Int. J. Environ. Res. Public Health, Volume 18, Issue 4 (February-2 2021) – 836 articles

The parametric model introduced by Lee and Carter in 1992 for modeling mortality rates in the USA was a seminal development in forecasting life expectancies and has been widely used since then. Different extensions of this model, using different hypotheses about the data, constraints on the parameters, and appropriate methods have led to improvements in the model’s fit to historical data and the model’s forecasting of the future. This paper’s main objective is to evaluate if differences between models are reflected in different mortality indicators’ forecasts. To this end, nine sets of indicator predictions were generated by crossing three models and three block-bootstrap samples with each of size fifty. Later the predicted mortality indicators were compared using functional ANOVA. Models and block bootstrap procedures are applied to Spanish mortality data. Results show model, block-bootstrap, and interaction effects for all mortality indicators. Although it was not our main objective, it is essential to point out that the sample effect should not be present since they must be realizations of the same population, and therefore the procedure should lead to samples that do not influence the results. Regarding significant model effect, it follows that, although the addition of terms improves the adjustment of probabilities and translates into an effect on mortality indicators, the model’s predictions must be checked in terms of their probabilities and the mortality indicators of interest. Full article

Objectives: This study aimed to assess the impact of the COVID-19 pandemic on the mental health status of healthcare professionals (HCPs) and undergraduate students in the health sciences center (HSCUs). In addition, it explored the factors associated with the increased levels of mental health burden among the study population. Methods: A cross-sectional study was performed using two online-administered questionnaires: the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7), which were distributed in parallel to HCPs and HSCUs in Kuwait. These instruments are validated assessment scales to assess mental health status: depression (PHQ-9) and anxiety (GAD-7). Statistical analyses were carried out using SPSS- version 25. Results: A total of 857 individuals (559 HCPs and 298 HSCUs) participated in this study. The prevalence of moderately severe depression or severe depression (PHQ-9 total score of ≥15) among respondents was 66.6%. The median (interquartile range, IQR) PHQ-9 score was significantly higher among HSCUs (20 {11.5}) compared to HCPs (17 {8}). The prevalence of severe anxiety (GAD-7 total score of ≥15) among respondents was 36.7%. There were no significant differences between the median (IQR) GAD-7 scores among the HCPs (14 {7}) and HSCUs (13 {8}). Binary logistic regression analysis revealed that three variables were significantly and independently associated with severe depression among HCPs. The prevalence of severe depression was found to be greater among females compared to males. In addition, it was significantly lower among those who were aged ≥50 years, and those who reported that they were not in direct contact with COVID-19 patients. Among HSCUs, females showed greater depression than males. In contrast, those aged >29 years and who had no history of chronic disease showed lower depression compared to their counterparts in the 18–29 years age group and who had a chronic disease history. Conclusions: The COVID-19 pandemic had a significant negative impact on the mental health of HCPs and HSCUs in Kuwait. This highlights the need for proactive efforts to support their mental health and well-being through educational campaigns and psychological support programs. Full article

Fractalkine (CX3CL1) is a chemokine that plays a significant role in inflammation, one of the pathophysiological processes underlying end-stage renal disease (ESRD). Genetic factors are significantly involved in cytokine expression and have been studied as potential risk factors for chronic kidney disease (CKD). Objectives: We aimed to elucidate the association of CX3CR1 gene polymorphisms rs3732378 and rs3732379 with the levels of CX3CL1, CX3CL1 receptor (CX3CR1), as well as C-reactive protein (CRP). Patients and methods: We enrolled 198 participants, including 106 patients with ESRD and 92 controls. Peripheral blood samples were collected from each patient for genetic (rs3732378 and rs3732379 polymorphisms) and immunoenzymatic (fractalkine, CX3CR1, CRP) tests. Results: CX3CR1 and CRP levels were higher in patients with ESRD than in controls (p < 0.05). Fractalkine levels were significantly higher in ESRD patients who were homozygous for the G allele of the rs3732378 polymorphism and for the C allele of the rs3732379 polymorphism than in homozygous controls. Moreover, carriers of these alleles among patients with ESRD had significantly higher CX3CR1 levels than controls. Conclusions: The G allele of the rs3732378 polymorphism and the C allele of the rs3732379 polymorphism of the CX3CR1 gene are associated with higher CX3CL1 and CX3CR1 levels. Our study suggests that CX3CR1 gene polymorphisms could be potentially involved in the pathogenesis of ESRD, but the study needs to be replicated in a larger population with a longitudinal follow-up study. Identification of genetic factors associated with inflammation in ESRD may contribute to the development of targeted gene therapies in the future. Full article

