Special Issue "Feature Papers in Public Health Statistics and Risk Assessment"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Public Health Statistics and Risk Assessment".

Deadline for manuscript submissions: 31 December 2021.

Special Issue Editor

Prof. Dr. Jimmy T. Efird
E-Mail Website
Guest Editor
Cooperative Studies Program Epidemiology Center, Health Services Research and Development (DVAHCS/Duke Affiliated Center), Durham, NC 28211, USA
Interests: statistical methods; epidemiological study design; risk modeling; cardiovascular disease; cancer
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues:

We are pleased to announce the Special Issue entitled “Feature Papers in Public Health Statistics and Risk Assessment”. This is a collection of relevant white papers, topic overviews, tutorials, and seminal work of current interest in the field.   

We hope this topic is of interest to you and invite you to send a tentative title and short abstract to our editorial office ([email protected]) for evaluation before submission. Please note that selected papers are still subject to thorough peer review. Well-prepared papers accepted for this Special Issue will be granted a discounted publication fee or waiver.

We look forward to receiving your excellent work.

Prof. Dr. Jimmy T. Efird, PhD, MSc
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Risk outcomes by geographic region, country or social stratum
  • Public health statistics
  • Epidemiologic methods
  • Seminal public health topics of current interest
  • Meta-analyses and systematic reviews
  • Clinical trial results
  • Disease risk analyses
  • Outbreak studies
  • Environmental health risk assessment

Published Papers (32 papers)

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Article
Understanding the Factors Related to Trauma-Induced Stress in Cancer Patients: A National Study of 17 Cancer Centers
Int. J. Environ. Res. Public Health 2021, 18(14), 7600; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147600 - 16 Jul 2021
Viewed by 328
Abstract
Objective: Posttraumatic stress symptoms (PTSS), defined as continued trauma, has been found to negatively impact mental and physical health. Many cancer centers routinely assess level of psychological distress but assessment of symptoms related to PTSS is less routine. Understanding the mechanisms by which [...] Read more.
Objective: Posttraumatic stress symptoms (PTSS), defined as continued trauma, has been found to negatively impact mental and physical health. Many cancer centers routinely assess level of psychological distress but assessment of symptoms related to PTSS is less routine. Understanding the mechanisms by which psychological distress results in, or influences, PTSS will aid in developing protocols to more effectively identify PTSS in cancer patients. Methods: Survey data were analyzed from intake data at 17 cancer centers across the U.S. Patients reported distress ratings on the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT), responded to questions related to intrusive cognitive symptoms of PTSS and provided information about current symptoms and social support systems. Hypotheses were tested using a conditional process model, and paths were provided for direct and indirect effects, including moderation and mediated moderation. Results: Findings indicated that, while distress scores were influential in the total model, the direct effect of distress on intrusive cognitive symptoms of PTSS was negated by the model’s indirect effects. The effects of social support and older age were independent protective factors, and there was a moderation effect that varied across groups. Lastly, physical cancer symptoms as a mediating variable further explained the relationship between psychological distress and intrusive cognitive symptoms of PTSS. Conclusions: Study results provide evidence for a potential mechanism by which distress relates to intrusive cognitive symptoms of PTSS. Furthermore, findings suggest that older age and social support may be protective factors for certain groups and risk factors for others. This study provides formative data for potential next steps that could lead to improvements in routine psychosocial screenings in cancer treatment settings. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Eye-Tracking Evaluation of Exit Advance Guide Signs in Highway Tunnels in Familiar and Unfamiliar Drivers
Int. J. Environ. Res. Public Health 2021, 18(13), 6820; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18136820 - 25 Jun 2021
Viewed by 340
Abstract
As a component of the traffic control plan, traffic signs on highways offer drivers necessary information. Unfortunately, many signs are unfamiliar to or misunderstood by drivers, especially when lacking a setting method; this includes exit advance guide signs in tunnels. These are generally [...] Read more.
As a component of the traffic control plan, traffic signs on highways offer drivers necessary information. Unfortunately, many signs are unfamiliar to or misunderstood by drivers, especially when lacking a setting method; this includes exit advance guide signs in tunnels. These are generally set in roadbed sections, but space limitations in tunnels dictate that they must be set differently. To evaluate the effect of the setting method, an experiment was designed and conducted, during which the eye movements of 44 drivers with different familiarity levels were tracked. Twenty-two of the drivers had not previously participated in any experiment involving exit advance guide signs in highway tunnels, while 22 of them had. Time period data were analyzed, including data from before the sign appeared, when it appeared, and when it disappeared. Based on area division and Markov theory, attributes related to gaze transition were obtained, including one- and two-step gaze transition probabilities and area gaze probabilities. The results showed that gaze transition was confirmed to be significantly different between the three periods and between the drivers. Features extracted from eye movement characteristics, gaze transition paths, and gaze areas demonstrated that visual attention is more dispersed in familiar drivers during the lane-change intention period. Therefore, signs should be placed on the left wall of the highway tunnel. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Comparison of Prediction Models for Mortality Related to Injuries from Road Traffic Accidents after Correcting for Undersampling
Int. J. Environ. Res. Public Health 2021, 18(11), 5604; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115604 - 24 May 2021
Viewed by 505
Abstract
In this study, four models—logistic regression (LR), random forest (RF), linear support vector machine (SVM), and radial basis function (RBF)-SVM—were compared for their accuracy in determining mortality caused by road traffic injuries. They were tested using five years of national-level data from the [...] Read more.
In this study, four models—logistic regression (LR), random forest (RF), linear support vector machine (SVM), and radial basis function (RBF)-SVM—were compared for their accuracy in determining mortality caused by road traffic injuries. They were tested using five years of national-level data from the Korea Disease Control and Prevention Agency’s (KDCA) National Hospital Discharge In-Depth Survey (2013 through to 2017). Model performance was measured for accuracy, precision, recall, F1 score, and Brier score metrics using classification analysis that included characteristics of patients, accidents, injuries, and illnesses. Due to the number of variables and differing units, the rates of survival and mortality related to road traffic accidents were imbalanced, so the data was corrected and standardized before the classification models’ performances were compared. Using the importance analysis, the main diagnosis, the type of injury, the site of the injury, the type of injury, the operation status, the type of accident, the role at the time of the accident, and the sex were selected as the analysis factors. The biggest contributing factor was the role in the accident, which is the driver, and the major sites of the injuries were head injuries and deep injuries. Using selected factors, comparisons of the classification performance of each model indicated RBF-SVM and RF models were superior to the others. Of the SVM models, the RBF kernel model was superior to the linear kernel model; it can be inferred that the performance of the high-dimensional transformed RBF model is superior when the dimension is complex because of the use of multiple variables. The findings suggest there are limitations to analyses involving imbalanced, multidimensional original data, such as data on road traffic mortality. Thus, analyses must be performed after imbalances are corrected. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Urban–Rural Disparities in the Magnitude and Determinants of Stunting among Children under Five in Tanzania: Based on Tanzania Demographic and Health Surveys 1991–2016
Int. J. Environ. Res. Public Health 2021, 18(10), 5184; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105184 - 13 May 2021
Viewed by 446
Abstract
Our study aims to examine the disparity of under-5 child stunting prevalence between urban and rural areas of Tanzania in the past three decades, and to explore factors affecting the rural–urban disparity. Secondary analyses of Tanzania Demographic and Health Surveys (TDHS) data drawn [...] Read more.
