Int. J. Environ. Res. Public Health, Volume 19, Issue 9 (May-1 2022) – 854 articles

Up to 50% of unsuccessful implementations of organizational change are due to a lack of organizational readiness for change (ORC). This qualitative study aims to investigate the experiences of occupational physicians (OPs) and staff of test and training centers (ETTCs) with team effectiveness in the context of ORC. The change setting is the implementation of a new occupational health program in a multicentric randomized controlled trial for musculoskeletal disorders (MSD) in Germany. Two rounds of expert interviews with OPs (1st round: n = 10, 2nd round: n = 13) and one round of expert interviews with ETTCs (n = 9) were conducted and analyzed with a deductive–inductive procedure. The focus of the analysis was the assessment of change commitment and change efficacy, as well as their influence on general ORC on a collective level according to Weiner’s model (2009). Differential critical assessment of change by the care providers led to a missing collective change commitment and consequently to a missing organizational change commitment. Main inhibiting factors include lacking feedback about (e.g., recruitment) success, limited time resources of and narrow communication between responsible study staff, along with a low rate of utilization and limited adherence of the study population. Main facilitators include standardized procedures and documentation along with easy-access digital tools. Researchers may use the findings to improve the development of new intervention studies, especially in a randomized setting. Full article

With this study, we aimed to investigate the effects of different warm-up intensities on counter-movement jump (CMJ) performance over time under cold conditions. Eleven male collegiate athletes volunteered. The participants performed high-intensity warm-up (HWU) at 80% VO_2max and moderate-intensity warm-up (MWU) at 60% VO_2max for 15 min on a bicycle ergometer in a laboratory room at 10 °C. CMJ height, vastus lateralis muscle temperature, heart rate, and perceived fatigue were measured before warm-up (Pre), immediately after (Post 0), 10 min after (Post 10), and 20 min after (Post 20). Significant main effects and interactions were found for CMJ height (time, p < 0.001 and η_p² = 0.859; interaction, p = 0.007 and η_p² = 0.327). HWU significantly increased CMJ height at Post 0 to Post 20 compared to that at Pre (p < 0.01), whereas MWU increased CMJ height at Post 0 only compared to that at Pre (p < 0.001). The results indicate that HWU achieved an increase in CMJ height for 20 min. MWU changed CMJ height instantly, but the change did not last compared to HWU in a cold environment. Full article

Smartphones are a necessity for many people; however, problematic smartphone use (PSU) may negatively influence people’s mental health. Using multivariate linear regression analysis, the study examined the associations of sexual minority stressors [namely perceived sexual stigma from family members, sexual orientation microaggressions (SOMs), and internalized sexual stigma] and gender nonconformity with PSU severity as well as the associations of PSU with depression and anxiety in young adult lesbian, gay, and bisexual (LGB) individuals. This cross-sectional survey study recruited 1000 young adult LGB individuals (500 men and 500 women). PSU severity was assessed using the Smartphone Addiction Inventory. The experiences of perceived sexual stigma from family members, SOMs, and internalized sexual stigma and the levels of gender nonconformity, depression, and anxiety were assessed. The results indicated that perceived sexual stigma from family members, SOMs, internalized sexual stigma in the dimensions of social discomfort and identity and gender nonconformity were significantly associated with PSU severity in LGB individuals. Moreover, PSU was significantly associated with depression and anxiety in LGB individuals. The findings highlight the significance of developing strategies for the prevention and early detection of PSU and sexual minority stress in LGB individuals. Full article

Objective: Identifying dietary and physical activity (PA) patterns in Russian youths and examining their dependence on gender, age, family characteristics and area of residence features. The research involved 783 school students 10–17 years of age and their parents living in the cities of Moscow and Murmansk. Using the principal component analysis, four integral indices were identified that characterized the habits and dietary patterns, PA and lifestyle. Boys, compared with girls, were more likely to consume unhealthy foods but less likely to practice malnutrition. Within the age ranges of 13–15 years old and 16–17 years old, the proportions of school students with a poor sleep pattern and low PA were higher than in children 10–12 years of age. In smoking families, children were less likely to consume healthy foods and more likely to eat unhealthy foods. In Murmansk school students, compared with their Moscow peers, a reduction in both sleep time and PA was observed less often. Our study demonstrated that the most significant factors of a balanced and healthy diet, rational daily routine and lifestyle in school students were their gender and age characteristics, as well as some contextual factors. Full article

