Int. J. Environ. Res. Public Health, Volume 18, Issue 23 (December-1 2021) – 597 articles

This study explores how the first wave of the COVID-19 pandemic influenced family routines, relationships and technology use (smartphones and tablet computers) among families with infants. Infancy is known to be an important period for attachment security and future child development, and a time of being susceptible to changes within and outside of the family unit. A qualitative design using convenience sampling was employed. A total of 30 mothers in Perth, Western Australia participated in semi-structured interviews by audio or video call. All mothers were parents of infants aged 9 to 15 months old. Interviews were audio-recorded and transcribed, and data were analysed using thematic analysis to code and identify themes in an inductive manner. Families described staying home and stopping all external activities. Three themes relating to family interactions and wellbeing were found: enhanced family relationships; prompted reflection on family schedules; and increased parental stress. Two themes related to family device use were found: enabled connections to be maintained; and source of disrupted interactions within the family unit. Overall, participants described more advantages than downsides of device use during COVID-19. Findings will be of value in providing useful information for families, health professionals and government advisors for use during future pandemic-related restrictions. Full article

Students’ commitment and engagement in the educational process are shaped by a dense combination of factors, with effects on educational attainment and on the length of their educational careers. Decisions of prolonging education by enrolling in master’s degrees are beneficial for both individuals and societies, as such programs provide higher levels of specialized skills Longer educational careers are favored by a mix of factors acting at the level of individual, university, or wider environment. We focus our study on exploring factors conducive for students’ intentions to pursue master’s degrees considering longer educational careers as desirable outcomes. Thus, this article investigates how the individual and environmental factors interplay and shape the predisposition of students to prolong their educational career by enrolling in master’s degrees. For this, we applied three-level logistic regression models for a sample of 502 students enrolled in their final year of bachelor studies grouped by universities and universities grouped by counties. The empirical results revealed that the final grade, the father level of education, the type of working contract, and job seniority are individual-level determinants influencing the decision of enrolment in a master’s program. At the university level, the type of university and the university performance score positively impact the students’ decision to enroll in a master’s program. At the county level, the empirical evidence pointed out the significance of determinants such as the proportion of students enrolled in bachelor studies; participation rate in education and training; employment level in high-technology sectors (HTC), total-knowledge intensive sectors (KIS), and knowledge-intensive high-technology sectors (KIS_HTC); proportion of persons with tertiary education employed in science and technology; proportion of scientists and engineers; local development; R&D expenditure, personnel, and researchers in the business sector; average gross earnings; density of active firms; birth rate of companies; proportion of innovative enterprises or those introducing product innovations on the decision to enroll in a master’s program. Full article

The economies of ASEAN member states are growing rapidly, and electrical and electronic waste (E-waste) generated from them are also showing a rapid increase. In this context, this study conducted an LMDI decomposition analysis on the amount of E-waste generated in ASEAN member countries from 2015 to 2019 and decomposed it into E-waste intensity, economic growth, and population effects. Then, based on analysis results, policy implications are suggested to improve their E-waste management. According to the analysis results, ASEAN countries can be classified into three groups. The first group includes Indonesia, the Philippines, Singapore, Thailand; economic growth was the main driving factor of E-waste increase in these countries. However, E-waste had also decreased due to the effect of E-waste intensity. The second group includes countries where economic growth was not the only driving factor for E-waste increase, but also where E-waste had increased due to the effect of E-waste intensity. These countries include Cambodia, Malaysia, and Viet Nam. Finally, the third group consists of countries where the effect of E-waste intensity is the main driving factor, including Brunei Darussalam, Lao PDR, and Myanmar. This research shows that ASEAN countries need policies that can effectively deal with the threat of E-waste as a result of high economic growth and policies that can improve intensity by reducing the generation of E-waste. Full article

