Int. J. Environ. Res. Public Health, Volume 15, Issue 10 (October 2018) – 268 articles

Little is known about how the intersection of being a forced migrant and living with HIV can contribute to the development or exacerbation of pre-existing mental conditions. This study is set in this context and it aims to explore specific risk factors affecting the mental health of refugee women living with HIV. A total of eight refugee women living with HIV took part in the study; they were individually interviewed, and their transcripts were thematically analyzed. The overall findings indicated that participants’ mental health was impaired by multiple stressors associated with their conditions, such as racial discrimination, HIV-related stigma, including from health professionals, loneliness, and resettlement adversities. These all represent threats to public health, as they discourage individuals from engaging with adequate health/mental health services. Despite their situation, participants had not received psychological interventions and their healthcare was reduced to managing the physical symptoms of HIV. Participants indicated their need to take part in group interventions that could promote their mental health and social recovery. These findings are relevant to raising awareness about the specific risk factors affecting refugee women living with HIV and to provide evidence for public health interventions based on this specific population’s need. Full article

Over the last few years, different theoretical approaches have emerged advocating for a positive understanding of adolescence, recognizing it as a stage characterized by plasticity, the acquisition of competences and the achievement of satisfactory levels of well-being and positive adjustment. Based on Ryff’s multidimensional model of psychological well-being, this study aims: (1) to develop an adjusted measuring instrument for adolescents (Brief Scale of Psychological Well-Being for Adolescents), as well as analysing its psychometric properties; and (2) to conduct a descriptive analysis of the levels of psychological and subjective well-being among adolescent boys and girls. A sample of 1590 Andalusian adolescents (51% girls), aged between 13 and 19 years old participated in this study. The Confirmatory Factor Analysis (CFA) showed the validity of the instrument, with a multidimensional factorial solution of four factors (self-acceptance, positive interpersonal relationships, autonomy and life development) with good levels of internal consistency. Descriptive analyses showed good scores of psychological and subjective well-being among the adolescents, with a significant impact of sex and age in both measures of well-being. The results are discussed in terms of the importance of considering adolescent well-being from a multidimensional view and the need to promote positive development from a multifactorial perspective which takes into account the diversity of the variables involved. Full article

Pork is the most commonly consumed meat in Vietnam, and Salmonella enterica is a common contaminant. This study aimed to assess potential S. enterica cross-contamination between raw and cooked pork in Vietnamese households. Different scenarios for cross-contamination were constructed based on a household survey of pork handling practices (416 households). Overall, 71% of people used the same knife and cutting board for both raw and cooked pork; however, all washed their hands and utensils between handling raw and cooked pork. The different scenarios were experimentally tested. First, S. enterica was inoculated on raw pork and surfaces (hands, knives and cutting boards); next, water used for washing and pork were sampled to identify the presence and concentration of S. enterica during different scenarios of food preparation. Bootstrapping techniques were applied to simulate transfer rates of S. enterica cross-contamination. No cross-contamination to cooked pork was observed in the scenario of using the same hands with new cutting boards and knives. The probability of re-contamination in the scenarios involving re-using the cutting board after washing was significantly higher compared to the scenarios which used a new cutting board. Stochastic simulation found a high risk of cross-contamination from raw to cooked pork when the same hands, knives and cutting boards were used for handling raw and cooked pork (78%); when the same cutting board but a different knife was used, cross-contamination was still high (67%). Cross-contamination between was not seen when different cutting boards and knives were used for cutting raw and cooked pork. This study provided an insight into cross-contamination of S. enterica, given common food handling practices in Vietnamese households and can be used for risk assessment of pork consumption. Full article

Previous studies on the effects of greenspace exposure on health are largely based on static contextual units, such as residential neighborhoods, and other administrative units. They tend to ignore the spatiotemporal dynamics of individual daily greenspace exposure and the mediating effects of specific activity type (such as physical activity). Therefore, this study examines individual daily greenspace exposure while taking into account people’s daily mobility and the mediating role of physical activity between greenspace exposure and health. Specifically, using survey data collected in Guangzhou, China, and high-resolution remote sensing images, individual activity space for a weekday is delineated and used to measure participants’ daily greenspace exposure. Structural equation modeling is then applied to analyze the direct effects of individual daily greenspace exposure on health and its indirect effects through the mediating variable of physical activity. The results show that daily greenspace exposure directly influences individual health and also indirectly affects participants’ health status through physical activity. With respect to the total effects, daily greenspace exposure helps improve participants’ mental health and contributes to promoting their social health. It also helps improve participants’ physical health, although to a lesser extent. In general, the higher the daily greenspace exposure, the higher the physical activity level and the better the overall health (including physical, mental, and social health). Full article

