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Int. J. Environ. Res. Public Health, Volume 17, Issue 18 (September-2 2020) – 501 articles

Cover Story (view full-size image): Inhalation of forest volatile organic compounds (VOCs) such as limonene and pinene can result in useful antioxidant and anti-inflammatory effects on the airways, and the pharmacological activity on the brain of some terpenes absorbed through inhalation may induce psychophysical relaxation and improve mood. An immune-boosting effect has also been hypothesized. Tree composition can markedly influence the concentration of specific VOCs in the forest air, which also exhibits cyclic diurnal variations. Moreover, the beneficial effects of visiting a forest cannot solely be attributed to VOC inhalation but are due to an integrated stimulation of the five senses, with the visual component probably playing a fundamental role. Globally, these findings can have useful implications for individual wellbeing, public health, and landscape design. View this paper.
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16 pages, 1033 KiB  
Review
An Introduction to Probabilistic Record Linkage with a Focus on Linkage Processing for WTC Registries
by Jana Asher, Dean Resnick, Jennifer Brite, Robert Brackbill and James Cone
Int. J. Environ. Res. Public Health 2020, 17(18), 6937; https://doi.org/10.3390/ijerph17186937 - 22 Sep 2020
Cited by 22 | Viewed by 5613
Abstract
Since its post-World War II inception, the science of record linkage has grown exponentially and is used across industrial, governmental, and academic agencies. The academic fields that rely on record linkage are diverse, ranging from history to public health to demography. In this [...] Read more.
Since its post-World War II inception, the science of record linkage has grown exponentially and is used across industrial, governmental, and academic agencies. The academic fields that rely on record linkage are diverse, ranging from history to public health to demography. In this paper, we introduce the different types of data linkage and give a historical context to their development. We then introduce the three types of underlying models for probabilistic record linkage: Fellegi-Sunter-based methods, machine learning methods, and Bayesian methods. Practical considerations, such as data standardization and privacy concerns, are then discussed. Finally, recommendations are given for organizations developing or maintaining record linkage programs, with an emphasis on organizations measuring long-term complications of disasters, such as 9/11. Full article
(This article belongs to the Special Issue 9/11 Health Update)
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14 pages, 2230 KiB  
Review
Are Advanced Glycation End Products in Skin Associated with Vascular Dysfunction Markers? A Meta-Analysis
by Alicia Saz-Lara, Celia Álvarez-Bueno, Vicente Martínez-Vizcaíno, Blanca Notario-Pacheco, Irene Sequí-Dominguez and Iván Cavero-Redondo
Int. J. Environ. Res. Public Health 2020, 17(18), 6936; https://doi.org/10.3390/ijerph17186936 - 22 Sep 2020
Cited by 18 | Viewed by 3702
Abstract
Evidence exists regarding the association between advanced glycation end products and different cardiovascular disease subclinical processes, such as arterial stiffness and atherosclerosis. With this systematic review and meta-analysis, we aimed to provide a synthesis of the evidence regarding the association of arterial stiffness [...] Read more.
Evidence exists regarding the association between advanced glycation end products and different cardiovascular disease subclinical processes, such as arterial stiffness and atherosclerosis. With this systematic review and meta-analysis, we aimed to provide a synthesis of the evidence regarding the association of arterial stiffness measured by pulse wave velocity and atherosclerosis measured by carotid intima media thickness with skin autofluorescence. A systematic search was performed using: MEDLINE (PubMed), SCOPUS, and Web of Science, until 30 March 2020. Cross-sectional studies or baseline data from prospective longitudinal studies were considered. The DerSimonian and Laird method was used to calculate the pooled estimates of correlation coefficients and the corresponding 95% confidence intervals (CI) for the association of pulse wave velocity and carotid intima media thickness with skin autofluorescence. Twenty-five studies were included in the systematic review and meta-analysis, including 6306 subjects. The pooled correlation coefficient was 0.25 (95% CI: 0.18, 0.31) for pulse wave velocity and skin autofluorescence, and 0.31 (95% CI: 0.25, 0.38) for carotid intima media thickness and skin autofluorescence. This systematic review and meta-analysis provide a synthesis of the evidence showing a positive weak association of pulse wave velocity and carotid intima media thickness with skin autofluorescence. Full article
(This article belongs to the Special Issue New Insights in Prevention and Treatment of Cardiovascular Disease)
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18 pages, 1714 KiB  
Article
Effectiveness of SaBang-DolGi Walking Exercise Program on Physical and Mental Health of Menopausal Women
by EunHee Noh, JiYoun Kim, MunHee Kim and EunSurk Yi
Int. J. Environ. Res. Public Health 2020, 17(18), 6935; https://doi.org/10.3390/ijerph17186935 - 22 Sep 2020
Cited by 7 | Viewed by 6344
Abstract
Objective: We investigated the effectiveness of a 12-week SaBang-DolGi walking exercise program on the physical and mental health of menopausal women and aimed to provide the basic data needed to develop health promotion programs for the active and healthy aging of menopausal women. [...] Read more.
Objective: We investigated the effectiveness of a 12-week SaBang-DolGi walking exercise program on the physical and mental health of menopausal women and aimed to provide the basic data needed to develop health promotion programs for the active and healthy aging of menopausal women. Materials and methods: The participants comprised 40 women aged 50–65 years who were divided into two randomly selected groups in training sessions (exercising group, n = 21 and control group, n = 19). A physical (grip, muscle and endurance) test and mental health test (simple mental health test II) were conducted using questionnaires with the aim of examining subjects’ physical and mental health before and after exercise. Results: After the intervention, the participants experienced positive changes in the physical dimension, with significant enhancements particularly in mental well-being and menopause-related health and subdomains. Controlled and regular exercise for 12 weeks was significantly correlated with a positive change in vitality and mental health. Conclusions: We found that the SaBang-DolGi walking exercise program helps to promote the physical and mental health of menopausal women who are exposed to the various stresses and depressions that accompany physical deterioration; the program was found to encourage active and healthy aging. Full article
(This article belongs to the Special Issue The Challenges and Opportunities for Promoting Active Healthy Ageing)
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10 pages, 757 KiB  
Article
Personal Music Players Use and Other Noise Hazards among Children 11 to 12 Years Old
by Weronika Swierniak, Elzbieta Gos, Piotr Henryk Skarzynski, Natalia Czajka and Henryk Skarzynski
Int. J. Environ. Res. Public Health 2020, 17(18), 6934; https://doi.org/10.3390/ijerph17186934 - 22 Sep 2020
Cited by 7 | Viewed by 3155
Abstract
Exposure to loud music—due to widespread personal music players (PMPs) and noisy leisure activities—are major risk factors for noise induced hearing loss (NIHL) in adolescents. However, there is little evidence of the impact of noise on the hearing of younger children. This study [...] Read more.
Exposure to loud music—due to widespread personal music players (PMPs) and noisy leisure activities—are major risk factors for noise induced hearing loss (NIHL) in adolescents. However, there is little evidence of the impact of noise on the hearing of younger children. This study aimed to explore an association between PMP use and hearing, and to identify other sources of noise among children. The study sample consisted of 1032 children aged 11–12 years old. Hearing thresholds were determined from 0.5 to 8 kHz. PMP use and other noise exposures were evaluated using a survey. We found that 82% of the children had a PMP, and 78% were exposed to noise when playing computer games. An audiometric notch was documented in 1.3% of the children. Only 11.5% of the children ever used hearing protection while engaged in noisy activities. We found no convincing evidence of an association between PMP use and hearing thresholds, although our results suggest that tinnitus may be an early sign of NIHL in young children. The study shows a need to provide children, their parents, and educators with knowledge of how to take care of hearing, including how to avoid and minimize noise exposure. Full article
(This article belongs to the Section Children's Health)
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17 pages, 2486 KiB  
Article
Unveiling COVID-19 from CHEST X-Ray with Deep Learning: A Hurdles Race with Small Data
by Enzo Tartaglione, Carlo Alberto Barbano, Claudio Berzovini, Marco Calandri and Marco Grangetto
Int. J. Environ. Res. Public Health 2020, 17(18), 6933; https://doi.org/10.3390/ijerph17186933 - 22 Sep 2020
Cited by 148 | Viewed by 7366
Abstract
The possibility to use widespread and simple chest X-ray (CXR) imaging for early screening of COVID-19 patients is attracting much interest from both the clinical and the AI community. In this study we provide insights and also raise warnings on what is reasonable [...] Read more.
