Int. J. Environ. Res. Public Health, Volume 16, Issue 19 (October-1 2019) – 282 articles

Dam-break flooding is a potential hazard for reservoirs that poses a considerable threat to human lives and property in downstream areas. Assessing the dam-break flood risk of the Zipingpu Reservoir in Chengdu, Sichuan Province, China, is critically important because this reservoir is located on the Longmen Shan fault, which experiences high seismic activity. In this paper, we develop an approach based on the protected object for dam-break flood risk management. First, we perform a numerical simulation of dam-break flooding in four possible dam break scenarios. Next, the flood areas are divided into 71 analysis units based on the administrative division. Based on the numerical simulation results and the socio-economic demographic data affected by a flood, the importance and risk level of each analysis unit is confirmed, and the flood risk map is established according to the classification results. Finally, multi-level flood risk management countermeasures are proposed according to the results of the unit classification shown in the map. Full article

In the global economy, tourism is one of the most noticeable and growing sectors. This
sector plays an important role in boosting a nation’s economy. An increase in tourism flow can
bring positive economic outcomes to the nations, especially in gross domestic product (GDP) and
employment opportunities. In South Asian countries, the tourism industry is an engine of
economic development and GDP growth. This study investigates the impact of tourism on
Pakistan’s economic growth and employment. The period under study was from 1990 to 2015. To
check whether the variables under study were stationary, augmented Dickey–Fuller and
Phillips–Perron unit root tests were applied. A regression technique and Johansen cointegration
approach were employed for the analysis of data. The key finding of this study shows that there is
a positive and significant impact of tourism on Pakistan’s economic growth as well as employment
sector and there is also a long‐run relationship among the variables under study. This study
suggests that legislators should focus on the policies with special emphasis on the promotion of
tourism due to its great potential throughout the country. Policy implications of this recent study
and future research suggestions are also mentioned. Full article

The evaluation of propulsive forces in water allows the selection of the most appropriate strategies to develop strength during water fitness sessions. The aim of this study was threefold: (i) to analyze the rate of force production; (ii) to analyze the rate of force variation; and (iii) to compare limbs’ symmetry in two water fitness exercises. Twenty-two young health subjects (age: 21.23 ± 1.51 years old, body mass: 67.04 ± 9.31 kg, and height: 166.36 ± 8.01 cm) performed incremental protocols of horizontal adduction (HA) and rocking horse (RH_add), from 105 until 150 b·min⁻¹. Data acquisition required an isokinetic dynamometer and a differential pressure system that allowed the assessment of (a) isometric peak force of dominant upper limb (IsometricF_D); (b) propulsive peak force of dominant upper limb (PropulsiveF_D); and (c) propulsive peak force of nondominant upper limb (PropulsiveF_ND). Significant differences were found in the rate of force production (RateF_D) between the majority cadences in both exercises. The RateF_D reached ~68% of the force in dry-land conditions, and lower cadences promoted a higher rate of force variation (ΔForce). Most actions were asymmetric, except for the HA at 135 b·min⁻¹. In conclusion, the musical cadence of 135 b·min⁻¹ seems to elicit a desired rate of force production with a symmetric motion in both exercises. Full article

The effect of the freeze-thaw process is an important factor in soil nutrient changes and erosion enhancement. Sediments in the middle reaches of the Yarlung Zangbo River are likely affected by the daily freeze-thaw cycles in winter. Examining the freeze-thaw effects of phosphorus from sediments in this area is of great significance for protecting the structure and safety of the ecosystem. The freeze-thaw process of sediments in the middle reaches of the Yarlung Zangbo River was simulated through laboratory experiments, and different phosphorus contents and particle states were synchronously detected and analyzed. The results show that freeze-thaw cycles can accelerate phosphorus migration and release in the sediments, and the total amount of phosphorus release increases by 12%. After being subjected to freeze-thaw cycles, the sediment particles were broken, and the competition between ions for adsorption sites reduced phosphorus adsorption onto the sediments from the middle reaches of the Yarlung Zangbo River. The organic matter on the sediment surface was also broken down, and the energy dispersive spectroscopy (EDS) results showed that the combined ions that were released competed for the adsorption sites on the particle surfaces, thereby promoting phosphorus release. Among the different forms of phosphorus, aluminum-bound phosphorus (Al-P) and iron-bound phosphorus (Fe-P) are the two most released phosphorus forms by the freeze-thaw process. Although the contents of Al-P and Fe-P only account for 2.41% of the total phosphorus content, both phosphorus forms are biologically available, and freeze-thaw cycles may increase the risk of nutrient loss. This research may provide information for the study of phosphorus in river ecosystems in areas subjected to freeze-thaw cycles. Full article

