bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantifying the Food and Physical Activity Environments in Rural, High Obesity Communities
Authors: McCormack Lacey A. , Meendering Jessica R. , Burdette Linda , Prosch Nikki , Moore Lindsay , Stluka Suzanne
Published: December 2021

The built environment contributes to an individual’s health, and rural geographies face unique challenges for healthy eating and active living. The purpose of this descriptive study was to assess the nutrition and physical activity environments in rural communities with high obesity prevalence. One community within each of six high obesity prevalence counties in a rural Midwest state completed the Nutrition Environment Measures Survey for Stores (NEMS-S) and the Rural Active Living Assessment (RALA). Data were collected by trained community members and study staff. All communities had at least one grocery store and five had at least one convenience store. Grocery stores had higher mean total NEMS-S scores than convenience stores (26.6 vs. 6.0, p < 0.001), and higher scores for availability (18.7 vs. 5.3, p < 0.001) and quality (5.4 vs. 0, p < 0.001) of healthful foods (higher scores are preferable). The mean RALA town-wide assessment score across communities was 56.5 + 15.6 out of a possible 100 points. The mean RALA program and policy assessment score was 40.8 + 20.4 out of a possible 100 points. While grocery stores and schools are important for enhancing food and physical environments in rural areas, many opportunities exist for improvements to impact behaviors and address obesity.
Generating Real-World Evidence on the Quality Use, Benefits and Safety of Medicines in Australia: History, Challenges and a Roadmap for the Future
Authors: Pearson Sallie-Anne , Pratt Nicole , de Oliveira Costa Juliana , Zoega Helga , Laba Tracey-Lea , Etherton-Beer Christopher , Sanfilippo Frank M. , Morgan Alice , Kalisch Ellett Lisa , Bruno Claudia , Kelty Erin , IJzerman Maarten , Preen David B. , Vajdic Claire M. , Henry David
Published: December 2021

Australia spends more than $20 billion annually on medicines, delivering significant health benefits for the population. However, inappropriate prescribing and medicine use also result in harm to individuals and populations, and waste of precious health resources. Medication data linked with other routine collections enable evidence generation in pharmacoepidemiology; the science of quantifying the use, effectiveness and safety of medicines in real-world clinical practice. This review details the history of medicines policy and data access in Australia, the strengths of existing data sources, and the infrastructure and governance enabling and impeding evidence generation in the field. Currently, substantial gaps persist with respect to cohesive, contemporary linked data sources supporting quality use of medicines, effectiveness and safety research; exemplified by Australia’s limited capacity to contribute to the global effort in real-world studies of vaccine and disease-modifying treatments for COVID-19. We propose a roadmap to bolster the discipline, and population health more broadly, underpinned by a distinct capability governing and streamlining access to linked data assets for accredited researchers. Robust real-world evidence generation requires current data roadblocks to be remedied as a matter of urgency to deliver efficient and equitable health care and improve the health and well-being of all Australians.
Meteorological Normalisation Using Boosted Regression Trees to Estimate the Impact of COVID-19 Restrictions on Air Quality Levels
Authors: Ceballos-Santos Sandra , González-Pardo Jaime , Carslaw David C. , Santurtún Ana , Santibáñez Miguel , Fernández-Olmo Ignacio
Published: December 2021

The global COVID-19 pandemic that began in late December 2019 led to unprecedented lockdowns worldwide, providing a unique opportunity to investigate in detail the impacts of restricted anthropogenic emissions on air quality. A wide range of strategies and approaches exist to achieve this. In this paper, we use the “deweather” R package, based on Boosted Regression Tree (BRT) models, first to remove the influences of meteorology and emission trend patterns from NO, NO2, PM10 and O3 data series, and then to calculate the relative changes in air pollutant levels in 2020 with respect to the previous seven years (2013–2019). Data from a northern Spanish region, Cantabria, with all types of monitoring stations (traffic, urban background, industrial and rural) were used, dividing the calendar year into eight periods according to the intensity of government restrictions. The results showed mean reductions in the lockdown period above −50% for NOx, around −10% for PM10 and below −5% for O3. Small differences were found between the relative changes obtained from normalised data with respect to those from observations. These results highlight the importance of developing an integrated policy to reduce anthropogenic emissions and the need to move towards sustainable mobility to ensure safer air quality levels, as pre-existing concentrations in some cases exceed the safe threshold.
Efficacy of Hair Total Mercury Content as a Biomarker of Methylmercury Exposure to Communities in the Area of Artisanal and Small-Scale Gold Mining in Madre de Dios, Peru
Authors: Koenigsmark Faye , Weinhouse Caren , Berky Axel , Morales Ana , Ortiz Ernesto , Pierce Eric , Pan William , Hsu-Kim Heileen
Published: December 2021