Our study aims to examine the disparity of under-5 child stunting prevalence between urban and rural areas of Tanzania in the past three decades, and to explore factors affecting the rural–urban disparity. Secondary analyses of Tanzania Demographic and Health Surveys (TDHS) data drawn from 1991–1992, 1996, 1999, 2004–2005, 2009–2010, and 2015–2016 surveys were conducted. Under-5 child stunting prevalence was calculated separately for rural and urban children and its decline trends were examined by chi-square tests. Descriptive analyses were used to present the individual-level, household-level, and societal-level characteristics of children, while multivariable logistic regression analyses were performed to examine determinants of stunting in rural and urban areas, respectively. Additive interaction effects were estimated between residence and other covariates. The results showed that total stunting prevalence was declining in Tanzania, but urban–rural disparity has widened since the decline was slower in the rural area. No interaction effect existed between residence and other determinants, and the urban–rural disparity was mainly caused by the discrepancy of the individual-level and household-level factors between rural and urban households. As various types of determinants exist, multisector nutritional intervention strategies are required to address the child stunting problem. Meanwhile, the intervention should focus on targeting vulnerable children, rather than implementing different policies in rural and urban areas. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Description of Main Predictors for Taking Sick Leave Associated with Work-Related Eye Injuries in Spain
Int. J. Environ. Res. Public Health 2021, 18(10), 5157; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105157 - 13 May 2021
Viewed by 499
Abstract
Recent studies in Spain have shown that males, younger workers, and people involved in manual jobs had the highest risk of suffering a work-related eye injury (WREI). This study aims to assess the predictors of sick leave associated with WREI and to compare [...] Read more.
Recent studies in Spain have shown that males, younger workers, and people involved in manual jobs had the highest risk of suffering a work-related eye injury (WREI). This study aims to assess the predictors of sick leave associated with WREI and to compare them with risk factors of initial injury. A retrospective and descriptive study of WREI that causes sick leave of one or more days among workers from an insurance labor mutual company in Spain was conducted over a period from 2008 to 2018. The variables of the study were sex, age, occupation, and type of injury. A total of 9352 (18.6% of 50,265 WREI) cases and 113,395 total days of sick leave were observed, with an estimated EUR 4,994,009.59 of associated labor cost. The main predictors of sick leave related to WREI were found to be female (highest incidence; 25.9 (95% CI (24.8–27.1))), >55 years of age (highest incidence; 20.5 (95% CI (19.3–21.7))), not working in the industry (lowest incidence; 13.8 (95% CI (13.3–14.2))), and not suffering “other disorders of conjunctiva” (lowest incidence; 5.7 (95% CI (4.7–6.8))). The consequences associated with WREI are worse for female and older workers, despite the main risk of suffering WREI being observed in males and younger workers. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
Article
The Cycle to Respectful Care: A Qualitative Approach to the Creation of an Actionable Framework to Address Maternal Outcome Disparities
Int. J. Environ. Res. Public Health 2021, 18(9), 4933; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094933 - 06 May 2021
Viewed by 1017
Abstract
Despite persistent disparities in maternity care outcomes, there are limited resources to guide clinical practice and clinician behavior to dismantle biased practices and beliefs, structural and institutional racism, and the policies that perpetuate racism. Focus groups and interviews were held in communities in [...] Read more.
Despite persistent disparities in maternity care outcomes, there are limited resources to guide clinical practice and clinician behavior to dismantle biased practices and beliefs, structural and institutional racism, and the policies that perpetuate racism. Focus groups and interviews were held in communities in the United States identified as having higher density of Black births. Focus group and interview themes and codes illuminated Black birthing individual’s experience with labor and delivery in the hospital setting. Using an iterative process to refine and incorporate qualitative themes, we created a framework in close collaboration with birth equity stakeholders. This is an actionable, cyclical framework for training on anti-racist maternity care. The Cycle to Respectful Care acknowledges the development and perpetuation of biased healthcare delivery, while providing a solution for dismantling healthcare providers’ socialization that results in biased and discriminatory care. The Cycle to Respectful Care is an actionable tool to liberate patients, by way of their healthcare providers, from biased practices and beliefs, structural and institutional racism, and the policies that perpetuate racism. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Physical Comorbidity According to Diagnoses and Sex among Psychiatric Inpatients in South Korea
Int. J. Environ. Res. Public Health 2021, 18(8), 4187; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084187 - 15 Apr 2021
Viewed by 582
Abstract
People with mental disorders are susceptible to physical comorbidities. Mind–body interventions are important for improving health outcomes. We examined the prevalence of physical comorbidities and their differences by diagnoses and sex among psychiatric inpatients. The dataset, from National Health Insurance claims data, included [...] Read more.
People with mental disorders are susceptible to physical comorbidities. Mind–body interventions are important for improving health outcomes. We examined the prevalence of physical comorbidities and their differences by diagnoses and sex among psychiatric inpatients. The dataset, from National Health Insurance claims data, included 48,902 adult inpatients admitted to psychiatric wards for at least 2 days in 2016 treated for schizophrenia, schizotypal and delusional disorders, or mood disorders. We identified 26 physical comorbidities using the Elixhauser comorbidity measure. Among schizophrenia-related disorders, other neurological disorders were most common, then liver disease and chronic pulmonary disease. Among mood disorders, liver disease was most common, then uncomplicated hypertension and chronic pulmonary disease. Most comorbid physical diseases (except other neurological disorders) were more prevalent in mood disorders than schizophrenia-related disorders. Male and female patients with schizophrenia-related disorders showed similar comorbidity prevalence patterns by sex. Among patients with mood disorders, liver disease was most prevalent in males and third-most in females. In both diagnostic groups, liver disease and uncomplicated diabetes mellitus were more prevalent in males, and hypothyroidism in females. Mental health professionals should refer to a specialist to manage physical diseases via early assessments and optimal interventions for physical comorbidities in psychiatric patients. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
Article
Associations between Lifestyle Habits, Perceived Symptoms and Gastroesophageal Reflux Disease in Patients Seeking Health Check-Ups
Int. J. Environ. Res. Public Health 2021, 18(7), 3808; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18073808 - 06 Apr 2021
Viewed by 634
Abstract
Gastroesophageal reflux disease (GERD) is one of the most common diseases. It mainly causes the stomach contents to flow back to the esophagus, thereby stimulating the esophagus and causing discomfort. From the results of our research, we intend to provide the general public [...] Read more.