Increased stair climbing reduces cardiovascular disease risk. While signage interventions for workplace stair climbing offer a low-cost tool to improve population health, inconsistent effects of intervention occur. Pedestrian movement within the built environment has major effects on stair use, independent of any health initiative. This paper used pooled data from UK and Spanish workplaces to test the effects of signage interventions when pedestrian movement was controlled for in analyses. Automated counters measured stair and elevator usage at the ground floor throughout the working day. Signage interventions employed previously successful campaigns. In the UK, minute-by-minute stair/elevator choices measured effects of momentary pedestrian traffic at the choice-point (n = 426,605). In Spain, aggregated pedestrian traffic every 30 min measured effects for ‘busyness’ of the building (n = 293,300). Intervention effects on stair descent (3 of 4 analyses) were more frequent than effects on stair climbing, the behavior with proven health benefits (1 of 4 analyses). Any intervention effects were of small magnitude relative to the influence of pedestrian movement. Failure to control for pedestrian movement compromises any estimate for signage effectiveness. These pooled data provide limited evidence that signage interventions for stair climbing at work will enhance population health. Full article

Background: Urinary incontinence (UI) represents a complex problem which commonly affects women and influences their physical, mental, and social wellbeing. The objective of this study was to explore the experiences of a group of women with urinary incontinence. Methods: A qualitative exploratory study. Purposeful sampling was used. Recruited patients were females aged >18 years old with positive symptoms, signs of urinary incontinence, and attending a specialized urinary incontinence center for the first time. We collected data using interviews and participants’ personal letters. A thematic analysis was performed. Results: 18 women participated with a mean age of 47.32 years. Four themes emerged: (a) Experiencing uncontrolled urinary leakage, (b) Information based on beliefs and myths regarding UI, (c) Adapting to change and developing strategies, (d) The role of education. Women’s experiences were accompanied by feelings of stress and shame. A lack of information regarding UI was found, together with numerous misconceptions. Urinary incontinence triggers many changes in women. Some women may develop feelings of rejection towards their own body. Family involvement during these times is essential for education and promoting healthy sexual practices. Conclusions: This study highlights the importance of developing educational programs that focus on women’s information and education regarding triggering factors and coping strategies. Full article

The objectives of study were to determine heavy metals content (Zn, Cu, Mn, Fe and Hg) and fatty acids in selected organs of roach, Rutilus rutilus (L.); bream, Abramis brama (L.); pike, Esox lucius (L.); Eurasian perch, Perca fluviatilis (L.) collected from reservoirs of Warmia and Mazury region (northeastern Poland). Heavy metals were determined with atomic absorption spectrometry AAS. The fatty acids were analyzed using gas chromatography. In a few cases, differences in the content of heavy metals and fatty acids were not significant between species. The muscles of fish characterized significantly higher values of mercury than other organs (p ≤ 0.05), except for bream. The reverse regularity was observed in the case of content of Cu, Zn, Mn and Fe. Fatty acids having a desirable dietary effect in humans (DFA-Hypocholesterolaemic fatty acids) (74.00–74.84) were more than OFA (hypercholesterolaemic fatty acids), i.e., those undesirable (24.03–24.79). The lipid quality indexes AI (index of atherogenicity) (0.40–0.44) and TI (index of thrombogenicity) (0.18–0.24) in muscles of fish were low, which means that the meat of the fish may be recommended for human health. THQ (target hazard quotient) and HI (hazard index) as individual foodstuff were below 1, whereas HI for a specific receptor/pathway combination exceeded 1. This may suggest that eating meat from a given species is safe from a health point of view. Full article

Estrogen deficiency frequently leads to a fall in estrogen receptor-α (ERα) numbers and then reduces the skeletal response to mechanical strain. It, however, is still unclear whether phytoestrogen administration will enhance the effects of exercise on the estrogen-deficient bone loss. This study aimed to determine the effect of Icariin treatment on the response of osteogenic formation to exercise in ovariectomized (OVX) rats. Thirty-two 3-month old female Sprague–Dawley rats were randomly allocated into four groups: (1) Sham-operated (SO); (2) OVX; (3) OVX plus exercise (EX); and (4) OVX plus exercise and Icariin (EI). After 8-week interventions, the rats were killed and samples were collected for bone morphometry, reverse transcription-polymerase chain reaction (RT-PCR), and Western blot analyses. EI interventions showed a greater improvement for the OVX-induced bone loss and the elevated serum tartrate-resistant acid phosphatase (TRAP) and alkaline phosphatase (ALP) compared with EX only. Both EX and EI interventions bettered the OVX-related reduction of BV/TV and trabecular number and thickness, and decreased the enlargement of trabecular bone separation (Tb. Sp); the improvement for BV/TV and Tb. Sp was greater in EI group. Furthermore, EX and EI treatment significantly increased the number of ALP⁺ cells and mineralized nodule areas compared with OVX group; the change was higher in EI group. Additionally, in comparison to OVX rats, the protein and mRNA expression of β-catenin, phosphorylated-Akt (p-Akt) or Akt, ERα, and Runt-related transcription factor 2 (Runx2) in osteoblasts were elevated in EX and EI intervention rats, with greater change observed in EI group. The upregulated β-catenin and Akt mRNA levels in EX and EI groups was depressed by ICI182780 treatment, and the difference in β-catenin and Akt mRNA levels between EX and EI groups was no longer significant. Conclusively, the combination of Icariin and exercise significantly prevent OVX-induced bone loss and increase osteoblast differentiation and the ability of mineralization compared with exercise alone; the changes might be regulated partly by ERα/Akt/β-catenin pathway. Full article

