Cover Story (view full-size image): There are many reasons why an individual may choose to practice a vegetarian diet, including religious beliefs, ethical considerations, perceived health benefits, or philosophical beliefs. As with all high-performance athletes, basic dietary requirements must be met as well as health and performance needs in order to ensure optimal performance. Creatine is naturally found in animal tissues such as meats, fish, and poultry. As a result, its intake is lower among vegetarian athletes. The minimum level of creatine supplementation required for vegetarians to prevent decreased creatine stores is about 1 gram per day. Overall, creatine supplementation has the ability to increase performance in vegetarians as well as omnivores; however, the research is not conclusive on whether this results in a greater increase in performance for vegetarians than their omnivore peers. View this paper

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13 pages, 2093 KiB

Open AccessArticle

An Endowment Effect Study in the European Union Emission Trading Market based on Trading Price and Price Fluctuation

by Jiqiang Wang, Fu Gu, Yingpeng Liu, Ying Fan and Jianfeng Guo

Int. J. Environ. Res. Public Health 2020, 17(9), 3343; https://doi.org/10.3390/ijerph17093343 - 11 May 2020

Cited by 6 | Viewed by 3668

Abstract

This paper pioneers to investigate the endowment effect in the European Union mission Trading Scheme (EU ETS) as well as the impacts of trading experience and compliance pressure on the endowment effect. This study is based on the complete transaction records of the market. In the data set, the records of two consecutive reverse transactions from a same emitting company are selected. The lowest price that the buyer is willing to pay (WTP) and the maximum price the seller is willing to accept (WTA) are evaluated by excluding their risk cost that is used to avoid short-term fluctuations in the price. By distinguishing the difference between WTA and WTP, and long-term fluctuations in the prices during the two transactions, the trader’s endowment effect can be quantitively assessed. The results show that the degree of endowment effect of traders follows the trading experience. In addition, since the EU ETS is a cap-and-trade market, the traders face different levels of compliance pressure; when the pressure of the emission companies increases, the degree of endowment effect will also decrease. Full article

(This article belongs to the Section Environment and Applied Ecology)

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Research framework. Full article ">Figure 2
Trend of carbon spot prices in Phase I and Phase II. Source: ICE and BlueNext. Full article ">Figure 3
Explanation on the relationship among Value at Risk (Var), trading price and WTP (WTA). Full article ">Figure 4
Results of the Empirical Mode Decomposition. Full article ">

Supplementary material:
Supplementary File 1 (PDF, 447 KiB)

16 pages, 1218 KiB

Open AccessArticle

Accumulation of Arsenic by Plants Growing in the Sites Strongly Contaminated by Historical Mining in the Sudetes Region of Poland

by Agnieszka Dradrach, Anna Karczewska, Katarzyna Szopka and Karolina Lewińska

Int. J. Environ. Res. Public Health 2020, 17(9), 3342; https://doi.org/10.3390/ijerph17093342 - 11 May 2020

Cited by 27 | Viewed by 3524

Abstract

The uptake of As by various plants growing in highly enriched sites was examined in order to identify potential As accumulators and to assess the risk associated with As presence in plant shoots. Representative samples of 13 plant species, together with soil samples, were collected from various sites affected by historical As mining: mine and slag dumps, tailings and contaminated soils with As concentrations in a range 72–193,000 mg/kg. Potentially and actually soluble As forms, extracted with 0.43 M HNO₃ and, 1M NH₄NO₃ were examined in relation to As concentrations in plant roots and shoots. The latter differed strongly among the species and within them and were in the ranges 2.3–9400 mg/kg and 0.5–509 mg/kg, respectively. The majority (over 66%) of plant samples had As shoot concentrations above 4 mg/kg, an upper safe limit for animal fodder. The uptake of As by plants correlated well with total and extractable soil As, though As concentrations in plants could not be predicted based on soil parameters. Equisetum spp. and C. epigejos indicated a particularly strong accumulation of As in shoots, while A. capillaris, and H. lanatus showed a limited As root-to-shoot transfer, apparently associated with species-related tolerance to As. Full article

(This article belongs to the Section Environmental Remediation and Management)

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Arsenic concentrations in shoots (a) and roots (b) of plant species examined. Full article ">Figure 2
The values of arsenic roots to shoots transfer factor (TF). Full article ">Figure 3
Arsenic concentrations in the aboveground parts of plants, as related to soil As. Graph (a) illustrates the relationships between As in the aboveground parts of plants and total soil As, and graph (b) relates the concentrations of As in the aboveground parts to 1M NH4NO3-extractable As in soils. Full article ">Figure 4
Roots to shoots transfer factor of arsenic (TF) as related to root As concentrations. Calculated correlation coefficient: R = −0.693, significant at p < 0.001. Full article ">

12 pages, 2391 KiB

Open AccessArticle

Fire Characteristics of Upholstery Materials in Seats

by Linda Makovická Osvaldová, Iveta Marková, Miroslava Vandlíčková, Stanislava Gašpercová and Michal Titko

Int. J. Environ. Res. Public Health 2020, 17(9), 3341; https://doi.org/10.3390/ijerph17093341 - 11 May 2020

Cited by 6 | Viewed by 3659

Abstract

The article deals with selected upholstery flammability test materials that, in the case of fire, can cause fire spread. For the research, frequently used materials for upholstery based on polyester were utilized: imitation leather, suede, and microplush. Initiation of initiating spontaneous flammability with various sources of ignition were measured including a smoldering cigarette and a match flame. Results were measured as smoldering time and length of the burnt-though sample. Upholstery materials are an integral part of seat construction. To be used in transport, upholstered material must meet safety measures such as the strength, sanitariness, and fire resistance. All tests were performed in accordance with applicable technical standards. Impact assessment of the sample (weight) on “smoldering time” and “length of degradation” was carried out using an ANOVA. Significant differences in length of degradation was observed between samples. Tests cannot provide reliable information about the flammability course of the final product. Upholstery is composed of external covering, of inner liner, and padding. Results of the research presented in this paper indicate the need to continue the research in a broader aspect. Full article

(This article belongs to the Special Issue Environmental Issues in Aerospace and their Impact on Public Health)

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Full article ">Figure 1
Pictures of the three samples. (a) Imitation leather, (b) suede, and (c) microplush. Full article ">Figure 2
Test equipment. (a) underlying panel and (b) upholstery for the experiment. Full article ">Figure 3
The experiment using a burning cigarette on (a) Sample 1, (b) Sample 2, and (c) Sample 3. Full article ">Figure 3 Cont.
The experiment using a burning cigarette on (a) Sample 1, (b) Sample 2, and (c) Sample 3. Full article ">Figure 4
The experiment with Sample 2 using an equivalent to a match. (a) Ignition by the equivalent of match, and (b) residual after experiment. Full article ">