Gastroesophageal reflux disease (GERD) is one of the most common diseases. It mainly causes the stomach contents to flow back to the esophagus, thereby stimulating the esophagus and causing discomfort. From the results of our research, we intend to provide the general public with information related to preventing gastroesophageal reflux disease and medical personnel with information on the treatment and care of patients with gastroesophageal reflux disease. This study aimed to investigate the association of lifestyle habits and perceived symptoms on GERD in patients who underwent routine health check-ups. This study was conducted as a retrospective cross-sectional design to collect GERD cases from the medical records containing the health questionnaires and the report of endoscopic findings on the day of the health check-up. A total of 5653 patients were enrolled between 1 January 2016, and 31 December 2018. About 60.2% (n = 3404) of patients with GERD were diagnosed based on endoscopic findings. Descriptive and multivariate logistic regression analyses were performed to identify the risk factors of the development of GERD. The results of the multivariate logistic regression analysis showed that age, sex, waist circumference, Areca catechu chewing habit, sleep disorders, otolaryngology symptoms, and hepatobiliary and gastrointestinal symptoms were significantly associated with GERD. In this study, our results can be used as a reference for public health care and clinicians. Because most GERD cases can be controlled and prevented by lifestyle modifications, health professionals should always obtain a detailed history regarding symptoms and lifestyle habits associated with GERD. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
Article
Glycaemic Variability and Risk Factors of Pregnant Women with and without Gestational Diabetes Mellitus Measured by Continuous Glucose Monitoring
Int. J. Environ. Res. Public Health 2021, 18(7), 3402; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18073402 - 25 Mar 2021
Viewed by 667
Abstract
Background: The aim of the study was to compare the continuous glucose monitoring (CGM)-determined glycaemic variability (GV) of pregnant women with gestational diabetes mellitus (GDM) and without GDM (CG; control group). The secondary aim was to evaluate the association between risk factors [...] Read more.
Background: The aim of the study was to compare the continuous glucose monitoring (CGM)-determined glycaemic variability (GV) of pregnant women with gestational diabetes mellitus (GDM) and without GDM (CG; control group). The secondary aim was to evaluate the association between risk factors of diabetes in pregnancy and parameters of glyceamic control. Methods: Demographic, biometric and biochemical parameters were obtained for pregnant women (20–38 years old) who after an oral glucose tolerance test were examined by 7-day continuous glucose monitoring using a iPro®2 Professional CGM. Results: The differences in GV between women with GDM and CG compared by total area under glucose curve (total AUC, (mmol·day/L) was statistically significant (p = 0.006). Other parameters of glycaemic control such as mean glucose, standard deviation, coefficient of variation, J-index, % time-above target range 7.8 mmol/L (%TAR), % time-in range 3.5–7.8 mmol/L (%TIR), time-below target range 3.5 mmol/L (%TBR), glycated haemoglobin were not significantly different in the study groups. Risk factors (a family history of diabetes, pre-pregnancy BMI, higher weight gain and age) correlated with parameters of glycaemic control. Conclusions: We found a significant difference in GV of women with and without GDM by total AUC determined from CGM. TIR metrics were close to significance. Our work points at an increased GV in relation to the risk factors of GDM. Pregnant women with risk factors have higher probability of severe GV with its consequences on maternal and fetal health state. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Perceived Suicide Stigma and Associated Factors in Chinese College Students: Translation and Validation of the Stigma of Suicide Attempt Scale and the Stigma of Suicide and Suicide Survivors Scale
Int. J. Environ. Res. Public Health 2021, 18(7), 3400; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18073400 - 25 Mar 2021
Viewed by 662
Abstract
This study aims to translate and validate two perceived suicide stigma scales, including the Stigma of Suicide Attempt Scale (STOSA) and the Stigma of Suicide and Suicide Survivor Scale (STOSASS) into Chinese language, examining the factor structure, and assessing the correlation between suicide [...] Read more.
This study aims to translate and validate two perceived suicide stigma scales, including the Stigma of Suicide Attempt Scale (STOSA) and the Stigma of Suicide and Suicide Survivor Scale (STOSASS) into Chinese language, examining the factor structure, and assessing the correlation between suicide stigma and a series of variables. After translating and back translating the STOSA and STOSASS, an online survey was administrated to 412 college students in China. These two scales were tested for their dimensionality in a series of confirmatory factor analyses. A series of regression analyses were conducted to examine the factors that are associated with perceived and public suicide stigma, including demographics, psychological distress, suicidality, suicide exposure, and perceived entitativity of suicide ideators, decedents, and survivors. The results showed that the two translated scales, STOSA and STOSASS, were reliable (Cronbach’s α = 0.79~0.83) and valid in Chinese contexts and it can be treated as unidimensional scales. Suicidality, exposure to suicide, and perceived entitativity of suicide-related persons were significantly associated with higher endorsement of public suicide stigma (SOSS Stigma, p < 0.03), but not perceived stigma (STOSA, STOSASS). Higher levels of psychological distress were associated with both higher perceived and public suicide stigma (p < 0.05). Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
Article
A Pilot Study Examining the Prognostic Utility of Tumor Shrinkage on Cone-Beam Computed Tomography (CBCT) for Stage III Locally Advanced Non-Small Cell Lung Cancer Patients Treated with Definitive Chemoradiation
Int. J. Environ. Res. Public Health 2021, 18(6), 3241; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063241 - 21 Mar 2021
Viewed by 623
Abstract
There has been growing interest in utilizing information from cone-beam computed tomography (CBCT) to help guide both treatment delivery and prognosis. In this assessment of locally advanced unresectable stage III non-small cell lung cancer (NSCLC) treated with definitive chemoradiation, we aimed to determine [...] Read more.
There has been growing interest in utilizing information from cone-beam computed tomography (CBCT) to help guide both treatment delivery and prognosis. In this assessment of locally advanced unresectable stage III non-small cell lung cancer (NSCLC) treated with definitive chemoradiation, we aimed to determine the survival advantage associated with using CBCT to measure tumor regression. Patient, tumor, and treatment characteristics were collected. The serial tumor shrinkage for each patient was determined from tumor volume contours on weekly CBCTs. Survival analysis was performed using the Kaplan–Meier technique and a Cox proportional hazards model. At least two-thirds of patients had a tumor volume reduction of at least 5% after each week of chemoradiation. A weekly reduction in tumor volume of 5% or greater seen on the CBCT images during radiation therapy was significantly associated with improved overall survival, which remained significant when adjusted for age, histology, grade, and T- and N-stages (p = 0.0036). Additionally, the presence of N3 disease was associated with a five-fold increased risk of recurrence (p = 0.0006) and a nearly three-fold increased risk of death (p = 0.053) compared with N0–N2 disease. Tumor volume shrinkage observed in the CBCT images during definitive chemoradiation holds promise as a prognostic indicator of stage III NSCLC, especially given its affordability, availability, and applicability. Further evaluation in a prospective fashion is warranted to validate the tumor volume shrinkage and its clinical utility. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Heavy Metal Contamination in an Industrially Affected River Catchment Basin: Assessment, Effects, and Mitigation
Int. J. Environ. Res. Public Health 2021, 18(6), 2881; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18062881 - 11 Mar 2021
Viewed by 678
Abstract
The concentrations of some heavy metals (Fe, Zn, Mn, Cu, Mo, Pb, Cd) were measured in river waters, macrozoobenthos, and fish (Kura scrapers) from one of the most developed mining areas in Armenia, the Debed River catchment basin. In order to assess heavy [...] Read more.