The possibility to use widespread and simple chest X-ray (CXR) imaging for early screening of COVID-19 patients is attracting much interest from both the clinical and the AI community. In this study we provide insights and also raise warnings on what is reasonable to expect by applying deep learning to COVID classification of CXR images. We provide a methodological guide and critical reading of an extensive set of statistical results that can be obtained using currently available datasets. In particular, we take the challenge posed by current small size COVID data and show how significant can be the bias introduced by transfer-learning using larger public non-COVID CXR datasets. We also contribute by providing results on a medium size COVID CXR dataset, just collected by one of the major emergency hospitals in Northern Italy during the peak of the COVID pandemic. These novel data allow us to contribute to validate the generalization capacity of preliminary results circulating in the scientific community. Our conclusions shed some light into the possibility to effectively discriminate COVID using CXR. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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22 pages, 6410 KiB  
Article
Thermal Sensation in Older People with and without Dementia Living in Residential Care: New Assessment Approaches to Thermal Comfort Using Infrared Thermography
by Charmaine Childs, Jennifer Elliott, Khaled Khatab, Susan Hampshaw, Sally Fowler-Davis, Jon R. Willmott and Ali Ali
Int. J. Environ. Res. Public Health 2020, 17(18), 6932; https://doi.org/10.3390/ijerph17186932 - 22 Sep 2020
Cited by 16 | Viewed by 4974
Abstract
The temperature of the indoor environment is important for health and wellbeing, especially at the extremes of age. The study aim was to understand the relationship between self-reported thermal sensation and extremity skin temperature in care home residents with and without dementia. The [...] Read more.
The temperature of the indoor environment is important for health and wellbeing, especially at the extremes of age. The study aim was to understand the relationship between self-reported thermal sensation and extremity skin temperature in care home residents with and without dementia. The Abbreviated Mental Test (AMT) was used to discriminate residents to two categories, those with, and those without, dementia. After residents settled and further explanation of the study given (approximately 15 min), measurements included: tympanic membrane temperature, thermal sensation rating and infrared thermal mapping of non-dominant hand and forearm. Sixty-nine afebrile adults (60–101 years of age) were studied in groups of two to five, in mean ambient temperatures of 21.4–26.6 °C (median 23.6 °C). Significant differences were observed between groups; thermal sensation rating (p = 0.02), tympanic temperature (p = 0.01), fingertip skin temperature (p = 0.01) and temperature gradients; fingertip-wrist p = 0.001 and fingertip-distal forearm, p = 0.001. Residents with dementia were in significantly lower air temperatures (p = 0.001). Although equal numbers of residents per group rated the environment as ‘neutral’ (comfortable), resident ratings for ‘cool/cold’ were more frequent amongst those with dementia compared with no dementia. In parallel, extremity (hand) thermograms revealed visual temperature demarcation, variously across fingertip, wrist, and forearm commensurate with peripheral vasoconstriction. Infrared thermography provided a quantitative and qualitative method to measure and observe hand skin temperature across multiple regions of interest alongside thermal sensation self-report. As an imaging modality, infrared thermography has potential as an additional assessment technology with clinical utility to identify vulnerable residents who may be unable to communicate verbally, or reliably, their satisfaction with indoor environmental conditions. Full article
(This article belongs to the Special Issue Health Care for Older Adults)
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21 pages, 5465 KiB  
Article
Effects of PM2.5 on Third Grade Students’ Proficiency in Math and English Language Arts
by Casey Mullen, Sara E. Grineski, Timothy W. Collins and Daniel L. Mendoza
Int. J. Environ. Res. Public Health 2020, 17(18), 6931; https://doi.org/10.3390/ijerph17186931 - 22 Sep 2020
Cited by 29 | Viewed by 7600
Abstract
Fine particulate air pollution is harmful to children in myriad ways. While evidence is mounting that chronic exposures are associated with reduced academic proficiency, no research has examined the frequency of peak exposures. It is also unknown if pollution exposures influence academic proficiency [...] Read more.
Fine particulate air pollution is harmful to children in myriad ways. While evidence is mounting that chronic exposures are associated with reduced academic proficiency, no research has examined the frequency of peak exposures. It is also unknown if pollution exposures influence academic proficiency to the same degree in all schools or if the level of children’s social disadvantage in schools modifies the effects, such that some schools’ academic proficiency levels are more sensitive to exposures. We address these gaps by examining the percentage of third grade students who tested below the grade level in math and English language arts (ELA) in Salt Lake County, Utah primary schools (n = 156), where fine particulate pollution is a serious health threat. More frequent peak exposures were associated with reduced math and ELA proficiency, as was greater school disadvantage. High frequency peak exposures were more strongly linked to lower math proficiency in more advantaged schools. Findings highlight the need for policies to reduce the number of days with peak air pollution. Full article
(This article belongs to the Special Issue Air Pollution Impact on Children’s Health)
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14 pages, 1122 KiB  
Article
The Visible Behaviour of Drowning Persons: A Pilot Observational Study Using Analytic Software and a Nominal Group Technique
by Aida Carballo-Fazanes, Joost J.L.M. Bierens and the International Expert Group to Study Drowning Behaviour
Int. J. Environ. Res. Public Health 2020, 17(18), 6930; https://doi.org/10.3390/ijerph17186930 - 22 Sep 2020
Cited by 25 | Viewed by 8853
Abstract
Although drowning is a common phenomenon, the behaviour of drowning persons is poorly understood. The purpose of this study is to provide a quantitative and qualitative analysis of this behaviour. This was an observational study of drowning videos observed by 20 international experts [...] Read more.
Although drowning is a common phenomenon, the behaviour of drowning persons is poorly understood. The purpose of this study is to provide a quantitative and qualitative analysis of this behaviour. This was an observational study of drowning videos observed by 20 international experts in the field of water safety. For quantitative analysis, each video was analysed with Lince observation software by four participants. A Nominal Group Technique generated input for the qualitative analysis and the two principal investigators conducted a post-hoc analysis. A total of 87.5% of the 23 videos showed drowning in swimming pools, 50% of the drowned persons were male, and 58.3% were children or teenagers. Nineteen persons were rescued before unconsciousness and showed just the beginning of downing behaviour. Another five were rescued after unconsciousness, which allowed the observation of their drowning behaviour from the beginning to the end. Significant differences were found comparing both groups regarding the length of disappearances underwater, number, and length of resurfacing (resp. p = 0.003, 0.016, 0.005) and the interval from the beginning of the incident to the rescue (p = 0.004). All persons drowned within 2 min. The qualitative analysis showed previously suggested behaviour patterns (immediate disappearance n = 5, distress n = 6, instinctive drowning response n = 6, climbing ladder motion n = 3) but also a striking new pattern (backward water milling n = 19). This study confirms previous assumptions of drowning behaviour and provides novel evidence-based information about the large variety of visible behaviours of drowning persons. New behaviours, which mainly include high-frequency resurfacing during a struggle for less than 2 min and backward water milling, have been recognised in this study. Full article
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12 pages, 844 KiB  
Article
Exploring Volatile Organic Compound Exposure and Its Association with Wheezing in Children under 36 Months: A Cross-Sectional Study in South Lisbon, Portugal
by Raquel Rodrigues dos Santos, João Gregório, Liliana Castanheira and Ana S. Fernandes
Int. J. Environ. Res. Public Health 2020, 17(18), 6929; https://doi.org/10.3390/ijerph17186929 - 22 Sep 2020
Cited by 6 | Viewed by 3098
Abstract
Air quality and other environmental factors are gaining importance in public health policies. Some volatile organic compounds (VOCs) have been associated with asthma and symptoms of respiratory disease such as wheezing. The aim of this study was to measure the concentration of Total [...] Read more.