Background: In general, nature relatedness is positively associated with physical activity, health, and subjective well-being. However, increased residence in urban areas, and the decrease in natural spaces, may affect the younger generation most adversely. The associated environmental changes can increase youths’ risk of spending most of their time indoors, and weaken their nature relatedness, making them less likely to enjoy nature’s health benefits. This is a serious public health issue, since inadequate physical activity, combined with minimum time spent in green space, can affect health across the whole lifespan. Thus, to develop effective interventions for physical activation and promote health and well-being among young men, further knowledge of the determinants of their nature relatedness is necessary. Aims: To explore factors related to nature relatedness, including physical activity, physical activity with parents, and residential environment. Methods: The study population consisted of all 914 young men (mean—17.8 years; SD—0.5) who participated in mandatory call-ups for military service and completed the study questionnaire in 2013. The questionnaire inquired about their nature relatedness, demographic characteristics, socioeconomic status, physical activity, health, and subjective well-being. A geographic information system (GIS) was used to assess the features of their residential environments. Multivariable linear regression was used to analyze the data. Results: Physical activity (p = 0.021) and physical activity with parents at primary school age (p = 0.007), and currently (p = 0.001) as well as good self-rated health (p = 0.001), and father’s higher socioeconomic status (p = 0.041), were positively connected to nature relatedness. Conclusions: Physical activity in general, physical activity with parents, and nature relatedness were positively related. This knowledge can be utilized in promoting physical activity and health among young men. Full article

There is a growing body of evidence that flavonoids show antibacterial activity against both Gram-positive and Gram-negative bacteria. The mechanisms of action of phenolic compounds on bacterial cell have been partially attributed to damage to the bacterial membrane, inhibition of virulence factors such as enzymes and toxins, and suppression of bacterial biofilm formation. What is more, some natural polyphenols, aside from direct antibacterial activity, exert a synergistic effect when combined with common chemotherapeutics. Many studies have proved that in synergy with antibiotics plant flavonoids pose a promising alternative for therapeutic strategies against drug resistant bacteria. In this review most recent reports on antimicrobial action of polyphenols on Staphylococcus aureus strains are described, highlighting where proven, the mechanisms of action and the structure–activity relationships. Since many reports in this field are, to some extent, conflicting, a unified in vitro and in vivo susceptibility testing algorithms should be introduced to ensure the selection of effective antibacterial polyphenolic compounds with low cytotoxicity and minimal side effects. Full article

In the international guidelines/standards for human protection against electromagnetic fields, the specific absorption rate (SAR) is used as a metric for radio-frequency field exposure. For radio-frequency near-field exposure, the peak value of the SAR averaged over 10 g of tissue is treated as a surrogate of the local temperature elevation for frequencies up to 3–10 GHz. The limit of 10-g SAR is derived by extrapolating the thermal damage in animal experiments. However, no reports discussed the difference between the time constant of temperature elevation in small animals and humans for local exposure. This study computationally estimated the thermal time constants of temperature elevation in human head and rat models exposed to dipole antennas at 3–10 GHz. The peak temperature elevation in the human brain was lower than that in the rat model, mainly because of difference in depth from the scalp. Consequently, the thermal time constant of the rat brain was smaller than that of the human brain. Additionally, the thermal time constant in human skin decreased with increasing frequency, which was mainly characterized by the effective SAR volume, whereas it was almost frequency-independent in the human brain. These findings should be helpful for extrapolating animal studies to humans. Full article

Fear-of-missing-out (FOMO) refers to feelings of anxiety that arise from the realization that you may be missing out on rewarding experiences that others are having. FOMO can be identified as an intra-personal trait that drives people to stay up to date of what other people are doing, among others on social media platforms. Drawing from the findings of a large-scale survey study among 2663 Flemish teenagers, this study explores the relationships between FOMO, social media use, problematic social media use (PSMU) and phubbing behavior. In line with our expectations, FOMO was a positive predictor of both how frequently teenagers use several social media platforms and of how many platforms they actively use. FOMO was a stronger predictor of the use of social media platforms that are more private (e.g., Facebook, Snapchat) than platforms that are more public in nature (e.g., Twitter, Youtube). FOMO predicted phubbing behavior both directly and indirectly via its relationship with PSMU. These findings support extant research that points towards FOMO as a factor explaining teenagers’ social media use. Full article