Privacy and information protection are important issues in the era of big data. At present, China’s elderly care industry is gradually adopting the supply model of smart elderly care to alleviate the contradiction between supply and demand. However, the low level of regulation of smart aging platforms may lead to a low level of privacy protection on the platforms. Therefore, in this paper, based on the evolutionary game and Lyapunov theory, we discuss the willingness of elderly people to participate in regulation, the privacy protection status of platform service providers, and the degree of government regulation, as well as the key factors affecting the equilibrium of the three-party game system, and conduct simulation analysis and game system optimization using MATLAB. The simulation results show that $A_1(0,0,1)$ and $A_5(0,0,0)$ can be transformed to $A_8(1,1,0)$ by adjusting the parameters, i.e., the optimal ESS is participation, high-quality protection, and low investment supervision; the service income of the elderly, the loss of privacy leakage, the investment cost of service providers, and the amount of government rewards and punishments are the key factors affecting the tripartite game system. By analyzing the impact of factors, such as benefits and costs, on privacy protection and the regulation of smart senior care platforms, the level of privacy protection of smart senior care platforms can be improved and the process of the comprehensive regulation of domestic senior care services can be promoted. Full article

Hospital workers have increased exposure risk of healthcare-associated infections due to the frontline nature of their work. Olfactory dysfunction is highly prevalent. The objectives for this investigation are to study the prevalence of long-lasting olfactory dysfunction associated with COVID-19 infection in hospital workers during the first pandemic wave, to identify clinical characteristics and associated symptomatology, and to analyze how many patients with COVID-19 infection had developed olfactory dysfunction during infection and maintained a reduced olfactory function for approximately 10 weeks after diagnosis. Between June and July of 2020, a cross-sectional study was carried out at the Hospital Central de la Cruz Roja San José and Santa Adela in Madrid, Spain. One hundred sixty-four participants were included, of which 110 were patient-facing healthcare staff and 54 were non-patient-facing healthcare staff. Participants were split into three groups, according to COVID-19 diagnosis and presence of COVID-19 related olfactory symptomatology. Participants were asked to complete a structured online questionnaire along with Sniffin’ Stick Olfactory Test measurements. In this study, 88 participants were confirmed for COVID-19 infection, 59 of those participants also reported olfactory symptomatology. The prevalence of COVID-19 infection was 11.35%, and the prevalence for olfactory dysfunction was 67.05%. Olfactory dysfunction associated with COVID-19 infection leads to long-lasting olfactory loss. Objective assessment with Sniffin’ Stick Olfactory Test points to odor identification as the most affected process. Lemon, liquorice, solvent, and rose are the odors that are worst recognized. Mint, banana, solvent, garlic, coffee, and pineapple, although they are identified, are perceived with less intensity. The findings of this study confirmed a high prevalence of SARS-CoV-2 infection among the hospital workers. Full article

We aimed to review the determinants of burnout onset in teachers. The study was conducted according to the PROSPERO protocol CRD42018105901, with a focus on teachers. We performed a literature search from 1990 to 2021 in three databases: MEDLINE, PsycINFO, and Embase. We included longitudinal studies assessing burnout as a dependent variable, with a sample of at least 50 teachers. We summarized studies by the types of determinant and used the MEVORECH tool for a risk of bias assessment (RBA). The quantitative synthesis focused on emotional exhaustion. We standardized the reported regression coefficients and their standard errors and plotted them using R software to distinguish between detrimental and protective determinants. A qualitative analysis of the included studies (n = 33) identified 61 burnout determinants. The RBA showed that most studies had external and internal validity issues. Most studies implemented two waves (W) of data collection with 6–12 months between W1 and W2. Four types of determinants were summarized quantitatively, namely support, conflict, organizational context, and individual characteristics, based on six studies. This systematic review identified detrimental determinants of teacher exhaustion, including job satisfaction, work climate or pressure, teacher self-efficacy, neuroticism, perceived collective exhaustion, and classroom disruption. We recommend that authors consider using harmonized methods and protocols such as those developed in OMEGA-NET and other research consortia. Full article

Orthodontic retention is the final important stage of orthodontic treatment, the aim of which is to consolidate the functional and aesthetic position of teeth. Among adults, fixed retainers made of different types of wires are the most common. The aim of this study was to analyse the mechanical properties of a new generation of fixed orthodontic retainers—printed by 3D printers. Materials and Methods: The study was conducted using samples made of Nextdent MFH C&B N1 resin in the form of cuboid bars with nominal dimensions of width b = 3 mm, thickness d = 0.8 mm; 1 mm; 1.2 mm, length l = 30 mm for each type. The influence of the thickness of the retainers on their strength under loaded conditions was evaluated. Flexural strength, elastic properties, deflection, and creep were compared. The samples were aged in an artificial saliva bath at 37 ± 1 °C during the strength tests. Results: It was shown that differences in the thickness of the samples affected their elastic and strength properties. The highest average flexural modulus, the highest deflection, creep, and strength was characteristic of the samples with the highest thickness (1.2 mm). Samples with an average thickness of 1 mm had the lowest modulus of elasticity. Conclusions: The mechanical properties of 3D printed retainers show that they can be an alternative to metal retainers and the procedure of making new retainers, especially when patients have aesthetic requirements or allergies to metals. Full article

