bluuebunny/crossref_metadata_2025 huggingface dataset:
Inequalities in Health: Methodological Approaches to Spatial Differentiation
Authors: Hübelová Dana , Kuncová Martina , Vojáčková Hana , Coufalová Jitka , Kozumplíková Alice , Lategan Francois Stefanus , Chromková Manea Beatrice-Elena
Published: November 2021

The prevalence of inequalities in the general health position of communities can be assessed by using selected determinants. The aims of this article are three-fold: (1) to apply a comprehensive approach to the assessment of inequalities in the general health position of communities, (2) to determine the spatial differentiation of determinants, and (3) to present selected assessment methods and their impact on the results. To present a quantitative assessment of these inequalities in health status in communities, a composite indicator (Health Index) was developed. This Health Index is composed of 8 areas of evaluation and 60 indicators which include, amongst others, determinants of health status and healthcare at district level (LAU 1) in the Czech Republic. The data are evaluated using multicriteria decision-making methods (the WSA and TOPSIS methods). Findings suggest that, when all eight domains are assigned the same weight of one, the spatial differentiation among the districts is similar when using both methods. If different weightings are assigned to the districts, changes occur in both the index values and the rankings of the analyzed districts. For example, the allocation of weightings in both methods results in a rearrangement of the ranking of districts for which the Health Index is around the average.
Morally Distressing Experiences, Moral Injury, and Burnout in Florida Healthcare Providers during the COVID-19 Pandemic
Authors: Dale Lourdes P. , Cuffe Steven P. , Sambuco Nicola , Guastello Andrea D. , Leon Kalie G. , Nunez Luciana V. , Bhullar Amal , Allen Brandon R. , Mathews Carol A.
Published: November 2021

Because healthcare providers may be experiencing moral injury (MI), we inquired about their healthcare morally distressing experiences (HMDEs), MI perpetrated by self (Self MI) or others (Others MI), and burnout during the COVID-19 pandemic. Participants were 265 healthcare providers in North Central Florida (81.9% female, Mage = 37.62) recruited via flyers and emailed brochures that completed online surveys monthly for four months. Logistic regression analyses investigated whether MI was associated with specific HMDEs, risk factors (demographic characteristics, prior mental/medical health adversity, COVID-19 protection concern, health worry, and work impact), protective factors (personal resilience and leadership support), and psychiatric symptomatology (depression, anxiety, and PTSD). Linear regression analyses explored how Self/Others MI, psychiatric symptomatology, and the risk/protective factors related to burnout. We found consistently high rates of MI and burnout, and that both Self and Others MI were associated with specific HMDEs, COVID-19 work impact, COVID-19 protection concern, and leadership support. Others MI was also related to prior adversity, nurse role, COVID-19 health worry, and COVID-19 diagnosis. Predictors of burnout included Self MI, depression symptoms, COVID-19 work impact, and leadership support. Hospital administrators/supervisors should recognize the importance of supporting the HCPs they supervise, particularly those at greatest risk of MI and burnout.
Comparison of the Levels of Hematological Parameters at Rest and after Maximum Exercise between Physically Active People with Spinal Cord Injury and Able-Bodied People
Authors: Szymczak Łukasz , Podgórski Tomasz , Domaszewska Katarzyna
Published: November 2021

The aim of the study was to reveal the difference in the hematological reaction to the applied exercise-induced workload between the able-bodied and physically active people with cervical spinal cord injury. The study covered 11 males with spinal cord injury and 11 able-bodied persons. An incremental stress test was carried out until the maximum individual workloads were achieved. The peak oxygen uptake was measured with the use of the ergospirometric method. Venous blood test results at rest and after finishing the maximal exercise showed hemoglobin (Hb) concentration, hematocrit (HCT) value, erythrocytes (RBC), leukocytes (WBC) and platelets (PLT) counts as well as the relative percentage of granulocytes (GRA), lymphocytes (LYM), and monocytes (MON). RBC, HCT as well as Hb and PLT among people with the injury were statistically lower (p < 0.001) large effect size, than in the control group. Statistically significant difference between the test and control group, subjected to the maximal exercise stress test, was observed in the exercise induced change of the PLT [p < 0.001, (ES: 2.631)] WBC [p < 0.05, (ES: 1.429)] and the percentage of LYM and GRA [p < 0.05, (ES: 1.447) for LYM and (ES: 1.332) for GRA] between both groups, subjected to the maximal cardiac stress test on the manual cycloergometer. The analysis of the obtained results indicates that people with spinal cord injury are much more vulnerable to the occurrence of microcytic anemia compared to able-bodied people. The after-exercise percentage shift of selected subpopulations of leukocytes in both groups indicates a delayed post-exercise recovery among people with spinal cord injury.
Clinical Usefulness of Retropulsion Tests in Persons with Mild to Moderate Parkinson’s Disease
Authors: Lindholm Beata , Franzén Erika , Duzynski Wojciech , Odin Per , Hagell Peter
Published: November 2021

