Int. J. Environ. Res. Public Health, Volume 15, Issue 1 (January 2018) – 175 articles

Aims: The concept of food security and its association with chronic diseases are both well-established. During the years within the scope of the study, there was a significant increase in the body shape index (ABSI) of Indonesian adults. This study tested the hypothesis that the association between food security and chronic diseases is mediated, in part, by ABSI. Methods: Data was obtained from 2156 Indonesian adults using the Indonesia Family Life Survey (IFLS) in 2007 and 2014. Longitudinal study participants were interviewed face-to-face for dietary intake data using the food frequency questionnaire (FFQ). Food security, a concept developed by the World Food Programme (WFP), was calculated based on a food consumption score analysis using the FFQ. A generalized estimating equation (GEE) and a Sobel–Goodman test were used to test the hypothesis in this study. Results: The food consumption score was negatively associated with ABSI. It was also negatively associated with systolic blood pressure (p < 0.001). In a formal mediation analysis, ABSI significantly mediated the pathway between the food consumption score and systolic blood pressure (p < 0.001). Conclusions: The effect of food security on hypertension is mediated through body shape. Strategies to improve the prevention of hypertension among adults may need to take the ABSI and food security, along with nutrition education, into account. Full article

Past research suggests that factors related to health care professionals’ (HCPs) knowledge, training and competency can contribute to the underutilisation of sexual and reproductive health (SRH) care by refugee and migrant women. The aim of this study was to examine the perceived preparedness of HCPs in relation to their knowledge, confidence and training needs when it comes to consulting refugee and migrant women seeking SRH care in Australia. A sequential mixed methods design, comprising an online survey with 79 HCPs (45.6% nurses, 30.3% general practitioners (GPs), 16.5% health promotion officers, and 7.6% allied health professionals) and semi-structured interviews with 21 HCPs, was utilised. HCPs recognised refugee and migrant women’s SRH as a complex issue that requires unique skills for the delivery of optimal care. However, they reported a lack of training (59.4% of nurses, 50% of GPs, and 38.6% of health promotion officers) and knowledge (27.8% of nurses, 20.8% of GPs, and 30.8% of health promotion officers) in addressing refugee and migrant women’s SRH. The majority of participants (88.9% of nurses, 75% of GPs, and 76% of health promotion officers) demonstrated willingness to engage with further training in refugee and migrant women’s SRH. The implications of the findings are argued regarding the need to train HCPs in culturally sensitive care and include the SRH of refugee and migrant women in university and professional development curricula in meeting the needs of this growing and vulnerable group of women. Full article

Background: Number of deaths increases during periods of elevated heat. Objectives: To examine whether differences in heat-related deaths between 2003 and 2015 occurred in Slovenia. Materials and Methods: We estimated relative risks for deaths for the observed diagnoses, sex, age, and area, as well as 95% confidence intervals and excess deaths associated with heat waves occurring in 2015 and 2003. For comparison between 2015 and 2003, we calculated relative risks ratio and 95% confidence intervals. Results: Statistically significant in 2015 were the following: age group 75+, all causes of deaths (RR = 1.10, 95% CI 1.00–1.22); all population, circulatory system diseases (RR = 1.14, 95% CI 1.01–1.30) and age group 75+, diseases of circulatory system (RR = 1.17, 95% CI 1.01–1.34). Statistically significant in 2003 were the following: female, age group 5–74, circulatory system diseases (RR = 1.69, 95% CI 1.08–2.62). Discussion: Comparison between 2015 and 2003, all, circulatory system diseases (RRR = 1.25, 95% CI 1.01–1.55); male, circulatory system diseases (RRR = 1.85, 95% CI 1.41–2.43); all, age group 75+ circulatory system diseases (RRR = 1.34, 95% CI 1.07–1.69); male, age group 75+, circulatory system diseases (RRR = 1.52, 95% CI 1.03–2.25) and female, age group 75+, circulatory system diseases (RRR = 1.43, 95% CI 1.08–1.89). Conclusions: Public health efforts are urgent and should address circulatory system causes and old age groups. Full article