The asset-based community development (ABCD) approach have been widely used to map local assets and to ensure participation of local communities in public health promotion strategies. Participatory practices, such as ABCD, have been applied to shift public health strategies towards addressing health inequities. In this meta-synthesis, we ask if, and how, ABCD enhance the level of participation for children, youth and schools. Three thousand eight hundred eight titles and abstracts were identified in ten databases and transferred to the online program Rayyan. Through a blinded process we excluded texts that did not meet the inclusion criteria. The twelve included texts on ABCD for children, youth and schools are of varying quality. The research on ABCD for children, youth and schools have not been cumulative. Nevertheless, the texts show that ABCD provides strategies that enhance the participation of children, youth, and schools, in health promotion projects. The projects were categorized according to Robert Hart’s classical participation ladder, and we found that the projects with the highest level of adherence to ABCD principles also had the highest level of participation. The projects with high levels of participation were supported by adult facilitators that created learning environments where children and youth developed their participatory skills. Full article

Quorum quenching-membrane bioreactors (QQ-MBRs) have been studied widely in recent decades. However, limited information is known about the influence of QQ on the microbial community. In this study, the indigenous QQ bacterium Bacillus cereus HG10 was immobilized and used to control biofouling in a bioreactor. QQ beads caused extracellular polymeric substance reduction and significantly hindered biofilm formation on a submerged membrane. Community profiling of 16S rRNA gene amplicons revealed that QQ beads dramatically altered the bacterial community structure in activated sludge but not in biofilm. Bacterial structure in the presence of QQ beads showed a clear divergence from that of the control groups at phylum, class, order, family, and genus taxonomic ranks. A significant enrichment of several bacterial genera, including Acinetobacter, Aeromonas, Delftia, Bacillus, and Pseudomonas, and depletion of over 12 bacterial genera were observed. These findings would contribute to a better understanding of why and how immobilized QQ bacteria impair membrane biofouling in QQ-MBRs. Full article

Senior co-housing communities offer an in-between solution for older people who do not want to live in an institutional setting but prefer the company of their age peers. Residents of co-housing communities live in their own apartments but undertake activities together and support one another. This paper adds to the literature by scrutinizing the benefits and drawbacks of senior co-housing, with special focus on the forms and limits of social support and the implications for the experience of loneliness. Qualitative fieldwork was conducted in eight co-housing communities in the Netherlands, consisting of document analysis, interviews, focus groups, and observations. The research shows that co-housing communities offer social contacts, social control, and instrumental and emotional support. Residents set boundaries regarding the frequency and intensity of support. The provided support partly relieves residents’ adult children from caregiving duties but does not substitute formal and informal care. Due to their access to contacts and support, few residents experience social loneliness. Co-housing communities can potentially also alleviate emotional loneliness, but currently, this happens to a limited degree. The paper concludes with practical recommendations for enhancing the benefits and reducing the drawbacks of senior co-housing. Full article

This study was conducted to explore the potential for 1,2-Dibromoethane (EDB) biodegradation by an acclimated microbial consortium under simulated dynamic groundwater conditions. The enriched EDB-degrading consortium consisted of anaerobic bacteria Desulfovibrio, facultative anaerobe Chromobacterium, and other potential EDB degraders. The results showed that the biodegradation efficiency of EDB was more than 61% at 15 °C, and the EDB biodegradation can be best described by the apparent pseudo-first-order kinetics. EDB biodegradation occurred at a relatively broad range of initial dissolved oxygen (DO) from 1.2 to 5.1 mg/L, indicating that the microbial consortium had a strong ability to adapt. The addition of 40 mg/L of rhamnolipid and 0.3 mM of sodium lactate increased the biodegradation. A two-phase biodegradation scheme was proposed for the EDB biodegradation in this study: an aerobic biodegradation to carbon dioxide and an anaerobic biodegradation via a two-electron transfer pathway of dihaloelimination. To our knowledge, this is the first study that reported EDB biodegradation by an acclimated consortium under both aerobic and anaerobic conditions, a dynamic DO condition often encountered during enhanced biodegradation of EDB in the field. Full article

The water quality target management of the control unit is a convenient and direct technology for water environment management and the development direction of water environment management in China, involving control unit division and water environment capacity calculation. Taking the Taihu Lake Basin in Jiangsu Province as an example, we propose herein the basic principle of the division of a regional control unit in a plain river network and the method of analyzing the rationality of the control unit division. On this basis, the Taihu Lake Basin in Jiangsu Province was divided into 70 control units. To calculate the water environmental capacity in the plain river network area, we established a water environmental capacity calculation framework based on multiple targets of lakes and rivers, and proposed the goal of water quality “double compliance” of the water environmental functional zone and the assessment section. For this study, we calculated the regional water environmental capacity using the mathematical model of the Taihu Lake Basin’s water environmental capacity, and the water environmental capacities of the 70 control units were allocated by the weight coefficient method, which established water area and functional division length. The research results described herein were applied to the pollution permit management of the Taihu Lake Basin in Jiangsu Province. It provides important technical support for the establishment of a pollution permit system based on the total capacity to improve environmental quality. Full article

