Int. J. Environ. Res. Public Health, Volume 17, Issue 5 (March-1 2020) – 350 articles

Located in the subtropics, Taiwan is one of the major epidemic areas for dengue fever, with severe epidemics occurring in recent years. Dengue fever has become a serious health threat to Taiwan’s residents and a potentially serious economic cost to society. This study recruited 730 random participants and adopted the contingent valuation method to understand the factors influencing the populace’s willingness to pay (WTP) to reduce the health risk of dengue fever. The results show that high-income women with children and people with higher preventive perceptions and behavior are more willing to invest in preventive measures against dengue fever. In the evaluation of WTP for preventive treatment for health risks, each person was willing to pay on average NT$751 annually to lower psychological health risks, NT$793 annually to lower the risk of illness, and NT$1086 annually to lower the risk of death. Full article

Early universal access to antiretroviral treatment (ART) is critical in the control of the HIV epidemic. However, prompt initiation of ART remains problematic in China. This study analyzed the late testing and lag time between HIV diagnosis and initiation of ART from 2004 to 2016 and identified the risk factors for delayed initiation of ART. Data from 16,957 people living with HIV were abstracted from a hospital electronic health record database and a case report database for AIDS prevention and control in Yunnan province. Reasons for delayed initiation of ART were categorized into late testing, defined as CD4 count of < 350 cells/μL at baseline HIV diagnosis, and delayed access, defined as a lag time of > 1 month between the diagnosis and initiation of ART. Binary logistic regression models were used to identify risk factors for late testing and delayed access. The CD4 counts at diagnosis increased from 201 ± 147 cells/μL (mean ± SD) in 2004 to 324 ± 238 cells/μL in 2016 (p = 0.024). The CD4 count was higher for persons < 45 years, unmarried, and men who have sex with men (MSM) (356, 357, and 409 cells/μL, respectively) compared to their peers in 2016 (p < 0.05). The lag time from diagnosis to initiation of ART was significantly reduced from 59.2 months in 2004 to 0.9 months in 2016 (p < 0.05). The shorter lag time over the years was consistent when analysis was stratified by sex, age, marital status, and transmission routes, even though the lag time for people using drugs was longest in 2016 (> 2 months versus 0.82 and 0.72 month of heterosexuals and MSM, respectively). Compared to their peers, married persons (AOR = 0.63, 95%CI: 0.57, 0.69) were less likely to have delayed access to ART, and drugs-using patients (AOR = 3.58, 95%CI: 2.95,4.33) were more likely to have delayed access to ART. Late testing rather than delayed access to ART after a diagnosis remains problematic in China, although improvements have been seen for both parameters from 2004 to 2016. Our data highlight the importance of continued efforts to promote early diagnosis of HIV to prevent transmission, morbidity, and early mortality in HIV infection. Full article

Few rural sanitation programs have documented large increases in sanitation coverage or have assessed if interventions equitably increase sanitation coverage for vulnerable groups. We characterize the impact of the Sustainable Sanitation and Hygiene for All (SSH4A) approach on key program WASH (water, sanitation, and hygiene) indicators, and also assess if these increases in WASH coverage are equitably reaching vulnerable groups. The SSH4A approach was administered in 12 program areas in 11 countries, including Bhutan, Ethiopia, Ghana, Indonesia, Kenya, Mozambique, Nepal, South Sudan, Tanzania, Uganda, and Zambia. Repeated cross-sectional household surveys were administered over four rounds at annual follow-up rounds from 2014 to 2018. Surveys were conducted in an average of 21,411 households at each round of data collection. Overall, sanitation coverage increased by 53 percentage points between baseline and the final round of data collection (95% CI: 52%, 54%). We estimate that 4.8 million people gained access to basic sanitation in these areas during the project period. Most countries also demonstrated movement up the sanitation ladder, in addition to increases in handwashing stations and safe disposal of child feces. When assessing equity—if sanitation coverage levels were similar comparing vulnerable and non-vulnerable groups—we observed that increases in coverage over time were generally comparable between vulnerable groups and non-vulnerable groups. However, the increase in sanitation coverage was slightly higher for higher wealth households compared to lower wealth households. Results from this study revealed a successful model of rural sanitation service delivery. However, further work should be done to explore the specific mechanisms that led to success of the intervention. Full article

