bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV–AIDS Stigma in Burundi: A Qualitative Descriptive Study
Authors: Njejimana Néstor , Gómez-Tatay Lucía , Hernández-Andreu José Miguel
Published: September 2021

HIV/AIDS stigma is a global issue and a serious problem in African countries. Although prevalence remains high in this region, no detailed study has yet been carried out to determine and characterize this problem in Burundi. Using a qualitative analysis based on an extensive series of 114 interviews, we describe the main characteristics of HIV stigma in the country. The results of our study indicate that the problem of HIV/AIDS stigma is widespread in Burundian society, as all participants in the research reported having experienced some kind of HIV stigma. The seven dimensions of stigma identified in people living with HIV/AIDS (PLWHA) in Burundi are physical violence, verbal violence, marginalization, discrimination, self-stigma, fear and insecurity, and healthcare provider stigma. These dimensions of stigma can be experienced through different manifestations, which have been characterized in this study, revealing that the problem of stigma in PLWHA is still an important issue in Burundi.
Evaluation of the Effectiveness of Employers and H&S Services in Relation to the COVID-19 System in Polish Manufacturing Companies
Authors: Bartnicka Joanna , Kabiesz Patrycja , Palka Dorota , Gajewska Paulina , Islam Ejaz Ul , Szymanek Damian
Published: September 2021

With the advent of the COVID-19 pandemic, companies had to adapt quickly to survive in the market. During this time, employers played a key role, along with employees involved in Occupational Health and Safety (OHS) activities, as they were responsible for implementing the recommendations of the European Commission. There is no unambiguous definition of OHS in Polish legislation. It is assumed that it is a set of rules defining the manner of performing work, and above all, a method of providing employees with working conditions so that their performance is safe and hygienic. Responsibility for the health and safety in the workplace is imposed on the employer by the legislature. Thus, effective health and safety training is an essential element of the success of any properly operating company. In the literature, no studies have been identified that evaluate the effectiveness of actions during the COVID-19 outbreak. The aim of the article is to present the actions of Polish employers along with their effectiveness assessment related to the protection of employees during the COVID-19 outbreak. The article presents a proposal for conducting remote OHS (Occupational Health and Safety) training using the platform Moodle. The created course was implemented during OHS training conducted in a selected manufacturing company. At its end, an evaluation of the course was carried out, and the collected opinions of training participants allowed the formulation of interesting conclusions, which became the contribution of this paper. The authors pay special attention to three main points of the work. The first is the form of training, which gives the possibility to conduct training at a distance while maintaining its effectiveness. The second important point is the mandatory feedback of the trainees, ensuring the possibility of continuous improvement and quality enhancement of both the program and the form of training. The evaluation was developed on the basis of the extended Kirkpatrick model, which is a completely new approach to OHS training evaluation. The third point emphasized by the authors is the possibility of precise adaptation of the training to other plants and even industries. Therefore, it can be concluded that the course developed by the authors is a very interesting and practical didactic tool with great implementation potential.
Comparison of Respiratory Health Impacts Associated with Wood and Charcoal Biomass Fuels: A Population-Based Analysis of 475,000 Children from 30 Low- and Middle-Income Countries
Authors: Woolley Katherine E. , Bartington Suzanne E. , Kabera Telesphore , Lao Xiang-Qian , Pope Francis D. , Greenfield Sheila M. , Price Malcolm J. , Thomas G. Neil
Published: September 2021

Background: The World Health Organisation reported that 45% of global acute respiratory infection (ARI) deaths in children under five years are attributable to household air pollution, which has been recognised to be strongly associated with solid biomass fuel usage in domestic settings. The introduction of legislative restrictions for charcoal production or purchase can result in unintended consequences, such as reversion to more polluting biomass fuels such as wood; which may increase health and environmental harms. However, there remains a paucity of evidence concerning the relative health risks between wood and charcoal. This study compares the risk of respiratory symptoms, ARI, and severe ARI among children aged under five years living in wood and charcoal fuel households across 30 low- and middle-income countries. Methods: Data from children (N = 475,089) residing in wood or charcoal cooking households were extracted from multiple population-based Demographic and Health Survey databases (DHS) (N = 30 countries). Outcome measures were obtained from a maternal report of respiratory symptoms (cough, shortness of breath and fever) occurring in the two weeks prior to the survey date, generating a composite measure of ARI (cough and shortness of breath) and severe ARI (cough, shortness of breath and fever). Multivariable logistic regression analyses were implemented, with adjustment at individual, household, regional and country level for relevant demographic, social, and health-related confounding factors. Results: Increased odds ratios of fever (AOR: 1.07; 95% CI: 1.02–1.12) were observed among children living in wood cooking households compared to the use of charcoal. However, no association was observed with shortness of breath (AOR: 1.03; 95% CI: 0.96–1.10), cough (AOR: 0.99; 95% CI: 0.95–1.04), ARI (AOR: 1.03; 95% CI: 0.96–1.11) or severe ARI (AOR: 1.07; 95% CI: 0.99–1.17). Within rural areas, only shortness of breath was observed to be associated with wood cooking (AOR: 1.08; 95% CI: 1.01–1.15). However, an increased odds ratio of ARI was observed in Asian (AOR: 1.25; 95% CI: 1.04–1.51) and East African countries (AOR: 1.11; 95% CI: 1.01–1.22) only. Conclusion: Our population-based observational data indicates that in Asia and East Africa there is a greater risk of ARI among children aged under 5 years living in wood compared to charcoal cooking households. These findings have major implications for understanding the existing health impacts of wood-based biomass fuel usage and may be of relevance to settings where charcoal fuel restrictions are under consideration.
Associations between Socio-Demographic Factors and Hypertension Management during the COVID-19 Pandemic: Preliminary Findings from Malaysia
Authors: Elnaem Mohamed Hassan , Kamarudin Nur Hasyimah , Syed Nabeel Kashan , Huri Hasniza Zaman , Dehele Inderpal Singh , Cheema Ejaz
Published: September 2021