People with Parkinson’s disease (PwPD) have an increased risk for falls and near falls. They have particular difficulties with maintaining balance against an external perturbation, and several retropulsion tests exist. The Unified PD Rating Scale item 30 (UPDRS30) is the most common, involving an expected shoulder pull. Others recommend using an unexpected shoulder pull, e.g., the Nutt Retropulsion Test (NRT). We aimed to evaluate the clinical usefulness of these tests for detecting future fallers. By using two different golden standards related to self-reported prospective falls and near falls over 6 months following two different time points with 3.5 years between, we estimated sensitivity/specificity, Youden index, predictive values, and likelihood ratios for each test. The different time points yielded a different prevalence of falls and near falls, as well as different predictive values. When comparing the performance of the NRT and UPDRS30 for detecting future fallers, we found that the NRT consistently performed better than UPDRS30. However, neither test exhibited optimal performance in terms of predictive values and associated likelihood ratios. Our findings speak against using either of these tests as a single assessment for this purpose and support previous recommendations of using a multifactorial approach when targeting balance problems in PwPD.
Attitudes and Arguments in the Voluntary Assisted Dying Debate in Australia: What Are They and How Have They Evolved Over Time?
Authors: Kresin Tracee , Hawgood Jacinta , De Leo Diego , Varghese Frank
Published: November 2021

This paper provides a broad discussion about voluntary assisted dying (VAD) in Australia. The discussion examines the history of the VAD debate in Australia and whether public support for VAD and the arguments that have provided the framework for the VAD debate have evolved over time. This seems a prudent time to have such a discussion, given the very recent rush by all Australian states to bring about or attempt to bring about VAD legislation. This rush, inexplicably perhaps, comes after decades of attempted but failed progress in the legalisation of VAD in Australia. The authors attempted to undertake a systematic literature review for this paper, but the paucity of academic research and the lack of consistent terminology in this area made such a search untenable. Instead, the authors examined parliamentary documentation and then widened the search via the sources found within this documentation. The examination of available data showed that VAD has enjoyed significant public support from Australians over time and that the arguments in the VAD debate in Australia have been consistent over time.
Conditioned Pain Modulation Is Not Impaired in Individuals with Frozen Shoulder: A Case-Control Study
Authors: Aguilar-Rodríguez Marta , Dueñas Lirios , Balasch i Bernat Mercè , Meeus Mira , Struyf Filip , Lluch Enrique
Published: November 2021

Frozen shoulder (FS) is a poorly understood condition resulting in substantial shoulder pain and mobility deficits. The mechanisms behind FS are not yet fully understood, but, similar to other persistent pain states, central pain mechanisms may contribute to ongoing symptoms in this population. The objective of this research was to investigate conditioned pain modulation (CPM) in people with FS compared with pain-free individuals. A total of 64 individuals with FS and 64 healthy volunteers participated in this cross-sectional study. CPM was assessed by using the pressure pain threshold (PPT) and an occlusion cuff (tourniquet test) as the test and conditioning stimulus, respectively. The absolute and percentage of change in PPT (CPM effect) as well as pain profiles (pro-nociceptive vs. anti-nociceptive) of individuals with FS and healthy controls were calculated. No significant differences in the absolute change in the PPT or CPM effect were found in people with FS compared to pain-free controls. Moreover, no between-group differences in the percentage of subjects with pro-nociceptive and anti-nociceptive pain profiles were observed. These results suggest that endogenous pain inhibition is normally functioning in people with FS. Altered central pain-processing mechanisms may thus not be a characteristic of this population.
Does Direct-to-Consumer Personal Genetic Testing Improve Gynecological Cancer Screening Uptake among Never-Screened Attendees? A Randomized Controlled Study
Authors: Watanabe Miki , Hosono Satoyo , Nakagawa-Senda Hiroko , Yamamoto Sachiyo , Aoyama Masami , Hattori Satoru , Yamada Tamaki , Suzuki Sadao
Published: November 2021

The clinical impact of direct-to-consumer genetic testing (DTC-GT) on health behavior change has remained controversial. The aim of this study is to clarify the short-term effects of DTC-GT on gynecological cancer screening uptake among middle-aged never-screened Japanese women in a randomized controlled trial (RCT). A total of 144 women aged 45–50 who had never undergone gynecological cancer screening were randomly selected to receive health education (control group), or health education and DTC-GT (intervention group), at a 1:1 ratio. We compared the gynecological screening uptake during the follow-up period. Furthermore, to estimate the impact of learning of an elevated genetic cancer risk in the intervention group, we conducted an analysis dichotomized by genetic risk category. A total of 139 women completed the one-year follow-up survey (69 in the control group and 70 in the intervention group). The follow-up period did not differ between control and intervention groups (the median follow-up period was 276 days and 279 days, respectively, p = 0.746). There were 7 (9.7%) women in the control group and 10 (13.9%) in the intervention group who attended breast cancer screening (p = 0.606), and 9 (12.5%) women from both groups attended cervical cancer screening (p = 1.000). Likewise, there were no significant differences in cancer screening uptake in the analysis stratified by risk category within the intervention group. In conclusion, there was no significant effect of DTC-GT on gynecological cancer screening uptake in this RCT setting. Increasing cancer screening attendance may require a combination of well-established intervention strategies and DTC-GT. Clinical Trial Registration: UMIN-CTR Identifier, UMIN000031709.
Risk Factors, Lifestyle and Prevention among Adolescents with Idiopathic Juvenile Scoliosis: A Cross Sectional Study in Eleven First-Grade Secondary Schools of Palermo Province, Italy
Authors: Scaturro Dalila , Costantino Claudio , Terrana Pietro , Vitagliani Fabio , Falco Vincenzo , Cuntrera Daniele , Sannasardo Claudia Emilia , Vitale Francesco , Letizia Mauro Giulia
Published: November 2021

