallest cities (Gorzów Wielkopolski and Olsztyn) to as much as 450 m in Warszawa. A detailed analysis showed that the discussed accessibility was reduced, on average, by almost 10% for the residents of the analysed cities. It was also found that the introduced barriers did not affect the accessibility of more distant, larger green space areas.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124492
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4493: Association between Sports-Related Concussion
           and Mouthguard Use among College Sports Players: A Case-Control Study
           Based on Propensity Score Matching

    • Authors: Yoshiaki Ono, Yuto Tanaka, Kazuki Sako, Masahiro Tanaka, Junya Fujimoto
      First page: 4493
      Abstract: Sports-related concussion (SRC) is a major public health concern. This study aimed to assess the association between mouthguard use and the incidence of SRC in college students through a case-control study using propensity score matching. In total, 195 of 2185 potential participants volunteered to participate in this study. We used Google Forms online to capture participants’ information, including: age; gender; height; weight; sports contact level; level of play; exposure time; frequency of mouthguard use; mouthguard type; and SRC experience. Data for 115 participants who played collision and contact sports were used for the analysis. The difference in the frequency of mouthguard use was assessed between matched pairs and the overall association between SRC and mouthguard use was evaluated. In the matched groups, those who had not experienced SRC wore a mouthguard more frequently than those who had experienced SRC (7/28 vs. 1/28; p = 0.051). Logistic regression analysis showed there was a significant negative association between the frequency of mouthguard use and the incidence of SRC (odds ratio 0.101; p = 0.041). Within the limitations of this study, these results suggest that mouthguard use may offer some benefit in preventing SRC.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-22
      DOI: 10.3390/ijerph17124493
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4494: Surfactant-Enhanced Solubilization of
           Chlorinated Organic Compounds Contained in DNAPL from Lindane Waste:
           Effect of Surfactant Type and pH

    • Authors: Raúl García-Cervilla, Arturo Romero, Aurora Santos, David Lorenzo
      First page: 4494
      Abstract: Application of surfactants in the remediation of polluted sites with dense nonaqueous phase liquid (DNAPL) still requires knowledge of partitioning between surfactants and pollutants in the organic and aqueous phases and the time necessary to reach this balance. Two real DNAPLs, generated as wastes in the lindane production and taken from the polluted sites from Sabiñanigo (Spain), were used for investigating the solubilization of 28 chlorinated organic compounds (COCs) applying aqueous surfactant solutions of three nonionic surfactants (E-Mulse® 3 (E3), Tween®80 (T80), and a mixture of Tween®80-Span®80 (TS80)) and an anionic surfactant (sodium dodecyl sulfate (SDS)). The initial concentrations of surfactants were tested within the range of 3–17 g·L−1. The pH was also modified from 7 to >12. The uptake of nonionic surfactants into the organic phase was higher than the anionic surfactants. Solubilization of COCs with the nonionic surfactants showed similar molar solubilization ratios (MSR = 4.33 mmolCOCs·g−1surf), higher than SDS (MSR = 0.70 mmolCOCs·g−1SDS). Furthermore, under strong alkaline conditions, the MSR value of the nonionic surfactants was unchanged, and the MSR of SDS value increased (MSR = 1.32 mmolCOCs·g−1SDS). The nonionic surfactants did not produce preferential solubilization of COCs; meanwhile, SDS preferentially dissolved the more polar compounds in DNAPL. The time required to reach phase equilibrium was between 24 and 48 h, and this contact time should be assured to optimize the effect of the surfactant injected on COC solubilization.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124494
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4495: Fostering Broad Oral Language Skills in
           Preschoolers from Low SES Background

    • Authors: Raffaele Dicataldo, Elena Florit, Maja Roch
      First page: 4495
      Abstract: Socioeconomic disparities increase the probability that children will enter school behind their more advantaged peers. Early intervention on language skills may enhance language and literacy outcomes, reduce the gap and, eventually, promote school readiness of low-SES (Socioeconomic Status) children. This study aimed to analyze the feasibility and effectiveness of a brief narrative-based intervention (treatment vs. control group) aimed to foster broad oral language skills in preschoolers (N = 69; Mean age = 5.5, SD = 4 months) coming from low-SES families. Moreover, it was analyzed whether children’s initial vocabulary mediates the intervention’s responsiveness. Results have shown that children in treatment group obtained greater gains than children in control group in almost all intervention-based measures. There is also some evidence for the generalizability of the intervention to other skills not directly trained during the intervention. Moreover, it was found that children’s initial vocabulary mediates the intervention’s responsiveness showing that children with high vocabulary made greater gains in higher-level components of language comprehension, whereas children with low vocabulary made higher gains in vocabulary. Taken together, our findings suggest that a relatively brief, but quite intensive narrative-based intervention, may produce improvements on broad oral language skills in preschoolers from low-SES backgrounds.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124495
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4496: Modeling Healthcare Costs Attributable to
           Secondhand Smoke Exposure at Home among South Korean Children

    • Authors: Jeewon Park, SeungJin Bae
      First page: 4496
      Abstract: Children exposed to secondhand smoke (SHS) are at increased risk for disease. We sought to estimate the medical costs among Korean children who were exposed to SHS at home. A Markov model was developed, including five diseases (asthma, acute otitis media, acute bronchitis, pneumonia and sudden infant death syndrome) that were significantly associated with SHS in children based on a systematic review. The time horizon of the analysis was 20 years (from birth to adulthood), and the cycle length was 1 week. The direct healthcare costs were discounted annually at 5%. Univariate and probabilistic sensitivity analyses were conducted. The Markov model estimated the healthcare costs for 20 years as 659.61 USD per exposed child, an increase of approximately 30% compared to the cost per unexposed child (507.32 USD). Sensitivity analysis suggested that the younger the age of the exposure, the greater the incremental healthcare costs incurred, implying that infants and young children were especially vulnerable to the SHS exposure. Findings of this study could provide key baseline data for future economic evaluations on SHS control policies in South Korea.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124496
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4497: Art Meets Sport: What Can Actor Training
           Bring to Physical Literacy Programs'

    • Authors: Lisa M. Barnett, Rea Dennis, Kate Hunter, John Cairney, Richard J. Keegan, Inimfon A. Essiet, Dean A. Dudley
      First page: 4497
      Abstract: The aim of this communication is to highlight synergies and opportunities between the fields of education, sport and health and the performing arts for the promotion of physical literacy. First, physical literacy is introduced and then defined according to the definition used in this communication. Secondly, we highlight the gap in physical literacy interventions, in that they do not address learning based on a holistic comprehensive definition of physical literacy. Then we provide examples of interventions that do borrow from the arts, such as circus arts, and show how these approaches explicitly link to the discipline of arts. This is followed by program examples, which approach motor and language development from discipline-specific perspectives. Then we introduce actor training (within the discipline of arts) in terms of how this approach may be useful to our understanding of physical literacy and how to expand the conception of physical literacy to include affective meaning making, and tolerance for ambiguity and discomfort in not-knowing. Finally, we conclude with the next step for the bridging of disciplines in order to further our journey to understand and improve physical literacy.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124497
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4498: Self-Reported Versus Observed Measures:
           Validation of Child Caregiver Food Hygiene Practices in Rural Malawi

    • Authors: Kondwani Chidziwisano, Elizabeth Tilley, Tracy Morse
      First page: 4498
      Abstract: Few studies have attempted to measure the differences between self-reported and observed food hygiene practices in a household setting. We conducted a study to measure the level of agreement between self-reported and observed food hygiene practices among child caregivers with children under the age of five years in rural Malawi. Fifty-eight child caregivers from an intervention and 29 from a control group were recruited into the study. At the end of a nine-month food hygiene intervention, household observations were conducted followed by self-reported surveys. Overall, practices were found to be more frequently reported than observed in both groups. However, the difference between self-reports and observed practices was minimal in the intervention compared to the control group. The odds ratio results confirm that more desirable practices were observed in the intervention group compared to the control group. Despite the effects of reactivity during observations, the study results imply that the intervention group did not just improve their knowledge, but also translated the messaging into better practice. Researchers and implementing agencies in water, sanitation and hygiene and food hygiene sector should ensure that interventions are context-appropriate, and that effective methods of observation are used to confirm any reported effects of an intervention.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124498
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4499: Development of a Scale for Assessing the
           Meaning of Participation in Care Prevention Group Activities Provided by
           Local Governments in Japan

    • Authors: Ryu Sasaki, Michiyo Hirano
      First page: 4499
      Abstract: The meaning of participation in care prevention group activities may encourage continuous participation, making older adults active and healthy throughout their lives. This study developed a scale to assess the meaning of participation in care prevention group activities. It involved 427 participants in care prevention group activities (CPGAs) in Japan who filled out a self-administered questionnaire between October 2017 and February 2018. The meaning of participation was assessed using 15 items. In total, there were 379 valid responses. A factor analysis yielded two factors: “promotion of self-growth” and “enrichment of daily life”. The goodness of fit index (GFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA) were satisfactory (GFI = 0.923; CFI = 0.960; RMSEA = 0.073). Cronbach’s α was 0.939 for the entire scale. The scale scores were significantly correlated with scores of the social activity-related daily life satisfaction scale and Ikigai-9. The scale’s reliability and validity were confirmed, indicating its usability for promoting care prevention efforts.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124499
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4500: Advanced Clinical Practitioners in Primary
           Care in the UK: A Qualitative Study of Workforce Transformation

    • Authors: Catrin Evans, Ruth Pearce, Sarah Greaves, Holly Blake
      First page: 4500
      Abstract: Escalating costs and changing population demographics are putting pressure on primary care systems to meet ever more complex healthcare needs. Non-medical ‘advanced clinical practitioner’ (ACP) roles are increasingly being introduced to support service transformation. This paper reports the findings of a qualitative evaluation of nursing ACP roles across General Practices in one region of the UK. Data collection involved telephone interviews with 26 participants from 3 different stakeholder groups based in 9 practice sites: ACPs (n = 9), general practitioners (n = 8) and practice managers (n = 9). The data was analysed thematically. The study found a high degree of acceptance of the ACP role and affirmation of the important contribution of ACPs to patient care. However, significant variations in ACP education, skills and experience led to a bespoke approach to their deployment, impeding system-wide innovation and creating challenges for recruitment and ongoing professional development. In addition, a context of high workforce pressures and high service demand were causing stress and there was a need for greater mentorship and workplace support. System wide changes to ACP education and support are required to enable ACPs to realise their full potential in primary care in the UK.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124500
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4501: Upper Limb’s Injuries in Agriculture: A
           Systematic Review

    • Authors: Nicola Mucci, Veronica Traversini, Lucrezia G. Lulli, Antonio Baldassarre, Raymond P. Galea, Giulio Arcangeli
      First page: 4501
      Abstract: Agriculture is one of the most hazardous economic sectors, and it accounts for many accidents and occupational diseases every year. In Italy, about one-third of injuries involve the upper extremity, with long-term consequences for the workers and economic damage for agricultural companies and farms. This systematic review describes upper limb injuries among farmworkers, especially hand injuries, and highlights the main dangerous risk factors. Literature review included articles published in the major databases (PubMed, Cochrane Library, Scopus), using a combination of some relevant keywords. This online search yielded 951 references; after selection, the authors analyzed 53 articles (3 narrative reviews and 50 original articles). From this analysis, it appears that younger male farmers are mostly involved, especially in the harvesting season. The upper limb and hand are often the body parts that sustain most damage as these are mostly involved in driving tractors or tools. The most frequent type of lesions are open wounds, lacerations, fractures, strains, and overexertion lesions. Sometimes, a distracting element (such as mobile phone use, quarrels, working hours load) is present; poor use of protective devices and lack of safety design in tools can also increase the risk of accidents. For these reasons, in the agricultural sector, a system of health promotion and good practices is needed to promote workers’ awareness of the sources of risk, highlight more dangerous situations and apply organizational behavioral measures.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124501
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4502: Association between Reflux Esophagitis
           Incidence and Palmar Hyperhidrosis

