International Journal of Environmental Research and Public Health — Open Access Journal

(1) Background: To determine paramedics’ frequency of contact with blood and other body fluids, as well as the analysis of knowledge of paramedics about blood-borne infections, their attitudes to patients infected with blood-borne viruses, and the post-exposure procedures implemented by paramedics; (2) Methods: An anonymous questionnaire among 190 paramedics working in various health care facilities in Poland (adjusted response rate, 76.3%); (3) Results: 78% of paramedics had contact with potentially infectious material at least several times a week. Paramedics’ knowledge on transferring infection was insufficient. Paramedics with longer employment time and better professional experience suffered fewer injuries with used needles/medical tools (p = 0.079). Most frequently reported factors that prevented the use of personal protective equipment were emergency situations (19.5%), skin irritations and contact allergies (19%) and, in the case of protective gloves, reduced manual dexterity (16%). In total, 82% of paramedics were concerned about the risk of being infected with HIV, HBV or HCV as a result of performing their job. In total, 97% of paramedics behaved more carefully while caring for infected patients. In total, 90% of the paramedics never refrained from performing the specific procedures necessary to help the patient whom they knew to be infected; (4) Conclusions: Despite the paramedics’ insufficient theoretical knowledge about the risk of blood-borne infections, the emphasis in the training of future paramedics should be on classes perfecting practical skills, because growing experience significantly reduces the risk of injury. Full article

Although physical activity has been widely recognized as an important influential factor in determining the risk of obesity, the results in the existing literature empirically examining such issue are mixed. Especially for China, relevant studies are rarely found. One aim of this study is to test the direction of effects between obesity and physical activity. It uses longitudinal data to investigate the relationship and causality between physical activity and obesity for both children and adults in China. The longitudinal data and dynamic panel model used here can yield more solid results than the other studies employing cross-sectional data, particularly considering strict endogeneity and self-selection. It is discovered that obesity does not affect children’s physical activity but that obese children are more sedentary. For adults in China, physical activity can significantly reduce the weight, but not in the opposite direction. Full article

The Shinkansen super-express railway system in Japan has greatly increased its capacity and has expanded nationwide. However, many inhabitants in areas along the railways have been disturbed by noise and ground vibration from the trains. Additionally, the Shinkansen railway emits a higher level of ground vibration than conventional railways at the same noise level. These findings imply that building vibrations affect living environments as significantly as the associated noise. Therefore, it is imperative to quantify the effects of noise and vibration exposures on each annoyance under simultaneous exposure. We performed a secondary analysis using individual datasets of exposure and community response associated with Shinkansen railway noise and vibration. The data consisted of six socio-acoustic surveys, which were conducted separately over the last 20 years in Japan. Applying a logistic regression analysis to the datasets, we confirmed the combined effects of vibration/noise exposure on noise/vibration annoyance. Moreover, we proposed a representative relationship between noise and vibration exposures, and the prevalence of each annoyance associated with the Shinkansen railway. Full article

In this study Yan’an City, a typical hilly valley city, was considered as the study area in order to explain the relationships between the surface urban heat island (SUHI) and land use/land cover (LULC) types, the landscape pattern metrics of LULC types and land surface temperature (LST) and remote sensing indexes were retrieved from Landsat data during 1990–2015, and to find factors contributed to the green space cool island intensity (GSCI) through field measurements of 34 green spaces. The results showed that during 1990–2015, because of local anthropogenic activities, SUHI was mainly located in lower vegetation cover areas. There was a significant suburban-urban gradient in the average LST, as well as its heterogeneity and fluctuations. Six landscape metrics comprising the fractal dimension index, percentage of landscape, aggregation index, division index, Shannon’s diversity index, and expansion intensity of the classified LST spatiotemporal changes were paralleled to LULC changes, especially for construction land, during the past 25 years. In the urban area, an index-based built-up index was the key positive factor for explaining LST increases, whereas the normalized difference vegetation index and modified normalized difference water index were crucial factors for explaining LST decreases during the study periods. In terms of the heat mitigation performance of green spaces, mixed forest was better than pure forest, and the urban forest configuration had positive effects on GSCI. The results of this study provide insights into the importance of species choice and the spatial design of green spaces for cooling the environment. Full article