Total mercury content (THg) in hair is an accepted biomarker for chronic dietary methylmercury (MeHg) exposure. In artisanal and small-scale gold mining (ASGM) communities, the validity of this biomarker is questioned because of the potential for contamination from inorganic mercury. As mining communities may have both inorganic and organic mercury exposures, the efficacy of the hair-THg biomarker needs to be evaluated, particularly as nations begin population exposure assessments under their commitments to the Minamata Convention. We sought to validate the efficacy of hair THg for public health monitoring of MeHg exposures for populations living in ASGM communities. We quantified both THg and MeHg contents in hair from a representative subset of participants (N = 287) in a large, population-level mercury exposure assessment in the ASGM region in Madre de Dios (MDD), Peru. We compared population MeHg-THg correlations and %MeHg values with demographic variables including community location, sex, occupation, and nativity. We observed that hair MeHg-THg correlations were high (r > 0.7) for all communities, regardless of location or nativity. Specifically, for individuals within ASGM communities, 81% (121 of 150 total) had hair THg predominantly in the form of MeHg (i.e., >66% of THg) and reflective of dietary exposure to mercury. Furthermore, for individuals with hair THg exceeding the U.S. EPA threshold (1.0 μg/g), 88 out of 106 (83%) had MeHg as the predominant form. As a result, had urine THg solely been used for mercury exposure monitoring, approximately 59% of the ASGM population would have been misclassified as having low mercury exposure. Our results support the use of hair THg for monitoring of MeHg exposure of populations in ASGM settings where alternative biomarkers of MeHg exposure are not feasible.
Comparative Effect of Antihypertensive Drugs in Improving Arterial Stiffness in Hypertensive Adults (RIGIPREV Study). A Protocol for Network Meta-Analysis
Authors: Cavero-Redondo Iván , Saz-Lara Alicia , García-Ortiz Luis , Lugones-Sánchez Cristina , Notario-Pacheco Blanca , Gómez-Sánchez Leticia , Martínez-Vizcaíno Vicente , Gómez-Marcos Manuel Ángel
Published: December 2021

(1) Background: Arterial stiffness is closely and bi-directionally related to hypertension and is understood as both a cause and a consequence of hypertension. Several studies suggest that antihypertensive drugs may reduce arterial stiffness. Therefore, effective prescription of antihypertensive drugs should consider both blood pressure and arterial stiffness. The aim of this protocol is to provide a review comparing the effects of different types of antihypertensive drug interventions on the reduction of arterial stiffness in hypertensive subjects. (2) Methods: The literature search will be performed through the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases. Randomised clinical trials assessing the effect of antihypertensive drug interventions on arterial stiffness measured in subjects with hypertension will be included. A frequentist network meta-analysis will be performed to determine the comparative effects of different antihypertensive drugs. (3) Results: The findings of this study will be published in a peer-reviewed journal. (4) Conclusions: This study will provide evidence for health care professionals on the efficacy of different antihypertensive drugs in decreasing arterial stiffness; in addition, it will analyse the efficacy of the drugs not only in terms of arterial stiffness but also in terms of blood pressure treatment.
Evaluating the Appropriateness and Feasibility of the Care Partner Hospital Assessment Tool (CHAT)
Authors: Carbery Madeline , Schulz Richard , Rodakowski Juleen , Terhorst Lauren , Fields Beth
Published: December 2021

Hospital practitioners rely on care partners of older adults to provide complex care without identifying and addressing their needs. The Care Partner Hospital Assessment Tool (CHAT) was developed to identify the education skill training needs of care partners of hospitalized older adults. This two-phased mixed-method study evaluated the appropriateness and feasibility of the CHAT. The phase 1 quantitative survey with caregiving experts indicated 70–100% agreement for the length and helpfulness of the CHAT (n = 23). These results were supported by phase 2 qualitative interviews with hospital administrators and practitioners, which revealed the following themes: (1) intuitive and clear design worth sustaining and (2) concerns and proposed solutions for implementation. Findings suggest the CHAT is an appropriate and feasible tool for hospital practitioners to tailor their education and skills training to address care partners’ needs. Identifying care partners’ needs is an important step in ensuring they are prepared to complete their caregiving responsibilities.
The Effect of a Supplier’s Eco-Design on the Economic Benefits of a Supply Chain and Associated Coordination
Authors: Liu Junjun , Geng Yong , Chen Biao , Xia Xiqiang
Published: December 2021

The eco-design of upstream suppliers can reduce the environmental impact from the production process for downstream customers. To analyze the effect of suppliers’ eco-design on the economic benefits of up-downstream supply chain and the mechanisms, this study constructed a master–slave game theory model for a supplier and a manufacturer. Based on this game theory model, this study comparatively analyzes the effects on raw material/part prices, retail product prices, sale volume, revenue, and eco-design effort level under three conditions (no eco-design, decentralized decision-making with eco-design, centralized decision-making with eco-design). And to further analyze the effect of eco-design costs on the optimal solution, this article takes the supply chain of tire production as an example. This analysis could provide suggestions for the suppliers and manufacturers to develop and improve their eco-design. The main results are as follows: the supplier eco-design is beneficial to improving the overall economic benefits for suppliers and manufacturers under certain conditions, and the range in which a supplier is willing to implement eco-design in a decentralized decision-making situation is wider than that in a centralized decision-making situation; when a supplier implements an eco-design, it will transfer part of the cost to the manufacturer by raising the unit raw material/parts prices. Meanwhile, the manufacturer can reduce the production cost when the benefit of eco-design is more than the increased purchasing price, and they can decrease the retail price to expand the sales volume. Hence, consumers will benefit from lower prices. Thus, it is a multi-win situation among the suppliers, manufacturers, and consumers.
Thermal Conditions and Hospital Admissions: Analysis of Longitudinal Data from Cyprus (2009–2018)
Authors: Pantavou Katerina , Giallouros George , Philippopoulos Kostas , Piovani Daniele , Cartalis Constantinos , Bonovas Stefanos , Nikolopoulos Georgios K.
Published: December 2021