Soil quality is directly affected by alterations in its microbiological, biological, biochemical, physical, and chemical aspects. The microbiological activities of soil can affect soil fertility and plant growth because it can speed up the cycling of nutrients, enzymes, and hormones that are needed by plants for proper growth and development. The use of different agricultural management practices can influence microbial biomass and enzyme activities by altering soil microclimate, soil microorganism habitat, and nutrient cycling. Based on this, the present work planned to evaluate the impact of conventional, low-input, and organic farming systems in a vegetable field growing celery on microbial biomass and different soil enzyme activities. The present study showed a comparison of the effect of different practices on biological soil quality indicators during two sampling times, i.e., one month after colonization and one month before harvesting. It was observed that the soil microbial biomass in the organic farming system was significantly higher than that found in conventional and low-input practices. Under an organic farming system, the soil microbial biomass in December was significantly higher than that in October. The soil microbial biomass carbon in the 0–20 cm soil layer showed higher variation compared to that in the 20–40 cm layer for all the three of the farming management practices that were used in the study. Additionally, the soil total carbon and total organic carbon were recorded as being higher in the December samples than they were in the October samples. Under all the three of the management practices that were applied, the soil catalase activity was higher in the October samples than it was in the December soil samples that were collected the from 20–40 cm soil layer compared to those that were taken from the 0–20 cm layer. The application of organic fertilizer (chicken and cowmanure compost) resulted inincreases in the soil urease and in the protease activity. The protease activity of the soil samples that were extracted from the 0–20 cm and 20–40 cm soil layers in October was higher in the samples that were taken from farms using conventional practices than it was in the samples that were taken from farms using organic and low-input practices, while the samples that were collected during December from both of the soil layers showed higher protease activity when organic methods had been used. No significant variation in the soil urease activity was observed between the two soil layer samples. Urease activity was the highest when organic management practices were being used, followed by the low-input and the conventional modes. For the conventional and low-input practices, the soil urease activity showed an obvious trend of change that was related to thetime of sampling, i.e., activity in December was significantly higher than activity in October. The novelty of this study was to determine the microbial biomass carbon and enzymatic activity in a six-field crop rotation (tomato, cucumber, celery, fennel, cauliflower, and eggplant) using three management practices: low-input, conventional, and organic systems. The present study showed that the long-term application of organic fertilizers plays a large role in maintaining excellent microbial and enzyme activitythat result in improved soil quality. Full article

Trauma is one of the leading causes of uncontrolled haemorrhage, death, and disability. Use of a tourniquet can be considered an optimal anti-haemorrhagic resource, in pre-hospital and emergency settings, and its lifesaving effect is clinically contradictory. This review aims to assess the clinical efficacy of the tourniquet in the emergency pre-hospital care setting for the management of haemorrhage. We conducted the systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the PRISMA statement. We searched the following electronic databases: EMBASE, MEDLINE, and Cochrane-CENTRAL. All studies included were appraised for risk of bias. Prevalent primary outcomes were mortality and use of blood products. Secondary outcomes were related to adverse effects. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Four studies were involved (1762 trauma patients). The adjusted odds ratio (aOR) of 0.47 (95% confidence Interval (CI) 0.19–1.16; three studies; 377 patients) for overall mortality estimates did not give a clear indication of the benefits of emergency pre-hospital tourniquets (PH-TQ) versus no pre-hospital tourniquet (NO PH-TQ) placement. The adjusted mean difference for blood product use was −3.28 (95% CI −11.22, 4.66) for packed red blood cells (pRBC) and −4.80 (95% CI −5.61, −3.99) for plasma, respectively. The certainty of evidence was downgraded to very low for all outcomes. Our results suggest an unclear effect of emergency pre-hospital tourniquet placement on overall mortality and blood product use. However, this systematic review highlights the availability of only observational studies and the absence of high quality RCTs assessing the efficacy of PH-TQs. Randomized controlled trials are needed. Full article

Background: Sustained exposure to excess noise in recreational settings is among the main causes of hearing loss among young adults worldwide. Within a global effort to develop standards for safe listening in entertainment venues, this study aims at identifying modifiable factors (knowledge, attitudes, and beliefs), which can hinder or facilitate the acceptance of safe listening measures in public venues among young venue-goers. Methods: An online questionnaire was developed inspired by the Health Belief Model. It was divided into five sections: (i) socio-demographics (ii) listening habits, (iii) experiences with loud music, (iv) knowledge, attitudes, and beliefs, and (v) willingness to change. Participants were recruited through social media. Results: 2264 individuals aged 16–35 completed the questionnaire. Most visited entertainment venues relatively infrequently, with the majority of them only visiting once per month or less. Nevertheless, most reported having experienced the negative consequences of listening to loud music. Overall, most people were favorable towards preventive measures, especially quiet areas. Conclusion: Our findings stress the urge to address the issue of safe listening in public venues and support an approach based on the introduction of standards. Moreover, they provide us with information on key factors to be considered when introducing and communicating preventive measures in public entertainment venues. Full article