Household energy conservation is an important contributor to achieve the carbon emission reduction target. However, the actual energy-saving effect of Chinese households is under expectation. One reason for this is because household energy consumption is locked in at a certain level, which has become an obstacle to household carbon emission reduction. In order to reduce this obstacle, this study explored the cause of household carbon lock-in based on grounded theory, targeting newly furnished households. A theoretical model was developed to reveal the formation mechanism of carbon lock-in effect in the purchasing process of household energy-using appliances. NVivo 12 software was used to analyze the decoration diaries of 616 sample households, and the results showed that (1) the direct antecedent of the household carbon lock-in effect was the lock-in of purchasing behavior, and the household carbon lock-in effect was mainly exhibited in the consumption path dependence (of energy-using appliances) and the solidification of energy structure; (2) the willingness to purchase household appliances was the direct antecedent of purchasing behavioral lock-in, and the cost had a moderating effect on the transformation from purchase willingness to behavioral lock-in; and (3) in the process of purchasing household appliances, reference groups, value perception, and ecological awareness can promote purchasing behavioral lock-in by affecting willingness of purchase. Suggestions to promote unlocking of household carbon were also proposed. Full article

Active tobacco exposure during pregnancy is a known determinant of fetal growth. Nitrates and atrazine metabolites in drinking water may affect fetal growth as a mixture of endocrine disruptors (ED). We aimed to determine whether EDC have an additional effect on fetal growth compared to active tobacco exposure. A historic cohort study was carried out with a sample stratified with regard to the maternity unit, drinking water exposure, and year of birth. The women included were living in Deux-Sèvres, had given birth between 2005 and 2010 in three selected maternity units, and ultrasound data were available in their obstetrical records. Mixed linear models were used to analyze fetal weight evolution from the second trimester to the time of birth according to drinking water exposure to EDC mixture and active tobacco exposure. We included 558 mother-neonate couples, of whom 9% were exposed to high doses of the mixture and 21% to active tobacco smoking. There was no difference in fetal weight evolution according to drinking water mixture exposure (0.97 g; 95% CI [−3.01; 4.94]). We could not show a supplementary effect of mixture exposure in drinking-water on fetal growth as compared to active tobacco exposure. Further research is needed, using more precise methods to estimate EDC exposure. Full article

Background: The prevailing sex education (SE) model falls within a neoliberal prevention- and risk-oriented paradigm. This model ignores the identity dimension of sexuality, is based on the cis-heteronormative and ethnocentric matrix and stigmatizes sexual and cultural diversity; this has significant consequences for sexually and culturally diverse adolescents and youth. In this study, we explored the potential of the identity dimension of SE to prevent violence toward sexual and cultural diversity. Specifically, our objective was to identify the influence of heteronormative and ethnocentric variables on violence exerted against trans* and gender-diverse people and people from minority ethnic groups. Methods: A total of 623 Spanish adolescents with a mean age of 14.73 years and an age range of 13 to 18 years participated in the study. Students completed a questionnaire that included measures regarding violence toward sexual and cultural diversity, gender stereotypes, sexist attitudes and rejection of sexual and cultural diversity. We performed two hierarchical linear regression models. Results: Students who exerted the highest amount of violence toward trans* and gender-diverse people were those who showed the lowest endorsement of expressive traits and the highest endorsement of instrumental traits as well as the highest level of hostile sexist, heteronormative and hostile racist attitudes (the five predictor variables explained 29.1% of the variance of gender-bashing). These same variables—except expressiveness—and benevolent sexism explained 46.1% of the variance of rejection of minority ethnic groups. Conclusions: There is a need for a comprehensive, intercultural, critical and queer SE aimed at transforming the classroom into a space that promotes social transformation through an educational practice that is transgressive and critical of cis-heteronormativity and normative ethnocentrism. Full article

Noise pollution is a growing global public health concern. Among other issues, it has been linked with sleep disturbance, hearing functionality, increased blood pressure and heart disease. Individuals are increasingly using social media to express complaints and concerns about problematic noise sources. This behavior—using social media to post noise-related concerns—might help us better identify troublesome noise pollution hotspots, thereby enabling us to take corrective action. The present work is a concept case study exploring the use of social media data as a means of identifying and monitoring noise annoyance across the United Arab Emirates (UAE). We explored an extract of Twitter data for the UAE, comprising over eight million messages (tweets) sent during 2015. We employed a search algorithm to identify tweets concerned with noise annoyance and, where possible, we also extracted the exact location via Global Positioning System (GPS) coordinates) associated with specific messages/complaints. The identified noise complaints were organized in a digital database and analyzed according to three criteria: first, the main types of the noise source (music, human factors, transport infrastructures); second, exterior or interior noise source and finally, date and time of the report, with the location of the Twitter user. This study supports the idea that lexicon-based analyses of large social media datasets may prove to be a useful adjunct or as a complement to existing noise pollution identification and surveillance strategies. Full article