The advancement of ICT and affordability of medical sensors enable healthcare data to be obtained remotely. Remote healthcare data is erroneous in nature. Detection of errors for remote healthcare data has not been significantly studied. This research aims to design and develop a software system to detect and reduce such healthcare data errors. Enormous research efforts produced error detection algorithms, however, the detection is done at the server side after a substantial amount of data is archived. Errors can be efficiently reduced if the suspicious data can be detected at the source. We took the approach to predict acceptable range of anthropometric data of each patient. We analyzed 40,391 records to monitor the growth patterns. We plotted the anthropometric items e.g., Height, Weight, BMI, Waist and Hip size for males and females. The plots show some patterns based on different age groups. This paper reports one parameter, height of males. We found three groups that can be classified with similar growth patterns: Age group 20–49, no significant change; Age group 50–64, slightly decremented pattern; and Age group 65–100, a drastic height loss. The acceptable range can change over time. The system estimates the updated trend from new health records. Full article

High-intensity interval training (HIIT) has similar or better effects than moderate-intensity continuous training (MICT) in increasing peak oxygen consumption (VO_2max), however, it has not been studied when HIIT is applied in a circuit (HIICT). The aim of this study was to compare the effects of a HIICT versus MICT on VO_2max estimated (VO_2max-ES), heart rate (HR) and blood pressure (BP) of middle-aged and older women. A quasi-experimental randomized controlled trial was used. Fifty-four women (67.8 ± 6.2 years) were randomized to either HIICT (n = 18), MICT (n = 18) or non-exercise control group (CG; n = 18) for 18 weeks. Participants in HIICT and MICT trained two days/week (one hour/session). Forty-one participants were assessed (HIICT; n = 17, MICT; n = 12, CG; n = 12). Five adverse events were reported. Cardiorespiratory fitness, HR and BP were measured. The tests were performed before and after the exercise intervention programs. VO_2max-ES showed significant training x group interaction, in which HIICT and MICT were statistically superior to CG. Moreover, HIICT and MICT were statistically better than CG in the diastolic blood pressure after exercise (DBP_ex) interaction. For the systolic blood pressure after exercise (SBP_ex), HIICT was statistically better than CG. In conclusion, both HIICT and MICT generated adaptations in VO_2max-ES and DBP_ex. Furthermore, only HIICT generated positive effects on the SBP_ex. Therefore, both training methods can be considered for use in exercise programs involving middle-aged and older women. Full article

Unsafe and unprotected sexual behaviours are some of the significant challenges of health promotions and planning for current school environment. Although schools and health specialists constantly host conferences and workshops for adolescents and university students, the results are not significant. Particularly for sexual minorities, the heterosexual-oriented materials may not satisfy their needs due to the differences. As a recommendation, the current pilot study established a Peer Modelling Programme which engaged gay social workers and gay university students who have associated with unsafe and unprotected sexual activities. The outcomes of this Peer Modelling Programme indicated that gay undergraduate students tended to accept the recommendations and peer modelling exchanges from their gay social workers who understood their difficulties and sexual needs as sexual minorities based on the guideline of Social Cognitive Theory. In conclusion, this study may be used to develop additional social work materials, sexual health promotions and health plans for sexual minorities and people with special needs in the society. This research serves as a guideline to social workers who care about the issues of LGBT and sexual minorities. Full article

In the past decades, food consumption in China has undergone a rapid increase and a significant structure transition, as a result of population growth and economic development. The food system is increasingly threatening the environment by depleting water resources, deteriorating water bodies, aggravating climate change, degrading ecosystems, etc. It is significant to understand how food consumption affected the environment and how its impacts were driven in the historical period. This study reveals the environmental impacts of China’s food system from 1961 to 2017 from a consumption perspective by assessing water, carbon, and ecological footprints. The logarithmic mean Divisia index method was used to examine the drivers of the growing environmental footprints. The assessment results show that all three environmental footprints have had a drastic increase of more than two times during the studied period, which indicates the high environmental pressure posed by food consumption. We also found that, before the 1980s, the main driving forces of the increasing footprints were population and per capita energy intake. From 1984, the diet pattern started to take a positive effect and then became the dominant driver of the growing environmental footprints after the end of the 1990s. Full article