Provision of mental health care in Poland has long been characterised by an overreliance on psychiatric hospitals and the underdevelopment of community care. The introduction of the first National Mental Health Protection Programme for 2011–2015, with the explicit goal to base provision of mental care on the community mental health centres, failed to achieve any tangible results. The ensuing critique led to the launch of the second National Mental Health Protection Programme for 2017–2022 and the establishment, from mid-2018 onwards, of 41 (33 in operation) mental health centres across Poland. These will be piloted until the end of 2022 but have already shown positive results in terms of access to non-stationary care and a small fall in hospitalisations. They have also performed well during the COVID-19 pandemic, allowing for a quick reorganization of care and continued provision of mental health services. Some of the key innovations of the new model include the introduction of recovery assistants (a new profession) and mental health coordinators (a new role); liaison with social assistance services; and a shift to budget financing. The key obstacles to the national rollout of mental health centres are the low financing of mental health care in Poland, which is among the lowest in Europe, and acute workforce shortages. Full article

Metal mesh devices (MMDs) are novel materials that enable the precise separation of particles by size. Structurally, MMDs consist of a periodic arrangement of square apertures of characteristic shapes and sizes on a thin nickel membrane. The present study describes the separation of aerosol particles using palm-top-size collection devices equipped with three types of MMDs differing in pore size. Aerosols were collected at a farm located in the suburbs of Nairobi, Kenya; aerosol particles were isolated, and pathogenic bacteria were identified in this microflora by next-generation sequencing analysis. The composition of the microflora in aerosol particles was found to depend on particle size. Gene fragments were obtained from the collected aerosols by PCR using primers specific for the genus Mycobacterium. This analysis showed that Mycobacterium obuense, a non-tuberculous species of mycobacteria that causes lung diseases, was present in these aerosols. These findings showed that application of this MMD analytical protocol to aerosol particles can facilitate the investigation of airborne pathogenic bacteria. Full article

Climate change caused by CO₂ emissions is a controversial topic in today’s society; improving CO₂ emission efficiency (CEE) is an important way to reduce carbon emissions. While studies have often focused on areas with high carbon and large economies, the areas with persistent contraction have been neglected. These regions do not have high carbon emissions, but are facing a continuous decline in energy efficiency; therefore, it is of great relevance to explore the impact and mechanisms of CO₂ emission efficiency in shrinking areas or shrinking cities. This paper uses a super-efficiency slacks-based measure (SBM) model to measure the CO₂ emission efficiency and potential CO₂ emission reduction (PCR) of 33 prefecture-level cities in northeast China from 2006 to 2019. For the first time, a Tobit model is used to analyze the factors influencing CEE, using the level of urban shrinkage as the core variable, with socio-economic indicators and urban construction indicators as control variables, while the mediating effect model is applied to identify the transmission mechanism of urban shrinkage. The results show that the CEE index of cities in northeast China is decreasing by 1.75% per annum. For every 1% increase in urban shrinkage, CEE decreased by approximately 2.1458%, with urban shrinkage, industrial structure, and expansion intensity index (EII) being the main factors influencing CEE. At the same time, urban shrinkage has a further dampening effect on CEE by reducing research and development expenditure (R&D) and urban compactness (COMP), with each 1% increase in urban shrinkage reducing R&D and COMP by approximately 0.534% and 1.233%, respectively. This can be improved by making full use of the available built-up space, increasing urban density, and promoting investment in research. Full article

(1) The objective of this socio-epidemiologic cross-sectional study was to investigate caries burdens in Ghanaian children aged 3 to 13 years. The main focus was the analysis of urban–rural disparities and associating socio-demographic and behavioural factors. (2) Standardized caries examination with documentation of decayed, missing, filled deciduous (dmft) and permanent teeth (DMFT) was conducted in 11 school facilities according to WHO guidelines. A parental questionnaire gathered data considering associating factors. Descriptive statistics were used to evaluate their influence on caries prevalence and experience using mean dmft+DMFT, Significant Caries Index (SiC), and Specific Affected Caries Index (SaC). (3) In total, 313 study participants were included (mean age 7.7 ± 3.8 years; 156 urban, 157 rural). The urban region showed slightly higher caries prevalence (40.4% vs. 38.9%). The rural region had higher caries experience in mean dmft+DMFT (1.22 ± 2.26 vs. 0.96 ± 1.58), SiC (3.52 ± 2.73 vs. 2.65 ± 1.71), and SaC (3.15 ± 2.68 vs. 2.37 ± 1.68). Lower education and occupation level of parents and rural residence were associated to higher caries values. Sugary diet showed an inverse relation with caries prevalence and oral hygiene practices supported the generally known etiologic correlation. (4) This study highlights the importance of targeting children vulnerable to caries due to social inequality with adequate preventive means. The implementation of regular dental screening and education, e.g. in schools, may be helpful. Full article