16 pages, 3002 KiB

Open AccessArticle

Using Ecosystem Service Flows to Inform Ecological Compensation: Theory & Application

by Xiaolong Gao, Binbin Huang, Ying Hou, Weihua Xu, Hua Zheng, Dongchun Ma and Zhiyun Ouyang

Int. J. Environ. Res. Public Health 2020, 17(9), 3340; https://doi.org/10.3390/ijerph17093340 - 11 May 2020

Cited by 36 | Viewed by 5093

Abstract

Ecological compensation is a crucial policy instrument that realigns the benefits of stakeholders to the ecosystem service provision. However, the spatial disconnections between locations where ecosystem services produced and used are common. The supply and demand for ecosystem services are calculated to reflect the status of the districts or counties based on ecosystem service flows. The replacement cost methods provide necessary technical supports for the calculation of compensation funds. The realigning of compensation funds between service-benefiting areas and service-providing areas not only identifies the beneficiaries and suppliers but also realizes the connection between them, which may be a feasible methodology. Fuzhou City is the study area, and two ecosystem services of water conservation and soil retention were taken into consideration. The prioritized development zone, Linchuan, and the key agricultural production zones paid ecological compensation funds. Linchuan paid the highest, 5.76 billion yuan. The key ecological function zones and the key agricultural production zones received the ecological compensation funds, of which Yihuang obtained the highest, 1.66 billion yuan. The realigning of compensation funds between the service benefiting and providing areas addresses the trade-offs between ecosystem services, social development, and ecosystem protection. Embedding the ecosystem service flows into the ecological compensation mechanism can most truly realize the value of ecosystem services, achieve the “beneficiary pays” principle, and be conducive to regional sustainable development. Full article

(This article belongs to the Section Environment and Applied Ecology)

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Full article ">Figure 1
The research area of Fuzhou City located in the eastern part of Jiangxi Province covers a total area of 18,800 square kilometers. The main functional zones are classified as prioritized development zones (Linchuan); key agricultural production zones (Dongxiang, Jinxi, Nancheng, Chongren, and Le’an); and key ecological function zones (Yihuang, Nanfeng, Guangchang, Lichuan, and Zixi). Full article ">Figure 2
Supply and demand for water conservation and soil retention. (a) Districts or counties can be classified into ecological deficit areas and ecological surplus areas by calculating the difference between supply and demand for water conservation. Dongxiang, Linchuan, Jinxi, and Chongren belong to ecological deficit areas in water conservation. (b) Dongxiang is the sole ecological surplus area in soil retention. Full article ">Figure 3
Identification of service-benefiting areas and service-providing areas. Districts or counties can be classified into service-benefiting areas or service-providing areas. The classification basically reflects the spatial direction of the ecosystem service flows. Full article ">

13 pages, 2621 KiB

Open AccessArticle

Spectroscopic Assessment of Platinum Group Elements of PM₁₀ Particles Sampled in Three Different Areas in Jeddah, Saudi Arabia

by Mohammad W. Kadi, Iqbal Ismail, Nadeem Ali and Abdallah A. Shaltout

Int. J. Environ. Res. Public Health 2020, 17(9), 3339; https://doi.org/10.3390/ijerph17093339 - 11 May 2020

Cited by 8 | Viewed by 3133

Abstract

Platinum group elements (PGE) including Ru, Rh, Pt and Pd have been quantified in air particulate matter with an aerodynamic diameter equal or less than 10 microns (PM₁₀) using inductively coupled plasma mass spectrometry (ICP-MS). PM₁₀ aerosols have been collected from three sites representing various activities in Jeddah city, Saudi Arabia. These locations are residential site with heavy traffic, industrial site and heavy traffic and a light traffic site outside the city. To obtain reasonable data of the PGE concentrations, a group from 10 to 15 PM₁₀ samples were collected every month. The annual and seasonal variation of the mass concentration of the PGE were demonstrated. In all locations, Pt and Pd were relatively higher than Ru and Rh possibly because their main use is in automobile catalytic converters. Concentrations of observed PGE in PM₁₀ could be arranged in ascending order as: Rh < Ru < Pd < Pt. In case of Ru and Pt, there are clear similarities in terms of the overall mean concentrations at the sampling locations. Due to the high concentration of Ru, Rh and Pd at low traffic site, there are certainly other sources of these elements rather than vehicle catalytic converters. However, at the industrial/heavy traffic location, high concentrations of Ru were detected during February 2015. In addition, high Pt concentrations were also detected at the light traffic site during May 2015. Results indicate that Pt source in PM₁₀ is mainly the automobile catalytic converters. Full article

(This article belongs to the Special Issue Outdoor and Indoor Air Quality)

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Air particulate matter with an aerodynamic diameter equal or less than 10 microns (PM10) sampling locations in Jeddah city, Saudi Arabia. Full article ">Figure 2
Overall monthly averages of platinum group elements (PGE) detected in PM10 from the three sampling sites in Jeddah city. Full article ">Figure 3
Seasonal variations of Ru, Rh, Pd and Pt in PM10 collected from three different sites in Jeddah city. Full article ">Figure 4
Concentration variations of Ru, Rh, Pd and Pt during working days and weekends in PM10 collected from three different sites in Jeddah city. Full article ">

12 pages, 341 KiB

Open AccessArticle

Factors Contributing to Retirement Decisions in Denmark: Comparing Employees Who Expect to Retire before, at, and after the State Pension Age

by Annette Meng, Emil Sundstrup and Lars L. Andersen

Int. J. Environ. Res. Public Health 2020, 17(9), 3338; https://doi.org/10.3390/ijerph17093338 - 11 May 2020

Cited by 19 | Viewed by 4936

Abstract

Aim: Analyse factors affecting retirement decisions comparing employees expecting to retire before, at, and after the state pension age. Methods: In the SeniorWorkingLife cohort, 12,269 workers aged +50 replied to questions about expected retirement age, reasons for leaving, and reasons for staying longer. Results: For all groups, poor health, wish for more leisure, and economy were the most salient expected reasons for retiring. Many would stay longer if there were better possibilities for more leisure time, more work flexibility, and economic benefits. Those expecting to retire before state pension age were more likely to point at desire for more leisure time as expected reason for retiring, and less likely to point at economic reasons, and more likely to point at health and work demands as possible reasons for prolonging working life. Those expecting to retire after state pension age were more likely to point at external factors and recognition from the management. Conclusion: Factors influencing retirement decisions are similar across the groups. Initiatives for better work–life balance, healthy lifestyle, and economic incentives to continue working may help prevent early retirement and motivate prolonging work life beyond retirement. Results also indicate that less strenuous work is particularly relevant to prevent early retirement. Full article