Purpose: The main objective of this study was to examine the role of social identification, collective action and resilience in reducing the negative consequences of internalized stigma on the psychological quality of life of people with physical disability using path analysis. We propose a model with two paths: the first through social identification and collective action and the second via resilience. Method: A total of 288 Spanish people with physical disability aged between 18 and 82 years (46.4% males; mean [SD] of age = 45.1 [12.3] responded to the questionnaire. Data were collected for three months through an online survey. Results: The tested model adequately fit the data. We found that the relationship between internalized stigma and the psychological quality of life of people with physical disability was mediated by resilience. However, neither social identification nor collective action mediated the association between internalized stigma and quality of life among our participants. Conclusions: The results confirmed the negative association between internalized stigma and quality of life in the population with physical disability. The results show that some interactive processes, such as resilience, may contribute to decreasing the negative effects of internalized stigma. In contrast, no effects of identification with the group or collective action intention were found. Full article

Coke production was classified as carcinogenic to humans by the International Agency for Research on Cancer. Besides polycyclic aromatic hydrocarbons, coke oven workers may be exposed to benzene and other volatile organic compounds (VOCs). The aim of this study was to assess the exposure to several VOCs in 49 coke oven workers and 49 individuals living in the same area by determining urinary mercapturic acids. Active tobacco smoking was an exclusion criterion for both groups. Mercapturic acids were investigated by a validated isotopic dilution LC-MS/MS method. Linear models were built to correct for different confounding variables. Urinary levels of N-acetyl-S-phenyl-L-cysteine (SPMA) (metabolite of benzene), N-acetyl-S-(2-hydroxy-1/2-phenylethyl)-L-cysteine (PHEMA) (metabolite of styrene), N-acetyl-S-(2-cyanoethyl)-L-cysteine (CEMA) (metabolite of acrylonitrile), N-acetyl-S-[1-(hydroxymethyl)-2-propen-1-yl)-L-cysteine and N-acetyl-S-(2-hydroxy-3-buten-1-yl)-L-cysteine (MHBMA) (metabolites of 1,3-butadiene) were 2–10 fold higher in workers than in controls (p < 0.05). For SPMA, in particular, median levels were 0.02 and 0.31 µg/g creatinine in workers and controls, respectively. Among workers, coke makers were more exposed to PHEMA and SPMA than foremen and engine operators. The comparison with biological limit values shows that the exposure of workers was within 20% of the limit values for all biomarkers, moreover three subjects exceeded the restrictive occupational limit value recently proposed by the European Chemicals Agency (ECHA) for SPMA. Full article

Worldwide, growth in the older population creates a pressing need to develop supportive environments that enhance quality of life as people age. Too often, built environments present barriers and challenges to older adults that compromise independent living and adversely affect health and life outcomes. Designing homes, buildings, and neighborhoods with older adults, through exercises in participatory or co-design, could help ensure that environments are better able to facilitate healthy aging. However, while it is potentially advantageous to involve this age group in environmental design decisions, doing so can be difficult. Analysis of and guidance on effective ways to involve older adults in these activities could make the challenge easier. With this aim in mind, this article provides critical perspectives on eight “less traditional” engagement techniques—walking interviews, photovoice, photo-elicitation, Talking Mats^®, participatory mapping, drawing, model-making, and the “Design Fair”. Insights into the strengths and limitations of these techniques, gained from observation of their use in participatory design activities, as well as feedback collected from older co-design participants, are presented. The article concludes by offering a number of practical recommendations for those interested in designing age-friendly homes and neighborhoods with older people. Full article