Although Iran’s Ghaen Plain provides saffron to much of the world, no regional groundwater quality (GQ) assessment has yet been undertaken. Given the region’s potential for saltwater intrusion and heavy metal contamination, it is important to assess the GQ and determine its main probable source of pollution (MPSP). Such knowledge would allow for informed mitigation or elimination of the potential adverse health effects of this groundwater through its use as drinking water, or indirectly as a result of the consumption of groundwater-irrigated crops. Total dissolved solids, sodium, and chloride in the water of the majority of 16 wells sampled within the region exceeded World Health Organization and Iranian permissible standards for drinking water. The groundwater proved to only be suitable for irrigating salt tolerant crops under good drainage conditions. Due to the precipitation of calcium carbonate in the water supply facilities, the water from all wells was deemed unsuitable for industrial purposes. Heavy metal pollution and contamination indices showed no groundwater contamination. Analysis of ionic ratios and the application of principal components analysis indicated the MPSP to be saltwater intrusion, with the geology subtending the plain, and to a lesser extent, anthropogenic activities. Reducing groundwater withdrawals, particularly those for agricultural production by using high performance irrigation methods could reduce saltwater intrusion and improve GQ in the Ghaen Plain. Full article

By systematically setting up a unique nation-wide wild bird surveillance network, we monitored migratory and resident birds for zoonotic arthropod-borne virus infections, such as the flaviviruses West Nile virus (WNV) and Usutu virus (USUV). More than 1900 wild bird blood samples, from 20 orders and 136 different bird species, were collected between 2014 and 2016. Samples were investigated by WNV and USUV-specific real-time polymerase chain reactions as well as by differentiating virus neutralization tests. Dead bird surveillance data, obtained from organ investigations in 2016, were also included. WNV-specific RNA was not detected, whereas four wild bird blood samples tested positive for USUV-specific RNA. Additionally, 73 USUV-positive birds were detected in the 2016 dead bird surveillance. WNV neutralizing antibodies were predominantly found in long-distance, partial and short-distance migrants, while USUV neutralizing antibodies were mainly detected in resident wild bird species, preferentially with low seroprevalences. To date, WNV-specific RNA has neither been detected in wild birds, nor in mosquitoes, thus, we conclude that WNV is not yet present in Germany. Continued wild bird and mosquito monitoring studies are essential to detect the incursion of zoonotic viruses and to allow risk assessments for zoonotic pathogens. Full article

We analyzed the temporal and spatial variations in mortality burden of cirrhosis and liver cancer attributable to injection drug use (IDU) from 1990 to 2016. Mortality data of IDU-attributable cirrhosis and IDU-attributable liver cancer on the global and national scales from 1990 to 2016 were collected from the Global Burden of Disease (GBD) studies. Age-period-cohort (APC) model analysis was used to analyze the global mortality trends of target disease, and spatial autocorrelation analysis based on Geographic Information System was applied to illustrate the clusters of the most epidemic countries. Globally, from 1990 to 2015, mortality rates (age-standardized, per 100,000) of IDU-attributable cirrhosis increased continually from 1.5 to 1.9, while from 0.4 to 0.9 for IDU-attributable liver cancer. The APC model analysis indicated that the increases of mortality were mainly driven by period effects, with the mortality risk increasing by 6.82-fold for IDU-attributable cirrhosis and 3.08-fold for IDU-attributable liver cancer. The spatial analysis suggested that IDU-attributable cirrhosis mortality were geographically clustered from 1990 to 2016, and hot spots were mainly located in less well developed countries of Latin America, East and Central Europe and Central Asia. Our study provides epidemiological evidence for global interventions against advanced liver disease among injection drug users (IDUs). Full article

Arsenic methylation capacity is associated with metabolic syndrome and its components among highly exposed populations. However, this association has not been investigated in low to moderately exposed populations. Therefore, we investigated arsenic methylation capacity in relation to the clinical diagnosis of metabolic syndrome in a low arsenic exposure population. Additionally, we compared arsenic methylation patterns present in our sample to those of more highly exposed populations. Using logistic regression models adjusted for relevant biological and lifestyle covariates, we report no association between increased arsenic methylation and metabolic syndrome in a population in which arsenic is regulated at 10 ppb in drinking water. However, we cannot rule out the possibility of a positive association between arsenic methylation and metabolic syndrome in a subsample of women with normal body mass index (BMI). To our knowledge this is the first investigation of arsenic methylation capacity with respect to metabolic syndrome in a low exposure population. We also report that methylation patterns in our sample are similar to those found in highly exposed populations. Additionally, we report that gender and BMI significantly modify the effect of arsenic methylation on metabolic syndrome. Future studies should evaluate the effectiveness of arsenic policy enforcement on subclinical biomarkers of cardiovascular disease. Full article