(This article belongs to the Special Issue Prolonging Working Life among Senior Workers)

10 pages, 625 KiB

Open AccessArticle

Relationship between Adherence to the Mediterranean Diet and Body Composition with Physical Fitness Parameters in a Young Active Population

by Samuel Manzano-Carrasco, Jose Luis Felipe, Javier Sanchez-Sanchez, Antonio Hernandez-Martin, Ivan Clavel, Leonor Gallardo and Jorge Garcia-Unanue

Int. J. Environ. Res. Public Health 2020, 17(9), 3337; https://doi.org/10.3390/ijerph17093337 - 11 May 2020

Cited by 19 | Viewed by 4138

Abstract

The current study aimed at analyzing the relationship between body composition, adherence to the Mediterranean diet (MD), and physical fitness (PF) in a young active population. A total of 1198 athletes (boys = 875; girls = 323) enrolled in different municipal sports schools participated in this study. Data on adherence to the MD (KIDMED questionnaire), anthropometric measurements, and PF (20 m shuttle run test, handgrip strength, vertical jump and forced spirometry) were collected. Results show that the pubertal boys had a higher score in the KIDMED test than the prepubertal ones (+0.38, p = 0.28). Moreover, boys with better adherence to the MD had significantly higher results in handgrip strength (+12.20 regarding low MD group and +9.13 regarding medium MD group, p < 0.05), as well as in forced vital capacity (FVC) (+0.66 regarding low MD group and 0.29 regarding medium MD group, p < 0.05). No differences were found in the girls. Finally, the result of the KIDMED test is a variable with a positive and significant relationship with cardiorespiratory fitness, along with the FVC, percentage of fat mass, and performance in the vertical jump (p < 0.05). It is concluded that adherence to the MD could show a relationship with various PF variables in boys and could be a predictor of cardiorespiratory fitness in both cases. Full article

(This article belongs to the Special Issue Advances in Community Nutrition and Physical Exercise)

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Differences between pubertal status. * Differences between prepubertal and pubertal groups, p < 0.05 Full article ">

16 pages, 791 KiB

Open AccessFeature PaperArticle

Prevalence of Multimorbidity among Asian Indian, Chinese, and Non-Hispanic White Adults in the United States

by Yifan Zhang, Ranjita Misra and Usha Sambamoorthi

Int. J. Environ. Res. Public Health 2020, 17(9), 3336; https://doi.org/10.3390/ijerph17093336 - 11 May 2020

Cited by 16 | Viewed by 4244

Abstract

Asian Americans are the fastest-growing minority group in the United States, yet little is known about their multimorbidity. This study examined the association of Asian Indians, Chinese and non-Hispanic whites (NHWs) to multimorbidity, defined as the concurrent presence of two or more chronic conditions in the same individual. We used a cross-sectional design with data from the National Health Interview Survey (2012–2017) of Asian Indians, Chinese, and NHWs (N = 132,666). Logistic regressions were used to examine the adjusted association of race/ethnicity to multimorbidity. There were 1.9% Asian Indians, 1.8% Chinese, and 96.3% NHWs. In unadjusted analyses (p < 0.001), 17.1% Asian Indians, 17.9% Chinese, and 39.0% NHWs had multimorbidity. Among the dyads, high cholesterol and hypertension were the most common combination of chronic conditions among Asian Indians (32.4%), Chinese (41.0%), and NHWs (20.6%). Asian Indians (AOR = 0.73, 95% CI = (0.61, 0.89)) and Chinese (AOR = 0.63, 95% CI = (0.53, 0.75)) were less likely to have multimorbidity compared to NHWs, after controlling for age, sex, and other risk factors. However, Asian Indians and Chinese were more likely to have high cholesterol and hypertension, risk factors for diabetes and heart disease. Full article

(This article belongs to the Special Issue Racial and Ethnic Disparities in Chronic Conditions among Adults and Older Adults)

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Selected sample characteristics in weighted % among Asian Indian, Chinese, and Non-Hispanic White adults (age ≥ 18 years). National Health Interview Survey, 2012–2017. Full article ">Figure 2
Adjusted Odds Ratios (AOR) and 95% Confidence Intervals (CI) of racial/ethnic categories from logistic regression on multimorbidity among Asian Indian, Chinese, Non-Hispanic White (NHW) adults (age ≥ 18 years) stratified by age group (<65 years vs. ≥65 years). National Health Interview Survey, 2012–2017. Full article ">

41 pages, 2501 KiB

Open AccessArticle

Evaluating the Investment Projects of Spinal Medical Device Firms Using the Real Option and DANP-mV Based MCDM Methods

by Chi-Yo Huang, Hong-Ling Hsieh and Hueiling Chen

Int. J. Environ. Res. Public Health 2020, 17(9), 3335; https://doi.org/10.3390/ijerph17093335 - 11 May 2020

Cited by 10 | Viewed by 4594

Abstract

In an era of global aging, spinal and other joint degeneration issues have become a major problem for many elders. Bone-related operations have become the largest percentage of surgeries, accounting for 40% of the top 10 operations in the United States. Further, these spine-related operations are now ranked second among all bone-related operations. Due to this enormous and daily increasing market demand, more and more firms have started to pay closer attention to related medical devices and products. The global venture capitalists (VCs) have also started to follow the mega trend and will continue to invest heavily in this industry. Although most VCs recognize that investing in firms that produce innovative spinal products or devices is a must, very few practical managers or research scholars have defined the appropriate evaluation methods for these firms to use. The traditional net present value (NPV) method, which does not consider operation flexibility and changes in strategy, is far from the reality. The real option method can reveal the vagueness and flexibilities of the values being embedded in the investment projects at spinal medical device firms. However, the real option method is strictly quantitative. Usually, the evaluation aspects contain qualitative factors or local criteria which are hard to quantify in monetary terms. Thus, the adoption of multiple criteria decision making (MCDM) methods that can manipulate both quantitative and qualitative factors will be very helpful in evaluating and selecting investment cases like the spinal medical device firms, where both quantitative and qualitative factors should be considered. An analytical framework that consists of hybrid MCDM methods and the real option method will thus be very useful to evaluate the newly established firms producing spinal medical devices. Therefore, the authors propose a real option valuation as well as the Decision-Making Trial and Evaluation Laboratory (DEMATEL) based analytic network process (DANP) and the modified VIšekriterijumsko KOmpromisno Rangiranje (VIKOR) method (DANP-mV) based MCDM framework for evaluating the investment projects offered by these firms of spinal medical devices. An empirical study based on three newly established spinal medical device companies specializing in vertebral compression fracture (VCF) surgical devices was used to demonstrate the feasibility of the proposed analytical framework. Sensitivity analysis is performed to determine the influence of modeling parameters on ranking results of alternatives. This analytical framework can thus serve as a tool for VCs to use to determine the value of a potential candidate for investment. The proposed method can also serve as an effective and efficient tool for investment projects in other fields. Full article