The state of the thermal environment can affect human health and well-being. Heat stress is associated with a wide range of health outcomes increasing morbidity and mortality and is recognized as an important health risk posed by climate change. This study aims at examining the effect of thermal conditions on the daily number of hospital admissions in Cyprus. Data from eight public hospitals located in five districts of Cyprus were analyzed from 2009 to 2018. Meteorological hourly gridded data were extracted by the ERA-5 Land reanalysis database with a spatial horizontal resolution of 0.1° × 0.1°. The Physiologically Equivalent Temperature (PET) and the Universal Thermal Climate Index (UTCI) were calculated as measures of the integrated effect of meteorological variables. Negative binomial regression was fitted to examine associations between the daily number of hospital admissions and meteorological variables, PET, and UTCI. The results showed that the mean daily temperature (Tair) was positively associated with hospital admissions from any cause. Hospital admissions increased by 0.6% (p < 0.001) for each 1 °C increase of Tair and by 0.4% (p < 0.001) for each 1 °C increase of PET and UTCI. Ozone and nitrogen oxides act as confounding factors. An effect of particulate matter (less than 10 μm in diameter) was observed when the analysis focused on April to August. Thresholds above which hospital admissions are likely to increase include daily mean Tair = 26.1 °C, PET = 29 °C, and UTCI = 26 °C. Studies on heat-related health effects are necessary to monitor health patterns, raise awareness, and design adaptation and mitigation measures.
Livelihoods, Technological Constraints, and Low-Carbon Agricultural Technology Preferences of Farmers: Analytical Frameworks of Technology Adoption and Farmer Livelihoods
Authors: Zhao Dandan , Zhou Hong
Published: December 2021

In the context of achieving carbon neutrality, it is scientifically important to quantitatively explore the relationships among livelihoods, technological property constraints, and the selection of low-carbon technologies by farmers to promote agricultural modernization and carbon neutrality in the agricultural sector of China. Based on the scientific classifications of farmer capital and low-carbon agricultural technologies, a farmer technology selection theory model considering capital constraints was developed in this study. Microcosmic survey data were collected from farmers in the Jiangsu province for empirical testing and analyses. A total of four low-carbon technologies related to fertilizer usage and three types of farmers’ livelihoods and their relationships were examined by using a logistic model. The results showed the existence of a significant coupling relationship between the intrinsic decision mechanism involved in selecting low-carbon agricultural technology and the properties of low-carbon agricultural technology for different types of farmers. Significant differences exist in the selection of different low-carbon technologies among large-scale farmers, mid-level part-time farmers, and low-level (generally small) part-time farmers. (1) When selecting technology, large-scale farmers are more inclined to accept capital-intensive, low-carbon technologies, such as new varieties, straw recycling, soil testing, and formulated fertilization. Mid-level part-time farmers are more inclined to accept capital intensive, labor saving, or low risk low-carbon agricultural technologies. In contrast, low-level part-time farmers are inclined to accept labor intensive technologies to reduce capital constraints and agricultural risks. (2) Large-scale farmers and low-level part-time farmers are influenced by household and plot characteristics, while mid-level part-time farmers are more influenced by plot characteristics. (3) Households with capital constraints created by differentiated livelihoods face challenges adopting capital-intensive low-carbon agricultural technologies, such as straw recycling, new varieties, soil testing, and formulated fertilization. However, farmers with stronger constraints in the areas of land and labor are more inclined to accept labor-saving technologies, such as soil testing and formulated fertilization technology. Moreover, farmers with stronger risk preferences tend to accept high-risk technologies, such as new technologies like straw recycling. The results of this study can provide a scientific basis for formulating carbon emission reduction policies and low-carbon technology policies for the agricultural sector.
Psychological Impact of the COVID-19 Pandemic on Students, Assistants, and Faculty of a Dental Institute of Saudi Arabia
Authors: Ali Saqib , Tauqir Saman , Farooqi Faraz Ahmed , Al-Jandan Badr , Al-Janobi Hawra , Alshehry Sami , Abdelhady Adel Ibrahim , Farooq Imran
Published: December 2021