A growing body of literature has documented the negative impacts of air pollution on labor productivity, especially the effects of fine particulate matter. In this paper, we build on this literature by dissecting two channels of how particulate matter affects labor productivity: decreasing labor supply through damaging the physical functioning of the human body, and decreasing the marginal productivity of labor through damaging the cognitive functioning of the human brain. Using the household panel survey from the China Health and Nutrition Survey (CHNS) spanning 2000 to 2015 and combining that information with remotely sensed data on exposure to particulate matter (PM2.5), namely, the most harmful air pollution, we find a significantly negative effect of PM2.5 (instrumented by thermal inversion) on labor productivity. We also find that workers who are male, without a college degree, and are employed in outdoor occupations are mainly affected by PM2.5 through decreasing working hours, whereas college-educated workers employed in indoor occupations are mainly affected by PM2.5 through decreasing unit wages. We provide suggestive evidence that health impacts are behind our measured labor-productivity losses as we find significantly lower metrics in physical activity and increasing disease prevalence under higher exposure to PM2.5. Full article

Background: Pelvic floor dysfunctions affect a third of the adult female population, including a large number of clinical conditions, which can be evaluated through validated questionnaires that inform us of the status and perception of women both objectively and subjectively. The main objective of this study was to review and explain the topics of the validated questionnaires in Spanish on pelvic floor dysfunctions and to review their psychometric properties. Methods: A systematic review was carried out in the PUBMED and WOS databases. The keywords used were in PUBMED: ((((((((“Fecal Incontinence” [Mesh]) OR “Urinary Incontinence” [Mesh]) OR “Pelvic Organ Prolapse” [Mesh]) OR “Pelvic Floor Disorders” [Mesh]) OR “Sexual Dysfunction, Physiological” [Mesh]) OR “Pelvic Girdle Pain” [Mesh]) OR “sexual function” [Title/Abstract]) OR “Prolapse” [Title/Abstract]) AND “Surveys and Questionnaires” [Mesh] AND “Validation” [Title/Abstract] combined with the Boolean operators “AND”/“OR”. In contrast, in WOS, a segregated search was carried out with each of the terms of pelvic floor dysfunction together with “Validation” and “Surveys and Questionnaires”. All articles published up to 19 November 2021 were considered. Methodological quality was assessed with the COSMIN scale. Results: A total of 687 articles were identified, of which 13 were included. The evaluated questionnaires and the structural characteristics and psychometric properties of each of them were collected. Conclusion: The Spanish versions of the questionnaires show good basic structural and psychometric characteristics for the evaluation of patients with pelvic floor dysfunctions and that they resemble other versions of the same questionnaire published in other languages. Full article

The COVID-19 epidemic has caused giant influences on people’s life, and China’s communities play an important role in dealing with these major public health events (MPHEs). Community as the grassroots autonomous organization has various significant functions in intervening in MPHEs. The community intervention follows a system which directly influences the anti-epidemic effectiveness. To explore the mechanism, we devise a theoretical system for community intervention, mainly consisting of “organizational structure”, “functional performance” and “internal and external connections”. Questionnaire surveys, the chi-square test, the independent sample T-test, and principal component analysis are used to identify the characteristics of Inner Mongolia Autonomous Region’s (Inner Mongolia) community intervention. Through the empirical research, it is verified that the community intervention in MPHEs is the combination of “the structural response of the organization”, “the performance of the community’s own function”, and “the establishment of internal and external connections”. The central Inner Mongolia delivers the best performance in community intervention compared to eastern Inner Mongolia and western Inner Mongolia. The urban communities commonly perform better than that in the agricultural and pastoral areas. The built system and findings could provide a guidance for future community to improve its intervention capability. Full article

The purpose of this study was to investigate relationships among mood states, perfectionism, and choking, and to identify a mediating effect of perfectionism on the relationship between mood states and choking experienced by Asian university baseball players in extremely stressful situations during a game. Data collected from a total of 209 male university baseball players were analyzed using SPSS 21 and AMOS 21 statistical software. The mean age of study subjects was 20.25 years. Results are as follows. First, mood states had a positive influence on perfectionism. Second, mood states had no significant influence on choking. Third, perfectionism had a positive influence on choking. Lastly, perfectionism had a complete mediating effect on the relationship between mood states and choking. The study findings will provide basic data to relieve athletes’ psychological burdens, and prevent manifestations of extreme perfectionism and choking, which can ultimately help athletes maintain high self-control of their mood states and perfectionism for better performance. Full article