    • Authors: Chun-Gu Cheng, Wu-Chien Chien, Chia-Peng Yu, Chi-Hsiang Chung, Chun-An Cheng
      First page: 4502
      Abstract: The autonomic dysfunction in palmar hyperhidrosis (PH) includes not only sympathetic overactivity but also parasympathetic impairment. A decrease of parasympathetic tone has been noted in gastroesophageal reflux disease of neonates and adults. Patients with reflux esophagitis have a defective anti-reflux barrier. The association between reflux esophagitis and PH is deliberated in this article. The National Health Insurance Database in Taiwan was used. At first-time visits, PH patients were identified by the International Classification of Disease, 9th Revision, Clinical Modification disease code of 780.8 without endoscopic thoracic sympathectomy. Patients were matched by age and gender as control groups. The reflux esophagitis incidence was assessed using disease codes 530.11, 530.81, and 530.85. The factors related to reflux esophagitis were established by the Cox proportional regression model. The risk of reflux esophagitis in PH patients had a hazard ratio of 3.457 (95% confidence interval: 3.043–3.928) after adjustment of the other factors. We confirmed the association between reflux esophagitis and PH. Health care providers must be alerted to this relationship and other risk factors of reflux esophagitis to support suitable treatments to improve the quality of life of patients.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124502
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4503: Guaranteed Equal Opportunities' The
           Access to Nursing Training in Central Europe for People with a Turkish
           Migration Background

    • Authors: Julia Keckeis, Margit Schäfer, Türkan Akkaya-Kalayci, Henriette Löffler-Stastka
      First page: 4503
      Abstract: This paper examines the reason for the small percentage of professional nurses with a Turkish migration background and investigates possibilities to increase this low amount. Our society grows older, and the number of chronic diseases increases. Furthermore, nursing professionals tend to migrate, and the retirement of the baby boomer generation will also create a lack of professional nurses in Vorarlberg, Austria. People with a Turkish migration background, who are the second largest group without Austrian citizenship in Austria, could be an important resource for the upcoming lack of qualified nurses. The nursing profession could be a secure career opportunity for these people, and therefore it is of great importance to make access to professional nursing training easier for people with a Turkish migration background. This paper describes the effects of migration on society, institutions and individuals and gives an overview of concepts related to how to deal with this situation. This qualitative study investigates the access to nursing training for people with a Turkish migration background from three different points of view—those of experts, students and nurses with a Turkish migration background, and people with a Turkish migration background who have to pass a university entrance qualification—in the form of guided interviews. The results will illustrate structural and social barriers due to complex social dynamics and also highlight possibilities to reduce those barriers. Based on the results, prospects for professional nursing are deduced on the macro, meso and micro levels, which should generate an increasing number of nurses with a Turkish migration background.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124503
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4504: Educational Inequalities in Self-Rated Health
           in Europe and South Korea

    • Authors: Kim, Khang, Kang, Lim
      First page: 4504
      Abstract: While numerous comparative works on the magnitude of health inequalities in Europe have been conducted, there is a paucity of research that encompasses non-European nations such as Asian countries. This study was conducted to compare Europe and Korea in terms of educational health inequalities, with poor self-rated health (SRH) as the outcome variable. The European Union Statistics on Income and Living Conditions and the Korea National Health and Nutrition Examination Survey in 2017 were used (31 countries). Adult men and women aged 20+ years were included (207,245 men and 238,007 women). The age-standardized, sex-specific prevalence of poor SRH by educational level was computed. The slope index of inequality (SII) and relative index of inequality (RII) were calculated. The prevalence of poor SRH was higher in Korea than in other countries for both low/middle- and highly educated individuals. Among highly educated Koreans, the proportion of less healthy women was higher than that of less healthy men. Korea’s SII was the highest for men (15.7%) and the ninth-highest for women (10.4%). In contrast, Korea’s RII was the third-lowest for men (3.27), and the lowest among women (1.98). This high-SII–low-RII mix seems to have been generated by the high level of baseline poor SRH.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124504
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4505: Behavior Change Following Pain Neuroscience
           Education in Middle Schools: A Public Health Trial

    • Authors: Louw, Landrus, Podolak, Benz, DeLorenzo, Davis, Rogers, Cooper, Louw, Zimney, Puentedura, Landers
      First page: 4505
      Abstract: Chronic pain and the opioid epidemic need early, upstream interventions to aim at meaningful downstream behavioral changes. A recent pain neuroscience education (PNE) program was developed and tested for middle-school students to increase pain knowledge and promote healthier beliefs regarding pain. In this study, 668 seventh-grade middle-school students either received a PNE lecture (n = 220); usual curriculum school pain education (UC) (n = 198) or PNE followed by two booster (PNEBoost) sessions (n = 250). Prior to, immediately after and at six-month follow-up, pain knowledge and fear of physical activity was measured. Six months after the initial intervention school, physical education, recess and sports attendance/participation as well as healthcare choices for pain (doctor visits, rehabilitation visits and pain medication use) were measured. Students receiving PNEBoost used 30.6% less pain medication in the last 6 months compared to UC (p = 0.024). PNEBoost was superior to PNE for rehabilitation visits in students experiencing pain (p = 0.01) and UC for attending school in students who have experienced pain > 3 months (p = 0.004). In conclusion, PNEBoost yielded more positive behavioral results in middle school children at six-month follow-up than PNE and UC, including significant reduction in pain medication use.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124505
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4506: Repeated Sprint Training vs. Repeated
           High-Intensity Technique Training in Adolescent Taekwondo Athletes—A
           Randomized Controlled Trial

    • Authors: Ouergui, Messaoudi, Chtourou, Wagner, Bouassida, Bouhlel, Franchini, Engel
      First page: 4506
      Abstract: This study investigated the effects of 4-weeks repeated sprint (RST) vs. repeated high-intensity-technique training (RTT) on physical performance. Thirty-six adolescent taekwondo athletes (age: 16 ± 1 yrs) were randomly assigned to RST (10 × 35 m sprint, 10 s rest), RTT (10 × 6 s Bandal-tchagui, 10 s rest) and control (control group (CG): no additional training) groups. Additionally, to their regular training, RST and RTT trained 2×/week for 4 weeks. Training load (TL), monotony, and strain were calculated using the rating of perceived exertion scale. The progressive specific taekwondo (PSTT), 20 m multistage shuttle run (SRT20m), 5 m shuttle run, agility T-test, taekwondo-specific agility (TSAT) and countermovement jump (CMJ) tests were performed before and after 4 weeks of training. Additionally, taekwondo athletes performed specific taekwondo exercises (i.e., repeated techniques for 10 s and 1 min). From week 1, mean TL increased continuously to week 4 and monotony and strain were higher at weeks 3 and 4 (p < 0.001). VO2max calculated from SRT20m and PSTT increased for RST and RTT in comparison to CG (p < 0.001). Agility performance during T-test and TSAT (p < 0.01) improved in RTT. The number of performed techniques during the 10 s specific exercise increased in RTT and RST (p < 0.01) for the dominant leg and in RTT for the non-dominant leg (p < 0.01). The number of techniques during the 1 min specific exercise was higher in RST and RTT compared to CG for the dominant leg (p < 0.001). Delta lactate at post-training was lower for RTT for both legs compared to RST and CG (p < 0.01). It is important to include a low-volume high-intensity training based on repeated sprint running or repeated technique in the training programs of adolescent taekwondo athletes.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124506
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4507: Internalized Stigmatization, Social Support,
           and Individual Mental Health Problems in the Public Health Crisis

    • Authors: Li, Liang, Yuan, Zeng
      First page: 4507
      Abstract: This study investigates the relationship between internalized stigmatization brought on by epicenter travel experiences and mental health problems (including anxiety, depression, and shame) during the period of the novel coronavirus disease emergency in China. The cross-sectional data were collected using the time-lag design to avoid the common method bias as much as possible. Regression results using structural equation modeling show that the internalized stigmatization of epicenter travel experiences may have positive relationships with mental health problems (i.e., anxiety, depression, and shame), and such relationships can be moderated by social support. Specifically, the positive relationships between internalized stigmatization and mental health problems are buffered/strengthened when social support is at a high/low level. The findings of this study suggest that, in this epidemic, people who have epicenter travel experience could be affected by internalized stigmatization, no matter whether they have ever got infected.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124507
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4508: A Process Evaluation Protocol for Examining
           the Impact of Instructions for Correct Use of Child Car Seats Designed
           through a Consumer-Driven Process and Evaluated in a Field-Based
           Randomised Controlled Trial

    • Authors: Julie Brown, Jane Elkington, Kate Hunter, Judith L. Charlton, Lynne E. Bilston, Andrew Hayen, Lisa Keay
      First page: 4508
      Abstract: The incorrect use of child car seats is common, with significant negative effects on crash protection for child passengers. There is currently little evidence for effective, practical countermeasures for incorrect use. The provision of clear and comprehensible materials on correct use supplied with restraints at the point of sale could be highly cost-effective and achieve similar benefits to restraint-fitting services or hands-on training; however, routinely supplied instructions in their current form are frequently difficult to understand. We are conducting a randomised controlled trial of the consumer-driven redesign of instructional materials, consisting of an instruction sheet, swing tags and online training videos. This paper presents the protocol that will be used in an innovate process evaluation that will use the primary outcome of overall serious misuse assessed at six months, together with a survey and semi-structured interviews to determine fidelity, dose and outcomes for all intervention participants. The study will assess intervention delivery and external factors that may impact the effectiveness of the intervention, including experience, health literacy, confidence and attitudes. When it has been conducted, this process evaluation will provide enhanced understanding of the mechanisms through which the intervention works or not, aspects of the implementation process key to success of the intervention and insight into how external factors influence the success of the intervention.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124508
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4509: Semi-Supervised Text Classification
           Framework: An Overview of Dengue Landscape Factors and Satellite Earth

    • Authors: Zhichao Li, Helen Gurgel, Nadine Dessay, Luojia Hu, Lei Xu, Peng Gong
      First page: 4509
      Abstract: In recent years there has been an increasing use of satellite Earth observation (EO) data in dengue research, in particular the identification of landscape factors affecting dengue transmission. Summarizing landscape factors and satellite EO data sources, and making the information public are helpful for guiding future research and improving health decision-making. In this case, a review of the literature would appear to be an appropriate tool. However, this is not an easy-to-use tool. The review process mainly includes defining the topic, searching, screening at both title/abstract and full-text levels and data extraction that needs consistent knowledge from experts and is time-consuming and labor intensive. In this context, this study integrates the review process, text scoring, active learning (AL) mechanism, and bidirectional long short-term memory (BiLSTM) networks, and proposes a semi-supervised text classification framework that enables the efficient and accurate selection of the relevant articles. Specifically, text scoring and BiLSTM-based active learning were used to replace the title/abstract screening and full-text screening, respectively, which greatly reduces the human workload. In this study, 101 relevant articles were selected from 4 bibliographic databases, and a catalogue of essential dengue landscape factors was identified and divided into four categories: land use (LU), land cover (LC), topography and continuous land surface features. Moreover, various satellite EO sensors and products used for identifying landscape factors were tabulated. Finally, possible future directions of applying satellite EO data in dengue research in terms of landscape patterns, satellite sensors and deep learning were proposed. The proposed semi-supervised text classification framework was successfully applied in research evidence synthesis that could be easily applied to other topics, particularly in an interdisciplinary context.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124509
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4510: Differences in Treatment Outcomes and
           Prognosis between Elderly and Younger Patients Receiving Definitive
           Radiotherapy for Cervical Cancer

