Int. J. Environ. Res. Public Health, Volume 18, Issue 20 (October-2 2021) – 442 articles

Objective measurement of the supply–demand of ecosystem services (ESs) has received increasing attention from recent studies. It reflects the relationship between green spaces and human society. However, these studies rarely assess the mountainous cities. To fill this gap, this study takes a typical mountainous city as a research case to reveal the supply–demand relationship of ecosystem services, then development and management strategies are proposed for different districts according to their spatial differentiation characteristics. Results shows that: (1) there are differences of ESs supply between each district, and supply from Banan District is significantly higher than others. (2) The demands for ES also vary widely, which are higher in the core urban areas. (3) There are different degrees of imbalance between supply and demand in each district. We classified green spaces into four types based on their supply–demand characteristics, and optimization strategies are proposed. We found that most of the districts are lack of ES supply while there is a relatively high demand for ES in Chongqing, and the balance of supply and demand between different districts varies greatly. Our study indicates that targeted urban green spaces strategies for different districts must be considered to adequately optimize ES in mountainous cities. Full article

Reinfection with SARS-CoV-2 seems to be a rare phenomenon. The objective of this study is to carry out a systematic search of literature on the SARS-CoV-2 reinfection in order to understand the success of the global vaccine campaigns. A systematic search was performed. Inclusion criteria included a positive RT-PCR test of more than 90 days after the initial test and the confirmed recovery or a positive RT-PCR test of more than 45 days after the initial test that is accompanied by compatible symptoms or epidemiological exposure, naturally after the confirmed recovery. Only 117 articles were included in the final review with 260 confirmed cases. The severity of the reinfection episode was more severe in 92/260 (35.3%) with death only in 14 cases. The observation that many reinfection cases were less severe than initial cases is interesting because it may suggest partial protection from disease. Another interesting line of data is the detection of different clades or lineages by genome sequencing between initial infection and reinfection in 52/260 cases (20%). The findings are useful and contribute towards the role of vaccination in response to the COVID-19 infections. Due to the reinfection cases with SARS-CoV-2, it is evident that the level of immunity is not 100% for all individuals. These data highlight how it is necessary to continue to observe all the prescriptions recently indicated in the literature in order to avoid new contagion for all people after healing from COVID-19 or becoming asymptomatic positive. Full article

Disability inclusive development practices require reliable data to identify people with disabilities, their barriers to participation and support needs. Although several tools are available for measuring different components of disability, it is often difficult for program teams in low resource settings, including lay community workers of community based inclusive development (CBID) programs, to collect and analyze data for program monitoring and evaluation. This paper presents the development of a digital CBID Modular Tool with automated data analysis to support routine case management processes and monitoring of a CBID program in Laos PDR. The tool was developed in different phases involving stakeholder consultations, auditing of existing tools, content development for the different modules for disability assessment and support needs, software development and testing. The tool was developed in a participatory process including people with disabilities. The tool measures needs and support requirements of people with disabilities in health, functioning, economic, education and caregiver support domains, and enables intervention planning. The content included is both context specific and universal as derived from the widely used validated tools. This unique digital CBID Modular Tool can support data collection by lay community workers and support reliable data collection to measure disability inclusion in a development program. Full article

Healthcare workers (HCW) play a vital role in the SARS-CoV-2 pandemic control. The aim of this study was to assess the prevalence of SARS-CoV-2 antibodies and the risk of COVID-19 infections in a cohort of HCW from four different risk groups (from intensive care unit to administration) of a hospital of a primary care level in rural Germany. The outcomes were monthly measures of antibody seroprevalence over a period of 6 months. Overall, a seroprevalence of 13.41% was determined, with significantly higher prevalence rates among HCW working in areas with more frequent contact to confirmed or suspected cases (30.30%, p = 0.003). The group specific differences in the risk of infection from COVID-19 were detected, as HCW groups with frequent exposure seemed to have an increased risk (RR = 3.18, p = 0.02; CI95 1.09–9.24). The findings contribute to the epidemiological understanding of the virus spread in an unvaccinated population group, which is highly relevant for the pandemic management. Full article