Background: Equitable utilization of health care is a primary goal of the Chinese health system. This study aimed to examine horizontal inequity in health care utilization and identify the factors resulting in inequity among the middle-aged and elderly in China. Methods: The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). We employed the concentration index (CI) and horizontal inequity (HI) to measure inequity in health care utilization. Non-linear regression models were used to decompose the CI into the contribution of each factor. Results: The CIs for the probability of and total number of outpatient visits were 0.0642 and 0.0780, respectively, and those for inpatient visits were 0.1418 and 0.1471, respectively. The HIs were also significantly positive. Living standard was the most important contributor. The contribution of health insurance varied between plans. Conclusions: This study supported the presence of pro-rich inequity in health care utilization for both probability and frequency among the middle-aged and elderly in China. Narrowing the living standard gap and improving the health insurance benefit package for the elderly should help to resolve these inequities. Full article

The upbringing of children relies heavily on shared responsibilities between parents and society. The Council of Europe Recommendation (2006) 19 on Policy to Support Positive Parenting and the European Commission Recommendation (2013) Investing in Children: Breaking the Cycle of Disadvantage, both aim at supporting parents to care and provide for their children in accordance with the UN Convention on the Rights of the Child. By means of a document analysis this article examines what kind of parental practices and provision to parents the recommendations suggest to safeguard children’s rights in the family. Three findings are highlighted: first, both recommendations reflect a commitment to respecting children’s rights while at the same time acknowledging parents as children’s primary caregivers. Second, both recognize parents’ rights to work, while also recognizing the necessity of adequate income support if work is not available or income too low. Third, adequate resources are defined as a combination of universal policies and services, which guarantee a minimum level for all, and targeted measures reaching out to the most disadvantaged. The recommendations’ emphasis on children and parents as partners and on the families’ economic situations are valuable for future development of family and child policy and support programs. Full article

Despite increasing socioeconomic inequalities in the health and well-being of adolescents, the voices of adolescents in disadvantaged communities regarding facilitators of physical activity (PA) have received relatively little attention. In response, the purpose of this study was to illuminate what adolescents in a multicultural community of low socioeconomic status (SES) in Sweden convey concerning facilitators of PA. Adolescents (n = 53, aged 12–13 years) were recruited from a school in a multicultural community of low SES in Sweden. Following an interpretive approach, 10 focus group interviews were conducted to produce data for a qualitative content analysis. When the adolescents mentioned PA, they mostly referred to spontaneous PA rather than organized PA, and expressed that they enjoyed their PA engagement, which they stated was promoted by the variation of PA, available options for PA, their physical skills, and the presence of peers. They reported that social support from family and friends facilitated their PA, and they offered several suggestions regarding how the school environment could better support their PA. From the perspective of self-determination theory (SDT), the results stress the importance of facilitating intrinsic motivation with a supportive PA environment in which adolescents can satisfy their needs for autonomy, competence, and relatedness. Full article

Brazil was rated the fourth leading producer and exporter of pork meat in the world. The aim of this study was to evaluate the temperature of the hands of pig slaughterhouse workers and its relation to the thermal sensation of the hands and the use of a cutting tool. The study included 106 workers in a pig slaughterhouse. An infrared camera FlirThermaCAM E320 (Flir Systems, Wilsonville, OR, USA) was used to collect the images of the dorsal and palmar surfaces of both hands. A numerical scale was used to obtain the thermal sensation. Chi-square test, Pearson correlation and Student’s t test or Wilcoxon were used (p ≤ 0.05). The majority of workers felt cold in the hands (66%) and workers who used the knife felt the coldest. There was an association between the thermal sensation and the use of knife (p = 0.001). Workers who used the tool showed correlation between the thermal sensation and the temperatures of the left fingers, with a difference between the temperatures of the right and left hands of those who used the knife (p ≤ 0.05). The hands (left) that manipulated the products presented the lowest temperatures. Findings indicate that employers of pig slaughterhouses should provide gloves with adequate thermal insulation to preserve the health of workers’ hands. Full article