The concentrations of some heavy metals (Fe, Zn, Mn, Cu, Mo, Pb, Cd) were measured in river waters, macrozoobenthos, and fish (Kura scrapers) from one of the most developed mining areas in Armenia, the Debed River catchment basin. In order to assess heavy metal contamination and its hydro-ecological and health effects, the macrozoobenthos quantitative and qualitative parameters, geo-accumulation index, and hazard index were determined. Microalgal extraction experiments were conducted to assess the microalgal remediation efficiency for heavy metal removal from mining wastewaters. The results showed that the rivers in many sites were polluted with different heavy metals induced by mining activities, which adversely affected macrozoobenthos growth and caused human health risks in the case of waters used for drinking purposes. However, the river fish, particularly Kura scrapers, were determined to be safe for consumption by the local people, as per the conditions of the evaluated fish ingestion rate. The results have shown that microalgal remediation, particularly with Desmodesmus abundans M3456, can be used for the efficient removal ~(62–100%) of certain emerging contaminants (Mn, Pb, Cu, Zn, Cd) from mining wastewater discharged in the Debed catchment basin. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Non-Institutional Childbirths and the Associated Socio-Demographic Factors in Gambella Regional State, Ethiopia
Int. J. Environ. Res. Public Health 2021, 18(6), 2859; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18062859 - 11 Mar 2021
Viewed by 570
Abstract
The decades-long global efforts to reduce maternal morbidity and mortality have shown overall progress, but most developing countries are still lagging significantly. This study aimed to assess the prevalence of non-institutional childbirths in the Gambella State and to identify socio-demographic factors responsible for [...] Read more.
The decades-long global efforts to reduce maternal morbidity and mortality have shown overall progress, but most developing countries are still lagging significantly. This study aimed to assess the prevalence of non-institutional childbirths in the Gambella State and to identify socio-demographic factors responsible for non-institutional utilization of available birth services by reproductive-aged mothers. A community-based cross-sectional study design was adopted using a multi-stage random sampling technique. Binary logistic regression was used to identify factors associated with the selected place of birth. EpiData version 3.1 and SPSS version 13.0 were applied for data entry and analyses. All the 657 eligible mothers recruited for this study responded to the interview. 71% of the total respondents had non-institutional childbirths (NICB), and the rest had their most recent childbirth in an institution with skilled healthcare providers’ assistance. Socio-demographic factors were significantly associated with NICB. Nuer (AOR = 2.12, 95% CI: 1.23–3.63) and Majang ethnic (AOR = 1.98, 95% CI: 1.02–3.83) groups had higher rates of NICB than the rest of the study population. The prevalence of non-institutional childbirths in Gambella remained two times higher than the institutional childbirths. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Nursing Students’ Perceptions of Smartphone Use in the Clinical Care and Safety of Hospitalised Patients
Int. J. Environ. Res. Public Health 2021, 18(3), 1307; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031307 - 01 Feb 2021
Viewed by 690
Abstract
Smartphones have become an indispensable item for nursing students. The use of these devices in the clinical setting could have various effects on the clinical work of nursing students. This study was to explore nursing students’ perceptions of their lived experiences of smartphone [...] Read more.
Smartphones have become an indispensable item for nursing students. The use of these devices in the clinical setting could have various effects on the clinical work of nursing students. This study was to explore nursing students’ perceptions of their lived experiences of smartphone use in the clinical setting, in regard to patient safety. A descriptive phenomenological study was carried out. A total of 24 nursing students from a university in the southeast of Spain participated in this study. There were 10 in-depth interviews and two focal groups from January to May 2020. The data analysis was performed using ATLAS.TI software to identify the emergent topics. The COREQ Checklist was used to prepare the manuscript. Three principal topics were identified that illustrated the nursing students’ experiences and perceptions of smartphone use in the clinical setting (1): Using smartphones in the clinical setting as a personal resource, (2) smartphones as a support mechanism for making clinical decisions, (3) impact of smartphones on patient care. The nursing students perceived smartphones as a support mechanism for making clinical decisions and for patient care. Smartphone use during clinical practicums may influence the quality of patient-centred communication and threaten clinical safety. The results of this study provide knowledge on the use of smartphones by nursing students in the clinical setting, which could help to establish measures that guarantee adequate patient care and responsible use of these devices. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
Article
Cross-Sectional Study of the Prevalence and Symptoms of Urinary Incontinence among Japanese Older Adults: Associations with Physical Activity, Health-Related Quality of Life, and Well-Being
Int. J. Environ. Res. Public Health 2021, 18(2), 360; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020360 - 06 Jan 2021
Cited by 1 | Viewed by 1073
Abstract
Urinary incontinence (UI) is a major social problem for older adults and leads to a decline in health-related quality of life (HRQoL), mental health, and physical activity. This study assessed the prevalence and symptoms of UI among older adults discharged from the hospital [...] Read more.
Urinary incontinence (UI) is a major social problem for older adults and leads to a decline in health-related quality of life (HRQoL), mental health, and physical activity. This study assessed the prevalence and symptoms of UI among older adults discharged from the hospital in Japan and investigated the association of UI symptoms with physical activity, HRQoL, and subjective well-being (SWB). By an international consultation, the Incontinence Questionnaire Short Form (ICIQ-SF) that assesses UI severity, was developed. Self-administered questionnaires were used to assess physical activity, HRQoL, SWB, and social demographic characteristics of the participants. In total, 145 participants (valid response rate, 48%; mean age, 78.6 ± 7.6 years) were included in the analysis. Multivariate logistic regression analysis was performed to identify significant factors associated with the presence of UI. Significant decreases in physical activity, HRQoL, and SWB were observed in patients with UI compared with those without UI (p < 0.05). Multivariate analysis revealed that age, number of reported conditions, and decreased SWB were associated with UI (p < 0.05). UI was associated with less physical activity and decreased mental health status in older adults (especially decreased SWB). Health-promoting measures for older adults with UI are essential for maintaining their well-being and extending healthy life expectancy. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Antithrombotic Preventive Medication Prescription Redemption and Socioeconomic Status in Hungary in 2016: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2020, 17(18), 6855; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17186855 - 19 Sep 2020
Cited by 3 | Viewed by 720
Abstract
This work was designed to investigate antithrombotic drug utilization and its link with the socioeconomic characteristics of specific population groups in Hungary by a comparative analysis of data for prescriptions by general practitioners and the redeemed prescriptions for antithrombotic drugs. Risk analysis capabilities [...] Read more.
This work was designed to investigate antithrombotic drug utilization and its link with the socioeconomic characteristics of specific population groups in Hungary by a comparative analysis of data for prescriptions by general practitioners and the redeemed prescriptions for antithrombotic drugs. Risk analysis capabilities were applied to estimate the relationships between socioeconomic status, which was characterized by quintiles of a multidimensional composite indicator (deprivation index), and mortality due to thromboembolic diseases as well as antithrombotic medications for the year 2016 at the district level in Hungary. According to our findings, although deprivation is a significant determinant of mortality due to thromboembolic diseases, clusters can be identified that represent exemptions to this rule: an eastern part of Hungary, consisting of two highly deprived counties, had significantly lower mortality than the country average; by contrast, the least-deprived northwestern part of the country, consisting of five counties, had significantly higher mortality than the country average. The fact that low socioeconomic status in general and poor adherence to antithrombotic drugs irrespective of socioeconomic status were associated with increased mortality indicates the importance of more efficient control of preventive medication and access to healthcare in all districts of the country to reduce mortality due to thromboembolic diseases. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Assessing Infection Risks among Clients and Staff Who Use Tattooing Services in Poland: An Observational Study
Int. J. Environ. Res. Public Health 2020, 17(18), 6620; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17186620 - 11 Sep 2020
Viewed by 585
Abstract
Across cultures and generations, people have tattooed their bodies. Although blood-borne infections from tattooing have been reduced, certain service aspects remain improperly managed. We assessed the infection risks associated with tattooing by conducting a cross-sectional study (2013–2014) in Poland using an anonymous questionnaire [...] Read more.
