International Journal of Environmental Research and Public Health

Research in instability has focused on the analysis of muscle activation. The aim of this systematic review was to analyse the effects of unstable devices on speed, strength and muscle power measurements administered in the form of controlled trials to healthy individuals in adulthood. A computerized systematic literature search was performed through electronic databases. According to the criteria for preparing systematic reviews PRISMA, nine studies met the inclusion criteria. The quality of the selected studies was evaluated using STROBE. The average score was 14.3 points, and the highest scores were located in ‘Introduction’ (100%) and ‘Discussion’ (80%). There is great heterogeneity in terms of performance variables. However, instability seems to affect these variables negatively. The strength variable was affected to a greater degree, but with intensities near to the 1RM, no differences are observed. As for power, a greater number of repetitions seems to benefit the production of this variable in instability in the upper limb. Instability, in comparison to a stable condition, decreases the parameters of strength, power, and muscular speed in adults. The differences shown are quite significant in most situations although slight decreases can be seen in certain situations. Full article

The super-aged society of Japan is experiencing an increased demand for dental hygienists, of which there is currently a shortage. This study aimed to investigate the factors related to the working status of dental hygienists in Japan. We conducted a survey by mailing a questionnaire on employment to 1444 dental hygienists and obtained 537 valid responses. We conducted a bivariate analysis using either a chi-square test or t-test as well as a multiple logistic regression analysis to determine the factors related to working status. The overall employment rate was 68.2%, with a significant difference between age groups (p < 0.01). Approximately 80% of respondents considered working hours and human relations at the workplace to be important, and more than 70% of respondents considered wages as important. Finally, the following four variables were found to be significantly associated with employment status: training course attendance, a desire to work full-time, consideration of wages as important, and consideration of working hours as important. These findings suggest that it is necessary to improve working conditions and environments, including wages and working hours, as well as provide a more robust system of continued professional development for dental hygienists to increase the workforce. Full article

The non-stationarity, nonlinearity and complexity of the PM_2.5 series have caused difficulties in PM_2.5 prediction. To improve prediction accuracy, many forecasting methods have been developed. However, these methods usually do not consider the importance of data preprocessing and have limitations only using a single forecasting model. Therefore, this paper proposed a new hybrid decomposition–ensemble learning paradigm based on variation mode decomposition (VMD) and improved whale-optimization algorithm (IWOA) to address complex nonlinear environmental data. First, the VMD is employed to decompose the PM_2.5 sequences into a set of variational modes (VMs) with different frequencies. Then, an ensemble method based on four individual forecasting approaches is applied to forecast all the VMs. With regard to ensemble weight coefficients, the IWOA is applied to optimize the weight coefficients, and the final forecasting results were obtained by reconstructing the refined sequences. To verify and validate the proposed learning paradigm, four daily PM_2.5 datasets collected from the Jing-Jin-Ji area of China are chosen as the test cases to conduct the empirical research. The experimental results indicated that the proposed learning paradigm has the best results in all cases and metrics. Full article

To minimize the damage from contaminant accidents in rivers, early identification of the contaminant source is crucial. Thus, in this study, a framework combining Machine Learning (ML) and the Transient Storage zone Model (TSM) was developed to predict the spill location and mass of a contaminant source. The TSM model was employed to simulate non-Fickian Breakthrough Curves (BTCs), which entails relevant information of the contaminant source. Then, the ML models were used to identify the BTC features, characterized by 21 variables, to predict the spill location and mass. The proposed framework was applied to the Gam Creek, South Korea, in which two tracer tests were conducted. In this study, six ML methods were applied for the prediction of spill location and mass, while the most relevant BTC features were selected by Recursive Feature Elimination Cross-Validation (RFECV). Model applications to field data showed that the ensemble Decision tree models, Random Forest (RF) and Xgboost (XGB), were the most efficient and feasible in predicting the contaminant source. Full article