As one of the nitrogen (N) limitation ecosystems, alpine meadows have significant effects on their structure and function. However, research on the response and linkage of vegetation-soil to short-term low-level N deposition with rhizosphere processes is scant. We conducted a four level N addition (0, 20, 40, and 80 kg N ha⁻¹ y⁻¹) field experiment in an alpine meadow on the Qinghai-Tibetan Plateau (QTP) from July 2014 to August 2016. We analyzed the community characteristics, vegetation (shoots and roots), total carbon (TC), nutrients, soil (rhizosphere and bulk) properties, and the linkage between vegetation and soil under different N addition rates. Our results showed that (i) N addition significantly increased and decreased the concentration of soil nitrate nitrogen (NO₃⁻-N) and ammonium nitrogen, and the soil pH, respectively; (ii) there were significant correlations between soil (rhizosphere and bulk) NO₃⁻-N and total nitrogen (TN), and root TN, and there was no strong correlation between plant and soil TC, TN and total phosphorus, and their stoichiometry under different N addition rates. The results suggest that short-term low-N addition affected the plant community, vegetation, and soil TC, TN, TP, and their stoichiometry insignificantly, and that the correlation between plant and soil TC, TN, and TP, and their stoichiometry were insignificant. Full article

The role of opioids and opioid medications in ADHD symptoms is still largely understudied. We tested the hypothesis that, in Heroin Use Disorder (HUD), when patients are treated with Agonist Opioid medications (AOT), treatment outcome is associated with the presence of Adult Attention-Deficit/Hyperactive Disorder (A-ADHD) symptomatology. A retrospective cohort study of 130 HUD patients in Castelfranco Veneto, Italy, covering 30 years, was divided into two groups according to the Adult ADHD Self-Report Scale (ASRS) score and compared them using demographic, clinical and pharmacological factors. Survival in treatment was studied by utilizing the available data for leaving treatment and relapsing into addictive behavior and for mortality during treatment as poor primary outcomes. Thirty-five HUD subjects (26.9%) were unlikely to have A-ADHD symptomatology, and 95 (73.1%) were likely to have it. Only current age and co-substance use at treatment entry differed significantly between groups. Censored patients were 29 (82.9%) for HUD patients and 70 (73.9%) for A-ADHD/HUD patients (Mantel-Cox test = 0.66 p = 0.415). There were no significant linear trends indicative of a poorer outcome with the presence of A-ADHD after adjustment for demographic, clinical and pharmacological factors. Conclusions: ADHD symptomatology does not seem to exert any influence on the retention in AOT of HUD patients. Full article

This contribution is a theoretical reflection based on statistical and empirical data as well as concepts proposed by other authors or institutions. Based on the thesis that the respective social developments equally influence and limit the orientation and design of workplace health promotion, this article deals with the challenges that arise from the contemporary social, political and economic developments for a needs-oriented and effective workplace health promotion. On the basis of a historical review of the lines of development in workplace health promotion, beginning with the Ottawa Charter in 1986, the field of tension in which work-related health promotion approaches generally operate is first outlined. Based on the results of a keyword search in relevant European statistics databases and specialized databases on the topics of demographic change, labor migration and digitalization and flexibilization of work, current development trends in the world of work are traced, priority desiderata for a future design of health promotion are derived from these, and their chances of realization are reflected upon. On the basis of the data collected, it becomes clear that today’s world of work is characterized by multidimensional diversification processes, which are accompanied by the risk of worsening social inequalities. The conclusion is that future concepts of workplace health promotion must be more universal than previous approaches, which are often limited to the focus of individual behavioral prevention. The attempt to promote workplace health promotion with economic benefit arguments also runs the risk of reinforcing social inequality. The task of effective workplace health promotion, conversely, must be to initiate critical reflection on current priorities. Full article

Many instruments have been created to measure knowledge and attitudes in palliative care. However, not only is it important to acquire knowledge, but also that this knowledge should reach patients and their relatives through application in clinical practice. This study aimed to develop and psychometrically test the INCUE questionnaire (Investigación Cuidados Enfermeros/Investigation into Nurses’ Care Understanding of End-of-Life) to assess the basic training needs of primary or home healthcare nurses in palliative care. A questionnaire was developed based on the classical theory of tests and factor analysis models. Initially, 18 experts developed 67 items in two blocks and determined content validity by two rounds of expert panels. Exploratory factor analysis and reliability testing were conducted with a non-probabilistic sample of 370 nurses. Some items were observed to have very low homogeneity indices or presented convergence problems and were eliminated. Questionnaire reliability was 0.700 in the theoretical block (KR20 Index) and 0.941 in the practical block (Cronbach’s alpha). The model converges and shows an adequate fit, specifically CFI = 0.977, TLI = 0.977 and RMSEA = 0.05. The correlation between the two factors in the model is ρ = 0.63. The questionnaire objectively evaluates primary or home healthcare nurses’ knowledge of palliative care and its practical application, thereby facilitating more efficient training plans. Full article