Air quality and other environmental factors are gaining importance in public health policies. Some volatile organic compounds (VOCs) have been associated with asthma and symptoms of respiratory disease such as wheezing. The aim of this study was to measure the concentration of Total VOCs and assess their possible association with the occurrence of wheezing episodes in children under 36 months of age, in a region south of Lisbon, Portugal. A cross-sectional study was performed from October 2015 to March 2016. The sample of children under 36 months of age was selected by convenience, by inviting parents to take part in the study. A survey was applied to collect information on bedroom features, as well as to verify the occurrence of wheezing episodes. The indoor air quality parameters of bedrooms were measured using three 3M Quest® EVM-7 environmental monitors. In total, 34.4% of infants had had wheezing episodes since birth, with 86.7% of these presenting at least one episode in the previous 12 months. Total VOC levels were above the reference values in 48% of the analyzed bedrooms. No significant association of VOC exposure in a domestic setting with episodes of wheezing was found. However, children living in households with smokers were 4 times more likely to develop wheezing episodes. Thus, this study provides relevant information that warrants further studies to assess infant exposure to indoor air pollution and parental smoking in a residential context. Full article
(This article belongs to the Special Issue Public Health and Risk Factors across the Lifespan)
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19 pages, 722 KiB  
Article
Gaelic4Girls—The Effectiveness of a 10-Week Multicomponent Community Sports-Based Physical Activity Intervention for 8 to 12-Year-Old Girls
by Orlagh Farmer, Kevin Cahill and Wesley O’Brien
Int. J. Environ. Res. Public Health 2020, 17(18), 6928; https://doi.org/10.3390/ijerph17186928 - 22 Sep 2020
Cited by 14 | Viewed by 4866
Abstract
Girls are less active than boys throughout childhood and adolescence, with limited research focusing on female community sports-based programs. This study aims to assess the effectiveness of a multi-component, community sports-based intervention for increasing girl’s physical activity (PA) levels, fundamental movement skill (FMS) [...] Read more.
Girls are less active than boys throughout childhood and adolescence, with limited research focusing on female community sports-based programs. This study aims to assess the effectiveness of a multi-component, community sports-based intervention for increasing girl’s physical activity (PA) levels, fundamental movement skill (FMS) proficiency, and psychological wellbeing, as relative to a second treatment group (the traditionally delivered national comparative program), and a third control group. One hundred and twenty female-only participants (mean age = 10.75 ± 1.44 years), aged 8 to 12 years old from three Ladies Gaelic Football (LGF) community sports clubs (rural and suburban) were allocated to one of three conditions: (1) Intervention Group 1 (n = 43) received a novel, specifically tailored, research-informed Gaelic4Girls (G4G) intervention; (2) Intervention Group 2 (n = 44) used the traditionally delivered, national G4G program, as run by the Ladies Gaelic Football (LGF) Association of Ireland; and (3) Control Group 3 (n = 33) received no G4G intervention (group 1 or 2) conditions and were expected to carry out their usual LGF community sports activities. Primary outcome measurements (at both pre- and 10-week follow up) examining the effectiveness of the G4G intervention included (1) PA, (2) FMS and (3) Psychological correlates (enjoyment levels, self-efficacy, peer and parental support). Following a two (pre to post) by three (intervention group 1, intervention group 2, and control group 3) mixed-model ANOVA, it was highlighted that intervention group 1 significantly increased in PA (p = 0.003), FMS proficiency (p = 0.005) and several psychological correlates of PA (p ≤ 0.005). The findings demonstrate that the 10-week, specifically tailored, research-informed G4G intervention is a feasible and efficacious program, leading to a positive effect on the physical and psychological wellbeing of pre-adolescent Irish girls, relative to the traditionally delivered national G4G comparative program and control group conditions. Full article
(This article belongs to the Special Issue Promoting Physical Activity and Healthy Lifestyles in Sports, Leisure-Time and Physical Education)
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17 pages, 1069 KiB  
Article
A Qualitative Study of a Mindfulness-Based Intervention in Educational Contexts in Chile: An Approach Based on Adolescents’ Voices
by Álvaro I. Langer, Sebastián Medeiros, Nelson Valdés-Sánchez, Rodrigo Brito, Christoph Steinebach, Cristian Cid-Parra, Antonella Magni and Mariane Krause
Int. J. Environ. Res. Public Health 2020, 17(18), 6927; https://doi.org/10.3390/ijerph17186927 - 22 Sep 2020
Cited by 10 | Viewed by 6851
Abstract
The application of mindfulness-based interventions in school settings has increased considerably in recent years, showing that differences between the characteristics of programmes can impact on the receptivity and effectiveness of mindfulness training. However, few studies have explored the learning process from the perspective [...] Read more.
The application of mindfulness-based interventions in school settings has increased considerably in recent years, showing that differences between the characteristics of programmes can impact on the receptivity and effectiveness of mindfulness training. However, few studies have explored the learning process from the perspective of the children and adolescents who participate in mindfulness practice. The goal of this paper is to analyse the subjective experience of a group of adolescents following the completion of a mindfulness-based intervention developed for schools in Chile. The intervention studied is the “.b curriculum”, which is part of the Mindfulness in School Project (MiSP) developed in the UK. Twenty adolescents participated in semi-structured interviews within their school, in which three key areas were explored: pedagogy, perceived effects, and mechanisms of action, each of them being analysed from the perspective of thematic analysis. The results support the view that pedagogy is a very relevant consideration in the implementation, development, and efficacy of mindfulness-based interventions within the school context. We propose that the inclusion of structure, contents, process/mindful practices, and teachers’ expertise provides the pedagogical-relational framework required for students to successfully develop mindfulness skills, which enables them to experience their cognitive, emotional, and somatic effects. These effects are linked to self-regulation strategies, based on paying attention to one’s somatic experience with kindness and curiosity, which works as an attentional anchor. It is hoped that these results will contribute to the spread of mindfulness research in adolescents in Latin America, thus facilitating cross-cultural and international comparisons. Full article
(This article belongs to the Special Issue Mental Health of Child and Young People)
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10 pages, 979 KiB  
Conference Report
A Review of Maternal Nutrition during Pregnancy and Impact on the Offspring through Development: Evidence from Animal Models of Over- and Undernutrition
by John F. Odhiambo, Christopher L. Pankey, Adel B. Ghnenis and Stephen P. Ford
Int. J. Environ. Res. Public Health 2020, 17(18), 6926; https://doi.org/10.3390/ijerph17186926 - 22 Sep 2020
Cited by 19 | Viewed by 4438
Abstract
Similarities in offspring phenotype due to maternal under- or over-nutrition during gestation have been observed in studies conducted at University of Wyoming. In these studies, ewes were either nutrient-restricted (NR) from early to mid-gestation, or fed an obesogenic diet (MO) from preconception through [...] Read more.