The aim of this narrative review is to introduce the reader to Bayesian methods that, in our opinion, appear to be the most important in the context of rare diseases. A disease is defined as rare depending on the prevalence of the affected patients in the considered population, for example, about 1 in 1500 people in U.S.; about 1 in 2500 people in Japan; and fewer than 1 in 2000 people in Europe. There are between 6000 and 8000 rare diseases and the main issue in drug development is linked to the challenge of achieving robust evidence from clinical trials in small populations. A better use of all available information can help the development process and Bayesian statistics can provide a solid framework at the design stage, during the conduct of the trial, and at the analysis stage. The focus of this manuscript is to provide a review of Bayesian methods for sample size computation or reassessment during phase II or phase III trial, for response adaptive randomization and of for meta-analysis in rare disease. Challenges regarding prior distribution choice, computational burden and dissemination are also discussed. Full article

The Mindful Eating Questionnaire is a reliable tool for the assessment of mindful eating behavior among the general population. This study aimed to determine the reliability and validity of The Malay Mindful Eating Questionnaire (MEQ-M) in a sample of overweight and obese adults. This is a cross-sectional survey which involved 144 overweight and obese adults in a selected public university. After linguistic validation of the Malay version of the MEQ, exploratory factor analysis (EFA) with varimax rotation was performed on the scale constructs. The psychometric properties of the MEQ were assessed through Cronbach’s alpha and intraclass correlation coefficient (ICC) analysis. The EFA of the MEQ produced a seven-dimensional model (58.8% of overall variances). The concurrent validity analysis between total MEQ scores and total Mindfulness Attention Awareness Scale (MAAS) scores indicated a weak non-significant correlation (p = 0.679). The internal consistency reliability of the MEQ was reasonable (Cronbach’s α = 0.64). The agreement stability of the MEQ over eight weeks was poor (ICC = 0.10). In conclusion, the psychometric properties of the Malay-translated MEQ are acceptable through construct validity and internal consistency reliability tests. This instrument may be used for assessing mindful eating habits in the Malaysian population, especially among overweight and obese adults. Full article

Introduction. Digital impressions in implant dentistry rely on many variables, and their accuracy, particularly in complete edentulous patients, is not well understood. Aim. The purpose of this literature review was to determine which factors may influence the accuracy of digital impressions in implant dentistry. Emphasized attention was given to the design of the intra-oral scan body (ISB) and scanning techniques. Materials and methods. A Medline, PubMed and EBSCO Host databases search, complemented by a hand search, was performed in order to select relevant reports regarding the appliance of digital impressions in implant dentistry. The search subject included but was not limited to accuracy of digital impressions in implant dentistry, digital scanning techniques, the design and material of the ISBs, and the depth and angulation of the implant. The related titles and abstracts were screened, and the remaining articles that fulfilled the inclusion criteria were selected for full-text readings. Results. The literature search conducted for this review initially resulted in 108 articles, among which only 21 articles fulfilled the criteria for inclusion. Studies were evaluated according to five subjects: accuracy of digital impressions in implant dentistry; the design and material of the intra-oral scan bodies; scanning technique; the influence of implants depth/angulations on the digital impression and accuracy of different intra-oral scanner devices. Conclusions. The accuracy of digital impressions in implant dentistry depends on several aspects. The depth/angulation of the implant, the experience of the operator, the intra-oral scanner used, and environmental conditions may influence the accuracy of digital impressions in implant dentistry. However, it seems that ISBs’ design and material, as well as scanning technique, have a major impact on the trueness and precision of digital impressions in implant dentistry. Future research is suggested for the better understanding of this subject, focusing on the optimization of the ISB design and scanning protocols. Full article