Primary and secondary emissions of volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) from a waterproof coal tar membrane and their effect on the indoor air quality were investigated through a case study in a residential building situated in Madrid, Spain. The air contaminants were analyzed in situ using photoionization method and several samples of contaminants were taken using three sorbents: activated carbon, XAD2 and Tenax GR. It was found that various VOCs such as toluene, p- and m-Xylene, PAHs such as naphthalene, methyl-naphthalenes, acenaphthene, acenaphthylene, phenanthrene and fluorine, volatile organic halogens including chloroform and trichlorofluoromethane, and alkylbenzene (1,2,4-trimethylbenzene) were found at concentrations, which exceeded the limits established by international and national agencies (WHO, EPA, OSHA). Some of the above organic compounds were found also in the samples of construction and building materials, which were obtained at different heights and places. The analysis of possible sources of the contaminants pointed at the original coal-tar membrane, which was applied on the terrace to be waterproof. During a posterior reparation the membrane was coated with a new one that hindered dissipation of emitted contaminants. The contaminants leached out and were absorbed by construction materials down in the dwelling. These materials then acted as secondary emission sources. To remediate the emission problem as the contaminated materials were removed and then a ventilation system was installed to force the gasses being emitted from the rest of contaminated slab outside. Follow-up has validated the success of the remediation procedure. Full article

This study investigated the effects of yelling intervention on symptoms and autonomic responses in motion sickness. Forty-two healthy participants were recruited, and they participated in Coriolis stimulation, a technique for inducing motion sickness. The experimental procedure comprised five 1-min rotating stimuli with 1-min rest after each stimulus. Then, the symptom severity was assessed using the Motion Sickness Symptom Rating (MSSR). The d2 Test of Attention scores and cardiovascular responses were recorded before and after Coriolis stimulation. The electrocardiogram results were documented to analyze heart rate variability (HRV). During Coriolis stimulus, the participants were required to yell 5–8 times in the experimental trial, and to keep quiet for each minute of rotation in the control trial. The yelling intervention significantly reduced the MSSR score (p < 0.001). Nevertheless, it did not significantly affect the d2 Test of Attention scores. Yelling while rotating did not significantly affect the heart rate nor blood pressure. However, it decreased the normalized low frequency of HRV (p = 0.036). Moreover, it improved motion sickness, but its effect on attention was not evident. Motion sickness could significantly affect cardiovascular responses and HRV. However, yelling did not affect cardiovascular response, and it reduced sympathetic nervous system activity. Full article

India is witnessing an increase in the prevalence of multimorbidity. Oral health is related to overall health but is seldom included in the assessment of multimorbidity. Hence, this study aimed to estimate the prevalence of oral morbidity and explore its association with physical multimorbidity using data from Longitudinal Ageing Study in India (LASI). LASI is a nationwide survey amongst adults aged ≥ 45 years conducted in 2018. Descriptive analysis was performed on included participants (n = 59,764) to determine the prevalence of oral morbidity. Multivariable logistic regression assessed the association between oral morbidity and physical multimorbidity. Self-rated health was compared between multimorbid participants with and without oral morbidity. Oral morbidity was prevalent in 48.56% of participants and physical multimorbidity in 50.36%. Those with multimorbidity were at a higher risk of having any oral morbidity (AOR: 1.60 (1.48–1.73)) than those without multimorbidity. Participants who had only oral morbidity rated their health to be good more often than those who had physical multimorbidity and oral morbidity (40.84% vs. 32.98%). Oral morbidity is significantly associated with physical multimorbidity. Multimorbid participants perceived their health to be inferior to those with only oral morbidity. The findings suggest multidisciplinary health teams in primary care should include the management of oral morbidity and physical multimorbidity. Full article

Cadaver studies represented a milestone in surgical orthopaedic research, and still today they play a crucial role in the achievement of new knowledge about joint disease behaviour and treatment. In this review, an overview of the cadaver studies available in the literature about the anatomy, role, and treatment of the antero-lateral ligament (ALL) of the knee was performed. The aim of the review was to describe and gain more insight into the part of in vitro study in understanding knee joint anatomy and biomechanics, and in developing surgical reconstruction techniques. The findings of the review showed that cadaver studies had, and will continue to have, a key role in the research of knee joint biomechanics and surgical reconstruction. Moreover, they represent a powerful tool to develop and test new devices which could be useful in clinical and surgical practice. Full article

Each year, 1.35 million people worldwide die due to Road Traffic Injuries (RTI), highlighting the need for further research. The risk of RTI is usually estimated as the number of casualties divided by the level of exposure in a population. Identifying the most appropriate exposure measures is one of the most important current challenges in this field. This paper presents an analysis of exposure measures used in empirical studies on road accidents. The results show a large variability in the exposure measures used, ranging from more general measures (such as population figures or vehicle fleet) to more specific measures related to mobility (such as number of trips, distances or travel time). A comparison of the risk patterns found shows that there is a partial consensus on the profiles with the highest risk of road traffic injuries. In conclusion, there is a need for the international standardization of criteria and data to be recorded, at least injury severity and measures of exposure to mobility, as the travel time disaggregated by socio-demographic variables and mode of transport. Such data would provide higher-quality results on risk profiles and facilitate the implementation of more effective, knowledge-based road safety policies. Full article