Repurchasing intention of agricultural materials is a key to a sustainable food business system. The novel contribution of this study is that we go beyond technical aspect and look into human capital dynamics in a general context, by examining how different dimensions of ‘guanxi’ (i.e., personal relations and instrumentality) between farmers and agricultural retailers affect trust between the two and, in turn, repeated purchase intention of agricultural materials by farmers in China. To further generate implications for food system as a whole, we also examined how dynamic environment moderates the effects mentioned above. Adopting survey method and multivariate analyses, this study tests the hypotheses with a collected data set of 578 farmers from representative rural areas of China. The results show that guanxi between farmers and agricultural retailers has a positive effect on trust between them and on repeated purchase intentions of farmers. While instrumentality has a negative effect on trust between them and on repeated purchase intentions of farmers. The trust between farmers and agricultural retailers promotes farmers’ repeated purchase intentions. The intensity of competition negatively moderates the positive relation between trust and repeated purchases. Demand uncertainty does not moderate the positive effect of trust on repeated purchases. The results and discussion shed light on agricultural food system sustainability from a dynamic environment embedded business relationship perspective. Full article

With rapid economic development in China, cardiorespiratory fitness (CRF) of children and adolescents is on a decline. However, this appears to have slowed down, reaching stagnation in certain areas. However, it is unclear if the change in CRF is related to economic growth and development or not. This study describes trends in CRF of Chinese children and adolescents, and empirically tests the relationships between China’s macro-economic developments and cardiorespiratory fitness of children and adolescents over the past 30 years using provincial panel data collected from one million samples. We used per capita disposable income as the economic indicator. CRF was assessed by using running tests: 50 m × 8 for boys and girls (7–12 years), 1000 m for boys (13–22 years), and 800 m for girls (13–22 years). The results show that economic growth has a U-shaped relationship with CRF of children and adolescents (both boys and girls). It appears that as incomes increased, CRF of urban male and female students in China gradually decreased to its lowest point, after which it showed an upward trend. From a horizontal perspective, it can be inferred that for low-developed provinces, increases in incomes cause a decrease in CRF levels. In contrast, for highly developed provinces, as incomes increase, CRF levels increase. This study provides the first empirical evidence of the relationship between macro-economy and CRF of youth, based on provincial panel data. The results presented here can be used to formulate health policies targeting the cardiorespiratory fitness of children and adolescents from middle-income provinces in China. This study also provides a reference for developing countries. Full article

Many older adults who live at home depend on a caregiver. When familial support cannot provide the necessary care, paid caregivers are frequently hired. Health literacy (HL) is the knowledge and competence required of people to meet the complex demands of health in modern society. The aim of this study is to assess the HL level of paid non-familial caregivers who were enrolled through two different sources: from the homes of assisted people in two Tuscan health districts (first sample) and during job interviews in a home care agency operating in Florence (second sample). The two different recruitment contexts allow us to provide a broader view of the phenomenon, presenting a picture of the HL level of those who are already working and those who are looking for a new job in this field. One-on-one face-to-face interviews, which include the administration of the Newest Vital Sign (NVS) to measure HL, were conducted. Recruitment resulted in 84 caregivers in the first sample and 68 in the second sample. In the first sample, the mean age was 51.2 ± 9 years; 94% of the participants were women. A high likelihood or likelihood of inadequate HL (i.e., a low level of HL) was found in 73.8% of cases. In the second sample, the mean age was 43.7 ± 11.5 years; 83.8% of the participants were women, and 80.9% had a low level of HL. In both samples, HL was statistically associated with the level of understanding of the Italian language. In conclusion, inadequate HL is an under-recognized problem among non-familial caregivers. Educational programs that aim to increase HL skills could be an effective approach to improving the qualification of informal healthcare professionals. Full article

Bisphenol A (BPA) is a major constituent of plastic products, including epoxy resin containers, mobile phones, dental sealants, as well as electronic and medical equipment. BPA is recognized as an endocrine system-disrupting chemical which has toxic effects on the brain and reproductive system. However, little is known about the effects of co-exposure of BPA with allergens on the memory function and neurological as well as immunological biomarker levels. In this study, we examined the effects of intratracheal instillation of BPA on the memory function and neuroimmune biomarker levels using a mouse model of allergic asthma. Male C3H/HeJ Jcl mice were given three doses of BPA (0.0625 pmol, 1.25 pmol, and 25 pmol BPA/animal) intratracheally once a week, and ovalbumin (OVA) intratracheally every other week from 5 to 11 weeks old. At 11 weeks of age, a novel object recognition test was conducted after the final administration of OVA, and the hippocampi and hypothalami of the animals were collected after 24 h. The expression levels of the memory function-related genes N-methyl-D-aspartate (NMDA) receptor subunits, inflammatory cytokines, microglia markers, estrogen receptor-alpha, and oxytocin receptor were examined by real-time RT-PCR (real-time reverse transcription polymerase chain reaction) and immunohistochemical methods. Impairment of the novel object recognition ability was observed in the high-dose BPA-exposed mice with allergic asthma. In addition, the allergic asthmatic mice also showed downregulation of neurological biomarkers, such as NMDA receptor subunit NR2B in the hippocampus but no significant effect on immunological biomarkers in the hypothalamus. These findings suggest that exposure to high-dose BPA triggered impairment of memory function in the allergic asthmatic mice. This is the first study to show that, in the presence of allergens, exposure to high-dose BPA may affect memory by modulating the memory function-related genes in the hippocampus. Full article