In recent decades, cities have been experiencing accelerated population growth, associated with an increase in the scales of production and consumption. This fact, combined with deficient management of resources and waste, has led to the loss of biological diversity, compromising the generation of ecosystem services, with disastrous consequences for human health and well-being, but also for the economic system. In the field of civil engineering, the predominance of artificialisation and impermeabilization of cities (called “grey engineering”) is being questioned to be replaced or complemented with new types of infrastructures that represent a transformative change to achieving more sustainable cities. Through system dynamics applied to the economic modelling of the city of Santander (Spain), the aim of this study is to analyse the profitability of investment in ecosystem restoration and in both green and blue infrastructure, and of the implementation of environmental policies based on the relationships of affection established in the model, which represent the interactions between the main actors in urban dynamics. As a main conclusion, it is found that investing in green infrastructures and ecosystem restoration, and environmental policies is highly profitable: EUR 1 spent can produce up to EUR 100 as a benefit. Full article

Background: Evidence points to unequal access to direct oral anticoagulant (DOAC) therapy, to the detriment of the most socioeconomically disadvantaged patients in different geographic areas; however, few studies have focused on people with atrial fibrillation. This study aimed to assess gender-based and socioeconomic differences in the prescriptions of anticoagulants in people with non-valvular atrial fibrillation who attended Primary Care. Method: A cross-sectional study with real-world data from patients treated in Primary Care in Catalonia (Spain). Data were obtained from the SIDIAP database, covering 287 Primary Care centers in 2018. Results were presented as descriptive statistics and odds ratios estimated by multivariable logistic regression. Results: A total of 60,978 patients on anticoagulants for non-valvular atrial fibrillation were identified: 41,430 (68%) were taking vitamin K antagonists and 19,548 (32%), DOACs. Women had higher odds of treatment with DOAC (adjusted odds ratio [ORadj] 1.12), while lower DOAC prescription rates affected patients from Primary Care centers located in high-deprivation urban centers (ORadj 0.58) and rural areas (ORadj 0.34). Conclusions: DOAC prescription patterns differ by population. Women are more likely to receive it than men, while people living in rural areas and deprived urban areas are less likely to receive this therapy. Following clinical management guidelines could help to minimize the inequality. Full article

To investigate the physiological and behavioral comfort of drivers traversing urban underpass tunnels with various spatial structure conditions, a driving simulator experiment was conducted using 3DMAX and SCANeRTM studio software. Three parameters, including the slope, slope length, and height of a tunnel, were selected as research objects to explore the optimal combination of structural parameters in urban underpass tunnels. The heart rate (HR), interbeat (RR) interval, speed, and lane centerline offset value were collected for 30 drivers. Then, a measurement model of the relationship among HR, RR interval, speed, lane centerline offset value, and structural parameters was established by using partial correlation analyses and the stepwise regression method. On this basis, a structural constraint model based on the drivers’ physiological and behavioral comfort thresholds was also constructed. The results show that the driver’s HR, RR interval, speed, and lane centerline offsets are significantly related to the tunnel height, slope, and slope length. More importantly, this paper not only analyzed the effects of various structural parameters on drivers’ physiology and behavior but also proposed an optimized combination of structural parameters based on drivers’ physiological and behavioral comfort. It can reasonably improve tunnel design in China, ensure tunnel traffic safety, and seek the maximum comfort of the driver in the driving process. Full article

Background: Autism spectrum disorder (ASD) diagnoses have rapidly increased globally. Both environmental and genetic factors appear to contribute to the development of ASD. Several studies have shown a potential association between prenatal or postnatal pesticide exposure and the risk of developing ASD. Methods: We reviewed the available literature concerning the relationship between early life exposure to pesticides used in agriculture, such as organochlorines, organophosphates and pyrethroids, and ASD onset in childhood. We searched on Medline and Scopus for cohort or case–control studies published in English from 1977 to 2020. Results: A total of seven articles were selected for the review. We found a remarkable association between the maternal exposure to pyrethroid, as well as the exposure to organophosphate during pregnancy or in the first years of childhood, and the risk of ASD onset. This association was found to be less evident with organochlorine pesticides. Pregnancy seems to be the time when pesticide exposure appears to have the greatest impact on the onset of ASD in children. Conclusions: Among the different environmental pollutants, pesticides should be considered as emerging risk factors for ASD. The potential association identified between the exposure to pesticides and ASD needs to be implemented and confirmed by further epidemiological studies based on individual assessment both in outdoor and indoor conditions, including multiple confounding factors, and using statistical models that take into account single and multiple pesticide residues. Full article