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The flowchart of decision-making framework. DEMATEL—Decision-Making Trial and Evaluation Laboratory; DANP—DEMATEL based analytic network process; ROV—Real Option Valuation; VIKOR—VIšekriterijumsko KOmpromisno Rangiranje. Full article ">Figure 2
Binomial Lattice. Source: Adapted from Kodukula and Papudesu [<a href="#B99-ijerph-17-03335" class="html-bibr">99</a>]. Full article ">Figure 3
The Causal Relationship Structure of Each Dimension and Its Criteria. Full article ">Figure 4
Results of the Experiment 1 of the Sensitivity Analysis. Full article ">Figure A1
Option Value Binomial Tree for company (a) S, (b) W, and (c) B. Remarks: All numbers are thousands USD. Top numbers are asset values. Bottom italicized numbers are option values. Option to invest is exercised at notes where the option value is not zero. Full article ">

19 pages, 3003 KiB

Open AccessArticle

A Long-Term Trend Study of Tuberculosis Incidence in China, India and United States 1992–2017: A Joinpoint and Age–Period–Cohort Analysis

by Yiran Cui, Hui Shen, Fang Wang, Haoyu Wen, Zixin Zeng, Yafeng Wang and Chuanhua Yu

Int. J. Environ. Res. Public Health 2020, 17(9), 3334; https://doi.org/10.3390/ijerph17093334 - 11 May 2020

Cited by 33 | Viewed by 6256

Abstract

Tuberculosis (TB) is one of the major infectious diseases with the largest number of morbidity and mortality. Based on the comparison of high and low burden countries of tuberculosis in China, India and the United States, the influence of age-period-cohort on the incidence of tuberculosis in three countries from 1992 to 2017 was studied based on the Global burden of Disease Study 2017. We studied the trends using Joinpoint regression in the age-standardized incidence rate (ASIR). The regression model showed a significant decreasing behavior in China, India and the United States between 1992 and 2017. Here, we analyzed the tuberculosis incidence trends in China, India, as well as the United States and distinguished age, period and cohort effects by using age-period-cohort (APC) model. We found that the relative risks (RRs) of tuberculosis in China and India have similar trends, but the United States was found different. The period effect showed that the incidence of the three countries as a whole declines with time. The incidence of tuberculosis had increased in most age group. The older the age, the higher the risk of TB incidence. The net age effect in China and India showed a negative trend, while the cohort effect decreased from the earlier birth cohort to the recent birth cohort. Aging may lead to a continuous increase in the incidence of tuberculosis. It is related to the aging of the population and the relative decline of the immune function in the elderly. This should be timely population intervention or vaccine measures, especially for the elderly. The net cohort effect in the United States showed an unfavorable trend, mainly due to rising smoking rates and the emergence of an economic crisis. Reducing tobacco consumption can effectively reduce the incidence. Full article

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11 pages, 1275 KiB

Open AccessArticle

Environmental and Patient Impact of Applying a Point-of-Care Ultrasound Model in Primary Care: Rural vs. Urban Centres

by Francesc X Marín-Gomez, Jacobo Mendioroz Peña, Vicenç Canal Casals, Marcos Romero Mendez, Ana Darnés Surroca, Antoni Nieto Maclino and Josep Vidal-Alaball

Int. J. Environ. Res. Public Health 2020, 17(9), 3333; https://doi.org/10.3390/ijerph17093333 - 11 May 2020

Cited by 4 | Viewed by 3653

Abstract

Motor vehicles are a major contributor to air pollution, and the exposure to this human-caused air pollution can lead to harmful health effects. This study evaluates the impact of the provision of point-of-care ultrasounds (POCUS) by primary care (PC) to avoid the patient’s need to travel to a specialized service. The study estimates the costs and air pollution avoided during 2019. The results confirm that performing this ultrasound at the point of care reduces the emission of 61.4 gr of carbon monoxide, 14.8 gr of nitric oxide and 2.7 gr of sulfur dioxide on each trip. During the study, an average of 17.8 km, 21.4 min per trip and almost 2000 L of fuel consumed in a year were avoided. Performing POCUS from PC reduces fuel consumption and the emission of air pollutants and also saves time and money. Furthermore, only 0.3% of the scans had to be repeated by radiologists. However, more studies with more participants need to be done to calculate the exact impact that these pollution reductions will have on human health. Full article

(This article belongs to the Special Issue Social Media and Public Health: Opportunities and Challenges)

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Map showing the primary care centres and their associated diagnostic imaging service in Osona. Full article ">

10 pages, 1168 KiB

Open AccessArticle

In-Vitro Growth Inhibition of Bacterial Pathogens by Probiotics and a Synbiotic: Product Composition Matters

by Jacek Piatek, Hanna Krauss, Arleta Ciechelska-Rybarczyk, Malgorzata Bernatek, Paulina Wojtyla-Buciora and Henning Sommermeyer

Int. J. Environ. Res. Public Health 2020, 17(9), 3332; https://doi.org/10.3390/ijerph17093332 - 11 May 2020

Cited by 24 | Viewed by 5427

Abstract

A variety of activities potentially contribute to the beneficial effects of probiotic bacteria observed in humans. Among these is a direct inhibition of the growth of pathogenic bacteria in the gut. The present study characterizes head-to-head the in-vitro pathogen growth inhibition of clinically relevant infectious bacterial strains by different types of probiotics and a synbiotic. In-vitro growth inhibition of Escherichia (E.) coli EPEC, Shigella (Sh.) sonnei, Salmonella (S.) typhimurium, Klebsiella (K.) pneumoniae and Clostridioides (C.) difficile were determined. Investigated products were a yeast mono strain probiotic containing Saccharomyces (Sac.) boulardii, bacterial mono strain probiotics containing either Lactobacillus (L.) rhamnosus GG or L. reuteri DSM 17938, a multi strain probiotic containing three L. rhamnosus strains (E/N, Oxy, Pen), and a multi strain synbiotic containing nine different probiotic bacterial strains and the prebiotic fructooligosaccharides (FOS). Inhibition of pathogens was moderate by Sac. boulardii and L. rhamnosus GG, medium by L. reuteri DSM 17938 and the L. rhamnosus E/N, Oxy, Pen mixture and strong by the multi strain synbiotic. Head-to-head in-vitro pathogen growth inhibition experiments can be used to differentiate products from different categories containing probiotic microorganisms and can support the selection process of products for further clinical evaluation. Full article