Hematopoietic cancer is a malignant transformation in immune system cells. Hematopoietic cancer is characterized by the cells that are expressed, so it is usually difficult to distinguish its heterogeneities in the hematopoiesis process. Traditional approaches for cancer subtyping use statistical techniques. Furthermore, due to the overfitting problem of small samples, in case of a minor cancer, it does not have enough sample material for building a classification model. Therefore, we propose not only to build a classification model for five major subtypes using two kinds of losses, namely reconstruction loss and classification loss, but also to extract suitable features using a deep autoencoder. Furthermore, for considering the data imbalance problem, we apply an oversampling algorithm, the synthetic minority oversampling technique (SMOTE). For validation of our proposed autoencoder-based feature extraction approach for hematopoietic cancer subtype classification, we compared other traditional feature selection algorithms (principal component analysis, non-negative matrix factorization) and classification algorithms with the SMOTE oversampling approach. Additionally, we used the Shapley Additive exPlanations (SHAP) interpretation technique in our model to explain the important gene/protein for hematopoietic cancer subtype classification. Furthermore, we compared five widely used classification algorithms, including logistic regression, random forest, k-nearest neighbor, artificial neural network and support vector machine. The results of autoencoder-based feature extraction approaches showed good performance, and the best result was the SMOTE oversampling-applied support vector machine algorithm consider both focal loss and reconstruction loss as the loss function for autoencoder (AE) feature selection approach, which produced 97.01% accuracy, 92.60% recall, 99.52% specificity, 93.54% F1-measure, 97.87% G-mean and 95.46% index of balanced accuracy as subtype classification performance measures. Full article

The COVID-19 pandemic has put an enormous burden on healthcare systems. As a direct consequence, many elective procedures were cancelled and available resources were relocated to emergencies and COVID-19 patients. We aimed to analyze the impact on orthopedic surgery in Romania. We performed a retrospective analysis of orthopedics and trauma cases admitted over the first six months of 2019 and 2020 in three representative clinics. In total, there were 1900 patients: 1241 from Timisoara, 216 from Cluj-Napoca, and 443 from Bucharest. In April, activity for all cases in the regional trauma center dropped to 23.8% and stopped in the other two. No arthroscopies or elective joint replacements were performed in April. By June, hospital admissions resumed for trauma cases while arthroscopies and joint replacements still lagged behind. Full article

The activity of scientists promotes medical research in health services. However, on many occasions, these professionals do not know how to transfer their research results to the market. Therefore, it is worth providing data on aspects such as training in entrepreneurship and scientific mobility to foster knowledge transfer. This paper discusses data on the Spanish case in Health Sciences to devise effective policies in these areas. To this end, following the methodology of the Global Entrepreneurship Monitor report and the existing scientific literature, 291 researchers involved in scientific mobility in Spain have been interviewed. Of these, 90 belonged to health areas: Spanish scientists abroad (37), Scientists returned to Spain (16), and Young researchers in Spain (37). The results show that the mobile scientists in this area have more entrepreneurial and intrapreneurial intentions, have acquired more entrepreneurial skills, and have received more training in these subjects. Furthermore, there are few permanent positions for all these groups whose mobility decisions fundamentally depend on job opportunities, so the health authorities can intensify these measures to promote knowledge transfer. Full article

The impact of individuals’ mobility on the degree of error in estimates of exposure to ambient PM${}_{2.5}$ concentrations is increasingly reported in the literature. However, the degree to which accounting for mobility reduces error likely varies as a function of two related factors—individuals’ routine travel patterns and the local variations of air pollution fields. We investigated whether individuals’ routine travel patterns moderate the impact of mobility on individual long-term exposure assessment. Here, we have used real-world time–activity data collected from 2013 participants in Erie/Niagara counties, New York, USA, matched with daily PM${}_{2.5}$ predictions obtained from two spatial exposure models. We further examined the role of the spatiotemporal representation of ambient PM${}_{2.5}$ as a second moderator in the relationship between an individual’s mobility and the exposure measurement error using a random effect model. We found that the effect of mobility on the long-term exposure estimates was significant, but that this effect was modified by individuals’ routine travel patterns. Further, this effect modification was pronounced when the local variations of ambient PM${}_{2.5}$ concentrations were captured from multiple sources of air pollution data (‘a multi-sourced exposure model’). In contrast, the mobility effect and its modification were not detected when ambient PM${}_{2.5}$ concentration was estimated solely from sparse monitoring data (‘a single-sourced exposure model’). This study showed that there was a significant association between individuals’ mobility and the long-term exposure measurement error. However, the effect could be modified by individuals’ routine travel patterns and the error-prone representation of spatiotemporal variability of PM${}_{2.5}$. Full article