Adolescent idiopathic scoliosis (AIS) has an incidence of 2–3% in the general population and a multifactorial etiology. The present study aims to analyze modifiable risk factors and their interactions in the development of AIS in order to increase knowledge about the disease and to prevent the evolution of AIS in young students with tailored public health strategies. A cross-sectional study was conducted over two consecutive school years among students attending 11 first-grade secondary schools in the province of Palermo, Italy. A self-administered questionnaire that investigated socio-demographical, physical and anamnestic characteristics and habits, focusing on possible risk factors associated with idiopathic scoliosis, was administered. In addition, a clinical evaluation was performed with Adams’ test and Bunnel’s inclinometer. Suspected AIS cases were associated with the practice of high-risk sports (p < 0.05), weekly physical activity lasting ≥3 h (p < 0.05), lower back pain (p < 0.001), posture disorders (p < 0.01) and having had no contact with a physician (p < 0.01). Practice of high-risk sports (adj OR = 1.83; CI 95% 1.11–4.76) and suffering of posture disorders (adj OR = 1.67; CI 95% 1.12–3.60) showed a significant association with a confirmed diagnosis of AIS (Cobb angle ≥ 10° at X-ray). The risk factors associated with AIS are still unclear. Therefore, it is crucial to identify early modifiable and multiple risk factors to prevent the evolution of scoliosis in school-age children.
The Risk Factors of Blood Cadmium Elevation in Chronic Kidney Disease
Authors: Tsai Kai-Fan , Hsu Pai-Chin , Kung Chia-Te , Lee Chien-Te , You Huey-Ling , Huang Wan-Ting , Li Shau-Hsuan , Cheng Fu-Jen , Wang Chin-Chou , Lee Wen-Chin
Published: November 2021

Low-level cadmium exposure has adverse effects on chronic kidney disease (CKD); however, the risk factors for elevated blood cadmium levels (BCLs) have not been studied in CKD. We conducted a cross-sectional investigation in 200 CKD patients and stratified them by the tertiles of BCL to compare their demographic, environmental, and biochemical data. The factors associated with BCL were identified, and their effects were examined in subgroups. In the analyses, female sex, smoking, and CKD stage 5D were associated with high BCL, and statin was inversely correlated with BCL (odds ratio [95% confidence interval, CI], 6.858 [2.381–19.746], p < 0.001, 11.719 [2.843–48.296], p = 0.001, 30.333 [2.252–408.520], p = 0.010, and 0.326 [0.122–0.873], p = 0.026; deviations of BCL [nmol/L, 95% CI], 2.66 [1.33–4.00], p < 0.001, 3.68 [1.81–5.56], p < 0.001, 3.38 [0.95–5.82], p = 0.007, and −2.07 [−3.35–−0.78], p = 0.002). These factors were also independently correlated with BCL in subgroups, including non-dialysis CKD, hypertensive patients, non-smokers, and male patients. In conclusion, female sex, smoking, and CKD stage 5D were the major risk factors for elevated BCL; additionally, statins were negatively associated with BCL in CKD.
Transparent Exopolymer Particles in Drinking Water Treatment—A Brief Review
Authors: Shi Jianchao , Yang Yongrui , Yi Qitao , Zhang Jin , Wang Lianxiang
Published: November 2021

Transparent exopolymer particles (TEP) have been described as a class of particulate acidic polysaccharides, which are commonly found in various surface waters. Due to their unique physicochemical characteristics, they have recently been receiving increasing attention on their effects in water treatment. Currently, TEP are commonly known as clear, gel-like polysaccharides. This review first introduced the definition of TEP in water treatment and the relationship between TEP and algal organic matter (AOM). Further, in the review, the authors attempt to offer a holistic view and critical analysis concerning the research on TEPs in source water reservoirs, water plants and membrane treatment processes. It was clearly demonstrated in this review that the formation of TEP in source water reservoirs is largely related to water quality and phytoplankton, and the seasonal water stratification may indirectly affect the formation of TEP. In the waterworks, the relationship between TEP and water treatment process is mutual and there is limited research on this relationship. Finally, the mechanism of TEP-induced membrane fouling and the effect of alleviating TEP-induced membrane fouling is discussed in this review. The TEP removed by ultrafiltration can be recombined after membrane, and the recombination mechanism may be an important way to reduce reverse osmosis membrane contamination.
Emotional Responses and Perceived Relative Harm Mediate the Effect of Exposure to Misinformation about E-Cigarettes on Twitter and Intention to Purchase E-Cigarettes among Adult Smokers
Authors: Liu Jessica , Wright Caroline , Elizarova Olga , Dahne Jennifer , Bian Jiang , Tan Andy S. L.
Published: November 2021