This study aimed to assess the perceived stress levels in students, assistants, and faculty members of the College of Dentistry, Imam Abdulrahman Bin Faisal, University (IAU), Kingdom of Saudi Arabia (KSA) during the novel coronavirus disease 2019 (COVID-19) pandemic. Using the Cohen’s perceived stress scale (PSS) questionnaire (consisting of 14 items, hence called PSS-14), an online observational survey was conducted. The PSS 14 was rated on a 5-point Likert scale ranging from 0 (never) to 4 (very often). The scores ranging from 0–18 represented low stress, 19–37 represented moderate stress, and 38–56 represented high stress. The second-and third-year students were designated as junior year students, while fourth-year onwards were considered senior year students. Out of total 265 participants, 65% (173) were female, and the majority of the participants were dental students 70% (185) with a mean age of 26.71 ± 9.26 years. In the present study, the average PSS score for the participants was computed as 29.89 (range score: 0–56) which shows moderate stress levels among the respondents. The PSS score for the students was 31.03; for the faculty, it was 28, while for the assistants, it was 27.05. Among the three participant groups, the students were found more on the severe stress side (19%) (p-value = 0.002), and among them, the senior year students (6th year) showed significantly higher stress levels compared to the junior year students (p-value = 0.005). Age-wise, the participants below 20 years were most stressed (21%), followed by those 20–30 years old (18%). Female participants were more severely stressed than males (17% vs. 10%, respectively). It was concluded that the students experienced more stress, followed by the faculty members and dental assistants. In addition, younger participants, females, and senior year students were more stressed than their counterparts. Future studies directed at evaluating stress levels of these groups from different dental institutes could provide an opportunity for policymakers to offer various resources to improve their mental health.
Sibship Size, Height and Cohort Selection: A Methodological Approach
Authors: Ramon-Muñoz Ramon , Ramon-Muñoz Josep-Maria , Candela-Martínez Begoña
Published: December 2021

This article deals with the historical relationship between the number of siblings in a family or household and height, a proxy for biological living standards. Ideally, this relationship is better assessed when we have evidence on the exact number of siblings in a family from its constitution onwards. However, this generally requires applying family reconstitution techniques, which, unfortunately, is not always possible. In this latter case, scholars must generally settle for considering only particular benchmark years using population censuses, from which family and household structures are derived. These data are then linked to the height data for the young males of the family or household. Height data are generally obtained from military records. In this matching process, several decisions have to be taken, which, in turn, are determined by source availability and the number of available observations. Using data from late 19th-century Catalonia, we explore whether the methodology used in matching population censuses and military records as described above might affect the relationship between sibship size and biological living standards and, if so, to what extent. We conclude that, while contextual factors cannot be neglected, the methodological decisions made in the initial steps of research also play a role in assessing this relationship.
Socioeconomic Vulnerability Index and Obesity among Korean Adults
Authors: Park Eunok , Ko Young
Published: December 2021

Examining the socioeconomic vulnerability–obesity relationship is a different approach than comparing obesity rates according to the socioeconomic level. This study explored the socioeconomic vulnerability–obesity relationship among Korean adults. This secondary analysis used data from the Korea National Health and Nutrition Examination Survey, which were collected nationwide from participants aged 30–64 years. Seven socioeconomic indicators (education level, residential area, personal income level, household income level, food insecurity, house ownership, and national basic livelihood security beneficiary status) were used to create the socioeconomic vulnerability index. The prevalence of obesity was higher in the lowest socioeconomic vulnerability index quartile than in the highest socioeconomic vulnerability index quartile (odds ratio = 1.31; 95% confidence interval = 1.13–1.52) after adjusting for gender. When developing future interventions for the prevention and management of obesity, health care providers and researchers need to consider the differences in socioeconomic vulnerability index in adults.
Preliminary Evidence of the Efficacy of Nitric Acid Treatment in Onychomycosis
Authors: Marcos-Tejedor Félix , Santos-Carnicero Natividad , Mayordomo Raquel
Published: December 2021

Onychomycosis is the main cause of toenail disorders and is produced by a fungal infection. It is becoming more prevalent because of new lifestyles and immunosuppression statuses. The therapeutic approach to onychomycosis is under considerable study because of the lengthy treatments that require strong patient commitment, the limited efficacy of treatments, the inclusion of active substances that can be hepatotoxic and cause pharmacological interactions, and/or the questionable efficacy of treatments due to a lack of clinical trials. This study responds to the demand for rapid treatment with minimal pharmacological interactions. Methods: The efficacy of nitric acid 60% treatment in patients with onychomycosis was monitored and studied. The antifungal efficacy of nitric acid was measured by microbiological culture before and after treatment and the clinical evolution of nail dystrophy was quantitatively measured by monitoring with the Onychomycosis Severity Index (OSI). Results: The results show that, with the protocol used, nitric acid 60% painlessly cured 40% (microbiologic cure) of the cases treated, and in all cases, clinical improvement was observed (p = 0.011). Conclusions: The treatment with nitric acid 60% is as efficient as conventional treatments, requires less patient compliance of the treatment and produces no pharmacological interactions, providing alternative treatment in the case of hepatotoxicity.
COVID-19 Vaccine Acceptance of Pregnant and Lactating Women (PLW) in Czechia: An Analytical Cross-Sectional Study
Authors: Riad Abanoub , Jouzová Anna , Üstün Batuhan , Lagová Eliška , Hruban Lukáš , Janků Petr , Pokorná Andrea , Klugarová Jitka , Koščík Michal , Klugar Miloslav
Published: December 2021