Introduction: The autonomic nervous system plays a vital role in the modulation of many vital bodily functions, one of which is sleep and wakefulness. Many studies have investigated the link between autonomic dysfunction and sleep cycles; however, few studies have investigated the links between short-term sleep health, as determined by the Pittsburgh Quality of Sleep Index (PSQI), such as subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction, and autonomic functioning in healthy individuals. Aim: In this cross-sectional study, the aim was to investigate the links between short-term sleep quality and duration, and heart rate variability in 60 healthy individuals, in order to provide useful information about the effects of stress and sleep on heart rate variability (HRV) indices, which in turn could be integrated into biological models for wearable devices. Methods: Sleep parameters were collected from participants on commencement of the study, and HRV was derived using an electrocardiogram (ECG) during a resting and stress task (Trier Stress Test). Result: Low-frequency to high-frequency (LF:HF) ratio was significantly higher during the stress task than during the baseline resting phase, and very-low-frequency and high-frequency HRV were inversely related to impaired sleep during stress tasks. Conclusion: Given the ubiquitous nature of wearable technologies for monitoring health states, in particular HRV, it is important to consider the impacts of sleep states when using these technologies to interpret data. Very-low-frequency HRV during the stress task was found to be inversely related to three negative sleep indices: sleep quality, daytime dysfunction, and global sleep score. Full article

The time-intensive work of publishing in scientific journals is an important indicator of job performance that is given much weight during promotion procedures for academic positions. The current study applied the job demands–resources model and analyzed whether family supportive supervisor behaviors (FSSB) moderated associations between work stress and feelings of exhaustion as a job resource and whether feelings of exhaustion ultimately mediated the link between work stress and academic employees’ publication activity. The current online cross-sectional questionnaire study was conducted in 133 academic employees (65.4% women, 34.6% men; M_age = 41.9, SD = 10.1) at an Austrian medical university and assessed employees’ numbers of publications, H-index, work stress, feelings of exhaustion, FSSB, and work–family services used. Manifest path models revealed that FSSB moderated the link between experiencing high levels of work stress and strong feelings of exhaustion, especially in employees who had at least one child below the age of 18. Part-time employment was most strongly linked with lower numbers of publications and lower H-index levels. The finding that FSSB acted as a job resource mostly for employees with at least one child below 18 underlines the fact that FSSB is different from other forms of supervisor support. The current study supports recommendations to increase the amount of work–family services and to change organizational norms to be supportive of the successful management of family and work obligations. Full article

An early, extensive, accurate, and cost-effective clinical diagnosis of neurocognitive disorders will have advantages for older people and their families, but also for the health and care systems sustainability and performance. BRAINCODE is a technology that assesses cognitive impairment in older people, differentiating normal from pathologic brain condition, based in an EEG biomarkers evaluation. This paper will address BRAINCODE’s pilot design, which intends to validate its efficacy, to provide guidelines for future studies and to allow its integration on the SHAPES platform. It is expected that BRAINCODE confirms a regular clinical diagnosis and neuropsychologic tests to discriminate ‘normal’ from pathologic cognitive decline and differentiates mild cognitive impairment from dementia in older adults with/without subjective cognitive complains. Full article

As in other parts of the world, undocumented migrants in Italy suffer worse health status due to their immigration enforcement situation and other vulnerabilities such as precarious illegal jobs, exploitation and abuse or barriers to higher education, with higher prevalence of chronic noncommunicable diseases. The COVID-19 pandemic, as other pandemics, has not affected everyone equally. The undocumented was one of the most affected groups with regard to hospitalization rates and mortality worldwide. Sicily is one of the gates of entrance to Europe for migrants and asylum seekers from Africa and Asia. Herein, we described the epidemiological characteristics of COVID-19 cases in Sicily to compare hospitalization rate and mortality between Italian nationals and foreigners. We extracted data from the integrated national surveillance system established by the Italian National Institute of Health (Istituto Superiore di Sanità, ISS) to collect information on all COVID-19 cases and deaths in Sicily. We found that the hospitalization rates were higher in undocumented foreigners, and they were most likely to present a more severe clinical outcome compared to Italian nationals. Inclusive public health policies should take this population group into consideration to achieve the Health for All goal. Full article