The perspectives of hypertensive patients on the state of hypertension control during the ongoing pandemic restrictions have not been extensively studied in Malaysia. Therefore, this study aimed to assess the impact of socio-demographic factors, health literacy, and adherence on the overall hypertension management in a group of Malaysian hypertensive patients during the COVID-19 pandemic. An anonymous, online cross-sectional study was conducted over three months that involved a group of Malaysian adults with hypertension. A validated, self-administered 30-item questionnaire was prepared in Malay and English languages on Google Forms. The link was then distributed to participants on social media (Facebook and WhatsApp). Following survey validation, a pilot study with 30 participants who met the inclusion criteria was carried out. The total scores for health literacy, adherence, and pandemic impact on hypertension control were calculated and compared across all independent variables. In a total of 144 study participants, controlled blood pressure was reported in 77% (N = 111). There were good levels of adherence and health literacy scores but moderate levels of pandemic impact scores. The total adherence scores showed a statistically significant difference between age groups (χ2 = 6.48, p = 0.039) and those who reported having controlled and uncontrolled blood pressure (U = 1116, p = 0.001). Moreover, the analysis revealed statistically significant differences in total pandemic impact scores based on the age group (χ2 = 15.008, p = 0.001), household income (χ2 = 6.887, p = 0.032), employment (U = 1712, p = 0.006), and marital status (U = 520.5, p < 0.001). The youngest age group (18–39) years, the lowest income group, unemployed and unmarried individuals, had significantly higher pandemic impact scores. This denotes that those individuals were more prone to be negatively affected by the pandemic regarding their hypertension management. Most participants reported relatively controlled blood pressure and good levels of health literacy as well as adherence amidst the pandemic. To a moderate extent, study participants perceived that the pandemic had a negative effect on hypertension management. The perceived negative impact of the pandemic was attributed to several socio-demographic factors, such as age, household income, employment, and marital status.
Trends of Perinatal Stress, Anxiety, and Depression and Their Prediction on Postpartum Depression
Authors: Cheng Ching-Yu , Chou Yu-Hua , Chang Chia-Hao , Liou Shwu-Ru
Published: September 2021

Perinatal stress, anxiety, and depression impacts not only women but also their child(ren). The purpose of this longitudinal study is to explore trends of stress, anxiety, and depressive symptoms from pregnancy to postpartum and understand predictions of stress and anxiety on postpartum depression. One-hundred-fifty-six women at 23–28 weeks gestation (T1), 147 at 32–36 weeks gestation (T2), 129 at over 36 weeks gestation (T3), and 83 at postpartum (T4) completed study surveys. The Perceived Stress Scale, Center for Epidemiologic Studies Depression scale, and State-Trait Anxiety Inventory were used to measure stress, depressive symptoms, and anxiety. Descriptive statistics, Pearson and Spearman’s correlation, and Generalized Estimating Equation were applied to analyze the data. Results showed that levels of anxiety and depressive symptoms increased from 24 weeks gestation to postpartum, whereas stress levels decreased during pregnancy but increased in postpartum. Over half of women experienced anxiety symptoms, especially during late pregnancy and postpartum. Stress, anxiety, and depressive symptoms were inter-correlated. Notably, women at late pregnancy and postpartum were prone to stress, anxiety, and depression. Prenatal anxiety could predict postpartum depressive symptoms. Active assessment and management of stress, anxiety, and depression is needed and should begin from early pregnancy and continue until postpartum.
Physical and Mental Health Factors Associated with Poor Nutrition in Elderly Cancer Survivors: Insights from a Nationwide Survey
Authors: Byun Mikyong , Kim Eunjung , Kim Jieun
Published: September 2021