Pregnant and lactating women (PLW) represent a particular population subset with increased susceptibility for COVID-19 morbidity and mortality, even though the evidence about the safety and efficacy of COVID-19 vaccines was delayed due to their initial exclusion from development trials. This unclear situation could have led to increased COVID-19 vaccine hesitancy levels among PLW; therefore, this study aimed to evaluate the attitudes of Czech PLW towards COVID-19 vaccines and the determinants of their attitudes. An analytical cross-sectional survey-based study was carried out in the University Hospital Brno (South Moravia, Czechia) between August and October 2021. The study utilised a self-administered questionnaire (SAQ) adapted from previous instruments used for the same purpose. The SAQ included closed-ended items covering demographic characteristics, clinical and obstetric characteristics, attitudes towards COVID-19 vaccination, and potential psychosocial predictors of vaccine acceptance. Out of the 362 included participants, 278 were pregnant (PW) and 84 were lactating women (LW). The overall COVID-19 vaccine acceptance (immediate and delayed) level was substantially high (70.2%), with a significant difference between PW (76.6%) and LW (48.8%). Out of the 70.2% who agreed to receive the vaccine, 3.6% indicated immediate acceptance, and 66.6% indicated delayed acceptance. Only 13.3% of the participants indicated their acceptance of their physician’s vaccination recommendation during pregnancy or while lactating, and 62.2% were against it. Our results agreed with the recent studies that revealed that PW tended to have a high level of COVID-19 vaccine acceptance, and they were also inclined to resist professional recommendations because they predominantly preferred to delay their vaccination. The pregnancy trimester, education level, employment status, and previous live births were significant determinants for COVID-19 vaccine acceptance. The most commonly preferred vaccine type was mRNA-based vaccines, followed by viral vector-based and inactivated virus vaccines. The first top priority of PLW was vaccine safety for their children, followed by vaccine safety for the PLW and vaccine effectiveness. Regarding psychosocial predictors, media/social media, trust in the government, the pharmaceutical industry, and healthcare professionals, partners, and a positive risk-benefit ratio were significant promoters for COVID-19 vaccine acceptance. Findings from this study suggest that promotional interventions targeting PLW should use web platforms and focus on vaccine safety evidence, the expected benefits of vaccines and potential harms of the infection.
The Sustained Psychological Impact of the COVID-19 Pandemic on Health Care Workers One Year after the Outbreak—A Repeated Cross-Sectional Survey in a Tertiary Hospital of North-East Italy
Authors: Lasalvia Antonio , Bodini Luca , Amaddeo Francesco , Porru Stefano , Carta Angela , Poli Ranieri , Bonetto Chiara
Published: December 2021

This study aimed to evaluate the mental health outcomes of health care workers (HCWs) of the Verona academic hospital trust (Italy) one year after the outbreak of COVID-19 and to identify predicted risk factors. A web-based survey was conducted from mid-April to mid-May 2021 on hospital workers one year after the first evaluation performed during the lock-down phase of the COVID-19 pandemic. Post-traumatic stress, general anxiety, depression, and burnout were assessed by using, respectively, the impact of event scale (IES-R), the self-rating anxiety scale (SAS), the patient health questionnaire (PHQ-9) and the Maslach burnout inventory-general survey (MBI-GS). Multivariate logistic regression analysis was performed to identify factors associated with each of the four mental health outcomes one year after the COVID-19 outbreak. A total of 1033 HCWs participated. The percentage of HCWs scoring above the cut-off increased from 2020 to 2021 in all of the outcome domains (anxiety, 50.1% vs. 55.7, p < 0.05; depression, 26.6% vs. 40.6%, p < 0.001; burnout, 28.6% vs. 40.6%, p < 0.001; chi-square test), with the exception of post-traumatic distress. There was also an increase when stratifying by occupation and workplace, with a greater increase for depression and burnout. Multivariate analysis revealed that, one year after the COVID-19 outbreak, nurses were at the greatest risk of anxiety and depression, whereas residents were at the greatest risk of burnout (in terms of low professional efficacy). Working in intensive care units was associated with an increased risk of developing severe emotional exhaustion and a cynical attitude towards work.
Cycling for a Sustainable Touristic Mobility: A Preliminary Study in an Urban Area of Italy
Authors: Mazzulla Gabriella , Bellizzi Maria Grazia , Eboli Laura , Forciniti Carmen
Published: December 2021

