Int. J. Environ. Res. Public Health, Volume 15, Issue 2 (February 2018) – 218 articles

By employing the Graph Model for Conflict Resolution methodology, this paper models and analyzes a brownfield conflict that occurred at the Changzhou Foreign Language School in Jiangsu, China, in 2016. This conflict made national headlines when news reports revealed that a large number of students and staff suffered from health issues after the school moved to a new site that is built on recently restored land adjacent to the original “Chang Long Chemical” block. Since stakeholders in the conflict hold different strengths of preference, a new option prioritization technique is employed to elicit both crisp preferences and the strength of preferences for the decision-makers (DMs) in the conflict. The conflict analysis result is consistent with the actual trajectory of the conflict and provides strategic insights into the conflict. More specifically, equilibrium results suggest that the firm should have been required to thoroughly clean the site, the local government should not have relocated the school, and the environmental agency and other stakeholders should have closely monitored the firm’s activities. In short, strategic insights garnered from this case study indicate that positive interactions should be fostered among the local government, the enterprise, and the public to ensure sustainable brownfield land redevelopment in the future. Full article

Experts around the world support the integration of health promotion and wellness (HPW) services into traditional health care services. If successfully executed, the addition of HPW services would reduce rates of death and disability and significantly reduce health care costs. While all health care providers should be engaged in providing HPW services, many believe that physical therapists (PTs) and occupational therapists (OTs) are uniquely positioned to provide these services. However, research suggests that clinicians in both fields may fall short in doing so. Likewise, research indicates that entry-level educational programs inadequately prepare PT and OT students to be HPW practitioners. The overall purpose of this paper is to provide recommendations to educators for preparing PT and OT students and clinicians to better meet the HPW needs of the clients and patients they serve. Full article

The aims of this study were to describe fatal and non-fatal self-harm burdens, as well as burdens from the main preventable risk factors, and to investigate the different suicide methods in Hubei province in central China utilizing data from both Global Burden of Disease Study 2015 and Hubei Disease Surveillance Points system. All self-harm burdens including mortality, years of life lost (YLLs), prevalence, years lived with disability (YLDs), and disability adjusted life-years (DALYs) consistently demonstrated downward trends in Hubei from 1990 to 2015, with a bigger decline gap observed among females and narrower decreasing amplitudes among the elderly. Hubei experienced much higher age-standardized rates for self-harm mortality (22.0 per 100,000), YLLs (560.1 per 100,000) and DALYs (563.9 per 100,000) than the national (9.0, 292.3 and 295.0 per 100,000 respectively) and global levels (11.5, 453.3 and 457.9 per 100,000 respectively) in 2015. Self-harm burdens have begun shifting from females to males and the elderly suffered more self-harm burdens than other age groups. Alcohol use accounted for 20.9% of all self-harm DALYs for males, whereas intimate partner violence accounted for 24.4% of all self-harm DALYs for females. Poisoning, mainly pesticide self-poisoning, was still the most common method of suicide. Effective interventions by multi-sectoral collaboration are urgently needed to reduce the alarmingly heavy self-harm burdens in Hubei. Full article

The present study develops an integrated methodology combining the results of the water-quality classification, according to the Water Framework Directive 2000/60/EC—WFD, with those of a mathematical integrity model. It is able to analyse the potential anthropogenic impacts on the receiving water body and to help municipal decision-makers when selecting short/medium/long-term strategic mitigation actions to be performed in a territory. Among the most important causes of water-quality degradation in a river, the focus is placed on pollutants from urban wastewater. In particular, the proposed approach evaluates the efficiency and the accurate localisation of treatment plants in a basin, as well as the capacity of its river to bear the residual pollution loads after the treatment phase. The methodology is applied to a sample catchment area, located in northern Italy, where water quality is strongly affected by high population density and by the presence of agricultural and industrial activities. Nearly 10 years of water-quality data collected through official monitoring are considered for the implementation of the system. The sample basin shows different real and potential pollution conditions, according to the resilience of the river and surroundings, together with the point and diffuse pressure sources acting on the receiving body. Full article