Despite the rapid increase in lesbian and gay (LG) people who desire and decide to become parents, LG childless individuals may encounter serious obstacles in the parenthood process, such as minority stress. Notwithstanding, the psychological processes by which prejudice events might affect the desire to become parents are still understudied. As an extension of the minority stress theory, the psychological mediation framework sheds light on these psychological processes, as it encompasses a more clinical view of stress. Within this framework, the current study aimed at assessing the role of prejudice events in affecting parenting desire in 290 childless Italian LG individuals (120 lesbians and 170 gay men), as well as the role of internalized heterosexism and sexual orientation concealment in mediating the relationship between prejudice events and parenting desire. The results suggest that only in lesbians prejudice events were negatively associated with parenting desire, and that sexual orientation concealment and internalized heterosexism were also negatively associated with parenting desire. Furthermore, sexual orientation concealment, and not internalized heterosexism, mediated the relationship between prejudice events and parenting desire in lesbians, but not gay men. The findings have important implications for clinical practice. Full article

In China, coalmine wastes, such as gangues, are used for reclamation of mining subsided land. However, as waste rocks, gangues contain several trace metal elements, which could be released under natural weathering and hydrodynamic leaching effects and then migrate into the reclamed soil layer. However, it is very difficult to find adequate other backfill materials for substitution of gangues. In this paper, we present a novel method and case study to restrict the migration ability of trace metal elements in gangues by using another kind of coalmine solid waste—fly ashes from coal combustion. In this study, fly ashes were mixed with gangues in different mass proportions 1:0.2, 1:0.4, 1:0.6 and 1:0.8 as new designed backfill materials. Due to the help of fly ash, the occurrence states of studied trace metal elements were greatly changed, and their releasing and migration ability under hydrodynamic leaching effect were also significantly restricted. In this research seven trace metal elements in gangues Cu, Zn, Pb, Cd, Cr, Mn and Ni were studied by using soil column hydrodynamical leaching method and simulated precipitation for one year. The results show that under the driving of natural precipitation trace metal elements were generally transported deep inside the reconstructed land base, i.e., far away from soil layer and most of the trace metal elements were transformed into a bonded state, or combined in inert occurrence states, especially the residual state. With this method, the migration activities of tested trace metal elements were greatly restricted and the environmental potential risk could be significantly reduced. Full article

In high-income countries, obesity disproportionately affects those from disadvantaged and rural areas. Poor diet is a modifiable risk factor for obesity and the food environment a primary driver of poor diet. In rural and disadvantaged communities, it is harder to access affordable and nutritious food, affecting both food insecurity and the health of rural residents. This paper aims to describe the food environment in a rural Australian community (approx. 7000 km² in size) to inform the development of community-relevant food supply interventions. We conducted a census audit of the food environment (ground truthing) of a local government area (LGA). We used the Nutrition Environment Measurement tools (NEMS-S and NEMS-R) to identify availability of a range of food and non-alcoholic beverages, the relative price of a healthy compared to a less healthy option of a similar food type (e.g., bread), the quality of fresh produce and any in-store nutrition promotion. Thirty-eight food retail outlets operated at the time of our study and all were included, 11 food stores (NEMS-S) and 27 food service outlets (NEMS-R). The mean NEMS-S score for all food stores was 21/54 points (39%) and mean NEMS-R score for all food service outlets was 3/23 points (13%); indicative of limited healthier options at relatively higher prices. It is difficult to buy healthy food beyond the supermarkets and one (of seven) cafés across the LGA. Residents demonstrate strong loyalty to local food outlets, providing scope to work with this existing infrastructure to positively impact poor diet and improve food security. Full article

Cognitive function is a critical health issue in later life, the decline of which disrupts well-being and daily life function. Cognitive decline in older ages can also be understood in the context of the social environment such as social connectedness and engagement in personal life. This study aimed to examine: (1) whether participation in social activities contributes to preventing cognitive decline, and (2) what type of social activities are beneficial to maintaining cognitive function. Data from the Korean Longitudinal Study of Aging (KLOSA) 2006–2014, a longitudinal survey of the household-dwelling population aged 45 and older in Korea were used. The results revealed that Mini-Mental State Examination (MMSE) scores decreased with increasing age, at a rate of approximately 0.18 units across all age-gender groups, and the decrease was steeper for adults aged 65 and over. Participation in social gatherings was likely to delay the decline in cognitive function after the age of 65. In a gender-stratified model, social activity may not have an impact on the decline of cognitive function for men, whereas participation in social gatherings was negatively related to the decline of MMSE scores in women. This study suggests the need for a gender-stratified policy for preventing the decline of cognitive function while promoting engagement in social activities in Korean older adults. Full article