Children with autism spectrum disorder (ASD) are reported to participate less in everyday activities, and their parents face stigma on account of having a child with ASD, which they often internalize as affiliate stigma. Studies have examined the impact of affiliate stigma on parents’ psychological well-being and social behaviors, but little is known about how affiliate stigma impacts their children’s activity participation. This study aimed to investigate the relationship between parents’ affiliate stigma and activity participation of their children with ASD. Sixty-three parents of children with ASD (aged 2–6 years) were recruited. They completed questionnaires, which captured affiliate stigma, their child’s participation (frequency and involvement) in home, preschool, and community activities, and demographic characteristics. Results indicated that these parents had a moderate level of affiliate stigma, which did not correlate with the frequency of their children’s participation in activities. However, the parents’ affiliate stigma was found to have negative impacts on their children’s involvement in overall community participation and participation in one particular activity at home. The findings highlight the importance of destigmatization of parents of children with ASD in order to promote their children’s participation in community activities. Full article

The effects of long-term repeated freeze-thaw cycles and pollution levels on the engineering properties (q_u, E₅₀, φ, c, and k) of Pb-contaminated soils were investigated in various laboratory tests. These soils were solidified/stabilized (S/S) with three types of cement-based combined binders (C2.5S5F5, C5S2.5F2.5, and C5S5, cement, lime, and fly ash, mixed in different proportions; these materials are widely used in S/S technology). The strength and permeability coefficient of compound solidified/stabilized Pb-contaminated soils (Pb-CSCSs) were determined based on measurements of unconfined compressive strength (UCS), direct shear, and permeability. CT scanning, scanning electron microscopy (SEM), and Fourier transform infrared spectroscopy (FTIR) tests were employed to analyse the deterioration mechanisms under various repetitions of freeze-thaw cycles. The results showed that, under repeated freeze-thaw cycles, the engineering properties of Pb-CSCSs all degraded to varying degrees, though degradation tended to stabilise after 30 days of freeze-thaw cycles. The study also found that the pollutants obstruct hydration and other favourable reactions within the soil structure (such as ion exchanges and agglomerations and pozzolanic reactions). The activation of hydration reactions and the rearrangement of soil particles by freeze-thaw cycles thus caused the engineering properties to fluctuate, and soils exhibited different deterioration characteristics with changes in Pb²⁺ content. Full article

Background: Misophonia is a condition related to experiencing psychophysiological sensations when exposed to specific sound triggers. In spite of progress in research on the subject, a fully validated questionnaire assessing misophonia has not been published yet. The goal of this study was to create and validate a new questionnaire to measure misophonia. Methods: MisoQuest is based on the diagnostic criteria proposed by Schröder et al. in 2013, with minor changes implemented by the authors of MisoQuest. A total of 705 participants took part in the study, completing the online questionnaires. Exploratory Factor Analysis (EFA) and analyses using the Item Response Theory (IRT) were performed. Internal consistency was evaluated with Cronbach’s alpha. Results: The reliability of the MisoQuest was excellent (α = 0.955). The stability at five weeks was strong. There was a significant difference in results between people classified as those with misophonia and those without misophonia. Conclusions: MisoQuest has good psychometric values and can be helpful in the identification of misophonia. A deeper analysis showed that certain triggers might be more specific for people with misophonia. Consideration of violent behavior in response to misophonic triggers as a symptom of misophonia was undermined. Full article

Perinatal growth vulnerability (e.g., Small for Gestational Age, SGA) poses the goal to not overlook subtle developmental susceptibilities and their impact on the parent–infant relationship. In this case study, we examined the application of a video-feedback intervention program to support parenting, the Primary Care-Video Intervention Therapy (PC-VIT), specifically developed to fit pediatric care characteristics. The case presentation details the principal steps of the intervention with the family of an SGA infant from birth up to toddlerhood. Findings for this family highlighted initial worries about the infant’s growth. Along sessions, PC-VIT held maternal anxiety and sustained parents’ abilities to recognize and talk about the infant’s developmental skills and regulatory abilities. The PC-VIT shows the powerful opportunity to limit the impact of infant growth vulnerability on the parent–child relationship and socio-emotional development. Pediatricians can prevent vulnerable developmental milestones from clinical outcomes by implementing timely and effective strategies embracing mental health and parenting-related issues. Full article