The aim of the study is to investigate the epidemiological situation regarding chronic respiratory diseases in populations that inhabit different climatic–geographical regions of Russia, and to develop targeted programs for prevention of these diseases. Methods: (1) a comparative analysis of the standardized mortality data in Russia and other selected regions of the Russian North using the European standard for respiratory diseases, in a population aged 25–64; and (2) data from a randomized cross-sectional epidemiological study, with subjects from three different climatic-geographical regions of Russia. Results: (1) the respiratory disease-related mortality rates in the majority of Russian Northern regions were much higher compared to the national average. Although death rates from chronic lower respiratory diseases were higher among the Northern regions and in the whole of Russia relative to the countries of European Union (EU), the cause of death in the populations of the Northern regions tend to be lower respiratory infections and pneumonia; and (2) despite the absence of any significant differences in the prevalence of smoking, the prevalence of chronic respiratory diseases (COPD) is significantly higher in Far North Yakutsk compared to the other two regions in this study—Chelyabinsk and Vologda. The status of hyperborean had the highest chance of a significant contribution to COPD and cardiorespiratory pathology among all other risk factors. The results revealed a need for effective targeted strategies for primary and secondary prevention of chronic respiratory diseases for the populations of the Northern regions of Russia. Conclusions: The revealed regional distinctions regarding the prevalence of, and mortality from, chronic respiratory diseases should be taken into consideration when designing integrated programs for chronic non-communicable disease prevention in these regions. Full article

As a disaster prone country, Bangladesh is regularly hit by natural hazards, including devastating cyclones, such as in 1970, 1991 and 2007. Although the number of cyclones’ fatalities reduced from 0.3 million in 1970 to a few thousand or fewer in recent events, loss of lives and impact on livelihoods remains a concern. It depends on the meteorological characteristics of cyclone and the general vulnerability and capacity of the exposed population. In that perspective, a spatially explicit risk assessment is an essential step towards targeted disaster risk reduction. This study aims at analyzing the spatial variation of the different factors contributing to the risk for coastal communities at regional scale, including the distribution of the hazards, exposure, vulnerability and capacity. An exploratory factor analysis method is used to map vulnerability contrasts between local administrative units. Indexing and ranking using geospatial techniques are used to produce maps of exposure, hazard, vulnerability, capacities and risk. Results show that vulnerable populations and exposed areas are distributed along the land sea boundary, islands and major inland rivers. The hazard, assessed from the density of historical cyclone paths, is highest in the southwestern part of the coast. Whereas cyclones shelters are shown to properly serve the most vulnerable populations as priority evacuation centers, the overall pattern of capacity accounting for building quality and road network shows a more complex pattern. Resultant risk maps also provide a reasonable basis from which to take further structural measures to minimize loss of lives in the upcoming cyclones. Full article

In 2011, China implemented a more severe drunk-driving law. This study evaluated the effectiveness of the law on road traffic morbidity and mortality attributed to alcohol use. Data were from two open-access data sources, the Global Burden of Disease (GBD) 2015 update and police data. Poisson regression examined the significance of changes in morbidity and mortality. Large gaps in crude death estimates from road traffic crashes attributed to alcohol use emerged between the two data sources. For the GBD 2015 update, crude and age-standardized mortality displayed consistent trends between 1990 and 2015; age-standardized mortality per 100,000 persons increased from 5.71 in 1990 to 7.48 in 2005 and then continuously decreased down to 5.94 in 2015. Police data showed a decrease for crude mortality per 100,000 persons from 0.29 in 2006 to 0.15 in 2010 and then an increase to 0.19 in 2015. We conclude available data are inadequate to determine the effectiveness of the implementation of the more severe drunk-driving law in China since the two data sources present highly inconsistent results. Further effort is needed to tackle data inconsistencies and obtain reliable and accurate data on road traffic injury attributable to alcohol use in China. Full article