The World Health Organization has promoted age-friendly city (AFC) projects in response to the aging population. Taiwan has also promoted AFC policies. This study was conducted in Taitung County, where 15.37% of the population is older adults in Taiwan. The aim was to understand the perceptions of older adults and service providers with regard to the current status of AFC policies to influence future policies. The participants of this study were older adults and service providers in various regions of Taitung. Quantitative questionnaires were completed by older adults and qualitative interviews were held with focus groups. The older adults were the most satisfied with the AFC domains of “respect and social inclusion” and “community and health services”, and the least satisfied with “transportation” and “civic participation and employment”. Homogeneity existed between the older adults’ satisfaction levels in different regions and the service providers’ opinions; however, there were notable differences between them. Both economic development and the ethnicity of groups in different regions are influential factors that determine the success of government policies. In promoting AFC policies, local governments should consider their applicability based on local conditions and resources to meet the needs of the aging population in rural areas. Full article

This paper describes the Increased Health and Wellbeing in Preschools (DAGIS) survey process and socioeconomic status (SES) differences in children’s energy balance-related behaviors (EBRBs), meaning physical activity, sedentary and dietary behaviors, and long-term stress that serve as the basis for the intervention development. A cross-sectional survey was conducted during 2015–2016 in 66 Finnish preschools in eight municipalities involving 864 children (3–6 years old). Parents, preschool personnel, and principals assessed environmental factors at home and preschool with questionnaires. Measurement of children’s EBRBs involved three-day food records, food frequency questionnaires (FFQ), seven-day accelerometer data, and seven-day sedentary behavior diaries. Children’s long-term stress was measured by hair cortisol concentration. Parental educational level (PEL) served as an indicator of SES. Children with low PEL had more screen time, more frequent consumption of sugary beverages and lower consumption of vegetables, fruit, and berries (VFB) than those with high PEL. Children with middle PEL had a higher risk of consuming sugary everyday foods than children with high PEL. No PEL differences were found in children’s physical activity, sedentary time, or long-term stress. The DAGIS intervention, aiming to diminish SES differences in preschool children’s EBRBs, needs to have a special focus on screen time and consumption of sugary foods and beverages, and VFB. Full article

Dechloranes (Decs) have been widely found in the environment, even in the Tibetan Plateau and remote polar regions. However, the understanding of their regional distribution characteristics in polar regions is limited. To study the long-range atmospheric transport and fates of these emerging contaminants, Decs were analyzed in soil and lichen from the Fildes Peninsula in Antarctica. The concentrations of five Decs in soil and lichen ranged from 141.46 to 838.47 pg/g dw and 237.04 to 3599.18 pg/g dw, respectively. The mean fractions of anti-Dechlorane Plus (DP) (f_anti) values estimated in the current soils (0.37) and lichen (0.24) were lower than those of commercial products (f_anti = 0.64–0.80), which confirms that long-range atmospheric transport is a main source of DP, and the DP burdens could be driven by the accumulation of syn-DP. The average ΣDP concentration in soil in the coastal area was higher than that in the inland area and Ardley Island, while in lichen, the average DP concentration at the Ardley Island site was approximately three-fold higher than that in the coastal area and inland areas. This indicates that the distribution of DP was influenced by anthropogenic interference and animal activities in the Fildes Peninsula. The spatial variation of f_anti of the three regions was clearer in soil than that in lichen. The f_anti values were negatively correlated with DP concentrations in soil, suggesting that DP concentration levels play an important role in determining the isomeric composition of DP in the soil. Full article

A comprehensive analysis of the effects obtained in the process of ultrasonic disintegration (UD) of waste activated sludge (WAS), was conducted. Sludge samples were collected periodically from Central Wastewater Treatment Plant (WWTP) in Gliwice (Poland) and disintegrated in the two ultrasonic devices of different construction and technical parameters, i.e., WK-2010 (A) and ultrasonic washer (B). The experiments were performed under a constant energy supply per sludge volume E_V = 160 kWh·m⁻³. The direct and technological effects, i.e., after UD and anaerobic digestion (AD) were investigated, respectively. Statistical analysis showed that characteristics and parameters of the WAS, which affects the magnitude of the direct effects create the following sequence: TS (total solids), VS (volatile solids), ΔT (temperature increase) > EPS (extracellular polymeric substances) > SCOD (soluble chemical oxygen demand) > CST (capillary suction time) > N_{TOT (}total nitrogen), P_TOT (total phosphorus) > pH. Whereas, in the case of technological effects, the above sequence was as follows: TS, VS > CST > N_TOT, P_TOT > pH. Ultrasonic disintegration of WAS prior to AD increased total biogas production (from 13.0% to 19.7%) and reduced the content of TS (from 4.1% to 8.2%) and VS (5.8% to 9.5%) in comparison to the control sample. This confirms the usefulness of ultrasonic disintegration as an effective method of sludge digestion intensification. The obtained results showed that changes in the characteristics of WAS have a significant impact on the magnitude of the effects of ultrasonic disintegration, especially TS, VS, ΔT, EPS, SCOD and CST. Concluding, it can be inferred that the most promising conditions for ultrasonic pretreatment conducted under constant energy supply per sludge volume, are: low power, long sonication time, large surface area of the emitter, and high increase of sludge temperature while conducting the process. Full article