Global temperature change is related to the destiny of all mankind, and carbon mitigation, as well as greenhouse gases control, are key points. In order to explore the basic knowledge, research hotspots and trends in global carbon mitigation research, this paper, based on 15,304 carbon mitigation articles from Web of Science, from 1991 to 2021, conducts spatio-temporal distribution, country distribution, research hotspots and cooperation network analysis, and draws frontier knowledge graphs of carbon mitigation by using CiteSpace, Gephi and other scientific knowledge mapping and literature analysis software. The key scholars, important literature, main contribution institutions and countries/regions in the field of carbon mitigation research were extracted, and the research basis and evolution law were displayed. The study found that: (1) The research on carbon mitigation is increasing every year, which can be roughly divided into four stages: germination, low-speed development, medium-speed development and high-speed development. (2) The spatial distribution of carbon mitigation research is unbalanced, mainly showing a characteristic of “one super and many strong” centered on the United States. (3) The research hotspots of carbon mitigation have gradually evolved from phenomenon analysis, policy guidance, method exploration to mechanism improvement. Further research might focus on ocean carbon sink, carbon trading and carbon-negative technology. Full article

Background: Nursing students are exposed to concepts of healthy lifestyles while they are attending university. Objective: The aim of this study was to analyze whether nursing students have a healthier lifestyle than non-nursing students and to determine whether their behaviour is consistent with their beliefs. Methods: A cross-sectional study, with 293 university students was performed by using a validated questionnaire to measure beliefs and behaviour regarding health. Results: The lifestyle pattern of the nursing students evaluated was characterised by a high percentage of nurses with low levels of physical activity, poor balanced diet and smoking habits. The comparative analysis showed no significant differences between nursing students and students from other degrees. Conclusions: Students have a positive attitude and knowledge about healthy lifestyle, but do not transfer it to their own lives. Nurses’ lifestyle can unintentionally affect the behaviour of other people through their own behaviour and beliefs because they serve as a model for a healthy lifestyle. These findings support that nurse educators have an active role as promoter of health by using lessons to modify the behaviour of their students. Full article

The purpose of this study is to evaluate the adequacy of the developed protocol by verifying the validity of the expert group for the earthquake and fire response simulation protocol. A protocol development team consisting of one emergency rescue professor, one counseling psychology professor, three paramedics, and one firefighter developed the study’s protocols to promote the core response and capabilities required at an earthquake fire site. We checked the content validity for the appropriateness of the contextual connection for each stage for the protocol. We also created an evaluation checklist to measure the items for each stage. The protocol developed in this study consists of earthquake response, fire response, evacuation, and fire suppression. We set the situation for each stage and composed learner activities and learning performance goals. The earthquake response stage included (1) shout “it’s an earthquake,” (2) protect yourself, (3) turn off electricity and gas, and (4) evacuate to a safe place. In the fire response stage, (1) shout “fire,” (2) press the emergency bell and call 119, (3) close the door of a dangerous place where fire can spread, and (4) evacuate to a safe place. In the evacuation stage, (1) open the emergency exit, (2) cover your nose and mouth, (3) lower your posture, and (4) evacuate quickly in one direction. Lastly, in the firefighting stage, (1) pull out the safety pin, (2) hold the nozzle and face the fire, (3) grab the handle, and (4) spray the powder evenly. The protocol contributes to the development of systematic and elaborate simulation education materials in the future. Furthermore, it provides basic data for future disaster simulation operation and protocol development through continuous training and practical exercises. Full article