Across cultures and generations, people have tattooed their bodies. Although blood-borne infections from tattooing have been reduced, certain service aspects remain improperly managed. We assessed the infection risks associated with tattooing by conducting a cross-sectional study (2013–2014) in Poland using an anonymous questionnaire survey. Scoring procedures for blood-borne infection risks for tattooists and their clients were used. Overall, 255 tattooists were interviewed. A quasi-random selection of tattoo parlors was based on a service register. Knowledge, attitudes, and behavior regarding blood-borne infection risks were assessed using a questionnaire. Simultaneously, tattoo centers were audited. Tattooing had a higher infection risk for tattooists than for clients. Approximately 50% of respondents underwent training on postexposure procedures, which constituted almost one in five of the reported needlestick/cut injuries sustained while working. Furthermore, 25.8% had no knowledge regarding risk from reliable sources, and 2.1% had not broadened their knowledge. Tattooists and their clients are at a risk of infection, and knowledge concerning infection risks remains an underestimated preventative factor. Service quality surveillance and creation of a register for tattoo-related complications may help assess the scale of this public health issue. However, a lack of these records implies the challenges in developing effective organizational and legal protections. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
Article
The Perceived Health Status from Young Adults to Elderly: Results of the MEHM Questionnaire within the CUORE Project Survey 2008–2012
Int. J. Environ. Res. Public Health 2020, 17(17), 6160; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176160 - 25 Aug 2020
Viewed by 622
Abstract
Improving healthy life years requires an effective understanding and management of the process of healthy ageing. Assessing the perceived health status and its determinants is a relevant step in this process. This study explored the potentialities of the Minimum European Health Module (MEHM) [...] Read more.
Improving healthy life years requires an effective understanding and management of the process of healthy ageing. Assessing the perceived health status and its determinants is a relevant step in this process. This study explored the potentialities of the Minimum European Health Module (MEHM) to cope with this critical issue. Investigation was conducted on 4798 Italian residents (49.7% women, aged 35–79 years), participating in the CUORE Project Health Examination Survey 2008–2012. The three MEHM questions—perceived health status, chronic morbidity and activity limitations—were examined also in association with living context, seasonality, marital status and level of education. A higher prevalence of health status negative perception was associated with older age (9% and 24% respectively in men and women aged 35–44 years; 46% and 61% respectively in men and women aged 75–79 years). In women, this negative perception was higher than in men in any age group, and reached 50% in the 65–69 age group, 10 years earlier than in men. For both sexes, the level of education had a strong impact on this negative perception (odds ratio 2.32 and 2.72 in men and women respectively), while “living alone” played a greater impact in women than in men. MEHM activity limitations subscale was as much as 30% higher for questionnaires answered during the hottest months. This study identified potential predictors of perceived health status in adults aged 35–79 years, which can be used to target interventions aimed at improving self-perceived health status. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Tendency to Worry and Fear of Mental Health during Italy’s COVID-19 Lockdown
Int. J. Environ. Res. Public Health 2020, 17(16), 5928; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17165928 - 15 Aug 2020
Cited by 16 | Viewed by 2456
Abstract
Background: We tested whether the tendency to worry could affect psychological responses to quarantine by capitalizing on the opportunity of having collected data before the COVID-19 outbreak on measures of worry, anxiety, and trait mindfulness in a group of university students. Methods: Twenty-five [...] Read more.
Background: We tested whether the tendency to worry could affect psychological responses to quarantine by capitalizing on the opportunity of having collected data before the COVID-19 outbreak on measures of worry, anxiety, and trait mindfulness in a group of university students. Methods: Twenty-five participants completed self-report measures assessing worry (Penn State Worry Questionnaire, PSWQ), anxiety (Anxiety Sensitivity Index, ASI-3), and trait mindfulness (Mindful Attention Awareness Scale, MAAS) at T0 (pre-lockdown, 4 November 2019–17 February 2020) and T1 (at the end of lockdown, 26 April–30 April 2020). We compared assessments at the two time points in the whole sample and in high and low worriers (defined at T0 by scores on PSWQ respectively above and below 1.5 SD from mean of the Italian normative sample). Outcomes: High worriers showed at T1 a significant increase of anxiety sensitivity and fear of mental health in comparison to low worriers. Moreover, in the whole sample, at T1 trait mindfulness was inversely related to worry and fear of mental health. Interpretation: A valuable approach to support individuals experiencing anxiety related to the COVID-19 outbreak could be represented by mindfulness-based interventions improving the ability to focus attention and awareness on the present moment. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
Communication
COVID-19 Global Risk: Expectation vs. Reality
Int. J. Environ. Res. Public Health 2020, 17(15), 5592; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17155592 - 03 Aug 2020
Cited by 2 | Viewed by 1906
Abstract
Background and Objective: COVID-19 has engulfed the entire world, with many countries struggling to contain the pandemic. In order to understand how each country is impacted by the virus compared with what would have been expected prior to the pandemic and the [...] Read more.
Background and Objective: COVID-19 has engulfed the entire world, with many countries struggling to contain the pandemic. In order to understand how each country is impacted by the virus compared with what would have been expected prior to the pandemic and the mortality risk on a global scale, a multi-factor weighted spatial analysis is presented. Method: A number of key developmental indicators across three main categories of demographics, economy, and health infrastructure were used, supplemented with a range of dynamic indicators associated with COVID-19 as independent variables. Using normalised COVID-19 mortality on 13 May 2020 as a dependent variable, a linear regression (N = 153 countries) was performed to assess the predictive power of the various indicators. Results: The results of the assessment show that when in combination, dynamic and static indicators have higher predictive power to explain risk variation in COVID-19 mortality compared with static indicators alone. Furthermore, as of 13 May 2020 most countries were at a similar or lower risk level than what would have been expected pre-COVID, with only 44/153 countries experiencing a more than 20% increase in mortality risk. The ratio of elderly emerges as a strong predictor but it would be worthwhile to consider it in light of the family makeup of individual countries. Conclusion: In conclusion, future avenues of data acquisition related to COVID-19 are suggested. The paper concludes by discussing the ability of various factors to explain COVID-19 mortality risk. The ratio of elderly in combination with the dynamic variables associated with COVID-19 emerge as more significant risk predictors in comparison to socio-economic and demographic indicators. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Cohort Analysis of Epithelial Cancer Mortality Male-to-Female Sex Ratios in the European Union, USA, and Japan
Int. J. Environ. Res. Public Health 2020, 17(15), 5311; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17155311 - 23 Jul 2020
Cited by 1 | Viewed by 858
Abstract
Objective: To illustrate trends in sex ratios in epithelial cancer mortality in the EU, USA, and Japan, with a focus on age-specific and cohort patterns. Methods: We obtained certified deaths and resident populations from the World Health Organisation for the period of 1970–2014 [...] Read more.