Over the past three decades, a range of mosquito-borne viruses that threaten public and veterinary health have emerged or re-emerged in Europe. Mosquito surveillance activities have highlighted the Culex pipiens species complex as being critical for the maintenance of a number of these viruses. This species complex contains morphologically similar forms that exhibit variation in phenotypes that can influence the probability of virus transmission. Critical amongst these is the choice of host on which to feed, with different forms showing different feeding preferences. This influences the ability of the mosquito to vector viruses and facilitate transmission of viruses to humans and domestic animals. Biases towards blood-feeding on avian or mammalian hosts have been demonstrated for different Cx. pipiens ecoforms and emerging evidence of hybrid populations across Europe adds another level of complexity to virus transmission. A range of molecular methods based on DNA have been developed to enable discrimination between morphologically indistinguishable forms, although this remains an active area of research. This review provides a comprehensive overview of developments in the understanding of the ecology, behaviour and genetics of Cx. pipiens in Europe, and how this influences arbovirus transmission. Full article

Botanical metabolites are increasingly realized as potential replacements to chemical insecticides. In the present study, Acacia nilotica seed essential oil and seed pod solvent extracts were tested for bioefficacy against three important types of mosquitoes. Mortality was recorded 24 h post-treatment, while smoke toxicity of adult mosquitoes was recorded at 10 min intervals for 40 min. Seed pod powder was extracted with different solvents and hydrodistilled seed oil chemical constituents were determined by using Gas chromatography mass spectroscopy (GC-MS) -. Larvicidal and adulticidal efficacy of seed hydrodistilled essential oil and solvent extracts were tested against larval and adult mosquitoes. The seed hydrodistilled oil provided strong larvicidal activity against Anopheles stephensi, (LC50 (lethal concentration that kills 50% of the exposed larvae) = 5.239, LC90 (lethal concentration that kills 90% of the exposed larvae) = 9.713 mg/L); Aedes aegypti, (LC50 = 3.174, LC90 = 11.739 mg/L); and Culex quinquefasciatus, (LC50 = 4.112, LC90 = 12.325 mg/L). Smoke toxicities were 82% in Cx. quinquefasciatus, 90% in Ae. aegypti, and 80% mortality in An. stephensi adults, whereas 100% mortality was recorded for commercial mosquito coil. The GC-MS profile of seed essential oil from A. nilotica showed the presence of hexadecane (18.440%) and heptacosane (15.914%), which are the main and active compounds, and which may be involved in insecticidal activity. Overall findings suggest that the seed oil showed strong mosquitocidal activity against mosquito vectors and therefore may provide an ecofriendly replacement to chemical insecticides. Full article

Since the origin of the Modern Movement, there has been a basic commitment to improving housing conditions and the well-being of occupants, especially given the prediction that 2/3 of humanity will reside in cities by 2050. Moreover, a compact model of the city with tall buildings and urban densification at this scale will be generated. Continuous constructive and technological advances have developed solid foundations on safety, energy efficiency, habitability, and sustainability in housing design. However, studies on improving the quality of life in these areas continue to be a challenge for architects and engineers. This paper seeks to contribute health-related information to the study of residential design, specifically the influence of the geomagnetic field on its occupants. After compiling information on the effects of geomagnetic fields from different medical studies over 23 years, a case study of a 16-story high-rise building is presented, with the goal of proposing architectural design recommendations for long-term occupation in the same place. The purpose of the present work is three-fold: first, to characterize the geomagnetic field variability of buildings; second, to identify the causes and possible related mechanisms; and third, to define architectural criteria on the arrangement of uses and constructive elements for housing. Full article