Introduction: Training in hand hygiene for health care workers is essential to reduce hospital-acquired infections. Unfortunately, training in this competency may be perceived as tedious, time-consuming, and expendable. In preceding studies, our working group detected overconfidence effects in the self-assessment of hand hygiene competencies. Overconfidence is the belief of being better than others (overplacement) or being better than tests reveal (overestimation). The belief that members of their profession are better than other professionals is attributable to the clinical tribalism phenomenon. The study aimed to assess the correlation of overconfidence effects on hand hygiene and their association with four motivational dimensions (intrinsic, identified, external, and amotivation) to attend hand hygiene training. Methods: We conducted an open online convenience sampling survey with 103 health care professionals (physicians, nurses, and paramedics) in German, combining previously validated questionnaires for (a) overconfidence in hand hygiene and (b) learning motivation assessments. Statistics included parametric, nonparametric, and cluster analyses. Results: We detected a quadratic, u-shaped correlation between learning motivation and the assessments of one’s own and others’ competencies. The results of the quadratic regressions with overplacement and its quadratic term as predictors indicated that the model explained 7% of the variance of amotivation (R² = 0.07; F(2, 100) = 3.94; p = 0.02). Similarly, the quadratic model of clinical tribalism for nurses in comparison to physicians and its quadratic term explained 18% of the variance of amotivation (R² = 0.18; F(2, 48) = 5.30; p = 0.01). Cluster analysis revealed three distinct groups of participants: (1) “experts” (n₁ = 43) with excellent knowledge and justifiable confidence in their proficiencies but still motivated for ongoing training, and (2) “recruitables” (n₂ = 43) who are less competent with mild overconfidence and higher motivation to attend training, and (3) “unawares” (n₃ = 17) being highly overconfident, incompetent (especially in assessing risks for incorrect and omitted hand hygiene), and lacking motivation for training. Discussion: We were able to show that a highly rated self-assessment, which was justified (confident) or unjustified (overconfident), does not necessarily correlate with a low motivation to learn. However, the expert’s learning motivation stayed high. Overconfident persons could be divided into two groups: motivated for training (recruitable) or not (unaware). These findings are consistent with prior studies on overconfidence in medical and non-medical contexts. Regarding the study’s limitations (sample size and convenience sampling), our findings indicate a need for further research in the closed populations of health care providers on training motivation in hand hygiene. Full article

(1) Background: Breast abscess (BA) is a condition leading in the majority of cases to breastfeeding interruption. Abscesses are commonly treated with antibiotics, needle aspiration or incision and drainage (I&D), but there is still no consensus on the optimal treatment. Since there are no well-defined clinical guidelines for abscess management, we conducted a retrospective, observational study with the aim of assessing ultrasound (US)-guided management of BA without surgery, regardless of the BA size. The secondary objective was the microbiologic characterization and, in particular, the S. aureus methicillin resistance identification. (2) Methods: our population included 64 breastfeeding mothers with diagnosis of BA. For every patient, data about maternal, perinatal and breastfeeding features were collected. All patients underwent office US scans and 40 out of 64 required a more detailed breast diagnostic ultrasound performed by a radiologist. In all cases, samples of milk or abscess material were microbiologically tested. All patients received oral antibiotic treatment. We performed needle aspiration, when feasible, even on abscesses greater than 5 cm. (3) Results: most of the women developed BA during the first 100 days (68.8% during the first 60 days) after delivery and 13 needed hospitalization. Four abscesses were bilateral and 16 had a US major diameter greater than 5 cm. All patients were treated with antibiotic therapy according to our clinical protocol and 71.9% (46/64) underwent fine needle aspiration. None of them required I&D. The average duration of breastfeeding was 5 months (IR 2; 9.5) and 40.6% of women with BA continued to breastfeed for more than 6 months. Only 21 mothers interrupted breastfeeding before 3 months. (4) Conclusions: our observational data suggest, regardless of the size and the clinical features of the BA, a conservative approach with antibiotic therapy targeted at the Methicillin-Resistant Staphilococcus aureus (MRSA) identified and needle aspiration, if feasible. In our experience, treatment with needle aspiration is a cost- effective method. Unlike drainage, it is an outpatient procedure, easily repeatable, with no cosmetic damage. In addition, it has lower risk of recurrences since, differently from surgical incision, it does not cause interruption of the ducts. Moreover, needle aspiration is less painful, does not require the separation of the mother-child dyad and allows for a quicker, if not immediate, return to breastfeeding. Full article

Bulky DNA adducts are a combined sign of aromatic chemical exposure, as well as an individual’s ability to metabolically activate carcinogens and repair DNA damage. The present study aims to investigate the association between PM exposure and DNA adducts in blood cells, in a population of 196 adults with an unhealthy BMI (≥25). For each subject, a DNA sample was obtained for quantification of DNA adducts by sensitive³²P post-labelling methods. Individual PM₁₀ exposure was derived from daily mean concentrations measured by single monitors in the study area and then assigned to each subject by calculating the mean of the 30 days (short-term exposure), and of the 365 (long-term exposure) preceding enrolment. Multivariable linear regression models were used to study the association between PM₁₀ and DNA adducts. The majority of analysed samples had bulky DNA adducts, with an average value of 3.7 ± 1.6 (mean ± SD). Overall, the findings of the linear univariate and multiple linear regression showed an inverse association between long-term PM₁₀ exposure and adduct levels; this unexpected result might be since the population consists of subjects with an unhealthy BMI, which might show an atypical reaction to airborne urban pollutants; a hermetic response which happens when small amounts of pollutants are present. Pollutants can linger for a long time in the adipose tissue of obese persons, contributing to an increase in oxidative DNA damage, inflammation, and thrombosis when exposure is sustained. Full article