(1) Background: Dance teachers (DT) are dependent on their functional body. Pain can hardly be avoided during the professional practice of dance. Pain can become so intense that it impairs, or even prevents, the professional practice. The aim of this study was to identify the determinants of pain intensity of the most severely affected body regions of DT in pain during the three-month period prior to the survey. (2) Methods: This cross-sectional study was conducted by an online survey. A total of 166 DT participated in the study; 143 of the DT were in pain during the three-month period and were included in the analysis. Using multiple linear regression, the determinants of pain intensity were identified from population parameters, occupational data, pain localisation, and temporal pain course. (3) Results: Regions of the lower extremity and head/trunk regions were most frequently indicated as the body regions with the most severe pain. The multiple regression model generated with the factors “functional impairment”, “biomechanical exposure”, and “pain at rest” explains a statistically significant, moderate proportion of the variance in pain intensity (R² = 0.22, F (3, 106) = 10.04, p < 0.001). (4) Conclusions: Intensity of pain in DT seems to be related to the physical demands of professional practice. Full article

With the aim of investigating the impact of gender-related personality characteristics on bullying perceptions and outcomes, a correlational study was designed with 114 individuals who had used a public health service aimed at harassed workers identifying themselves as victims of mobbing in central Italy. The study was conducted using the following questionnaires: the Negative Acts Questionnaire (NAQ), a measure of workplace bullying; the Minnesota Multiphasic Personality Inventory (MMPI-2), used to provide information to measure personality dimensions for workplace screening; the World Health Organization Quality of Life (WHOQOL-BRIEF) which assesses four domains assumed to represent the quality of life construct; and the Suicidal Potential Scale (SPS) used to assess suicidal ideation. MMPI-2 profile results show a significant elevation of specific MMPI scales and gender differences. When compared to women, men who complain of being the victims of negative actions at work are more depressed, paranoid, introverted, anxious, and obsessive, and have higher anger levels and lower self-esteem. Many different MMPI-2 scales are also predictors of quality of life (QoL) perceptions and suicidal tendencies. The NAQ total score, however, predicts quality of life and suicide risk. Perceptions of negative actions have a serious effect on life outcomes. The results provide useful indications on personality profiles and gender differences, which can be understood as antecedents in the perception of negative events, and factors capable of modulating the effect of perceived bullying actions on outcomes. Full article

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic and a burden to global health at the turn of 2019 and 2020. No targeted treatment for COVID-19 infection has been identified so far, thus supportive treatment, invasive and non-invasive oxygen support, and corticosteroids remain a common therapy. High-flow nasal cannula (HFNC), a non-invasive oxygen support method, has become a prominent treatment option for respiratory failure during the SARS-CoV-2 pandemic. HFNC reduces the anatomic dead space and increases positive end-expiratory pressure (PEEP), allowing higher concentrations and higher flow of oxygen. Some studies suggest positive effects of HFNC on mortality and avoidance of intubation. Spontaneous pneumothorax has been observed in patients suffering from SARS-CoV-2 pneumonia. Although the viral infection itself contributes to its development, higher PEEP generated by both HFNC and mechanical ventilation is another risk factor for increased alveoli damage and air-leak. Herein, we present three cases of patients with no previous history of lung diseases who were diagnosed with COVID-19 viral pneumonia. All of them were supported with HFNC, and all of them presented spontaneous pneumothorax. Full article

Background: Differential exposure to endocrine-disrupting chemicals, including phthalate diesters, may contribute to persistent racial/ethnic disparities in women’s reproductive health outcomes. We sought to characterize sources of gestational exposure to these agents that may differ according to maternal race. Methods: We enrolled pregnant Black (n = 198), including African American, and White (n = 197) women during the second trimester, and measured eight phthalate monoester metabolites in urine. We assessed confounder-adjusted associations between multiple food and beverage consumption habits, summarized using a principal component analysis, as predictors of maternal urinary phthalate metabolite levels, stratified by race. Results: Whites reported significantly greater unprocessed food consumption (42.5% vs. 32.0%; p < 0.001) and storage of food in clear unbreakable plastic containers (66.5% vs. 49.3%; p < 0.001) than Blacks, while Blacks consumed more canned fruits and vegetables (23.5% vs. 12.2%; p < 0.001) than Whites. Using plastics for food storage, microwaving in plastic containers, and using hard plastic water bottles was associated with urinary phthalate concentrations, especially DEHP metabolites (e.g., mean difference = 5.13%; 95% CI: 3.05, 7.25). These associations were driven primarily by Black pregnant women. Conclusions: Targeted interventions to reduce maternal exposure to phthalates need to be designed with specific attention to differences in food and beverage consumption behaviors among Black and White women. Full article

