Background: China is at its most important stage of air pollution control. Research on the association between air pollutants and human health is very important and necessary. The purpose of this study was to evaluate the association between PM_2.5 concentrations and residents’ mortality and to compare the effect of PM_2.5 on the different diseases, accidental deaths, sex or age of residents from high polluted areas with less polluted areas. Methods: The semi-parametric generalized additive model (GAM) with Poisson distribution of time series analysis was used. The excess risk (ER) of mortality with the incremental increase of 10 µg/m³ in PM_2.5 concentration was calculated. Concentration-response relationship curves and autocorrelation between different lags of PM_2.5 were also evaluated. Results: PM_2.5 exposure was significantly associated with the mortality of residents. The strongest ERs per 10 µg/m³ increase in PM_2.5 were 0.74% (95% CI: 0.11–1.38%) for all-cause, 0.67% (95% CI: 0.01–1.33%) for non-accidental, 1.81% (95% CI: 0.22–3.42%) for accidental, 3.04% (95% CI: 0.60–5.55%) for total respiratory disease, 6.38% (95% CI: 2.78–10.11%) for chronic lower respiratory disease (CLRD), 8.24% (95% CI: 3.53–13.17%) for chronic obstructive pulmonary disease (COPD), 1.04% (95% CI: 0.25–1.84%) for male and 1.32% (95% CI: 0.46–2.19%) for elderly. Furthermore, important information on the concentration-response relationship curves was provided. Conclusions: PM_2.5 can increase the risk of residents’ mortality, even in places with less air pollution and developed economy in China. Full article

Misuse and poor handling of chemical pesticides in agriculture is hazardous to the health of farmers, consumers, and to the environment. We studied the pest and disease management practices and the type of pesticides used in four root, tuber, and banana (RTB) crops in Rwanda and Burundi through in-depth interviews with a total of 811 smallholder farmers. No chemical pesticides were used in banana in either Rwanda and Burundi, whereas the use of insecticides and fungicides in potato was quite frequent. Nearly all insecticides and about one third of the fungicides used are moderately hazardous. Personal protective equipment was used by less than a half of the interviewed farmers in both countries. Reported cases of death due to self- or accidental-poisoning among humans and domestic animals in the previous 12 months were substantial in both countries. Training of farmers and agrochemical retailers in safe use of pesticide and handling and, use of integrated pest management approaches to reduce pest and disease damage is recommended. Full article

Local health centers (LHCs) play a key role in public health. Because it has now become popular to seek health information on the Internet, an effective website is indispensable to an LHC. Our study aimed to survey the official websites of LHCs in Taiwan with an evaluation framework. All 369 LHCs in Taiwan were surveyed in March 2018. The evaluation indicators included health information, online interactive services, technical features, institutional information, links to external resources, website management, the last updated time, and number of visitors. The indicators were stratified by the urbanization levels of the LHCs. In total, 98.0% (n = 360) of the LHCs had official websites. The majority (n = 241) of the websites were updated within the past 30 days, and most of the websites (n = 353) provided health information. However, the information provided varied considerably. Few LHCs (n = 31) provided online interactive services in terms of an online appointment function. In terms of providing online consultation services, rural LHCs outperformed suburban and urban LHCs (16.4% versus 14.5% and 6.0%, respectively). Most LHCs in Taiwan do not seem to take full advantage of the Internet, with their websites typically serving as static bulletin boards instead of new channels of communication. Further studies could focus on the effectiveness of these websites. Full article

Vietnam is among the countries with the highest prevalence of chronic hepatitis B (CHB) and individuals who suffer from CHB oftentimes perceive high levels of stigma and discrimination. Our study aimed to provide evidence on the prevalence of stigma against hepatitis B virus (HBV), HBV infection, and social determinants of stigma and discrimination in patients. A cross-sectional study was conducted at Viet-Tiep Hospital, Hai Phong, Vietnam. Stigma and discrimination against CHB in the last month were measured via four dimensions: (1) Blame/Judgment; (2) Shame; (3) Discrimination in different settings; (4) Disclosure of CHB status. Multivariate Logistic and Tobit regressions were used to identify factors associated with CHB-related stigma and discrimination. Among 298 enrolled patients, 4.8% experienced blame/judgement, 10.2% perceived shame, 48.5% felt discriminated in healthcare facilities, and 90.6% disclosed their health status with spouses/partners. Factors associated with lower odds of CHB-related stigma/discrimination included living with spouses/partners, old age, being employed, and the existence of comorbidities was linked with higher odds of stigma. Anti-stigma programs should target those who are younger and have comorbidities. This could be done by community-based interventions which focus on inaccurate beliefs about viral hepatitis. Furthermore, families, healthcare providers, and society should play a crucial role in supporting CHB patients. Full article