Although the marathon race has been democratized, it remains complex due to the famous “hitting the wall” phenomenon after the 25th km. To characterize this “wall” from a physiological and Rate of Perceived Exertion (RPE) perspective in recreational marathon runners, we report first continuous breath-by-breath gas exchange measurements during an actual marathon race. In order to test the hypothesis that RPE could be a candidate for controlling the marathon pace, this study examined the relationship between RPE and the physiological variables time course throughout a marathon. Only the respiratory frequency and heart rate increased progressively during the race in all the runners, while the oxygen uptake and ventilatory rate followed different kinetics according the individuals. However, the indexation of the physiological parameters and speed by RPE showed the same decreased tendency for all the runners. In conclusion, these results suggest that running a marathon must be self-paced with the RPE. Full article

Energy efficiency and energy intensity are gradually gaining attention, and it is now an important proposition to reconcile financial marketization, fiscal decentralization, and regional energy intensity. Using Chinese mainland provincial panel data (except Tibet) from 2007 to 2019, this study applied the dynamic panel system generalized method of moments model, the spatial Durbin model, and the panel threshold model to investigate the mechanisms of financial marketization and fiscal decentralization on regional energy intensity. The study found that financial marketization can play a significant role in suppressing regional energy intensity, while fiscal decentralization promotes energy intensity. Meanwhile, financial marketization in one province can have a negative spatial transmission effect on energy intensity in other provinces, while fiscal decentralization in one province has a negative spatial spillover effect on energy intensity in other provinces. Based on the analysis of the moderating and threshold effects, financial marketization not only moderates the negative externality of fiscal decentralization, making it inhibit energy intensity in the opposite direction, but also gradually increases the moderating effect on fiscal decentralization as the degree of financial marketization increases, showing a nonlinear inhibiting effect on regional energy intensity. Full article

Maximal oxygen consumption (VO_2max) has been associated with body fat percentage (%BF) or fat free mass. However, most analyses do not consider total body composition (TBC) as defined by %BF, fat free mass index (FFMI—a height-adjusted measure of muscle mass), visceral adipose tissue, and bone mineral content (BMC). The aim of this study was to determine if TBC predicts cardiorespiratory fitness in healthy adults and if a relationship exists in young and older adults. Sixty healthy individuals (age group 1 (AG1, ≤35 years), n = 35; age group 2 (AG2, >35 years), n = 25) were screened in a cross-sectional study and retrospectively examined. All participants completed a full body DEXA scan and a standardized multistage treadmill test to determine VO₂max. A multiple linear regression analysis was performed to examine the relationship between TBC and VO_2max. The multiple regression model showed an overall significant effect for TBC (p < 0.001, R² = 0.282). When analyzed by age group, the regression model of TBC was not significant in young adults (AG1, p = 0.319, R² = 0.141), but significant in older adults (AG2, p < 0.001, R² = 0.683). Significant predictors of VO_2max in the older cohort were %BF (β = −0.748, p = 0.001) and BMC (β = 0.014, p = 0.002). Total body composition predicted VO_2max in a small cohort of healthy adults. This study highlights the importance of TBC for cardiovascular health, especially in mid-to later-life individuals. Full article

Romantic jealousy is a well-known relational driver of intimate partner violence (IPV), but is under-studied among displaced and polygynous populations. This study aimed to explore factors that elicit jealousy among Somali refugees in the Bokolmayo Refugee camp in Ethiopia, and the pathways leading from jealousy to IPV against women and men, to inform interventions. We conducted an exploratory, thematic analysis of 30 in-depth interviews with both women and men who were Somali refugees, as well as elders and religious leaders, organizational and service providers, policy makers, and host community members. We found that jealousy experienced by women was elicited by an unequal distribution of money and affection between co-wives, which was exacerbated by displacement-related economic hardship, and women in monogamous partnerships suspecting their husband of having other relationships. The jealousy experienced by men was elicited by their wives’ increased financial independence and interactions with other men when working outside of the home, which became more common because of displacement-related economic hardship and relaxed patriarchal gender norms. IPV interventions should address jealousy and controlling behaviors in all relationship types. Addressing conflict and relationship dynamics in polygynous households and in humanitarian settings may require specialized content, acknowledging the complex interactions and resource allocation between co-wives. Gender-transformative interventions that move away from masculinities that are built on the provider role and the introduction of alternative masculinities could also be effective in reducing IPV in this and other similar contexts. Full article