Sources of information are a key part of the news process as it guides certain topics, influencing the media agenda. The goal of this study is to examine the most frequent voices on vaccines in the Portuguese press. A total of 300 news items were analysed via content analysis using as sources two newspapers from 2012 to 2017. Of all the articles, 97.7% included a source (n = 670). The most frequent were “governmental organisations”, “professional associations” and the “media”. Less frequent sources were “university scientists”, “governmental scientific bodies”, “consumer groups”, “doctors”, “scientific companies”, “NGOs” and “scientific journals”. Most articles used only non-scientific sources (n = 156). A total of 94 articles used both categories and 43 used exclusively scientific sources. Our findings support the assertion that media can be an instrument to disseminate information on vaccines. Nevertheless, despite being present in most articles, the number of sources per article was low, therefore not presenting a diversity of opinions and there was a lack of scientific voices, thus suggesting lower quality of the information being offered to the audience. Full article

Background: Men who develop behaviors connected with the model of hegemonic masculinity present several health problems. Previous research has shown the types of problems that men commonly suffer in this regard such as chronic diseases, dietary disorders, and traffic accidents. To combat and overcome this situation, several campaigns, policies and recommendations have been undertaken, and consequently, their influence has been analyzed. However, there have been few investigations into the role of men’s friendship in the reduction of these physical health problems. The findings presented in this article are focused on this issue, illustrating the impact of male friendship on the shaping of healthy behaviors. Methods: Drawing upon a qualitative-based methodology articulated in a case study of the Men in Dialogue association, located in Spain, the study has followed the premises of the communicative approach, a total of 15 structured online open-ended questionnaires have been performed and analyzed. The median age of the participants is 37.5 years. Results: The findings show how men involved in Men in Dialogue are promoting a kind of masculine friendship that is improving men’s emotional well-being and, consequently, their physical health. Full article

Systemic inflammatory response syndrome (SIRS) is defined as the systemic host response to infection or a non-infectious factor. The purpose of this study was to evaluate the involvement of reactive oxygen species (ROS) in severe inflammation and to assess the discrimination strength of the neutrophil BURSTTEST assay regarding its etiology in three groups of patients (sepsis, burns, and bone fractures) who met the SIRS criteria. The neutrophil activation (respiratory burst of granulocytes as well as p55 and p75 tumor necrosis factor (TNF-α) receptor expression) was evaluated twice using flow cytometry, and the results were compared with healthy controls and among SIRS subjects. A decreased oxygen metabolism in neutrophils after E.coli stimulation and increased TNF-α receptor expression were found in septic and burned patients on admission, while ROS production augmented and TNF-α receptor expression diminished with the applied therapy. The significant differences in neutrophil respiratory burst intensity among septic and burned patients and those with sepsis and bone fractures were found (however, there were not any such differences between patients with thermal and mechanical injuries). This study indicates that the neutrophil BURSTTEST evaluation might be a clinically reliable marker for differentiating the SIRS etiology. Full article

(1) Background: Teenagers (in particular, females) suffering from eating disorders report being not satisfied with their physical aspect and they often perceive their body image in a wrong way; they report an excessive use of websites, defined as PRO-ANA and PRO-MIA, that promote an ideal of thinness, providing advice and suggestions about how to obtain super slim bodies. (2) Aim: The aim of this review is to explore the psychological impact of pro-ana and pro-mia websites on female teenagers. (3) Methods: We have carried out a systematic review of the literature on PubMed. The search terms that have been used are: “Pro” AND “Ana” OR “Blogging” AND “Mia”. Initially, 161 publications were identified, but in total, in compliance with inclusion and exclusion criteria, 12 studies have been analyzed. (4) Results: The recent scientific literature has identified a growing number of Pro Ana and Pro Mia blogs which play an important role in the etiology of anorexia and bulimia, above all in female teenagers. The feelings of discomfort and dissatisfaction with their physical aspect, therefore, reduce their self-esteem. (5) Conclusion: These websites encourage anorexic and bulimic behaviors, in particular in female teenagers. Attention to healthy eating guidelines and policies during adolescence, focused on correcting eating behavioral aspects, is very important to prevent severe forms of psychopathology with more vulnerability in the perception of body image, social desirability, and negative emotional feedback. Full article