The fast population ageing has generated and will continue to generate large social, economic and health challenges in the 21th century in Australia, and many other developed and developing countries. Population ageing is projected to lead to workforce shortages, welfare dependency, fiscal unsustainability, and a higher burden of chronic diseases on health care system. Promoting health and sustainable work capacity among mature age and older workers hence becomes the most important and critical way to address all these challenges. This paper used the pooled data from the longitudinal Household, Incomes and Labour Dynamics in Australia (HILDA) survey 2002–2011 data to investigate common and different factors predicting voluntary or involuntary workforce transitions among workers aged 45 to 64. Long term health conditions and preference to work less hours increased while having a working partner and proportion of paid years decreased both voluntary and involuntary work force transitions. Besides these four common factors, the voluntary and involuntary workforce transitions had very different underlying mechanisms. Our findings suggest that government policies aimed at promoting workforce participation at later life should be directed specifically to life-long health promotion and continuous employment as well as different factors driving voluntary and involuntary workforce transitions, such as life-long training, healthy lifestyles, work flexibility, ageing friendly workplace, and job security. Full article

A new variant of the bla_OXA-546 gene, namely bla_OXA-894, was identified on the chromosome of Shewanella xiamenensis isolated from pig wastewater in rural China. OXA-894 differs from OXA-546 (A46V, I219del) and OXA-48 (T167I, I219del) with two amino acid substitutions, respectively. The isolate was resistant to ampicillin, aztreonam, imipenem, meropenem and fosfomycin. Carba NP test confirmed S. xiamenensis strain sx20 as a carbapenemase-producer. The bla_OXA-894 gene was located between the gene encoding a LysR family transcriptional regulator and the C15 gene. Its gene environment was similar to other S. xiamenensis with chromosome-located bla_OXA-48-like genes. The T24H and T94V amino acid substitutions of LuxS protein were predicted to be deleterious, which may affect the virulence phenotype. The occurrence and potential health risk of carbapenem-resistant S. xiamenensis in a water environment is of concern. Full article

The aim of this study was to investigate the associations between ambient air pollutants and cognitive impairment in Korean older adults. The cognitive function of 2,896 participants aged 70 to 84 years was measured using the Korean version of the mini-mental state examination, the digit span test, the word list learning test, and the frontal assessment battery. After matching the average concentrations of particulate matter (PM) <10 μm in size (PM₁₀) and <2.5 μm (PM_2.5), NO₂, CO, SO₂, and O₃ between 2013 and 2017, the association between air pollutants and cognitive scales was analyzed using a linear mixed regression and a multiple logistic regression analysis (after adjusting for age, sex, health related behaviors, socioeconomic status, comorbidity, and meteorological data). Exposure to PM_2.5, PM₁₀, NO₂, SO₂, and CO was associated with cognitive impairment above and beyond age or education level effects. Specifically, PM_2.5 was negatively associated with most components of the cognitive scales (interquartile range for PM_2.5: 2.0 μg/m³, odds ratio for poor global cognition: 2.28, 95% confidence interval: 1.60–3.26). These associations may be affected by sex, residence area, or alcohol intake. Conclusively, air pollutants, especially PM_2.5, were associated with cognitive impairment, including global cognition, attention, memory, and executive function in Korean older adults aged ≥70 years. Full article

Organized running events have gained substantial popularity. This study aimed to elucidate the prevalence of musculoskeletal pain, knowledge about injury prevention as well as the attitudes and motivations of individuals participating in the JP Morgan Corporate Challenge in Frankfurt (Germany). A total of 720 recreational runners completed a digital questionnaire immediately prior to the start. The majority of them displayed low to moderate physical activity levels and were rather unambitious regarding targeted finishing time. One quarter (25.3%) participated for the first time in an organized race. The most stated reasons to register were team building (76.4%) and experiencing the run’s atmosphere (50.6%). In contrast, improving health played a minor role (19.4%). More than one in five individuals (n = 159 runners) reported pain, with the most common locations being the knee and lower back. Both at rest (3.2/10 on a numerical rating scale) and during activity (4.7/10), average pain intensity was clinically relevant. Almost three thirds of the participants believed that stretching and wearing appropriate shoes would be effective for injury prevention while other methods such as resistance training, balance exercise or wearing of orthoses were rarely named. Musculoskeletal pain is a significant burden in runners participating in an urban mass event. In view of the poor knowledge about injury prevention, organizers and coaches may consider offering structured preparation programs as well as tailored running-related health education. Full article