Research on the influence of relationships among satiety, muscle mass, and outdoor environmental factors is sparse. In this work the relationships among satiety feeling, body composition, and outdoor environmental factors on eating in healthy young Japanese women are investigated. Fifty three (53) women were examined over an approximately 2-year period. All participants ate the same lunch; feelings of satiety and body composition were measured before and immediately after lunch. Satiety was assessed using a visual analog scale. Outdoor environmental factors were recorded at the time of measurement. Results showed that satiety before lunch decreased with increased muscle mass and decreased humidity (p < 0.05). The Δ satiety increased on eating with increased outdoor temperature (p < 0.05). The Δ satiety with high outdoor temperature was significantly greater than with low outdoor temperature (p = 0.005). Decreased muscle mass more influenced Δ satiety with respect to outdoor temperature than increased muscle mass (p = 0.007). The results suggest that increased muscle mass and decreased humidity increase hunger (unlike satiety) before eating. The findings also show that outdoor temperature clearly influences the magnitude of satiety on eating. Increasing muscle mass may be useful for satiety control at various outdoor temperatures in young women. Full article

Background: Traditionally, workers employed in police forces have been found to be exposed to a high risk of distress. Several studies reported that the main stressors were associated more with organizational aspects, whilst other researchers underlined that the main stressor were associated more with operational issues. The aim of this research was to investigate operational and organizational stressors, their consequences also in terms of anxiety and the coping strategies adopted. Methods: We compared Patrol Police Officers working in the Operational Service (Outdoor Patrol Officers) and those in the Interior Department (Indoor Patrol Officers) in the same Municipal Police force. Results: The results revealed that both Outdoor Patrol Officers and Interior Patrol Officers suffered from organizational and occupational stressor. Outdoor Patrol Officers appeared more willing to use different coping strategies, whereas Indoor Patrol Officers used avoidance strategies. This allows Outdoor Patrol Officers to explore new responses and approaches to deal with situations which—owing to the type of work—it is impossible to change. Outdoor Patrol Officers appeared better equipped to change their attitude to work than Indoor Patrol Officers. Conclusion: Interventions on both organizational and operational stressors would improve the quality of Patrol Police Officers’ working life and have positive repercussions on the service offered to the general public. Full article

Introduction: Although e-health interventions are widely implemented as a supportive measure to smoking cessation, there is a lack of evidence in the feasibility of its application among Vietnamese youths, which is considered to be one of the most frequent internet using populations. This study assessed the quitting attempts among smokers and their preference and willingness to pay for smartphone-based cessation supporting applications in a sample of active internet users approached. Methods: A total of 1082 participants were recruited for the online-based survey from August to October 2015 in Vietnam. Information on sociodemographic characteristics, health information seeking behaviors on the internet, smoking status, quitting attempts and willingness to pay for smartphone-based cessation supporting applications were collected. Multivariate logistic regression was used to determine the associated factors with current smoking and willingness to pay for the smoking cessation application. Results: About 11% of participants were current smokers while 73.4% had attempted to quit smoking. Only 26.8% of the individuals indicated that they were willing to utilize a smartphone application to assist them in quitting. Participants who were male, had partners/spouse and lived at other places were more likely to smoke cigarette. Meanwhile, people who spent 50–70% of their online time to read health information were less likely to smoke. Results also show that living with family and never sharing health information on the internet were negatively associated with a participant’s willingness to pay for the smartphone application. Meanwhile, people who highly trusted health information were more likely to be willing to pay for the application. Conclusions: This prevalence of smoking and associated factors can provide potential indicators for creating several public health interventions in the new environment with the increasing development of information technology. This study implies that in order to expand the coverage of smoking cessation interventions, we recommend the integration of e-health interventions with clinical- or telephone-based conventional models by providing smartphone applications and information on the internet from reliable sources. Full article