This research analyzed the impact of environmental regulations and their power in suppressing tourism carbon emissions. The results showed that: (1) four types of environmental regulations had significant inhibiting effects on tourism carbon emissions, but different types of regulations had varying effects; and (2) environmental regulations had a significant time lag effect on tourism carbon emissions. The decay rates of the environmental regulation effects were dissimilar for supervisory management, market incentives, command and control, and public participation; and (3) environmental regulations had dissimilar influences on tourism carbon emissions at the regional level. Government agencies should choose differentiated environmental regulation tools, attach great importance to the time-lag effect of environmental regulations on tourism carbon emissions, and establish systems and mechanisms of public participation in environmental matters. Full article

Ligament reconstruction is indicated in patients with an isolated posterior cruciate ligament (PCL) injury who fail conservative treatment. To eliminate the need for PCL reconstruction, an ideal rehabilitation program is important for patients with an isolated PCL injury. The purpose of this study was to investigate the improvement in functional outcome, proprioception, and muscle strength after a Both Sides Up (BOSU) ball was used in a balance combined with strength training program in patients with an isolated PCL injury. Ten patients with isolated PCL injuries were recruited to receive a 12 week training program as a study group. In the control group (post-PCL reconstruction group), ten subjects who had undergone isolated PCL reconstruction for more than 2 years were enrolled without current rehabilitation. The Lysholm score, IKDC score, proprioception (active and passive), and isokinetic muscle strength tests at 60°/s, 120°/s, and 240°/s, were used before and after training on the injured and normal knees in the study group, and in the post-PCL reconstruction group. The results were analyzed with a paired t-test to compare the change between pre-training, post-training, and the normal leg in the study group, and with an independent t-test for comparisons between the study and post-PCL reconstruction groups. Both the Lysholm and IKDC scores were significantly improved (p < 0.01) after training, and no difference was observed compared to the post-PCL reconstruction group. The active and passive proprioception was improved post-training compared to pre-training, with no difference to that in the post-PCL reconstruction group. Isokinetic knee quadriceps muscle strength was significantly greater post-training than pre-training in PCL injured knees at 60°/s, 120°/s, and 240°/s, and in hamstring muscle strength at 60°/s and 120°/s. Muscle strength in the post-training injured knee group showed no significant difference compared to that in the post-training normal leg and the post-PCL reconstruction group. The post-training improvement of muscle strength was higher in the PCL injured leg compared to the normal leg and there was no difference between the dominant and non-dominant injured leg in the study group. After 12 weeks of BOSU balance with strength training in patients with an isolated PCL injury, the functional outcome, proprioception, and isokinetic muscle strength were significantly improved, and comparable to the contralateral normal leg and the post-PCL reconstruction group. We suggest that programs combining BOSU balance and strength training should be introduced in patients with a PCL injury to promote positive clinical results. Full article

The impact of chemical to organic fertilizer substitution on soil labile organic and stabilized N pools under intensive farming systems is unclear. Therefore, we analyzed the distribution of soil total N (STN), particulate organic N (PON), microbial biomass N (MBN), dissolved organic N (DON), and mineral N (NO₃⁻ and NH₄⁺) levels down to 100 cm profile under wheat–maize rotation system in northern China. The experiment was established with four 270 kg ha⁻¹ N equivalent fertilizer treatments: Organic manure (OM); Organic manure with nitrogen fertilizer (OM + NF); Nitrogen fertilizer (NF); and Control (CK). Results found that the OM and OM + NF treatments had significantly higher STN, PON, MBN, DON, and NO₃⁻ contents in 0–20 cm topsoil depths. Conversely, the NF treatment resulted in the highest (p < 0.01) DON and NO₃⁻ depositions in 40–100 cm subsoil depths. The NH₄⁺ contents in selected profile depths were significantly highest (p < 0.01) under OM treatment. The correlations between STN and its fractions were positively significant at 0–10 and 10–20 cm topsoil depths. Our results suggest that partial substitution of chemical fertilizer with organic manure could be a sustainable option for soil N management of intensive farming systems. Full article