In the landscape of Covid-19 pandemic, people’s well-being, to some extent, can be affected through virtual reality tourism because it has the opportunity to enhance their level of well-being and destination recovery. To verify this empirically an investigation was conducted among people who used Quanjingke, the largest tourism-related virtual reality website in China, during the pandemic. The specific the aim of this paper is to prove the effectiveness of virtual reality tourism in promoting people’s subjective well-being. Hence, an integrated model with the constructs of peripheral attribute, core attribute and pivotal attribute, presence, perceived value, satisfaction, and subjective well-being was proposed and tested. The results indicate that attributes of virtual reality tourism have a positive effect on presence during virtual reality experiences, which positively influences perceived value. The values of virtual reality tourism perceived by tourists result in their satisfaction. Eventually, it was found that tourists’ subjective well-being is improved due to their satisfaction with virtual reality tourism. Practical suggestions are also provided based on the findings. Full article

Medication-induced jaw osteonecrosis (MRONJ) is a rare and serious disease with a negative impact on patients’ quality of life, whose exact cause remains unclear and which may have a multifactorial origin. Although there are different therapeutic protocols, there is still no consensus. This case series evaluated three patients diagnosed with staged 2 MRONJ treated at the University of Murcia dental clinic according to the protocols described by the Spanish Society of Oral and Maxillofacial Surgery and the American Association of Oral and Maxillofacial Surgeons. Within 12 months of the application of therapeutic protocols, the lesions were completely healed in all cases. Radiography showed slow but progressive healing with normal bone structure. Conservative treatment with antibiotics, chlorhexidine rinses and minimally invasive surgical intervention with necrotic bone resection is effective in treating stage 2 of MRONJ. In cases of refractory osteonecrosis, the application of platelet and leukocyte-rich fibrin (PRF-L) in the surgical approach improves the outcome in soft tissue healing and bone regeneration but further research is needed to confirm its effectiveness. Full article

According to the World Health Organization, cancer is the second leading cause of death in the world. In Spain, about a quarter of a million cases were diagnosed in 2017, and 81% of the Spanish population has used, at least once, some kind of complementary therapy. Said therapies are increasingly being used by cancer patients. The purpose of the study is to analyse the effectiveness of complementary therapies among cancer patients. A systematic peer review was conducted following the PRISMA-ScR guide in four databases (PubMed, CINAHL, Scopus and WOS). The inclusion criteria were Randomised Clinical Trials, published between 2013 and 2018, with a value of 3 or more on the Jadad Scale. The protocol was registered in PROSPERO (CRD42019127593). The study sample amounted to 1845 patients (64.55% women), the most common being breast cancer patients (794), followed by lung cancer patients (341). Fifteen complementary therapies were identified. We found two studies for each of the following: electroacupuncture, phytotherapy, hypnotherapy, guided imagery and progressive muscle relaxation. From the remaining ones, we identified a study on each therapy. The findings reveal some effective complementary therapies: auriculotherapy and acupuncture, laser moxibustion, hypnosis, Ayurveda, electroacupuncture, progressive muscle relaxation and guided imagery, yoga, phytotherapy, music therapy and traditional Chinese medicine. On the other hand, electroacupuncture, laser moxibustion and traditional Chinese medicine presented adverse effects, and kinesiology did not show effectiveness. Full article

Owing to the convenience, reliability and contact-free feature of Mobile payment (M-payment), it has been diffusely adopted in China during the COVID-19 pandemic to reduce the direct and indirect contacts in transactions, allowing social distancing to be maintained and facilitating stabilization of the social economy. This paper aims to comprehensively investigate the technological and mental factors affecting users’ adoption intentions of M-payment under the COVID-19 pandemic, to expand the domain of technology adoption under the emergency situation. This study integrated Unified Theory of Acceptance and Use of Technology (UTAUT) with perceived benefits from Mental Accounting Theory (MAT), and two additional variables (perceived security and trust) to investigate 739 smartphone users’ adoption intentions of M-payment during the COVID-19 pandemic in China. The empirical results showed that users’ technological and mental perceptions conjointly influence their adoption intentions of M-payment during the COVID-19 pandemic, wherein perceived benefits are significantly determined by social influence and trust, corresponding with the situation of pandemic. This study initially integrated UTAUT with MAT to develop the theoretical framework for investigating users’ adoption intentions. Meanwhile, this study originally investigated the antecedents of M-payment adoption under the pandemic situation and indicated that users’ perceptions will be positively influenced when technology’s specific characteristics can benefit a particular situation. Full article