The article presents the results of a correlation study, aimed at quantifying the food intake of the Roma population in the South Bohemian Region. To achieve the goal, we applied the method of one-day dietary recall and frequency food analysis (non-standardized). The quantification was carried out by analysis in the Nutridan program. The study involved 302 Roma persons and 298 persons in the control group. Both groups had the same representation of males and females (50:50). The age categories of both sets differed; the average age of the Roma was lower (39.2 years) (p < 0.001). The probands from the Roma population were chosen with the help of the snowball method through known respondents. The statistical analysis shows differences in nutritional estimate between the Roma population and the control sample. The Roma differ in their energy intake. Both groups showed lower intake of sugars, below 50% total energy intake (TEI) and higher intake of fats, above 30% TEI. The respondents from both groups consume little fruits and vegetables, which may be connected with their low dietary fiber intake. In addition to the differences in the nutritional estimates, we recorded statistically significant differences in body mass index (BMI; p < 0.001), in age (p < 0.001), regular alimentation (p = 0) and demanding physical activities (p = 0). In spite of the fact our groups differed in age (the Roma are younger), it can be assumed that the obesity of the Roma may be caused by unbalanced alimentation and lack of physical activities. Full article

Despite numerous efforts to identify the molecular and cellular effectors of the adaptive immunity that induce a long-lasting immunity against dengue or Zika virus infection, the specific mechanisms underlying such protective immunity remain largely unknown. One of the major challenges lies in the high level of dengue virus (DENV) seroprevalence in areas where Zika virus (ZIKV) is circulating. In the context of such a pre-existing DENV immunity that can exacerbate ZIKV infection and disease, and given the lack of appropriate treatment for ZIKV infection, there is an urgent need to develop an efficient vaccine against DENV and ZIKV. Notably, whereas several ZIKV vaccine candidates are currently in clinical trials, all these vaccine candidates have been designed to induce neutralizing antibodies as the primary mechanism of immune protection. Given the difficulty to elicit simultaneously high levels of neutralizing antibodies against the different DENV serotypes, and the potential impact of pre-existing subneutralizing antibodies induced upon DENV infection or vaccination on ZIKV infection and disease, additional or alternative strategies to enhance vaccine efficacy, through T cell immunity, are now being considered. In this review, we summarize recent discoveries about cross-reactive B and T cell responses against DENV and ZIKV and propose guidelines for the development of safe and efficient T cell vaccines targeting both viruses. Full article

The most effective way of reducing the global burden of asbestos-related diseases is through the implementation of asbestos bans and minimising occupational and non-occupational exposure to respirable asbestos fibres. Australia’s asbestos consumption peaked in the 1970s with Australia widely thought to have had among the highest per-capita asbestos consumption level of any country. Australia’s discontinuation of all forms of asbestos and asbestos-containing products and materials did not occur at a single point of time. Crocidolite consumption ceased in the late 1960s, followed by amosite consumption stopping in the mid 1980s. Despite significant government reports being published in 1990 and 1999, it was not until the end of 2003 that a complete ban on all forms of asbestos (crocidolite, amosite, and chrysotile) was introduced in Australia. The sustained efforts of trade unions and non-governmental organisations were essential in forcing the Australian government to finally implement the 2003 asbestos ban. Trade unions and non-government organisations continue to play a key role today in monitoring the government’s response to Australian asbestos-related disease epidemic. There are significant challenges that remain in Australia, despite a complete asbestos ban being implemented almost fifteen years ago. The Australian epidemic of asbestos-related disease has only now reached its peak. A total of 16,679 people were newly diagnosed with malignant mesothelioma between 1982 and 2016, with 84% of cases occurring in men. There has been a stabilisation of the age-standardised malignant mesothelioma incidence rate in the last 10 years. In 2016, the incidence rate per 100,000 was 2.5 using the Australian standard population and 1.3 using the Segi world standard population. Despite Australia’s complete asbestos ban being in place since 2003, public health efforts must continue to focus on preventing the devastating effects of avoidable asbestos-related diseases, including occupational and non-occupational groups who are potentially at risk from exposure to respirable asbestos fibres. Full article