Social distancing measures have been a key component in government strategies to mitigate COVID-19 globally. Based on official documents, this study aimed to identify, compare and analyse public social distancing policy measures adopted in Denmark and Sweden regarding the coronavirus from 1 March 2020 until 1 October 2020. A key difference was the greater emphasis on laws and executive orders (sticks) in Denmark, which allowed the country to adopt many stricter policy measures than Sweden, which relied mostly on general guidelines and recommendations (sermons). The main policy adopters in Denmark were the government and the Danish Parliament, whereas the Public Health Agency issued most policies in Sweden, reflecting a difference in political governance and administrative structure in the two countries. During the study period, Sweden had noticeably higher rates of COVID-19 deaths and hospitalizations per 100,000 population than Denmark, yet it is difficult to determine the impact or relative effectiveness of sermons and sticks, particularly with regard to broader and longer-term health, economic and societal effects. Full article

Consuming nuts may have advantages over other snack foods for health and body-weight regulation. Suggested mechanisms include increased satiety and lower glycaemia. We used an acute randomised crossover trial to assess glycaemic and appetite responses to consuming two isocaloric snacks (providing 10% of participants’ total energy requirements or 1030 kJ (equivalent to 42.5 g almonds), whichever provided greater energy): raw almonds and sweet biscuits among 100 participants with available data (25 males and 75 females) following 106 being randomised. Two hours after consuming a standardised breakfast, participants consumed the snack food. Finger-prick blood samples measuring blood glucose and subjective appetite ratings using visual analogue scales were taken at baseline and at 15 or 30 min intervals after consumption. Two hours after snack consumption, an ad libitum lunch was offered to participants and consumption was recorded. Participants also recorded food intake for the remainder of the day. The mean area under the blood glucose response curve was statistically and practically significantly lower for almonds than biscuits (mean (95% CI) difference: 53 mmol/L.min (45, 61), p < 0.001). Only the composite appetite score at 90 min was higher in the almond treatment compared to the biscuit treatment (45.7 mm vs. 42.4 mm, p = 0.035 without adjustment for multiple comparisons). There was no evidence of differences between the snacks for all other appetite ratings or for energy intake at the ad libitum lunch. However, mean energy intakes following snack consumption were significantly lower, both statistically and in practical terms, for the almond treatment compared to the biscuit (mean (95% CI) diff: 638 kJ (44, 1233), p = 0.035). Replacing popular snacks with almonds may have advantages in terms of glycaemia and energy balance. Full article

Patients with diabetes mellitus are exposed to important complications, such as diabetic neuropathy or peripheral vascular disease. The evidence on the guidelines that these patients, with a certain risk of suffering foot ulcerations, should follow before, during and after physical exercise is scarce. The objective of this study is to identify the physical exercise guidelines to recommend based on the risk of the foot of the patient with diabetes through a consensus of experts. A three-round Delphi study will be conducted. A scientific committee (multidisciplinary group of four national experts) will review the proposal of experts and the Delphi questionnaire before submitting. A group of experts in the management and approach of the diabetic foot of an international and multidisciplinary nature will form the panel of experts, who must express their degree of (dis)agreement with each of the statements contained in the Delphi questionnaire. The percentage will be calculated in response categories, and a cut-off point of 80% will be set to define the consensus of (dis)agreement of the panelists. The results of the study could provide a series of recommendations on the realization of physical exercise in diabetic patients at risk of suffering foot ulcerations. Full article

