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Showing papers in "International Journal of Environmental Research and Public Health in 2019"


Journal ArticleDOI
TL;DR: The main impacts due to waste mismanagement in developing countries are reviewed, focusing on environmental contamination and social issues, and the activity of the informal sector in developing cities was also reviewed.
Abstract: Environmental contamination due to solid waste mismanagement is a global issue. Open dumping and open burning are the main implemented waste treatment and final disposal systems, mainly visible in low-income countries. This paper reviews the main impacts due to waste mismanagement in developing countries, focusing on environmental contamination and social issues. The activity of the informal sector in developing cities was also reviewed, focusing on the main health risks due to waste scavenging. Results reported that the environmental impacts are pervasive worldwide: marine litter, air, soil and water contamination, and the direct interaction of waste pickers with hazardous waste are the most important issues. Many reviews were published in the scientific literature about specific waste streams, in order to quantify its effect on the environment. This narrative literature review assessed global issues due to different waste fractions showing how several sources of pollution are affecting the environment, population health, and sustainable development. The results and case studies presented can be of reference for scholars and stakeholders for quantifying the comprehensive impacts and for planning integrated solid waste collection and treatment systems, for improving sustainability at a global level.

937 citations


Journal ArticleDOI
TL;DR: About one in three medical students globally have anxiety—a prevalence rate which is substantially higher than the general population, and further research is needed to identify risk factors of anxiety unique to medical students.
Abstract: Anxiety, although as common and arguably as debilitating as depression, has garnered less attention, and is often undetected and undertreated in the general population. Similarly, anxiety among medical students warrants greater attention due to its significant implications. We aimed to study the global prevalence of anxiety among medical students and the associated factors predisposing medical students to anxiety. In February 2019, we carried out a systematic search for cross-sectional studies that examined the prevalence of anxiety among medical students. We computed the aggregate prevalence and pooled odds ratio (OR) using the random-effects model and used meta-regression analyses to explore the sources of heterogeneity. We pooled and analyzed data from sixty-nine studies comprising 40,348 medical students. The global prevalence rate of anxiety among medical students was 33.8% (95% Confidence Interval: 29.2–38.7%). Anxiety was most prevalent among medical students from the Middle East and Asia. Subgroup analyses by gender and year of study found no statistically significant differences in the prevalence of anxiety. About one in three medical students globally have anxiety—a prevalence rate which is substantially higher than the general population. Administrators and leaders of medical schools should take the lead in destigmatizing mental illnesses and promoting help-seeking behaviors when students are stressed and anxious. Further research is needed to identify risk factors of anxiety unique to medical students.

360 citations


Journal ArticleDOI
TL;DR: How positive interactions in urban green space can catalyze social cohesion, social capital and critical health-promoting behaviors that may enhance psychological health and well-being is discussed.
Abstract: Social cohesion involves the interpersonal dynamics and sense of connection among people. Increased social cohesion can be associated with various physical and psychological health benefits. The presence of urban green spaces can encourage positive social interactions that cultivate social cohesion in ways that enhance health and well-being. Urban green spaces have also been linked to positive health behaviors and outcomes including increased physical activity and social engagement. Understanding the relationship between social cohesion and urban green space is important for informing holistic approaches to health. In this article, we discuss how positive interactions in urban green space can catalyze social cohesion, social capital and critical health-promoting behaviors that may enhance psychological health and well-being. We also summarize the strengths and limitations of previous studies and suggest directions for future research.

340 citations


Journal ArticleDOI
TL;DR: The agricultural waste sector can benefit immensely from some of the examples from other waste sectors such as the municipal solid waste and wastewater management where collection, segregation, recycling and disposal are institutionalized to secure an operational system.
Abstract: India, the second largest agro-based economy with year-round crop cultivation, generates a large amount of agricultural waste, including crop residues. In the absence of adequate sustainable management practices, approximately 92 seems a very small number of metric tons of crop waste is burned every year in India, causing excessive particulate matter emissions and air pollution. Crop residue burning has become a major environmental problem causing health issues as well as contributing to global warming. Composting, biochar production and mechanization are a few effective sustainable techniques that can help to curtail the issue while retaining the nutrients present in the crop residue in the soil. The government of India has attempted to curtail this problem, through numerous measures and campaigns designed to promote sustainable management methods such as converting crop residue into energy. However, the alarming rise of air pollution levels caused by crop residue burning in the city of Delhi and other northern areas in India observed in recent years, especially in and after the year of 2015, suggest that the issues is not yet under control. The solution to crop residue burning lies in the effective implementation of sustainable management practices with Government interventions and policies. This manuscript addresses the underlying technical as well as policy issues that has prevented India from achieving a long-lasting solution and also potential solutions that have been overlooked. However, effective implementation of these techniques also requires us to look at other socioeconomic aspects that had not been considered. This manuscript also discusses some of the policy considerations and functionality based on the analyses and current practices. The agricultural waste sector can benefit immensely from some of the examples from other waste sectors such as the municipal solid waste (MSW) and wastewater management where collection, segregation, recycling and disposal are institutionalized to secure an operational system. Active stakeholder involvement including education and empowerment of farmers along with technical solutions and product manufacturing can also assist tremendously. Even though the issue of crop residue burning touches many sectors, such as environment, agriculture, economy, social aspects, education, and energy, the past governmental efforts mainly revolved around agriculture and energy. This sectorial thinking is another barrier that needs to be broken. The government of India as well as governments of other developing countries can benefit from the emerging concept of nexus thinking in managing environmental resources. Nexus thinking promotes a higher-level integration and higher level of stakeholder involvement that goes beyond the disciplinary boundaries, providing a supporting platform to solve issues such as crop residue burning.