Hygienic fecal treatment in resource-oriented sanitation (ROS) systems is an important concern. Although the addition of nitrifying microorganisms is a sustainable fecal treatment method in ROS systems, it is essential to examine the cleanliness of this method. In this study, we investigated the fate of fecal indicators in source-separated fecal samples through tracking Escherichia coli and total coliforms. The effects of adding different amounts of Nitrosomonas europaea bio-seed, along with a constant amount of Nitrobacter winogradskyi bio-seed, were studied. In intact feces samples, the pathogen population underwent an initial increase, followed by a slight decrease, and eventually became constant. Although the addition of nitrifying microorganisms initially enhanced the pathogen growth rate, it caused the reduction process to become more efficient in the long-term. In addition to a constant concentration of 10,000 cells of N. winogradskyi per 1 g feces, a minimum amount of 3000 and 7000 cells of N. europaea per 1 g feces could completely remove E. coli and total coliforms, respectively, in less than 25 days. Increasing the amount of bio-seeds added can further reduce the time required for total pathogen removal. Full article

Air pollution exposure and HIV infection can each cause neurocognitive insult in children. The purpose of this study was to test whether children with combined high air pollution exposure and perinatal HIV infection have even greater risk of neurocognitive impairment. This was a cross-sectional study of HIV-uninfected unexposed (HUU) and HIV-infected children and their caregivers in Nairobi, Kenya. We used a detailed neuropsychological battery to evaluate neurocognitive functioning in several domains. We measured caregiver 24-h personal CO exposure as a proxy for child CO exposure and child urinary 1-hydroxypyrene (1-OHP), a biomarker for exposure to polycyclic aromatic hydrocarbons (PAHs). Median 24-h caregiver CO exposure was 6.1 and 3.7 ppm for 45 HIV-infected (mean age 6.6 years) and 49 HUU (mean age 6.7 years), respectively; 48.5% of HIV-infected and 38.6% of HUU had caregiver 24-h CO levels exceeding the WHO recommended level. Median 1-OHP exposure was 0.6 and 0.7 µmol/mol creatinine among HIV-infected and HUU children, respectively. HIV-infected children with high urinary 1-OHP (exceeding 0.68 µmol/mol creatinine) had significantly lower global cognition (p = 0.04), delayed memory (p = 0.01), and attention scores (p = 0.003). Among HUU children, urinary 1-OHP and caregiver 24-h caregiver CO were not significantly associated with neurocognitive function. Our findings suggest that combined chronic exposure to air pollutants and perinatal HIV infection may be associated with poorer neurocognitive outcomes. High prevalence of air pollution exposure highlights the need to reduce these exposures. Full article

Exposure to lead has long been a community health concern in St. Louis, Missouri. The objective of this study was to examine public response to reports of elevated lead levels in school drinking water in St. Louis, Missouri via Twitter, a microblogging platform with over 320 million active users. We used a mixed-methods design to examine Twitter user status updates, known as “tweets,” from 18 August to 31 December 2016. The number of tweets each day was recorded, and Twitter users were classified into five user types (General Public, Journalist/News, Health Professional/Academic, Politician/Government Official, and Non-Governmental Organization). A total of 492 tweets were identified during the study period. The majority of discourse on Twitter occurred during the two-week period after initial media reports and was driven by members of the General Public. Thematic analysis of tweets revealed four themes: Information Sharing, Health Concerns, Sociodemographic Disparities, and Outrage. Twitter users characterized lead in school drinking water as an issue of environmental inequity. The findings of this study provide evidence that social media platforms can be utilized as valuable tools for public health researchers and practitioners to gauge public sentiment about environmental health issues, identify emerging community concerns, and inform future communication and research strategies regarding environmental health hazards. Full article

The possibility for all babies to be born and remain HIV-negative for the first year of life is achievable in South Africa. HIV-positive mothers’ adherence to their antiretroviral medication is one of the crucial factors to achieve this target. Cross-sectional data were collected at 12 community health centres, over 12 months (2014–2015), from 673 HIV-positive women, less than 6 months pregnant, attending antenatal care, and on Option B treatment. Adherence measures included the Adults AIDS Clinical Trials Group (AACTG) four-day measure, as well as the Visual Analog Scale (VAS) seven-day measure. Bivariate analyses and multivariate logistic regressions are presented. 78.8% of respondents were adherent on AACTG, while 68.8% reported VAS adherence. Bivariate analyses for increased adherence show significant associations with older age, less/no alcohol usage, disclosure of HIV status, higher HIV knowledge, no desire to avoid ARV side effects, low stigma, and low depression. AACTG showed a negative association with intimate partner violence. Multivariable logistic regression on AACTG and VAS adherence rates resulted in unique contributions to increased adherence of older age, less/no alcohol usage, higher HIV knowledge, lack of depression, and non-disclosure. Programs targeting closer side effect monitoring, HIV disclosure, pre-natal depression, alcohol intake, and HIV knowledge need consideration. Full article