    • Authors: PeiYu Hou, ChenHsi Hsieh, MingChow Wei, ShengMou Hsiao, PeiWei Shueng
      First page: 4510
      Abstract: The aim was to compare the clinical outcomes and prognostic factors of cervical cancer between elderly and younger women, and to explore which treatment strategy is more appropriate for elderly patients. We retrospectively reviewed patients with cervical cancer receiving definitive radiotherapy (RT) between 2007 and 2016, and divided them into two age groups: age < 70 vs. age ≥ 70. The clinical outcomes were compared between the two age groups. The median follow-up was 32.2 months. A total of 123 patients were eligible, 83 patients in group 1 (age < 70), and 40 patients in group 2 (age ≥ 70). Patients in group 2 received less intracavitary brachytherapy (ICRT) application, less total RT dose, and less concurrent chemoradiotherapy (CCRT), and tended to have more limited external beam radiotherapy (EBRT) volume. The treatment outcomes between the age groups revealed significant differences in 5-year overall survival (OS), but no differences in 5-year cancer-specific survival (CSS), 66.2% vs. 64.5%, and other loco-regional control. In multivariate analyses for all patients, the performance status, pathology with squamous cell carcinoma (SCC), International Federation of Gynecology and Obstetrics (FIGO) stage, and ICRT application were prognostic factors of CSS. The elderly patients with cervical cancer had comparable CSS and loco-regional control rates, despite receiving less comprehensive treatment. Conservative treatment strategies with RT alone could be appropriate for patients aged ≥ 70 y/o, especially for those with favorable stages or histopathology.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124510
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4511: The Relationship between Emotional
           Intelligence and Entrepreneurial Self-Efficacy of Chinese Vocational
           College Students

    • Authors: Ya Wen, Huaruo Chen, Liman Pang, Xueying Gu
      First page: 4511
      Abstract: The purpose of this study is to explore the relationship between emotional intelligence and entrepreneurial self-efficacy. The sample consisted of 529 students. The tools used to measure the relationship between emotional intelligence and entrepreneurial self-efficacy were the Emotional Intelligence Scale developed by Wong and Law and the Entrepreneurial Self-Efficacy Scale developed by Zhan. The results showed that there was a significant difference between male and female college students in entrepreneurial self-efficacy, but no significant difference between male and female college students in emotional intelligence. In entrepreneurial self-efficacy as well as emotional intelligence, there were significant differences between the third grade and the first and second grade, respectively. In addition, the results showed a significant positive correlation between entrepreneurial self-efficacy and emotional intelligence. With the improvement of the emotional intelligence level of vocational college students, the entrepreneurial self-efficacy will increase. The lower the emotional intelligence, the faster the improvement in entrepreneurial self-efficacy. The higher the emotional intelligence, the more stable the entrepreneurial self-efficacy. The university stage is considered an ideal entrepreneurial period, especially for vocational colleges’ students, who pay more attention to entrepreneurship and innovation education. Encouraging the cultivation of the emotional intelligence of vocational college students in life will help to improve personal entrepreneurial self-efficacy. This research emphasizes that improving the emotional intelligence of vocational college students can enhance their sense of self-efficacy in entrepreneurship and help students with entrepreneurship and career development.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124511
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4512: Attributable Risk to Assess the Health Impact
           of Air Pollution: Advances, Controversies, State of the Art and Future

    • Authors: Annunziata Faustini, Marina Davoli
      First page: 4512
      Abstract: Despite the increased attention given to the health impact assessment of air pollution and to the strategies to control it in both scientific literature and concrete interventions, the results of the implementations, especially those involving traffic, have not always been satisfactory and there is still disagreement about the most appropriate interventions and the methods to assess their effectiveness. This state-of-the-art article reviews the recent interpretation of the concepts that concern the impact assessment, and compares old and new measurements of attributable risk and attributable fraction. It also summarizes the ongoing discussion about the designs and methods for assessing the air pollution impact with particular attention to improvements due to spatio-temporal analysis and other new approaches, such as studying short term effects in cohorts, and the still discussed methods of predicting the values of attributable risk (AR). Finally, the study presents the more recent analytic perspectives and the methods for directly assessing the effects of not yet implemented interventions on air quality and health, in accordance with the suggestion in the strategic plan 2020−2025 from the Health Effect Institute.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124512
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4513: Effects of Surfactants on the Degradation of
           Diclofenac by Manganese Oxide

    • Authors: Kuan, Liu, Hu
      First page: 4513
      Abstract: Amine-containing pharmaceuticals are the most often detected pharmaceuticals in wastewater and ambient aquatic environments. They can usually be degraded by manganese oxide (MnO2), which is a common natural oxidant in soils. Surfactants often coexist with pharmaceuticals in wastewater. Some amine-containing pharmaceuticals, such as diclofenac (DIC), are acidic and are thus ionic compounds in neutral conditions. These compounds, therefore, have similar properties to surfactants. Surfactants, thus, may influence the adsorption and degradation processes of DIC by MnO2. The effect of the type of surfactant on the degradation of DIC by MnO2 was investigated in this study with the addition of two common biodegradable surfactants (cetyltrimethyl-ammonium bromide (CTAB) and sodium dodecylsulfate (SDS)). The results indicated that the cationic surfactant (CTAB) significantly increased the degradation rate in neutral and alkaline conditions. On the other hand, the anionic surfactant (SDS) slightly increased the DIC removal rate in an acidic condition but significantly decreased the removal in neutral and alkaline conditions. Coexisting cationic surfactants not only influenced the kinetics but also altered the transformation mechanism of DIC by MnO2. Decarboxylation is the main transformation mechanism of DIC in the presence of CTAB, while both decarboxylation and hydroxylation are the main transformation mechanisms in the absence of CTAB.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124513
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4514: Health and Healthcare Utilization among
           Asylum-Seekers from Berlin’s LGBTIQ Shelter: Preliminary Results of a

    • Authors: Nora Gottlieb, Conny Püschmann, Fabian Stenzinger, Julia Koelber, Laurette Rasch, Martha Koppelow, Razan Al Munjid
      First page: 4514
      Abstract: Background: LGBTIQ asylum-seekers face multiple health risks. Yet, little is known about their healthcare needs. In 2016, Berlin opened the only major shelter for LGBTIQ asylum-seekers in Germany. This preliminary study describes health and healthcare utilization by asylum-seekers living in Berlin’s LGBTIQ shelter. To identify particular healthcare needs, we compared our results to asylum-seekers from other shelters. Methods: We surveyed residents of the LGBTIQ shelter and 21 randomly selected shelters in Berlin, using a validated questionnaire in nine languages (n = 309 respondents, including 32 respondents from the LGBTIQ shelter). Bivariate tests and generalized linear mixed models were applied to examine differences in health and healthcare utilization between the two groups. Results: Residents of the LGBTIQ shelter show high rates of chronic and mental illness. They use ambulatory and mental health services more frequently than asylum-seekers from other shelters, including a significantly higher chance of obtaining psychotherapy/psychiatric care in case of need. Emergency room utilization is also higher in the LGBTIQ group. Conclusions: Asylum-seekers from the LGBTIQ shelter face high chronic and mental health burdens. Tailored services in the LGBTIQ shelter help obtain adequate healthcare; they should be scaled up to maximize their potential. Yet, unmet needs remain and warrant further research.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124514
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4515: Business Results and Well-Being: An Engaging
           Leadership Intervention Study

    • Authors: Lars van Tuin, Wilmar B. Schaufeli, Willem van Rhenen, Rebecca M. Kuiper
      First page: 4515
      Abstract: The present quasi-experimental study tested the business impact of a leadership development program focusing on psychological well-being through the satisfaction of basic psychological needs. Based on the concept of engaging leadership and self-determination theory, the 8-month program targeted midlevel team leaders of the customer fulfilment center of a health systems multinational organization. The program was designed in co-creation between senior leadership and the team leaders that participated in the program. Outcomes showed positive business results through significant increases in a preselected key performance indicator and decreased employee absenteeism. Through changes in autonomy satisfaction and intrinsic motivation, the team leaders (N = 14) benefitted in a moderate to very large extent relative to a similar control group (N = 52). In contrast, team members (N = 148) displayed no such benefits. Specifically, higher levels of autonomy satisfaction are said to lead to higher levels of psychological well-being and motivation. Still, the link with business performance is absent in most organizational studies within self-determination theory, making the present study one of the first to fill this gap. The study discloses the program design, compares the effects to a relevant control group, evaluates the lessons learned, and provides practical suggestions.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124515
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4516: Distribution of HPV Genotypes in Patients
           with a Diagnosis of Anal Cancer in an Italian Region

    • Authors: Narcisa Muresu, Giovanni Sotgiu, Laura Saderi, Illari Sechi, Antonio Cossu, Vincenzo Marras, Marta Meloni, Marianna Martinelli, Clementina Cocuzza, Francesco Tanda, Andrea Piana
      First page: 4516
      Abstract: Objectives: Anal cancer is a rare disease. However, its incidence is increasing in some population groups. Infection caused by Human Papillomavirus (HPV) is strongly associated with the risk of anal cancer, whose variability depends on samples, histology, and HPV detection methods. The aim of the study was to assess prevalence and distribution of HPV genotypes in patients diagnosed with anal carcinoma. Methods: An observational, retrospective study was carried out in a tertiary care hospital in North Sardinia, Italy. Specimens of anal cancer diagnosed from 2002–2018 were selected. Demographic, epidemiological, and clinical variables were collected to assess their relationship with the occurrence of anal cancer. Results: The overall HPV positivity was 70.0% (21/30), with HPV-16 being the predominant genotype (~85%). The highest prevalence of anal cancer was in patients aged ≥55 years. HPV positivity was higher in women (p-value > 0.05) and in moderately differentiated samples (G2) (p-value < 0.05). p16INK4a and E6-transcript positivity were found in 57% and 24% of the HPV positive samples, respectively. The OS (overall survival) showed a not statistically significant difference in prognosis between HPV positive sand negatives (10, 47.6%, vs. 4, 44.4%; p-value = 0.25). Conclusions: HPV-DNA and p16INK4a positivity confirmed the role of HPV in anal carcinoma. Our findings could support the implementation and scale-up of HPV vaccination in males and females to decrease the incidence of HPV-associated cancers. Further studies are needed to better clarify the prognostic role of HPV/p16 status.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124516
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4517: Bird Species Involved in West Nile Virus
           Epidemiological Cycle in Southern Québec