Ecological stoichiometry has been widely used to determine how plant-soil systems respond to global change and to reveal which factors limit plant growth. Arbuscular mycorrhizal fungi (AMF) can increase plants’ uptake of nutrients such as nitrogen (N) and phosphorus (P), thereby altering plant and soil stoichiometries. To understand the regulatory effect of AMF feedback on plants and soil stoichiometry under global change, a microcosm experiment was conducted with warming and N input. The C₄ grass Setaria viridis, C₃ grass Leymus chinensis, and Chenopodiaceae species Suaeda corniculata were studied. The results showed that the mycorrhizal benefits for the C₄ grass S. viridis were greater than those for the C₃ grass L. chinensis, whereas for the Chenopodiaceae species S. corniculata, AMF symbiosis was antagonistic. Under N input and a combination of warming and N input, AMF significantly decreased the N:P ratios of all three species. Under N input, the soil N content and the N:P ratio were decreased significantly in the presence of AMF, whereas the soil C:N ratio was increased. These results showed that AMF can reduce the P limitation caused by N input and improve the efficiency of nutrient utilization, slow the negative influence of global change on plant growth, and promote grassland sustainability. Full article

Urban particulate air pollution is a known cause of adverse human health effects worldwide. Urumqi is a large oasis city in which rapid urbanization has caused a series of eco-environmental problems including serious air pollution, water shortage, dense population, excess energy consumption, and the creation of an urban heat island, among others. Coal is the most important source of energy and air pollutants that are poorly dispersed into the natural surroundings are the main reasons for serious pollution in the Urumqi urban area. Using differential optical absorption spectroscopy (DOAS), aerosol levels were determined using the double optical path method. We found that aerosol concentrations in Urumqi increased rapidly in winter, and that the concentration of fine particles was much higher than that of coarse particles. The background aerosol concentration was highest in winter in the research area, and the air-flow speed had a significant impact on this because high speed surface winds that correspond to high air flows can transport the aerosol to other places. Some of the observed day-to-night differences may be caused by differing wind directions that transport air masses from different emission sources during the day and the night. Daily and seasonal differences in PM_1.0 concentrations of different grades of polluted air were statistically analyzed using average daily concentration data for particles smaller than 10, 2.5 and 1.0 microns (PM₁₀, PM_2.5 and PM_1.0), and meteorological observations for Urumqi, Tianshan District in 2010. Full article

Polyolefin (PO) polymers constitute the majority of consumer plastic commodities. The reliance on such materials make it near imposable to avoid touching one in any given day. Therefore, the accumulation of plastic solid waste (PSW) in developed and developing societies alike requires immediate attention to manage and valorize this type of waste. In this work, PSW originating from real life sources and virgin linear low-density polyethylene (LLDPE) films were compounded in a mechanical recycling effort. The recycled blends constituted up to 100% (by weight) of the waste material. Accelerated weathering (aging) was conducted on the blends, reaching threshold limit of exposure to study the major changes occurring on the recycled blends. Thermogravimetry and differential scanning calorimetry (DSC) were used to determine their characteristics and applicability for future recycling using thermo-chemical treatment (TCT) methods. Analytical solution methods following the international committee of thermal analysis and calorimetry (ICTAC) were followed in conducting the measurements and kinetic calculations alike. A novel analytical mathematical solution model is also introduced to determine both the pre-exponential factor (A_o) and apparent activation energy (E_a) of the degradation reaction. The model proved to be a more accurate analysis tool, and the work in whole enabled the determination of future plans for using such waste components as a feedstock to thermal units. Full article