(This article belongs to the Special Issue Community and Family-Focused Public Health and Sustainable Development)

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In-vitro growth inhibition of pathogens by different probiotics and a multi strain synbiotic. The L. rhamnosus E/N, Oxy, Pen mixture contains the three different probiotics in a CFU ratio of 40/20/40. The multi strain synbiotic contains a mixture of equal CFU amounts of L. acidophilus LA-14; L. casei R0215; L. paracasei Lpc-3; L. plantarum Lp-115; L. rhamnosus GG, L. salivarius Ls-33, B. lactis Bl-04, B. bifidum R0071, B. longum R0175 and the prebiotic fructooligosaccharides (FOS). Significant differences (p-values < 0.01) between the inhibitions by different products are indicated by horizontal lines marked with an asterisk (*). Full article ">Figure 2
Example of the effects of the multi strain synbiotic (A) and FOS (B) on the in-vitro growth of Enteropathogenic E. coli EPEC. Full article ">

3 pages, 257 KiB

Open AccessEditorial

Global Community Child Health

by Matthew Ellis and Puspa Raj Pant

Int. J. Environ. Res. Public Health 2020, 17(9), 3331; https://doi.org/10.3390/ijerph17093331 - 11 May 2020

Cited by 2 | Viewed by 3297

Abstract

This special issue of IJERPH has published a range of studies in this developing field of Global Community Child Health research. A number of manuscripts submitted in response to our invitation describing ‘community-based interventions which impact on child health and wellbeing around the globe. In addition to rural community-based initiatives given that most children now live in cities we are also interested to hear about urban initiatives….’ We hope this issue will of great interest to the researchers and practitioners as well as academia from the fields of Global Health as well as Global Child Health because it comprised of 14 articles representing all five continents. Physical activity appears a key component of the scientific community’s current conception of child well-being judging from the four papers published addressing this area. This issue also has papers on childhood obesity to rubella vaccination. Despite of the journal’s strive for reaching out to a wider global child health community, this issue missed contributions relating to child safeguarding and social determinants of urban health. Full article

(This article belongs to the Special Issue Global Community Child Health)

16 pages, 747 KiB

Open AccessReview

The Application of the Teaching Games for Understanding in Physical Education. Systematic Review of the Last Six Years

by Raúl A. Barba-Martín, Daniel Bores-García, David Hortigüela-Alcalá and Gustavo González-Calvo

Int. J. Environ. Res. Public Health 2020, 17(9), 3330; https://doi.org/10.3390/ijerph17093330 - 11 May 2020

Cited by 69 | Viewed by 16377

Abstract

A systematic review of the research conducted on Teaching Games for Understanding in Physical Education in the last six years (2014–2019), updating and expanding with new categories the last published review by Harvey and Jarret in 2014. Four databases were used to select those articles that included information on the implementation of Teaching Games for Understanding in different educational stages. According to PRISMA guidelines and including the PICO strategy after the exclusion criteria, 12 articles were fully assessed based on eight criteria: (1) year and author; (2) country; (3) number of participants, educational level, and duration of implementation; (4) type of research; (5) curricular content; (6) purpose of the research; (7) most relevant results; and (8) learning environment. The results showed how research focuses on both primary and secondary education, primarily in short-term interventions. Quantitative, qualitative and mixed research is used almost equally, and dealt evenly with sports and games, leaving motor skills, physical abilities and body expression underrepresented. Regarding the goals of the studies, motor and cognitive learning were the most frequently assessed, focusing on improvement of game development, such as tactical aspects, decision-making, technical skills or level of physical activity. The implementation of the model is carried out in too short a time to achieve significant outcomes. This review can help researchers and practitioners conduct Teaching Games for Understanding intervention programs in primary and secondary Physical Education. They must be rigorous when they claim that they implement this pedagogical model in schools. Full article

(This article belongs to the Special Issue Neuroeducation, Motivation and Physical Activity in Students of Physical Education)

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Flow diagram of the systematic search process. Full article ">

11 pages, 760 KiB

Open AccessArticle

Lacrosse Athletes Load and Recovery Monitoring: Comparison between Objective and Subjective Methods

by Richard Hauer, Antonio Tessitore, Reinhard Knaus and Harald Tschan

Int. J. Environ. Res. Public Health 2020, 17(9), 3329; https://doi.org/10.3390/ijerph17093329 - 11 May 2020

Cited by 11 | Viewed by 4062

Abstract

Both objective (OM) and subjective (SM) methods are used in athletic studies, regardless of sport type, to identify and analyze load and recovery status of athletes. As little information exists about the comparison of these two methodologies, the aim of this study is to compare and contrast information that defines the relationship between both methods. Twelve international male lacrosse athletes participated in this study over the course of which participants heart-rate-variability and questionnaire-data were collected. Statistical analysis was performed to evaluate changes over time and correlations between used methods. Comparison between baseline values and competition showed a reduction in root-mean-square of successive differences (RMSSD) (p < 0.01) and the proportion of beat-intervals (NN) that differ by more than 50 ms divided by total number of NNs (pNN50) (p < 0.01). Further, RMSSD values showed differences during competition with large effects (p = 0.02; η² = 0.24). SM (p < 0.01) showed different progression during competition. Correlation was found for used SM and OM, when considered separately. No evidence for a reliable prediction of OM values using SM could be found. According to these findings, we recommend using a combination of SM and OM data to quantify the physiological stress of training and competition, respectively. Full article

(This article belongs to the Special Issue Sports and Health)

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Daily differences for RMSSD and pNN50 over the course of competition. Results are presented as mean ± SD (95% CI) in (ms) for RMSSD and (%) for pNN50. Full article ">Figure 2
Daily differences for SRS-S, SRS-R, TQR, and RPE over the course of competition. Results are presented as mean ± SD (95% CI) of normalized questionnaires scale level; #—Significant difference for SRS-R to 1st day of competition; *—Significant difference for TQR to 1st day of competition. Full article ">

21 pages, 873 KiB

Open AccessReview

A Systematic Review of Literature on User Behavior in Video Game Live Streaming

by Yi Li, Chongli Wang and Jing Liu

Int. J. Environ. Res. Public Health 2020, 17(9), 3328; https://doi.org/10.3390/ijerph17093328 - 11 May 2020