Similarities in offspring phenotype due to maternal under- or over-nutrition during gestation have been observed in studies conducted at University of Wyoming. In these studies, ewes were either nutrient-restricted (NR) from early to mid-gestation, or fed an obesogenic diet (MO) from preconception through term. Offspring necropsies occurred at mid-gestation, late-gestation, and after parturition. At mid gestation, body weights of NR fetuses were ~30% lighter than controls, whereas MO fetuses were ~30% heavier than those of controls. At birth, lambs born to NR, MO, and control ewes exhibited similar weights. This was a consequence of accelerated fetal growth rates in NR ewes, and reduced fetal growth rates in MO ewes in late gestation, when compared to their respective controls. These fetal growth patterns resulted in remarkably similar effects of increased susceptibility to obesity, cardiovascular disease, and glucose intolerance in offspring programmed mostly during fetal stages of development. These data provide evidence that maternal under- and over-nutrition similarly induce the development of the same cadre of physical and metabolic problems in postnatal life. Full article
(This article belongs to the Special Issue Proceedings of the 2019 Research Centers in Minority Institutions (RCMI) Program National Conference)
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13 pages, 2088 KiB  
Article
Prevalence of Arterial Hypertension and Characteristics of Nocturnal Blood Pressure Profile of Asthma Patients According to Therapy and Severity of the Disease: The BADA Study
by Domenico Di Raimondo, Gaia Musiari, Alida Benfante, Salvatore Battaglia, Giuliana Rizzo, Antonino Tuttolomondo, Nicola Scichilone and Antonio Pinto
Int. J. Environ. Res. Public Health 2020, 17(18), 6925; https://doi.org/10.3390/ijerph17186925 - 22 Sep 2020
Cited by 11 | Viewed by 3554
Abstract
Background: several studies report an increased risk for asthmatic subjects to develop arterial hypertension and the relationship between these two diseases, frequently co-existing, still has some unclear aspects. Methods: The BADA (blood pressure levels, clinical features and markers of subclinical cardiovascular damage of [...] Read more.
Background: several studies report an increased risk for asthmatic subjects to develop arterial hypertension and the relationship between these two diseases, frequently co-existing, still has some unclear aspects. Methods: The BADA (blood pressure levels, clinical features and markers of subclinical cardiovascular damage of asthma patients) study is aimed to evaluate the prevalence of the cardiovascular comorbidities of asthma and their impact on the clinical outcome. The main exclusion criteria were the presence of other respiratory diseases, current smoking, any contraindication to ambulatory blood pressure monitoring (ABPM). Results: The overall percentage of asthmatics having also hypertension was 75% (30 patients) vs. 45% (18 patients) of the control group (p: 0.012). Reduced level of FEV1 (but not inhaled steroid therapy) was associated to newly-diagnosed hypertension (p: 0.0002), higher day SBP levels (p: 0.003), higher day DBP levels (p: 0.03), higher 24 h-SBP levels (p: 0.005) and higher 24h-DBP levels (p: 0.03). The regression analysis performed taking into account sex, age, diabetes, fasting glucose, and body mass index confirms the independent role played by asthma: odds ratio (OR): 3.66 (CI: 1.29–11.1). Conclusions: hypertension is highly prevalent in asthma; the use of ABPM has allowed the detection of a considerable number of unrecognized hypertensives. Full article
(This article belongs to the Special Issue New Insights in Prevention and Treatment of Cardiovascular Disease)
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16 pages, 1645 KiB  
Article
Public Awareness and Behaviour in Great Britain in the Context of Sunlight Exposure and Vitamin D: Results from the First Large-Scale and Representative Survey
by Kevin Burchell, Lesley E. Rhodes and Ann R. Webb
Int. J. Environ. Res. Public Health 2020, 17(18), 6924; https://doi.org/10.3390/ijerph17186924 - 22 Sep 2020
Cited by 8 | Viewed by 3186
Abstract
In recent years, UK public health messages about the risks of sunlight exposure (skin cancer) have been increasingly balanced by messages about its benefits (vitamin D production). Currently, data about the effects of this shift on public knowledge, awareness, and behaviour are scant. [...] Read more.
In recent years, UK public health messages about the risks of sunlight exposure (skin cancer) have been increasingly balanced by messages about its benefits (vitamin D production). Currently, data about the effects of this shift on public knowledge, awareness, and behaviour are scant. Thus, the objective of this paper is to report the findings of the first large-scale and representative survey of the awareness, knowledge, and behaviour of adults in Great Britain (England, Scotland, and Wales) (n = 2024) with respect to sunlight exposure, vitamin D, and sunburn and skin cancer. The findings suggest that the public in Great Britain is much more aware of public promotion of the risks of sunlight exposure than its benefits. That said, knowledge about sunlight exposure and vitamin D is fairly strong, though not with respect to the detail of the ‘little and often’ approach. However, the survey also suggests that levels of sunlight exposure among the public are often excessive. The survey indicates that knowledge and behaviour are both less satisfactory among men and people in lower socio-economic groups. The paper concludes with recommendations for public health communications and for research in this area. Full article
(This article belongs to the Section Health Communication and Informatics)
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12 pages, 685 KiB  
Article
Correlation of Caries Prevalence, Oral Health Behavior and Sweets Nutritional Habits among 10 to 19-Year-Old Cluj-Napoca Romanian Adolescents
by Cosmin Tudoroniu, Monica Popa, Simona Maria Iacob, Anca Lucia Pop and Bogdana Adriana Năsui
Int. J. Environ. Res. Public Health 2020, 17(18), 6923; https://doi.org/10.3390/ijerph17186923 - 22 Sep 2020
Cited by 28 | Viewed by 5472
Abstract
Background and objectives: The primary oral disease during adolescence is dental caries. Less is known about the caries prevalence, oral health behavior, and sweets nutritional habits in Romanian adolescents. The objective of this study was to assess the actual caries prevalence among [...] Read more.
Background and objectives: The primary oral disease during adolescence is dental caries. Less is known about the caries prevalence, oral health behavior, and sweets nutritional habits in Romanian adolescents. The objective of this study was to assess the actual caries prevalence among Romanian adolescents in a representative area of Romania, Cluj, and to correlate with oral hygiene behaviors and dietary sugary foods intake. Materials and methods: We have done a cross-sectional study of 650 adolescents aged 10 to 19-years-old (average age 15.3 ± 2.8). We performed the oral dental examination according to the WHO methodology, calculated the number of decayed, missing (due to caries), and filled teeth (DMFT index), assessed the oral hygiene and dietary behaviors using a two-section valid questionnaire and statistically analyzed the interrelation between DMFT, oral hygiene and eating behaviors by multivariate statistical analysis. Results: (a) The caries prevalence in the adolescent population enrolled in the study was 95.5%; (b) the mean DMFT was 3.13 ± 2.0, without significant differences between the urban and rural adolescents (p = 0.253); lower in females than males (p < 0.050), (c) more than one third (33.7%, n = 219) of teenagers are seldom or never brush their teeth in the evening; (c) 40.6% of adolescents are missing the regular annual dental check-ups leading to an increased DMFT as shown in the multivariate analysis (p = 0.038); and (d) there is an increased prevalence of caries with age (p = 0.020), and with sugary sweetened beverages consumption (p = 0.028). Conclusions: Our study evidenced a persistent high caries prevalence in Romanian teenagers. Their dietary habits and irregular dental check-up were associated with the occurrence of dental conditions. Full article
(This article belongs to the Special Issue Oral Prevention and Management of Oral Healthcare)
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15 pages, 653 KiB  
Article
Leaders’ Future Orientation and Public Health Investment Intention: A Moderated Mediation Model of Self-Efficacy and Perceived Social Support
by Jianming Wang, Tsung Piao Chou, Chia-Pin Chen and Xiangzhi Bu
Int. J. Environ. Res. Public Health 2020, 17(18), 6922; https://doi.org/10.3390/ijerph17186922 - 22 Sep 2020
Viewed by 2897
Abstract
Prior studies have investigated the issue of public health and health policy from economic, environmental, and healthcare perspectives. Research on public health from leaders’ perspective may also help to advance our knowledge about leaders’ perceptions, attitudes, and behavioral intentions toward public health management. [...] Read more.