328 citations


Journal ArticleDOI
TL;DR: The results show that consumers aware of the meat impact on the planet, willing to stop or significantly reduce meat consumption for environmental reasons, and who have already changed their meat intake for ecological concerns are a small minority.
Abstract: Meat consumption is a major contributor to global warming. Given the worldwide growing demand of meat, and the severe impact of meat production on the planet, reducing animal protein consumption is a matter of food security and public health. Changing consumer food behavior is a challenge. Taste preferences, culinary traditions and social norms factor into food choices. Since behavioral change cannot occur without the subject’s positive attitude based on reasons and motivations, a total of 34 papers on consumer attitudes and behavior towards meat consumption in relation to environmental concerns were examined. The results show that consumers aware of the meat impact on the planet, willing to stop or significantly reduce meat consumption for environmental reasons, and who have already changed their meat intake for ecological concerns are a small minority. However, environmental motives are already appealing significant proportions of Westerners to adopt certain meat curtailment strategies. Those who limit meat intake for environmental reasons are typically female, young, simply meat-reducer (not vegan/vegetarian), ecology-oriented, and would more likely live in Europe and Asia than in the U.S.

274 citations


Journal ArticleDOI
TL;DR: This study provides a first spatial overview of key processes affecting pesticide fate that can be used to identify areas potentially vulnerable to pesticide accumulation and compiled a database of studies that measured pesticide residues in Africa.
Abstract: The application of agricultural pesticides in Africa can have negative effects on human health and the environment. The aim of this study was to identify African environments that are vulnerable to the accumulation of pesticides by mapping geospatial processes affecting pesticide fate. The study modelled processes associated with the environmental fate of agricultural pesticides using publicly available geospatial datasets. Key geospatial processes affecting the environmental fate of agricultural pesticides were selected after a review of pesticide fate models and maps for leaching, surface runoff, sedimentation, soil storage and filtering capacity, and volatilization were created. The potential and limitations of these maps are discussed. We then compiled a database of studies that measured pesticide residues in Africa. The database contains 10,076 observations, but only a limited number of observations remained when a standard dataset for one compound was extracted for validation. Despite the need for more in-situ data on pesticide residues and application, this study provides a first spatial overview of key processes affecting pesticide fate that can be used to identify areas potentially vulnerable to pesticide accumulation.

247 citations


Journal ArticleDOI
TL;DR: Comprehensive observations suggest that exposure to Cd and Pb mixtures produces more pronounced effects compared to the response observed after exposure to single metal solutions, however, further research is needed to confirm toxicokinetic or toxicodynamic interactions between these two toxic metals in the organisms.
Abstract: Background: Cadmium and lead are widespread and non-biodegradable pollutants of great concern to human health. In real life scenarios, we are exposed to mixtures of chemicals rather than single chemicals, and it is therefore of paramount importance to assess their toxicity. In this study, we investigated the toxicity of Cd and Pb alone and as a mixture in an animal model of acute exposure. Methods: Experimental groups received a single treatment of aqueous solution of Cd-chloride (15 and 30 mg/kg body weight (b.w.) and Pb-acetate (150 mg/kg b.w.), while the mixture group received 15 mg Cd/kg b.w. and 150 mg Pb/kg b.w. Toxic effects of individual metals and their mixture were investigated on hematological and biochemical parameters, and the redox status in the plasma, liver, and kidneys of treated Wistar rats. Results: Tissue-specific changes were recorded in various parameters of oxidative damage, while the accumulation of metals in tissues accompanied the disturbances of both hematological and biochemical parameters. It was observed that the level of toxic metals in tissues had a different distribution pattern after mixture and single exposure. Conclusions: Comprehensive observations suggest that exposure to Cd and Pb mixtures produces more pronounced effects compared to the response observed after exposure to single metal solutions. However, further research is needed to confirm toxicokinetic or toxicodynamic interactions between these two toxic metals in the organisms.

233 citations


Journal ArticleDOI
TL;DR: Current practices to improve life cycle and waste management of plastics that can be implemented to reduce health and environmental impacts of plastics and reduce plastics pollution are discussed.
Abstract: Plastic pollution is generated by the unsustainable use and disposal of plastic products in modern society, threatening economies, ecosystems, and human health. Current clean-up strategies have attempted to mitigate the negative effects of plastic pollution but are unable to compete with increasing quantities of plastic entering the environment. Thus, reducing inputs of plastic to the environment must be prioritized through a global multidisciplinary approach. Mismanaged waste is a major land-based source of plastic pollution that can be reduced through improvements in the life-cycle of plastics, especially in production, consumption, and disposal, through an Integrated Waste Management System. In this review paper, we discuss current practices to improve life cycle and waste management of plastics that can be implemented to reduce health and environmental impacts of plastics and reduce plastics pollution. Ten recommendations for stakeholders to reduce plastic pollution include (1) regulation of production and consumption; (2) eco-design; (3) increasing the demand for recycled plastics; (4) reducing the use of plastics; (5) use of renewable energy for recycling; (6) extended producer responsibility over waste; (7) improvements in waste collection systems; (8) prioritization of recycling; (9) use of bio-based and biodegradable plastics; and (10) improvement in recyclability of e-waste.