The use of hearing protectors in various noisy workplaces is often necessary. For safety reasons, auditory information may be required to correctly localize the direction of an auditory danger signal. The purpose of this study was to verify if the selection of a specific level-dependent hearing protector may be important for the ability to localize a vehicle back-up alarm signal. The laboratory conditions reflected industrial conditions, under which an impulse noise was emitted against a background of continuous noise. A passive mode and a level-dependent mode (maximum and incomplete amplification) were considered. Four different models of level-dependent earmuffs and one model of level-dependent earplugs were included in the tests. The tests enabled differentiation between the individual hearing protectors. The use of earplugs in level-dependent mode did not significantly affect the ability to correctly localize the back-up alarm signal. For the earmuffs, the global assessment of the impact of a mode change revealed that, depending on the model of the earmuffs, the impact may be insignificant, but may also result in considerable impairment of the ability to localize the back-up alarm signal. Full article

The rapid economic growth of China in the last twenty years has caused a commensurate rise in atmospheric pollution which has had an impact on both the environment and public health. Since 2013, SO₂, CO₂ and nitrogen oxide levels have reached a level that may cause climate change and have adverse effects on the health of the local residents. Past environmental efficiency analyses have rarely examined economic development, air pollution and health as interacting systems; therefore, this study used a new two-stage DEA model, the Modified Undesirable EBM Two Stage DEA (Epsilon-Based Measure) to explore the environmental, economic and health efficiencies in thirty-one major cities in China. The results were as follows: while all cities needed to improve their GDP, the environmental efficiencies were continuing to rise in most cities. The health efficiency index indicated that disease efficiency had increased in most cities but declined in one third; therefore, it is necessary to strengthen treatment. The respiratory disease treatment efficiency in most cities was rising, and the room for improvement had significantly reduced. There were improvements in the mortality rate in 15 cities; however, the mortality rate treatment efficiency declined in 11 cities. Full article

Colonoscopy services working in colorectal cancer screening programs must perform periodic controls to improve the quality based on patients’ experiences. However, there are no validated instruments in this setting that include the two core dimensions for optimal care: satisfaction and safety. The aim of this study was to design and validate a specific questionnaire for patients undergoing screening colonoscopy after a positive fecal occult blood test, the Colonoscopy Satisfaction and Safety Questionnaire based on patients’ experience (CSSQP). The design included a review of available evidence and used focus groups to identify the relevant dimensions to produce the instrument (content validity). Face validity was analyzed involving 15 patients. Reliability and construct and empirical validity were calculated. Validation involved patients from the colorectal cancer screening program at two referral hospitals in Spain. The CSSQP version 1 consisted of 15 items. The principal components analysis of the satisfaction items isolated three factors with saturation of elements above 0.52 and with high internal consistency and split-half readability: Information, Care, and Service and Facilities features. The analysis of the safety items isolated two factors with element saturations above 0.58: Information Gaps and Safety Incidents. The CSSQP is a new valid and reliable tool for measuring patient’ experiences, including satisfaction and safety perception, after a colorectal cancer screening colonoscopy. Full article

Outdoor fitness equipment (OFE) areas have become a popular form of built environment infrastructure in public open spaces as a means to improve public health through increased physical activity. However, the benefits of using OFE are not consistent, and several OFE accidents have been reported. In this study, we videotaped how OFE users operate OFE in parks and selected four types of popular OFE (the waist twister, air walker, ski machine, and waist/back massager) for video content analysis. Furthermore, we established coding schemes and compared results with the instructions provided by OFE manufacturers. The results revealed various usage behaviors for the same OFE types. In addition, we observed that a significant portion of user behaviors did not follow manufacturers’ instructions, which might pose potential risks or actually cause injuries. Children are especially prone to act improperly. This study provides empirical evidence indicating the existence of potential safety risks due to inappropriate usage behaviors that might lead to accidents and injuries while using OFE. This study provides crucial information that can be used to evaluate the effectiveness of OFE and to develop future park or open space initiatives. Full article