Prior studies have investigated the issue of public health and health policy from economic, environmental, and healthcare perspectives. Research on public health from leaders’ perspective may also help to advance our knowledge about leaders’ perceptions, attitudes, and behavioral intentions toward public health management. Therefore, this study is based on social ideal theory, social cognitive theory, and social trust theory to investigate the influence of leaders’ future orientation on public health investment intention with the mediating role of leaders’ self-efficacy and the moderating role of perceived social support. Using a structural equation modeling with a sample data of 381 leaders of government agencies in Vietnam, empirical results indicate that leaders’ future orientation has a positive influence on public health investment intention. Furthermore, self-efficacy is found to have a positive mediating effect in the relationship between leaders’ future orientation and public health investment intention. In addition, perceived social support positively moderates the link between leaders’ future orientation and self-efficacy. Perceived social support also moderates the indirect effect of leaders’ future orientation on public health investment intention through self-efficacy. On one hand, this study contributes to theoretical research by clarifying the effects of leaders’ perceptions, and cognitive and behavioral intentions toward public health investment. Findings of this study may have implications for researchers who may have interest in studying the issue of public health management from leaders’ viewpoints. On the other hand, this study contributes to practitioners since understanding how leaders’ characteristics affect public health investment will enhance the quality of policy makers’ decision-making in improving public health for citizens and society. Full article
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11 pages, 667 KiB  
Article
“My Friends are at the Bottom of My Schedule”: A Qualitative Study on Social Health among Nursing Students during Clinical Placement
by Hon Lon Tam, Aimei Mao, Pak Leng Cheong and Iat Kio Van
Int. J. Environ. Res. Public Health 2020, 17(18), 6921; https://doi.org/10.3390/ijerph17186921 - 22 Sep 2020
Cited by 4 | Viewed by 3908
Abstract
Clinical placement is an essential component for nursing students, allowing them to transfer professional knowledge into practice. The quality of life among nursing students and nurses was reviewed to examine its impact on the quality of provided care. However, it is unclear how [...] Read more.
Clinical placement is an essential component for nursing students, allowing them to transfer professional knowledge into practice. The quality of life among nursing students and nurses was reviewed to examine its impact on the quality of provided care. However, it is unclear how social health among nursing students is affected during clinical placement. Final-year students who had finished clinical placement were invited to participate in this qualitative study. Twenty-one in-depth interviews were conducted and transcribed verbatim for thematic analysis. Two main themes, i.e., contributors to lack of social health, and manifestations of lack of social health, emerged from seven sub-themes. Students experienced different challenges during the clinical placement, but some of these did contribute to effects on their social health. Lack of social health might further influence career development after graduation. Supportive strategies from colleagues, nursing colleges and hospitals might potentially improve students’ social health during the clinical placement. Full article
(This article belongs to the Special Issue Qualitative Research and Mixed Methods, Application in Health Care Science)
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20 pages, 1800 KiB  
Review
Radiological Outcomes of Bone-Level and Tissue-Level Dental Implants: Systematic Review
by Saverio Cosola, Simone Marconcini, Michela Boccuzzi, Giovanni Battista Menchini Fabris, Ugo Covani, Miguel Peñarrocha-Diago and David Peñarrocha-Oltra
Int. J. Environ. Res. Public Health 2020, 17(18), 6920; https://doi.org/10.3390/ijerph17186920 - 22 Sep 2020
Cited by 25 | Viewed by 4642
Abstract
Background: to assess the radiological marginal bone loss between bone-level or tissue-level dental implants through a systematic review of literature until September 2019. Methods: MEDLINE, Embase and other database were searched by two independent authors including only English articles. Results: [...] Read more.
Background: to assess the radiological marginal bone loss between bone-level or tissue-level dental implants through a systematic review of literature until September 2019. Methods: MEDLINE, Embase and other database were searched by two independent authors including only English articles. Results: The search provided 1028 records and, after removing the duplicates through titles and abstracts screening, 45 full-text articles were assessed for eligibility. For qualitative analysis 20 articles were included, 17 articles of them for quantitative analysis counting a total of 1161 patients (mean age 54.4 years) and 2933 implants, 1427 inserted at Tissue-level (TL) and 1506 inserted at Bone-level (BL). The survival rate and the success rate were more than 90%, except for 2 studies with a success rate of 88% and 86.2%. No studies reported any differences between groups in term of success and survival rates. Three studies showed that BL-implants had statistically less marginal bone loss (p < 0.05). Only one study reported statistically less marginal bone loss in TL-implants (p < 0.05). Conclusion: In the most part of the studies, differences between implant types in marginal bone loss were not statistically significant after a variable period of follow-up ranged between 1 and 5 years. Full article
(This article belongs to the Special Issue Advances in Oral Implantology)
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9 pages, 490 KiB  
Article
The Analysis of the Frequency of Leukoplakia in Reference of Tobacco Smoking among Northern Polish Population
by Aida Kusiak, Adrian Maj, Dominika Cichońska, Barbara Kochańska, Aleksandra Cydejko and Dariusz Świetlik
Int. J. Environ. Res. Public Health 2020, 17(18), 6919; https://doi.org/10.3390/ijerph17186919 - 22 Sep 2020
Cited by 15 | Viewed by 4107
Abstract
Objective: The aim of the study was an updated analysis of the frequency of leukoplakia in reference to tobacco smoking among the northern Polish population. Material and Methods: Medical records of 5720 patients who suffer from abnormalities and oral mucosa diseases between [...] Read more.
Objective: The aim of the study was an updated analysis of the frequency of leukoplakia in reference to tobacco smoking among the northern Polish population. Material and Methods: Medical records of 5720 patients who suffer from abnormalities and oral mucosa diseases between January 2015–December 2018 were analyzed. Among them, 416 medical charts of patients with leukoplakia were selected. The study group consisted of 196 women and 220 men aged between 21–86 years (average 45.6 years). The analysis was conducted in terms of age, gender, and smoking tobacco. The basic criterion for inclusion in the study was the presence of oral leukoplakia confirmed by histopathological examination, recorded in the chart. Information about the patient’s active smoking was obtained from documented medical interviews. An active smoker was defined as a patient who smoked 10 or more cigarettes a day for at least the previous six months. The study used parametric and non-parametric statistical methods. Results: The highest incidence of leukoplakia was found in the age group 41–60 (46.6%), where the vast majority were active smokers (85.1%), and mostly men (86.2%). However, among patients with leukoplakia, the highest prevalence of smoking was found in the age group 21–40 years (86.8%) in women, where out of 38 patients with leukoplakia, 33 were active smokers. More patients with leukoplakia were observed in groups of smokers and it was statistically significant. Homogeneous form was the most commonly diagnosed form of leukoplakia in our study; it was found in almost 95% of cases. Leukoplakia was mainly observed on the cheeks. Changes on the gums, the alveolar process or the bottom of the tongue and mouth were rarely found. Conclusion: Our studies revealed that there is a statistically significant correlation between tobacco smoking and the presence of oral leukoplakia among the northern Polish population. It should be noted that dentists, in particular, are capable of early diagnosis and implementation of appropriate treatment of leukoplakia and, most often, crucial elimination of the main risk factor, which is smoking, and the implementation of effective tobacco control interventions. Full article
(This article belongs to the Special Issue Oral Prevention and Management of Oral Healthcare)
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9 pages, 299 KiB  
Article
Impact of Individual Headache Types on the Work and Work Efficiency of Headache Sufferers
by Svetlana Simić, Tamara Rabi-Žikić, José R. Villar, José Luis Calvo-Rolle, Dragan Simić and Svetislav D. Simić
Int. J. Environ. Res. Public Health 2020, 17(18), 6918; https://doi.org/10.3390/ijerph17186918 - 22 Sep 2020
Cited by 13 | Viewed by 4488
Abstract
Background: Headaches have not only medical but also great socioeconomic significance, therefore, it is necessary to evaluate the overall impact of headaches on a patient’s life, including their work and work efficiency. The aim of this study was to determine the impact of [...] Read more.