Objective: To illustrate trends in sex ratios in epithelial cancer mortality in the EU, USA, and Japan, with a focus on age-specific and cohort patterns. Methods: We obtained certified deaths and resident populations from the World Health Organisation for the period of 1970–2014 for the USA, Japan, and the EU for 12 epithelial cancer sites. From these, we calculated both the age-specific and age-standardised male-to-female mortality sex ratios. We applied an age-period-cohort model to the sex ratios in order to disentangle the effects of age, period of death, and birth cohort. Results: Age-standardised mortality sex ratios were found to be unfavourable to males, apart from thyroid cancer. The highest standardised rates were in laryngeal cancer: 7·7 in the 1970s in the USA, 17·4 in the 1980s in the EU, and 16·8 in the 2000s in Japan. Cohort patterns likely to be due to excess smoking (1890 cohort) and drinking (1940 cohort) in men were identified in the USA, and were present but less defined in the EU and Japan for the oral cavity, oesophagus, liver, pancreas, larynx, lung, bladder, and kidney. Conclusion: Mortality sex ratio patterns are partly explained by the differences in exposure to known and avoidable risk factors. These are mostly tobacco, alcohol, and obesity/overweight, as well as other lifestyle-related factors. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Effect of Post-Stroke Rehabilitation on Body Mass Composition in Relation to Socio-Demographic and Clinical Factors
Int. J. Environ. Res. Public Health 2020, 17(14), 5134; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17145134 - 16 Jul 2020
Cited by 2 | Viewed by 769
Abstract
Background and objectives: Stroke is one of the leading causes of morbidity, mortality and long-term adult disability. The aim of this study was to assess the changes in body mass composition in patients after stroke in connection with selected socio-demographic and clinical [...] Read more.
Background and objectives: Stroke is one of the leading causes of morbidity, mortality and long-term adult disability. The aim of this study was to assess the changes in body mass composition in patients after stroke in connection with selected socio-demographic and clinical factors (sex, age, type of stroke and time from the first symptoms) following the rehabilitation process. Materials and Methods: The study group consisted of 100 post-stroke subjects who participated in a comprehensive rehabilitation program for a duration of five weeks. The measurements of body composition by a Tanita MC 780 MA analyser were performed on the day of admission to hospital, on the day of discharge (after 5 weeks) and 12 weeks after discharge from hospital. Results: It was shown that before rehabilitation (Exam I) in the study group there were significant differences in body composition relative to sex, age and time from stroke. The rates of fat mass % and visceral fat level decreased after rehabilitation (Exam II) in both males and females. Exam II, at the end hospital rehabilitation, showed lower levels of fat mass %, visceral fat level, as well as fat-free mass % and higher values of total body water % and muscle mass %. In Exam III, i.e., 12 weeks after discharge, all of the parameters retained their values. Conclusions: The study shows an association between stroke risk factors (primarily age, sex and time from the onset of the first symptoms of stroke) and body mass composition resulting from rehabilitation. The type of stroke and the effects of rehabilitation on body mass components showed no differences. Comprehensive rehabilitation had a positive effect on the body mass components. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Spatial Statistics and Influencing Factors of the COVID-19 Epidemic at Both Prefecture and County Levels in Hubei Province, China
Int. J. Environ. Res. Public Health 2020, 17(11), 3903; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17113903 - 31 May 2020
Cited by 16 | Viewed by 2290
Abstract
The coronavirus disease 2019 (COVID-19) epidemic has had a crucial influence on people’s lives and socio-economic development. An understanding of the spatiotemporal patterns and influencing factors of the COVID-19 epidemic on multiple scales could benefit the control of the outbreak. Therefore, we used [...] Read more.
The coronavirus disease 2019 (COVID-19) epidemic has had a crucial influence on people’s lives and socio-economic development. An understanding of the spatiotemporal patterns and influencing factors of the COVID-19 epidemic on multiple scales could benefit the control of the outbreak. Therefore, we used spatial autocorrelation and Spearman’s rank correlation methods to investigate these two topics, respectively. The COVID-19 epidemic data reported publicly and relevant open data in Hubei province were analyzed. The results showed that (1) at both prefecture and county levels, the global spatial autocorrelation was extremely significant for the cumulative confirmed COVID-19 cases (CCC) in Hubei province from 30 January to 18 February 2020. Further, (2) at both levels, the significant hotspots and cluster/outlier areas were observed solely in Wuhan city and most of its districts/sub-cities from 30 January to 18 February 2020. (3) At the prefecture level in Hubei province, the number of CCC had a positive and extremely significant correlation (p < 0.01) with the registered population (RGP), resident population (RSP), Baidu migration index (BMI), regional gross domestic production (GDP), and total retail sales of consumer goods (TRS), respectively, from 29 January to 18 February 2020 and had a negative and significant correlation (p < 0.05) with minimum elevation (MINE) from 2 February to 18 February 2020, but no association with the land area (LA), population density (PD), maximum elevation (MAXE), mean elevation (MNE), and range of elevation (RAE) from 23 January to 18 February 2020. (4) At the county level, the number of CCC in Hubei province had a positive and extremely significant correlation (p < 0.01) with PD, RGP, RSP, GDP, and TRS, respectively, from 27 January to 18 February 2020, and was negatively associated with MINE, MAXE, MNE, and RAE, respectively, from 26 January to 18 February 2020, and negatively associated with LA from 30 January to 18 February 2020. It suggested that (1) the COVID-19 epidemics at both levels in Hubei province had evident characteristics of significant global spatial autocorrelations and significant centralized high-risk outbreaks. (2) The COVID-19 epidemics were significantly associated with the natural factors, such as LA, MAXE, MNE, and RAE, -only at the county level, not at the prefecture level, from 2 February to 18 February 2020. (3) The COVID-19 epidemics were significantly related to the socioeconomic factors, such as RGP, RSP, TRS, and GDP, at both levels from 26 January to 18 February 2020. It is desired that this study enrich our understanding of the spatiotemporal patterns and influencing factors of the COVID-19 epidemic and benefit classified prevention and control of the COVID-19 epidemic for policymakers. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
Impact of Computed Tomography Scans on the Risk of Thyroid Disease in Minor Head Injury Patients: A Population-Based Retrospective Cohort Study
Int. J. Environ. Res. Public Health 2020, 17(11), 3873; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17113873 - 29 May 2020
Viewed by 795
Abstract
We investigated the association between head computed tomography (CT) scans and the risk of noncancer thyroid diseases in patients with minor head injury in a Taiwanese healthcare setting. For this retrospective population-based cohort study, the 2009–2013 Longitudinal Health Insurance Database was used to [...] Read more.
We investigated the association between head computed tomography (CT) scans and the risk of noncancer thyroid diseases in patients with minor head injury in a Taiwanese healthcare setting. For this retrospective population-based cohort study, the 2009–2013 Longitudinal Health Insurance Database was used to include patients with a minor head injury at admission or emergency visit between 2009 and 2013. Multivariate analysis with a multiple Cox regression model was applied to analyze the data. According to whether a CT scan was conducted within 14 days of admission, patients were divided into a CT scan group (n = 14,041) or a non-CT scan group (n = 34,684). No increased incidence of thyroid diseases was observed in the CT scan group regardless of the number of CT scans performed. The incidence rate ratio for one scan was 1.10 (95% confidence interval: 0.94–1.29) and for two or more scans was 1.09 (95% confidence interval: 0.93–1.28). In conclusion, this population-based cohort study showed that a head CT scan is not associated with increased risk of thyroid disease in patients with minor head injury. The short-term adverse effects on the thyroid could be mild when a regular CT scan is appropriately performed. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
The Urban-Rural Disparity in the Status and Risk Factors of Health Literacy: A Cross-Sectional Survey in Central China
Int. J. Environ. Res. Public Health 2020, 17(11), 3848; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17113848 - 29 May 2020
Cited by 6 | Viewed by 974
Abstract
Health literacy is the ability of individuals to access, process, and understand health information to make decisions regarding treatment and their health on the whole; it is critical to maintain and improve public health. However, the health literacy of urban and rural populations [...] Read more.