Elderly cancer survivors (patients with any stage of cancer or a history of cancer) are precious members of our society and they can be easily found in various types of surveys. As is well known, good nutrition is important in elderly people suffering from cancer. Proper nutritional evaluation and intervention not only improves their quality of life but also helps them to receive adequate treatment, thereby prolonging individual survival and reducing social healthcare costs. In this study, we retrieved elderly cancer survivors from national survey data and assessed their nutritional status as good or bad. Then, we described the individual, physical, and mental health factors between people with good and bad nutrition. Physical and psychological variables associated with poor nutritional status were evaluated through regression analysis. We investigated data from the 2017 National Survey of Older Persons, and cancer patients aged 65 years or over were eligible. A total of 360 adults were enrolled and more than half (57.2%, n = 206) were in a poor nutritional status. We applied individual variable-adjusted statistical models and discovered that limited instrumental activities of daily living (IADL) (OR 2.15, 95% CI 1.08–4.28) and poor subjective health status (OR 1.74, 95% CI 1.00–3.02) were significantly associated with poor nutrition on logistic regression. Our research findings suggested that IADL and self-rated health status needed to be addressed in old cancer survivors at nutritional risk. The early recognition and management of nutrition in these populations might help them to live longer and have a better quality of life, eventually reducing socioeconomic burdens.
Socio-Demographic and General Health Factors Associated with Quality of Life in Long-Term Breast Cancer Survivors from Southwestern Poland
Authors: Socha Małgorzata , Sobiech Krzysztof A.
Published: September 2021

Background: Identification of factors associated with quality of life (QOL) in breast cancer survivors can contribute to better functioning in this group of patients. The study aimed to assess the association between QOL and anthropometric, sociodemographic, and medical characteristics in postmastectomy women from southwestern Poland, 9.4 (±6.5) years after completed treatment. Materials and methods: QOL was estimated with the SF-36v2 questionnaire in 250 survivors aged 62.8 (±8.0) years with previously histologically confirmed invasive breast cancer. Results: Women in this study rated their overall QOL with an average of 60.7 (±17.9), Mental Component Summary of 62.8 (±19.8), and Physical Component Summary of 57.5 (±18.8) points. The use of multivariate regression analysis revealed that depression, chronic diseases, abdominal obesity, and pregnancy history have a statistically significant negative effect on the QOL of women after mastectomy, whereas participation in regular physical activity, living with a partner, the education level ≥ 12 years, and living in the city were associated with a higher QOL assessment. There were no significant relationships between QOL and the age, time since surgery, type of treatment, smoking, and occupational status of the patients. Conclusions: Health education, greater social support, specialist care in the treatment of comorbidities, and propagation of a physically active lifestyle can improve the physical and mental functioning of breast cancer survivors long after diagnosis and treatment.
Towards Ecological Sustainability: Assessing Dynamic Total-Factor Ecology Efficiency in Africa
Authors: Amowine Nelson , Li Huaizong , Boamah Kofi Baah , Zhou Zhixiang
Published: September 2021

Ecological footprint (EF) and human development index (HDI) are two critical indicators for assessing sustainable development worldwide. Past studies in Africa have ignored dynamic sustainable total-factor ecological efficiency (DSTFEE) assessment. This present study proffers a novel dynamic sustainable total-factor ecological efficiency (DSTFEE) that comprehensively assesses the ecological efficiency among 44 sampled African economies from 2010 to 2016. Our study incorporates EF and HDI in the model. Second, the study evaluates regional DSTFEE heterogeneity efficiency as well as the technological gap efficiency in Africa. Further, projection analysis is done to offer a viable solution path to address the inefficient African countries. Third, the study investigates the determinants of ecological efficiency using the bootstrap truncation regression technique. The results from the implemented models are as follows: first, the DSTFEE for the 44 sampled African countries is very low (0.403), indicating enormous potential for improvement. Second, the heterogeneity of DSTFEE across the five Africa regional blocs is evident. The southern bloc had the highest efficiency score, followed by the northern, central, western, and eastern regions. The technology gap ratio also reveals a massive gap among the five Africa regional blocs. Third, the bootstrap truncation regression results established a U-shape nexus between growth and DSTFEE in Africa. REC and trade openness is positively corrected to DSTFEE for African countries. In contrast, financial development, foreign direct investment (FDI), and urbanization impede dynamic ecological efficiency in Africa. The study’s results equip African countries with adequate knowledge of their ecological efficiency situation and provide them a viable path to improve environmental efficiency, thereby boosting their ecological sustainability.
Exploration of Preventable Hospitalizations for Colorectal Cancer with the National Cancer Control Program in Taiwan
Authors: Hung Yu-Han , Chung Yu-Chieh , Lee Pi-Yueh , Kao Hao-Yun
Published: September 2021

Background: Causing more than 40,000 deaths each year, cancer is one of the leading causes of mortality and preventable hospitalizations (PH) in Taiwan. To reduce the incidence and severity of cancer, the National Cancer Control Program (NCCP) includes screening for various types of cancer. A cohort study was conducted to explore the long-term trends in PH/person-years following NCCP intervention from 1997 to 2013. Methods: Trend analysis was carried out for long-term hospitalization. The Poisson regression model was used to compare PH/person-years before (1997–2004) and after intervention (2005–2013), and to explore the impact of policy intervention. Results: The policy response reduced 26% for the risk of hospitalization; in terms of comorbidity, each additional point increased the risk of hospitalization by 2.15 times. The risk of hospitalization doubled for each 10-year increase but was not statistically significant. Trend analysis validates changes in the number of hospitalizations/person-years in 2005. Conclusions: PH is adopted as an indicator for monitoring primary care quality, providing governments with a useful reference for which to gauge the adequacy, accessibility, and quality of health care. Differences in PH rates between rural and urban areas can also be used as a reference for achieving equitable distribution of medical resources.
A Direct Observation Video Method for Describing COVID-19 Transmission Factors on a Micro-Geographical Scale: Viral Transmission (VT)-Scan
Authors: Suminski Richard R. , Dominick Gregory M. , Wagner Norman J.
Published: September 2021