This study’s aim was to analyse the relationship between musculoskeletal disorders (low back pain and dorsalgia) and sociodemographic characteristics, workload and occupational hazards among casual dockworkers. This cross-sectional study addressed casual dockworkers from the state of Rio Grande do Sul, Brazil. The convenience sample was composed of 232 casual dockworkers. Data were collected using a structured interview and observation. Poisson regression analysis was used. Association between low back pain and physiological occupational risk (p = 0.006), total exertion levels (p = 0.014) and frustration (p = 0.020) remained statistically significant, while the use of illicit drugs (p = 0.023), being a quayside worker (p = 0.021) and physiological occupational risk (p = 0.040) remained associated with dorsalgia. Decreasing these variables in the workplace may also reduce the prevalence of musculoskeletal disorders such as low back pain and dorsalgia. Full article

School absenteeism, particularly among junior high school students, has increased annually in Japan. This study demonstrates the relationship between subjective adjustment to school life and students’ absenteeism. Data were collected from 17,378 junior high school students in Japan. A longitudinal design was used for the study. Teachers were asked to distribute the Adaptation Scale for School Environments on Six Spheres (ASSESS) questionnaire to junior high school students and ask the students to fill out the questionnaire at the beginning of the 2014 academic year in April 2014, and the relationship between their subjective adjustment and absenteeism as measured by the total number of absent days during the 2014 academic year was evaluated by logistic regression and a survival analysis model. Low life satisfaction was associated with absences. The corresponding odds ratio (OR) was higher for seventh graders (OR 3.29, confidence interval (CI): 2.41–4.48, hazard ratio (HR) 5.57, CI: 3.51–8.84) than for students in other grades. Interpersonal relationships were significantly related to absenteeism for seventh and eighth graders in the group with scores less than 39 points. Lower adjustment to learning seemed to be related to absenteeism for seventh and eighth graders. For effective interventions, a well-designed study that uses detailed information regarding life-related covariates is necessary. Full article

Mobile genetic elements play an important role in the dissemination of antibiotic resistant bacteria among human and environmental sources. Therefore, the aim of this study was to determine the occurrence and patterns of integrons and insertion sequences of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli isolated from different sources in Navarra, northern Spain. A total of 150 isolates coming from food products, farms and feeds, aquatic environments, and humans (healthy people and hospital inpatients), were analyzed. PCRs were applied for the study of class 1, 2, and 3 integrons (intI1, intI2, and intI3), as well as for the determination of insertion sequences (IS26, ISEcp1, ISCR1, and IS903). Results show the wide presence and dissemination of intI1 (92%), while intI3 was not detected. It is remarkable, the prevalence of intI2 among food isolates, as well as the co-existence of class 1 and class 2 (8% of isolates). The majority of isolates have two or three IS elements, with the most common being IS26 (99.4%). The genetic pattern IS26–ISEcp1 (related with the pathogen clone ST131) was present in the 22% of isolates (including human isolates). In addition, the combination ISEcp1–IS26–IS903–ISCR1 was detected in 11 isolates being, to our knowledge, the first study that describes this genetic complex. Due to the wide variability observed, no relationship was determined among these mobile genetic elements and β-lactam resistance. More investigations regarding the genetic composition of these elements are needed to understand the role of multiple types of integrons and insertion sequences on the dissemination of antimicrobial resistance genes among different environments. Full article

Background: Iranian children with disabilities invariably attend special schools and many may be excluded from education entirely. Information on preschool education is limited but probably mirrors the situation in schools. There is a lack of information in terms of parental preferences for schooling and teachers’ experiences of inclusion in Iran. Method: Two feasibility studies were undertaken; one with 89 parents of children with autism or intellectual disabilities, and another with the head teachers of two private kindergartens. Results: Two-thirds of parents favored inclusive schools; most parents whose children had autism or were verbally proficient were in favor of their child attending ordinary schools, even if their child had been placed in a specialist preschool facility. The head teachers justified inclusion in terms of children’s rights but identified three main challenges: coping with the diverse level of functioning, the need for special devices and training of teachers, and challenging the negative reactions of parents of non-disabled children. Conclusions: Further exploration of the views of those who have experienced inclusion would further challenge existing practices. Moreover, the training and preparation of teachers is key to reforming schools. However, wider social values and beliefs towards disabilities also need to change. Full article