Cited by 69 | Viewed by 19016

Abstract

Video game live streaming is a kind of real-time video social media that integrates traditional broadcasting and online gaming. With the rapid popularity of video game live streaming in the past decade, researchers have started to investigate the relationship between the use of video game live streaming and various psychological variables. In order to fully understand the factors that affected user participation (streamers and audiences) in video game live streaming and provide a reference to the mental health issues of Internet addiction, this paper summarizes the relevant literature on user behavior in video game live streaming. First, we comprehensively searched literature in six social science databases and thus obtained 24 papers that meet our inclusion criteria. Second, the above literature was presented in table form for classification and we found that the effect factors of user behavior in video game live streaming mainly include user demands and platform impact. Based on Use and Satisfaction theory, this paper reviewed the following four aspects: streamer demand, audience demand, interaction behavior and platform impact, then a relevant theoretical framework was constructed. Finally, this paper looks forward to possible future research topics based on the research platform, research data and research content and so on, hoping to provide a foundation and new ideas for future research. Full article

(This article belongs to the Special Issue Mental and Physical Health, Aggressiveness, and Sedentary Behavior on eSports and Videogames)

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Flowchart of the systematic review process. Note: There were two instances in which the same paper was included for both records for the audiences and records for interaction. Full article ">Figure 2
The research framework of video game live streaming. Source: Compiled by the authors. Full article ">

12 pages, 633 KiB

Open AccessArticle

The Impact of Cigarette Excise Tax Increases on Regular Drinking Behavior: Evidence from China

by Zili Zhang and Rong Zheng

Int. J. Environ. Res. Public Health 2020, 17(9), 3327; https://doi.org/10.3390/ijerph17093327 - 11 May 2020

Cited by 7 | Viewed by 3894

Abstract

(1) Background: Many studies have shown that increasing taxation on cigarettes does play a role in tobacco control, but few studies have focused on whether increasing cigarette excise taxes significantly affects alcohol consumption. In this article, we aim to examine the effects of China’s 2015 increase in the cigarette excise tax on residents’ regular drinking behavior. (2) Methods: Using survey data from China Family Panel Studies (CFPS), we performed a panel logit regression analysis to model the relationship between the cigarette excise tax and regular drinking behavior. The Propensity Score Matching with Difference-in-Differences (PSM-DID) approach was adopted to determine the extent to which the cigarette excise tax affected residents’ drinking behavior. To test whether the cigarette excise tax could change regular drinking behavior by decreasing daily smoking quantity, we used an interaction term model. (3) Results: China’s 2015 increase in the cigarette excise tax had a significant negative effect on the probability of regular alcohol consumption among smokers, and the cigarette excise tax worked by reducing the average daily smoking of smokers. We also found that the regular drinking behavior of male smokers was more deeply affected by the increased cigarette excise tax than females. (4) Conclusions: Our research results not only give a deeper understanding of the impact of the cigarette excise tax, but also provide an important reference with which to guide future decisions concerning excise taxes imposed on cigarettes. Full article

(This article belongs to the Special Issue Incentivizing Healthy Behavior: Policies for Curbing Tobacco, Alcohol and Drug Use and for Promoting Healthy Diets and Increased Physical Activity)

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(a) Cigarette sales volume in China (2010–2018). (b) Regular drinking rate of smokers and non-smokers. Full article ">

17 pages, 1150 KiB

Open AccessReview

Hand Sanitizers: A Review on Formulation Aspects, Adverse Effects, and Regulations

by Jane Lee Jia Jing, Thong Pei Yi, Rajendran J. C. Bose, Jason R. McCarthy, Nagendran Tharmalingam and Thiagarajan Madheswaran

Int. J. Environ. Res. Public Health 2020, 17(9), 3326; https://doi.org/10.3390/ijerph17093326 - 11 May 2020

Cited by 173 | Viewed by 60250

Abstract

Hand hygiene is of utmost importance as it may be contaminated easily from direct contact with airborne microorganism droplets from coughs and sneezes. Particularly in situations like pandemic outbreak, it is crucial to interrupt the transmission chain of the virus by the practice of proper hand sanitization. It can be achieved with contact isolation and strict infection control tool like maintaining good hand hygiene in hospital settings and in public. The success of the hand sanitization solely depends on the use of effective hand disinfecting agents formulated in various types and forms such as antimicrobial soaps, water-based or alcohol-based hand sanitizer, with the latter being widely used in hospital settings. To date, most of the effective hand sanitizer products are alcohol-based formulations containing 62%–95% of alcohol as it can denature the proteins of microbes and the ability to inactivate viruses. This systematic review correlated with the data available in Pubmed, and it will investigate the range of available hand sanitizers and their effectiveness as well as the formulation aspects, adverse effects, and recommendations to enhance the formulation efficiency and safety. Further, this article highlights the efficacy of alcohol-based hand sanitizer against the coronavirus. Full article

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Various types of hand sanitizer dosage forms. Full article ">Figure 2
List of alcohol, non-alcohol compounds, and commonly used excipients in hand sanitizers. Full article ">Figure 3
Illustration of alcohols antiviral mechanism. (Acknowledgement: The illustration was designed using BioRender scientific illustration program). Full article ">

15 pages, 2275 KiB

Open AccessArticle

Dentistry during the COVID-19 Epidemic: An Italian Workflow for the Management of Dental Practice

by Matteo Peditto, Simone Scapellato, Antonia Marcianò, Paola Costa and Giacomo Oteri

Int. J. Environ. Res. Public Health 2020, 17(9), 3325; https://doi.org/10.3390/ijerph17093325 - 11 May 2020

Cited by 45 | Viewed by 14633

Abstract

The COVID-19 outbreak has raised concerns about infection control all over the world. Among health workers, dentists are particularly exposed to the COVID-19 infection risk. The aim of this paper is to present a workflow to manage dental procedures already in use at the Dental Unit of the University Hospital of Messina. The proposed workflow accounts for the many aspects of dental practitioners’ risk in the COVID-19 era, and focuses on the assessment of patient risk level, a two-phase dental procedure management (remote and face-to-face), and the use of specific preventive measures. No cases of COVID-19 infection were detected among patients and staff of the dental unit in a two-month period of time while using this protocol. This workflow seems a promising and effective solution to manage dental procedures during the COVID-19 outbreak, and could be implemented in both public and private practices until the emergency is contained. Full article

(This article belongs to the Special Issue Dental Public Health: Issues, Challenges and Opportunities)

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Flow chart of “urgency of treatment” category assignation, a modified version of the one proposed by SDCEP [<a href="#B43-ijerph-17-03325" class="html-bibr">43</a>]. Full article ">Figure 2
Proposed flow-chart for patient management. Full article ">

11 pages, 572 KiB

Open AccessCase Report

Physician-Delivered Pain Neuroscience Education for Opioid Tapering: A Case Report

by Vikas Agarwal, Adriaan Louw and Emilio J. Puentedura

Int. J. Environ. Res. Public Health 2020, 17(9), 3324; https://doi.org/10.3390/ijerph17093324 - 11 May 2020