The COVID-19 pandemic severely affected many aspects of human life. While most health agencies agree mask wearing and physical distancing reduce viral transmission, efforts to improve the assessment of these behaviors are lacking. This study aimed to develop a direct observation video method [Viral Transmission (VT)-Scan] for assessing COVID-19 transmission behaviors and related factors (e.g., environmental setting). A wearable video device (WVD) was used to obtain videos of outdoor, public areas. The videos were examined to extract relevant information. All outcomes displayed good to excellent intra- and inter-reliability with intra-class correlation coefficients ranging from 0.836 to 0.997. The majority of people had a mask (60.8%) but 22.1% of them wore it improperly, 45.4% were not physical distancing, and 27.6% were simultaneously mask and physical distancing non-compliant. Transmission behaviors varied by demographics with white, obese males least likely to be mask-compliant and white, obese females least likely to physical distance. Certain environments (e.g., crosswalks) were identified as “hot spots” where higher rates of adverse transmission behaviors occurred. This study introduces a reliable method for obtaining objective data on COVID-19 transmission behaviors and related factors which may be useful for agent-based modeling and policy formation.
Nitric Oxide, Oxidative Stress and Streptococcus mutans and Lactobacillus Bacterial Loads in Saliva during the Different Stages of Pregnancy: A Longitudinal Study
Authors: Wagle Madhu , Basnet Purusotam , Vårtun Åse , Acharya Ganesh
Published: September 2021

Hormonal changes associated with pregnancy promote oral bacterial growth, which may affect salivary nitric oxide (NO) levels, oxidative stress (OS), and antioxidant capacity (AC). We hypothesized that caries-related bacterial load, NO level, and OS in the saliva change with advancing gestation. The aim of this study was to investigate longitudinal changes in salivary NO, OS, and AC during pregnancy and correlate them with Streptococcus mutans (SM) and Lactobacillus (LB) colonization at different stages of pregnancy. We assessed NO level by Griess method, OS by measuring malondialdehyde (MDA), AC by ABTS radicals and bacterial load by culturing SM and LB in the saliva of pregnant women (n = 96) and compared with non-pregnant women (n = 50) as well as between different stages of pregnancy. Compared with non-pregnant women, NO was 77% higher (4.73 ± 2.87 vs. 2.67 ± 1.55 µM; p < 0.001), MDA was 13% higher (0.96 ± 0.27 vs. 0.85 ± 0.22 nM; p = 0.0055), and AC was 34% lower (60.35 ± 14.33 vs. 80.82 ± 11.60%; p < 0.001) in the late third trimester. NO increased with advancing gestation, but AC and OS did not change significantly during pregnancy. SM were more abundant in pregnant women compared with non-pregnant (p = 0.0012). Pregnancy appears to have an adverse impact on oral health emphasizing the importance optimal oral healthcare during pregnancy.
Zoonotic Risk of Encephalitozoon cuniculi in Animal-Assisted Interventions: Laboratory Strategies for the Diagnosis of Infections in Humans and Animals
Authors: Santaniello Antonio , Cimmino Ilaria , Dipineto Ludovico , Agognon Ayewa Lawoe , Beguinot Francesco , Formisano Pietro , Fioretti Alessandro , Menna Lucia Francesca , Oriente Francesco
Published: September 2021

The involvement of animals for therapeutic purposes has very ancient roots. To date, it is clear that animal-assisted interventions (AAIs), in addition to ensuring the replacement of missing or deficient affects, improves psychophysiological parameters connected to human health. However, AAI could potentially present risks related to the transmission of infectious agents from animals to humans. Among these microorganisms, E. cuniculi is a microspore which induces pathological effects (fever, headache, nausea, vomiting, diarrhea, breathlessness, respiratory symptoms, and weakness) in both humans and animals. Consequently, an accurate and fast diagnosis of E. cuniculi infection, as well as the identification of new diagnostic approaches, is of fundamental importance. This literature review was carried out to provide an extensive and comprehensive analysis of the most recent diagnostic techniques to prevent and care for E. cuniculi-associated risks in the AAI field.
Associations between Fast-Food Restaurants Surrounding Kindergartens and Childhood Obesity: Evidence from China
Authors: Wang Chenyang , Zhen Zhiping , Zhao Nan , Zhao Chenlin
Published: September 2021

The prevalence of obesity among preschool children has risen dramatically due to the influx of Western fast food in China. In this study, we aimed to provide clear evidence on the associations between fast-food restaurants and childhood obesity. We collected and combined three unique cross-sectional datasets: physical fitness data, geographic information, and the financial data of each kindergarten. The two-stage least squares were used for empirical analyses. The final data including 75,730 children were from 785 kindergartens in 82 cities and 23 provinces in China in 2018. The mean age of participants was 4.94 ± 0.87; 34,249 (45.2%) females and 41,481 (54.8%) males. The number of fast-food restaurants within 1, 2, and 3 km radii had a significant and positive correlation with obesity, and this correlation decreased as the radius increased. Furthermore, the distance to the nearest fast-food restaurant had a significant and negative correlation with obesity. Western fast-food restaurants contributed more to obesity than the broader definition of fast-food restaurants. There was marked heterogeneity between urban and rural areas. Our findings documented that fast-food restaurants had a significant and positive association with childhood obesity, thus the restriction of fast-food restaurants surrounding kindergartens might be considered.
The Burden of Disease Due to Road Traffic Noise in Hesse, Germany
Authors: Hegewald Janice , Schubert Melanie , Lochmann Matthias , Seidler Andreas
Published: September 2021