Climate change is a complex and cross-cutting problem that needs an integrated and transformative systems approach to respond to the challenge. Current sectoral approaches to climate change adaptation initiatives often create imbalances and retard sustainable development. Regional and international literature on climate change adaptation opportunities and challenges applicable to southern Africa from a water-energy-food (WEF) nexus perspective was reviewed. Specifically, this review highlights climate change impacts on water, energy, and food resources in southern Africa, while exploring mitigation and adaptation opportunities. The review further recommends strategies to develop cross-sectoral sustainable measures aimed at building resilient communities. Regional WEF nexus related institutions and legal frameworks were also reviewed to relate the WEF nexus to policy. Southern Africa is witnessing an increased frequency and intensity in climate change-associated extreme weather events, causing water, food, and energy insecurity. A projected reduction of 20% in annual rainfall by 2080 in southern Africa will only increase the regional socio-economic challenges. This is exacerbating regional resource scarcities and vulnerabilities. It will also have direct and indirect impacts on nutrition, human well-being, and health. Reduced agricultural production, lack of access to clean water, sanitation, and clean, sustainable energy are the major areas of concern. The region is already experiencing an upsurge of vector borne diseases (malaria and dengue fever), and water and food-borne diseases (cholera and diarrhoea). What is clear is that climate change impacts are cross-sectoral and multidimensional, and therefore require cross-sectoral mitigation and adaptation approaches. In this regard, a well-coordinated and integrated WEF nexus approach offers opportunities to build resilient systems, harmonise interventions, and mitigate trade-offs and hence improve sustainability. This would be achieved through greater resource mobilisation and coordination, policy convergence across sectors, and targeting nexus points in the landscape. The WEF nexus approach has potential to increase the resilience of marginalised communities in southern Africa by contributing towards attaining the Sustainable Development Goals (SDGs 1, 2, 3, 6, 7, and 13). Full article

Aims: High-touch surfaces cleaning and disinfection require the adoption of effective and proper executed protocols, especially during carbapenem-resistant Acinetobacter baumannii (CRAB) endemo-epidemic situations. We evaluated the effectiveness and residual disinfectant activity of disposable pre-impregnated wipes (Modified Operative Protocol, MOP) in reducing environmental bioburden versus a two-step Standard Operative Protocol (SOP) in a 12-bed Intensive Care Unit. Methods: Five high-touch surfaces were cleaned and disinfected either according to the SOP (alcohol-based cleaning and chlorine-based disinfection) or using quaternary ammonium compounds-based disposable wipes (MOP). Sampling was performed before each procedure and at 0.5, 2.5, 4.5 and 6.5 h after (560 sites). Total viable count (TVC) was evaluated according to Italian hygiene standard (<50 CFU/24 cm²). Clinical and environmental CRAB strains isolated were genotyped. Results: On non-electromedical surfaces the difference between TVC before procedure and at each of the following times was significant only for the MOP (p < 0.05, Wilcoxon test). Using the MOP, only 7.4% (10/135) of sites showed TVC >50 CFU/24 cm² (hygiene failures) versus 18.9% (25/132) after SOP (p < 0.05, Fisher’s Exact test). On infusion pumps a higher number of hygiene failures was observed after the SOP (7/44, 15.9%) compared with the MOP (4/45, 8.9%). Genotyping highlighted a common source of infection. Conclusion: On high-touch surfaces, the use of disposable wipes by in-house auxiliary nurses may represent a more effective alternative to standard cleaning and disinfection procedure performed by outsourced cleaning services, showing effectiveness in reducing microbial contamination and residual disinfection activity up to 6.5 h. Full article

Ecological efficiency (eco-efficiency) reflects the synergetic degree of the development of resource, economic, and environmental systems. This paper measures urban eco-efficiency based on a nonconvex metafrontier data envelopment analysis (DEA) approach using data from 191 cities in China during the years of 2003 to 2013. In particular, the impacts of dynamic agglomeration externalities on urban eco-efficiency are investigated. Our empirical results show that eco-efficiency decreased from 2003 to 2013, and its spatial distribution demonstrates significant regional heterogeneity. Additionally, there exists an inverted U-shape relationship between dynamic externalities, including Marshall-Arrow-Romer (MAR), Jacobs and Porter externalities, and eco-efficiency. We also find that eco-efficiency can be enhanced by strengthening environmental regulations, optimizing industrial structures, and improving technological capacity. These findings are robust to alternative eco-efficiency measures, model specifications, and estimation approaches. Furthermore, we discuss related policy implications of our research results. Full article