The purposes of the study were to (1) identify clusters based on patterns of sleep quality and duration and physical activity levels of healthy Korean pregnant women, and (2) subsequently investigate the association of identified clusters with pre-pregnancy healthy behaviors, depressive symptoms, and pregnancy stress. Two hundred eighty-four pregnant women participated in the study while attending a prenatal education program provided by a tertiary hospital in Seoul, Korea. The survey questionnaire consisted of the Pittsburg Sleep Quality Index, the International Physical Activity Questionnaire, and the Center for Epidemiologic Studies Depression scale. We used the Latent GOLD to identify distinct clusters and the chi-square test and ANOVA to compare clusters. We identified three clusters: ‘good sleeper’ (63.4%), ‘poor sleeper’ (24.6%), and ‘low activity’ (12.0%). Women in the good-sleeper cluster were more likely to have higher education and income levels and reported more healthy behaviors before pregnancy. Poor-sleeper and low-activity clusters were more likely to report higher scores in depressive symptoms and pregnancy stress (p < 0.001 and p = 0.005, respectively). Tailored intervention for pregnant women who are physically inactive or sleep poorly may promote their psychological well-being as well as bringing good obstetric outcomes. Full article

The beneficial effects of physical activity on body image perception and bone are debated among artistic gymnasts. Gymnasts seem to be at greater risk of developing body dissatisfaction, eating disorders and osteoporosis due to inadequate nutrition and attention to the appearance of the body. The objective of this work was to investigate the association between the artistic gymnast and a more favorable body image compared to their sedentary peers and if a preworkout high-carbohydrate meal (HCM; 300 kcal, 88% carbohydrates, 9% protein, 3% fat) or high-protein meal (HPM; 300 kcal, 55% carbohydrates, 31% protein, 13% fat) is able to attenuate bone resorption in young rhythmic gymnasts. Twenty-eight preadolescent female gymnasts were examined. Self-esteem tests were used to analyze body image perception. Preworkout eating habits were examined by short food frequency questions (FFQ) validated for children. The biomarker of the bone resorption C-terminal telopeptide region of collagen type 1 (CTX) was measured in the urine (fasting, postmeal and postworkout). Gymnasts reported higher satisfaction with their body appearance compared to sedentary peers. Of the gymnasts, 30% did not have a preworkout meal regularly, and the timing of the consumption was variable. Bone resorption was decreased by the HCM, consumed 90 min before the training, with respect to the HPM. The study suggests that playing artistic gymnastics is associated with a positive body self-perception in a child. The variability in preworkout meal frequency and timing need attention to prevent inadequate eating habits in light of the ability of the HCM to reduce acute bone resorption. Full article

Most HIV research combines transgender women who have sex with men (TWSM) with cisgender men who have sex with men (MSM), despite emerging evidence of important differences. Using data from The MARI Study, we compared Black TWSM and Black cisgender MSM on personal and ecological factors. Black TWSM reported more unemployment (71.4% versus 51.4%, p = 0.015), incarceration (52.4% versus 36.0%, p = 0.046), stressful life experiences (median score 135.5 versus 90, p = 0.033), and HIV positivity (66.7% versus 22.9%, p = 0.008). Further research into the causes and consequences of these differences, and regarding TWSM specifically, is needed. Full article

Background: The COVID-19 pandemic continues to rise. In order to control the COVID-19 pandemic, healthcare professionals have been subjected to increased exposure to work stress. In this systematic review, we aimed at investigating the prevalence and determinants of immediate and long-term post-traumatic stress disorder (PTSD) effects on healthcare professionals by the COVID-19 (SARS CoV-2) and SARS-2003 (SARS CoV-1) pandemics. Methods: This systematic review was conducted according to the recommendations of the Protocols for Systemic Review and Meta-Analysis (PRISMA) statement. Only studies reporting the prevalence of PTSD (frequency, percentage) and related risk factors (adjusted odds ratio (OR)) in healthcare professionals (HCPs) during the SARS CoV-2 and SARS CoV-1 pandemics were included. The following databases were screened: Medline, Embase, PsychINFO, and Health Psychosocial Instrument (HaPI). Results: Six of eight studies reported PTSD symptoms among healthcare professionals during the COVID-19 pandemic in China (three), Singapore (one), India (one), and the United States of America (USA) (two), while two studies reported symptoms during the SARS-2003 pandemic in China (one) and Singapore (one). Sample sizes ranged from 263 to 5062 with a combined total of 10,074 participants. All of the studies self-reported the level of exposure to coronaviruses (CoV-1 and CoV-2) and severity of PTSD. Seven studies reported the prevalence of immediate PTSD and determinants, while one study reported delayed-onset PTSD (3 years after CoV-1 pandemic). Determinants of immediate PTSD were reported for the CoV-2 pandemic, while those for long-term PTSD were reported for the CoV-1 pandemic. Conclusions: A comprehensive understanding of the prevalence and determinants of immediate or long-term pandemic PTSD for healthcare workers can improve prevention, diagnosis, and management. Rigorous research measuring the prevalence of PTSD and its associated risk factors (adjusted OR) for the CoV-2 pandemic are envisaged. Although strategies to resolve immediate PTSD are key, long-term PTSD must not be overlooked. Full article