Background: Headaches have not only medical but also great socioeconomic significance, therefore, it is necessary to evaluate the overall impact of headaches on a patient’s life, including their work and work efficiency. The aim of this study was to determine the impact of individual headache types on work and work efficiency. Methods: This research was designed as a cross-sectional study performed by administering a questionnaire among employees. The questionnaire consisted of general questions, questions about headache features, and questions about the impact of headaches on work. Results: Monthly absence from work was mostly represented by migraine sufferers (7.1%), significantly more than with sufferers with tension-type headaches (2.23%; p = 0.019) and other headache types (2.15%; p = 0.025). Migraine sufferers (30.2%) worked in spite of a headache for more than 25 h, which was more frequent than with sufferers from tension-type and other-type headaches (13.4%). On average, headache sufferers reported work efficiency ranging from 66% to 90%. With regard to individual headache types, this range was significantly more frequent in subjects with tension-type headaches, whereas 91–100% efficiency was significantly more frequent in subjects with other headache types. Lower efficiency, i.e., 0–40% and 41–65%, was significantly more frequent with migraine sufferers. Conclusions: Headaches, especially migraines, significantly affect the work and work efficiency of headache sufferers by reducing their productivity. Loss is greater due to reduced efficiency than due to absenteeism. Full article
12 pages, 1160 KiB  
Article
Association between Primary Healthcare and Medical Expenditures in a Context of Hospital-Oriented Healthcare System in China: A National Panel Dataset, 2012–2016
by Mengping Zhou, Jingyi Liao, Nan Hu and Li Kuang
Int. J. Environ. Res. Public Health 2020, 17(18), 6917; https://doi.org/10.3390/ijerph17186917 - 22 Sep 2020
Cited by 11 | Viewed by 3024
Abstract
Total health expenditure in China has grown considerably since a new round of health system reform was enacted in 2009. Researchers have shown that strengthening primary healthcare may be an option for countries to solve the rapid expansion of their medical expenditures. This [...] Read more.
Total health expenditure in China has grown considerably since a new round of health system reform was enacted in 2009. Researchers have shown that strengthening primary healthcare may be an option for countries to solve the rapid expansion of their medical expenditures. This study was designed to explore the association between the strength of primary healthcare and medical expenditures, in the context of the hospital-oriented healthcare system in China. A longitudinal ecological study was conducted using a 5-year panel dataset of 27 provinces in mainland China. The linear mixed effects regression model was used to assess the effects of primary healthcare-related metrics on medical expenditures, controlling for the provincial level specialty care physician supply and socio-economic parameters. All of the three primary healthcare-related metrics showed negative associations with the two medical expenditure parameters. Primary care physicians per 10,000 population was significantly associated with the per capita hospital medical expenditures (p < 0.05), and the percentage of public health expenditure in total health expenditure was significantly associated with both per capita total medical expenditure and per capita hospital medical expenditures (p < 0.01 for both). Our study found negative associations between the primary healthcare capacity and medical expenditure in the context of hospital-oriented healthcare systems in China, adding to the previous evidence that primary healthcare may play a positive role in reducing medical expenditure. Policies on increasing the primary care physician supply and the public share of total health expenditure should be conducted to strengthen the primary healthcare system. With the gradual advance of medical reform and the policy inclination to primary healthcare, this will play a more important role in controlling the rapid growth of medical expenditure. Full article
(This article belongs to the Section Health Economics)
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16 pages, 566 KiB  
Article
Clinical Application of Mindfulness-Oriented Meditation: A Preliminary Study in Children with ADHD
by Ornella Santonastaso, Vittoria Zaccari, Cristiano Crescentini, Franco Fabbro, Viviana Capurso, Stefano Vicari and Deny Menghini
Int. J. Environ. Res. Public Health 2020, 17(18), 6916; https://doi.org/10.3390/ijerph17186916 - 22 Sep 2020
Cited by 20 | Viewed by 12068
Abstract
Mindfulness-oriented meditation (MOM) is a self-regulatory training used for attentional and behavioral problems. With its focus on attention, MOM is a promising form of training that is gaining empirical support as a complementary or alternative intervention for attention deficit/hyperactivity disorder (ADHD). In this [...] Read more.
Mindfulness-oriented meditation (MOM) is a self-regulatory training used for attentional and behavioral problems. With its focus on attention, MOM is a promising form of training that is gaining empirical support as a complementary or alternative intervention for attention deficit/hyperactivity disorder (ADHD). In this study, we tested the preliminary efficacy of MOM training in children with ADHD, by comparing its efficacy with an active control condition (Emotion Education Program, EEP). Twenty-five children with ADHD aged 7–11 years participated in MOM training (n = 15) or EEP (n = 10) 3 times per week for 8 weeks. Neuropsychological and academic measures and behavioral, emotional, and mindfulness ratings were collected before and after the two programs. On average, MOM training had positive effects on neuropsychological measures, as evidenced by a significant mean improvement in all outcome measures after training. Moreover, positive effects on ADHD symptoms were found only in the MOM group. Although they are preliminary, our results documented that MOM training promotes changes in neuropsychological measures and in certain behavioral symptoms, suggesting it as a promising tool for ameliorating cognitive and clinical manifestations of ADHD. Full article
(This article belongs to the Section Children's Health)
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18 pages, 4461 KiB  
Article
Assessing 3-D Spatial Extent of Near-Road Air Pollution around a Signalized Intersection Using Drone Monitoring and WRF-CFD Modeling
by Seung-Hyeop Lee and Kyung-Hwan Kwak
Int. J. Environ. Res. Public Health 2020, 17(18), 6915; https://doi.org/10.3390/ijerph17186915 - 22 Sep 2020
Cited by 18 | Viewed by 4191
Abstract
In this study, we have assessed the three-dimensional (3-D) spatial extent of near-road air pollution around a signalized intersection in a densely populated area using collaborating methodologies of stationary measurements, drone monitoring, and atmospheric dispersion modeling. Stationary measurement data collected in the roadside [...] Read more.