Epidemiology studies indicated that air pollution has been associated with adverse neurological effects in human. Moreover, the secretion of glucocorticoid (GC) affects the mood regulation, and the negative feedback of hippocampal glucocorticoid receptors (GR) inhibits the GC secretion. Meanwhile, the over secretion of GC can interfere the immune system and induce neurotoxicity. In the present study, the human test showed that the secretion of the cortisol in plasma was elevated after exposure in heavy air pollution. In the mouse model, we found that breathing the highly polluted air resulted in the negative responses of the mood-related behavioral tests and morphology of hippocampus, as well as the over secretion of GC in plasma, down regulation of GR, and up-regulation of cytokine and chemokine in the hippocampus. When considering the interrelated trends between the hippocampal GR, inflammatory factors, and plasmatic GC, we speculated that PM_2.5 exposure could lead to the increased secretion of GC in plasma by decreasing the expression of GR in hippocampus, which activated the inflammation response, and finally induced neurotoxicity, suggesting that PM_2.5 exposure negatively affects mood regulation. When combined with the results of the human test, it indicated that exposure to ambient air particles increased the risk of mental disorder. Full article

The aim of this work is investigate relationship between health-related quality of life and work-related stress and the impact of gender, education level, and age on this relationship. A cross-sectional study was conducted among workers of various setting in Rome and Frosinone. Work-related stress was measured with a demand–control questionnaire and health-related functioning by SF (short form)-12 health survey. There were 611 participants. Men reported high mental composite summary (MCS) and physical composite summary (PCS). In multivariate analysis age, gender (p < 0.001) and job demand (0.045) predicted low PCS. Low MCS predicted poor PCS. Job demand and educational level resulted negatively associated with MCS. In an analysis stratified for age, gender, and educational level, gender and age resulted effect modifier for MCS, gender and education level for PCS. In women increase of decision latitude predict (p = 0.001) an increase in MCS; a low job demand predict high MCS in male (p ≤ 0.001). In younger workers, a lower level of job demand predicted high MCS (<0.001). For PCS, gender and education level resulted effect modifier. In women, high decision latitude predicted higher PCS (p = 0.001) and lower level of job demand results in higher PCS (p ≤ 0.001). Higher educational level resulted predictor of low PCS. Management of risk about work-related stress should consider socio-demographic factors. Full article

Background: Social engagement is key to health and quality of life. Little is known about social engagement patterns of middle-aged and older adults who live with one or more chronic illnesses. This study investigated social engagement restrictions among middle-aged and older adults with chronic conditions and factors associated with these restrictions. Methods: Cross-sectional representative data from the National Council on Aging Chronic Care Survey were examined for relationships between social engagement restrictions and chronic conditions, health status, support, quality of life implications, self-care barriers, caregiving, and demographics. Associations were tested using bivariate analyses and binary logistic regression. Results: Participants were 793 middle-aged (age 44–64) and older adults (age 65+) with one or more chronic conditions. Factors associated with social engagement restrictions included having higher education, receiving care, having more physician visits and hospitalizations, being disabled, being unemployed, and having higher Emotional and Physical Problems Scale scores. Conclusions: Findings reveal the prevalence of social engagement restrictions among middle-aged and older adults with chronic conditions. Results highlight the importance of promoting research, assessments, and interventions to increase social engagement among this aging population. Full article

Diabetic Retinopathy is a microvascular complication of diabetes, that can go undetected and unnoticed until irreversible damage and even blindness has occurred. Effective screening for diabetic retinopathy has been proven to reduce the risk of sight loss. The National Health Service (NHS) which provides healthcare for all UK citizens, implemented systematic retinal screening for diabetic retinopathy in England in 2003, with the aim of identifying and treating all patients with sight threatening retinopathy. Crucial to this is patients partaking in the programme. Therefore, increasing screening uptake has been a major focus of the programme. This review explores the views of people living with diabetes who do not attend retinal screening, their characteristics, concerns, experiences of retinal screening and their understanding of the risks of diabetic retinopathy. All studies that satisfied the study inclusion criteria on ‘patients’ non-attendance at retinal screening’, between 2003 to 2017 were included after extensive database search. A total of 16 studies were included in the review. Findings showed that socio-economic deprivation was a major risk factor for non-attendance, about 11.5–13.4% of the screened population had sight threatening retinopathy (STDR), repeated nonattendance was linked to sight threatening diabetic retinopathy, and that certain factors, could be barriers or incentives for screening uptake. Some of those factors are modifiable whilst others are not. Full article