    • Authors: Ludivine Taieb, Antoinette Ludwig, Nick H. Ogden, Robbin L. Lindsay, Mahmood Iranpour, Carl A. Gagnon, Dominique J. Bicout
      First page: 4517
      Abstract: Despite many studies on West Nile Virus (WNV) in the US, including the reservoir role of bird species and the summer shifts of the Culex mosquito, feeding from birds to mammals, there have been few equivalent studies in the neighboring regions of Canada where WNV is endemic. Here, a priority list of bird species likely involved in WNV transmission in the greater Montréal area is constructed by combining three sources of data: (i) from WNV surveillance in wild birds (2002–2015); (ii) blood meal analysis of Culex pipiens–restuans (CPR), the primary enzootic vectors of WNV in the region, collected from surveillance in 2008 and 2014; (iii) literature review on the sero-prevalence/host competence of resident birds. Each of these data sources yielded 18, 23 and 53 species, and overall, 67 different bird species were identified as potential WNV amplifiers/reservoirs. Of those identified from CPR blood meals, Common starlings, American robins, Song sparrows and House sparrows ranked the highest and blood meal analysis demonstrated a seasonal shift in feed preference from birds to mammals by CPR. Our study indicates that there are broad similarities in the ecology of WNV between our region and the northeastern US, although the relative importance of bird species varies somewhat between regions.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124517
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4518: Weight Status Is Related to Health-Related
           Physical Fitness and Physical Activity but Not to Sedentary Behaviour in

    • Authors: José Francisco López-Gil, Javier Brazo-Sayavera, Juan Luis Yuste Lucas, Fernando Renato Cavichiolli
      First page: 4518
      Abstract: Purpose: The aim of this research was to describe, examine, and compare the level of physical fitness, physical activity, and sedentary behaviour in pupils aged 6–13 in the Region of Murcia, Spain, in accordance with weight status. Methods: A total of 370 children (166 girls and 204 boys) aged 6–13 (M = 8.7; DT = 1.8) from the Region of Murcia participated in this descriptive and cross-sectional study. Some anthropometric parameters such as body mass index, waist circumference, as well as skinfold measurements were determined. ALPHA-FIT Test Battery was used to evaluate physical fitness. Krece Plus Short Test was used to measure physical activity level and sedentary behaviour. Results: 52.4% of the children presented excess weight (according to the World Health Organization growth references). Regarding boys, statistically significant differences were found for cardiorespiratory fitness (p < 0.001), relative handgrip strength (p < 0.001), lower muscular strength (p < 0.001), speed-agility (p < 0.001), as well as sport activities hours (p = 0.001) among the three weight status groups (normal weight, overweight, and obesity). As for girls, statistically significant differences were found for cardiorespiratory fitness (p = 0.004), relative handgrip strength (p < 0.001), lower muscular strength (p < 0.001), sport activities hours (p = 0.005), as well as physical activity level (assessed by Krece Plus Test) (p = 0.017). A negative statistically significant correlation was found between body mass index and cardiorespiratory fitness (rho = −0.389), lower muscular strength, (rho = −0.340), and relative handgrip strength (rho = −0.547). At the same time, a positive statistically significant relationship between body mass index and the time spent in speed-agility (rho = 0.263) was shown. Regarding waist circumference and body fat percentage, similar relationships were identified. Moreover, a greater probability of having higher cardiorespiratory fitness (OR = 1.58; CI95% = 1.38–1.82), relative handgrip strength (OR = 1.25; CI95% = 1.19–1.31), more hours of sport activities (OR = 1.40; CI95% = 1.19–1.66), and physical activity level (assessed by Krece Plus Test) (OR = 1.23; CI95% = 1.07–1.42) was noted in the normal weight group. Conclusions: Children that presented normal weight achieved higher results for health-related physical fitness and physical activity than those with excess weight; this was, however, not found to be the case for sedentary behaviour. The authors emphasise the need for changes in public policies and school-based intervention programmes to develop higher levels of both PF and PA in overweight and obese children.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124518
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4519: Empowering Health Workers to Protect Their
           Own Health: A Study of Enabling Factors and Barriers to Implementing
           HealthWISE in Mozambique, South Africa, and Zimbabwe

    • Authors: Elizabeth S. Wilcox, Ida Tsitsi Chimedza, Simphiwe Mabhele, Paulo Romao, Jerry M. Spiegel, Muzimkhulu Zungu, Annalee Yassi
      First page: 4519
      Abstract: Ways to address the increasing global health workforce shortage include improving the occupational health and safety of health workers, particularly those in high-risk, low-resource settings. The World Health Organization and International Labour Organization designed HealthWISE, a quality improvement tool to help health workers identify workplace hazards to find and apply low-cost solutions. However, its implementation had never been systematically evaluated. We, therefore, studied the implementation of HealthWISE in seven hospitals in three countries: Mozambique, South Africa, and Zimbabwe. Through a multiple-case study and thematic analysis of data collected primarily from focus group discussions and questionnaires, we examined the enabling factors and barriers to the implementation of HealthWISE by applying the integrated Promoting Action on Research Implementation in Health Services (i-PARiHS) framework. Enabling factors included the willingness of workers to engage in the implementation, diverse teams that championed the process, and supportive senior leadership. Barriers included lack of clarity about how to use HealthWISE, insufficient funds, stretched human resources, older buildings, and lack of incident reporting infrastructure. Overall, successful implementation of HealthWISE required dedicated local team members who helped facilitate the process by adapting HealthWISE to the workers’ occupational health and safety (OHS) knowledge and skill levels and the cultures and needs of their hospitals, cutting across all constructs of the i-PARiHS framework.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124519
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4520: Testing the Multiple Pathways of Residential
           Greenness to Pregnancy Outcomes Model in a Sample of Pregnant Women in the
           Metropolitan Area of Donostia-San Sebastián

    • Authors: Asier Anabitarte, Mikel Subiza-Pérez, Jesús Ibarluzea, Kepa Azkona, Gonzalo García-Baquero, Carme Miralles-Guasch, Jon Irazusta, Kristina W. Whitworth, Guillem Vich, Aitana Lertxundi
      First page: 4520
      Abstract: Residential greenness may positively impact diverse human health indicators through the reduction of air pollution, the improvement of psychological health, and the promotion of physical activity. Previous studies indicate a weak but positive association with pregnancy outcomes. Our aim was to test the multiple pathways from residential greenness to pregnancy outcomes model, using residential NO2 concentrations, psychological health, and moderate-to-vigorous physical activity (MVPA) during the first trimester of pregnancy, in a sample of 440 pregnant women residing in Donostia, Spain. Three metrics of residential greenness were calculated around each participant’s home address: normalized difference vegetation index (NDVI) within 300 m, and green space (>5000 m2) availability within 300 and 500 m. Residential NO2 concentrations, psychological health, and MVPA were explored as mediators of the associations between these metrics and the following pregnancy outcomes: birth weight (BW), low birth weight (LBW), prematurity, small for gestational age (SGA), and large for gestational age (LGA). Educational attainment, parity, and body mass index (BMI) were treated as covariates. Counterfactual mediation analyses showed very low to null statistical support for an association between any of the greenspace metrics and pregnancy outcomes in the full sample. Green space availability (300 m) was associated with lower BW and showed a marginal protective effect against LGA.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124520
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4521: Environmental and Occupational Risk Factors
           Associated with Chronic Kidney Disease of Unknown Etiology in West
           Javanese Rice Farmers, Indonesia

    • Authors: Laila Fitria, Nurhayati Adnan Prihartono, Doni Hikmat Ramdhan, Tri Yunis Miko Wahyono, Pornpimol Kongtip, Susan Woskie
      First page: 4521
      Abstract: Chronic kidney disease of unknown etiology (CKDu) in agricultural population is an increasing issue. This study aims to obtain a prevalence estimate of CKDu in male rice farmers in West Java, Indonesia; and analyze the relationship between CKDu and environmental and occupational factors. The study design was cross-sectional. This study included 354 healthy male farmers in two rice agriculture areas in West Java with different altitudes (low altitude and high-altitude location). This research included blood and urine sampling from the farmers for serum creatinine (SCr) level and proteinuria; questionnaire on demographic information, occupational factors and other risk factors for CKDu. We measured ambient temperature and humidity in both study locations for environmental factors. From SCr level and proteinuria, we categorized the farmers into five stages of CKD; then we distinguished CKDu from CKD if the farmers had stage 1–4 of CKD but without diabetes, hypertension and other traditional causes. Data were analyzed with multivariate logistic regression to get prevalence odd ratios of CKDu and its relationship with environmental and occupational factors, adjusted with other risk factors of CKDu. The overall prevalence of CKD was 24.9% and CKDu was 18.6%. For the environmental factors, farm location (high altitude versus low altitude location) was associated with CKDu (Prevalence Odds Ratio (POR): 2.0; 95% CI: 1.2–3.5). For the occupational factors, although not significant, the risk of CKDu increased with the longer use of insecticide and with the more frequent of insecticide use. We suggested that there was a need to conduct future research to investigate more on the association of those environmental and occupational factors with CKDu.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124521
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4522: The Office Work and Stretch Training (OST)
           Study: An Individualized and Standardized Approach to Improve the Quality
           of Life in Office Workers

    • Authors: Fabian Holzgreve, Laura Maltry, Jasmin Hänel, Helmut Schmidt, Andreas Bader, Markus Frei, Natalie Filmann, David Alexander Groneberg, Daniela Ohlendorf, Anke van Mark
      First page: 4522
      Abstract: In the context of workplace health promotion, physical activity programs have been shown to reduce musculoskeletal diseases and stress, and to improve the quality of life. The aim of this study was to examine the effects of using the “five-Business” stretch training device for office workers on their quality of life. A total of 313 office workers (173m/137f) participated voluntarily in this intervention–control study with an average age of 43.37 ± 11.24 (SD) years, 175.37 ± 9.35 cm in height and 75.76 ± 15.23 kg in weight, with an average BMI of 24.5 ± 3.81 kg/m2. The participants completed the stretch training twice a week for approximately 10 minutes for a duration of 12 weeks. The SF-36 questionnaire was used to evaluate the effectiveness of the intervention at baseline and after 12 weeks. Significantly improved outcomes in mental sum score (p = 0.008), physical functioning (p < 0.001), bodily pain (p = 0.01), vitality (p = 0.025), role limitations due to physical problems (p = 0.018) and mental health (p = 0.012) were shown after the stretching training. The results suggest that a 12-week stretching program for office desk workers is suitable to improve significantly their health-related quality of life.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124522
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4523: Age-Friendly Environments in ASEAN Plus
           Three: Case Studies from Japan, Malaysia, Myanmar, Vietnam, and Thailand

    • Authors: Sariyamon Tiraphat, Doungjai Buntup, Murallitharan Munisamy, Thang Huu Nguyen, Motoyuki Yuasa, Myo Nyein Aung, Aung Hpone Myint
      First page: 4523
      Abstract: Promoting age-friendly environment is one of the appropriate approaches to support quality of life toward ageing populations. However, the information regarding age-friendly environments in the Association of Southeast Asian Nations (ASEAN) Plus Three countries is still limited. This study aimed to survey the perceived age-friendly environments among ASEAN Plus Three older populations. This study employed cross-sectional quantitative research using multistage cluster sampling to select a sample of older adults in the capital cities of Japan, Malaysia, Myanmar, Vietnam and Thailand. The final sample was composed of 2171 older adults aged 55 years and over, including 140 Japanese, 510 Thai, 537 Malaysian, 487 Myanmarese, and 497 Vietnamese older adults. Data collection was conducted using a quantitative questionnaire with 20 items of perceived age-friendly environments with the rating scale based on the World Health Organization (WHO) standard. The score from the 20 items were analyzed and examined high-risk groups of “bad perception level” age-friendly environments using ordinal logistic regression. The research indicated the five highest inadequacies of age-friendly environments including: (1) participating in an emergency-response training session or drill which addressed the needs of older residents; (2) enrolling in any form of education or training, either formal or non-formal in any subject; (3) having opportunities for paid employment; (4) involvement in decision making about important political, economic and social issues in the community; and (5) having personal care or assistance needs met in the older adult’s home setting by government/private care services. Information regarding the inadequacy of age-friendliness by region was evidenced to guide policy makers in providing the right interventions towards older adults’ needs.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124523
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4524: The Differences in the Diagnostic Profile in
           Children with Vasovagal Syncope between the Result of Head-Up Tilt Table