There is a gap in knowledge on the affective mechanisms underlying effects of exposure to health misinformation. This study aimed to understand whether discrete emotional responses and perceived relative harm of e-cigarettes versus smoking mediate the effect of exposure to tweets about the harms of e-cigarettes on Twitter and intention to purchase e-cigarettes among adult smokers. We conducted a web-based experiment in November 2019 among 2400 adult smokers who were randomly assigned to view one of four conditions of tweets containing different levels of misinformation. We fitted mediation models using structural equation modeling and bootstrap procedures to assess the indirect effects of exposure to tweets through perceived relative harm of e-cigarettes and six discrete emotions. Our findings support that exposure to tweets about harms of e-cigarettes influence intention to purchase e-cigarettes through perceived relative harm, discrete emotional responses, and serially through emotional responses and perceived relative harm. Feeling worried, hopeful, and happy mediated the effects of condition on intention to purchase e-cigarettes. Feeling scared, worried, angry, and hopeful mediated the effects serially through perceived relative harm. Affective responses and perceived relative harm following exposure to misinformation about e-cigarette harm may mediate the relationship with intention to purchase e-cigarettes among adult smokers.
Improving the Hydraulic Effects Resulting from the Use of a Submerged Biofiter to Enhance Water Quality in Polluted Streams
Authors: El-Saiad Atef A. , Abd-Elhamid Hany F. , Salama Zeinab I. , Zeleňáková Martina , Weiss Erik , El-Gohary Emad H.
Published: November 2021

Water scarcity is one of the most serious problems facing many countries. In addition, water pollution could lose more water. A submerged biofilter (SB) is used to enhance the self-purification process in polluted streams. However, most previous studies have focused on the efficiency of SB to remove pollutants and there is a lack of studies investigating the hydraulic changes in streams. The current paper aimed to study the hydraulic effects of SB on the flow behavior in streams and how to improve it. An empirical equation for determining the flow rate through SB was developed. Different cases were studied to improve the hydraulic effects resulting from the use of SB. The effect of increasing SB length was tested using different SB lengths. The results showed that increasing the length increased the upstream water depth (h1) and relative heading up (h1/h2). In the second case, comparison between continuous and fragmented SB was tested. The results showed that a fragmented biofilter increased the upstream water depth and the relative heading up. Case three tested the effect of SB height. Different SB heights were tested with a fixed length and constant flow rate. The results revealed that the upstream water depth and relative heading up decreased when the biofilter height decreased. Case four tested the effect of SB with a fixed volume and constant flow rate. In this case, the length and height of SB were changed where the volume was fixed. The results showed that the relative heading up decreased when the SB height decreased and the length increased, which revealed that the SB height can improve the hydraulic impacts. Finally, the use of SB to improve the water quality in polluted streams led to an increase of the relative heading up, which can be reduced by decreasing the height of SB.
Parents’ Report of Canadian Elementary School Children’s Physical Activity and Screen Time during the COVID-19 Pandemic: A Longitudinal Study
Authors: Ostermeier Emma , Tucker Patricia , Clark Andrew , Seabrook Jamie A. , Gilliland Jason
Published: November 2021

COVID-19 public health protocols have altered children’s daily routines, limiting their physical activity opportunities. The purpose of this study was to examine how the COVID-19 pandemic affected children’s (ages 10–12 years) physical activity and screen time, and to explore the impact of gender, socioeconomic status (SES), and public health constraints (i.e., facility use and social interaction) on the changes in children’s health behaviors. Online surveys were disseminated to parents at two time points: before COVID-19 (May 2019 to February 2020) and during COVID-19 (November to December 2020). Wilcoxon signed-rank tests were used to assess changes in physical activity and screen time, and for subgroup analyses. Parents (n = 95) reported declines in children’s physical activity (Z = −2.53, p = 0.01, d = 0.18), and increases in weekday (Z = −4.61, p < 0.01, d = 0.33) and weekend screen time (Z = −3.79, p < 0.01, d = 0.27). Significant changes in physical activity and screen time behaviors were identified between gender, SES, and facility use groups. All social interaction groups underwent significant changes in screen time. Overall, COVID-19 protocols have negatively influenced children’s physical activity and screen time. Due to the negative consequences of inactivity and excessive screen time, resources must be made available to support families during the pandemic.
Spike in Asthma Healthcare Presentations in Eastern England during June 2021: A Retrospective Observational Study Using Syndromic Surveillance Data
Authors: Elliot Alex J. , Bennett Christopher D. , Hughes Helen E. , Morbey Roger A. , Todkill Daniel , Thompson Ross , Landeg Owen , OConnell Emer , Seltzer Mark , Lang Will , Edeghere Obaghe , Oliver Isabel
Published: November 2021

Thunderstorm asthma is often characterised by a sudden surge in patients presenting with exacerbated symptoms of asthma linked to thunderstorm activity. Here, we describe a large spike in asthma and difficulty breathing symptoms observed across parts of England on 17 June 2021. The number of healthcare presentations during the asthma event was compared to expected levels for the overall population and across specific regions. Across affected geographical areas, emergency department attendances for asthma increased by 560% on 17 June compared to the average number of weekday daily attendances during the previous 4 weeks. General practitioner out of hours contacts increased by 349%, National Health Service (NHS) 111 calls 193%, NHS 111 online assessments 581% and ambulance call outs 54%. Increases were particularly noted in patient age groups 5–14 and 15–44 years. In non-affected regions, increases were small (<10%) or decreased, except for NHS 111 online assessments where there was an increase of 39%. A review of the meteorological conditions showed several localised, weak, or moderate thunderstorms specifically across parts of Southeast England on the night of June 16. In this unprecedented episode of asthma, the links to meteorologically defined thunderstorm activity were not as clear as previous episodes, with less evidence of ‘severe’ thunderstorm activity in those areas affected, prompting further discussion about the causes of these events and implications for public health management of the risk.
The Association between Obesity and Chronic Conditions: Results from a Large Electronic Health Records System in Saudi Arabia
Authors: Alghnam Suliman , Alessy Saleh A. , Bosaad Mohamed , Alzahrani Sarah , Al Alwan Ibrahim I. , Alqarni Ali , Alshammari Riyadh , Al Dubayee Mohammed , Alfadhel Majid
Published: November 2021