Road-traffic-noise exposition is widespread in Germany and can have harmful health effects. As guidance for informed decision-making, we estimated the environmental burden of disease attributable to road-traffic noise in Hesse, Germany as disability-adjusted life-years (DALYs). Using detailed road-traffic-noise exposure data provided by the Hessian Agency for Nature Conservation, Environment, and Geology (HLNUG), we calculated the DALYs due to road-traffic noise > 40 dB(A) L24h (unweighted average 24 h noise level) and other noise metrics for endpoints with known dose-response functions and evidence in the literature (NORAH-study on disease risks and WHO reviews): cardiovascular disease, depressive disorders, road-traffic annoyance, and sleep disturbance. We calculated the population-attributable fractions (PAF) for road-noise-related cardiovascular disease (hypertensive heart disease, ischemic heart disease, and stroke) and depressive disorders in the population using published relative risk estimates. We multiplied the PAFs with the Hessian proportion of the 2015 WHO DALY estimates for Germany in people aged ≥ 40 years. For high annoyance and high sleep disturbance, we used published dose-response functions to determine the burden for residents of all ages. For Hesse, we found a total of 26,501 DALYs attributable to road-traffic noise or 435 DALY per 100,000 persons for the reference year, 2015. Further, we estimated that a hypothetic uniform road-traffic-noise reduction of 3 dB would prevent 23% of this burden of disease.
What Demographic, Social, and Contextual Factors Influence the Intention to Use COVID-19 Vaccines: A Scoping Review
Authors: AlShurman Bara’ Abdallah , Khan Amber Fozia , Mac Christina , Majeed Meerab , Butt Zahid Ahmad
Published: September 2021

Background: During the COVID-19 crisis, an apparent growth in vaccine hesitancy has been noticed due to different factors and reasons. Therefore, this scoping review was performed to determine the prevalence of intention to use COVID-19 vaccines among adults aged 18–60, and to identify the demographic, social, and contextual factors that influence the intention to use COVID-19 vaccines. Methods: This scoping review was conducted by using the methodological framework for scoping review outlined by Arksey and O’Malley. A search strategy was carried out on four electronic databases: PubMed, Scopus, CINAHL, and PsycINFO. All peer-reviewed articles published between November 2019 and December 2020 were reviewed. Data were extracted to identify the prevalence of, and factors that influence, the intention to use COVID-19 vaccines. Results: A total of 48 relevant articles were identified for inclusion in the review. Outcomes presented fell into seven themes: demographics, social factors, vaccination beliefs and attitudes, vaccine-related perceptions, health-related perceptions, perceived barriers, and vaccine recommendations. Age, gender, education level, race/ethnicity, vaccine safety and effectiveness, influenza vaccination history, and self-protection from COVID-19 were the most prominent factors associated with intention to use COVID-19 vaccines. Furthermore, the majority of studies (n = 34/48) reported a relatively high prevalence of intention to get vaccinated against COVID-19, with a range from 60% to 93%. Conclusion: This scoping review enables the creation of demographic, social, and contextual constructs associated with intention to vaccinate among the adult population. These factors are likely to play a major role in any targeted vaccination programs, particularly COVID-19 vaccination. Thus, our review suggests focusing on the development of strategies to promote the intention to get vaccinated against COVID-19 and to overcome vaccine hesitancy and refusal. These strategies could include transparent communication, social media engagement, and the initiation of education programs.
The Impact of the COVID-19 Pandemic on Students’ Mental Health and Sleep in Saudi Arabia
Authors: Alyoubi Azizah , Halstead Elizabeth J. , Zambelli Zoe , Dimitriou Dagmara
Published: September 2021

Background: Mental health problems are prevalent among university students in Saudi Arabia. This study aimed to investigate the impact of the COVID-19 pandemic on university students’ mental health and sleep in Saudi Arabia. Method: A total of 582 undergraduate students from Saudi Arabia aged between 18 and 45 years old (M = 20.91, SD = 3.17) completed a cross-sectional online questionnaire measuring depression, anxiety, stress, resilience, and insomnia during the COVID-19 pandemic (2020). Analysis included an independent samples t-test, one-way ANOVA, and Hierarchical regression analysis. Results: Undergraduate students reported high levels of depression, anxiety, and perceived stress and low levels of resilience (p < 0.001) during the pandemic. In addition, students reported experiencing insomnia. A hierarchical regression analysis indicated that lower resilience, high levels of insomnia, having a pre-existing mental health condition, and learning difficulties (such as dyslexia, dyspraxia, or dyscalculia) were significantly associated with high levels of depression and stress. In addition, lower resilience, a high level of insomnia, and pre-existing mental health conditions were significantly associated with high levels of anxiety. Finally, a lower level of psychological resilience and a high level of insomnia were significantly associated with increased levels of depression, anxiety and stress within university students. Conclusion: This study has provided evidence that a lower level of psychological resilience and insomnia were associated with mental health problems among undergraduate students in Saudi Arabia, thus enhancing psychological resilience and interventions to support sleep and mental health are vital to support student well-being outcomes throughout the pandemic.
Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study
Authors: Sánchez Muñoz-Torrero Juan F. , Escudero-Sánchez Guillermo , Calderón-García Julián F. , Rico-Martín Sergio , Robles Nicolás Roberto , Bacaicoa M. Asunción , Alcalá-Pedrajas José N. , Gil-Fernández Guadalupe , Monreal Manuel ,   on behalf of the FRENA Investigators
Published: September 2021