    • Authors: Ewelina Kolarczyk, Lesław Szydłowski, Agnieszka Skierska, Grażyna Markiewicz-Łoskot
      First page: 4524
      Abstract: (1) Background: The features characterizing vasovagal syncope (VVS) are an important factor in the correct evaluation of diagnostic risk stratification in children and adolescents. The aim of the study was to determine the value of identifying the clinical characteristics in children with VVS. (2) Methods: We made a retrospective analysis of the medical records of 109 children with diagnosed VVS. We investigated the specific characteristics of syncope in children with VVS including the positive VVS (+) and negative VVS (−) result of the Head-Up Tilt Table Test (HUTT). (3) Results: We did not observe significant differences in the prodromal symptoms of VVS with HUTT response. In addition to typical prodromal symptoms, no difference in statistically reported palpitations (35/109 or 32.1%) and chest discomfort (27/109 or 27.7%) were recorded. Fear–pain–stress emotions as circumstances of syncope were more often reported by children with a negative HUTT (p = 0.02). Cramps–contractures (p = 0.016) and speech disorders (p = 0.038) were significantly higher in the group with negative HUTT. (4) Conclusions: There is a close relationship in the diagnostic profile between the negative and positive results of head-up tilt table test in children with vasovagal syncope.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124524
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4525: Association between Surrounding Greenness and
           Mortality: An Ecological Study in Taiwan

    • Authors: Hsiao-Yun Lee, Chih-Da Wu, Yi-Tsai Chang, Yinq-Rong Chern, Shih-Chun Candice Lung, Huey-Jen Su, Wen-Chi Pan
      First page: 4525
      Abstract: Exposure to surrounding greenness is associated with reduced mortality in Caucasian populations. Little is known however about the relationship between green vegetation and the risk of death in Asian populations. Therefore, we opted to evaluate the association of greenness with mortality in Taiwan. Death information was retrieved from the Taiwan Death Certificate database between 2006 to 2014 (3287 days). Exposure to green vegetation was based on the normalized difference vegetation index (NDVI) collected by the Moderate Resolution Imagine Spectroradiometer (MODIS). A generalized additive mixed model was utilized to assess the association between NDVI exposure and mortality. A total of 1,173,773 deaths were identified from 2006 to 2014. We found one unit increment on NDVI was associated with a reduced mortality due to all-cause (risk ratio [RR] = 0.901; 95% confidence interval = 0.862–0.941), cardiovascular diseases (RR = 0.892; 95% CI = 0.817–0.975), respiratory diseases (RR = 0.721; 95% CI = 0.632–0.824), and lung cancer (RR = 0.871; 95% CI = 0.735–1.032). Using the green land cover as the alternative green index showed the protective relationship on all-cause mortality. Exposure to surrounding greenness was negatively associated with mortality in Taiwan. Further research is needed to uncover the underlying mechanism.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124525
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4526: Chronic Regulatory Focus and Work-Family
           Conflict among Chinese Workers

    • Authors: Xinyuan (Roy) Zhao, Karthik Namasivayam, Nicholas J. Beutell, Jingyan Liu, Fujin Wang
      First page: 4526
      Abstract: Survey data from 226 service employees were used to test the hypothesized moderating role of chronic self-regulatory focus on the relationships between work–family conflict (WFC) and challenge/hindrance strain. A follow-up scenario-based experiment (N = 93 executives) confirmed the results of the hypothesized model. Results from the two studies together demonstrated the moderating role of self-regulatory processes: chronic promotion-focused individuals perceived WFC as a challenge-type strain, while chronic prevention-focused individuals viewed WFC as a hindrance-type strain. Individuals use self-regulation strategically: in work domains, they regulate themselves so that family does not interfere with work. Individuals’ stress perceptions differ depending on the two dimensions of WFC as they regard interferences from (WIF) as a personal challenge, perhaps affording them an opportunity to balance work and life and to refine their abilities, but interferences from family to work (FIW) act as a barrier preventing them from achieving career success. When two-way interactions between WIF/FIW and chronic promotion/prevention foci were taken into consideration, the WIF/FIW main effects on challenge/hindrance stress became insignificant, suggesting that chronic self-regulation fully moderated the relationship. The results extend the current work–family research by incorporating self-regulatory processes as an important moderating variable, suggesting new research directions. The findings can help human resource management establish policies and benefit programs that take individual differences into account.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124526
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4527: Utilizing Green Design as Workplace
           Innovation to Relieve Service Employee Stress in the Luxury Hotel Sector

    • Authors: Han, Ariza-Montes, Giorgi, Lee
      First page: 4527
      Abstract: This study is an empirical endeavor to provide a clear comprehension regarding how hotel green design as a workplace innovation contributes to relieving employee stress and emotional fatigue and improves job satisfaction and involvement in the formation of organizational citizenship behavior. A quantitative process was employed to attain the research goal. Our empirical findings demonstrated that a green design as a workplace innovation boosts the stress resilience that leads to the decreased emotional exhaustion and increased job satisfaction. In addition, job satisfaction and job involvement were the crucial drivers of the organizational citizenship behavior among the luxury hotel service employees. Moreover, stress resilience, satisfaction and involvement were significant mediators. Job satisfaction and involvement had the strongest influence on organizational citizenship behavior than other variables. The findings of our research will help hotel proprietors to invent efficient strategies to minimize employee stress and maximize fulfillment at work, which will eventually enhance the organizational citizenship behavior.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124527
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4528: Understanding the Barriers and Opportunities
           for Effective Management of Shared Sanitation in Low-Income
           Settlements—The Case of Kumasi, Ghana

    • Authors: Antwi-Agyei, Dwumfour-Asare, Adjei, Kweyu, Simiyu
      First page: 4528
      Abstract: Improved sanitation for all is a daunting task for low-income countries, and shared toilets often provide an alternative to private household sanitation for most urban residents. This study sought to provide better understanding of the existing barriers and opportunities for improved management of shared sanitation. The study used focus group discussions and in-depth interviews with 70 users (landlords and tenants) of shared sanitation in Kumasi, Ghana to assess barriers and opportunities of “high-quality” shared sanitation. The commonly used toilet facilities were dry toilets—Kumasi Ventilated Improved Pit latrine and Ventilated Improved Pit latrines; and flush systems—water closet and pour flush connected to septic tanks. Between 2 and 21 households, or 4 and 84 people, shared one facility. Participants’ description of “high-quality” (Ideal) shared sanitation was centred on cleanliness, user behaviour, smell, and user crowding. They also identified challenges of shared sanitation as overcrowded users, poor user behaviours, conflicts among users, and high cost associated with frequent desludging. However, opportunities for improvement included users’ preference for shared toilets due to enjoyed benefits, existing facility management practices, and mutual understanding among users (tenants and landlords). Interventions and policy guidelines to influence behaviour change of shared sanitation users are proposed and are intended to be delivered by local government and users.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124528
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4529: Physical Activity Levels of Chilean Children
           in a National School Intervention Programme. A Quasi-Experimental Study

    • Authors: Fernando Rodríguez-Rodríguez, Carlos Cristi-Montero, José Castro-Piñero
      First page: 4529
      Abstract: Background. Recess is a great opportunity to interrupt sedentary behaviour and increase moderate-to-vigorous physical activity (MVPA) in schoolchildren. This quasi-experimental study aimed to compare the levels of physical activity (PA) during the school day of children in a school intervention programme vs. those in a control group, and to determine compliance with MVPA recommendations. Methods. A sample of 154 schoolchildren (6–12 years old) was obtained from several schools (70 with the intervention and 84 controls). This programme was structured with a duration of 90 min/session and performed three times/week. PA levels were recorded with triaxial accelerometers during the school day: during recess, during a PA session or physical education session (PE), and during lunchtime. No pre-intervention evaluation was performed. Results. The MVPA of the control group was higher than that of the intervention group during the first recess (p < 0.001). None of the groups complied with the recommendations for steps during the PA or PE sessions. During the PA session, sedentary time was lower and MVPA was higher, in the intervention group than in the control group. Fifty percent of the children from the intervention group complied with the MVPA recommendations, vs. 22.7% of those in the control group. Conclusions. The schoolchildren in the intervention group performed more MVPA than those in the control group. Future interventions could include other periods, such as recess and lunchtime, which are opportunities for improving the MVPA levels of schoolchildren.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-23
      DOI: 10.3390/ijerph17124529
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4530: Integrated Family Planning and Immunization
           Service Delivery at Health Facility and Community Sites in Dowa and
           Ntchisi Districts of Malawi: A Mixed Methods Process Evaluation

    • Authors: Chelsea M. Cooper, Jacqueline Wille, Steven Shire, Sheila Makoko, Asnakew Tsega, Anne Schuster, Hannah Hausi, Hannah Gibson, Hannah Tappis
      First page: 4530
      Abstract: The Government of Malawi’s Health Sector Strategic Plan II highlights the importance of service integration; however, in practice, this has not been fully realized. We conducted a mixed methods evaluation of efforts to systematically implement integrated family planning and immunization services in all health facilities and associated community sites in Ntchisi and Dowa districts during June 2016–September 2017. Methods included secondary analysis of service statistics (pre- and postintervention), focus group discussions with mothers and fathers of children under age one, and in-depth interviews with service providers, supervisors, and managers. Results indicate statistically significant increases in family planning users and shifts in use of family planning services from health facilities to community sites. The intervention had no effect on immunization doses administered or dropout rates. According to mothers and fathers, benefits of service integration included time savings, convenience, and improved understanding of services. Provision and use of integrated services were affected by availability of human resources and commodities, community linkages, data collection procedures and availability, sociocultural barriers, organization of services, and supervision and commitment of health surveillance assistants. The integration approach was perceived to be feasible and beneficial by clients and providers.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124530
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4531: Regional Heterogeneity of Application and
           Effect of Telemedicine in the Primary Care Centres in Rural China

    • Authors: Wanchun Xu, Zijing Pan, Shan Lu, Liang Zhang
      First page: 4531
      Abstract: The increasing concerns of the geographical maldistribution of medical resources have sparked worldwide interests in exploring the potential of telemedicine in the rural health system. This study aimed to investigate the application and effect of telemedicine as well as their regional heterogeneity in the primary care centres in rural China. Based on the stratified multistage cluster sampling, a cross-sectional study was conducted among 358 township health centres (THCs) from eastern, central and western China. A self-administered questionnaire was used and the data of the Health Statistical Annual Reports in 2017 were collected to investigate the implication of telemedicine as well as the performance and other characteristics of each THCs. Propensity score matching was used to estimate the effect of telemedicine application on the bed occupancy rate and the number of annual outpatient visits of the THCs, with comparison among the regions. The overall prevalence of telemedicine application was 58.66% in 2017, and it was found to increase the bed occupancy rate of the THCs in the national range (p < 0.1). When divided into different regions, telemedicine was found to improve the number of annual outpatient visits in western China (p < 0.05) and the bed occupancy rate in eastern China (p < 0.1). Disparities in the degree of remoteness and the capability of THCs among the regions were also found in this study, which may be the reasons for the regional heterogeneous effects of telemedicine. These findings suggested the potential of telemedicine in improving the utilization of primary care centres in rural areas. Further studies were needed to investigate the underlying reasons for its regional heterogeneous effects.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124531
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4532: Association between Health Problems and
           Turnover Intention in Shift Work Nurses: Health Problem Clustering