This cross-sectional study aimed to estimate the prevalence of obesity and its association with diabetes and hypertension among beneficiaries in the National Guard Health Affairs system of Saudi Arabia. We included individuals aged 17 years and older, and patients were classified as diabetic or hypertensive if they had any visit during the 4 years where the primary diagnosis was one of those conditions or they were taking diabetes or hypertension medications. The association between obesity (body mass index ≥30) and diabetes and hypertension were evaluated using a multiple logistic regression model, adjusting for age, gender, nationality, and region. A total of 616,092 individuals were included. The majority were Saudi nationals (93.1%). Approximately 68% of the population were either obese (38.9%) or overweight (29.30%). Obesity was more prevalent among Saudi nationals (39.8% vs. 26.7%, p < 0.01) and females (45.3% vs. 31.2%, p < 0.01). Obesity was independently associated with diabetes mellitus (OR = 2.24, p < 0.01) and hypertension (OR = 2.15, p < 0.01). The prevalence of obesity in the study population was alarming and more pronounced among women. Our findings call for efforts to intensify preventive measures to reduce obesity and associated conditions. Using electronic records to examine the impact of interventions to reduce obesity and chronic conditions may help monitor and improve population health.
Mental Health Interest and Its Prediction during the COVID-19 Pandemic Using Google Trends
Authors: Sycińska-Dziarnowska Magdalena , Szyszka-Sommerfeld Liliana , Kłoda Karolina , Simeone Michele , Woźniak Krzysztof , Spagnuolo Gianrico
Published: November 2021

This study aimed to analyze and predict interest in mental health-related queries created in Google Trends (GT) during the COVID-19 pandemic. The Google Trends tool collected data on the Google search engine interest and provided real-time surveillance. Five key phrases: “depression”, “insomnia”, ”loneliness”, “psychologist”, and “psychiatrist”, were studied for the period from 25 September 2016 to 19 September 2021. The predictions for the upcoming trend were carried out for the period from September 2021 to September 2023 and were estimated by a hybrid five-component model. The results show a decrease of interest in the search queries “depression” and “loneliness” by 15.3% and 7.2%, respectively. Compared to the period under review, an increase of 5.2% in “insomnia” expression and 8.4% in the “psychiatrist” phrase were predicted. The expression “psychologist” is expected to show an almost unchanged interest. The upcoming changes in the expressions connected with mental health might be explained by vaccination and the gradual removal of social distancing rules. Finally, the analysis of GT can provide a timely insight into the mental health interest of a population and give a forecast for a short period trend.
How Phantom Networks, Provider Qualities, and Poverty Sway Medicaid Dental Care Access: A Geospatial Analysis of Manhattan
Authors: Kelley Destiny , Sun Shipeng
Published: November 2021

Access to general dental care is essential for preventing and treating oral diseases. To ensure adequate spatial accessibility for the most vulnerable populations, New York State mandates a ratio of one general dentist to 2000 Medicaid recipients within 30 min of public transportation. This study employed geospatial methods to determine whether the requirement is met in Manhattan by verifying the online directories of ten New York managed care organizations (MCOs), which collectively presented 868 available dentists from 259 facilities. Our survey of 118 dental facilities representing 509 dentists revealed that significantly fewer dentists are available to treat Medicaid recipients compared to MCO directories. The average dentist-to-patient ratio derived from the MCO listings by the Two-Step Floating Catchment Area (2SFCA) method was 1:315, while the average verified ratio was only 1:1927. “Phantom networks”, or inaccurate provider listings, substantially overstated Medicaid dental accessibility. Surprisingly, our study also discovered additional Medicaid providers unlisted in any MCO directory, which we coined “hidden networks”. However, their inclusion was inconsequential to the overall dental supply. We further scrutinized dental care access by uniquely applying six “patient-centered characteristics”, and these criteria vastly reduced accessibility to an average ratio of merely 1:4587. Our novel evaluation of the spatial association between poverty, dental care access, and phantom networks suggests that Medicaid dental providers wish to be located in wealthier census tracts that are in proximity to impoverished areas for maximum profitability. Additionally, we discovered that poverty and phantom networks were positively correlated, and phantom providers masked a lack of dental care access for Medicaid recipients.
Will Smog Cause Mental Health Problems? Indication from a Microsurvey of 35 Major Cities in China
Authors: Li Yanming , Xin Ying , Lu Kangyin , Du Wencui , Guo Fei
Published: November 2021