228 citations


Journal ArticleDOI
TL;DR: It is argued that communities of opportunity should be developed to minimize some of the adverse impacts of systemic racism, and new research is needed to identify the optimal strategies to build political will and support to address social inequities in health.
Abstract: This paper provides an overview of the scientific evidence pointing to critically needed steps to reduce racial inequities in health. First, it argues that communities of opportunity should be developed to minimize some of the adverse impacts of systemic racism. These are communities that provide early childhood development resources, implement policies to reduce childhood poverty, provide work and income support opportunities for adults, and ensure healthy housing and neighborhood conditions. Second, the healthcare system needs new emphases on ensuring access to high quality care for all, strengthening preventive health care approaches, addressing patients’ social needs as part of healthcare delivery, and diversifying the healthcare work force to more closely reflect the demographic composition of the patient population. Finally, new research is needed to identify the optimal strategies to build political will and support to address social inequities in health. This will include initiatives to raise awareness levels of the pervasiveness of inequities in health, build empathy and support for addressing inequities, enhance the capacity of individuals and communities to actively participate in intervention efforts and implement large scale efforts to reduce racial prejudice, ideologies, and stereotypes in the larger culture that undergird policy preferences that initiate and sustain inequities.

225 citations


Journal ArticleDOI
TL;DR: The findings suggest a high prevalence of burnout among medical and surgical residents, and older and male residents suffered more than their respective counterparts.
Abstract: The burnout syndrome is characterized by emotional exhaustion, depersonalization, and reduced personal achievement. Uncertainty exists about the prevalence of burnout among medical and surgical residents. Associations between burnout and gender, age, specialty, and geographical location of training are unclear. In this meta-analysis, we aimed to quantitatively summarize the global prevalence rates of burnout among residents, by specialty and its contributing factors. We searched PubMed, PsycINFO, Embase, and Web of Science to identify studies that examined the prevalence of burnout among residents from various specialties and countries. The primary outcome assessed was the aggregate prevalence of burnout among all residents. The random effects model was used to calculate the aggregate prevalence, and heterogeneity was assessed by I2 statistic and Cochran’s Q statistic. We also performed meta-regression and subgroup analysis. The aggregate prevalence of burnout was 51.0% (95% CI: 45.0–57.0%, I2 = 97%) in 22,778 residents. Meta-regression found that the mean age (β = 0.34, 95% CI: 0.28–0.40, p < 0.001) and the proportion of males (β = 0.4, 95% CI = 0.10–0.69, p = 0.009) were significant moderators. Subgroup analysis by specialty showed that radiology (77.16%, 95% CI: 5.99–99.45), neurology (71.93%, 95% CI: 65.78–77.39), and general surgery (58.39%, 95% CI: 45.72–70.04) were the top three specialties with the highest prevalence of burnout. In contrast, psychiatry (42.05%, 95% CI: 33.09–51.58), oncology (38.36%, 95% CI: 32.69–44.37), and family medicine (35.97%, 95% CI: 13.89–66.18) had the lowest prevalence of burnout. Subgroup analysis also found that the prevalence of burnout in several Asian countries was 57.18% (95% CI: 45.8–67.85); in several European countries it was 27.72% (95% CI: 17.4–41.11) and in North America it was 51.64% (46.96–56.28). Our findings suggest a high prevalence of burnout among medical and surgical residents. Older and male residents suffered more than their respective counterparts.

212 citations


Journal ArticleDOI
TL;DR: A systematic analysis of all the existing scientific works was carried out to verify the evolution of this line of research and found that the three main countries researching this field are China, Spain, and the USA.
Abstract: Background: Water is a scarce resource and is considered a fundamental pillar of sustainable development. The modern development of society requires more and more drinking water. For this cleaner wastewater, treatments are key factors. Among those that exist, advanced oxidation processes are being researched as one of the sustainable solutions. The main objective of this manuscript is to show the scientific advances in this field. Methods: In this paper, a systematic analysis of all the existing scientific works was carried out to verify the evolution of this line of research. Results: It was observed that the three main countries researching this field are China, Spain, and the USA. Regarding the scientific collaboration between countries, three clusters were detected—one of Spain, one of China and the USA, and one of Italy and France. The publications are grouped around three types of water: industrial, urban, and drinking. Regarding the research, 15 clusters identified from the keywords analyzed the advanced oxidation process (alone or combined with biological oxidation) with the type of wastewater and the target pollutant, removal of which is intended. Finally, the most important scientific communities or clusters detected in terms of the number of published articles were those related to the elimination of pollutants of biological origin, such as bacteria, and of industrial nature, such as pesticides or pharmaceutical products.