Background: In orthodontic therapy, the enamel around brackets is very susceptible to bacterial-plaque retention, which represents a risk factor for dental tissues. The aim of this study was to evaluate the effect of methylene blue and a chlorophyllin–phycocyanin mixture, used with and without light activation, in contrast with a 2% chlorhexidine solution, on Streptococcus mutans colonies. Methods: Twenty caries-free human extracted teeth were randomized into five groups. A Streptococcus mutans suspension was inoculated on teeth in groups B, C, D, and E (A was the positive-control group). Bacterial colonies from groups C, D, and E (B was the negative-control group) were subjected to photosensitizers and 2% chlorhexidine solution. For groups C and D, a combined therapy consisting of photosensitizer and light activation was performed. The Streptococcus mutans colonies were counted, and smears were examined with an optical microscope. Two methods of statistical analysis, unidirectional analysis of variance and the Tukey–Kramer test, were used to evaluate the results. Results: A statistically significant reduction in bacterial colonies was detected after the combined therapy was applied for groups C and D, but the most marked bacterial reduction was observed for group D, where a laser-activated chlorophyll–phycocyanin mixture was used. Conclusions: Photodynamic therapy in combination with methylene blue or chlorophyllin–phycocyanin mixture sensitizers induces a statistically significant decrease in the number of bacterial colonies. Full article

Effective interventions for guiding children to change behaviours are needed to tackle obesity. We evaluated the effectiveness of the ‘Planning Health in School’ programme (PHS-pro) on children’s nutritional status. A non-randomised control group pretest-posttest trial was conducted at elementary schools of a sub-urban municipality in Porto’s metropolitan area (Portugal). A total of 504 children of grade-6, aged 10–14, were assigned in two groups: children of one school as the intervention group (IG), and three schools as the control group (CG). Anthropometric measures included height, weight, waist circumference (WC), BMI and waist-to-height ratio (WHtR), and lifestyle behaviours (self-reported questionnaire) were assessed at baseline and after PHS-pro. IG children grew significantly taller more than CG ones (p < 0.001). WC had reduced significantly in IG (−0.4 cm) whereas in the CG had increased (+0.3 cm; p = 0.015), and WHtR of IG showed a significant reduction (p = 0.002) compared with CG. After PHS-pro, IG children consumed significantly fewer soft drinks (p = 0.043) and ate more fruit and vegetables daily than CG. Physical activity time increased significantly in IG (p = 0.022), while CG maintained the same activity level. The PHS-pro did improve anthropometric outcomes effectively leading to better nutritional status and appears to be promising in reducing overweight and obesity. Full article

Background: Associated lesions in the diagnostic MRI may be related to worse long-term subjective outcomes. There is a lack of conclusive information about the long-term outcomes of associated injuries in anterior cruciate ligament (ACL) tears. The purpose of this study is to assess the long-term effects of associated injuries in ACL tears measured by means of a quality of life (QOL) assessment. Methods: A retrospective cohort study of 225 consecutive patients admitted for physical therapy with ACL injury (42 ± 12 years, 28.2% female) were conducted. All demographic and clinical variables were used to measure a QOL. Univariate and multivariable analyses were completed. Results: The mean follow-up period was 8.4 ± 2.6 years. In univariate analysis, male gender, and sports as the cause of the ACL lesion were factors significantly associated with improved International Knee Documentation Committee (IKDC) scores at the end of follow-up (all p < 0.002). In multivariable analysis, the occurrence of bone contusion was positively associated with injury (OR = 2.12) and negatively associated with sports injury (OR = 0.44) and medial collateral ligament (MCL) injury (OR = 0.48). Conclusions: After ACL injury, male gender and sports injury were associated with better clinical outcomes. Full article

To evaluate the digital platforms most used by adolescents for healthy lifestyle information, perceived helpfulness of platform information, helpfulness for positive behaviour changes, and quality of platforms’ lifestyle health information. Mixed-methods study including a cross-sectional online survey and content analysis. Eligible participants were 13–18-years; living in Australia; and had searched online for healthy lifestyle behaviour (nutrition, physical activity, weight management, sleep) information in the previous three months. Survey items examined the use of digital platforms, self-perceived helpfulness, usefulness for positive behaviour, and popular content. Data were analysed using descriptive statistics and ordinal logistic regression models. Content analysis was performed on popular digital content to evaluate expertise, objectivity, transparency, popularity, and relevance. In total, 297 participants completed the survey (62.3% female; 15.8 [SD1.5] years). Seventy-eight percent and 77% of participants reported using websites and social media, respectively, for seeking healthy lifestyle information. Websites and social media were rated as somewhat helpful by 43% and 46% of participants, respectively. Sixty-six percent and 53% of participants agreed/strongly agreed smartphone apps and social media were helpful for positive behaviour change, respectively. Helpfulness did not differ by age or gender. We evaluated 582 popular digital content; 38% were produced by a commercial company. Only 7% of content was from health organisations, 10% from health professionals and only 10% of content was objective, and 14% was transparent. Adolescents extensively utilise websites and social media for health information, yet popular content has limited objectivity and transparency. Governments and health organisations should consider creating age-appropriate digital information for healthy lifestyle behaviours. Full article