Health literacy is the ability of individuals to access, process, and understand health information to make decisions regarding treatment and their health on the whole; it is critical to maintain and improve public health. However, the health literacy of urban and rural populations in China has been little known. Thus, this study aims to assess the status of health literacy and explore the differences of its possible determinants (e.g., socio-economic factors) among urban and rural populations in Henan, China. A cross-sectional study, 78,646 participants were recruited from a populous province in central China with a multi-stage random sampling design. The Chinese Resident Health Literacy Scale was adopted to measure the health literacy of the respondents. In the participants, the level of health literacy (10.21%) in central China was significantly lower than the national average, and a big gap was identified between urban and rural populations (16.92% vs. 8.09%). A noticeable difference was reported in different aspects and health issues of health literacy between urban and rural populations. The health literacy level was lower in those with lower levels of education, and a significant difference was identified in the level of health literacy among people of different ages and occupations in both urban and rural areas. Note that in rural areas, as long as residents educated, they all had higher odds to exhibit basic health literacy than those uneducated; in rural areas, compared with those aged 15 to 24 years, residents aged 45 to 54 years (OR = 0.846,95% CI (0.730, 0.981)), 55 to 64 years (OR = 0.716,95% CI (0.614, 0.836)) and above 65 years (OR = 0.679, 95% CI (0.567, 0.812)) were 84.6%, 71.6%, and 67.9%, respectively, less likely to exhibit basic health literacy. Considering the lower health literacy among rural residents compared with their urban counterparts, a reorientation of the health policy-making for Chinese rural areas is recommended. This study suggests that urban–rural disparity about health literacy risk factors should be considered when implementing health literacy promotion intervention. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Article
The Development of a Screening Tool for Chinese Disordered Gamers: The Chinese Internet Gaming Disorder Checklist (C-IGDC)
Int. J. Environ. Res. Public Health 2020, 17(10), 3412; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17103412 - 14 May 2020
Cited by 1 | Viewed by 995
Abstract
Despite the increasing research attention being paid to gaming disorder globally, a screening tool developed specifically for the Chinese population is still lacking. This study aims to address this gap by constructing a screening tool to assess Internet gaming disorder (IGD) symptomology, defined [...] Read more.
Despite the increasing research attention being paid to gaming disorder globally, a screening tool developed specifically for the Chinese population is still lacking. This study aims to address this gap by constructing a screening tool to assess Internet gaming disorder (IGD) symptomology, defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), among Chinese gamers. Based on expert interviews and consultations, a focus group of gamers, a background literature review, and the IGD criteria proposed by the DSM-5, we developed the Chinese Internet Gaming Disorder Checklist (C-IGDC). This study evaluated its dimensional structure, reliability, validity, and screening efficacy with 464 Chinese past-year gamers (53% female; mean age = 19.84). The two-level structure of the 27-item C-IGDC showed a satisfactory model fit, acceptable reliability, as well as good validity via expected associations with Internet addiction, gameplay frequency, and depressive symptoms. The optimal screening cutoff score (≥20) was proposed to detect probable IGD cases. The C-IGDC is the first DSM-5-based, multidimensional IGD screening tool designed specifically for Chinese gamers. Further evaluation of the C-IGDC in epidemiological studies and clinical settings is recommended. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
Article
Comparison of Elixhauser and Charlson Methods for Discriminative Performance in Mortality Risk in Patients with Schizophrenic Disorders
Int. J. Environ. Res. Public Health 2020, 17(7), 2450; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17072450 - 03 Apr 2020
Cited by 3 | Viewed by 798
Abstract
Although Charlson Comorbidity Index scores (CCIS) and Elixhauser comorbidity index scores (ECIS) have been used to assess comorbidity in patients with schizophrenia, only CCIS, not ECIS, have been used to predict mortality in this population. This nationwide retrospective study investigated discriminative performance of [...] Read more.
Although Charlson Comorbidity Index scores (CCIS) and Elixhauser comorbidity index scores (ECIS) have been used to assess comorbidity in patients with schizophrenia, only CCIS, not ECIS, have been used to predict mortality in this population. This nationwide retrospective study investigated discriminative performance of mortality of these two scales in patients with schizophrenia. Exploiting Taiwan’s National Health Insurance Research Database (NHRID), we identified patients diagnosed with schizophrenia discharged from hospitals between Jan 1, 1996 and Dec 31, 2007. They were followed up for subsequent death. Comorbidities presented one year prior to hospital admissions were identified and adapted to the CCIS and ECIS. Discriminatory ability was evaluated using the adjusted hazard ratio and Akaike information criterion (AIC) and Harrell’s C-statistic. We identified 58,771 discharged patients with schizophrenic disorders and followed them for a mean of 10.4 years, 16.6% of whom had died. Both ECIS and CCIS were significantly associated with mortality, but ECIS had superior discriminatory ability by a lower AIC and higher Harrell’s C-statistic (201231 vs. 201400; 0.856 vs. 0.854, respectively). ECIS had better discriminative performance in mortality risk than CCIS in patients with schizophrenic disorders. Its use may be encouraged for risk adjustment in this population. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
Article
Prevalence and Risk Factors of Metabolic Associated Fatty Liver Disease in Xinxiang, China
Int. J. Environ. Res. Public Health 2020, 17(6), 1818; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17061818 - 11 Mar 2020
Cited by 6 | Viewed by 1283
Abstract
Metabolic associated fatty liver disease (MAFLD) is recognized as the liver disease component of metabolic syndrome, which is mainly related to insulin resistance and genetic susceptibility. It is the most prevalent chronic liver disease worldwide. With rapid lifestyle transitions, its prevalence worldwide is [...] Read more.
Metabolic associated fatty liver disease (MAFLD) is recognized as the liver disease component of metabolic syndrome, which is mainly related to insulin resistance and genetic susceptibility. It is the most prevalent chronic liver disease worldwide. With rapid lifestyle transitions, its prevalence worldwide is increasing, and tremendous challenges in controlling this pandemic are arising. The objective of this study was to investigate the prevalence and risk factors of MAFLD in rural areas of Xinxiang, Henan in 2017. We conducted a cross-sectional analysis of rural inhabitants aged 20–79 years in Xinxiang, Henan in 2017, using cluster random sampling (N = 9140). Physical examinations were conducted at local clinics from April to June 2017. After overnight fasting, all participants underwent physical examinations, blood routine tests, biochemical examinations, and liver ultrasound and completed questionnaires. We investigated the crude and age-adjusted MAFLD prevalence and analyzed the characteristics of those with, and without, MAFLD, using logistic regression. Approximately 2868 (31.38%) participants were diagnosed with MAFLD. The overall age-adjusted MAFLD prevalence was 29.85% (men: 35.36%; women: 26.49%). The MAFLD prevalence increased with age, and peaked at the 50–59-year age group, and then began to decline. Higher body mass index, waist circumference, percentage of lymphocytes, levels of hemoglobin, platelet count, triglyceride, fasting plasma glucose, and serum uric acid were independently and positively correlated with MAFLD; In contrary, active physical activity and high-density lipoprotein cholesterol were negatively correlated with MAFLD. In summary, the MAFLD prevalence in the study population was 29.85%. Higher body mass index, waist circumference, percentage of lymphocytes, levels of hemoglobin, platelet count, triglyceride, fasting plasma glucose, and serum uric acid were risk factors for MAFLD. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Review

Jump to: Research

Review
Vegetarian Diet: An Overview through the Perspective of Quality of Life Domains
Int. J. Environ. Res. Public Health 2021, 18(8), 4067; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084067 - 12 Apr 2021
Cited by 2 | Viewed by 1191
Abstract
Vegetarianism has gained more visibility in recent years. Despite the well-described effects of a vegetarian diet on health, its influence on the quality of life of the individuals who follow it still needs to be properly investigated. Quality of life relates to a [...] Read more.