Inequalities in health have been identified for lesbian, gay, and bisexual (LGB) populations nationally. Policies in the U.S. South offer fewer protections for LGB people than in other regions, yet, limited data exist for this region. North Carolina (NC) BRFSS data from 2011 to 2014 were combined (LGB n = 604; heterosexual n = 33,170) and analyzed using SAS survey procedures to estimate health characteristics by sexual orientation within gender. Many examined indicators were not different by sexual orientation, however, other results were significant and consistent with findings from state population surveys in other regions of the country. Both genders showed inequities in mental health, having over twice the odds of five or more poor mental health days in the past month and of having ever been diagnosed with a depressive disorder. Sexual minority women had higher odds compared with heterosexual women for ever having smoked cigarettes, current smoking, exposure to secondhand smoke both in the workplace and at home, and both alcohol risk factors, binge and heavy drinking. Being part of the LGB population in NC is associated with worse health. The implementation of anti-LGB policies in the NC warrants ongoing monitoring of LGB health inequities in NC and in other southeastern states for potential effects on the health and well-being of sexual minorities. Full article

The presence of pesticide residues in primary and derived agricultural products raises serious health concerns for consumers. The aim of this study was to assess the level of pesticide residues in commonly consumed fruits and vegetables in Kuwait. A total of 150 samples of different fresh vegetables and fruits were analyzed for the presence of 34 pesticides using the quick easy cheap effective rugged and safe (QuEChERS) multi-residue extraction, followed by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-tandem mass spectrometry (LC-MS/MS). Pesticide residues above the maximum residue limits (MRL) were detected in 21% of the samples and 79% of the samples had no residues of the pesticides surveyed or contained residues below the MRL. Multiple residues were present in 40% of the samples with two to four pesticides, and four samples were contaminated with more than four pesticide residues. Of the pesticides investigated, 16 were detected, of which imidacloprid, deltamethrin, cypermethrin, malathion, acetamiprid, monocrotophos, chlorpyrifos-methyl, and diazinon exceeded their MRLs. Aldrin, an organochlorine pesticide, was detected in one apple sample, with residues below the MRL. The results indicate the occurrence of pesticide residues in commonly consumed fruits and vegetables in Kuwait, and pointed to an urgent need to develop comprehensive intervention measures to reduce the potential health risk to consumers. The need for the regular monitoring of pesticide residues and the sensitization of farmers to better pesticide safety practices, especially the need to adhere to recommended pre-harvest intervals is recommended. Full article

An exploratory spatial analysis investigates the location of schools in Calgary (Canada) in relation to air pollution and active transportation options. Air pollution exhibits marked spatial variation throughout the city, along with distinct spatial patterns in summer and winter; however, all school locations lie within low to moderate pollution levels. Conversely, the study shows that almost half of the schools lie in low walkability locations; likewise, transitability is low for 60% of schools, and only bikability is widespread, with 93% of schools in very bikable locations. School locations are subsequently categorized by pollution exposure and active transportation options. This analysis identifies and maps schools according to two levels of concern: schools in car-dependent locations and relatively high pollution; and schools in locations conducive of active transportation, yet exposed to relatively high pollution. The findings can be mapped and effectively communicated to the public, health practitioners, and school boards. The study contributes with an explicitly spatial approach to the intra-urban public health literature. Developed for a moderately polluted city, the methods can be extended to more severely polluted environments, to assist in developing spatial public health policies to improve respiratory outcomes, neurodevelopment, and metabolic and attention disorders in school-aged children. Full article