    • Authors: Jison Ki, Jaegeum Ryu, Jihyun Baek, Iksoo Huh, Smi Choi-Kwon
      First page: 4532
      Abstract: Shift work nurses experience multiple health problems due to irregular shifts and heavy job demands. However, the comorbidity patterns of nurses’ health problems and the association between health problems and turnover intention have rarely been studied. This study aimed to identify and cluster shift work nurses’ health problems and to reveal the associations between health problems and turnover intention. In this cross-sectional study, we analyzed data from 500 nurses who worked at two tertiary hospitals in Seoul, South Korea. Data, including turnover intention and nine types of health issues, were collected between March 2018 and April 2019. Hierarchical clustering and multiple ordinal logistic regressions were used for the data analysis. Among the participants, 22.2% expressed turnover intention and the mean number of health problems was 4.5 (range 0–9). Using multiple ordinal logistic regressions analysis, it was shown that sleep disturbance, depression, fatigue, a gastrointestinal disorder, and leg or foot discomfort as a single health problem significantly increased turnover intention. After clustering the health problems, four clusters were identified and only the neuropsychological cluster—sleep disturbance, fatigue, and depression—significantly increased turnover intention. We propose that health problems within the neuropsychological cluster must receive close attention and be addressed simultaneously to decrease nurse’s turnover intentions.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124532
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4533: Stress Measured by Allostatic Load Varies by
           Reason for Immigration, Age at Immigration, and Number of Children: The
           Africans in America Study

    • Authors: Thomas Hormenu, Elyssa M. Shoup, Nana H. Osei-Tutu, Arsene F. Hobabagabo, Christopher W. DuBose, Lilian S. Mabundo, Stephanie T. Chung, Margrethe F. Horlyck-Romanovsky, Anne E. Sumner
      First page: 4533
      Abstract: Stress leads to physiologic dysfunction and cardiometabolic disease. Allostatic load score (ALS) measures stress-induced cardiovascular, metabolic, and inflammatory biomarkers. We estimated the odds of high ALS by reason for and age at immigration, duration of American residence, number of children, and socioeconomic status in 193 African immigrants (male: 65%, age 41 ± 10 y (mean ± Standard Deviation (SD)), range 22–65 y). ALS was calculated with High-ALS defined as ALS ≥ 3.0 and Low-ALS defined as ALS < 3.0. Oral glucose tolerance tests (OGTT) were performed, the cardiovascular disease (CVD) risk estimated, and TNF-α, an inflammatory cytokine, measured. Logistic regression was used to estimate odds of High-ALS. In the High- and Low-ALS groups, ALS were 4.0 ± 1.2 vs. 1.3 ± 0.7, diabetes prevalence: 14% vs. 4%, CVD risk: 23% vs. 8%, TNF-α levels: 15 ± 9 vs. 11 ± 6 pg/mL, respectively (all p ≤ 0.01). Immigrants were more likely to be in the High-ALS group if their reason for immigration was work or asylum/refugee (OR 2.18, p = 0.013), their age at immigration was ≥30 y (OR 3.28, p < 0.001), their duration of residence in United States was ≥10 y (OR 3.16, p = 0.001), or their number of children was ≥3 (OR 2.67, p = 0.019). Education, income, health insurance, marital status, and gender did not affect High-ALS odds. Factors adversely influencing allostatic load and cardiometabolic health in African immigrants were age at and reason for immigration, duration of residence in America, and number of children.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124533
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4534: Follower Dependence, Independence, or
           Interdependence: A Multi-Foci Framework to Unpack the Mystery of
           Transformational Leadership Effects

    • Authors: Qing Lu, Yonghong Liu, Xu Huang
      First page: 4534
      Abstract: We develop a multi-foci framework—“follower dependence,” “follower independence,” and “leader-follower interdependence”—to explain how transformational leadership influences follower performance. Follower’s personal identification with the leader, psychological empowerment, and leader-member exchange are employed as proxies for each of the three foci. Two separate studies consistently show that personal identification (denoting a “follower dependence” focus) is a more salient mechanism than the other two in explaining the transformational leadership-organizational citizenship behavior relationship. These results suggest transformational leadership is perhaps a theory of follower dependence rather than independence or interdependence. Theoretical implications, limitations, and future directions are discussed.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124534
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4535: Lung Function Testing and Prediction
           Equations in Adult Population from Maputo, Mozambique

    • Authors: Olena Ivanova, Celso Khosa, Abhishek Bakuli, Nilesh Bhatt, Isabel Massango, Ilesh Jani, Elmar Saathoff, Michael Hoelscher, Andrea Rachow
      First page: 4535
      Abstract: Background: Local spirometric prediction equations are of great importance for interpreting lung function results and deciding on the management strategies for respiratory patients, yet available data from African countries are scarce. The aim of this study was to collect lung function data using spirometry in healthy adults living in Maputo, Mozambique and to derive first spirometric prediction equations for this population. Methods: We applied a cross-sectional study design. Participants, who met the inclusion criteria, underwent a short interview, anthropometric measurements, and lung function testing. Different modelling approaches were followed for generating new, Mozambican, prediction equations and for comparison with the Global Lung Initiative (GLI) and South African equations. The pulmonary function performance of participants was assessed against the different reference standards. Results: A total of 212 males and females were recruited, from whom 155 usable spirometry results were obtained. The mean age of participants was 35.20 years (SD 10.99) and 93 of 155 (59.35%) were females. The predicted values for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and the FEV1/FVC ratio based on the Mozambican equations were lower than the South African—and the GLI-based predictions. Conclusions: This study provides first data on pulmonary function in healthy Mozambican adults and describes how they compare to GLI and South African reference values for spirometry.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124535
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4536: Analysis of the Relationship between Stress
           Intensity and Coping Strategy and the Quality of Life of Nursing Students
           in Poland, Spain and Slovakia

    • Authors: Kupcewicz, Grochans, Kadučáková, Mikla, Jóźwik
      First page: 4536
      Abstract: Background: This study aimed to determine the relationship between stress intensity and coping strategies and the quality of life and health among nursing students in Poland, Spain and Slovakia. Methods: The study was performed on a group of 1002 nursing students from three European countries. A diagnostic survey was used as a research method and the data collection was based on the Perceived Stress Scale PSS-10, Mini-COPE Coping Inventory-and the WHOQoL-Bref questionnaire. Results: The average age of all the respondents was 21.6 years (±3.4). Most of the surveyed students rated their stress intensity over the last month as moderate or high. Comparison of the results of the stress levels in relation to the country of residence did not reveal statistically significant differences. In the group of Polish students, the most positive relationship between active coping strategies and the quality of life in the psychological (r = 0.43; p < 0.001) and physical health domain (r = 0.42; p < 0.001) were most strongly marked. Among Slovak students, significant correlations of low intensity were found between active coping strategies and the quality of life in the physical health (r = 0.15; p < 0.01), psychological (r = 0.21; p < 0.001), social relationships (r = 0.12; p < 0.05) and environment (r = 0.19; p < 0.001) domain. In overcoming stressful situations, Spanish students used the Sense of Humour strategy, which is considered less effective, although very useful in some cases. In this group, the strongest positive correlation was found for the psychological domain (r = 0.40; p < 0.001). Conclusions: There is a need to implement prevention and stress coping programmes at every stage of studies to ensure effective protection against the negative effects of stress and to improve the quality of life of nursing students.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124536
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4537: Urban Atmospheric Environment Quality
           Assessment by Naturally Growing Bryophytes in Central China

    • Authors: Yanbin Jiang, Xifeng Zhang, Ronggui Hu, Jinsong Zhao, Miao Fan, Muhammad Shaaban, Yupeng Wu
      First page: 4537
      Abstract: Bryophytes are popular biomonitoring plants for atmospheric environments. The objectives of this study were to examine the characteristics of bryophyte communities, determine a suitable monitor species, and assess urban atmospheric environment quality by the joint use of bryophyte features and chemical properties in a large city in China. A pleurocarpous feather moss Haplocladium angustifolium was recognized as a good biomonitor of atmospheric deposition in central China by investigating bryophyte communities and habitat environment in various ecological function regions of the urban areas in Wuhan. The concentrations of trace elements, including As, Cd, Co, Cr, Cu, Mn, Ni, V, Pb, and Zn, in moss and soil samples from 25 sampling sites were analyzed by inductively coupled plasma mass spectrometry. The concentrations of Cd and Zn in Haplocladium angustifolium collected from the entire study area were much higher than those in substrate soil. Cd was at the highest ecological risk level among the 10 elements, which contributed 34.5% to the potential ecological risk index (RI). An RI value of 392.8 indicated that urban atmospheric quality in Wuhan was in a considerable potential ecological risk. The index of atmospheric purity, regarding species richness, cover, and frequency of bryophytes, was spatially and negatively correlated with RI, also demonstrated the atmospheric quality. Effective measures should be considered to alleviate certain airborne trace element contamination and protect the environment and human health in this metropolis.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124537
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4538: A Mixed Methods Evaluation of a Digital
           Intervention to Improve Sedentary Behaviour Across Multiple Workplace

    • Authors: Bradley MacDonald, Ann-Marie Gibson, Xanne Janssen, Alison Kirk
      First page: 4538
      Abstract: Background: Prolonged sedentary behaviour (SB) is associated with risk of chronic diseases. Digital interventions in SB require mixed method evaluations to understand potential for impact in real-world settings. In this study, the RE-AIM QuEST evaluation framework will be used to understand the potential of a digital health promotion application which targets reducing and breaking up SB across multiple workplace settings. Methods: Four companies and 80 employees were recruited to use a digital application. Questionnaires were used to measure SB, and additional health and work-related outcomes at baseline, one month, three month and six month follow-up. Qualitative data was collected through focus groups with employees and interviews with stakeholders. Questionnaire data was analysed using Wilcoxon Sign Rank tests and qualitative data was thematically analysed. Results: The digital application significantly increased standing time at one month for the total group and transitions per hour in one of the companies. Facilitators and barriers were identified across RE-AIM. Conclusions: Addressing the barriers which have been identified, while maintaining the positive attributes will be critical to producing an effective digital application which also has the potential for impact in the real world.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124538
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4539: Should Waste Separation Be Mandatory' A
           Study on Public’s Response to the Policies in China