This study was performed to evaluate the health information system regarding the dengue surveillance system in Indonesia. Major obstacles to the implementation of an effective health information system regarding dengue cases in Bandung are examined, and practical suggestions on measures to overcome them are discussed. The study utilized a mixed-method research design using qualitative approaches: document analysis, key informants and focus group interviews. Thirty key informants were selected, comprised of policymakers, senior managers, and staff at the Ministry of Health. Data from documents and transcripts were evaluated through a modified Institutional Analysis and Development (IAD) framework described by Ostrom. Through this study, we have identified several issues that hinder the effective implementation of the health information system in the case of dengue in Bandung. In the end, we propose several recommendations for reform that encompasses motivational, strategic, and structural approaches to each component of the analysis. Through evaluation of the health information system for dengue surveillance in Indonesia, we conclude that well-coordination in multi-level governance in a country as large as Indonesia is the key in the implementation of the health information system in different levels of agencies. Furthermore, the adaptability of human resources in adopting a new information system also plays an important part. Full article

Lead and cadmium are known to be potential female reproductive toxins. However, studies on the relationship between these metals and infertility are limited. This study examines the association between self-reported infertility and blood lead and cadmium levels in US women by comparing metal levels in infertile and pregnant women. Data on blood lead, blood cadmium, and infertility from women aged 20–39 years who participated in the 2013–2014 and 2015–2016 National Health and Nutrition Examination Surveys were analyzed (n = 124, ‘pregnant’ n = 42, ‘infertile’ n = 82). Blood lead and cadmium levels were measured using inductively coupled plasma mass spectrometry, and infertility and pregnancy status were assessed using a self-reported questionnaire. Low blood lead and cadmium levels (geometric mean of blood lead = 0.50 µg/dL and blood cadmium = 0.26 µg/L) were positively associated with self-reported infertility after adjusting for confounding effects (odds ratio (OR) for lead per two-fold increase in blood metal levels = 2.60; 95% confidence interval (95% CI), 1.05–6.41 and OR for cadmium per two-fold increase = 1.84; 95% CI, 1.07–3.15). Although our findings require confirmation, they suggest that even low blood cadmium and lead levels may be deleterious to female fecundity. Full article

Background: Few existing tools quickly identify dietary behaviours related to dental caries. The objectives of this study were to (i) create a patient-generated questionnaire identifying these dietary behaviours, (ii) capture information on these dietary behaviours in two specific populations via questionnaire pilot testing and (iii) determine questionnaire test-retest reliability. Methods: After development, the questionnaire was reviewed by an expert panel. Cognitive interviewing was conducted, followed by pilot testing in a general university campus population (n = 80) and a university dental clinic (n = 10). Retesting was done with the general campus group (n = 53). Results: Most participants reported never receiving dietary advice from professionals regarding caries. Sugary foods were most often consumed as snacks in the evening or afternoon, then breakfast. In total, 41.3% of campus participants consumed high risk items at least a few times per week or more often. Weekly or more frequent consumption of “other” sugary drinks (e.g., iced tea) was common. In total, 77.6% of questionnaire items had a kappa value representing moderate agreement or greater. Conclusions: Dietary behaviours related to caries were common in this pilot study. Given the high prevalence of caries and low occurrence of prior dietary advice for the same, increased preventive efforts may be warranted. Full article

Employees’ voluntary green behavior (EVGB) is indispensable in realizing organizations’ environmental sustainability objectives. Leaders can act as catalysts to shape the behavior of their employees. On EVGB, noticeably the missing link is investigating the influence of servant leadership and the mechanism through which it operates. Building upon self-determination and psychological empowerment theories, this research examined the impact of servant leadership on EVGB through the simple and sequential mediation of psychological empowerment and autonomous motivation for the environment (AME). Through systematic sampling, dyadic data were collected from 315 pairs of subordinates and supervisors working in the power sector organizations of Pakistan. Results were obtained by employing the partial least squares structural modeling (PLS-SEM) technique with Smart-PLS 3.2.8 software. Findings revealed that psychological empowerment and AME simply and sequentially mediate the influence of servant leadership on EVGB. Implications for theory and organizational practitioners are offered, accompanied by suggestions for future research. Full article