This study addressed school-contextual features of social disorder in relation to sixth-grade students’ experiences of bullying victimization and mental health complaints. It investigated, firstly, whether the school’s concentrations of behavioural problems were associated with individual students’ likelihood of being bullied, and secondly, whether the school’s concentrations of behavioural problems and bullying victimization predicted students’ emotional and psychosomatic health complaints. The data were derived from the Swedish National Survey of Mental Health among Children and Young People, carried out among sixth-grade students (approximately 12–13 years old) in Sweden in 2009. The analyses were based on information from 59,510 students distributed across 1999 schools. The statistical method used was multilevel modelling. While students’ own behavioural problems were associated with an elevated risk of being bullied, attending a school with a higher concentration of students with behavioural problems also increased the likelihood of being bullied. Attending a school with higher levels of bullying victimization and behavioural problems predicted more emotional and psychosomatic complaints, even when adjusting for their individual level analogues. The findings indicate that school-level features of social disorder influence bullying victimization and mental health complaints among students. Full article

Surveillance data on the level of resistant bacteria is needed to inform strategies to reduce the development and spread of antibiotic resistance. The aim of this study was to determine the non-susceptibility trends to extended-spectrum cephalosporins and carbapenems among Escherichia coli and Klebsiella spp. isolates from the district of Nashik in Western India during the period 2004–2014. Antibacterial susceptibility testing of clinical isolates was performed using Kirby-Bauer disc diffusion method to determine inhibitory zone diameters. The change in proportions of non-susceptible bacteria over calendar time was investigated with spline transformations in a logistic regression model. For the extended-spectrum cephalosporins, the proportions of non-susceptible E. coli and Klebsiella spp. isolates were above 78.4% and 84.9% throughout the study period, respectively. E. coli and Klebsiella spp. isolates exhibited carbapenem non-susceptibility levels as high as 76.9% and 84.1% respectively. The proportions of extended-spectrum betalactamase (ESBL)-producing isolates ranged from 38.3–85.9% in E. coli and from 45.1–93.1% in Klebsiella spp. Significantly higher proportions of non-susceptible and ESBL-producing isolates were found among isolates from inpatients compared to isolates from outpatients for both E. coli and Klebsiella spp. (p < 0.050). The high proportions of non-susceptible isolates observed show that there is great need to focus on optimal use of antibiotics to reduce the development of antibiotic resistance. Full article

Few published studies have investigated the presence of lead in the e-liquid of electronic nicotine delivery systems (ENDS). Lead inhalation is associated with increased risk of stroke, heart disease, and other diseases. This study used a novel application of graphite furnace technology to compare the concentration of lead between e-liquids of different packaging and product designs using e-liquids that are or were commercially available in the United States and Canada. Eleven nicotine-free disposable ENDS devices and 12 bottled refill solutions that contained nicotine were purchased from retailers in Canada and the United States between 2015 and 2017. E-liquids extracted from the disposable products and individual containers were analyzed for lead content by graphite furnace using atomic absorption detection. The lead concentration of open-wick ENDS devices ranged from 25.2 ppb to 838.4 ppb, with a standard deviation of 187.4 ppb. None of the bottled e-liquids contained quantifiable levels of lead. This study found that quantifiable levels of lead are present in certain disposable e-cigarette devices, and there is evidence from this study that the design of ENDS devices may contribute to lead exposure. These findings suggest that lead testing should be incorporated into future chemical analyses of ENDS devices. Full article