Journal ArticleDOI
TL;DR: It can be concluded that catalytic oxidation processes are very active and environmentally friendly methods for dye removal.
Abstract: Dyes are used in various industries as coloring agents. The discharge of dyes, specifically synthetic dyes, in wastewater represents a serious environmental problem and causes public health concerns. The implementation of regulations for wastewater discharge has forced research towards either the development of new processes or the improvement of available techniques to attain efficient degradation of dyes. Catalytic oxidation is one of the advanced oxidation processes (AOPs), based on the active radicals produced during the reaction in the presence of a catalyst. This paper reviews the problems of dyes and hydroxyl radical-based oxidation processes, including Fenton's process, non-iron metal catalysts, and the application of thin metal catalyst-coated tubular reactors in detail. In addition, the sulfate radical-based catalytic oxidation technique has also been described. This study also includes the effects of various operating parameters such as pH, temperature, the concentration of the oxidant, the initial concentration of dyes, and reaction time on the catalytic decomposition of dyes. Moreover, this paper analyzes the recent studies on catalytic oxidation processes. From the present study, it can be concluded that catalytic oxidation processes are very active and environmentally friendly methods for dye removal.

Journal ArticleDOI
TL;DR: Subgroup analyses showed that full-time school attendance, non-Western countries, low and middle-income countries, and geographical locations might contribute to the higher aggregate prevalence of suicidal behaviors, deliberate self-harm, and non-suicidal self-injury.
Abstract: Objective: This meta-analysis aimed to estimate the global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents. Methods: A systematic search for relevant articles published between 1989 to 2018 was performed in multiple electronic databases. The aggregate 12-month and lifetime prevalence of suicidal behavior, deliberate self-harm, and non-suicidal self-injury were calculated based on the random-effects model. Subgroup analyses were performed to compare the prevalence according to school attendance and geographical regions. Results: A total of 686,672 children and adolescents were included. The aggregate lifetime and 12-month prevalence of suicide attempts was 6% (95% CI: 4.7–7.7%) and 4.5% (95% CI: 3.4–5.9%) respectively. The aggregate lifetime and 12-month prevalence of suicidal plan was 9.9% (95% CI: 5.5–17%) and 7.5% (95% CI: 4.5–12.1%) respectively. The aggregate lifetime and 12-month prevalence of suicidal ideation was 18% (95% CI: 14.2–22.7%) and 14.2% (95% CI: 11.6–17.3%) respectively. The aggregate lifetime and 12-month prevalence of non-suicidal self-injury was 22.1% (95% CI: 16.9–28.4%) and 19.5% (95% CI: 13.3–27.6%) respectively. The aggregate lifetime and 12-month prevalence of deliberate self-harm was 13.7% (95% CI: 11.0–17.0%) and 14.2% (95% CI: 10.1–19.5%) respectively. Subgroup analyses showed that full-time school attendance, non-Western countries, low and middle-income countries, and geographical locations might contribute to the higher aggregate prevalence of suicidal behaviors, deliberate self-harm, and non-suicidal self-injury. Conclusions: This meta-analysis found that non-suicidal self-injury, suicidal ideation, and deliberate self-harm were the three most common suicidal and self-harm behaviors in children and adolescents.

Journal ArticleDOI
TL;DR: A one-dimensional convolutional neural network (1D-CNN) is developed using electroencephalogram (EEG) and electrooculogram (EOG) signals for the classification of sleep stages and is ready for clinical usage, and can be tested with big PSG data.
Abstract: Sleep disorder is a symptom of many neurological diseases that may significantly affect the quality of daily life. Traditional methods are time-consuming and involve the manual scoring of polysomnogram (PSG) signals obtained in a laboratory environment. However, the automated monitoring of sleep stages can help detect neurological disorders accurately as well. In this study, a flexible deep learning model is proposed using raw PSG signals. A one-dimensional convolutional neural network (1D-CNN) is developed using electroencephalogram (EEG) and electrooculogram (EOG) signals for the classification of sleep stages. The performance of the system is evaluated using two public databases (sleep-edf and sleep-edfx). The developed model yielded the highest accuracies of 98.06%, 94.64%, 92.36%, 91.22%, and 91.00% for two to six sleep classes, respectively, using the sleep-edf database. Further, the proposed model obtained the highest accuracies of 97.62%, 94.34%, 92.33%, 90.98%, and 89.54%, respectively for the same two to six sleep classes using the sleep-edfx dataset. The developed deep learning model is ready for clinical usage, and can be tested with big PSG data.

Journal ArticleDOI
TL;DR: Potential sources of POP food contamination, analytical approaches to measure POP levels in food and efforts to control food contamination with POPs are described.
Abstract: Persistent organic pollutants (POPs) present in foods have been a major concern for food safety due to their persistence and toxic effects. To ensure food safety and protect human health from POPs, it is critical to achieve a better understanding of POP pathways into food and develop strategies to reduce human exposure. POPs could present in food in the raw stages, transferred from the environment or artificially introduced during food preparation steps. Exposure to these pollutants may cause various health problems such as endocrine disruption, cardiovascular diseases, cancers, diabetes, birth defects, and dysfunctional immune and reproductive systems. This review describes potential sources of POP food contamination, analytical approaches to measure POP levels in food and efforts to control food contamination with POPs.