To investigate the association among lower urinary tract infection (UTI), the type and timing of antibiotic usage, and the subsequent risk of developing cancers, especially genitourinary cancers (GUC), in Taiwan. This retrospective population-based cohort study was conducted using 2009–2013 data from the Longitudinal Health Insurance Database. This study enrolled patients who were diagnosed with a UTI between 2010 and 2012. A 1:2 propensity score-matched control population without UTI served as the control group. Multivariate analysis with a multiple Cox regression model was applied to analyze the data. A total of 38,084 patients with UTI were included in the study group, and 76,168 participants without UTI were included in the control group. The result showed a higher hazard ratio of any cancer in both sexes with UTI (for males, adjusted hazard ratio (aHR) = 1.32; 95% confidence interval (CI) = 1.12–1.54; for females, aHR = 1.21; 95% CI = 1.08–1.35). Patients with UTI had a higher probability of developing new GUC than those without UTI. Moreover, the genital organs, kidney, and urinary bladder of men were significantly more affected than those of women with prior UTI. Furthermore, antibiotic treatment for more than 7 days associated the incidence of bladder cancer in men (7–13 days, aHR = 1.23, 95% CI = 0.50–3.02; >14 days, aHR = 2.73, CI = 1.32–5.64). In conclusion, UTI is significantly related to GUC and may serve as an early sign of GUC, especially in the male genital organs, prostate, kidney, and urinary bladder. During UTI treatment, physicians should cautiously prescribe antibiotics to patients. Full article

The aims of this study were to determine compartmental air pollution during navigation of a large oceangoing ship and to identify preliminarily the major pollution sources. During the voyage of a bulk carrier ship, air samples were collected at 18 selected sites using a stratified sampling method. The concentrations of 15 pollutants were determined using gas chromatography. Results showed the concentrations of these pollutants varied significantly among the sampling sites, indicating major pollution sources at or nearby those locations. Five common factors extracted using factor analysis explained 89.092% of the total variance. Multivariate linear regression analysis showed the contributions to air pollution of these five common factors, i.e., the volatilization of ship paint, volatilization of ship-based oil, cooking activities, high-temperature release of rubber components on the ship and daily use of chemical products, and the application of deodorant and insecticide, were 41.07%, 25.14%, 14.37%, 11.78%, and 7.63%, respectively. Three significant groups were determined using cluster analysis based on their similarity, i.e., high, medium, and low pollution of sampling sites. This study established that the air of the bulk carrier ship was heavily polluted, and that effective identification of pollution sources could provide a scientific basis for its control. Full article

Studying moderators of the effects of anti-bullying universal interventions is essential to elucidate what works for whom and to tailor more intensive, selective, and indicated programs which meet the needs of non-responders. The present study investigated whether early adolescents’ temperament—effortful control (EC), negative emotionality (NE), and positive emotionality (PE)—moderates the effects of the KiVa anti-bullying program. The sample consisted of 13 schools, with 1051 sixth-grade early adolescents (mean age = 10.93; SD = 0.501), randomly assigned to the KiVa intervention (seven schools; n = 536) or to the control condition (six schools; n = 516). Adolescents reported bullying and victimization before the intervention (pre-test) and after (post-test). Temperament was assessed by a self-report pre-test. Findings showed that EC and NE moderated intervention effects on bullying, indicating that subgroups with high levels of EC, and with low and medium levels of NE were those who benefited most from the intervention. The low-EC subgroup showed a lower increase compared to the control condition, with a considerable effect size. Conversely, the high-NE subgroup did not show any positive effects compared to the control group. Regarding victimization, findings showed that early adolescents with high and medium levels of PE were the subgroups who benefited the most from the intervention, whereas the low-PE subgroup was the most resistant. The present study confirms the relevance of considering temperament as a moderator of intervention effects, since interventions tailored to early adolescents with specific traits might yield larger effects. Full article

Public health has always been, and remains, an interdisciplinary field, and engineering was closely aligned with public health for many years. Indeed, the branch of engineering that has been known at various times as sanitary engineering, public health engineering, or environmental engineering was integral to the emergence of public health as a distinct discipline. However, in the United States (U.S.) during the 20th century, the academic preparation and practice of this branch of engineering became largely separated from public health. Various factors contributed to this separation, including an evolution in leadership roles within public health; increasing specialization within public health; and the emerging environmental movement, which led to the creation of the U.S. Environmental Protection Agency (EPA), with its emphasis on the natural environment. In this paper, we consider these factors in turn. We also present a case study example of public health engineering in current practice in the U.S. that has had large-scale positive health impacts through improving water and sanitation services in Native American and Alaska Native communities. We also consider briefly how to educate engineers to work in public health in the modern world, and the benefits and challenges associated with that process. We close by discussing the global implications of public health engineering and the need to re-integrate engineering into public health practice and strengthen the connection between the two fields. Full article