Cited by 2 | Viewed by 7342

Abstract

We describe the case of a 75-year-old female with chronic low back pain (CLBP), on opioids for more than 15 years. She presented with an acute episode of nausea, vomiting, abdominal pain, and shortness of breath. After a complete work-up, it was concluded that her presenting symptoms were likely due to her high levels of CLBP and high dose opioids. At the time of intervention, her opioid dosage was between 50–90 MME (Morphine milligram equivalent) (Norco 8 × 7.5 mg/day + Fentanyl 12 mcg patch). She was subsequently seen by the physician for seven outpatient internal medicine appointments over nine months and received Pain Neuroscience Education (PNE) in conjunction with monitored tapering of opioids and other medication associated with her CLBP. This case report demonstrates how a physician might deliver PNE as a viable nonpharmacological treatment option for the tapering of long-term opioids for chronic pain. Full article

(This article belongs to the Special Issue Pain Neuroscience Education, Chronic Pain, and Health Care)

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Self-reported low back pain rating (NPRS). Full article ">Figure 2
Medication-use for CLBP over the course of the treatment (milligrams/day). Full article ">

5 pages, 237 KiB

Open AccessEditorial

Social Media and Health Promotion

by Michael Stellefson, Samantha R. Paige, Beth H. Chaney and J. Don Chaney

Int. J. Environ. Res. Public Health 2020, 17(9), 3323; https://doi.org/10.3390/ijerph17093323 - 11 May 2020

Cited by 25 | Viewed by 6701

Abstract

With over 3 billion users worldwide, social media has become a staple of daily life for people across the globe [...] Full article

(This article belongs to the Special Issue Exploring the Role of Social Media in Health Promotion)

13 pages, 325 KiB

Open AccessArticle

Association between Frequency of Breakfast Consumption and Insulin Resistance Using Triglyceride-Glucose Index: A Cross-Sectional Study of the Korea National Health and Nutrition Examination Survey (2016–2018)

by Hye Jin Joo, Gyu Ri Kim, Eun-Cheol Park and Sung-In Jang

Int. J. Environ. Res. Public Health 2020, 17(9), 3322; https://doi.org/10.3390/ijerph17093322 - 10 May 2020

Cited by 15 | Viewed by 4384

Abstract

Diabetes mellitus is an important chronic disease causing economic and social burden. Insulin resistance is a determinant of diabetes, and regular eating patterns are an important factor in blood sugar control. This study investigated the association between breakfast frequency and the risk of increased insulin resistance in Koreans. Data for 12,856 participants without diabetes in the 2016–2018 Korea National Health and Nutrition Examination Survey were analyzed. Insulin resistance was assessed using the triglyceride-glucose (TyG) index, while the median TyG index value was used to define higher (≥8.5) vs. lower (<8.5) insulin resistance. Association between breakfast frequency and risk of increased insulin resistance was investigated using multiple logistic regression. Compared with those who had regular breakfast 5–7 times per week, the odds ratios (95% confidence intervals) of individuals who did not eat breakfast were the highest at 1.42 (95% CI = 1.24–1.64, p ≤ 0.0001). Those who had breakfast 1–4 times per week had an odds ratio of 1.17 (95% CI = 1.03–1.32, p = 0.0153). We found that a lower weekly breakfast consumption was associated with a higher risk of insulin resistance in Koreans. Promoting the benefits of breakfast can be an important message to improve the health of the population. Full article

17 pages, 1492 KiB

Open AccessArticle

An Empirical Analysis of Energy Consumption, FDI and High Quality Development Based on Time Series Data of Zhejiang Province

by Shaolong Zeng, Yiqun Liu, Junjie Ding and Danlu Xu

Int. J. Environ. Res. Public Health 2020, 17(9), 3321; https://doi.org/10.3390/ijerph17093321 - 10 May 2020

Cited by 33 | Viewed by 4411

Abstract

This paper aims to identify the relationship among energy consumption, FDI, and economic development in China from 1993 to 2017, taking Zhejiang as an example. FDI is the main factor of the rapid development of Zhejiang’s open economy, which promotes the development of the economy, but also leads to the growth in energy consumption. Based on the time series data of energy consumption, FDI inflow, and GDP in Zhejiang from 1993 to 2017, we choose the vector auto-regression (VAR) model and try to identify the relationship among energy consumption, FDI, and economic development. The results indicate that there is a long-run equilibrium relationship among them. The FDI inflow promotes energy consumption, and the energy consumption promotes FDI inflow in turn. FDI promotes economic growth indirectly through energy consumption. Therefore, improving the quality of FDI and energy efficiency has become an inevitable choice to achieve the transition of Zhejiang’s economy from high speed growth to high quality growth. Full article

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Energy consumption and economic growth in Zhejiang Province (1993 to 2017). Data source: Zhejiang Statistical Yearbook. Full article ">Figure 2
Energy consumption intensity in Zhejiang Province (1993 to 2017). Data source: China Environmental Statistics Yearbook, Zhejiang Statistical Yearbook. Full article ">Figure 3
FDI in Zhejiang Province (1993 to 2017). Data source: Zhejiang Statistical Yearbook. Full article ">Figure 4
AR roots graph of the VAR model. Full article ">Figure 5
Impulse response of DLNEC to DLNFDI and DLNGDP. Full article ">Figure 6
Impulse response of DLNFDI to DLNEC and DLNGDP. Full article ">Figure 7
Impulse response of DLNGDP to DLNEC and DLNFDI. Full article ">

12 pages, 292 KiB

Open AccessArticle

Access to Healthcare for Immigrant Children in Canada

by Bukola Salami, Alleson Mason, Jordana Salma, Sophie Yohani, Maryam Amin, Philomena Okeke-Ihejirika and Tehseen Ladha

Int. J. Environ. Res. Public Health 2020, 17(9), 3320; https://doi.org/10.3390/ijerph17093320 - 10 May 2020

Cited by 34 | Viewed by 11256

Abstract

Immigrants experience poorer health outcomes than nonimmigrants in Canada for several reasons. A central contributing factor to poor health outcomes for immigrants is access to healthcare. Previous research on access to healthcare for immigrants has largely focused on the experience of immigrant adults. The purpose of this study was to investigate how immigrants access health services for their children in Alberta, Canada. Our study involved a descriptive qualitative design. Upon receiving ethics approval from the University of Alberta Research Ethics Board, we invited immigrant parents to participate in this study. We interviewed 50 immigrant parents, including 17 fathers and 33 mothers. Interviews were audio recorded, transcribed, and analyzed according to the themes that emerged. Findings reveal that systemic barriers contributed to challenges in accessing healthcare for immigrant children. Participants identified several of these barriers—namely, system barriers, language and cultural barriers, relationship with health professionals, and financial barriers. These barriers can be addressed by policymakers and service providers by strengthening the diversity of the workforce, addressing income as a social determinant of health, and improving access to language interpretation services. Full article