The obesity rate in China has risen significantly in the past few decades. While a number of causes for the rise in obesity have been explored, little attention has been paid to the role of health insurance per se. This study aims to investigate the impact of health insurance on the risk of obesity in rural China using longitudinal data from the China Health and Nutrition Survey (CHNS). We employed pooled ordinary least squares (OLS), probit estimation, and pooled two-stage least squares (2SLS) for an instrumental variable (IV). The IV model revealed that New rural cooperative medical insurance (NRCMS) participation had a significant positive impact on people’s tendency towards unhealthy lifestyles, for instances, high-fat food (8.01% for female and 7.35% for male), cigarette smoking (25% for male), heavy drinking (25% for female), sedentary activity (6.48 h/w for female and 6.48 h/w for male), waist circumference (1.97 cm for female and 1.80 cm for male), body mass index (0.58 kg/m² for female), which in turn leads to an elevated probability of general obesity (51% for female) and abdominal obesity (24% for female and 20% for male). An “ex ante moral hazard” is prevalent in rural China, which should not be ignored by policymakers so as to minimize the related low efficiency in the process of promoting the universal coverage of insurance. Full article

Hypertension has become the leading cause of death worldwide; data on hypertension among Nanchang adults are sparse. The aim of this study was to investigate the prevalence and gender-specific influencing factors of hypertension in adults in Nanchang, China. A cross-sectional survey was conducted with a representative sample of 2722 Chinese residents aged 18 years and above between May and September 2016, with a response rate of 92.4% (2516/2722). A stratified cluster sampling method was adopted in this study. Data on prevalence and influencing factors were obtained from a standard questionnaire and physical measurements. Univariate and multivariate logistic regressions were performed to analyze the influencing factors. The age-standardized prevalence was 19.8% (18.2–21.3) (male: 19.5% (18.0–21.1); female, 20.01% (18.5–21.6)). Factors positively associated with hypertension prevalence were past smoking, diabetes mellitus (DM), and overweight and obesity in both genders. Abdominal obesity and family history of cardiovascular diseases (CVD) were risk factors only in males; sleeping time and consumption of fresh vegetables and fruits were related to the prevalence of hypertension only in females. These findings will form the baseline information for the development of more effective approaches to enhance current prevention and control management of hypertension. Full article

This survey aimed to evaluate the applicability of the Nordic Occupational Skin Questionnaire (NOSQ) as a preliminary screening tool to investigate the presence of contact dermatological disorders in sea fishermen. The Italian version of the NOSQ was administered to 143 male fishermen working at an Apulia (Southern Italy) Fisheries, and 136 male workers who had never worked as sea fishers (controls). A significantly higher rate of frequency of transient itchy wheals on the hands, wrists, and forearms was recorded in the fishermen as compared to the controls (49.6% vs. 8.1%; p < 0.001), while there was no significant difference in the frequency of eczema (8.4% vs. 6.6%). In 46.1% of the fishermen, the onset of transient itchy wheals was associated with contact with specific agents and the most common causes were algae and aquatic plants (49.3%) and seabed sludge (25.3%). In conclusion, the administration of the NOSQ can be useful in preliminary screening for dermatitis in fishermen, although it could show a possible overestimation of the prevalence of transient itchy wheals. Full article

Background: Oral clefts (OCs) are common human birth defects. Children with OCs in underdeveloped regions are more likely to suffer from poverty and hardship in their future lives. Here, we attempted to estimate the prevalence of OCs among live births in Gansu Province in 2008 to understand the epidemiologic pattern of the disease. Methods: A cross-sectional study was conducted from January 2008 to December 2008 in Gansu Province. The live births delivered between January and December 2008 with OCs were investigated through face-to-face questionnaire survey. Results: A total of 468 infants with OCs were identified among 347,137 live births in 2008 in Gansu Province, which yielded a prevalence of 1.35 per 1000 live births. The majority of these cases were CL (cleft lip) (prevalence = 0.85 per 1000 live births), and the prevalence of CLP (cleft lip and palate) and CP (cleft palate) was 0.34 and 0.11 per 1000 live births, respectively. We also found that the prevalence of OCs in Jiayuguan (3.39 per 1000 live births) and Dingxi (2.71 per 1000 live births) was higher than those of other cities in Gansu Province. Additionally, we failed to detect significant correlation between economic conditions of the cities and the prevalence of OCs in our study. Conclusions: The prevalence of OCs among live births in Gansu Province in 2008 was higher than the prevalence of OCs in other provinces in China. The high prevalence may reflect the need for further etiological studies to explore the potential risk factors in this region. In addition, more subtype information needs to be collected in future prevalence studies for better understanding of the epidemiologic pattern of the disease. Full article