This study wants to give a contribution for the investigation of sustainable mobility with positive consequences on public health implementing policies starting from cyclists’ perceptions. Data were collected by interviewing cyclists along three bike lanes of an urban area of southern Italy through a face-to-face survey. The survey was conducted in Autumn 2019, interviewing a sample of 129 cyclists. In order to identify the critical aspects of the bike paths, both an importance-performance analysis (IPA) and a gap-IPA were performed. The average values of the cyclists’ perceptions of each aspect have been considered as performance values. The importance values have been obtained by performing a principal component analysis (PCA), which was helpful also for better defining the service quality phenomenon. From the PCA, six latent constructs can be identified as: “Physical Nuisance”; “Non-physical Nuisance”; “Physical Comfort”; “Non-physical Comfort”; “Protection”; and “Ambience”. The results of Gap-IPA confirmed that the criticalities of the bike paths relate to the degree of protection in relation to accidents, and to the degree of nuisance caused by pollution and opposing pedestrians along the path. Based on the conducted analyses, sustainable tourism implementing policies should be oriented in solving the emerged criticalities of the existing bike paths. The results of Gap-IPA are very intuitive and can certainly be helpful for identifying the most convenient strategies.
Diet Quality and Mental Health Status among Division 1 Female Collegiate Athletes during the COVID-19 Pandemic
Authors: Christensen Natalie , van Woerden Irene , Aubuchon-Endsley Nicki L. , Fleckenstein Pamela , Olsen Janette , Blanton Cynthia
Published: December 2021

The International Olympic Committee has identified mental health as a priority that significantly affects the physical health and safety of collegiate athletes. Interventions that improve diet quality have been shown to improve mental health in several populations. However, studies are needed to examine this relationship in female collegiate athletes, who have elevated risk of experiencing anxiety and depression symptoms, as well as dietary insufficiencies. In a quantitative, cross-sectional study, female student athletes at a U.S. university completed three mental health questionnaires: Depression Anxiety and Stress Scale (DASS-21), Athlete Psychological Strain Questionnaire (APSQ), and COVID Stress Scales (CSS). Each female athlete also completed a validated, web-based Diet History Questionnaire (DHQ-III) resulting in a Healthy Eating Index (HEI). Seventy-seven participants completed all survey information. HEI scores were consistently higher for athletes with poorer mental health. HEI scores were significantly positively associated with stress (p = 0.015), performance concerns (p = 0.048), CSS components of danger (p = 0.007), contamination (p = 0.006), and traumatic stress (p = 0.003). Although findings support statistically significant associations among dietary quality and mental health indicators, including broad symptom severity or stressors specific to athletics or COVID-19, these associations were in the opposite direction hypothesized. Possible reasons for results and suggestions for future research are discussed.
Rethinking of Environmental Health Risks: A Systematic Approach of Physical—Social Health Vulnerability Assessment on Heavy-Metal Exposure through Soil and Vegetables
Authors: Yang Jun , Ma Silu , Song Yongwei , Li Fei , Zhou Jingcheng
Published: December 2021

In the field of environmental health risk assessment and management research, heavy metals in soil are a constant focus, largely because of mining and metallurgical activities, and other manufacturing or producing. However, systematic vulnerability, and combined research of social and physical vulnerability of the crowd, have received less attention in the research literature of environmental health risk assessment. For this reason, tentative design modelling for comprehensive environmental health vulnerability, which includes the index of physical and social vulnerability, was conducted here. On the basis of experimental data of heavy-metal pollution in soil and vegetables, and population and societal survey data in Daye, China, the physical, social, and comprehensive environmental health vulnerabilities of the area were analyzed, with each village as an evaluation unit. First, the polluted and reference areas were selected. Random sampling sites were distributed in the farmland of the villages in these two areas, with two sampling sites per village. Then, 204 vegetable samples were directly collected from the farmland from which the soil samples had been collected, composed of seven kinds of vegetables: cowpea, water spinach, amaranth, sweet potato leaves, tomato, eggplant, and pepper. Moreover, 400 questionnaires were given to the local residents in these corresponding villages, and 389 valid responses were obtained. The results indicated that (1) the average physical vulnerability values of the population in the polluted and reference areas were 3.99 and 1.00, respectively; (2) the village of Weiwang (WW) had the highest physical vulnerability of 8.55; (3) vegetable intake is exposure that should be paid more attention, as it contributes more than 90% to physical vulnerability among the exposure pathways; (4) arsenic and cadmium should be the priority pollutants, with average physical vulnerability value contributions of 63.9% and 17.0%, respectively; (5) according to the social vulnerability assessment, the village of Luoqiao (LQ) had the highest social vulnerability (0.77); (6) for comprehensive environmental health vulnerability, five villages near mining activities and two villages far from mine-affected area had high physical and social vulnerability, and are the urgent areas for environmental risk management. In order to promote environmental risk management, it is necessary to prioritize identifying vulnerable populations in the village-scale dimension as an innovative discovery.
Assessment of Health Professionals’ Attitudes on Radiation Protection Measures
Authors: Goula Aspasia , Chatzis Athanasios , Stamouli Maria-Aggeliki , Kelesi Martha , Kaba Evridiki , Brilakis Emmanouil
Published: December 2021