Objectives: The most appropriate targets for systolic blood pressure (SBP) levels to reduce cardiovascular morbidity and mortality in patients with symptomatic artery disease remain controversial. We compared the rate of subsequent ischemic events or death according to mean SBP levels during follow-up. Design: Prospective cohort study. FRENA is an ongoing registry of stable outpatients with symptomatic coronary (CAD), cerebrovascular (CVD) or peripheral artery disease (PAD). Setting: 24 Spanish hospitals. Participants: 4789 stable outpatients with vascular disease. Results: As of June 2017, 4789 patients had been enrolled in different Spanish centres. Of these, 1722 (36%) had CAD, 1383 (29%) CVD and 1684 (35%) PAD. Over a mean follow-up of 18 months, 136 patients suffered subsequent myocardial infarction, 125 had ischemic stroke, 74 underwent limb amputation, and 260 died. On multivariable analysis, CVD patients with mean SBP levels 130–140 mm Hg had a lower risk of mortality than those with levels <130 mm Hg (hazard ratio (HR): 0.39; 95% CI: 0.20–0.77), as did those with levels >140 mm Hg (HR: 0.46; 95% CI: 0.26–0.84). PAD patients with mean SBP levels >140 mm Hg had a lower risk for subsequent ischemic events (HR: 0.57; 95% CI: 0.39–0.83) and those with levels 130–140 mm Hg (HR: 0.47; 95% CI: 0.29–0.78) or >140 mm Hg (HR: 0.32; 95% CI: 0.21–0.50) had a lower risk of mortality. We found no differences in patients with CAD. Conclusions: In this real-world cohort of symptomatic arterial disease patients, most of whom are not eligible for clinical trials, the risk of subsequent events and death varies according to the levels of SBP and the location of previous events. Especially among patients with large artery atherosclerosis, PAD or CVD, SBP <130 mm Hg may result in increased mortality. Due to potential factors in this issue, Prospective, well designed studies are warranted to confirm these observational data.
The Effects of Electrical Stimulation Program on Navicular Height, Balance, and Fear of Falling in Community-Dwelling Elderly
Authors: Namsawang Juntip , Muanjai Pornpimol , Luangpon Nongnuch , Kiatkulanusorn Sirirat
Published: September 2021

Introduction: Intrinsic foot muscle weakness is a crucial cause of balance deficit in the elderly, which leads to a limited range of motion from the fear of falling and subsequently decreases the quality of life. Muscle strengthening via transcutaneous electrical stimulation (TENS) is an effective intervention; however, its effects on elderly people have rarely been reported. This study was conducted to investigate the effects of TENS on navicular height, balance, and fear of falling. Method: In this study, forty-eight participants aged 65–75 years were included and were randomly divided into two groups: the TENS and control groups. Before and after 4 weeks of training, navicular height, balance, and fear of falling were measured. Result: After 4 weeks of training, navicular height significantly increased in both groups (p < 0.05); however, the increase was higher in the TENS group (p = 0.035). The TENS group had a better improvement in balance in all four directions—front, back, left, and right (p < 0.05). However, postural balance improvements in the control group were observed in three directions only—front, back, and left (p < 0.05)—without any significant difference between the two groups. Furthermore, the TENS group decreased the scale of fear of falling after 4 weeks of training (p = 0.039). Conclusion: In summary, the results of this study can be used as part of the muscle strengthening via ES for decreasing the risk of falls or fear of falling in the elderly.
Antibiotic Susceptibility of Environmental Legionella pneumophila Strains Isolated in Northern Italy
Authors: Cocuzza Clementina Elvezia , Martinelli Marianna , Perdoni Federica , Giubbi Chiara , Vinetti Maria Erica Alessandra , Calaresu Enrico , Frugoni Sergio , Scaturro Maria , Ricci Maria Luisa , Musumeci Rosario
Published: September 2021