To update the current state of evidence and assess its quality, we conducted a systematic review on the effects of environmental noise exposure on the cardio-metabolic systems as input for the new WHO environmental noise guidelines for the European Region. We identified 600 references relating to studies on effects of noise from road, rail and air traffic, and wind turbines on the cardio-metabolic system, published between January 2000 and August 2015. Only 61 studies, investigating different end points, included information enabling estimation of exposure response relationships. These studies were used for meta-analyses, and assessments of the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). A majority of the studies concerned traffic noise and hypertension, but most were cross-sectional and suffering from a high risk of bias. The most comprehensive evidence was available for road traffic noise and Ischeamic Heart Diseases (IHD). Combining the results of 7 longitudinal studies revealed a Relative Risk (RR) of 1.08 (95% CI: 1.01–1.15) per 10 dB (L_DEN) for the association between road traffic noise and the incidence of IHD. We rated the quality of this evidence as high. Only a few studies reported on the association between transportation noise and stroke, diabetes, and/or obesity. The quality of evidence for these associations was rated from moderate to very low, depending on transportation noise source and outcome. For a comprehensive assessment of the impact of noise exposure on the cardiovascular and metabolic system, we need more and better quality evidence, primarily based on longitudinal studies. Full article

To establish a micro foundation to understand the impacts of greenhouse gas (GHG) emission regulations and financial development levels on firms’ GHG emissions, we build a two-stage dynamic game model to incorporate GHG emission regulations (in terms of an emission tax) and financial development (represented by the corresponding financing cost) into a two-echelon supply chain. With the subgame perfect equilibrium, we identify the conditions to determine whether an emission regulatory policy and/or financial development can affect GHG emissions in the supply chain. We also reveal the impacts of the strictness of GHG emission regulation, the financial development level, and the unit GHG emission rate on the operations of the supply chain and the corresponding profitability implications. Managerial insights are also discussed. Full article

Whereas the topic of the ‘cultural sensitivity’ of healthcare systems has been addressed extensively in the US and the UK, literature on the subject in most European countries, specifically looking at the situation of Roma, is still scarce. Drawing on qualitative research conducted mainly in the city of Barcelona under the communicative approach with Roma subjects who have stable socioeconomic positions and higher cultural capitals (end-users, professionals of the healthcare system, and key informants of a regional policy oriented to the improvement of Roma living conditions), the present study aims to fill this gap. We explore the barriers that the Roma face in accessing the healthcare system, reflecting on how these barriers are accentuated by the existing anti-Roma prejudices and institutional arrangements that do not account for minority cultures. Our results point out a series of obstacles at two levels, in the interaction with healthcare professionals, and in relation to existing institutional arrangements, which prevent Roma families from having equal access to the healthcare system. Education stands up as a mechanism to contest anti-Roma sentiments among healthcare professionals. Full article

The purpose of the study was to assess the quality of life (QoL) and satisfaction with life (SwL) of women with polycystic ovary syndrome (PCOS) in comparison with those of healthy controls, and to identify and analyze factors determining QoL and SwL in women with PCOS. The cross-sectional study was performed between January and November 2016 in 504 women using health care services in Poland. The study group comprised women with PCOS, the control group women without PCOS. The study used a diagnostic survey with questionnaires. Research instruments included the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, the satisfaction with life scale (SWLS), and a standardized interview questionnaire comprising questions on the participants’ characteristics. Women with PCOS have lower QoL and SwL than healthy controls (p < 0.05). Factors affecting QoL in PCOS patients included socio-economic standing, time from PCOS diagnosis, BMI, age, and professional activity (p < 0.05). Factors affecting SwL in PCOS patients included socio-economic standing, having children, BMI, and time from PCOS diagnosis (p < 0.05). The higher the PCOS patients’ QoL, the higher their SwL (p < 0.05). Further studies are required, focusing both on PCOS and its etiology, and on its impact on the women diagnosed with the disease. Full article