Developments in anthropometric history in the Iberian Peninsula have been remarkable in recent decades. In contrast, we barely know about the behavior of insular population groups and infants’ and adults’ growth during the nutritional transition in the Canary Islands. This paper analyzes the height, weight and body mass index of military recruits (conscripts) in a rural municipality from the eastern Canaries during the economic modernization process throughout the 20th century. The case study (municipality of San Bartolomé (SB) in Lanzarote, the island closest to the African continent) uses anthropometric data of military recruits from 1907–2001 (cohorts from 1886 to 1982). The final sample is composed of 1921 recruits’ records that were measured and weighed at the ages of 19–21 years old when adolescent growth had finished. The long-term anthropometric study is carried out using two approaches: a malnutrition and growth retardation approach and an inequality perspective. In the first one, we use the methodology recommended by the World Health Organization (WHO) that is based on z-scores. In the second one, we implement several inequality dimensions such as the coefficient of variation (CV), percentiles and an analysis for height and BMI evolution by five socioeconomic categories. The data suggest that improvements in biological well-being were due to advances in nutrition since the 1960s. They show that infant nutrition is sensitively associated with economic growth and demographic and epidemiological changes. Full article

Climate change affects public health, and improving eco-efficiency means reducing the various pollutants that are the result of economic activities. This study provided empirical evidence of the quantitative impact analysis of climate change on the health conditions of residents across China due to improvements that have been made to eco-efficiency. First, the indicators that were collected present adequate graphical trends and regional differences with a priori evidence about their relationships to each other; second, the present study applied Sensitivity Evaluation with Support Vector Machines (SE-SVM) to Chinese provincial panel data, taking the Visits to Hospitals, Outpatients with Emergency Treatment, and Number of Inpatients as proxy variables for the health conditions of the residents in each area and temperature, humidity, precipitation, and sunshine as the climate change variables, simultaneously incorporating the calculated eco-efficiency with six controlling indicators; third, we compared in-sample forecasting to acquire the optimal model in order to conduct elasticity analysis. The results showed that (1) temperature, humidity, precipitation, and sunshine performed well in forecasting the health conditions of the residents and that climate change was a good forecaster for resident health conditions; (2) from the national perspective, climate change had a positive relationship with Visits to Hospitals and Outpatients with Emergency Treatment but a negative relationship with the Number of Inpatients; (3) An increase in regional eco-efficiency of 1% increase the need for Visits to Hospitals and Outpatients with Emergency Treatment by 0.2242% and 0.2688%, respectively, but decreased the Number of Inpatients by 0.6272%; (4) increasing the regional eco-efficiency did not show any positive effects for any individual region because a variety of local activities, resource endowment, and the level of medical technology available in each region played different roles. The main findings of the present study are helpful for decision makers who are trying to optimize policy formulation and implementation measures in the cross-domains of economic, environmental, and public health. Full article

Poor freshwater beach quality, measured by Escherichia coli (E. coli) levels, poses a risk of recreational water illness. This study linked environmental data to E. coli geometric means collected at 18 beaches in Toronto (2008–2019) and the Niagara Region (2011–2019) to examine the environmental predictors of E. coli. We developed region-specific models using mixed effects models to examine E. coli as a continuous variable and recommended thresholds of E. coli concentration (100 CFU/100 mL and 200 CFU/100 mL). Substantial clustering of E. coli values at the beach level was observed in Toronto, while minimal clustering was seen in Niagara, suggesting an important beach-specific effect in Toronto beaches. Air temperature and turbidity (measured directly or visually observed) were positively associated with E. coli in all models in both regions. In Toronto, waterfowl counts, rainfall, stream discharge and water temperature were positively associated with E. coli levels, while solar irradiance and water level were negatively associated. In Niagara, wave height and water level had a positive association with E. coli, while rainfall was negatively associated. The differences in regional models suggest the importance of a region-specific approach to addressing beach water quality. The results can guide beach monitoring and management practices, including predictive modelling. Full article