Extremely low frequency (ELF) magnetic field (MF) exposure in electric vehicles (EVs) has raised public concern for human health. There have been many studies evaluating magnetic field values in these vehicles. However, there has been no report on the temporal variation of the magnetic field in the cabin. This is the first study on the long-term monitoring of actual MFs in EVs. In the study, we measured the magnetic flux density (B) in three shared vehicles over a period of two years. The measurements were performed at the front and rear seats during acceleration and constant-speed driving modes. We found that the B amplitudes and the spectral components could be modified by replacing the components and the hubs, while regular checks or maintenance did not influence the B values in the vehicle. This observation highlights the necessity of regularly monitoring ELF MF in EVs, especially after major repairs or accidents, to protect car users from potentially excessive ELF MF exposure. These results should be considered in updates of the measurement standards. The ELF MF effect should also be taken into consideration in relevant epidemiological studies. Full article

Benign prostatic hyperplasia (BPH) is one of the major public health concerns, which has a high prevalence rate and causes significant decline in men’s quality of life. BPH is highly related to sexual hormone metabolism and aging. In particular, dihydrotestosterone (DHT), to which testosterone is modified by 5α-reductase (5AR), has a significant effect on BPH development. DHT binds to an androgen receptor (AR) and steroid receptor coactivator 1 (SRC-1); then, it induces the proliferation of a prostate cell and expression of prostate specific antigen (PSA). Paecilomyces tenuipes (P. tenuipes) is a mushroom that has been popularized by the artificial cultivation of fruiting bodies based on silkworms by researchers from the Republic of Korea. In a previous study, we identified the effect of PE on PSA mRNA expression in LNCaP cells. This suggests that PE may have an inhibitory effect on androgen signaling. Therefore, we confirmed the expression of androgen signaling-related factors, such as AR, SRC-1, and PSA in LNCaP. Furthermore, we confirmed the androgen signaling inhibitory effect of PE using the testosterone propionate (TP)-induced BPH rat model. A BPH rat model was established with a four-week treatment of daily subcutaneous injections of testosterone propionate (TP, 3 mg/kg) dissolved in corn oil after castration. The rats in the treatment group were orally gavaged P. tenuipes extract (PE), finasteride (Fi), or saw palmetto extract (Saw) with TP injection. DHT induced an increase in the expression levels of AR, SRC-1, and PSA proteins in LNCaP cells. On the contrary, the PE treatment reduced the expression levels. In vivo, the BPH group showed an increase in prostate size compared with the control group. The PE gavaged group showed a decrease in prostate size compared with the BPH group. In addition, the protein expressions of AR, 5AR2, and PSA were significantly lower in the PE gavaged group than BPH group in prostate tissue. These results suggest the beneficial effects of PE on BPH via the modulation of AR signaling pathway. Full article

Background: Poor oral health is a common condition in patients suffering from dementia. Several aspects of this systemic pathology contribute to causing oral problems: cognitive impairment, behavior disorders, communication and, motor skills deterioration, low levels of cooperation and medical-nursing staff incompetency in the dental field. Objectives: The objectives of this study were to evaluate the prevalence and the characteristics of oral pathology in a demented elderly population, as well as to check the association between the different degree of dementia and the oral health condition of each patient. Materials and Methods: In this observational study (with cross-sectional design) two groups of elderly patients suffering from dementia, living in two different residential care institutions were recruited. The diagnosis of dementia of each included patient was performed using the Clinical Dementia Rating Scale. In order to evaluate the oral health condition of the included subjects, each patient underwent a physical examination of the oral cavity, during which different clinical parameters were analyzed (number of remaining teeth, oral mucosa, periodontal tissues, bone crests). To each parameter, a score was assigned. Spearman’s Rho test was used. Results: Regarding the prevalence of oral pathology in elderly suffering from dementia, it emerged that 20.58% of the included patients had mucosal lesions and/or new mucosal formations (in most cases undiagnosed and therefore untreated). The prevalence of periodontal disease was equal to 82.35% and a marked clinically detectable reabsorption of bone crests was found in almost all patients (88.23%). 24.13% of patients, who underwent the oral examination, had totally edentulous maxillae and/or with retained roots, without prosthetic rehabilitations. The correlation index r showed the presence of a linear correlation (inverse relationship) between the degree of dementia and the state of health of the oral cavity of each patient. Conclusions: Several factors contribute to poor oral health in the elderly suffering from dementia: cognitive functions deterioration, behavioral disorders and inadequate medical-staff nursing training on oral hygiene. This study also demonstrated that the lower the dementia degree is, the lower tends to be the oral health status. In order to guarantee a complete assistance to these patients, residential care institutions should include in their healthcare program specific dental protocols. Full article