Military veterans can experience limb loss as a direct result of conflict, an accident, illness or injury. Whatever the cause, there is a need to recognise the long-term consequences and challenges of limb loss on maintaining independence in one’s home. This study aimed to examine the housing needs of veterans experiencing limb loss, and the impact of limb loss on housing needs and home adaptations of ageing military veterans. Thirty-two military veterans (aged 43–95) participated in this study and up to three life-story interviews were carried out with each participant. Two themes were generated: availability of support and changing housing needs. It is evident from the findings that military veterans are unique in various ways, specifically due to military culture, geographical relocation and the additional support that is available to the Armed Forces Community. This must be considered in long-term support to maintain independence in the home. Full article

Forestland is a key land use/land cover (LULC) type that affects nonpoint source (NPS) pollution, and has great impacts on the spatiotemporal features of watershed NPS pollution. In this study, the forestland characteristics of the Chaohu Basin, China, were quantitatively represented using forestland types (FLTs), watershed forest coverage (WFC) and forest distance from the river (DFR). To clarify the impact of forests on NPS pollution, the relationship between forestland characteristics and watershed nutrient outputs (TN and TP) was explored on a monthly scale using SWAT (Soil and Water Assessment Tool) and the period simulation was 2008–2016. The results showed that: (1) the TN and TP showed similar output characteristics and the rainy season was the peak period of nitrogen and phosphorus output. (2) Among the forestland characteristics of forestland types, watershed forest coverage and forest distance from the river, watershed forest coverage and forest distance from the river had greater effects than forestland types on the control of watershed nutrient outputs (TN and TP). (3) In different forestland types, the watershed nutrient outputs intensity remained at the lowest level when the FLTs was mixed forest, with a TN output of 1244.73kg/km² and TP output of 341.39 kg/km². (4) The watershed nutrient outputs and watershed forest coverage were negatively correlated, with the highest watershed forest coverage (over 75%) reducing the TN outputs by 56.69% and the TP outputs by 53.46% compared to the lowest watershed forest coverage (below 25%), it showed that in areas with high forest land coverage, the non-point source pollution load in the watershed is smaller than in other areas. (5) forest distance from the river had an uncertain effect on the TN and TP output of the basin, the forestland itself is a source of pollution, but it also has the function of intercepting pollution movement; the forest distance from the river in the range of 500–1000 m had the lowest NPS pollution. Considering the different forest characteristics and topographical factors, an optimal allocation mode of differentiated forest land was proposed, these suggestions will provide a scheme for surface source pollution prevention and control in the basin. This research gap is the basis of real forestland optimization. We may optimize the forestland layout for NPS pollution prevention and control by clarifying the internal mechanism. Full article

Background: Many countries have clinical practice guidelines (CPG) for asthma that serve as an important resource for healthcare professionals and inform the development of policies and practices relevant to asthma care. The purpose of this scoping review was to search for CPGs related to asthma to determine what recommendations related to the 24-h movement behaviours are provided. Methods: We searched for the most recent CPGs published by a national authoritative body from 195 countries. Guidelines were reviewed for all movement behaviours; that is, physical activity, sedentary behaviour, and sleep. Results: In total, 82 documents were searched for eligibility and 19 were included in our review. Of these, only 10 CPGs provided information on physical activity; none provided recommendations consistent with the FITT principle, while seven recommended activity levels similar to the general population. None of the guidelines included information on sedentary behaviour. Nine guidelines included information on sleep: recommendations mostly focused on changes to medication to reduce disruptions in sleep. Conclusions: It is recommended that future work be conducted to create comprehensive movement behaviour guidelines accompanied with relevant precautions and strategies to ensure that adults with asthma are able to safely and effectively engage in movement behaviours throughout the day. Full article