Green exercise can be classified into three levels based on engagement with nature. Although this classification was proposed more than a decade ago, few studies have investigated it since. The present study examined the effects of green exercise levels on engagement with nature and physical activity (PA) through a field experiment. A questionnaire was distributed to 95 students from a technology university in Central Taiwan to measure their level of engagement with nature in people-environment transactions, while their PA was measured using three instruments. In addition, because social interaction may distract individual attention from activities or their environments, the present study incorporated the presence of partners as a control variable. The results revealed that (1) engagement with nature and PA significantly differed between the levels of green exercise, and the higher the level of green exercise participated in, the greater the level of engagement with nature; and (2) although the presence of partners did not influence the level of engagement with nature, it significantly affected the level of PA. Full article

Despite its small size, a moss bag can reveal the different temporal and spatial deposition patterns of pollutants at a particular site; therefore, researchers can use moss bags to determine pollution sources and to put forward strategies for pollution control. Although the use of moss bags to monitor atmospheric pollution has been widely reported in Europe, there are few such empirical studies in China. Thus, in this study, bags containing the moss Sphagnum junghuhnianum were used to assess the concentrations of heavy metals (chromium (Cr), copper (Cu), lead (Pb), vanadium (V), and zinc (Zn)) at five sampling sites (four roads and a forest park) during the summer and winter of 2012. According to the relative accumulation factor (RAF) and contamination factor (CF) results, pollution in winter was heavier than that in summer, and Cr was found to be the most contaminating, having the highest mean CF. There was a significant positive correlation (p < 0.05) between traffic volume and concentration for three heavy metals (Cr, Cu, and V) in winter, whereas a significant positive correlation (p < 0.05) was observed between traffic volume and concentrations for four heavy metal elements (Cr, Pb, V, and Zn) in summer, indicating a close relationship between heavy metal contents and traffic volume. Although there was substantial variation in the concentrations of the five heavy metals in the moss bags, significant correlations between heavy metals suggested that the contaminants originated from a common source, namely vehicle emissions. The results demonstrated that the four roads were subject to different degrees of pollution depending on the volume of traffic using each road. Therefore, the results of this study suggest that traffic volume is a major reason for heavy metal pollution. Full article

The perspectives of at-risk adolescent clients can play an important role in informing treatment services. The current study examines qualitative interview data from 15 young women with histories of maltreatment. Using a semi-structured qualitative interview approach, we asked the women to think retrospectively about their treatment experiences as adolescent girls. Results highlight the need for providing adolescent girls with reliable and practical information about risky sexual behavior and drug use from relatable and trustworthy helping professionals. We discuss strategies for developing and maintaining trust and delivering specific content. Full article

Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense—i.e., body image, self-esteem, and gender equitable norms—and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10–14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7–28) and median 22 (IQR: 19, 24, possible range: 5–25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11–44). We noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended. Full article

The current study is the first study to emphasize family systems, violent norms, and violent peer association as three domains of the social environment that influence both adolescent violent offending and victimization among Chinese adolescents using a longitudinal sample. Under the framework of cultural spillover theory, the purpose of the current study was to explore how these three factors influenced adolescent violent offending and victimization. A total of 1192 middle and high school students were randomly selected from one of the largest cities in Southwest China. Structural equation model analysis was applied to investigate the direct and indirect effect of violence in the family system on violent offending and victimization. The results indicated that violent offending and victimization overlapped among Chinese adolescents. Violent peer association and acceptance of the violence norm fully mediated the effect of violence in the family system on violent offending, and partially mediated the effect of violence in the family system on violent victimization. In conclusion, adolescents who had experienced violence in their family system were more likely to be exposed to violent peer influences and to accept violent norms, which increased the likelihood of violence perpetration and victimization later in their life. Full article