The type of delivery influences breastfeeding, both in terms of initiation and duration. The aim of the study was to determine the association between the type of delivery and factors associated with exclusive breastfeeding (EBF) practice among Polish women. Data on sociodemographic variables, pre-pregnancy weight, height, course of pregnancy, type of delivery and duration of breastfeeding were collected using a Computer-Assisted Web Interview. Of the 1024 breastfeeding women who participated in the study, 59.9% gave birth vaginally and 40.1% gave birth by caesarean section. The chance of starting EBF [OR: 0.478; 95% Cl: 0.274, 0.832] and continuing it for four months [OR: 0.836; 95% Cl: 0.569, 0.949] was lower in the case of caesarean delivery. Starting EBF was negatively affected by pre-pregnancy overweight status and obesity in the case of caesarean delivery. EBF practice for four months was negatively affected by age [18–24 years and 25–34 years], elementary education and average income [2001–4000 PLN] in the case of caesarean delivery. A negative impact on the chance of EBF for six months was also observed for younger age [18–24 years], elementary and secondary education and average income [2001–4000 PLN] in the case of caesarean delivery. There was no association between starting EBF and age, net income, place of living, pregnancy complications or the child′s birth weight category in the case of both subgroups, as well as between education and previous pregnancies in the case of vaginal delivery. These results suggest that women who deliver by caesarean section need additional breastfeeding support. Full article

In this study, we investigated whether the partial replacement of dietary fat with polyunsaturated fatty acids (PUFAs) ameliorated the lipopolysaccharide (LPS)-induced hepatic inflammation in rats fed a high-fat diet. Male Sprague-Dawley rats were divided into three groups and provided each of the following diets: (1) high-fat diet (HFD), (2) HFD with perilla oil (PO), and (3) HFD with corn oil (CO). After 12 weeks of dietary intervention, the rats were intraperitoneally injected with LPS (5 mg/kg) from Escherichia coli O55:B5 or phosphate-buffered saline (PBS). Following LPS stimulation, serum insulin levels were increased, while PO and CO lowered the serum levels of glucose and insulin. In the liver, LPS increased the triglyceride levels, while PO and CO alleviated the LPS-induced hepatic triglyceride accumulation. In the LPS injected rats, the mRNA expression of genes related to inflammation and endoplasmic reticulum (ER) stress was attenuated by PO and CO in the liver. Furthermore, hepatic levels of proteins involved in the nuclear factor kappa-light-chain-enhancer of activated B cells/mitogen-activated protein kinase pathways, antioxidant response, and ER stress were lowered by PO- and CO-replacement. Therefore, the partial replacement of dietary fat with PUFAs alleviates LPS-induced hepatic inflammation during HFD consumption, which may decrease metabolic abnormalities. Full article

Lactoferrin (Lf), a multifunctional cationic glycoprotein synthesized by exocrine glands and neutrophils, possesses an in vitro antiviral activity against SARS-CoV-2. Thus, we conducted an in vivo preliminary study to investigate the antiviral effect of oral and intranasal liposomal bovine Lf (bLf) in asymptomatic and mild-to-moderate COVID-19 patients. From April 2020 to June 2020, a total of 92 mild-to-moderate (67/92) and asymptomatic (25/92) COVID-19 patients were recruited and divided into three groups. Thirty-two patients (14 hospitalized and 18 in home-based isolation) received only oral and intranasal liposomal bLf; 32 hospitalized patients were treated only with standard of care (SOC) treatment; and 28, in home-based isolation, did not take any medication. Furthermore, 32 COVID-19 negative, untreated, healthy subjects were added for ancillary analysis. Liposomal bLf-treated COVID-19 patients obtained an earlier and significant (p < 0.0001) SARS-CoV-2 RNA negative conversion compared to the SOC-treated and untreated COVID-19 patients (14.25 vs. 27.13 vs. 32.61 days, respectively). Liposomal bLf-treated COVID-19 patients showed fast clinical symptoms recovery compared to the SOC-treated COVID-19 patients. In bLf-treated patients, a significant decrease in serum ferritin, IL-6, and D-dimers levels was observed. No adverse events were reported. These observations led us to speculate a potential role of bLf in the management of mild-to-moderate and asymptomatic COVID-19 patients. Full article

Sustainable green development and environment preservation problems are relevant for unique territories with special economic activity modes, such as the Baikal natural territory. Within Russia, the Republic of Buryatia serves as the model territory for the Lake Baikal ecosystem preservation. Determining the socio-economic development impact on the region’s natural environment and resolving contradictions in transition to the green economic development requires the systematization of economic, social, and environmental processes of quantitative information based on the construction of composite indicators. We construct a composite indicator to assess the socio-economic factor’s impact on the Republic of Buryatia’s current economic state and to compare the current environmental subsystem state and the socio-economic parameters of Buryatia to the average Russian level. We use multiple regression models to determine relationships between various environmental-socio-economic parameters and identify the factors that most impact the environmental states (situations). The measures taken to preserve the unique ecosystem of Lake Baikal have an actual effect. This study shows, that according to the accepted scale, the environmental situation in the region can be characterized as a step towards the green economy transition. The proposed sustainable green development criteria and tools assessment system of the Republic may serve as the basis for forming information and analytical support for an effective economic policy. Full article