Legionella pneumophila is ubiquitous in aquatic environments and responsible for severe pneumonia in humans through inhalation of aerosol containing Legionella spp. Macrolides and fluoroquinolones are frequently used antimicrobials, but treatment failures are increasingly being reported. As susceptibility testing is not routinely performed, this study aimed to determine the minimum inhibitory concentrations (MICs) on 58 environmental Legionella pneumophila strains (24 of serogroup 1 and 34 of non-serogroup 1) isolated in Northern Italy. MICs of azithromycin, erythromycin, ciprofloxacin, levofloxacin, and rifampicin were determined by the microdilution method using buffered yeast extract broth supplemented with α-ketoglutarate (BYEα). Seventy-five percent of Legionella pneumophila isolates showed MIC values below the tentative highest MICs indicated by the European Committee on Antimicrobial Susceptibility Testing (EUCAST); rifampicin was the most active agent with MIC90 values below 0.008 mg/L. Interestingly, one isolate was tested and found to be PCR-positive for the azithromycin LpeAB active efflux system, further confirmed by the reserpine/resazurin microtiter assay. In conclusion, this study has provided additional susceptibility data for environmental Legionella pneumophila isolates from Northern Italy demonstrating, in general, low MICs values for the tested antimicrobials, although one strain tested was shown to possess the LpeAB resistance determinant, indicating that future surveillance studies are warranted.
Poor Health Related Quality of Life and Unhealthy Lifestyle Habits in Weight-Loss Treatment-Seeking Youth
Authors: Mozzillo Enza , Zito Eugenio , Calcaterra Valeria , Corciulo Nicola , Di Pietro Mario , Di Sessa Anna , Franceschi Roberto , Licenziati Maria Rosaria , Maltoni Giulio , Morino Giuseppe , Predieri Barbara , Street Maria Elisabeth , Trifirò Giuliana , Gallè Francesca , Franzese Adriana , Valerio Giuliana
Published: September 2021

Obesity is associated with unhealthy lifestyle behaviors and poor Health Related Quality of Life (HRQOL). The cumulative effect of lifestyle behaviors on HRQOL has been demonstrated in chronically ill adolescents, but not in adolescents with obesity. The present study aimed to assess the association between HRQOL and adherence to the Mediterranean Diet (MD) and/or low levels of physical activity (PA) in a large sample of outpatient adolescents with overweight or obesity seeking weight loss treatment. Four-hundred-twenty participants were enrolled from 10 Italian outpatient clinics. The demographics and anthropometric features, KIDMED scores, and exercise levels of the participants were collected, together with parental features. The HRQOL was assessed by the Pediatric Quality of Life Inventory (PedsQL™), Adolescents Version 4.0. PedsQL total score and functioning subscales were lower in adolescents who reported one or two unhealthy habits. Compared with the high/intermediate groups, the risk of low HRQOL was twice as high for each unit increase in BMI SDS, while the percentage was reduced by 12.2% for every unit increase in the KIDMED score and by 32.3% for each hour increase of exercise. The clustering of these two unhealthy behaviors conferred a 120% higher risk of low HRQOL. Similarly, adolescents displaying better diet quality and/or a physically more active lifestyle have better physical and psychological functioning. Further studies are needed to disclose whether these characteristics may be predictive of better adherence to weight loss treatment.
Japan’s Dental Care Facing Population Aging: How Universal Coverage Responds to the Changing Needs of the Elderly
Authors: Okamoto Etsuji
Published: September 2021

Although universal health coverage (UHC) is pursued by many countries, not all countries with UHC include dental care in their benefits. Japan, with its long-held tradition of UHC, covers dental care as an essential benefit, and the majority of dental care services are provided to all patients with minimal copayment. Being under UHC, the scope of services as well as prices are regulated by the uniform fee schedule, and dentists submit claims according to the uniform format and fee schedule. The author analyzed the publicly available dental health insurance claims data as well as a sampling survey on dental hygiene to illustrate how Japan’s dental care is responding to the challenges from population aging. A marked improvement was found in dental health status in the elderly population as measured by improved tooth-specific survival. The improvement may be attributable to the universal coverage of dental care, as evidenced by the steady increase in home visits by dentists/dental hygienists as well as home oral rehabilitation services.
Physical Fitness Profiling of National Category Table Tennis Players: Implication for Health and Performance
Authors: Picabea Jon Mikel , Cámara Jesús , Yanci Javier
Published: September 2021

The aims of this study were to: (1) analyze table tennis players’ physical profiles considering and comparing players age categories (i.e., under U12, U14, U16, U20, Senior and Older); and (2) to quantify the correlations among the variables measured by each test. Seventy-one table tennis players (61 men and 10 women, 19.7 ± 11.23 years, 1.65 ± 0.13 m, 59.71 ± 17.72 kg and 21.60 ± 4.22 kg/m2) divided into six age groups, performed a sprint test, forearm isometric strength test, countermovement vertical test, countermovement horizontal test, change of direction ability (CODA) test and flexibility test. U14 players performed better than U12 in all tests (ES = −0.70 to 1.98, moderate to large) except in Sit and Reach (SAR) test (ES = 0.19, trivial). The U16 group also obtained better results than U14 in all tests (ES = 0.77 to −2.31, moderate to large) except for the SAR test (ES = 0.19, trivial). The U20 group performed better than U16 in all the tests (ES = 0.73 to −1.53, moderate to large) except for the 5 m sprint test (ES = −0.02, trivial), 10 m sprint test (ES = −0.51, moderate) and SAR (ES = 0.11, trivial). Differences between Senior and U20 were only found in the arm swing counter movement jump (CMJAS) (ES = −0.82, large) and modified agility test (MAT) (ES = 1.19, large), with the U20 group being better in both variables. The senior group performed better in the MAT test than the older group (ES = 0.94, large). The relation found between forearm isometric strength, vertical jump, horizontal jump, sprint and CODA ability (r = −0.53; ±0.14, 0/0/100, most likely to r = 0.83; ±0.06, 100/0/0, most likely) indicates that these capacities are related in table tennis players. Nevertheless, the lack of association between the sit and reach test with the other capacities may indicate that flexibility is an independent capacity.
Effects of Community-Based Physical-Cognitive Training, Health Education, and Reablement among Rural Community-Dwelling Older Adults with Mobility Deficits
Authors: Song Chen-Yi , Lin Pay-Shin , Hung Pei-Lun ,   ADLers Occupational Therapy Clinic
Published: September 2021