Background: Within the context of the widespread use of technologies by adolescents, the objectives of this study were to identify the perpetrators of intimate partner cyberstalking (IPCS) in adolescents; to analyze the relationship between IPCS and gender, age, sexting behaviors, pornography consumption, and ambivalent sexism; and to investigate the influence of the study variables as predictors of IPCS and determine their moderating role. Methods: Participants were 993 Spanish students of Secondary Education, 535 girls and 458 boys with mean age 15.75 (SD = 1.47). Of the total sample, 70.3% (n = 696) had or had had a partner. Results: Boys perform more sexting, consume more pornographic content, and have more hostile and benevolent sexist attitudes than girls. However, girls perpetrate more IPCS than boys. The results of the hierarchical multiple regression indicate that hostile sexism is a predictor of IPCS, as well as the combined effect of Gender × Pornography and Benevolent Sexism × Sexting. Conclusions: it is essential to implement sexual affective education programs in schools in which Information and Communication Technologies (ICT) are incorporated so that boys and girls can experience their relationships, both offline and online, in an egalitarian and violence-free way. Full article

Neglected Tropical Diseases (NTDs) trap individuals in a cycle of poverty through their devastating effects on health, wellbeing and social–economic capabilities that extend to other axes of inequity such as gender and/or ethnicity. Despite NTDs being regarded as equity tracers, little attention has been paid toward gender dynamics and relationships for gender-equitable access to NTD programs in sub-Saharan Africa (SSA). This paper examines the impact of NTDs on women’s health and wellbeing in SSA using Kenya as a case study. This research is part of a larger research program designed to examine the impact of NTDs on the health and wellbeing of populations in Kenya. Thematic analysis of key informants’ interviews (n = 21) and focus groups (n = 5) reveals first that NTDs disproportionately affect women and girls due to their assigned gender roles and responsibilities. Second, women face financial and time constraints when accessing health care due to diminished economic power and autonomy. Third, women suffer more from the related social consequences of NTDs (that is, stigma, discrimination and/or abandonment), which affects their health-seeking behavior. As such, we strongly suggest a gender lens when addressing NTD specific exposure, socio-economic inequities, and other gender dynamics that may hinder the successful delivery of NTD programs at the local and national levels. Full article

Pregnancy loss, natural or induced, is linked to higher rates of mental health problems, but little is known about its effects during the postpartum period. This study identifies the percentages of women receiving at least one postpartum psychiatric treatment (PPT), defined as any psychiatric treatment (ICD-9 290-316) within six months of their first live birth, relative to their history of pregnancy loss, history of prior mental health treatments, age, and race. The population consists of young women eligible for Medicaid in states that covered all reproductive services between 1999–2012. Of 1,939,078 Medicaid beneficiaries with a first live birth, 207,654 (10.7%) experienced at least one PPT, and 216,828 (11.2%) had at least one prior pregnancy loss. A history of prior mental health treatments (MHTs) was the strongest predictor of PPT, but a history of pregnancy loss is also another important risk factor. Overall, women with a prior pregnancy loss were 35% more likely to require a PPT. When the interactions of prior mental health and prior pregnancy loss are examined in greater detail, important effects of these combinations were revealed. About 58% of those whose first MHT was after a pregnancy loss required PPT. In addition, over 99% of women with a history of MHT one year prior to their first pregnancy loss required PPT after their first live births. These findings reveal that pregnancy loss (natural or induced) is a risk factor for PPT, and that the timing of events and the time span for considering prior mental health in research on pregnancy loss can significantly change observed effects. Clinicians should screen for a convergence of a history of MHT and prior pregnancy loss when evaluating pregnant women, in order to make appropriate referrals for counseling. Full article