We aimed to identify persistent asthma phenotypes among adolescents and to evaluate longitudinally asthma-related outcomes across phenotypes. Adolescents (13–17 years) from the prospective, observational, and multicenter INSPIRERS studies, conducted in Portugal and Spain, were included (n = 162). Latent class analysis was applied to demographic, environmental, and clinical variables, collected at a baseline medical visit. Longitudinal differences in clinical variables were assessed at a 4-month follow-up telephone contact (n = 128). Three classes/phenotypes of persistent asthma were identified. Adolescents in class 1 (n = 87) were highly symptomatic at baseline and presented the highest number of unscheduled healthcare visits per month and exacerbations per month, both at baseline and follow-up. Class 2 (n = 32) was characterized by female predominance, more frequent obesity, and uncontrolled upper/lower airways symptoms at baseline. At follow-up, there was a significant increase in the proportion of controlled lower airway symptoms (p < 0.001). Class 3 (n = 43) included mostly males with controlled lower airways symptoms; at follow-up, while keeping symptom control, there was a significant increase in exacerbations/month (p = 0.015). We have identified distinct phenotypes of persistent asthma in adolescents with different patterns in longitudinal asthma-related outcomes, supporting the importance of profiling asthma phenotypes in predicting disease outcomes that might inform targeted interventions and reduce future risk. Full article

Background: Lower socioeconomic groups and disadvantaged populations across the world suffer disproportionately from the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to examine the impact of health- and social-inequality–related factors on well-being in order to further distinguish each of their effects during the pandemic. Methods: A nationally-representative sample of 5077 UK respondents aged 18 years or older was recruited through an online survey panel during the COVID-19 pandemic. Their subjective well-being was measured using the 11-point Cantril Ladder of Life Scale. The impact of inequality-related health and social factors (pre-existing medical conditions, household size and occupation), as well as COVID-19–related risk factors (symptoms, confirmed infections, and social distancing behaviours) on well-being were analysed using multiple linear regression models. The associations between the COVID-19–related risk factors and well-being according to the respondents’ household size and occupation were modelled in order to test the differences by their socioeconomic profile. Results: We identified inverted V-shaped associations between household size and subjective well-being during the COVID-19 pandemic. Compared to single-person households, respondents from households of two to four persons showed better well-being (β = 0.57; CI (0.44, 0.72)), whereas living in crowded households of five persons or more was associated with decreased well-being (β = −0.48; CI (−0.71, −0.25)). Furthermore, lower-skilled occupations (elementary occupations: β = −0.31; CI (−0.58, −0.03); logistics and transport services: β = −0.37; CI (−0.74, −0.01)) and chronic medical conditions (cardiometabolic or respiratory diseases: β = −0.25; CI (−0.41, −0.1); and mental health conditions: β = −1.12; CI (−1.28, −0.96)) were factors associated with reduced well-being during the pandemic. Interactions between a positive COVID-19 diagnosis, symptoms, and crowded households were identified (β = −0.95; CI (−1.76, −0.14) and β = −4.74; CI (−9.87, −1.61), respectively). Conclusions: In a national sample, the levels of general subjective well-being during the COVID-19 pandemic and lockdowns were disproportionately distributed across different groups within society. Preventive policies should explicitly focus on reaching lower socioeconomic groups; more emphasis should be placed on the coordination of multisectoral support in order to tackle existing health and social inequalities. Full article