Journal ArticleDOI
TL;DR: There is a positive and significant impact of tourism on Pakistan’s economic growth as well as employment sector and there is also a long-run relationship among the variables under study.
Abstract: In the global economy, tourism is one of the most noticeable and growing sectors. Thissector plays an important role in boosting a nation's economy. An increase in tourism flow canbring positive economic outcomes to the nations, especially in gross domestic product (GDP) andemployment opportunities. In South Asian countries, the tourism industry is an engine ofeconomic development and GDP growth. This study investigates the impact of tourism onPakistan's economic growth and employment. The period under study was from 1990 to 2015. Tocheck whether the variables under study were stationary, augmented Dickey-Fuller andPhillips-Perron unit root tests were applied. A regression technique and Johansen cointegrationapproach were employed for the analysis of data. The key finding of this study shows that there isa positive and significant impact of tourism on Pakistan's economic growth as well as employmentsector and there is also a long-run relationship among the variables under study. This studysuggests that legislators should focus on the policies with special emphasis on the promotion oftourism due to its great potential throughout the country. Policy implications of this recent studyand future research suggestions are also mentioned.

Journal ArticleDOI
TL;DR: The findings suggested that consumers’ concerns regarding the environment, health, food safety and their knowledge of organic food, all significantly impacted their attitude towards the purchase behavior of organic meat, but their positive attitude did not necessarily translate into their actual purchase of organic Meat in Vietnam.
Abstract: The consumption of food has a significant impact on the environment, individuals and public health. This study aims to investigate the integrative effects of consumers’ personal and situational factors on their attitude and purchase behavior of organic meat. The consumption of this product has been widely regarded as contributing towards sustainable food practices. The study was conducted in an emerging market economy, i.e., Vietnam. Data were collected using a customized and validated survey instrument from a sample of 609 organic meat consumers at four food outlets in Hanoi. The findings suggested that consumers’ concerns regarding the environment, health, food safety and their knowledge of organic food, all significantly impacted their attitude towards the purchase behavior of organic meat. Interestingly, their positive attitude did not necessarily translate into their actual purchase of organic meat. Additionally, food stores’ green marketing practices significantly enhanced consumers’ actual purchase behavior. Conversely, premium prices of organic meat were certainly a deterrent for the actual purchase of organic meat. The findings of this study have several important implications for organic food producers, retailers, policy makers and socio-environmental organizations that seek to develop intervention strategies aimed at increasing organic meat consumption in Vietnam.

Journal ArticleDOI
TL;DR: Long working hours were shown to adversely affect the occupational health of workers, and the management on safeguarding the occupational Health of workers working long hours should be reinforced.
Abstract: There has been no subsequent meta-analysis examining the effects of long working hours on health or occupational health since 1997. Therefore, this paper aims to conduct a meta-analysis covering studies after 1997 for a comparison. A total of 243 published records were extracted from electronic databases. The effects were measured by five conditions, namely, physiological health (PH), mental health (MH), health behaviours (HB), related health (RH), and nonspecified health (NH). The overall odds ratio between long working hours and occupational health was 1.245 (95% confidence interval (CI): 1.195–1.298). The condition of related health constituted the highest odds ratio value (1.465, 95% CI: 1.332–1.611). The potential moderators were study method, cut-point for long weekly working hours, and country of origin. Long working hours were shown to adversely affect the occupational health of workers. The management on safeguarding the occupational health of workers working long hours should be reinforced.

Journal ArticleDOI
TL;DR: The extant literature on green space and academic performance is small, shows mixed results, and mostly includes articles using observational, school-level research designs, but there is sufficient evidence to warrant further research on this topic, including effect moderation and mechanistic pathways.
Abstract: Background: Scholars and policymakers have criticized public education in developed countries for perpetuating health and income disparities. Several studies have examined the ties between green space and academic performance, hypothesizing that green space can foster performance, and, over time, help reduce such disparities. Although numerous reviews have analyzed the link between nature and child health, none have focused on academic achievement. Methods: We identified 13 peer-reviewed articles that examined associations between academic outcomes, types of green spaces, and distances in which green spaces were measured around schools. Results: Of the 122 findings reported in the 13 articles, 64% were non-significant, 8% were significant and negative, and 28% were significant and positive. Positive findings were limited to greenness, tree cover, and green land cover at distances up to 2000 m around schools. End-of-semester grades and college preparatory exams showed greater shares of positive associations than math or reading test scores. Most findings regarding writing test scores were non-significant, and moderation effects of socioeconomic status, gender, and urbanization showed mixed results. Conclusions: The extant literature on green space and academic performance is small, shows mixed results, and mostly includes articles using observational, school-level research designs. Regardless, there is sufficient evidence to warrant further research on this topic, including effect moderation and mechanistic pathways.