Malawi has a high maternal mortality rate, of which unsafe abortion is a major cause. About 140,000 induced abortions are estimated every year, despite there being a restrictive abortion law in place. This leads to complications, such as incomplete abortions, which need to be treated to avoid further harm. Although manual vacuum aspiration (MVA) is a safe and cheap method of evacuating the uterus, the most commonly used method in Malawi is curettage. Medical treatment is used sparingly in the country, and the Ministry of Health has been trying to increase the use of MVA. The aim of this study was to investigate the treatment of incomplete abortions in three public hospitals in Southern Malawi during a three-year period. All medical files from the female/gynecological wards from 2013 to 2015 were reviewed. In total, information on obstetric history, demographics, and treatment were collected from 7270 women who had been treated for incomplete abortions. The overall use of MVA at the three hospitals during the study period was 11.4% (95% CI, 10.7–12.1). However, there was a major increase in MVA application at one District Hospital. Why there was only one successful hospital in this study is unclear, but may be due to more training and dedicated leadership at this particular hospital. Either way, the use of MVA in the treatment of incomplete abortions continues to be low in Malawi, despite recommendations from the World Health Organization (WHO) and the Malawi Ministry of Health. Full article

From 1985 to 2013, the mean birth weight of infants in Japan decreased from 3120 g to 3000 g, and the low-birth-weight rate among live births increased from 6.3% to 9.6%. No prospective study has elucidated the risk factors for poor fetal growth and preterm birth in recent Japanese parents, such as increased parental age, maternal body figure, assisted reproductive technology (ART), and socioeconomic status. Participants were mother–infant pairs (n = 18,059) enrolled in a prospective birth cohort in Hokkaido, Japan from 2002 to 2013. Parental characteristics were obtained via self-reported questionnaires during pregnancy. Medical records helped identify very-low-birth-weight (VLBW; <1500g), term-small-for-gestational-age (term-SGA), and preterm-birth (PTB; <37 weeks) infants. We calculated relative risks (RRs) for PTB, VLBW, and term-SGA birth based on parental characteristics. The prevalence of PTB, VLBW, and term-SGA was 4.5%, 0.4%, and 6.5%, respectively. Aged parents and ART were risk factors for PTB and VLBW. Maternal alcohol drinking during pregnancy increased the risk; a parental educational level of ≥16 years reduced risk of term-SGA. Maternal pre-pregnancy BMI of <18.5 kg/m² increased the risk of PTB and term-SGA. The RR for low BMI was highest among mothers who have low educational level. Among various factors, appropriate nutritional education to maintain normal BMI is important to prevent PTB and term-SGA in Japan. Full article

The purpose of this study was to examine the effectiveness of the Brain Breaks^® Physical Activity Solutions in changing attitudes toward physical activity of school children in a community in Poland. In 2015, a sample of 326 pupils aged 9–11 years old from 19 classes at three selected primary schools were randomly assigned to control and experimental groups within the study. During the classes, children in the experimental group performed physical activities two times per day in three to five minutes using Brain Breaks^® videos for four months, while the control group did not use the videos during the test period. Students’ attitudes toward physical activities were assessed before and after the intervention using the “Attitudes toward Physical Activity Scale”. Repeated measures of ANOVA were used to examine the change from pre- to post-intervention. Overall, a repeated measures ANOVA indicated time-by-group interaction effects in ‘Self-efficacy on learning with video exercises’, F(1.32) = 75.28, p = 0.00, η² = 0.19. Although the changes are minor, there were benefits of the intervention. It may be concluded that HOPSports Brain Breaks^® Physical Activity Program contributes to better self-efficacy on learning while using video exercise of primary school children. Full article

Reducing carbon emissions, including emission abatement outsourcing at the supply-chain level, is becoming a significant but challenging problem in practice. Confronting this challenge, we therefore break down the practice to focus on a low-carbon supply chain consisting of one supplier, one manufacturer and one third-party emission-reducing contractor. The contractor offers a carbon reduction service to the manufacturer. In view of the increasing proportion of Greenhouse Gases (GHG) emissions and absence of carbon reduction policies in developing countries, we adopt the prospect of consumers’ low-carbon preferences to capture the demand sensitivity on carbon emission. By exploiting the Mean-Variance (MV) model, we develop a supply chain game model considering risk aversion. Comparing the supply chain performances of the cases under risk neutrality and risk aversion, we investigate the impact of the risk aversion of the supplier and the manufacturer on the low-carbon supply chain performances, respectively. We show that the risk aversion of chain members will not influence the relationship underlain by the profit-sharing contract between the manufacturer and contractor, whereas they may extend the supplier’s concerning range. Although the manufacturer’s risk aversion has a positive impact on the wholesale price, interestingly, the supplier’s impact on the wholesale price is negative. Furthermore, we propose a contract to coordinate the risk-averse low-carbon supply chain by tuning the aversion levels of the supplier and the manufacturer, respectively. Through numerical study, we draw on managerial insights for industrial practitioners to adopt a low carbon strategy potentially by managing the risk attitudes along the supply chain channel. Full article