(1) Background: Health professionals’ knowledge, beliefs and perceptions concerning radiation protection may affect their behaviour during surgery and consequently influence the quality of health services. This study highlights the health professionals’ average knowledge level and captures the beliefs, perceptions, and behaviours in a large public Greek hospital. (2) Materials and Methods: A cross-sectional study was carried out, including health professionals working in operating rooms. One hundred thirty-two staff members participated by responding to an original questionnaire. The sample consisted of nurses, radiographers and medical doctors of various specialties involved daily in surgical procedures where ionizing radiation is required. The survey was conducted from March to June 2021, and the response rate was 97%. (3) Results: The level of overall knowledge of health professionals regarding radiation protection safety was not satisfactory. Females and employees with a lower level of education had more misconceptions about radiation and radiation protection. Employees of younger ages and with less previous experience were more likely to have negative emotions towards radiation exposure. Finally, employees with fewer children tended to express physical complaints caused by their negative emotions due to radiation exposure. (4) Conclusions: Health professionals’ lack of basic and specialized knowledge concerning radiation protection safety had a negative impact on the provision of health services. The continuing training of the staff seemed to be the only solution to reverse this trend. The training should highlight how radiation exposure can be minimized, safeguarding health professionals’ trust and sense of security by significantly improving their working environment.
A Low-Cost, Easy-to-Assemble Device to Prevent Infant Hyperthermia under Conditions of High Thermal Stress
Authors: Farré Ramon , Rodríguez-Lázaro Miguel A. , Dinh-Xuan Anh Tuan , Pons-Odena Martí , Navajas Daniel , Gozal David
Published: December 2021

High ambient temperature and humidity greatly increase the risk of hyperthermia and mortality, particularly in infants, who are especially prone to dehydration. World areas at high risk of heat stress include many of the low- and middle-income countries (LMICs) where most of their inhabitants have no access to air conditioning. This study aimed to design, evaluate, and test a novel low-cost and easy-to-assemble device aimed at preventing the risk of infant hyperthermia in LMICs. The device is based on optimizing negative heat transfer from a small amount of ice and transferring it directly to the infant by airflow of refrigerated air. As a proof of concept, a device was assembled mainly using recycled materials, and its performance was assessed under laboratory-controlled conditions in a climatic chamber mimicking realistic stress conditions of high temperature and humidity. The device, which can be assembled by any layperson using easily available materials, provided sufficient refrigerating capacity for several hours from just 1–2 kg of ice obtained from a domestic freezer. Thus, application of this novel device may serve to attenuate the adverse effects of heat stress in infants, particularly in the context of the evolving climatic change trends.
The Effects of Physical Exercise on Mental Health: From Cognitive Improvements to Risk of Addiction
Authors: Caponnetto Pasquale , Casu Mirko , Amato Miriam , Cocuzza Dario , Galofaro Valeria , La Morella Alessandra , Paladino Sara , Pulino Kamil , Raia Nicoletta , Recupero Flavia , Resina Cristian , Russo Samuele , Terranova Laura Maria , Tiralongo Jennifer , Vella Maria Chiara
Published: December 2021

(1) Background: we aimed to investigate the effects of physical activity on cognitive functions and deficits of healthy population and other needy groups. Secondly, we investigated the relation between healthy habits and psychopathological risks. Finally, we investigated the impact of COVID-19 pandemic on exercise addiction and possible associated disorders. (2) Methods: From April 2021 to October 2021, we conducted a review aimed at identifying the effects of physical exercise on mental health, from cognitive improvements to risk of addiction; we searched for relevant studies on PubMed, Web of Science, EMBASE, PsycINFO and CINHAL. (3) Results: For the first purpose, results indicated multiple effects such as better precision and response speed in information processing tasks on healthy populations; improvement of executive functions, cognitive flexibility and school performance in children; improvement of attention and executive functions and less hyperactivity and impulsiveness on children with attention deficit hyperactivity disorder (ADHD); improvement of executive and global functions on adults; improvement of overall cognitive functioning on patients with schizophrenic spectrum disorder or bipolar disorder. Data also demonstrated that exercise addiction seems to be related to low levels of education, low self-esteem, eating disorders and body dysmorphisms. Eventually, it was found that people with lower traits and intolerance of uncertainty show a strong association between COVID-19 anxiety and compulsive exercise and eating disorder. (4) Conclusions: these findings underline on one side the beneficial effects of physical activity on cognitive function in healthy individuals in a preventive and curative key, while on the other side the importance of an adequate evaluation of psychological distress and personality characteristics associated with exercise addiction.
Public Perceptions around mHealth Applications during COVID-19 Pandemic: A Network and Sentiment Analysis of Tweets in Saudi Arabia
Authors: Binkheder Samar , Aldekhyyel Raniah N. , AlMogbel Alanoud , Al-Twairesh Nora , Alhumaid Nuha , Aldekhyyel Shahad N. , Jamal Amr A.
Published: December 2021