Journal ArticleDOI
TL;DR: There is a need to redefine what is meant by “women’s health” to encompass the whole lifecycle, with a stronger emphasis on CVD and other non-communicable diseases.
Abstract: Age-standardised rates of cardiovascular disease (CVD) are substantially higher in men than women. This explains why CVD has traditionally been seen as a “man’s problem”. However, CVD is the leading cause of death in women, worldwide, and is one of the most common causes of disability-adjusted life-years lost. In general, this is under-recognised and, in several ways, women are disadvantaged in terms of CVD. Both in primary and secondary prevention, there is evidence that women are undertreated, compared to men. Women often experience heart disease in a different way compared to men, and lack of recognition of this has been shown to have adverse consequences. Female patients of male cardiac physicians have been found to have worse outcomes than their male counterparts, with no such gender differential for female cardiologists. Clinical trials in CVD primarily recruit male patients, yet, it is well recognised that some drugs act differently in women and men. Diabetes and smoking, and perhaps other risk factors, confer a greater proportional excess cardiovascular risk to women than to men, whilst adverse pregnancies and factors concerned with the female reproductive cycle give women added vulnerability to CVD. However, women’s health research is skewed towards mother and child health, an area where, arguably, the greatest public health gains have already been made, and breast cancer. Hence there is a need to redefine what is meant by “women’s health” to encompass the whole lifecycle, with a stronger emphasis on CVD and other non-communicable diseases. Sex-specific analyses of research data should be the norm, whenever feasible.

Journal ArticleDOI
TL;DR: The results indicated that SES had a significant impact on people’s physical health, but the impact of SES on psychological health was not significant, and lifestyle mediated the relationship between SES and health.
Abstract: Health is correlated to people’s socioeconomic status (SES) and lifestyle. This study examined the impact of SES on respondents’ physical and psychological health. Moreover, we explored the potential mediating effect of lifestyle on the relationship between SES and health. The participants were 986 respondents from the 2015 Chinese General Social Survey (CGSS). Structural equation modeling (SEM) was used to test the hypothesized relationship between the variables. The results indicated that SES had a significant impact on people’s physical health, but the impact of SES on psychological health was not significant. Lifestyle had significant positive effects on both physical and psychological health. In addition, lifestyle mediated the relationship between SES and health. This research is helpful in gaining a better understanding of the relationship and mediating mechanism between SES, lifestyle, and health. It is recommended that research with longitudinal design and comprehensive indicators be undertaken in the future.

Journal ArticleDOI
TL;DR: The main mechanisms underlying their cardioprotective effects have been attributed to improvement in cardiac cell metabolism, improvement in ventricular loading conditions, inhibition of the Na+/H+ exchange in the myocardial cells, alteration in adipokines and cytokines production, as well as reduction of cardiac cells necrosis and cardiac fibrosis.
Abstract: Type 2 diabetes mellitus is a chronic metabolic disease associated with high cardiovascular (CV) risk. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are the latest class of antidiabetic medication that inhibit the absorption of glucose from the proximal tubule of the kidney and hence cause glycosuria. Four SGLT2i are currently commercially available in many countries: canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. SGLT2i reduce glycated hemoglobin by 0.5%–1.0% and have shown favorable effects on body weight, blood pressure, lipid profile, arterial stiffness and endothelial function. More importantly, SGLT2i have demonstrated impressive cardioprotective and renoprotective effects. The main mechanisms underlying their cardioprotective effects have been attributed to improvement in cardiac cell metabolism, improvement in ventricular loading conditions, inhibition of the Na+/H+ exchange in the myocardial cells, alteration in adipokines and cytokines production, as well as reduction of cardiac cells necrosis and cardiac fibrosis. The main adverse events of SGLT2i include urinary tract and genital infections, as well as euglycemic diabetic ketoacidosis. Concerns have also been raised about the association of SGLT2i with lower limb amputations, Fournier gangrene, risk of bone fractures, female breast cancer, male bladder cancer, orthostatic hypotension, and acute kidney injury.

Journal ArticleDOI
TL;DR: There was limited evidence to support the view that green exercise offers superior benefits to exercise without exposure to nature, and a high risk of bias across trials and an overall low quality of evidence were found.
Abstract: We aimed to examine the evidence for the proposed additive effect of exercise in the presence of nature (green exercise) by systematically reviewing studies that investigated the effects of outdoor or virtual green exercise compared with indoor exercise. Our review updates an earlier review, whose searches were conducted in April 2010. Trials were eligible if: (a) participants in an outdoor or virtual exercise condition were exposed to views of nature (green exercise); (b) green exercise was compared with indoor exercise with no exposure to nature; (c) included an outcome related to physical or mental health; (d) used comparative or crossover trial design. We searched the following databases from 1st January 2010 to 28th June 2018: PubMed, CENTRAL, EMBASE, PsycINFO, GreenFile, and Sports DISCUS. We assessed risk of bias using the Cochrane “risk of bias” tool. Where possible we conducted a meta-analysis using the inverse variance random-effects method, and where this approach was not possible we presented the results qualitatively and in harvest plots. We identified 28 eligible trials. In a meta-analysis of just three longitudinal trials, the only statistical finding was slightly lower post-intervention perceived exertion with green versus indoor exercise (mean difference: −1.02; 95% confidence intervals: −1.88, −0.16). Compared with indoor exercise, acute bouts of outdoor green exercise may favorably influence affective valence and enjoyment, but not emotion, perceived exertion, exercise intensity, and biological markers. No other consistent statistical differences were observed, apart from a higher enjoyment of outdoor green versus virtual green exercise. We found a high risk of bias across trials and an overall low quality of evidence. In conclusion, there was limited evidence to support the view that green exercise offers superior benefits to exercise without exposure to nature. The low quality of evidence prohibits clear interpretation of trial findings. Future robust and rigorously designed trials are needed to evaluate the effects of long-term and multiple-bout exposure to nature during exercise compared with exercise indoors.