The purpose of this study was to quantify the time-magnitude changes in cardiometabolic health outcomes that occur with cessation of regular exercise training. All participants (n = 22) performed baseline testing, completed a 13-week exercise program, and completed post-program testing. Upon completion of the 13-week exercise program, participants were randomized to one of the following two treatment groups: (1) the treatment group that continued their exercise for 4 weeks (TRAIN); or (2) the treatment group that discontinued exercise (DETRAIN). Changes from baseline to 13 weeks in both the TRAIN and DETRAIN treatment groups for maximal oxygen consumption (VO₂max), body fat percentage, mean arterial pressure, high-density lipoprotein (HDL) cholesterol, and triglycerides were significantly favourable (p < 0.05). VO₂max, body fat percentage, and favourable cardiometabolic health adaptations continued to improve (p < 0.05) with an additional one month of exercise training. Upon cessation of exercise, all measures of VO₂max and body fat percentage, along with mean arterial pressure, HDL cholesterol, and triglycerides significantly worsened (p < 0.05) in the DETRAIN treatment group. Favourable training adaptations were further enhanced with an additional month of continued exercise training, and cessation of regular exercise rapidly abolished all training adaptations within one month. These novel findings underscore the importance of sustained and uninterrupted exercise training. Full article

Rivers and reservoirs in urban areas have been associated with environmental quality problems because of the discharge of domestic waste into water bodies. However, the key effects and the extent to which environmental factors can influence the integrated structure and function of urban river ecosystems remain largely unknown. Here, a relationship model involving the species composition of the community and the various environmental factors related to the water and sediment was developed in the dry season (N) and the flood season (F) in both the urban Jiaomen River (JR) and the Baihuitian Reservoir (BR) of Guangzhou City. Canonical correspondence analysis was used to determine the spatiotemporal drivers of the phytoplankton, zooplankton and macrobenthic communities in the river and reservoir systems. The combination of the thermodynamic-oriented ecological indicators and the biodiversity measures reflected the integrated structure and function of the ecosystems. Overall, the plankton community composition was found to be largely determined by the nutrient concentrations and oxygen index, and the development of the macrobenthic communities was mainly restricted by organic matter and heavy metals. Based on the results of the integrated assessment, the structure and function of the JR ecosystem were superior to that of the BR, and the F period displayed healthier results than the N period. Moreover, the structural and functional statuses of the high eco-exergy grade communities (macrobenthic communities) in the ecosystem influenced the regional changes observed in the results of the integrated assessment. The significant seasonal variations in the plankton community affected the seasonal variations in the integrated assessment. The results of this study provide a scientific basis for the management and restoration of regional freshwater environments and ecosystems. Full article

Obesity is characterized by the induction of skeletal muscle remodeling and mitochondria-mediated apoptosis. Exercise has been reported as a positive regulator of skeletal muscle remodeling and apoptosis. However, the effects of exercise on skeletal muscle remodeling and mitochondria-mediated apoptosis in obese skeletal muscles have not been clearly elucidated. Four-week-old C57BL/6 mice were randomly assigned into four groups: control (CON), control plus exercise (CON + EX), high-fat diet (HFD), and HFD plus exercise groups (HFD + EX). After obesity was induced by 20 weeks of 60% HFD feeding, treadmill exercise was performed for 12 weeks. Exercise ameliorated the obesity-induced increase in extramyocyte space and a decrease in the cross-sectional area of the skeletal muscle. In addition, it protected against increases in mitochondria-mediated apoptosis in obese skeletal muscles. These results suggest that exercise as a protective intervention plays an important role in regulating skeletal muscle structure and apoptosis in obese skeletal muscles. Full article

Objective: The purpose of this study was to explore the full distribution of children’s lead poisoning and identify “high risk” locations or areas in the neighborhood of the inner city of Syracuse (NY, USA), using quantile regression models. Methods: Global quantile regression (QR) and geographically weighted quantile regression (GWQR) were applied to model the relationships between children’s lead poisoning and three environmental factors at different quantiles (25th, 50th, 75th, and 90th). The response variable was the incident rate of children’s blood lead level ≥ 5 µg/dL in each census block, and the three predictor variables included building year, town taxable values, and soil lead concentration. Results: At each quantile, the regression coefficients of both global QR and GWQR models were (1) negative for both building year and town taxable values, indicating that the incident rate of children lead poisoning reduced with newer buildings and/or higher taxable values of the houses; and (2) positive for the soil lead concentration, implying that higher soil lead concentration around the house may cause higher risks of children’s lead poisoning. Further, these negative or positive relationships between children’s lead poisoning and three environmental factors became stronger for larger quantiles (i.e., higher risks). Conclusions: The GWQR models enabled us to explore the full distribution of children’s lead poisoning and identify “high risk” locations or areas in the neighborhood of the inner city of Syracuse, which would provide useful information to assist the government agencies to make better decisions on where and what the lead hazard treatment should focus on. Full article