Since 1995, a national health insurance (NHI) program has been in operation in Taiwan, which provides uniform comprehensive coverage. Forced by severe financial deficit, global budgeting reimbursement was adopted in the healthcare sector to control healthcare expenditures in 2002. A two-stage data envelopment analysis (DEA) approach was used to measure the efficiency of hospital resource allocation among stakeholders in Taiwan’s NHI system, and to further explore the changes in resource allocation after the introduction of a global budgeting payment scheme. The dataset was collected from the annual statistical reports of Taiwan’s Ministry of Health and Welfare (MOHW) and was used to estimate the efficiency of resource allocation in hospital-based healthcare services under global budgeting. In terms of efficiency during the period from 2003 to 2009, one-third of decision-making units (DMUs) improved their productivity in stage I, and seven out of the total of eighteen DMUs saw falls in financial efficiency in stage II. After global budgeting was implemented, there were significant positive impacts on the efficiency of hospital resource allocation in Taiwan. The two-stage DEA model for analyzing the effects of the global budgeting reimbursement system on productivity and financial efficiency represents a key decision-making tool for hospital administrators and policymakers. Full article

Social contextual factors could determine mortality by the coronavirus disease 2019 (COVID-19), with social capital as a potential determinant. This study aimed to examine the association between prefecture-level social capital and COVID-19 deaths in Japan. Data on the cumulative number of COVID-19 deaths per 100,000 individuals between 1 October 2020 and 30 June 2021 in 47 prefectures were obtained from the government open-access database. Prefecture-level social capital was collected from a large-scale web-based nationwide survey conducted between August and September 2020. We included trust in neighbors, norm of reciprocity in the neighborhood, and trust in the national government as cognitive social capital, and neighborhood ties and social participation as structural social capital. The cumulative COVID-19 deaths per 100,000 individuals (1 October 2020 to 30 June 2021) ranged from 0.15 to 27.98 in 47 prefectures. A multiple regression analysis after adjusting for covariates showed that a greater norm of reciprocity and government trust were associated with fewer COVID-19 deaths during the first and second 3-month periods of observation. In the third 3-month period, the association between COVID-19 deaths and government trust became nonsignificant. Trust in neighbors, neighborhood ties, and social participation were not related to COVID-19 deaths during any time period. The disparity of COVID-19 deaths by prefecture in Japan can be explained by cognitive social capital. This study suggests that the association between social capital and COVID-19 deaths may vary according to the dimension of social capital and time period. Full article

This study aims to investigate the changes in the structural relationship between alienation in physical education (PE) classes, school happiness, and future healthy life expectations in Korean adolescents after the COVID-19 pandemic. The data were collected from Korean adolescents using different scales. The collected data were analyzed using frequency analysis, reliability analysis, validity analysis, independent t test, and path analysis. The key results were: First, there were partial changes in each of the parameters since the outbreak of COVID-19. Second, before the pandemic, alienation in PE classes negatively affected school happiness, and school happiness positively affected expectations of a future healthy life; however, alienation in PE classes did not affect the expectations of a future healthy life, showing a complete mediating effect. Third, during the pandemic, alienation in PE classes negatively affected school happiness, and school happiness positively affected the expectations of a future healthy life; alienation in PE classes negatively affected the expectations of a future healthy life, showing a partial mediating effect. These findings emphasize the importance and potential of school education, especially PE, in promoting happiness and healthy lives in adolescents. We expect these findings to have practical implications for future research by presenting theoretical and empirical data. Full article

Background: Ensuring adherence guarantees the efficacy of pre-exposure prophylaxis (PrEP). Methods: We conducted a cross-sectional study among 816 sexually transmitted infection (STI) patients in Shanghai. The questionnaire included self-reported demographic characteristics, self-administered items on adherence to free oral PrEP, and PrEP uptake behavior measurement. We conducted item analysis, reliability analysis, validity analysis and receiver operating characteristic (ROC) curve analysis. Results: Not all items were considered acceptable in the item analysis. The questionnaire had a McDonald’s ω coefficient of 0.847. The scale-level content validity index (CVI) was 0.938 and the item-level CVI of each item ranged from 0.750 to 1. In exploratory factor analysis, we introduced a four-factor model accounting for 79.838% of the aggregate variance, which was validated in confirmatory factor analysis. Adding PrEP adherence questionnaire scores contributed to prediction of PrEP uptake behavior (p < 0.001) in regression analysis. The maximum area under the ROC curve was 0.778 (95% IC: 0.739–0.817). Conclusion: The PrEP adherence questionnaire presented psychometric validation among STI patients. Full article