Monothioarsenate (MTAs^V) is one of the major arsenic species in sulfur- or iron-rich groundwater, and the sediment adsorption of MTAs^V plays an important role in arsenic cycling in the subsurface environment. In this study, batch experiments and characterization are conducted to investigate the sorption characteristic and mechanism of MTAs^V on natural sediments and the influences of arsenite and arsenate. Results show that MTAs^V adsorption on natural sediments is similar to arsenate and arsenite, manifested by a rapid early increasing stage, a slowly increasing stage at an intermediate time until 8 h, before finally approaching an asymptote. The sediment sorption for MTAs^V mainly occurs on localized sites with high contents of Fe and Al, where MTAs^V forms a monolayer on the surface of natural sediments via a chemisorption mechanism and meanwhile the adsorbed MTAs^V mainly transforms into other As species, such as AlAs, Al-As-O, and Fe-As-O compounds. At low concentration, MTAs^V sorption isotherm by natural sediments becomes the Freundlich isotherm model, while at high concentration of MTAs^V, its sorption isotherm becomes the Langmuir isotherm model. The best-fitted maximum adsorption capacity for MTAs^V adsorption is about 362.22 μg/g. Furthermore, there is a competitive effect between MTAs^V and arsenate adsorption, and MTAs^V and arsenite adsorption on natural sediments. More specifically, the presence of arsenite greatly decreases MTAs^V sorption, while the presence of MTAs^V causes a certain degree of reduction of arsenite adsorption on the sediments before 4 h, and this effect becomes weaker when approaching the equilibrium state. The presence of arsenate greatly decreases MTAs^V sorption and the presence of MTAs^V also greatly decreases arsenate sorption. These competitive effects may greatly affect MTAs^V transport in groundwater systems and need more attention in the future. Full article

The Coronavirus disease 2019 (COVID-19) pandemic, immigrant status and being a member of the LGBT+ community are all independent factors associated with increased stress levels. Few studies provide more complex analysis on this issue, and there has been no research on the cumulative burden of perceived stress that people belonging to both minorities experience in the current epidemiological situation. The aim of this study was to assess the ability to deal with an external situation during the third wave of the COVID-19 pandemic in Poland in the following groups with different stress levels (total sample n = 370): Polish heterosexual men (n = 202), heterosexual men from Ukraine (n = 131) and homo- and bisexual men (men who have sex with men—MSM) from Ukraine (n = 37). A Perceived Stress Scale (PSS-10) was used. The analysis of the survey did not show statistically significant differences between the three study groups in the general level of perceived stress (24.71, 24.77 and 26.49 points, respectively, p = 0.551), but it revealed numerous differences in coping with various aspects of everyday functioning between these groups. Negative assessment of one’s own health proved to be the main factor negatively affecting the level of perceived stress, however specific health risks, medical history or the participants’ previous experience have not been taken into account in the study. Our research shows differences in the needs, resources and methods of coping with stress between men who are Polish citizens and migrants from Ukraine, both heterosexual and belonging to the MSM group. Proper identification and addressing of these needs, taking into account different availability of health services, could be the responsibility of NGOs or insurance providers. This should result in the reduction of mental health burdens and the risk of developing serious mental disorders, and consequently in better functioning of persons belonging to minorities and in a reduced burden on the health care system. Full article

Neurodevelopmental disorders are a heterogeneous group of conditions with overlapping symptomatology and fluctuating developmental trajectories that transcend current diagnostic categorisation. There is a need for validated screening instruments which dimensionally assess symptomatology from a holistic, transdiagnostic perspective. The primary aim is to co-design a Neurodevelopment Assessment Scale (NAS), a user-friendly transdiagnostic assessment inventory that systematically screens for all signs and symptoms commonly encountered in neurodevelopmental disorders. Our first objective is to undertake development of this tool, utilising co-design principles in partnership with stakeholders, including both those with lived experience of neurodevelopmental disorders and service providers. Our second objective is to evaluate the face validity, as well as the perceived utility, user-friendliness, suitability, and acceptability (i.e., ‘social validity’), of the NAS from the perspective of parents/caregivers and adults with neurodevelopmental disorders, clinicians, and service providers. Our third objective is to ascertain the psychometric properties of the NAS, including content validity and convergent validity. The NAS will provide an efficient transdiagnostic tool for evaluating all relevant signs, symptoms, and the dimensional constructs that underpin neurodevelopmental presentations. It is anticipated that this will maximise outcomes by enabling the delivery of personalised care tailored to an individual’s unique profile in a holistic and efficient manner. Full article

The intestinal mucosa provides a selective permeable barrier for nutrient absorption and protection from external factors. It consists of epithelial cells, immune cells and their secretions. The gut microbiota participates in regulating the integrity and function of the intestinal barrier in a homeostatic balance. Pathogens, xenobiotics and food can disrupt the intestinal barrier, promoting systemic inflammation and tissue damage. Genetic and immune factors predispose individuals to gut barrier dysfunction, and changes in the composition and function of the gut microbiota are central to this process. The progressive identification of these changes has led to the development of the concept of ‘leaky gut syndrome’ and ‘gut dysbiosis’, which underlie the relationship between intestinal barrier impairment, metabolic diseases and autoimmunity. Understanding the mechanisms underlying this process is an intriguing subject of research for the diagnosis and treatment of various intestinal and extraintestinal diseases. Full article