Using the survey data of 21,861 participants from 35 major cities in China in 2018 and 2019, the effect of air quality on participants’ mental health was empirically tested based on the ordered probit model. The results showed that smog can significantly influence the mental health of participants. The better the air quality, the better the participants’ mental health, while poor air quality results in poor mental health. The older and higher-paid participants demonstrated poorer mental health. Additionally, for different health conditions, the air quality had different effects on the participants’ mental health. The healthier the participants, the more sensitive their mental health to changes in air pollution; the poorer the physical condition of the participants, the less sensitive their mental health to changes in air quality. Therefore, we need to more comprehensively and scientifically understand the effect of air quality on health. We need to pay attention not only to the adverse effects of smog on participants’ physical health, but also to its effects on participants’ mental health to improve both the physical and mental health of participants by improving the air quality.
Towards a Comprehensive Strategy for the Management of Rare Diseases in Slovenia: Outlining an IT-Enabled Ecosystemic Approach
Authors: Stanimirovic Dalibor , Murko Eva , Battelino Tadej , Groselj Urh , Zerjav Tansek Mojca
Published: November 2021

Rare diseases (RDs), with distinctive and complex features, pose a serious public health concern and represent a considerable challenge for the Slovenian healthcare system. One of the potential approaches to tackling this problem and treating patients with RDs in a quality and effective manner is to form an RD ecosystem. This represents a functional environment that integrates all stakeholders, procedures, and relationships required for the coordinated and effective treatment of patients. This paper explores the current situation in the field of RDs, especially in light of the proposed ecosystemic arrangement, and provides an outline for the design of an RD ecosystem in Slovenia. The research applies a case-study design, where focus groups are used to collect evidence from the field, assess the state of affairs, and generate ideas. Structured focus group discussions were conducted with preeminent experts affiliated with the leading institutions in the field of RDs in Slovenia. Analyses and interpretations of the obtained data were carried out by means of conventional content analysis. Setting up an RD ecosystem in Slovenia would lead to significant benefits for patients, as it could promote the coordination of healthcare treatment and facilitate extensive monitoring of the treatment parameters and outcomes. A well-organized RD ecosystem could garner considerable systemic benefits for evidence-informed policymaking, a better utilization of resources, and technological innovation. Delivering quality healthcare in this complex field is largely reliant on the effective integration and collaboration of all entities within the RD ecosystem, the alignment of related systemic factors, and the direction of healthcare services to support the needs and well-being of patients with RDs.
Predicting Public Adherence to COVID-19 Preventive Measures: A Cross-Sectional Study in Hong Kong
Authors: Yan Elsie , Lai Daniel W. L. , Lee Vincent W. P. , Ng Haze K. L.
Published: November 2021

Objectives: To effectively control the spread of COVID-19, the public’s adherence to relevant disease preventive measures (DPM) is critical. This study examined individuals’ adherence to various DPM and identified facilitators and barriers to adherence in a community sample in Hong Kong. Methods: In this cross-sectional study, telephone surveys were conducted over December 2020 and January 2021. Participants provided responses on their adherence to DPM as well as other psychosocial and cognitive factors via the phone. Results: Of the sample of 1255 Chinese adults (aged >18 years, 53% women), 94.4% wore face masks in public areas; 88.4% avoided touching their eyes, nose, and mouth; 82.1% performed hand hygiene practices; 81.5% used alcohol-based hand rubs; 74.6% abided by social distancing; and 39.7% tested for COVID-19 on a voluntary basis. Perceived benefits, perceived barriers, self-efficacy, cues to action, perceived acceptability, and disruptions to daily life related to COVID-19 were associated with individuals’ adherence to DPM. Conclusions: Adherence to DPM was strong in Hong Kong, and the adherence level could be predicted by various factors. It is vital to consider these factors in order to improve the public’s adherence.
Cervical Visual Inspection with Acetic Acid (VIA) and Oncogenic Human Papillomavirus Screening in Rural Indigenous Guatemalan Women: Time to Rethink VIA
Authors: Jeffries Anne , Beck-Sagué Consuelo M. , Marroquin-Garcia Ariel Bernardo , Dean Michael , McCoy Virginia , Cordova-Toma Diego Aurelio , Fenkl Eric , Madhivanan Purnima
Published: November 2021

Single-visit “screen-and-treat” strategies using visual inspection with acetic acid (VIA) and cryotherapy (liquid nitrous oxide ablation) in low-resource settings are commonly used to detect and treat precancerous lesions for cervical cancer prevention. This study compared VIA sensitivity and specificity in rural indigenous Guatemalan communities, to that of oncogenic human papillomavirus (HPV) testing for detection of precancerous changes, using cytology as the reference standard. Between 3–8 September 2017, trained nurses examined 222 women aged 23–58 years with VIA. Specimens for liquid-based cytology and HPV testing were obtained prior to VIA with a cytobrush and transported in PreservCyt to a US clinical laboratory. VIA and HPV test sensitivities were assessed as proportions of women with abnormal cytology that had abnormal VIA or HPV results, respectively, and specificities, as proportions with normal cytology with normal VIA or negative HPV tests. Of 222 women, 18 (8.1%) had abnormal cytology (1 carcinoma in a participant who received VIA-based cryotherapy in 2015, 4 high- and 5 low-grade squamous intraepithelial lesions, and 8 atypical squamous cells of undetermined significance (ASCUS)). Excluding ASCUS, sensitivities of VIA and HPV were 20.0% and 100%, respectively. VIA-based screening may not be acceptable for detecting precancerous lesions, and field cryotherapy for preventing malignancy. The World Health Organization recommended in 2021 “…using HPV DNA detection as the primary screening test rather than VIA or cytology”.
Understanding Loneliness in Adolescence: A Test of Competing Hypotheses on the Interplay of Extraversion and Neuroticism
Authors: Wieczorek Larissa L. , Humberg Sarah , Gerstorf Denis , Wagner Jenny
Published: November 2021