Parental co-participation in physical activity (PA) may be a beneficial parenting practice for diminishing children’s sedentary time (ST). Less information is available, however, on the explanatory role of co-participation in PA regarding parental educational differences in children's ST. Preschool-aged children (N = 864, mean age 4.8, 52% boys) with their parents participated in a cross-sectional DAGIS (Increased Health and Wellbeing in Pre-schools) study between years 2015 and 2016. Children (N = 821) wore an accelerometer for one week. Parents were informed of their educational background, and the frequency of visits with their child in nature, to parks or playgrounds, their own yard, and indoor sport facilities (N = 808). Testing the associations required multiple regression analyses. Parents with a low educational background reported more frequent visits with their child to their own yard, and these visits were associated with children’s lower ST. More highly educated parents co-visited indoor sport facilities more frequently, although this did not have a significant association with children’s ST. More frequent visits in nature were associated with a lower ST at weekdays, regardless of educational background. Future health promotion strategies should inform parents that frequent co-participation in PA, for example, in one’s own yard, is beneficial for lowering children’s ST. Full article

Heavy metals represent the fourth most often notified hazard category in the Rapid Alert System for Food and Feed (RASFF) from 1980–2016. The goal of the study was to examine the similarities in notifications of particular heavy metals within the RASFF year, product category, notifying country, country of origin, notification basis, notification type, distribution status, risk decision, and action taken, taking into account the particular product type, such as food, food contact material, and feed. The data originated from the RASFF database. Cluster analysis on pivot tables was applied using joining and two-way joining methods. Most notifications concerned food, in which the highest number were related to mercury, cadmium, chromium, lead, arsenic, and nickel. Notifications were mainly related to fish and food contact materials, in addition to fruits and vegetables, seafood, and dietetic food. The number of notifications decreased in 2015 and 2016. The majority of products were notified by Italy, Spain, Germany, and France. The notified products originated mainly from China and Spain. The notification was usually based on official controls on the market, as well as border controls. The notification types were mainly information, alert, and border rejections. Products were not frequently distributed due to distribution restriction to the notifying country or the possibility of distribution to the market. A risk decision was not usually made. The taken actions included re-dispatch of products, withdrawal from the market, or destruction. The data on heavy metals from the RASFF database can help European and national authorities in shaping public health. Full article

Bullying involves repeated exposure to negative actions while also invoking a power asymmetry between the involved parties. From a stress perspective, being bullied can be seen as a severe and chronic stressor, and an everyday social-evaluative threat, coupled with a shortage of effective social resources for dealing with this particular stressor. The aim of this study was to investigate whether exposure to bullying among mid-adolescent girls and boys is associated with subjective and objective stress-related outcomes in terms of perceived stress, recurrent pain, and salivary cortisol. The data came from the School Stress and Support Study (TriSSS) including students in grades 8–9 in two schools in Stockholm, Sweden, in 2010 (study sample n = 392; cortisol subsample n = 198). Bullying was self-reported and measured by multiple items. The statistical analyses included binary logistic and linear (OLS) regression. Being bullied was associated with greater perceived stress and an increased risk of recurrent pain, among both boys and girls. Also, bullied students had lower cortisol output (AUC_G) and lower cortisol awakening response (CAR_G) as compared to those who were not bullied. Gender-stratified analyses demonstrated that these associations were statistically significant for boys but not for girls. In conclusion, this study demonstrated that being bullied was related to both subjective and objective stress markers among mid-adolescent girls and boys, pointing to the necessity of continuously working against bullying. Full article