The purpose of the study was to determine the proportions of multidrug-resistant (MDR) Acinetobacter spp. isolates from the district of Nashik in Western India during the period from 2011–2014. Antibacterial susceptibility testing of isolates from inpatients and outpatients was performed using Kirby–Bauer disc diffusion method to determine inhibitory zone diameters. Proportions of non-susceptible isolates were calculated from the antibacterial susceptibility data. MDR was defined as an isolate being non-susceptible to at least one antibacterial agent in at least three antibacterial categories. The change in proportions of MDR isolates; extended-spectrum β-lactamase (ESBL)-producing isolates; and non-susceptible isolates to specific antibacterial categories over calendar time was investigated by logistic regression. The proportions of MDR and ESBL-producing isolates ranged from 89.4% to 95.9% and from 87.9% to 94.0%; respectively. The proportions of non-susceptible isolates to aminoglycosides; carbapenems; antipseudomonal penicillins/β-lactamase inhibitors; cephalosporins; folate pathway inhibitors; or penicillins/β-lactamase inhibitors exceeded 77.5%. Proportions of fluoroquinolone and tetracycline non-susceptible isolates ranged from 65.3% to 83.3% and from 71.3% to 75.9%; respectively. No changes in trends were observed over time; except for a decreasing trend in fluoroquinolone non-susceptible isolates (OR = 0.75 (95% CI, 0.62–0.91)). Significantly higher proportions of non-susceptible; MDR and ESBL-producing isolates were found among isolates from the respiratory system compared to isolates from all other specimen types (p < 0.05). High proportions of MDR Acinetobacter spp. isolates were observed in the period from 2011–2014. Antimicrobial stewardship programmes are needed to prevent the emergence and spread of antibiotic resistance. Full article

Human beings think in metaphor and reason through analogy. The metaphors through which we think influence how we understand and feel about social issues as well as the actions that we see as appropriate and important. Metaphors can be used to increase understanding of how issues work and increase the salience of a given issue, build support for programs and policies necessary to address the issue, and instigate demand for change and civic action. In this paper, we use a mixed methods research design, including brief qualitative interviews, experimental surveys, and focus groups, to test the ability of different metaphors to influence public understanding of the social determinants of child abuse and neglect in the UK. We find one metaphor in particular that improves people’s understanding of the social causes of child maltreatment and increases support for structural solutions. This metaphor can be used to build support for preventative public health solutions. Full article

Men who have sex with men (MSM) may be at higher risk for human papillomavirus (HPV)-associated cancers. Healthcare professionals’ recommendations can affect HPV vaccination uptake. Since 2016, MSM up to 45 years have been offered HPV vaccination at genitourinary medicine (GUM) clinics in a pilot programme, and primary care was recommended as a setting for opportunistic vaccination. Vaccination prior to potential exposure to the virus (i.e., sexual debut) is likely to be most efficacious, therefore a focus on young MSM (YMSM) is important. This study aimed to explore and compare the knowledge and attitudes of UK General Practitioners (GPs) and sexual healthcare professionals (SHCPs) regarding HPV vaccination for YMSM (age 16–24). A cross-sectional study using an online questionnaire examined 38 GPs and 49 SHCPs, including 59 (67.82%) females with a mean age of 40.71 years. Twenty-two participants (20 SHCPs, p < 0.001) had vaccinated a YMSM patient against HPV. GPs lack of time (25/38, 65.79%) and SHCP staff availability (27/49, 55.10%) were the main reported factors preventing YMSM HPV vaccination. GPs were less likely than SHCPs to believe there was sufficient evidence for vaccinating YMSM (OR = 0.02, 95% CI = 0.01, 0.47); less likely to have skills to identify YMSM who may benefit from vaccination (OR = 0.03, 95% CI = 0.01, 0.15); and less confident recommending YMSM vaccination (OR = 0.01, 95% CI = 0.00, 0.01). GPs appear to have different knowledge, attitudes, and skills regarding YMSM HPV vaccination when compared to SHCPs. Full article

Promoting physical activity and sustainable transportation is essential in the face of rising health care costs, obesity rates, and other public health threats resulting from lack of physical activity. Targeted communications can encourage distinct population segments to adopt active and sustainable transportation modes. Our work is designed to promote the health, social, and environmental benefits of sustainable/active transportation (ST) using the Transtheoretical Model of Change (TTM), which has been successfully applied to a range of health, and more recently, sustainability behaviors. Earlier, measurement development confirmed both the structure of ST pros and cons and efficacy measures as well as the relationship between these constructs and ST stages of change, replicating results found for many other behaviors. The present paper discusses a brief pre-post video pilot intervention study designed for precontemplators and contemplators (N = 604) that was well received, effective in moving respondents towards increased readiness for ST behavior change, and improving some ST attitudes, significantly reducing the cons of ST. This research program shows that a brief stage-targeted behavior change video can increase readiness and reduce the cons for healthy transportation choices. Full article