Given that adolescents often experience fundamental changes in social relationships, they are considered to be especially prone to loneliness. Meanwhile, theory and research highlight that both extraversion and neuroticism are closely intertwined with individual differences in loneliness. Extant research has explored the linear main effects of these personality traits, yet potential non-linear associations (e.g., exponential effects) and the potential interplay of extraversion and neuroticism (e.g., mutual reinforcement effects) remain unknown. We addressed these open questions using cross-sectional and one-year longitudinal data from two adolescent samples (overall N = 583, Mage = 17.57, 60.55% girls) and an information-theoretic approach combined with polynomial regression. Analyses showed little evidence for interaction effects but revealed non-linear effects in addition to the main effects of extraversion and neuroticism on loneliness. For example, the positive cross-sectional association between neuroticism and loneliness was stronger at higher neuroticism levels (i.e., exponential effect). Results differed across loneliness facets in that both traits predicted emotional loneliness, but only extraversion predicted social loneliness. Longitudinal analyses showed that loneliness changes were mainly related to neuroticism. We discuss results in the light of sample differences, elaborate on the importance to differentiate between emotional versus social aspects of loneliness, and outline implications for adolescent development.
Threshold Effect in the Relationship between Environmental Regulations and Haze Pollution: Empirical Evidence from PSTR Estimation
Authors: Chang Yonglian , Huang Yingjun , Li Manman , Duan Zhengmin
Published: November 2021

The impact of environmental regulations (ER) on haze pollution control has been continuously debated in the field of sustainable development. This paper explores the direct and indirect threshold effects of ER on haze pollution, and five underlying mechanisms—technological innovation (TI), industrial structure (IS), foreign direct investment (FDI), urbanization (UR), and electricity consumption (EC)—are adopted to investigate the indirect threshold effects. Panel data, over the period 2008–2018, of 284 Chinese cities were used and the threshold effects were predicted endogenously based on the panel smooth transition regression (PSTR) model. The results showed the following: (1) For the direct threshold effect, there exists a U-shaped relationship between ER and haze pollution. ER significantly reduced haze pollution when ER < 38.86 due to “cost effects”. However, ER increased haze pollution after the threshold owing to the “green paradox”, which was not significant. (2) For the indirect threshold effect, when TI = 0.37, IS = 39.61, FDI = 7.25, and UR = 42.86, the relationships between ER and haze pollution changed. The changes and corresponding reasons for the indirect threshold effects are discussed in detail. (3) After a comprehensive analysis, the threshold effects have obvious regional distribution characteristics and internal connections. Finally, based on the results, it is essential for governments to enact appropriate environmental regulatory policies and enhance inter-regional synergies in environmental governance.
What about Your Body Ornament? Experiences of Tattoo and Piercing among Italian Youths
Authors: Gallè Francesca , Valeriani Federica , Marotta Daniela , De Giorgi Andrea , Bargellini Annalisa , Bianco Aida , Colucci Maria Eugenia , Coniglio Maria Anna , Dallolio Laura , De Giglio Osvalda , Di Giuseppe Gabriella , Diella Giusy , Laganà Pasqualina , Licata Francesca , Liguori Giorgio , Marchesi Isabella , Marini Sofia , Montagna Maria Teresa , Napoli Christian , Orsi Giovanni Battista , Pasquarella Cesira , Pelullo Concetta Paola , Ricciardi Luca , Romano Spica Vincenzo , Sacchetti Rossella , Tardivo Stefano , Veronesi Licia , Vitali Matteo , Protano Carmela
Published: November 2021

Background: tattooing and piercing are increasingly common, especially among youths. However, several health complications may be associated with these practices if basic hygiene rules are not respected. This multicenter study was aimed at exploring tattoo and piercing experiences reported by a large sample of Italian undergraduate students through a public health perspective. Methods: tattooed and/or pierced students attending 12 Italian universities were asked to complete a web-based questionnaire regarding their body art experience. Results: out of 1472 respondents, 833 (56.6%) were tattooed and 1009 (68.5%) were pierced. The greatest proportion of tattooed students (93.9%) got her/his first tattoo in a tattoo studio, while most of the pierced were serviced in a jewelry store (48.0%). The pierced ones were less informed on health issues related to the procedure (56.0% versus 77.8% of tattooed p < 0.001), and tattooists were reportedly more attentive to hygiene rules (instrument sterilization 91.5% versus 79.1% of piercers, p < 0.001; use of disposable gloves 98.2% versus 71% of piercers, p < 0.001). Conclusions: educational interventions for both professionals and communities are needed to improve the awareness and the control of health risks related to body art throughout the Italian territory.
In Vitro Recapitulation of Neuropsychiatric Disorders with Pluripotent Stem Cells-Derived Brain Organoids
Authors: Gulimiheranmu Maisumu , Li Shuang , Zhou Junmei
Published: November 2021