Caring for a person diagnosed with Alzheimer’s disease has a negative impact on family caregivers’ psychological health. This study examined the factors related to ‘perceived health’ and ‘presence of new-onset mental health problems’ in family caregivers of people diagnosed with mild and moderate Alzheimer’s disease. A cross-sectional observational study carried out in Almeria’s Healthcare District (Spain). A total of 255 family caregivers (42.4% cared for people with mild Alzheimer’s disease and 57.6% cared for people with moderate Alzheimer’s disease) participated in the study from January to December 2015. Mainly, caregivers were women (81.5% in the mild Alzheimer’s disease group and 88.4% in the moderate Alzheimer’s disease group), and their average age was 56.54 years (standard deviation (SD) = 13.13) and 54.47 years (SD = 11.71), respectively. Around 47% of the caregivers had been caring for the person with Alzheimer’s between two and five years. The Goldberg General Health Questionnaire was used to measure perceived health and the presence of new-onset mental health problems. An exploratory descriptive analysis and a multivariate logistic regression analysis were conducted. For caregivers of people with mild Alzheimer’s disease, ‘perceived health’ was related to ‘perceived social support’ (r = −0.21; p = 0.028), ‘person’s level of dependency’ (r = −0.24, p = 0.05), ‘severity of the person’s neuropsychiatric symptoms’ (r = 0.22; p = 0.05), and ‘caregiver’s emotional distress in response to the person’s neuropsychiatric symptoms’ (r = 0.22; p = 0.05). For caregivers of people with moderate Alzheimer’s disease, ‘perceived health’ was related to ‘perceived social support’ (r = −0.31; p ˂ 0.01), ‘presence of neuropsychiatric symptoms’ (r = 0.27, p = 0.01), ‘severity of the person’s neuropsychiatric symptoms’ (r = 0.32, p = 0.01) and ‘caregiver’s emotional distress in response to the person’s neuropsychiatric symptoms’ (r = 0.029; p = 0.01). The presence of new-onset mental health problems was detected in 46.3% (n = 50) of caregivers of people with mild Alzheimer’s and 61.9% (n = 91) of caregivers of people with moderate Alzheimer’s. When people are diagnosed with mild Alzheimer’s disease, intervention programs for caregivers should aim to regulate emotions and promote positive coping strategies. When people are diagnosed with moderate Alzheimer’s disease, intervention programs for caregivers must allow them to adapt to caregiving demands that arise with the progression of Alzheimer’s disease. Full article

In order to determine the role of surface water in the development and spread of antibiotic-resistant (AR) bacteria, water samples were collected quarterly from 2015 to 2016 from a mixed-use watershed in Georgia. In our previous study, 496 Escherichia coli were isolated from surface water, out of which, 34 isolates were resistant to antimicrobials. For the current study, these 34 AR E. coli were characterized using pulsed-field gel electrophoresis, AR gene detection, plasmid replicon typing, class I integron detection, and multi-locus sequence typing. Genes were identified as conferring resistance to azithromycin (mph(A)); β-lactams (bla_CMY, bla_CTX, bla_TEM); chloramphenicol (floR); streptomycin (strA, strB); sulfisoxazole (sul1, sul2); tetracycline (tetA, tetB, tetC); and trimethoprim/sulfamethoxazole (dhfr5, dhfr12). Five ciprofloxacin- and/or nalidixic-resistant isolates contained point mutations in gyrA and/or parC. Most of the isolates (n = 28) carried plasmids and three were positive for class I integrons. Twenty-nine sequence types (ST) were detected, including three epidemic urinary-tract-infection-associated ST131 isolates. One of the ST131 E. coli isolates exhibited an extended-spectrum β-lactamase (ESBL) phenotype and carried bla_CTX-M-15 and bla_TEM-1. To our knowledge, this is the first study on the emergence of an ESBL-producing E. coli ST131 from environmental water in the USA, which poses a potential risk to human health through the recreational, agricultural, or municipal use of this natural resource. This study identified E. coli with AR mechanisms to commonly used antimicrobials and carrying mobile genetic elements, which could transfer AR genes to other bacteria in the aquatic environment. Full article

Background: Air pollution exposure is associated with greater risk for cardiovascular events. This study aims to examine the effects of increased exposure to short-term air pollutants on ST-segment elevation myocardial infarction (STEMI) and determine the susceptible groups. Methods: Data on particulate matter PM2.5 and PM10 and other air pollutants, measured at each of the 11 air-quality monitoring stations in Kaohsiung City, were collected between 2011 and 2016. The medical records of non-trauma adult (>17 years) patients who had visited the emergency department (ED) with a typical electrocardiogram change of STEMI were extracted. A time-stratified and case-crossover study design was used to examine the relationship between air pollutants and daily ED visits for STEMI. Results: An interquartile range increment in PM2.5 on lag 0 was associated with an increment of 25.5% (95% confidence interval, 2.6%–53.4%) in the risk of STEMI ED visits. Men and persons with ≥3 risk factors (male sex, age, hypertension, diabetes, current smoker, dyslipidemia, history of myocardial infarction, and high body mass index) for myocardial infarction (MI) were more sensitive to the hazardous effects of PM2.5 (interaction: p = 0.039 and p = 0.018, respectively). The associations between PM10, NO2, and O3 and STEMI did not achieve statistical significance. Conclusion: PM2.5 may play an important role in STEMI events on the day of exposure in Kaohsiung. Men and persons with ≥3 risk factors of MI are more susceptible to the adverse effects of PM2.5 on STEMI. Full article