Vegetarianism has gained more visibility in recent years. Despite the well-described effects of a vegetarian diet on health, its influence on the quality of life of the individuals who follow it still needs to be properly investigated. Quality of life relates to a subjective perception of well-being and functionality, and encompasses four main life domains: physical, psychological, social, and environmental. The adoption of a vegetarian diet, despite being a dietary pattern, could potentially influence and be influenced by all of these domains, either positively or negatively. This review aims to present an overview of the background, conceptualization, features, and potential effects of vegetarianism in all quality of life domains. The choice of adopting a vegetarian diet could have positive outcomes, such as better physical health, positive feelings related to the adoption of a morally correct attitude, an increased sense of belonging (to a vegetarian community), and lower environmental impact. Other factors, however, could have a negative impact on the quality of life of those choosing to abstain from meats or other animal products, especially when they go beyond one’s control. These include the environment, the social/cultural group in which a person is inserted, gender-based differences, economic aspects, and a limited access to a wide variety of plant-based foods. It is important to understand all the effects of adopting a vegetarian diet—beyond its nutritional aspects. Not only do studies in this area provide more consistent data, but they may also contribute to mitigating all factors that might prevent individuals from adopting a vegetarian diet, or that may have a negative impact on the quality of life of those who already follow it. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Review
Evaluation of Fetal Exposures to Metals and Metalloids through Meconium Analyses: A Review
Int. J. Environ. Res. Public Health 2021, 18(4), 1975; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18041975 - 18 Feb 2021
Viewed by 727
Abstract
This paper surveys the existing scientific literature on metals concentrations in meconium. We examine some 32 papers that analyzed meconium for aluminum, arsenic, barium, calcium, chromium, copper, iron, lithium, magnesium, manganese, zinc, lead, mercury, manganese, molybdenum, nickel, phosphorus, lead, antimony, selenium, tin, vanadium, [...] Read more.
This paper surveys the existing scientific literature on metals concentrations in meconium. We examine some 32 papers that analyzed meconium for aluminum, arsenic, barium, calcium, chromium, copper, iron, lithium, magnesium, manganese, zinc, lead, mercury, manganese, molybdenum, nickel, phosphorus, lead, antimony, selenium, tin, vanadium, and zinc. Because of the lack of detail in the statistics it is not possible to do a rigorous meta-analysis. What stands out is that almost every study had subjects with seemingly large amounts of at least one of the metals. The significance of metals in meconium is not clear beyond an indication of exposure although some studies have correlated metals in meconium to a number of adverse outcomes. A number of outstanding questions have been identified that, if resolved, would greatly increase the utility of meconium analysis for assessment of long-term gestational metals exposures. Among these are questions of the developmental and long-term significance of metals detected in meconium, the kinetics and interactions among metals in maternal and fetal compartments and questions on best methods for meconium analyses. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
Review
Risk and Protective Factors for PTSD in Caregivers of Adult Patients with Severe Medical Illnesses: A Systematic Review
Int. J. Environ. Res. Public Health 2020, 17(16), 5888; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17165888 - 13 Aug 2020
Cited by 6 | Viewed by 1296
Abstract
Caregivers of severely ill individuals often struggle to adjust to new responsibilities and roles while experiencing negative psychological outcomes that include depression, anxiety and Post-Traumatic Stress Disorder (PTSD). This systematic review aims to outline potential risk and protective factors for the development of [...] Read more.
Caregivers of severely ill individuals often struggle to adjust to new responsibilities and roles while experiencing negative psychological outcomes that include depression, anxiety and Post-Traumatic Stress Disorder (PTSD). This systematic review aims to outline potential risk and protective factors for the development of PTSD in caregivers of adult subjects affected by severe somatic, potentially life-threatening illnesses. Twenty-nine studies on caregivers of adult patients affected by severe, acute, or chronic somatic diseases have been included. Eligibility criteria included: full-text publications reporting primary, empirical data; PTSD in caregivers of adult subjects affected by severe physical illnesses; risk and/or protective factors related to PTSD; and English language. Specific sociodemographic and socioeconomic characteristics, besides the illness-related distress, familiar relationships, exposure characteristics, coping style, and support, were identified as relevant risk/protective factors for PTSD. The review limitations are the small number of studies; studies on different types of diseases; studies with same samples. It is crucial to consider factors affecting caregivers of severely ill adult patients in order to plan effective intervention strategies aimed at reducing the risk of an adverse mental health outcome and at enhancing the psychological endurance of this population. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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Review
Interventions to Reduce the Risk of Cardiovascular Disease among Workers: A Systematic Review and Meta-Analysis
Int. J. Environ. Res. Public Health 2020, 17(7), 2267; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17072267 - 27 Mar 2020
Cited by 2 | Viewed by 1091
Abstract
This study examined the effect of lifestyle interventions on cardiovascular disease risk factors among workers. The study comprised a systematic review and meta-analysis of controlled trials. Relevant controlled trials were searched, with selections based on the Preferred Reporting Items for Systematic Reviews and [...] Read more.
This study examined the effect of lifestyle interventions on cardiovascular disease risk factors among workers. The study comprised a systematic review and meta-analysis of controlled trials. Relevant controlled trials were searched, with selections based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN). Of 1174 identified publications, one low-quality study was excluded. Finally, 10 were analyzed. The effect sizes were analyzed for heterogeneity, and random effect models (Hedge’s g) were used. A subgroup analysis was performed on the follow-up point of intervention (≤ 12 months vs. > 12 months). Publication bias was also analyzed. Interventions were effective for systolic (g = 0.66, 95% CI: 0.27-1.60) and diastolic blood pressure (g = 0.63, 95% CI: 0.21–1.06), and BMI (g = 0.71, 95% CI: 0.15-1.11). Interventions were ineffective for weight (g = 0.18, 95% CI: −0.04, 0.40) and LDL-cholesterol (g = 0.46, 95% CI: −0.02, 0.93). There was high heterogeneity between studies (I2 =78.45 to I2 = 94.61). There was no statistically significant publication bias, except for systolic blood pressure. Interventions to reduce risk of cardiovascular disease risk might be effective in improving physical outcomes, but additional high-quality trials are needed in the future. Full article
(This article belongs to the Special Issue Feature Papers in Public Health Statistics and Risk Assessment)
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