Food addiction is currently not an official diagnosis (as a standalone disorder substance-related and addictive disorder) in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). To best of our knowledge, there is no previous research on differences between addictive-like eating behavior regarding its associations with psychological distress, eating behaviors and physical activity among individuals with obesity. The objective of the present study was to distinguish psychological and behavioral patterns of individuals with obesity concerning food addiction using a cluster analysis. We determined the profiles of the participants in terms of psychological distress, eating behaviors and physical activity and evaluated their association with food addiction. A cross-sectional study was conducted between September and November 2020, during the lockdown period imposed by the government for the COVID-19 pandemic. A sample of 507 individuals with obesity aged between 18 and 65 years participated in the present study by filling in the online questionnaire, including the validated Arabic version of the modified version of the Yale Food Addiction Scale, the Arabic version of the Depression, Anxiety and Stress Scale, the Three-Factor Eating Questionnaire, and the short version of the International Physical Activity Questionnaire. A cluster analysis was performed using the K-mean method to identify and group participants according to their patterns/profiles. A stepwise linear regression was conducted, taking the food addiction score as the dependent variable. Higher levels of uncontrolled eating, emotional eating and stress were significantly associated with higher food addiction score. Belonging to cluster 2 (psychological well-being and cognitive restraint) (B = 14.49) or cluster 3 (moderate psychological distress and cognitive restraint) (B = 6.67) compared to cluster 1 (psychological well-being, appropriate physical activity levels and eating behaviors) was significantly associated with higher food addiction score. The present research revealed that food addiction is significantly associated with higher psychological distress and maladaptive eating behaviors. Higher levels of uncontrolled eating, emotional eating and stress as well as belonging to clusters 2 and 3 were found to be predictors of food addiction in individuals with obesity in the present study. This knowledge could be useful in regard to psychological treatment of obesity and addictive-like eating behavior. Full article

Background: Since the onset of the COVID-19 pandemic, the psychological state of university students has been a cause for concern. In particular, odontology students have experienced symptoms of anxiety due to the closure of universities and the suspension of clinical training. Methods: Medline via PubMed was searched for studies on the prevalence of anxiety in dental undergraduates, published from 1 December 2019 to 1 August 2021. Results: A total of fifteen studies were included in this review. Our results show a prevalence of anxiety of 35% reported by dental students, which was independent of gender, response rate or methodological quality. The only significant finding was a lower prevalence of anxiety in studies located in Europe compared to those located in other continents. Conclusions: The results suggest dental students are experiencing significant levels of anxiety during this COVID-19 pandemic and that there seem to be differences between students from different regions of the world. Therefore, it is important to help dental students psychologically as the pandemic situation continues. Full article

The physical and social characteristics of urban neighborhoods engender unique stressors and assets, contributing to community-level variation in health over the lifecourse. Actors such as city planners and community organizations can help strengthen resilience in places where chronic stress is endemic, by learning about perceived stressors and assets from neighborhood users themselves (residents, workers, business owners). This study piloted a methodology to identify Toronto neighborhoods experiencing chronic stress and to engage them to identify neighborhood stressors, assets, and solutions. Crescent Town was identified as one neighborhood of interest based on relatively high levels of emotional stress in Twitter Tweets produced over two one-year periods (2013–2014 and 2017–2018) and triangulation using other neighborhood-level data. Using concept mapping, community members (n = 23) created a ten-cluster concept map describing neighborhood stressors and assets, and identified two potential strategies, a Crescent Town Residents’ Association and a community fair to promote neighborhood resources and build social networks. We discuss how this knowledge has circulated through the City of Toronto and community-level organizations to date, and lessons for improving this methodology. Full article