The Syrian conflict has displaced five million individuals outside their country with Lebanon hosting the largest numbers per capita. Around 24% of Syrian refugees fleeing to Lebanon are women of reproductive age (15–49). Yet, a better understanding of the sexual and reproductive health needs of Syrian refugee women in Lebanon is required to improve provided services. Eleven focus group discussions were conducted in four regions of Lebanon with 108 Syrian refugee women of reproductive age. Thematic analysis was used to examine the data. Interviewed women were mainly adults. They believed that, in Lebanon, they were subjected to early marriage compared to the norm in Syria due to their financial situation and uncertainty. Cost was reported as the main barrier to use contraception in Lebanon but some Syrian refugee women were not aware of free services covering sexual and reproductive health. In general, marriage, pregnancy, and family planning behavior of Syrian refugee women in Lebanon slightly differed from those in Syria pre-conflict in terms of age of marriage, conception subsequent to marriage, and contraception method. Hence, interventions to increase awareness of subsidized sexual and reproductive health services, including free contraceptives at primary health care centers, and those targeting protection from early marriage of Syrian refugee women in Lebanon are strongly recommended. Full article

In this study, graphene Th(IV) phosphate was prepared by sol–gel precipitation method. The ion-exchange behavior of this cation-exchanger was studied by investigating properties like ion-exchange capacity for various metal ions, the effect of eluent concentration, elution behavior, and thermal effect on ion-exchange capacity (IEC). Several physicochemical properties as Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD) study, thermal studies, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) studies were also carried out. The material possessed an IEC of 1.56 meq·dry·g⁻¹ of the exchanger and was found to be nano-composite. The selectivity studies showed that the material is selective towards Pb(II) ions. The selectivity of this cation-exchanger was demonstrated in the binary separation of Pb(II) ions from mixture with other metal ions. The recovery was found to be both quantitative and reproducible. Full article

To mitigate the negative effects of modern cities on health, scientists are focusing on the diverse benefits of natural environments; a conceptual approach to use gardens for promoting human health is being attempted. In this study, the effects of the visual landscape of a traditional garden on psychological and physiological activities were investigated. Eighteen male and female adults participated in this indoor experiment (mean age, 26.7 years). Twelve different landscape images for city and garden were presented continuously for 90 s. In the time series changes of oxygenated hemoglobin (O₂Hb), different patterns of changes were observed between the city and garden. The mean O₂Hb values increased for the city landscapes, whereas they decreased for the garden landscapes both in the left and right prefrontal cortices. Significant differences in the negative psychological states of tension, fatigue, confusion, and anxiety were observed between the city and garden landscapes. Important differences in the physiological and psychological responses to the two different landscapes were also detected between male and female participants, providing valuable clues to individual differences in the health benefits of natural landscapes. To validate the use of gardens as a resource for promoting health in urban dwellers, further scientific evidence, active communication, and collaboration among experts in the relevant field are necessary. Full article

Purpose: This study aimed to determine the patterns associated with adult mandibular fractures from a Level-I trauma center in southern Taiwan. Methods: The data of adult trauma patients admitted between 1 January 2009 and 31 December 2014 were retrieved from the Trauma Registry System and retrospectively reviewed. Fracture site and cause of injury were categorized into groups for comparison, and corresponding odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by multivariate logistic regression. Results: Motorcycle accidents were the most common cause of mandibular fractures (76.3%), followed by falls (10.9%), motor vehicle accidents (4.8%), and being struck by/against objects (4.5%). Of the 503 cases of mandibular fractures, the condylar neck and head were the most common sites (32.0%), followed by the parasymphysis (21.7%), symphysis (19.5%), angle and ramus (17.5%), and body (9.3%). The location of mandibular fractures in patients who had motorcycle accidents was similar to that in all patients. Motor vehicle accidents resulted in a significantly higher number of body fractures (OR 3.3, 95% CI 1.24–8.76, p = 0.017) and struck injury in a significantly higher number of angle and ramus fractures (OR 3.9, 95% CI 1.48–10.26, p = 0.006) compared to motorcycle accidents. The helmet-wearing status and body weight were not associated with the location of mandibular fractures in motorcycle accidents. Conclusions: Our study revealed that the anatomic fracture sites of mandible were specifically related to different etiologies. In southern Taiwan, motorcycle accidents accounted for the major cause of mandibular fractures and were associated with the condylar neck and head as the most frequent fracture sites. In contrast, motor vehicle accidents and struck injuries tended to cause more body fracture as well as angle and ramus fracture compared to motorcycle accidents. Furthermore, the status of helmet-wearing and body weight were not associated with the location of mandible fractures caused by motorcycle accidents. Full article