This is the first systematic review and meta-analysis to ascertain incidences of post-vasectomy pain following traditional scalpel, or non-scalpel vasectomy. Electronic databases PubMed, Embase and PsycINFO were searched up to 1 July 2019 for peer-reviewed articles recording post-vasectomy pain. We identified 733 publications, screened 559 after removal of duplicates and excluded 533. Of the remaining 26 full-text articles, 8 were excluded with reasons, leaving 18 for detailed analyses. Meta-analysis was performed on 25 separate datasets (11 scalpel, 11 non-scalpel, 3 other/combined). Study follow-up ranged from 2 weeks to 37 years and sample sizes from 12 to 723 patients. The overall incidence of post-vasectomy pain was 15% (95% CI 9% to 25%). The incidences of post-vasectomy pain following scalpel and non-scalpel techniques were 24% (95% CI 15% to 36%) and 7% (95% CI 4% to 13%), respectively. Post-vasectomy pain syndrome occurred in 5% (95% CI 3% to 8%) of subjects, with similar estimates for both techniques. We conclude that the overall incidence of post-vasectomy pain is greater than previously reported, with three-fold higher rates of pain following traditional scalpel, compared to non-scalpel vasectomy, whereas the incidence of post-vasectomy pain syndrome is similar. Full article

This study explored factors affecting parents’ intentions to use physical violence (PV) to discipline their children in the future. The theory of planned behavior (TPB) guided selection of variables. A sample of 1337 preschool children’s parents from nine kindergartens located in a county of Henan Province, China were selected by stratified random cluster sampling. Data on parents’ attitudes, subjective norms, and perceived behavioral control over PV, intentions to engage in PV to discipline their preschool children in the future, self-reported PV behavior toward their children during the past three months, and demographic characteristics were collected via a paper-based questionnaire. Multivariable logistic regression analyses examined putative predictors of parents’ intentions to use physically violent discipline. Nearly three-quarters of the sample said they definitely will not use violent discipline, while 23.4% either said they would use it, or did not rule it out. Logistic regression analysis showed that parents’ lower level of perceived behavioral control over using violence (OR 4.17; 95% CI: 2.659, 6.551), attitudes that support PV (OR 2.23; 95% CI: 1.555, 3.203), and having been physically violent with their children during the past three months (OR 1.62; 95% CI: 1.032, 2.556) were significantly associated with parents’ tendency either to include, or not exclude, the use of violent discipline. Parents’ subjective norms regarding PV had no significant impact on their intentions (p > 0.05). The influence of TPB constructs varied according to parents’ gender. Intervention programs that aim to reduce violent discipline should focus both on increasing parents’ perceived behavioral control over PV and changing their attitudes toward physically violent practices, especially among mothers and parents who have already used PV to discipline their children. Full article

Child obesity is understudied in Asian Americans, which include a growing population of recent immigrants. We examined the relationship between maternal nativity and time in the US, and obesity and obesogenic behaviors among Asian American children. We analyzed public-use data from the 2013–2016 California Health Interview Survey for Asian American children ages 2 to 11 years. We used logistic regression to determine the odds of obesity and obesogenic behaviors associated with maternal nativity and time in the US. This study included n = 609 children. Children of US-born mothers had lower odds of obesity (adjusted odds ratio, AOR, 0.12; 95% CI 0.02 to 0.91) and lower fruit intake (AOR 0.15, 95% CI 0.03 to 0.81) than children of recent immigrants (< 5 years in the US). Asian American children with recent immigrant mothers are more likely to be obese and eat less fruit than children with US-born mothers. Efforts to prevent obesity and increase fruit consumption are particularly important for this vulnerable population of children of recent immigrants. Full article

The Gaelic Athletic Association (GAA) is a major stakeholder in promoting smoke-free policies in Ireland. Several GAA clubs have adopted smoke-free policies, and there is a growing interest among other GAA clubs to also become smoke-free. As such, the purpose of this study is to explore the process of how GAA clubs adopt, implement, and enforce smoke-free policies in order to discover best practices that other clubs could replicate. Representatives from 15 smoke-free clubs were interviewed regarding how their club became smoke-free. Interview data were analyzed, in which four major themes emerged: (1) process (planning a smoke-free policy, communicating the policy to the community, providing smoking cessation resources), (2) barriers (opinions and behaviors of club members who smoke, bars connected to club houses, policy exceptions, visitors and umpires who were unaware of the policy), (3) enforcement (community-based style of enforcement, non-confrontational approach, non-enforcement), and (4) impact (observation of policy compliance and decrease in cigarette litter). The study’s findings indicate a general ease of becoming smoke-free with minimal barriers. As such, the GAA should urge each club to become smoke-free and to use the effective methods used by current smoke-free clubs for communicating and enforcing smoke-free policies. Full article