Journal ArticleDOI
TL;DR: It is concluded that food quality receives high attention both from Belgian and Romanian consumers and health and environment related cues can be used as a means of improving consumer health and environmental protection.
Abstract: The last few decades testify that consumers’ concerns for healthier lifestyles and environment care are driving forces for reshaping food buying intentions and their perspectives on food quality. The present study identifies the importance that consumers attach to quality, health, and environment selected cues of purchased food products. More precisely, to elicit preferences for social, environmental, and qualitative food cues, a survey instrument was developed and applied on 797 Belgian and Romanian consumers. Our findings suggest that investigated consumers most frequently use freshness, taste, and appearance to evaluate food quality. The use frequency of food quality cues related to health is primarily influenced by the attention paid to food quality. The most relevant cues of food healthiness are ingredients, nutrition facts, and additives and for food environmental impact are packaging, food origin, and production type. It is concluded that food quality receives high attention both from Belgian and Romanian consumers and health and environment related cues can be used as a means of improving consumer health and environmental protection.

Journal ArticleDOI
TL;DR: Feelings of loneliness are directly related to satisfaction with one’s social network and neighborhood attachment and are indirectly related to perceived safety and satisfaction with local amenities and services and are relevant to urban planners and policy makers who focus on creating livable and healthy social neighborhoods for the aging population.
Abstract: The social participation and integration of older adults are important aspects of healthy aging. However, in general, older adults have smaller social networks than their younger counterparts due to changes in their life cycle stage, such as retirement or age-related losses, along with a declining health and increasing mobility limitations. Consequently, with increasing age, an increasing proportion of older people experience feelings of loneliness and social isolation. Previous studies that have analyzed the relationships between loneliness, social networks, and the living environment have often been based on bivariate relationships or included only a limited number of variables. Therefore, the aim of this study was to analyze multiple relationships in a more comprehensive framework. Data were collected using a survey among 182 adults aged 65 years and over in the Netherlands. A Bayesian belief network (BBN) modeling approach was used that derives all direct and indirect relationships between the variables. The results showed that feelings of loneliness are directly related to satisfaction with one's social network and neighborhood attachment and are indirectly related to perceived safety and satisfaction with local amenities and services. This knowledge is relevant to urban planners and policy makers who focus on creating livable and healthy social neighborhoods for the aging population.

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TL;DR: Observations confirmed that D1 bacteria has an ability to degrade PE.
Abstract: Plastic polymers are widely used in agriculture, industry, and our daily life because of their convenient and economic properties. However, pollution caused by plastic polymers, especially polyethylene (PE), affects both animal and human health when they aggregate in the environment, as they are not easily degraded under natural conditions. In this study, Enterobacter sp. D1 was isolated from the guts of wax moth (Galleria mellonella). Microbial colonies formed around a PE film after 14 days of cultivation with D1. Roughness, depressions, and cracks were detected on the surface of the PE film by scanning electron microscopy (SEM) and atomic force microscopy (AFM). Fourier transform infrared spectroscopy (FTIR) showed the presence of carbonyl functional groups and ether groups on the PE film that was treated with D1. Liquid chromatography-tandem mass spectrometry (LC-MS) also revealed that the contents of certain alcohols, esters, and acids were increased as a result of the D1 treatment, indicating that oxidation reaction occurred on the surface of the PE film treated with D1 bacteria. These observations confirmed that D1 bacteria has an ability to degrade PE.

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TL;DR: A random parameters bivariate ordered probit model has been developed to examine factors affecting injury sustained by two drivers involved in the same rear-end crash between passenger cars and demonstrates that there indeed exists significant correlation between two drivers’ injuries.
Abstract: The existing studies on drivers’ injury severity include numerous statistical models that assess potential factors affecting the level of injury. These models should address specific concerns tailored to different crash characteristics. For rear-end crashes, potential correlation in injury severity may present between the two drivers involved in the same crash. Moreover, there may exist unobserved heterogeneity considering parameter effects, which may vary across both crashes and individuals. To address these concerns, a random parameters bivariate ordered probit model has been developed to examine factors affecting injury sustained by two drivers involved in the same rear-end crash between passenger cars. Taking both the within-crash correlation and unobserved heterogeneity into consideration, the proposed model outperforms the two separate ordered probit models with fixed parameters. The value of the correlation parameter demonstrates that there indeed exists significant correlation between two drivers’ injuries. Driver age, gender, vehicle, airbag or seat belt use, traffic flow, etc., are found to affect injury severity for both the two drivers. Some differences can also be found between the two drivers, such as the effect of light condition, crash season, crash position, etc. The approach utilized provides a possible use for dealing with similar injury severity analysis in future work.