The study aim was to implement and evaluate the feasibility of a culturally informed (“BeFAB”) app for African American/Black women to address postpartum weight. Women (n = 136; mean age = 27.8 ± 5.4; mean BMI = 32.5 ± 4.3) were recruited from postpartum units, and randomly assigned to receive BeFAB (n = 65) or usual care (n = 71) for 12 weeks. App content included didactic lessons delivered via a virtual coach, app-based messages, goal setting and tracking, and edutainment videos. Feasibility outcomes included recruitment, retention and engagement, and self-reported acceptability. Behavioral (i.e., diet, physical activity), psychosocial (i.e., stress, coping, support, self-efficacy) and weight outcomes were also examined. Recruitment goals were met, but attrition was high, with 56% retention at 12 weeks. Approximately half of participants accessed the app and set a goal ≥one time, but <10% reported achieving a nutrition or activity goal. Among study completers, ≥60% found the app content at least somewhat helpful. Within-group changes for BeFAB among completers were found for increased moderate-to-vigorous physical activity and decreased fruit/vegetable intake and weight. Findings indicate initial feasibility of recruiting postpartum women to participate in a digital healthy body weight program but limited use, reflecting low acceptability and challenges in engagement and retention. Future research is needed on strategies to engage and retain participants in postpartum interventions. Full article

Particulate matter (PM) is a major factor contributing to air quality deterioration that enters the atmosphere as a consequence of various natural and anthropogenic activities. In PM, polycyclic aromatic hydrocarbons (PAHs) represent a class of organic chemicals with at least two aromatic rings that are mainly directly emitted via the incomplete combustion of various organic materials. Numerous toxicological and epidemiological studies have proven adverse links between exposure to particulate matter-bound (PM-bound) PAHs and human health due to their carcinogenicity and mutagenicity. Among human exposure routes, inhalation is the main pathway regarding PM-bound PAHs in the atmosphere. Moreover, the concentrations of PM-bound PAHs differ among people, microenvironments and areas. Hence, understanding the behaviour of PM-bound PAHs in the atmosphere is crucial. However, because current techniques hardly monitor PAHs in real-time, timely feedback on PAHs including the characteristics of their concentration and composition, is not obtained via real-time analysis methods. Therefore, in this review, we summarize personal exposure, and indoor and outdoor PM-bound PAH concentrations for different participants, spaces, and cities worldwide in recent years. The main aims are to clarify the characteristics of PM-bound PAHs under different exposure conditions, in addition to the health effects and assessment methods of PAHs. Full article

School-based programs can effectively prevent substance use; however, systematic reviews and consultation with stakeholders identified a need for effective, culturally inclusive programs for Aboriginal and/or Torres Strait Islander (hereafter Aboriginal) youth. This paper describes the development of Strong & Deadly Futures, a six-lesson, curriculum-aligned wellbeing and substance use prevention program that was designed for, and with, the Aboriginal youth. Formative reviews and consultation recommended that the program (i) combine effective components of mainstream prevention with cultural elements, highlighting Aboriginal cultural strengths; (ii) avoid stigma and celebrates the cultural diversity by catering to both Aboriginal and non-Aboriginal students; and (iii) use digital technology to enhance engagement, implementation and scalability. Guided by an Appreciative Inquiry approach, the program was developed in partnership with an Indigenous Creative Design Agency, and four schools in New South Wales and Queensland, Australia. Aboriginal (n = 41) and non-Aboriginal students (n = 36) described their role models, positive aspects of their community and reasons to avoid substance use; these formed the basis of an illustrated story which conveyed the key learning outcomes. Feedback from teachers, students and content experts supported the acceptability of the program, which will be evaluated in a subsequent randomised controlled trial. Full article

Background: The objectives of this study were to describe the oral health status in the institutionalized geriatric population in an area of southern Italy and to identify the impact of oral health on the Oral Health Related Quality of Life (OHRQoL). Methods: Data were collected from individuals aged ≥60 years in randomly selected Calabrian long-term care facilities. The dental health status was assessed recording the decayed, missing, or filled dental elements due to the carious lesions (DMFT) index, the presence of visible dental plaque, and the gingival condition. The influence of the dental health status on the self-perceived value of life was assessed using the Geriatric Oral Health Assessment Index (GOHAI). Results: Among the 344 elderly individuals included, 18.4% reported frequent tooth-brushing, and only 39.9% reported the need of dental care. The DMFT index was 26.4. Less than a third of the participants had a GOHAI score of ≤50 which is suggestive of highly compromised OHRQoL. The GOHAI score was significantly better for elderly individuals with no self-perceived need of dental care and with a lower DMFT index. Conclusions: The burden of oral conditions among residents in long-term care facilities was considerable, with a high prevalence of missing teeth and dentures. Strategies targeting care providers are needed. Full article