In this study, we have assessed the three-dimensional (3-D) spatial extent of near-road air pollution around a signalized intersection in a densely populated area using collaborating methodologies of stationary measurements, drone monitoring, and atmospheric dispersion modeling. Stationary measurement data collected in the roadside apartment building showed a substantial effect of emitted pollutants, such as nitrogen oxides (NOx), black carbon (BC), and ultrafine particles (UFPs), especially during the morning rush hours. Vertical drone monitoring near the road intersection exhibited a steeper decreasing trend with increasing altitude for BC concentration rather than for fine particulate matter (PM2.5) concentration below the apartment building height. Atmospheric NOx dispersion was simulated using the weather research and forecasting (WRF) and computational fluid dynamics (CFD) models for the drone measurement periods. Based on the agreement between the measured BC and simulated NOx concentrations, we concluded that the air pollution around the road intersection has adverse effects on the health of residents living within the 3-D spatial extent within at least 120 m horizontally and a half of building height vertically during the morning rush hours. The comparability between drone monitoring and WRF-CFD modeling can further guarantee the identification of air pollution hotspots using the methods. Full article
(This article belongs to the Special Issue Spatial Modeling of Air Pollutant Variability)
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15 pages, 1416 KiB  
Article
Chest CT Computerized Aided Quantification of PNEUMONIA Lesions in COVID-19 Infection: A Comparison among Three Commercial Software
by Roberto Grassi, Salvatore Cappabianca, Fabrizio Urraro, Beatrice Feragalli, Alessandro Montanelli, Gianluigi Patelli, Vincenza Granata, Giuliana Giacobbe, Gaetano Maria Russo, Assunta Grillo, Angela De Lisio, Cesare Paura, Alfredo Clemente, Giuliano Gagliardi, Simona Magliocchetti, Diletta Cozzi, Roberta Fusco, Maria Paola Belfiore, Roberta Grassi and Vittorio Miele
Int. J. Environ. Res. Public Health 2020, 17(18), 6914; https://doi.org/10.3390/ijerph17186914 - 22 Sep 2020
Cited by 43 | Viewed by 5487
Abstract
Purpose: To compare different commercial software in the quantification of Pneumonia Lesions in COVID-19 infection and to stratify the patients based on the disease severity using on chest computed tomography (CT) images. Materials and methods: We retrospectively examined 162 patients with confirmed COVID-19 [...] Read more.
Purpose: To compare different commercial software in the quantification of Pneumonia Lesions in COVID-19 infection and to stratify the patients based on the disease severity using on chest computed tomography (CT) images. Materials and methods: We retrospectively examined 162 patients with confirmed COVID-19 infection by reverse transcriptase-polymerase chain reaction (RT-PCR) test. All cases were evaluated separately by radiologists (visually) and by using three computer software programs: (1) Thoracic VCAR software, GE Healthcare, United States; (2) Myrian, Intrasense, France; (3) InferRead, InferVision Europe, Wiesbaden, Germany. The degree of lesions was visually scored by the radiologist using a score on 5 levels (none, mild, moderate, severe, and critic). The parameters obtained using the computer tools included healthy residual lung parenchyma, ground-glass opacity area, and consolidation volume. Intraclass coefficient (ICC), Spearman correlation analysis, and non-parametric tests were performed. Results: Thoracic VCAR software was not able to perform volumes segmentation in 26/162 (16.0%) cases, Myrian software in 12/162 (7.4%) patients while InferRead software in 61/162 (37.7%) patients. A great variability (ICC ranged for 0.17 to 0.51) was detected among the quantitative measurements of the residual healthy lung parenchyma volume, GGO, and consolidations volumes calculated by different computer tools. The overall radiological severity score was moderately correlated with the residual healthy lung parenchyma volume obtained by ThoracicVCAR or Myrian software, with the GGO area obtained by the ThoracicVCAR tool and with consolidation volume obtained by Myrian software. Quantified volumes by InferRead software had a low correlation with the overall radiological severity score. Conclusions: Computer-aided pneumonia quantification could be an easy and feasible way to stratify COVID-19 cases according to severity; however, a great variability among quantitative measurements provided by computer tools should be considered. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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19 pages, 649 KiB  
Article
A Call for Leadership and Management Competency Development for Directors of Medical Services—Evidence from the Chinese Public Hospital System
by Zhanming Liang, Peter Howard, Jian Wang and Min Xu
Int. J. Environ. Res. Public Health 2020, 17(18), 6913; https://doi.org/10.3390/ijerph17186913 - 22 Sep 2020
Cited by 8 | Viewed by 3914
Abstract
Background: A competent medical leadership and management workforce is key to the effectiveness and efficiency of health service provision and to leading and managing the health system reform agenda in China. However, the traditional recruitment and promotion approach of relying on clinical performance [...] Read more.
Background: A competent medical leadership and management workforce is key to the effectiveness and efficiency of health service provision and to leading and managing the health system reform agenda in China. However, the traditional recruitment and promotion approach of relying on clinical performance and seniority provides limited incentive for competency development and improvement. Methods: A three-component survey including the use of a validated management competency assessment tool was conducted with Directors of Medical Services (n = 143) and Deputy Directors of Medical Services (n = 152) from three categories of hospital in Jinan, Shandong Province, China. Results: The survey identified the inadequacy of formal and informal management training received by hospital medical leaders before commencing their management positions and confirms that the low self-perceived competency level across two medical management level and three hospitals was beyond acceptable. The study also indicates that the informal and formal education provided to Chinese medical leaders have not been effective in developing the required management competencies. Conclusions: The study suggests two system level approaches (health and higher education systems) and one organization level approach to formulate overall medical leadership and management workforce development strategies to encourages continuous management competency development and self-improvement among clinical leaders in China. Full article
(This article belongs to the Special Issue The Future Health Workforce: Integrated Solutions and Models of Care)
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15 pages, 5830 KiB  
Article
Health Risks and Potential Sources of Contamination of Groundwater Used by Public Schools in Vhuronga 1, Limpopo Province, South Africa
by John Ogony Odiyo, Mashudu Maxwell Mathoni and Rachel Makungo
Int. J. Environ. Res. Public Health 2020, 17(18), 6912; https://doi.org/10.3390/ijerph17186912 - 22 Sep 2020
Cited by 12 | Viewed by 3556
Abstract
Public schools in most rural areas of South Africa depend on untreated groundwater due to unreliable water supply by the municipalities. This has the potential to cause water-related health problems to school children. Temperature, pH, and electrical conductivity (EC) were measured in situ. [...] Read more.
Public schools in most rural areas of South Africa depend on untreated groundwater due to unreliable water supply by the municipalities. This has the potential to cause water-related health problems to school children. Temperature, pH, and electrical conductivity (EC) were measured in situ. Chemical (fluoride, chloride, sulphate, phosphate, nitrate, magnesium, calcium, sodium, and potassium) and microbial (Escherichia coliform (E. coli), Salmonella typhimurium, and Shigella flexneri) water quality parameters were analysed in groundwater samples from 10 public schools in Vhuronga 1 to determine suitability for use. Quantitative microbial risk assessment was carried out to determine risks of infection and illness due to consumption of groundwater. Correlation analysis was used to identify potential sources of contamination. All physical and most chemical water quality parameters were within guidelines for domestic water use. A high proportion of schools had high levels of microbial organisms. Risks of infection per day were relatively low for all schools. The annual risks of infection due to E. coli and Shigella flexneri for most schools was high, with maximum values of 89.11 and 83.75%, respectively. Maximum risks of illness per year were 31.19, 30.37, and 29.31% for E. coli, Salmonella typhimurium, and Shigella flexneri, respectively. Correlation analysis indicated potential contamination of groundwater by agricultural activities, domestic waste, and faecal contamination from pit latrines. Preventive and mitigation measures to minimise such risks, including locating boreholes at safe distances from pit latrines, prevention/minimisation of pollution of groundwater from agricultural activities, and point-of-use treatment of groundwater by the schools are therefore essential. Full article
(This article belongs to the Section Environmental Health)
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15 pages, 809 KiB  
Article
The Role of Specific Warm-up during Bench Press and Squat Exercises: A Novel Approach
by Bruno Ribeiro, Ana Pereira, Pedro P. Neves, António C. Sousa, Ricardo Ferraz, Mário C. Marques, Daniel A. Marinho and Henrique P. Neiva
Int. J. Environ. Res. Public Health 2020, 17(18), 6882; https://doi.org/10.3390/ijerph17186882 - 22 Sep 2020
Cited by 13 | Viewed by 6771
Abstract
The current study aims to verify the effects of three specific warm-ups on squat and bench press resistance training. Forty resistance-trained males (19–30 years) performed 3 × 6 repetitions with 80% of maximal dynamic strength (designated as training load) after one of the [...] Read more.