This study aims to compare adequate fruit and vegetable (F&V) intake between immigrants and natives in Portugal, and to analyse factors associated with consumption of F&V among immigrants. Data from a population based cross-sectional study (2014) was used. The final sample comprised 17,410 participants (≥20 years old), of whom 7.4% were immigrants. Chi-squared tests and logistic regression models were conducted to investigate the association between adequate F&V intake, sociodemographic, anthropometric, and lifestyle characteristics. Adequate F&V intake was more prevalent among immigrants (21.1% (95% CI: 19.0–23.4)) than natives (18.5% (95% CI: 17.9–19.1)), (p = 0.000). Association between migrant status and adequate F&V intake was only evident for men: immigrants were less likely to achieve an adequate F&V intake (OR = 0.67, 95% CI = 0.66–0.68) when compared to Portuguese. Among immigrants, being female, older, with a higher education, and living in a low urbanisation area increased the odds of having F&V consumption closer to the recommendations. Adjusting for other factors, length of residence appears as a risk factor (15 or more years vs. 0–9 years: OR = 0.52, 95% CI = 0.50–0.53), (p = 0.000) for adequate F&V intake. Policies aiming to promote adequate F&V consumption should consider both populations groups, and gender-based strategies should address proper sociodemographic, anthropometric, and lifestyle determinants. Full article

Background: Both overall mortality and avoidable mortality have decreased in recent years in most European countries. It has become clear that less privileged socioeconomic groups have an increased risk of death. In 2008, most countries went into a severe economic recession, whose effects on the health of the population are still ongoing. While on the one hand, some evidence associates the economic crisis with positive health outcomes (pro-cyclical effect), on the other hand, some other evidence suggests that the economic crisis may pose serious public health problems (counter-cyclical effect), which has given rise to controversy. Objectives: To describe the evolution of overall mortality and amenable mortality in Spain between 2002–2007 (before the economic crisis) and 2008–2013 (during the economic crisis), nationally and by province, as well as to analyse trends in the risks of death and their association with indicators of the impact of the crisis. Methods: Ecological study of overall mortality and amenable mortality describing the evolution of the risks of death between 2002–2007 and 2008–2013. Age Standardised Rates were calculated, as well as their percentage change between periods. The association between percentage changes and provincial indicators of the impact of the crisis was analysed. Amenable mortality was studied both overall and categorised into five groups. Results: Amenable mortality represented 8.25% of overall mortality in 2002–2007, and 6.93% in 2008–2013. Age Standardised Rates for overall mortality and global amenable mortality generally declined, with the sharpest decline in amenable mortality. Decreases in overall mortality and amenable mortality were directly related to vulnerability indicators. The most significant decreases were registered in ischaemic heart disease, cerebrovascular disease, and other amenable causes. The relationship with vulnerability indices varied from direct (cancer) to inverse (hypertensive disease). Conclusions: Amenable mortality shows a more significant decrease than overall mortality between both study periods, albeit unevenly between provinces causes of death. Higher vulnerability indicators entail greater declines, although this trend varied for different causes. Mortality trends and their relationship with socioeconomic indicators in a situation of crisis must be conducted cautiously, taking into consideration a possible pro-cyclical effect. Full article

Background: Given the health and welfare impacts of haze, haze reduction governance challenges Chinese policy-makers. Surprisingly, there have been no studies of the differences in the public’s willingness to pay (WTP) for haze governance within a province. Yet haze reduction policies are implemented at the provincial level. Based on the contingent valuation method, data on WTP for haze governance across four industrial cities in Shandong province were collected using a questionnaire survey. Method: A combination of stratified sampling and non-probability sampling methods were used, yielding a valid sample of 1006 respondents. The Heckman sample selection model was used to analyze factors determining WTP and WTP amount. Results: 53% of respondents were unwilling to pay for haze reduction, while less than 1% of these respondents were satisfied with Shandong’s air quality. About half (47%) of the respondents were willing to pay, on average, US$14.14 per household per year for haze governance. We found that there were significant inter-city differences in the WTP and WTP amounts: those with a higher income, education, haze knowledge, and haze concern were WTP; age, marital status, and subjective indicators displayed a negative relationship with WTP amount. About two thirds of the non-payers, and those with poor environmental knowledge, argued that air quality improvement was mainly the responsibility of governments (39.3%) and polluters (25.6%), instead of ordinary citizens. Further, 27% of non-payers said that their income was too low to contribute to a pollution tax and 6.3% claimed that they did not believe the funds would be used effectively for environmental conservation. Conclusions: City-specific differences in WTP may caution against “one size fits all” policies. The study indicates that the government may need to target policies to specific cities and the characteristics of residents in those cities by age, education, and income groups and residents’ subjective evaluation of the government and the haze problem and those responsible for pollution. Full article