The European Union (EU) labor market needs a better-skilled workforce that can work in any of the Member States. In order to develop the skills and competencies of future competitors in this market, several student mobility programs have been set up in the EU, where they can travel to universities in partner countries to further their studies and enrich their academic performance, culture and knowledge. The best known of these programs is ERASMUS (European Region Action Scheme for the Mobility of University Students). Because Romania also participates in this program in the exchange of university students, the authors wanted, through this study, to highlight the benefits and challenges of participation in the program, to analyze how international mobilities are emotionally perceived by students and what are the behavioral reasons that determine Romanian students to choose a certain university as a study destination abroad. For this purpose, the authors conducted quantitative marketing research among students from the Transilvania University of Brasov who have been abroad with ERASMUS scholarships. The research results show that an important component in choosing a certain university is not the financial expense during the mobility as might have been expected, but rather the initial desire to study abroad. Students also consider the improvement of their academic performance as an equally important reason for embarking on mobility to the social aspect of getting to know other cultures. Full article

Whilst effective public expenditure policies are essential for transforming the traditional factor-driven economy into a green and innovation-driven economy, the impacts of public expenditure’s size and composition on green economic development have not been comprehensively investigated. This paper attempts to fill this research gap. Based on the data of Chinese prefecture-level cities from 2010 to 2018, we first measure green total factor productivity (GTFP), the proxy variable for green development, and briefly analyze its spatial-temporal trends. Then, using the dynamic panel models, dynamic panel mediation models, and dynamic panel threshold models, we evaluate how public expenditure affects GTFP. The main findings are fourfold: (1) there is a significant inverted U-shaped relationship between the expenditure size and GTFP. (2) The expansion of social expenditures and science and technology (S&T) and environmental protection expenditures play an important role in stimulating green growth, while economic expenditures and administrative expenditures have adverse effects. (3) Public expenditure mainly promotes green development through four channels: human capital accumulation, technological innovation, environmental quality improvement, and labor productivity increase. (4) The expenditure composition influences the turning point of the inverted U-shaped relationship. Based on these findings, we propose some targeted policy suggestions to promote green development. Full article

Substance use disorder (SUD) is associated with poor nutrition. Vitamin B9, or folate, is an important micronutrient for health. The aim of this prospective longitudinal cohort study was to assess serum folate levels among people with SUD and to investigate the impact of factors related to substance use severity on folate status. Participants were recruited from outpatient clinics for opioid agonist therapy (OAT) and municipal health-care clinics for SUD in Western Norway. They were assessed annually, including blood sampling for determination of micronutrient status. Overall, 663 participants with a total of 2236 serum folate measurements were included. A linear mixed model was applied, and measures are presented as β-coefficients with 95% confidence interval (CI). Forty-eight percent (CI: 44–51) of the population had low serum folate levels (s-folate < 10 nmol/L), and 23% (CI: 20–26) were deficient (s-folate < 6.8 nmol/L) at baseline. Sixty percent (CI: 53–65) sustained their poor folate status in at least one subsequent assessment. Except for weekly use of cannabis (mean difference in serum folate [nmol/L]: −1.8, CI: −3.3, −0.25) and alcohol (1.9, CI: 0.15, 3.6), weekly use of no other substance class was associated with baseline differences in serum folate when compared to less frequent or no use. Injecting substances was associated with a reduction in serum folate over time (−1.2, CI: −2.3, −0.14), as was higher dosages of OAT medication (−1.1, CI: −2.2, −0.024). Our findings emphasize the need of addressing nutrition among people with severe SUD. Full article

Nature-based recreation (NBR) is an important cultural ecosystem service providing human well-being from natural environments. As the most concentrated and high-quality wilderness in China, the Qinghai-Tibet Plateau (QTP) has unique advantages for NBR. In this study, we designed an integrated nature-based recreation potential index (INRPI) based on four aspects: nature-based recreation resources, landscape attractiveness, recreation comfort and opportunity, and recreation reception ability. A combination of the analytic hierarchy process (AHP) and entropy evaluation method was adopted to assess the NBR potential in the QTP from 2000 to 2020. The research shows that: (i) The INRPI for the QTP decreases gradually from southeast to northwest and increases slightly from 2000 to 2020. (ii) The INRPI displays a pronounced difference on either side of the Qilian-Gyirong line. The areas with very high and high potentials mainly distributed in the southeast of the line, while areas with very low and low potentials distributed in the northwest. (iii) The construction of protected areas effectively improves NBR potential. Areas of INRPI at diverse levels within protected areas obviously increased in 2020. (iv) Increasing altitude has a notable effect on INRPI, and 3000 m is a critical dividing line for the NBR in the QTP. These findings can contribute to decision-makers in guiding rational use and spatial planning of natural land and promoting sustainable recreational development. Full article