    • Authors: Jing Hou, Yujing Jin, Feiyu Chen
      First page: 4539
      Abstract: The implementation of effective waste separation policy is an important pathway to guide the public to actively participate in the waste separation action. This study focused on exploring the Chinese public’s response to the rigid and flexible waste separation policies from the perspectives of understanding, willingness to support, and willingness to implement. We used a big data mining technique to obtain 10,057 entries of the Chinese public’s response to the mandatory waste separation policy. The results showed that “public’s understanding–support willingness-implement willingness” regarding mandatory waste separation policy was characterized by a U-shaped response. Specifically, the public’s understanding and willingness to implement the rigid waste separation policy were relatively high in the short term, but their willingness to support this policy was relatively low and became increasingly low over time. Particularly, “troublesome” implementation was deemed to the main reason for the public’s low willingness to support the rigid waste separation policy. In addition, we further obtained the sample data of the Chinese public regarding the flexible waste separation policy through the situational survey. Contrary to the response characteristics of mandatory waste separation policy, the results showed that “public’s understanding-support willingness-implement willingness” regarding flexible waste separation policy was characterized by an inverted U-shaped response, and the Chinese public showed more positive sentiment regarding the willingness to support and implement. The results have important implications for guiding the public to actively participate in the waste separation action.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124539
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4540: Computational Forecasting Methodology for
           Acute Respiratory Infectious Disease Dynamics

    • Authors: Daniel Alejandro Gónzalez-Bandala, Juan Carlos Cuevas-Tello , Daniel E. Noyola , Andreu Comas-García , Christian A García-Sepúlveda 
      First page: 4540
      Abstract: The study of infectious disease behavior has been a scientific concern for many years as early identification of outbreaks provides great advantages including timely implementation of public health measures to limit the spread of an epidemic. We propose a methodology that merges the predictions of (i) a computational model with machine learning, (ii) a projection model, and (iii) a proposed smoothed endemic channel calculation. The predictions are made on weekly acute respiratory infection (ARI) data obtained from epidemiological reports in Mexico, along with the usage of key terms in the Google search engine. The results obtained with this methodology were compared with state-of-the-art techniques resulting in reduced root mean squared percentage error (RMPSE) and maximum absolute percent error (MAPE) metrics, achieving a MAPE of 21.7%. This methodology could be extended to detect and raise alerts on possible outbreaks on ARI as well as for other seasonal infectious diseases.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124540
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4541: Impact of Age, Multimorbidity and Frailty on
           the Prescription of Preventive Antiplatelet Therapy in Older Population

    • Authors: Caroline Laborde, Jérémy Barben, Anca-Maria Mihai, Valentine Nuss, Jérémie Vovelle, Philippe d’Athis, Pierre Jouanny, Alain Putot, Patrick Manckoundia
      First page: 4541
      Abstract: Platelet aggregation inhibitors (PAI) have widely proven their efficiency for the prevention of ischemic cardiovascular events. We aimed to describe PAI prescription in an elderly multimorbid population and to determine the factors that influence their prescription, including the impact of age, comorbidities and frailty, evaluated through a comprehensive geriatric assessment. This cross-sectional study included all patients admitted to the acute geriatric department of a university hospital from November 2016 to January 2017. We included 304 consecutive hospitalized patients aged 88.7 ± 5.5 years. One third of the population was treated with PAI. A total of 133 (43.8%) patients had a history of cardiovascular disease, 77 of whom were on PAI. For 16 patients, no indication was identified. The prescription or the absence of PAI were consistent with medical history in 61.8% of patients. In the multivariate analysis, among the 187 patients with an indication for PAI, neither age (odds ratio (OR) = 1.00; 95% confidence interval (CI): [0.91–1.08], per year of age), nor comorbidities (OR = 0.97; 95% CI: [0.75–1.26], per point of Charlson comorbidity index), nor cognitive disorders (OR = 0.98; 95% CI [0.91–1.06] per point of Mini Mental State Examination), nor malnutrition (OR = 1.07; 95% CI [0.96–1.18], per g/L of albumin) were significantly associated with the therapeutic decision. PAI were less prescribed in primary prevention situations, in patients taking anticoagulants and in patients with a history of bleeding. In conclusion, a third of our older comorbid population of inpatients was taking PAI. PAI prescription was consistent with medical history for 61.8% of patients. Age, multimorbidity and frailty do not appear to have a significant influence on therapeutic decision-making. Further research is needed to confirm such a persistence of cardiovascular preventive strategies in frail older patients from other settings and to assess whether these strategies are associated with a clinical benefit in this specific population.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124541
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4542: Does Interpersonal Interaction Really Improve
           Emotion, Sleep Quality, and Self-Efficacy among Junior College

    • Authors: Po-Yu Wang, Pin-Hsuan Lin, Chung-Ying Lin, Shang-Yu Yang, Kai-Li Chen
      First page: 4542
      Abstract: This study discusses the correlation between teenagers’ real-life interpersonal interactions and teenagers’ online interpersonal interactions with regards to emotion, sleep quality, and self-efficacy. This study adopted a cross-sectional design that included a survey using a structured questionnaire which included demographic data, the Chinese version of the Depression Anxiety Stress Scale (DASS-21), the Pittsburgh Sleep Quality Index (PSQI), the General Self-Efficacy Scale (GSE), the Real Interpersonal Interaction Scale (RIIS), and the Internet Interpersonal Interaction Scale (IIIS). This study enlisted 917 teenage students (age = 17.16 ± 1.48 years). The study found that RIIS had significant negative correlations with DASS and PSQI scores and a significant positive correlation with GSE. Namely, the greater the degree of real-life interpersonal interaction, the lower the degree of negative emotion. Likewise, the more satisfactory sleep quality is, the higher self-efficacy is. In addition, IIIS scores demonstrate significantly positive correlations with DASS and PSQI scores. Therefore, the greater the degree of online interpersonal interaction, the greater the levels of negative emotion, and the poorer the sleep quality is. This study showed that online interpersonal interaction may not improve emotions, sleep quality, or self-efficacy among junior college students. However, real-life interpersonal interaction may improve those three parameters.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124542
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4543: Displacement and Emotional Well-Being among
           Married and Unmarried Syrian Adolescent Girls in Lebanon: An Analysis of

    • Authors: Roupetz, Bartels, Michael, Najjarnejad, Anderson, Davison
      First page: 4543
      Abstract: Lebanon hosts over one million refugees displaced from Syria as a result of the armed conflict—of whom, approximately 15% are adolescents aged between 12 and 17 years of age. Many female adolescent migrants report a decrease in quality of life and an increase in family tensions. This study sought to investigate the emotional well-being of adolescent Syrian girls in Lebanon. We hypothesized that married girls may experience additional hardships and thus greater feelings of dissatisfaction in daily life, given their young marriage and responsibilities at home. This study was part of a large mixed-methods study on the experiences of Syrian refugee girls in Lebanon (n = 1422). Using line-by-line coding and thematic analysis, 188 first-person narratives from Syrian girls were analysed. Our results highlight poor emotional well-being among married and unmarried girls, with sadness, fear and anger commonly mentioned. Some participants expressed feelings of hope, happiness, gratefulness and empowerment. Unmarried girls (n = 111) were more likely to associate their shared stories with negative feelings such as sadness (47% vs. 22%), disappointment (30% vs. 19%), and frustration (32% vs. 22%) than were married girls (n = 77). Four themes emerged as important determinants: access to education, perceived safety, peer support, and longing for life back in Syria. Continued efforts to improve emotional well-being for married and unmarried refugee girls are needed in Lebanon, in particular those that address the nuances for these groups.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124543
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4544: Efficacy of an Internet-Based Program to
           Promote Physical Activity and Exercise after Inpatient Rehabilitation in
           Persons with Multiple Sclerosis: A Randomized, Single-Blind, Controlled

    • Authors: Flachenecker, Bures, Gawlik, Weiland, Kuld, Gusowski, Streber, Pfeifer, Tallner
      First page: 4544
      Abstract: Background: Multimodal rehabilitation improves fatigue and mobility in persons with multiple sclerosis (PwMS). Effects are transient and may be conserved by internet-based physical activity promotion programs. Objective: Evaluate the effects of internet-based physical activity and exercise promotion on fatigue, quality of life, and gait in PwMS after inpatient rehabilitation. Methods: PwMS (Expanded Disability Status Scale (EDSS) ≤ 6.0, fatigue: Würzburg Fatigue Inventory for Multiple Sclerosis (WEIMuS) ≥ 32) were randomized into an intervention group (IG) or a control group (CG). After rehabilitation, IG received 3 months of internet-based physical activity promotion, while CG received no intervention. Primary outcome: self-reported fatigue (WEIMuS). Secondary outcomes: quality of life (Multiple Sclerosis Impact Scale 29, MSIS-29), gait (2min/10m walking test, Tinetti score). Measurements: beginning (T0) and end (T1) of inpatient rehabilitation, 3 (T2) and 6 (T3) months afterwards. Results: 64 of 84 PwMS were analyzed (IG: 34, CG: 30). After rehabilitation, fatigue decreased in both groups. At T2 and T3, fatigue increased again in CG but was improved in IG (p < 0.001). MSIS-29 improved in both groups at T1 but remained improved at T2 and T3 only in IG. Gait improvements were more pronounced in IG at T2. Conclusions: The study provides Class II evidence that the effects of rehabilitation on fatigue, quality of life, and gait can be maintained for 3–6 months with an internet-based physical activity and exercise promotion program.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124544
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4545: Validity and Reliability of a New Test of
           Change of Direction in Fencing Athletes

    • Authors: Hichem Chtara, Yassine Negra, Helmi Chaabene, Moktar Chtara, John Cronin, Anis Chaouachi
      First page: 4545
      Abstract: The aim of this study was to validate a new test of change of direction (COD) for fencer athletes and to establish its relationship with selected measures of physical fitness. Thirty-nine fencer athletes participated to this study (age: 20.8 ± 3.0 years). They performed the new specific fencing COD test (SFCODT) on two separate occasions to establish its reliability. In addition, assessment of COD, jumping ability (i.e., squat jump, countermovement jump, five jump test), sprint time (e.g., 5-m, 10-m and 20-m), isokinetic concentric and eccentric quadriceps, and hamstring force tests were assessed. To establish SFCODT’s construct validity, two subgroups were identified based on their international and national fencing results: High- vs. low-ranked fencer athletes. Reliability, validity, and sensitivity of the SFCODT were established from the intraclass correlation coefficient (ICC), typical error of measurement (TEM), smallest worthwhile change (SWC), and receiving operator characteristic (ROC) analysis. The ICC of SFCODT was excellent at >0.95, and the TEM was < 5%. Based on the usefulness analysis, the ability to detect small performance changes can be rated as “good” in fencer athletes (SWC > TEM). SFCODT was very largely associated with the COD test and moderate to very large associated with jumping ability, sprint time, and isokinetic strength. High-ranked fencer athletes were better than low-ranked fencer athletes on SFCODT (p < 0.01). The area under the ROC curve was 0.76. In conclusion, the SFCODT is a highly reliable, valid, and sensitive test. Therefore, the SFCODT could be used by practitioners to evaluate specific CODS performance in fencer athletes.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124545
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4546: Associations between Multimorbidity and
           Physical Performance in Older Chinese Adults