Open defecation (OD) is still a significant public health challenge worldwide. In Timor-Leste, where an estimated 20% of the population practiced OD in 2017, increasing access and use of improved sanitation facilities is a government priority. Community-led total sanitation (CLTS) has become a popular strategy to end OD since its inception in 2000, but evidence on the uptake of CLTS and related interventions and the long-term sustainability of OD-free (ODF) communities is limited. This study utilized a mixed-methods approach, encompassing quantitative monitoring and evaluation data from water, sanitation, and hygiene (WASH) agencies, and semi-structured interviews with staff working for these organizations and the government Department of Environmental Health, to examine sanitation interventions in Timor-Leste. Recommendations from WASH practitioners on how sanitation strategies can be optimized to ensure ODF sustainability are presented. Whilst uptake of interventions is generally good in Timor-Leste, lack of consistent monitoring and evaluation following intervention delivery may contribute to the observed slippage back to OD practices. Stakeholder views suggest that long-term support and monitoring after ODF certification are needed to sustain ODF communities. Full article

Lateral elbow tendinopathy, or “tennis elbow,” is a pathology that affects around 1.3% of the general population. Capacitive–resistive electric transfer therapy aims to provoke temperature and current flow changes in superficial and deep tissues. The aim of this in vitro study was to analyze the thermal behavior and transmission of electric current on the superficial and deep tissues of the elbow during the application of different modalities of a capacitive–resistive electric transfer treatment protocol for chronic elbow tendinopathy. A cross-sectional study was designed; five fresh cryopreserved cadavers (10 elbows) were included in this study. A 30 min intervention was performed based on a protocol commonly used in clinics for the treatment of chronic lateral elbow tendinopathy by diathermy using the “T-Plus.” Common extensor tendon, radiohumeral capsule, and superficial temperatures were registered after each application for the duration of the 30 min treatment protocol. During all applications, we observed a current flow of over 0.03 A. The protocol showed a statistically significant increase in superficial temperature by 24% (5.02°) (p < 0.005), the common extensor tendon by 19.7% (4.36°) (p < 0.007), and the radiohumeral joint capsule by 17.5% (3.41°) (p < 0.005) at the end of the 30 min protocol compared with the baseline temperature. The different applications of the protocol showed specific effects on the temperature and current flow in the common extensor tendon and radiohumeral capsule. All applications of the protocol produced a current flow that is associated with the generation of cell proliferation. These results strengthen the hypothesis of cell proliferation and thermal changes in deep and distal structures. More studies are needed to confirm these results. Full article

The impact of the COVID-19 pandemic on US adults’ smoking and quitting behaviors is unclear. We explored the impact of COVID-19 on smoking behaviors, risk perceptions, and reactions to text messages during a statewide stay-at-home advisory among primary care patients who were trying to quit. From May–June 2020, we interviewed smokers enrolled in a 12-week, pilot cessation trial providing text messaging and mailed nicotine replacement medication (NCT04020718). Twenty-two individuals (82% white, mean age 55 years), representing 88% of trial participants during the stay-at-home advisory, completed exit interviews; four (18%) of them reported abstinence. Interviews were thematically analyzed by two coders. COVID-19-induced environmental changes had mixed effects, facilitating quitting for some and impeding quitting for others. While stress increased for many, those who quit found ways to cope with stress. Generally, participants felt at risk for COVID-19 complications but not at increased risk of becoming infected. Reactions to COVID-19 and quitting behaviors differed across age groups, older participants reported difficulties coping with isolation (e.g., feeling disappointed when a text message came from the study and not a live person). Findings suggest that cessation interventions addressing stress and boredom are needed during COVID-19, while smokers experiencing isolation may benefit from live-person supports. Full article