The current study aims to verify the effects of three specific warm-ups on squat and bench press resistance training. Forty resistance-trained males (19–30 years) performed 3 × 6 repetitions with 80% of maximal dynamic strength (designated as training load) after one of the following warm-ups (48 h between): (i) 2 × 6 repetitions with 40% and 80% of the training load (WU), (ii) 6 × 80% of training load (WU80), or (iii) 6 × 40% of the training load (WU40). Mean propulsive velocity (MPV), velocity loss (VL), peak velocity (PV), time to achieve PV, power, work, heart rates, and ratings of perceived exertion were analyzed. In squat exercises, higher MPV were found in WU80 compared with WU40 (2nd set: 0.69 ± 0.09 vs. 0.67 ± 0.06 m.s−1, p = 0.02, ES = 0.80; 3rd set: 0.68 ± 0.09 vs. 0.66 ± 0.07 m.s−1, p = 0.05, ES = 0.51). In bench press exercises, time to PV was lower in WU compared with WU40 (1st set: 574.77 ± 233.46 vs. 694.50 ± 211.71 m.s−1, p < 0.01, ES = 0.69; 2nd set: 533.19 ± 272.22 vs. 662.31 ± 257.51 m.s−1, p = 0.04, ES = 0.43) and total work was higher (4749.90 ± 1312.99 vs. 4631.80 ± 1355.01 j, p = 0.01, ES = 0.54). The results showed that force outputs were mainly optimized by WU80 in squat training and by WU in bench press training. Moreover, warming-up with few repetitions and low loads is not enough to optimize squat and bench press performances. Full article
(This article belongs to the Special Issue Monitoring and Evaluation of Training in Sport and Exercise)
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18 pages, 4206 KiB  
Communication
Graphene Oxide–ZnO Nanocomposites for Removal of Aluminum and Copper Ions from Acid Mine Drainage Wastewater
by Carolina Rodríguez, Camila Tapia, Enzo Leiva-Aravena and Eduardo Leiva
Int. J. Environ. Res. Public Health 2020, 17(18), 6911; https://doi.org/10.3390/ijerph17186911 - 21 Sep 2020
Cited by 60 | Viewed by 4549
Abstract
Adsorption technologies are a focus of interest for the removal of pollutants in water treatment systems. These removal methods offer several design, operation and efficiency advantages over other wastewater remediation technologies. Particularly, graphene oxide (GO) has attracted great attention due to its high [...] Read more.
Adsorption technologies are a focus of interest for the removal of pollutants in water treatment systems. These removal methods offer several design, operation and efficiency advantages over other wastewater remediation technologies. Particularly, graphene oxide (GO) has attracted great attention due to its high surface area and its effectiveness in removing heavy metals. In this work, we study the functionalization of GO with zinc oxide nanoparticles (ZnO) to improve the removal capacity of aluminum (Al) and copper (Cu) in acidic waters. Experiments were performed at different pH conditions (with and without pH adjustment). In both cases, decorated GO (GO/ZnO) nanocomposites showed an improvement in the removal capacity compared with non-functionalized GO, even when the pH of zero charge (pHPZC) was higher for GO/ZnO (5.57) than for GO (3.98). In adsorption experiments without pH adjustment, the maximum removal capacities for Al and Cu were 29.1 mg/g and 45.5 mg/g, respectively. The maximum removal percentages of the studied cations (Al and Cu) were higher than 88%. Further, under more acidic conditions (pH 4), the maximum sorption capacities using GO/ZnO as adsorbent were 19.9 mg/g and 33.5 mg/g for Al and Cu, respectively. Moreover, the removal percentages reach 95.6% for Al and 92.9% for Cu. This shows that decoration with ZnO nanoparticles is a good option for improving the sorption capacity of GO for Cu removal and to a lesser extent for Al, even when the pH was not favorable in terms of electrostatic affinity for cations. These findings contribute to a better understanding of the potential and effectiveness of GO functionalization with ZnO nanoparticles to treat acidic waters contaminated with heavy metals and its applicability for wastewater remediation. Full article
(This article belongs to the Special Issue Environmental Chemistry and Technology)
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18 pages, 1624 KiB  
Article
Spatial-Temporal Differentiation Analysis of Agricultural Land Use Intensity and Its Driving Factors at the County Scale: A Case Study in Hubei Province, China
by Li Yu, Zhanqi Wang, Hongwei Zhang and Chao Wei
Int. J. Environ. Res. Public Health 2020, 17(18), 6910; https://doi.org/10.3390/ijerph17186910 - 21 Sep 2020
Cited by 3 | Viewed by 2949
Abstract
Scientifically characterizing the spatial-temporal distribution characteristics of agricultural land use intensity and analyzing its driving factors are of great significance to the formulation of relevant agricultural land use intensity management policies, the realization of food safety and health, and the achievement of sustainable [...] Read more.
Scientifically characterizing the spatial-temporal distribution characteristics of agricultural land use intensity and analyzing its driving factors are of great significance to the formulation of relevant agricultural land use intensity management policies, the realization of food safety and health, and the achievement of sustainable development goals. Taking Hubei Province as an example, and taking counties as the basic evaluation unit, this paper establishes an agricultural land use intensity evaluation system, explores the spatial autocorrelation of agricultural land use intensity in each county and analyzes the driving factors of agricultural land use intensity. The results show that the agricultural land use intensity in Hubei Province increased as a whole from 2000 to 2016, and the spatial agglomeration about the agricultural land use intensity in Hubei Province experienced a process of continuous growth and a fluctuating decline; the maximum of the Global Moran’s I was 0.430174 (in 2007) and the minimum was 0.148651 (in 2001). In terms of Local Moran’s I, H-H agglomeration units were mainly concentrated in two regions: One comprising the cities of Huanggang, Huangshi and Ezhou, and the other the cities of Xiangyang and Suizhou; the phenomenon is particularly obvious after 2005. On the other hand, factors such as the multiple cropping index (MCI) that reflect farmers’ willingness to engage in agricultural production have a great impact on agricultural land use intensity, the influence of the structure of the industry on agricultural land use intensity varies with the degree of influence of different industries on farmers’ income, and agricultural fiscal expenditure (AFE) has not effectively promoted the intensification of agricultural land use. The present research has important significance for enhancing insights into the sustainable improvement of agricultural land use intensity and for realizing risk control of agricultural land use and development. Full article
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8 pages, 1043 KiB  
Article
Construction of the Infection Curve of Local Cases of COVID-19 in Hong Kong using Back-Projection
by Pui Hing Chau, Wei Ying Li and Paul S. F. Yip
Int. J. Environ. Res. Public Health 2020, 17(18), 6909; https://doi.org/10.3390/ijerph17186909 - 21 Sep 2020
Cited by 4 | Viewed by 2795
Abstract
This study aimed to estimate the infection curve of local cases of the coronavirus disease (COVID-19) in Hong Kong and identify major events and preventive measures associated with the trajectory of the infection curve in the first two waves. The daily number of [...] Read more.
This study aimed to estimate the infection curve of local cases of the coronavirus disease (COVID-19) in Hong Kong and identify major events and preventive measures associated with the trajectory of the infection curve in the first two waves. The daily number of onset local cases was used to estimate the daily number of infections based on back-projection. The estimated infection curve was examined to identify the preventive measures or major events associated with its trajectory. Until 30 April 2020, there were 422 confirmed local cases. The infection curve of the local cases in Hong Kong was constructed and used for evaluating the impacts of various policies and events in a narrative manner. Social gatherings and some pre-implementation announcements on inbound traveler policies coincided with peaks on the infection curve. Full article
(This article belongs to the Section Public Health Statistics and Risk Assessment)
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