Adolescent neuropsychiatric disorders have been recently increasing due to genetic and environmental influences. Abnormal brain development before and after birth contribute to the pathology of neuropsychiatric disorders. However, it is difficult to experimentally investigate because of the complexity of brain and ethical constraints. Recently generated human brain organoids from pluripotent stem cells are considered as a promising in vitro model to recapitulate brain development and diseases. To better understand how brain organoids could be applied to investigate neuropsychiatric disorders, we analyzed the key consideration points, including how to generate brain organoids from pluripotent stem cells, the current application of brain organoids in recapitulating neuropsychiatric disorders and the future perspectives. This review covered what have been achieved on modeling the cellular and neural circuit deficits of neuropsychiatric disorders and those challenges yet to be solved. Together, this review aims to provide a fundamental understanding of how to generate brain organoids to model neuropsychiatric disorders, which will be helpful in improving the mental health of adolescents.
Health Literacy, Socio-Economic Determinants, and Healthy Behaviours: Results from a Large Representative Sample of Tuscany Region, Italy
Authors: Zanobini Patrizio , Lorini Chiara , Lastrucci Vieri , Minardi Valentina , Possenti Valentina , Masocco Maria , Garofalo Giorgio , Mereu Giovanna , Bonaccorsi Guglielmo
Published: November 2021

Background: Health Literacy (HL) is one of the main determinants of health and is crucial for the prevention of noncommunicable diseases, by influencing key health-related behaviours. The aim of the present study was to assess the role of HL and sociodemographic factors in predicting the adoption of two healthy behaviours—physical activity and fruits and vegetables consumption. Methods: This study was conducted on the Tuscan population subsample of the Italian Behavioral Risk Factor Surveillance System in 2017–2018. HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6). Results: About 40% of the 7157 interviewees reported an inadequate or problematic HL level. Female sex, poor financial status, foreign nationality, and low education were associated with a problematic HL level, while an inadequate HL level was associated with being 50–69 years old, low education level, foreign nationality, poor financial status and unemployment or inactive status. Inadequate HL level was a strong predictor of both eating less than three portions of fruits/vegetables per day and not engaging in sufficient PA during leisure times. Conclusions: Our findings showed that an inadequate level of HL could negatively affect physical activity and diet, independently from the other sociodemographic conditions, confirming the role of HL as a relevant social determinant of health.
Impact of Vitamin B12 Insufficiency on Sarcopenia in Community-Dwelling Older Korean Adults
Authors: Chae Seon A , Kim Hee-Sang , Lee Jong Ha , Yun Dong Hwan , Chon Jinmann , Yoo Myung Chul , Yun Yeocheon , Yoo Seung Don , Kim Dong Hwan , Lee Seung Ah , Chung Sung Joon , Soh Yunsoo , Won Chang Won
Published: November 2021

Vitamin B12 (B12) is involved as a cofactor in the synthesis of myelin. A lack of B12 impairs peripheral nerve production, which can contribute to sarcopenia. In this cross-sectional study, we aimed to investigate the relationship between B12 insufficiency and sarcopenia in community-dwelling older Korean adults. A total of 2325 (1112 men; 1213 women) adults aged 70–84 years were recruited. The tools used for sarcopenia were based on the Asian Working Group for Sarcopenia (AWGS) guidelines. Individuals with low appendicular skeletal muscle mass index (ASMI) (<7.0 kg/m2 for men; <5.4 kg/m2 for women) and low hand grip strength (HGS) (<28 kg for men; <18 kg for women) were defined as the sarcopenia group. Among this group, those who showed low physical performance (≤9 points on the Short Physical Performance Battery (SPPB)) were defined as the severe sarcopenia group. B12 concentrations were classified into insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). Univariate and multivariate logistic regression analyses were used to evaluate the relationship between sarcopenia and B12 levels. Low ASMI showed a high incidence in the B12-insufficient group. However, HGS, SPPB, and the severity of sarcopenia showed no correlation with B12. Further, insufficient B12 may affect muscle quantity rather than muscle strength or physical performance.
The Current Safety Regulation for Radiation Emergency Medicine in Korea
Authors: Choi You Yeon , Yoo Seung Yeol , Yang Mihyun , Seong Ki Moon
Published: November 2021

Radiation emergency medicine (REM) systems are operated around the world to provide specialized care for injured individuals who require immediate medical attention in accidents. This manuscript describes the current status of REM safety regulation in Korea and summarizes an assessment of the effects of this regulation. Responding to the requests of people for stronger safety regulations related to radiation exposure, a unique REM safety regulation for nuclear licensees, which is enforceable by laws, has been established and implemented. It is not found in other countries. It can provide a good example in practice for sustainable REM management including document reviews on medical response procedures and inspections of equipment and facilities. REM preparedness of nuclear or radiologic facilities has been improved with systematic implementation of processes contained in the regulation. In particular, the medical care system of licensees has become firmly coordinated in the REM network at the national level, which has enhanced their abilities by providing adequate medical personnel and facilities. This legal regulation service has contributed to preparing the actual medical emergency response for unexpected accidents and should ultimately secure the occupational safety for workers in radiation facilities.