    • Authors: Shan-Shan Yao, Xiangfei Meng, Gui-Ying Cao, Zi-Ting Huang, Zi-Shuo Chen, Ling Han, Kaipeng Wang, He-Xuan Su, Yan Luo, Yonghua Hu, Beibei Xu
      First page: 4546
      Abstract: Background: Evidence on the association between physical performance and multimorbidity is scarce in Asia. This study aimed to identify multimorbidity patterns and their association with physical performance among older Chinese adults. Methods: Individuals aged ≥60 years from the China Health and Retirement Longitudinal Study 2011–2015 (N = 10,112) were included. Physical performance was measured by maximum grip strength (kg) and average gait speed (m/s) categorized as fast (>0.8 m/s), median (>0.6–0.8 m/s), and slow (≤0.6 m/s). Multimorbidity patterns were explored using exploratory factor analysis. Generalized estimating equation was conducted. Results: Four multimorbidity patterns were identified: cardio–metabolic, respiratory, mental–sensory, and visceral–arthritic. An increased number of chronic conditions was associated with decreased normalized grip strength (NGS). Additionally, the highest quartile of factor scores for cardio–metabolic (β = −0.06; 95% Confidence interval (CI) = −0.07, −0.05), respiratory (β = −0.03; 95% CI = −0.05, −0.02), mental–sensory (β = −0.04; 95% CI = −0.05, −0.03), and visceral–arthritic (β = −0.04; 95% CI = −0.05, −0.02) patterns were associated with lower NGS compared with the lowest quartile. Participants with ≥4 chronic conditions were 2.06 times more likely to have a slow gait speed. Furthermore, the odds ratios for the highest quartile of factor scores of four patterns with slow gait speed compared with the lowest quartile ranged from 1.26–2.01. Conclusion: Multimorbidity was related to worse physical performance, and multimorbidity patterns were differentially associated with physical performance. A shift of focus from single conditions to the requirements of a complex multimorbid population was needed for research, clinical guidelines, and health-care services. Grip strength and gait speed could be targeted to routinely measure clinical performance among older adults with multimorbidity, especially mental–sensory disorders, in clinical settings.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124546
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4547: The Mediating Effects of Marital Intimacy and
           Work Satisfaction in the Relationship between Husbands’ Domestic Labor
           and Depressive Mood of Married Working Women

    • Authors: Choi, Kim, Myong
      First page: 4547
      Abstract: The purpose of the study was to examine the relationships between the husbands’ domestic labor and marital intimacy, work satisfaction, and depressive mood in married working women. We used the sixth (2016) dataset from the Women and Families Panel Survey conducted by the Korean Women’s Development Institute (KWDI). The subjects were 791 married working women who lived with a wage-earner husband and who did not have a housework assistant. The correlations between variables were measured and the fit of the structural equation model was assessed. We used a mediation model in which the husbands’ domestic labor affected the depressive mood of married working women through mediation of marital intimacy and work satisfaction. Bootstrapping was used to verify the significance of the indirect effects of the mediating variables. Husbands’ domestic labor had a significant effect on married women’s marital intimacy and work satisfaction, but no significant direct effect on depressive mood. Marital intimacy had a significant effect on work satisfaction, and these two variables were significantly related to reductions in the depressive mood score. Husbands’ domestic labor was found to be a complete mediator of depressive mood through its effects on marital intimacy and work satisfaction. Husbands’ domestic labor did not directly reduce married working women’s depressive mood scores, but instead reduced them indirectly through effects on marital intimacy and work satisfaction.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124547
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4548: The Impact of COVID-19 on HIV Treatment and
           Research: A Call to Action

    • Authors: Tiffany Chenneville, Kemesha Gabbidon, Patricia Hanson, Cashea Holyfield
      First page: 4548
      Abstract: The impact of the COVID-19 pandemic is far reaching, with devastating effects on individuals, communities, and societies across the world. People with chronic health conditions may be at greater risk of contracting or experiencing complications from COVID-19. In addition to illness or death for those who contract the virus, the physical distancing required to flatten the curve of new cases is having a negative impact on the economy, the effects of which intersect with mental health and other existing health concerns, thus affecting marginalized communities. Given that HIV also has a disproportionate impact on marginalized communities, COVID-19 is affecting people with HIV (PWH) in unique ways and will continue to have an impact on HIV research and treatment after the COVID-19 crisis passes. Using the biopsychosocial framework to contextualize the impact of COVID-19 on PWH, the purpose of this review article is to: (1) outline the similarities and differences between the COVID-19 and HIV pandemics; (2) describe the current and future impact of COVID-19 on PWH; and (3) outline a call to action for scientists and practitioners to respond to the impact of COVID-19 on HIV prevention and treatment.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124548
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4549: The Cost of Inflammatory Bowel Disease
           Management Matches with Clinical Course: A Single Outpatient Centre

    • Authors: Mariabeatrice Principi, Nunzia Labarile, Francesco Paolo Bianchi, Antonella Contaldo, Silvio Tafuri, Enzo Ierardi, Alfredo Di Leo
      First page: 4549
      Abstract: Inflammatory bowel diseases (IBD) have a large economic burden on health systems. Our single-centre observational retrospective study aimed to assess an economic evaluation in two IBD outpatient cohorts (biological and conventional therapy) in relation to disease activity within a three-year follow-up. Four hundred and seventeen consecutive IBD patients referred to our tertiary gastroenterology unit (Bari-Puglia-Southern Italy) on January 2014–December 2016 were included. For each group (conventional/biological), we assessed direct/indirect costs and clinical/endoscopic activity within the first year and along the three-year follow-up. Statistical analyses: Wilcoxon signed-rank test (continuous variables), chi-square and Fisher’s test (categorical variables), Spearman ranks (single outcome) and ANOVA (detection time, clinical/endoscopic scores) were used. Continuous variables were expressed as mean ± standard deviation and range and/or median, interquartile range and range; categorical variables were expressed as proportions with 95% confidence interval. Direct and indirect cost items of 2014 and 2014–2016 were higher in patients treated with biological than conventional therapy. Subjects on biological therapy were younger and showed clinical and endoscopic moderate-to-severe disease activity. After three years, they reached a significant improvement from baseline. Conversely, disease activity was mild when conventional treatment had a beneficial effect. In conclusion, overall IBD management cost matches with clinical course and needs long-term evaluation in critical patients.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124549
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4550: Residential Radon in Central and South
           America: A Systematic Review

    • Authors: Alexandra Giraldo-Osorio, Alberto Ruano-Ravina, Leonor Varela-Lema, Juan M. Barros-Dios, Mónica Pérez-Ríos
      First page: 4550
      Abstract: Radon gas is a pulmonary carcinogen and the second leading cause of lung cancer after smoking. There are many countries that have not implemented measures to reduce the risk it poses to the general population. The aim of this study was to locate available evidence on exposure to residential radon and the regulations to monitor and control this across Central and South America, by conducting a review of the scientific literature and government documents in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review included 31 studies which had taken measurements of radon in these countries. While Brazil, Argentina, and Peru have undertaken most research, no country in Central and South America has a national map of exposure to residential radon. The prevalence of exposure to radon was uneven, both among the different countries and within individual countries. No country has regulations to prevent the entry of radon into homes, and nine countries have not set maximum permissible concentrations for residential radon. There is a limited number of studies in South and Central America, with a limited spatial coverage, and there is a need to improve knowledge on exposure to residential radon and its effects, and for governments to take the necessary actions to introduce preventive measures in their statutory regulations.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124550
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4551: Towards Inclusive Healthcare Delivery:
           Potentials and Challenges of Human-Centred Design in Health Innovation
           Processes to Increase Healthy Aging

    • Authors: Catharina Thiel Sandholdt, Jason Cunningham, Rudi G.J. Westendorp, Maria Kristiansen
      First page: 4551
      Abstract: National healthcare systems need to adjust services and operations to accommodate the needs of complex, aging populations living with multimorbidity and polypharmacy. This paper suggests the use of a human-centred design as a method to engage older adults and key professionals in innovation processes aiming to design person-centred healthcare services and improve quality of life in older adults. We outline three innovation phases and highlight how such processes can create engagement and new insights on how life experiences of older adult’s shape preferences, beliefs, and habits. It is important to incorporate these insights into the design of successful strategies for ensuring age-friendly healthcare services. Our viewpoint is contextualised through a small-scale case study focusing on polypharmacy in older adults. From this case study, we extracted three challenges to producing co-designed health research: recruitment, time and resources, and funding. We discuss how to address these challenges. We argue for the involvement of older adults and professional stakeholders at an early stage in the design process to align expectations and to increase the likelihood of successful implementation of healthcare innovations that improve the quality of life for older adults.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124551
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4552: Examining the Impact of COVID-19 Lockdown in
           Wuhan and Lombardy: A Psycholinguistic Analysis on Weibo and Twitter

    • Authors: Yue Su, Jia Xue, Xiaoqian Liu, Peijing Wu, Junxiang Chen, Chen Chen, Tianli Liu, Weigang Gong, Tingshao Zhu
      First page: 4552
      Abstract: Many countries are taking strict quarantine policies to prevent the rapid spread of COVID-19 (Corona Virus Disease 2019) around the world, such as city lockdown. Cities in China and Italy were locked down in the early stage of the pandemic. The present study aims to examine and compare the impact of COVID-19 lockdown on individuals’ psychological states in China and Italy. We achieved the aim by (1) sampling Weibo users (geo-location = Wuhan, China) and Twitter users (geo-location = Lombardy, Italy); (2) fetching all the users’ published posts two weeks before and after the lockdown in each region (e.g., the lockdown date of Wuhan was 23 January 2020); (3) extracting the psycholinguistic features of these posts using the Simplified Chinese and Italian version of Language Inquiry and Word Count (LIWC) dictionary; and (4) conducting Wilcoxon tests to examine the changes in the psycholinguistic characteristics of the posts before and after the lockdown in Wuhan and Lombardy, respectively. Results showed that individuals focused more on “home”, and expressed a higher level of cognitive process after a lockdown in both Wuhan and Lombardy. Meanwhile, the level of stress decreased, and the attention to leisure increased in Lombardy after the lockdown. The attention to group, religion, and emotions became more prevalent in Wuhan after the lockdown. Findings provide decision-makers timely evidence on public reactions and the impacts on psychological states in the COVID-19 context, and have implications for evidence-based mental health interventions in two countries.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124552
      Issue No: Vol. 17, No. 12 (2020)
  • IJERPH, Vol. 17, Pages 4553: Progress in Occupational Asthma

    • Authors: Angelica I. Tiotiu, Silviya Novakova, Marina Labor, Alexander Emelyanov, Stefan Mihaicuta, Plamena Novakova, Denislava Nedeva
      First page: 4553
      Abstract: Occupational asthma (OA) represents one of the major public health problems due to its high prevalence, important social and economic burden. The aim of this review is to summarize current data about clinical phenotypes, biomarkers, diagnosis and management of OA, a subtype of work-related asthma. Most studies have identified two phenotypes of OA. One is sensitizer-induced asthma, occuring after a latency period and caused by hypersensitivity to high- or low-molecular weight agents. The other is irritant-induced asthma, which can occur after one or more exposures to high concentrations of irritants without latency period. More than 400 agents causing OA have been identified and its list is growing fast. The best diagnostic approach for OA is a combination of clinical history and objective tests. An important tool is a specific inhalation challenge. Additional tests include assessments of bronchial hyperresponsiveness to methacholine/histamine in patients without airflow limitations, monitoring peak expiratory flow at- and off-work, sputum eosinophil count, exhaled nitric oxide measurement, skin prick tests with occupational allergens and serum specific IgE. Treatment of OA implies avoidance of exposure, pharmacotherapy and education. OA is a heterogeneous disease. Mechanisms of its different phenotypes, their diagnosis, role of new biomarkers and treatment require further investigation.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2020-06-24
      DOI: 10.3390/ijerph17124553
      Issue No: Vol. 17, No. 12 (2020)
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