Noise exposure prediction models for health effect studies normally estimate free field exposure levels outside. However, to assess the noise exposure inside dwellings, an estimate of indoor sound levels is necessary. To date, little field data is available about the difference between indoor and outdoor noise levels and factors affecting the damping of outside noise. This is a major cause of uncertainty in indoor noise exposure prediction and may lead to exposure misclassification in health assessments. This study aims to determine sound level differences between the indoors and the outdoors for different window positions and how this sound damping is related to building characteristics. For this purpose, measurements were carried out at home in a sample of 102 Swiss residents exposed to road traffic noise. Sound pressure level recordings were performed outdoors and indoors, in the living room and in the bedroom. Three scenarios—of open, tilted, and closed windows—were recorded for three minutes each. For each situation, data on additional parameters such as the orientation towards the source, floor, and room, as well as sound insulation characteristics were collected. On that basis, linear regression models were established. The median outdoor–indoor sound level differences were of 10 dB(A) for open, 16 dB(A) for tilted, and 28 dB(A) for closed windows. For open and tilted windows, the most relevant parameters affecting the outdoor–indoor differences were the position of the window, the type and volume of the room, and the age of the building. For closed windows, the relevant parameters were the sound level outside, the material of the window frame, the existence of window gaskets, and the number of windows. Full article

Walking is being promoted for health and transportation purposes across all climatic regions in the US and beyond. Despite this, an uncomfortable microclimate condition along sidewalks is one of the major deterrents of walking, and more empirical research is needed to determine the risks of heat exposure to pedestrians while walking. This study examined the effect of street trees and grass along sidewalks on air temperatures. A series of thermal images were taken at the average heights of adults and children in the US to objectively measure the air temperatures of 10 sidewalk segments in College Station, TX, USA. After controlling the other key physical environmental conditions, sidewalks with more trees or wider grass buffer areas had lower air temperatures than those with less vegetation. Children were exposed to higher temperatures due to the greater exposure or proximity to the pavement surface, which tends to have higher radiant heat. Multivariate regression analysis suggested that the configuration of trees and grass buffers along the sidewalks helped to promote pleasant thermal conditions and reduced the differences in ambient air temperatures measured at child and adult heights. This study suggests that street trees and vegetated ground help reduce the air temperatures, leading to more thermally comfortable environments for both child and adult pedestrians in warm climates. The thermal implications of street landscape require further attention by researchers and policy makers that are interested in promoting outdoor walking. Full article

Resettlement affects not only the resettlers’ production activities and life but also, directly or indirectly, the normal operation of power stations, the sustainable development of the resettlers, and regional social stability. Therefore, a scientific evaluation index system for the sustainable development of reservoir resettlement must be established that fits Chinese national conditions and not only promotes reservoir resettlement research but also improves resettlement practice. This essay builds an evaluation index system for resettlers’ sustainable development based on a back-propagation (BP) neural network, which can be adopted in China, taking the resettlement necessitated by step hydropower stations along the Wujiang River cascade as an example. The assessment results show that the resettlement caused by step power stations along the Wujiang River is sustainable, and this evaluation supports the conclusion that national policies and regulations, which are undergoing constant improvement, and resettlement has increasingly improved. The results provide a reference for hydropower reservoir resettlement in developing countries. Full article

This study examines factors associated with the physical health of Korea’s growing immigrant population. Specifically, it focuses on the associations between ethnic networks, community social capital, and self-rated health (SRH) among female marriage migrants. For empirical testing, secondary analysis of a large nationally representative sample (NSMF 2009) is conducted. Given the clustered data structure (individuals nested in communities), a series of two-level random intercepts and slopes models are fitted to probe the relationships between SRH and interpersonal (bonding and bridging) networks among foreign-born wives in Korea. In addition to direct effects, cross-level interaction effects are investigated using hierarchical linear modeling. While adjusting for confounders, bridging (inter-ethnic) networks are significantly linked with better health. Bonding (co-ethnic) networks, to the contrary, are negatively associated with immigrant health. Net of individual-level covariates, living in a commuijnity with more aggregate bridging social capital is positively linked with health. Community-level bonding social capital, however, is not a significant predictor. Lastly, two cross-level interaction terms are found. First, the positive relationship between bridging network and health is stronger in residential contexts with more aggregate bridging social capital. Second, it is weaker in communities with more aggregate bonding social capital. Full article