(1) Background: In recent decades, the prevalence of obesity has grown rapidly worldwide, thus causing many diseases, including male hypogonadism. Sulforaphane (SFN), an isothiocyanate compound, has been reported to protect the reproductive system. This research investigated the protective effect of SFN against obesity-induced impairment in the male reproductive system and explored the potential mechanism involved in mice. (2) Methods: One hundred thirty mice were divided into 5 groups (Control, DIO (diet-induced obesity), DIO + SFN 5 mg/kg, DIO + SFN 10 mg/kg, and DIO + SFN 20 mg/kg). The effects of SFN on the male reproductive system were determined based on the sperm count and motility, relative testes and epididymis weights, hormone levels, and pathological analyses. Oxidative stress was determined by measuring malondialdehyde (MDA), total antioxidant capacity (T-AOC), superoxide dismutase (SOD), glutathione (GSH), H₂O₂, catalase (CAT), and glutathione peroxidase (GSH-PX) levels. Protein expression of nuclear factor erythroid-2 related factor 2 (Nrf2), Kelch-like ECH-associated protein-1 (Keap1), Microtubule-associated protein light chain 3 (LC3), Beclin1, and P62 were determined by western blotting. (3) Results: High-fat diet (HFD)-induced obesity significantly decreased relative testes and epididymis weights, sperm count and motility, and testosterone levels but increased leptin and estradiol levels. SFN supplementation ameliorated these effects. Additionally, SFN administration inhibited the obesity-induced MDA accumulation and increased the SOD level. Western blot indicated that SFN had an important role in the downregulation of Keap1. Moreover, SFN treatment attenuated obesity-induced autophagy, as detected by LC3 and Beclin1. (4) Conclusions: SFN ameliorated the reproductive toxicity associated with obesity by inhibiting oxidative stress mediated by the nuclear factor erythroid-2 related factor 2/ antioxidant response element (Nrf2/ARE) signaling pathway and recovery of normal autophagy. Full article

Objective: Numerous studies have proved the importance of Evidence-Based Medicine (EBM) in daily clinical practice, however, clinicians’ attitudes play an important role in determining its implementation. The objective of this study was to investigate Chinese clinical physicians’ perception of and attitude towards EBM and their Evidence-Based Practice (EBP) as well as the barriers towards EBP. Methods: Using a cross-sectional design, self-response questionnaires were distributed to clinical physicians (internal medicine and surgery departments) across three tertiary hospitals in Wuhan, China. Results: In total, 131 out of 195 (67.2%) physicians completed and returned the questionnaire. A total of 64.9% of the physicians either knew moderately or a lot about EBM. The mean score of physicians’ attitude toward EBM was 2.35 ± 0.35, and that of their EBP skill/ competency was 1.51 ± 0.56 (on 0–3 Likert scale). In total, 76.0% of physicians often or sometimes applied EBM in routine daily practice. The largest barrier preventing implementation was the varying individual differences in diseases (61.0%), followed by a lack of investment from the hospital/department (39.8%), and a lack of patient cooperation (37.4%). Chinese physicians in tertiary hospitals possessed expressed positive attitudes towards EBM; however, they only retained a moderate level of clinical evidence competency. Both an individual factor (personal interest) and organizational factors (workload, hospital requirement) had an effect on physicians’ attitudes and their EBP skills. Management and organizational efforts, in addition to time dedicated for EBP projects could help reduce barriers that prevent EBP. Full article

As a primary pioneering region in China’s ongoing urbanization process, the Yangtze River Economic Belt’s (YREB’s) urbanization process is itself continually accelerating, causing increasing pressure on the area’s water ecosystem. It is necessary to examine the coordination relationship between the urbanization system and the water ecosystem in the YREB for realizing sustainable urban development. To this purpose, we use two comprehensive index systems, along with an improved coupling coordination degree (CCD) model. This method is used to analyze the coordination between urbanization and the water ecosystem across spatial gradients and temporal scales in the YREB, from 2008 to 2017. The factors acting as obstacles were diagnosed by utilizing the obstacle degree model. The results show that: (1) the coordination state of each region gradually improved during the 2008–2017 period. In terms of spatial distribution, the coordination state between two systems gradually increased from east to west. Moreover, the spatial differences across the 11 analyzed regions gradually narrowed with the passage of time. (2) The coordination between the two systems, from 2008 to 2017, evolved from a state of serious imbalance to a state of good coordination. The two systems passed from an initial period of imbalance or antagonism, coupled with rapid growth (2008–2011), through a period of basic coordination with steady growth (2011–2014), and finally toward a period of good coordination with slow growth (2014–2017). (3) Spatial urbanization and pressures on subsystems are the key factors acting as obstacles in the urbanization system and water ecosystem, respectively. Facing the process of rapid urbanization in China, the coupling analysis of the coordination between urbanization and the water ecosystem can help the government to formulate a reasonable new-type urban development strategy. This strategy will play an important role in China’s sustainable urban development and water environmental protection. The findings of this study provide important support for urban planning in the future. Full article