A series of mitigation efforts were implemented in response to the COVID-19 pandemic in Saudi Arabia, including the development of mobile health applications (mHealth apps) for the public. Assessing the acceptability of mHealth apps among the public is crucial. This study aimed to use Twitter to understand public perceptions around the use of six Saudi mHealth apps used during COVID-19: “Sehha”, “Mawid”, “Sehhaty”, “Tetamman”, “Tawakkalna”, and “Tabaud”. We used two methodological approaches: network and sentiment analysis. We retrieved Twitter data using specific mHealth apps-related keywords. After including relevant tweets, our final mHealth app networks consisted of a total of 4995 Twitter users and 8666 conversational relationships. The largest networks in size (i.e., the number of users) and volume (i.e., the conversational relationships) among all were “Tawakkalna” followed by “Tabaud”, and their conversations were led by diverse governmental accounts. In contrast, the four remaining mHealth networks were mainly led by the health sector and media. Our sentiment analysis approach included five classes and showed that most conversations were neutral, which included facts or information pieces and general inquires. For the automated sentiment classifier, we used Support Vector Machine with AraVec embeddings as it outperformed the other tested classifiers. The sentiment classifier showed an accuracy, precision, recall, and F1-score of 85%. Future studies can use social media and real-time analytics to improve mHealth apps’ services and user experience, especially during health crises.
Geographical Differences and Their Associated Factors in Chronic Obstructive Pulmonary Disease Mortality in Japan: An Ecological Study Using Nationwide Data
Authors: Okui Tasuku , Park Jinsang
Published: December 2021

Geographical differences in chronic obstructive pulmonary disease (COPD) mortality have not been determined using municipal-specific data in Japan. This study determined the geographical differences in COPD mortality in Japan using municipal-specific data and identified associated factors. Data on COPD mortality from 2013 to 2017 for each municipality were obtained from the Vital Statistics of Japan. We calculated the standardized mortality ratio (SMR) of COPD by an empirical Bayes method for each municipality and located the SMRs on a map of Japan. In addition, an ecological study was conducted to identify factors associated with the SMR using demographic, socioeconomic, and medical characteristics of municipalities by a spatial statistics model. Geographical differences in the SMR were different in men and women, and municipalities with a low SMR tended to be more frequent in women. Spatial regression analysis identified that the total population and taxable income per capita were negatively associated with the SMR in men. In women, population density, the proportion of fatherless households, and the number of clinics per capita were positively associated with the SMR, whereas taxable income per capita was negatively associated with the SMR. There were some differences in regional characteristics associated with COPD mortality by sex.
Trends of Total Knee Arthroplasty According to Age Structural Changes in Korea from 2011 to 2018
Authors: Kim Yong-Beom , Choi Hyung-Suk , Kang Eun Myeong , Park Suyeon , Seo Gi-Won , Chun Dong-Il , Min Tae-Hong
Published: December 2021

Total Knee Arthroplasty (TKA) is one of the most commonly performed surgeries worldwide since it can improve pain, quality of life, and functional outcome. Due to the expansion of hospitals specialized in joint surgery, the topography of TKA implementation in Korea is changing. This study analyzed longitudinal trends of TKA based on changes in age distribution, sex, hospital, and region based on the Health Insurance Review and Assessment Service (HIRA) of Korea database. Data were collected from the National Health Insurance Service (NHIS), the Korean Statistical Information Service (KOSIS), and the Health Insurance Review and Assessment Service (HIRA) in Korea for the period 2011–2018. Results show the total number of surgeries increased and the number of patients by age decreased in those under the age of 70, while the number of patients over 70 years of age increased. A remarkable increase in women was found, and there was no significant difference between regions. TKA is spreading in a more universal and easily accessible form in Korea and has increased more in other relatively small medical institutions compared to tertiary referral medical centers. Due to the increase of orthopedics’ specialized hospitals and clinics, TKA is becoming more prominent in those hospitals.
Use of State Sequence Analysis in Pharmacoepidemiology: A Tutorial
Authors: Vanoli Jacopo , Nava Consuelo Rubina , Airoldi Chiara , Ucciero Andrealuna , Salvi Virginio , Barone-Adesi Francesco
Published: December 2021

While state sequence analysis (SSA) has been long used in social sciences, its use in pharmacoepidemiology is still in its infancy. Indeed, this technique is relatively easy to use, and its intrinsic visual nature may help investigators to untangle the latent information within prescription data, facilitating the individuation of specific patterns and possible inappropriate use of medications. In this paper, we provide an educational primer of the most important learning concepts and methods of SSA, including measurement of dissimilarities between sequences, the application of clustering methods to identify sequence patterns, the use of complexity measures for sequence patterns, the graphical visualization of sequences, and the use of SSA in predictive models. As a worked example, we present an application of SSA to opioid prescription patterns in patients with non-cancer pain, using real-world data from Italy. We show how SSA allows the identification of patterns in prescriptions in these data that might not be evident using standard statistical approaches and how these patterns are associated with future discontinuation of opioid therapy.
Contaminants of Emerging Concern (CECs): Occurrence and Fate in Aquatic Ecosystems
Authors: Pastorino Paolo , Ginebreda Antoni
Published: December 2021

Contaminants of emerging concern (CECs) are typically divided into chemicals, as they are properly called, and biological CECs, such as pathogens [...]