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TL;DR: The results indicated that the WWTPs of the studied paint companies were ineffective in reducing the TS, TSS, BOD, COD and (O & G) to acceptable limits.
Abstract: Effluents from the paint industry have been a major source of environmental pollution. There is a need to investigate the compliance of wastewater discharged from paint industries with regulatory standards. In response, this study evaluates the physicochemical parameters of both raw and treated wastewater, the wastewater treatment plants (WWTPs) efficiencies as well as the compliance level of five selected paint manufacturing companies in Lagos, Nigeria with some regulatory standards: Federal Ministry of Environment (FME) in Nigeria, World Health Organization (WHO) and Department of Water Affairs (DWA) in South Africa. All parameters investigated were analysed using standard methods. The values of pH, electrical conductivity (EC) and total dissolved solids (TDS) levels were in the range of 4–12.2, 149.1–881.3 mS/m and 1100–6510 mg/L, respectively. The range of other parameters include total suspended solids (TSS); 0–2470 mg/L, TS; 1920–6510 mg/L, chloride; 63.8–733.8 mg/L, dissolved oxygen (DO); 0–6.7 mg/L, oil and grease (O & G); 44–100 mg/L, biochemical oxygen demand (BOD); 162.8–974.7 mg/L, chemical oxygen demand (COD); 543–1231 mg/L, nitrates;12.89–211.2 mg/L, phosphate; below detection limit (bdl)–0.02 mg/L, sulphate; 195–1434 mg/L, nickel; bdl–1.9 mg/L while copper, lead and chromium were below detection limits. The results indicated that the WWTPs of the studied paint companies were ineffective in reducing the TS, TSS, BOD, COD and (O & G) to acceptable limits. Routine monitoring of wastewater from paint industries is therefore recommended to prevent the risk of contamination to the receiving watershed which many communities rely on as source for domestic water.

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TL;DR: It is indicated that interventions that focus solely on education might be less likely to result in positive outcomes than interventions targeting behavioural change and the methodologically strongest evidence (RCTs) is available for body composition and stress.
Abstract: Background: Prior research has investigated various strategies to improve health, wellbeing and the job-related outcomes of nurses. However, the scope of this evidence is not clear and the types of intervention most likely to have positive outcomes are unknown. Objective: To provide an overview and synthesis of the effectiveness of interventions conducted with the goal of improving health, wellbeing and the job-related outcomes of nurses. Methods: A systematic database search was conducted from January 2000 to December 2018, with pre-defined criteria (Cochrane Central Register of Controlled Trials; MEDLINE and PubMed; EMBASE; CINAHL; PsycINFO; and BioMed Central). In total, 136 intervention studies with a total sample of 16,129 participants (range 9–3381) were included and evaluated. Data extraction, quality assessment and risk of bias analyses were performed. Results: Studies included randomised controlled trials (RCTs; n = 52, 38%), randomised crossover design studies (n = 2, 1.5%) and non-randomised pre-post studies with a control group (n = 31, 23%) and without a control group (n = 51, 37.5%). The majority of interventions focused on education, physical activity, mindfulness, or relaxation. Thirty-seven (27%) studies had a multimodal intervention approach. On average, studies had relatively small samples (median = 61; mode = 30) and were conducted predominantly in North America (USA/Canada, n = 53). The findings were mixed overall, with some studies reporting benefits and others finding no effects. Dietary habits was the most successfully improved outcome (8/9), followed by indices of body composition (20/24), physical activity (PA) (11/14), and stress (49/66), with >70% of relevant studies in each of these categories reporting improvements. The lowest success rate was for work-related outcomes (16/32). Separate analysis of RCTs indicated that interventions that focus solely on education might be less likely to result in positive outcomes than interventions targeting behavioural change. Conclusions: Interventions targeting diet, body composition, PA, or stress are most likely to have positive outcomes for nurses’ health and/or wellbeing. The methodologically strongest evidence (RCTs) is available for body composition and stress. Interventions relying solely on educational approaches are least likely to be effective. Organisational outcomes appear to be more challenging to change with lifestyle intervention, likely requiring more complex solutions including changes to the work environment. There is a need for more high-quality evidence since many studies had moderate or high risk of bias and low reporting quality.

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TL;DR: The present work supports the notion that it is time to critically reflect on the prevailing business model of ‘user data in exchange for app-use allowance’ and suggests that it ultimately might be better to ban or regulate certain design elements in apps to come up with less addictive products.
Abstract: Currently about 2.71 billion humans use a smartphone worldwide. Although smartphone technology has brought many advances, a growing number of scientists discuss potential detrimental effects due to excessive smartphone use. Of importance, the likely culprit to understand over-usage is not the smartphone itself, but the excessive use of applications installed on smartphones. As the current business model of many app-developers foresees an exchange of personal data for allowance to use an app, it is not surprising that many design elements can be found in social media apps and Freemium games prolonging app usage. It is the aim of the present work to analyze several prominent smartphone apps to carve out such elements. As a result of the analysis, a total of six different mechanisms are highlighted to illustrate the prevailing business model in smartphone app development. First, these app-elements are described and second linked to classic psychological/economic theories such as the mere-exposure effect, endowment effect, and Zeigarnik effect, but also to psychological mechanisms triggering social comparison. It is concluded that many of the here presented app-elements on smartphones are able to prolong usage time, but it is very hard to understand such an effect on the level of a single element. A systematic analysis would require insights into app data usually only being available for the app-designers, but not for independent scientists. Nevertheless, the present work supports the notion that it is time to critically reflect on the prevailing business model of ‘user data in exchange for app-use allowance’. Instead of using a service in exchange for data, it ultimately might be better to ban or regulate certain design elements in apps to come up with less addictive products. Instead, users could pay a reasonable fee for an app service.