Reablement services are approaches for maintaining and improving the functional independence of older adults. Previous reablement studies were conducted in a home environment. Due to the limited evidence on the effects of multicomponent interventions and reablement in a community-based context, this study aimed to develop and evaluate the effect of community-based physical–cognitive training, health education, and reablement (PCHER) among rural community-dwelling older adults with mobility deficits. The trial was conducted in rural areas of New Taipei City, Taiwan. Older adults with mild to moderate mobility deficits were recruited from six adult daycare centers, and a cluster assignment was applied in a counterbalanced order. The experimental group (n = 16) received a PCHER intervention, comprising 1.5 h of group courses and 1 h of individualized reablement training, while the control group (n = 12) underwent PCHE intervention, comprising 1.5 h of group courses and 1 h of placebo treatment. A 2.5-h training session was completed weekly for 10 weeks. The outcome measures contained the de Morton Mobility Index (DEMMI), the Saint Louis University Mental Status (SLUMS) Examination, the Barthel Index (BI), the Short Physical Performance Battery (SPPB), and the Canadian Occupational Performance Measure (COPM). The PCHER significantly improved the DEMMI, SLUMS, BI, SPPB, and COPM (all p < 0.05), with medium-to-large effect sizes. PCHER also showed an advantage over PCHE in terms of the SPPB (p = 0.02). This study verified that combining individualized reablement with group-based multicomponent training was superior to group courses alone in enhancing the functional abilities of community-dwelling older adults with mobility deficits.
Towards Culture-Aware Smart and Sustainable Cities: Integrating Historical Sources in Spatial Information Infrastructures
Authors: Bucher Bénédicte , Hein Carola , Raines Dorit , Gouet Brunet Valérie
Published: September 2021

This article addresses the integration of cultural perspectives in the smart city discourse and in the implementation of the UN Agenda 2030; it does so specifically with respect to land patterns and land use. We hope to increase the ability of relevant stakeholders, including scientific communities working in that field, to handle the complexity of the current urban challenges. Culture is understood here in the broadest sense of the word, including the values and conceptualizations of the world, and the modes of technological creation and control of the environment. This concept of culture varies among stakeholders, depending, in particular, on their activities, on the place they live in, and also depending on their scientific background. We propose to complement existing targets that are explicitly related to culture in the UN and UNESCO agendas for 2030, and introduce a target of culture awareness for city information infrastructures. We show that, in the specific case of land patterns and land use, these new targets can be approached with historical data. Our analysis of the related core functionalities is based on interviews with practitioners, draws on insights from the humanities, and takes into account the readiness of the existing technologies.
Metastatic Melanoma Progression Is Associated with Endothelial Nitric Oxide Synthase Uncoupling Induced by Loss of eNOS:BH4 Stoichiometry
Authors: Melo Fabiana Henriques Machado de , Gonçalves Diego Assis , Sousa Ricardo Xisto de , Icimoto Marcelo Yudi , Fernandes Denise de Castro , Laurindo Francisco R. M. , Jasiulionis Miriam Galvonas
Published: September 2021

Melanoma is the most aggressive type of skin cancer due to its high capability of developing metastasis and acquiring chemoresistance. Altered redox homeostasis induced by increased reactive oxygen species is associated with melanomagenesis through modulation of redox signaling pathways. Dysfunctional endothelial nitric oxide synthase (eNOS) produces superoxide anion (O2−•) and contributes to the establishment of a pro-oxidant environment in melanoma. Although decreased tetrahydrobiopterin (BH4) bioavailability is associated with eNOS uncoupling in endothelial and human melanoma cells, in the present work we show that eNOS uncoupling in metastatic melanoma cells expressing the genes from de novo biopterin synthesis pathway Gch1, Pts, and Spr, and high BH4 concentration and BH4:BH2 ratio. Western blot analysis showed increased expression of Nos3, altering the stoichiometry balance between eNOS and BH4, contributing to NOS uncoupling. Both treatment with L-sepiapterin and eNOS downregulation induced increased nitric oxide (NO) and decreased O2• levels, triggering NOS coupling and reducing cell growth and resistance to anoikis and dacarbazine chemotherapy. Moreover, restoration of eNOS activity impaired tumor growth in vivo. Finally, NOS3 expression was found to be increased in human metastatic melanoma samples compared with the primary site. eNOS dysfunction may be an important mechanism supporting metastatic melanoma growth and hence a potential target for therapy.