Background: Heterosexual transmission (HST) has become the current predominant transmission pathways of the HIV-1 epidemic in China. The aim of this study was to explore the geographic and dynamic change of HIV-1 subtypes through HST in China from published studies. Methods: Several electronic databases were searched to identify the studies, and the overall prevalence of HIV-1 subtypes was estimated by a meta-analysis method. Subgroup analysis was conducted by study region and time period. Publication bias was evaluated using Egger’s test. The χ² test was used to evaluate the proportion differences among subgroups. Sensitivity analysis was carried out to assess the stability of the overall prevalence estimates. Results: 42 studies were included in our final analysis. The overall prevalence of CRF01_AE was 46.34% (95% CI: 40.56–52.17%), CRF07_BC was 19.16% (95% CI: 15.02–23.66%), B/B’ was 13.25% (95% CI: 9.68–17.25%), CRF08_BC was 10.61% (95% CI: 7.08–14.70%), and C was 4.29% (95% CI: 1.85–7.48%). In subgroup analysis, the prevalence of CRF01_AE and CRF07_BC increased, while the prevalence of B/B’ decreased over time, whereby the prevalence of CRF07_BC and CRF08_BC have exceeded that of B/B’ since 2010. A significant higher prevalence of CRF01_AE was found in the South provinces, CRF07_BC in East provinces, CRF08_BC and C in Southwest provinces, and B/B’ in North provinces. Conclusions: The HIV-1 prevalent strains have evolved into complicated and diverse subtypes, and the proportion of HIV-1 subtypes through HST has changed constantly in different regions and periods in China. This highlights the urgent need to vigorously strengthen the prevention and control of the HIV-1 epidemic. Full article

The mycotoxin patulin (PAT) was purified from Penicillium vulpinum CM1 culture that has been isolated from a soil cultivated with maize. The effect of PAT and of a fungal culture filtrate on the activities of glutathione-S-transferase (GST) and some antioxidant enzymes viz. ascorbate peroxidase (APX), glutathione reductase (GR), dehydroascorbate reductase (DHAR) and monodehydroascorbate reductase (MDHAR) was investigated in roots and shoots of 8-day-old maize seedlings. PAT and culture filtrate caused significant reduction effects in a dose-related manner on the total GST activity. Upon application of the high PAT concentration (25 μg·mL⁻¹) and of the concentrated fungal filtrate (100%, v/v), the reduction in GST activity of roots was 73.8–76.0% and of shoots was 60–61.7%. Conversely, significant increases in the activities of antioxidant enzymes were induced. Application of 25 μg·PAT·mL⁻¹ increased APX, GR, DHAR, and MDHAR activity of root by 2.40-, 2.00-, 1.24-, and 2.16-fold, respectively. In shoots, the enzymatic activity was increased by 1.57-, 1.45-, 1.45-, and 1.61-fold, respectively. Similar induction values of the enzymatic activity were obtained upon application of the concentrated fungal filtrate. This is the first report describing the response of GST and antioxidant enzyme activities of plant cells to PAT toxicity. Full article