The current study aimed to longitudinally evaluate anthropometric, physiological, and biomechanical variables related to middle-distance performance during a 45-week swimming training season. Thirty-four swimmers (age: 12.07 ± 1.14 years) performed a maximum of 400 m front crawl at the beginning (T1) and finish of the first macrocycle (T2, 15 weeks) and the finish of the second (T3, 18 weeks) and third macrocycles (T4, 12 weeks). Time-related variables, stroke rate (SR), stroke length (SL), and stroke index (SI) were recorded during the test, and blood lactate ([La]) and glucose ([Glu]) concentrations were measured post-exercise. The time of the 400 m effort decreased after each macrocycle (T2 vs. T1, 7.8 ± 5.6%; T3 vs. T2, 3.7 ± 3.1%; T4 vs. T3, 3.8 ± 3.4%; p < 0.01). Four hundred meter speed changes between T1 and T2 were positively related to variations in [La], [Glu], SL, and SI (r = 0.36–0.60, p < 0.05). Changes between T2 and T3 were related to SI only (r = 0.5, p < 0.05), and modifications between T3 and T4 were associated with SL and SI variations (r = 0.34 and 0.65, p < 0.05). These results indicate that a well-structured year plan including three macrocycles leads to a significant age-group swimming performance improvement, mostly connected with an increase in technical proficiency. Full article

(1) Background: Gender-based violence has no geographical, personal, or social boundaries. It constitutes a serious public health problem that affects the entire society. This research aims to identify and compare the level of ambivalent sexism in Spanish and Colombian university students and its relationship with sociodemographic factors. Ambivalent sexism, developed by Glick and Fiske (1996), is considered a new type of sexism since, for the first time, it combines negative and positive feelings that give rise to hostile and benevolent sexism, maintaining the subordination of women through punishment and rewards. (2) Methods: The methodology consisted of the application of the validated Spanish version of the Ambivalent Sexism Inventory (ASI) to a sample of 374 students in their final academic year of the Law program, of which 21.7% were students at the University of Santander (Bucaramanga, Colombia), 45.5% at the University Rey Juan Carlos (Madrid, Spain), and the remaining 32.9% at the University of Seville (Seville, Spain). (3) Results: A high level of ambivalent sexism is reported in Colombian students nowadays. In the two countries. there are similarities (e.g., the great weight of religion and the variation in attitudes towards sexism in people who identify themselves as women, compared to male or students consulted that prefer not to answer) and differences (e.g., absence in Colombia of gender-specific legislation, low number of students who have received gender education in Spain). (4) Conclusions: These findings may contribute to the construction of laws that take into account the particular problems of women and the development of educational programs on gender that are offered in a transversal and permanent way and that take into account cultural factors and equity between men and women as an essential element in the training of future judges who have the legal responsibility to protect those who report gender violence. Full article

Risky play is challenging, exciting play with the possibility of physical, social, or emotional harm. Through risky play, children learn, develop, and experience wellbeing. Children with disabilities have fewer opportunities than their typically developing peers to engage in this beneficial type of play. Our team designed a novel, school-based intervention to address this disparity; however, our intervention yielded unexpected quantitative results. In the present study, we qualitatively examined divergent results at two of the five schools that participated in the intervention. Specifically, we aimed to explore how staff culture (i.e., shared beliefs, values, and practices) influenced the intervention. To explore this relationship, we employed a retrospective, qualitative, multiple case study. We used thematic analysis of evaluative interviews with staff members to elucidate the cultures at each school. Then, we used cross-case analysis to understand the relationships between aspects of staff culture and the intervention’s implementation and results. We found that staff cultures around play, risk, disability influenced the way, and the extent to which, staff were willing to let go and allowed children to engage in risky play. Adults’ beliefs about the purpose of play and recess, as well as their expectations for children with disabilities, particularly influenced the intervention. Furthermore, when the assumptions of the intervention and the staff culture did not align, the intervention could not succeed. The results of this study highlight the importance of (1) evaluating each schools’ unique staff culture before implementing play-focused interventions and (2) tailoring interventions to meet the needs of individual schools. Full article