According to the World Health Organization (WHO), one out of 10 people get sick from eating contaminated food. Complex food production process and globalization make food supply chain more delicate. Many technologies have been investigated in recent years to address food insecurity and achieve efficiency in dealing with food recalls. One of the most promising technologies is Blockchain, which has already been used successfully in financial aspects, such as bitcoin, and it is attracting interests from food supply chain organizations. As blockchain has characteristics, such as decentralization, security, immutability, smart contract, it is therefore expected to improve sustainable food supply chain management and food traceability. This paper applies a content-analysis based literature review in blockchain adoption within food supply chain. We propose four benefits. Blockchain can help to improve food traceability, information transparency, and recall efficiency; it can also be combined with Internet of things (IoT) to achieve better efficiency. We also propose five potential challenges, including lack of deeper understanding of blockchain, technology difficulties, raw data manipulation, difficulties of getting all stakeholders on board, and the deficiency of regulations. Full article

Hodgkin lymphoma is a haematological malignancy predominantly affecting young adults. Hodgkin lymphoma is a highly curable disease by current treatment standards. Latest treatment guidelines for Hodgkin lymphoma however imply access to diagnostic and treatment modalities that may not be available in settings with restricted healthcare resources. Considerable discrepancies in Hodgkin lymphoma patient survival exist, with poorer outcomes reported in resources-constrained settings. Resources-stratified guidelines for diagnosis, staging and treatment of Hodgkin lymphoma were derived in an effort to optimize patient outcome provided a given setting of available resources. These guidelines were derived based on the framework of the Breast Health Global Initiative stratifying resource levels in basic, core, advanced and maximal categories. Full article

In 2009, China launched a new health care reform as it endeavoured to develop a tiered system of disease diagnosis and treatment to promote the integration of medical resources. This was important for improving service capacity and building medical alliances that would eventually lead to improved health service utilisation efficiency. However, while the 2009 reform aimed to provide universal health insurance coverage to all citizens, its overall effect on health service utilisation efficiency remains unclear. We aimed to examine the new health care reform’s mixed effect by applying a longitudinal study using China Health and Nutrition Survey (CHNS) data and the difference-in-difference (DID) method to estimate the health reform’s impact on health insurance coverage rate. Then, we studied whether the increase in health insurance coverage rate affected health service utilisation efficiency in China. Our results showed that the increase in insurance coverage rate has indeed made expensive medical services available to low-income individuals. However, it also increased the likelihood of use of hospitals rather than primary care facilities, since there is more insurance cover for outpatient visits, which has led to an increased demand for quality services. This effect has generated a negative impact on health care utilisation which directly pertains to systemic inefficiency. This study thus indicates that China’s latest health reform requires further policies to improve its overall efficiency. Full article

This study aimed to estimate the efficiency and its influencing factors of Primary Health Care Institutions (PHCIs) in counties in Hunan Province, China, and put forward feasible suggestions for improving the efficiency of PHCIs in Hunan Province. We applied the Input-Oriented Data Envelopment Analysis (DEA) method and the Malmquist Index Model to estimate the efficiency of PHCIs in 86 counties in Hunan Province from 2009 to 2017. Then, the Tobit model was used to estimate the factors that influence the efficiency of PHCIs. Since the implementation of the new health-care reform in 2009, the number of health resources in PHCIs in Hunan Province has increased significantly, but most counties’ PHCIs remain inefficient. The efficiency of PHCIs is mainly affected by the total population, city level, the proportion of health technicians and the proportion of beds, but the changes in per capita GDP have not yet played a significant role in influencing efficiency. In the future, the efficiency of PHCIs should be improved by increasing medical technology skills and enthusiasm of health technicians and by improving the payment policies of medical insurance funds. Full article