For the lack of quantitative basis of traffic sign combination information, this paper established a model of information quantity of urban road traffic signs by analyzing the driver’s information processing and the visual recognition of traffic signs combined with theories of informatics. It used various analytical methods to build a model of the relationship between the traffic sign information quantity (TSIQ) and the driver’s visual recognition. Based on factors, the relationship between the TSIQ and the driver’s visual recognition was studied and analyzed to provide a reference for the design of urban traffic sign layout information. The results show that the TSIQ can explain 61% of the driver’s recognition time (DRT). The more information the road traffic sign conveys, the longer DRT will be. The TSIQ’s threshold is 642 bits, and exceeding this value will cause information overload. Different influence factors have a certain impact on drivers’ visual recognition distance (VRD). The male VRD is shorter than the female. The VRD of the young driver is larger than the old driver. The VRD of a novice driver is longer than an experienced driver, while the visual recognition sign of an experienced driver is shorter. Full article

The increasing amount of waste in cities poses a great challenge for sustainable development. Promoting waste sorting is one of the priorities for various levels of public authorities in the context of the rapid growth of waste generation all around China. To achieve this goal, waste-sorting policies should be precisely designed to ensure successful waste reduction at all stages. Previous studies have neglected the spillover effects of different regulatory policies, which may affect the overall goal of reducing waste by influencing different waste production stages. This paper fills this gap by comparing the spillover effects of two typical waste-sorting policies on sustainable consumption behaviours through a survey conducted in Shanghai and Beijing (control group). By combining quasi-natural experiment and questionnaire methods, this paper analyses data through a mediation test to explore the spillover effects between different regulatory policy groups and the effects of the mediation psychological factors. Results show that a penalty policy significantly decreases people’s sustainable consumption behaviours through a negative spillover effect, while a voluntary participation policy significantly increases sustainable consumption behaviours through a positive spillover effect. Results can provide implications for policymaking in waste management and other pro-environmental fields to help cities become more sustainable by shifting multiple behaviours. Full article

It has been considered that widowed persons have a higher risk of death. This study intended to explore whether social participation could improve this trend. A longitudinal study database was constructed to explore the trend of survival and its change with social participation in widowed persons. The Taiwan Longitudinal Study on Aging (TLSA), based on four consecutive waves of longitudinal follow-up data in 1999, 2003, 2007, and 2011 was linked with the National Death Registry from 1999 through 2012. In total, there were 1417 widowed persons and 4500 nonwidowed persons included in this study, excluding divorced and never-married people. The survival trend analysis was carried out with social participation as the main predictive factor stratified for comparative analysis. Our results showed that the widowed were older than the nonwidowed, were female-dominant, had a lower education level, were more economically stressed, and were less likely to engage in regular exercise, and thus showed generally poorer health; for example, being more vulnerable to having chronic diseases, disability with the Activities of Daily Living (ADL), cognitive impairment with the Short Portable Mental State Questionnaire (SPMSQ), and depression with The Center for Epidemiological Studies-Depression (CES-D). The death risk of the widowed was significantly higher than that of the nonwidowed, but the death trend for those with social participation was significantly lower than that of their counterparts in both the widowed and nonwidowed. After matching with gender and age for widowed persons, the widowed with social participation had a significantly lower risk of death (adjusted hazard ratio (HR), 0.83; 95% confidence interval (CI), 0.71–0.98) compared to the widowed without social participation. It was concluded that social participation can improve the death risk for the widowed, and it is worthily included in health promotion plans and social welfare services for widowed persons. Full article

Objectives: To use a quantitative approach to examine the effects of high-intensity interval training (HIIT) interventions on sleep for adults. Methods: PubMed, Ebsco, Web of Science, Cochrane Central Register of Controlled Trials, the China National Knowledge Infrastructure, and Wanfang Data were searched from their inception to December 2020. Intervention studies with a control group that examined the effects of HIIT interventions on sleep were included in this meta-analysis. The risk of bias was assessed using the tool provided by the Cochrane Handbook for Systematic Reviews of Interventions. Effect sizes (ESs), calculated as weighted mean difference (WMD) and standardized mean difference (SMD), were used to examine the effects of objective outcomes and subjective outcomes separately. Results: A large increase in sleep quality (SQ) reflected by the Pittsburgh Sleep Quality Index global scores [WMD = −0.90, 95%CI (−1.72, −0.07), p = 0.03, n = 8] and a small-to-medium favorable effect on sleep efficiency (SE) [SMD = 0.43, 95%CI (0.20, 0.65), p = 0.0002, n = 10] were found after HIIT intervention. In addition, sub-analyses results suggest that ESs were moderated by the type, duration and frequency, as well as the length of the HIIT intervention. Conclusions: HIIT may be a promising way to improve overall subjective SQ and objective SE. PROSPERO, protocol registration number: CRD42021241734. Full article