(This article belongs to the Section Children's Health)

10 pages, 314 KiB

Open AccessArticle

Early Osteoporosis Risks and Associated Factors among Caregivers Working in Disability Institutions: IOF One-Minute Osteoporosis Risk Check

by Lan-Ping Lin, Wei-Ju Lai, Shang-Wei Hsu and Jin-Ding Lin

Int. J. Environ. Res. Public Health 2020, 17(9), 3319; https://doi.org/10.3390/ijerph17093319 - 10 May 2020

Cited by 6 | Viewed by 3222

Abstract

This study employed the International Osteoporosis Foundation’s One-Minute Osteoporosis Risk Test to examine factors related to the osteoporosis risk of institutional caregivers. In this cross-sectional study, a self-developed structured questionnaire comprising the One-Minute Osteoporosis Risk Test was used to obtain data on the caregivers’ demographic data, health habits, working style, and osteoporosis risk. Seven disability welfare institutions were selected as research sites, and 465 copies of questionnaires were distributed to the institutions’ employees, with 455 valid responses collected for a valid return rate of 98%. SPSS for Windows (Version 20.0) was used to analyze questionnaire data; descriptive-statistical frequency, a χ² test, and logistic regression were used to determine the correlation between demographic data, health habits, working style, and osteoporosis risk. The results revealed that primary risk factors include <30 min of daily exercise (38%), lack of dairy product or calcium tablet intake (28%), and <10 min of daily outdoor activity or not taking vitamin D supplements (29.9%). In total, 395 (86.8%) of the respondents scored less than 5 in the osteoporosis risk test; the remaining 60 (13.2%) scored 5 or higher, revealing a high risk of early osteoporosis. An independent variable analysis revealed that the risk factors of early osteoporosis include age, education level, having undergone bone density tests, prior disease diagnosis, long-term medication use, physical fitness, dietary habits, and average time of exposure to sunlight. In the multivariate analysis, poor physical fitness (odds ratio [OR] = 2.18, 95% confidence interval [CI]: 1.12–4.27, p = 0.023) and average daily time of exposure to sunlight (OR = 0.24, 95% CI: 0.59–2.59, p < 0.001) were significantly correlated with osteoporosis risk. In other words, respondents with poor physical fitness were 2.18 times as likely to have osteoporosis as those with good physical fitness, and those exposed to sunlight for 30 min or longer every day were 0.24 times as likely to have osteoporosis as those exposed to sunlight for less than 30 min every day. Accordingly, institutions must encourage employees to spend more time in the sun every day and improve their physical fitness through exercise. Full article

(This article belongs to the Special Issue Physical Activity and Exercise in Osteosarcopenia)

16 pages, 1412 KiB

Open AccessArticle

A Conceptual Framework for Modelling Safe Walking and Cycling Routes to High Schools

by Mohammad Lutfur Rahman, Antoni Moore, Melody Smith, John Lieswyn and Sandra Mandic

Int. J. Environ. Res. Public Health 2020, 17(9), 3318; https://doi.org/10.3390/ijerph17093318 - 10 May 2020

Cited by 24 | Viewed by 6922

Abstract

Active transport to or from school presents an opportunity for adolescents to engage in daily physical activity. Multiple factors influence whether adolescents actively travel to/from school. Creating safe walking and cycling routes to school is a promising strategy to increase rates of active transport. This article presents a comprehensive conceptual framework for modelling safe walking and cycling routes to high schools. The framework has been developed based on several existing relevant frameworks including (a) ecological models, (b) the “Five Es” (engineering, education, enforcement, encouragement, and evaluation) framework of transport planning, and (c) a travel mode choice framework for school travel. The framework identifies built environment features (land use mix, pedestrian/cycling infrastructure, neighbourhood aesthetics, and accessibility to local facilities) and traffic safety factors (traffic volume and speed, safe road crossings, and quality of path surface) to be considered when modelling safe walking/cycling routes to high schools. Future research should test this framework using real-world data in different geographical settings and with a combination of tools for the assessment of both macro-scale and micro-scale built environment features. To be effective, the modelling and creation of safe routes to high schools should be complemented by other interventions, including education, enforcement, and encouragement in order to minimise safety concerns and promote active transport. Full article

(This article belongs to the Special Issue Environmental and Psychosocial Factors Associated with Physical Activity Behavior and Motor Competence among Children and Adolescents)

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A conceptual framework for modelling safe walking and cycling routes to high schools. Full article ">Figure 2
Factors considered for modelling safe walking and cycling routes to school for adolescents. Full article ">

12 pages, 1955 KiB

Open AccessArticle

Effects of Long-Term Endurance Exercise and Lithium Treatment on Neuroprotective Factors in Hippocampus of Obese Rats

by Jusik Park, Wookwang Cheon and Kijin Kim

Int. J. Environ. Res. Public Health 2020, 17(9), 3317; https://doi.org/10.3390/ijerph17093317 - 10 May 2020

Cited by 7 | Viewed by 3887

Abstract

To investigate the effects of long-term lithium treatment and low intensity endurance exercise on brain-derived neurotrophic factor (BDNF) expression and glycogen synthase kinase 3 beta (GSK3β) activity in the hippocampus of obese rats. Fifty 10-week-old male Sprague-Dawley rats were selected. There was a control group of 10 rats (chow control group) while the other forty rats were fed on a high-fat diet for eight weeks to induce obesity. Rats were then assigned into four random groups. The rats were given 10 mg/kg lithium chloride (LiCl) dissolved in 1 mL sterile distilled water once a day, 5 times a week. The rats did 20 min of treadmill walking with an exercise intensity of 40% maximal oxygen uptake (VO₂ max) (12 m/min, slope 0%). This was performed for 20 min a day, 3 days a week. Twelve weeks of lithium treatment or endurance exercise significantly reduced body weight and body fat mass in obese rats, without showing additive effects when the treatments were given in parallel or significant toxic responses in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in blood and kidney and liver tissues. BDNF expression in the hippocampus was significantly increased both in exercise and lithium groups with synergistic effects found in the group where both exercise and lithium treatments were given in parallel. On the other hand, the decrease in GSK3β activity was shown only in the lithium treatment group, without showing additive effects when the treatments were given in parallel. Lithium and low-intensity endurance exercise for 12 weeks increased the expression of BDNF, a neuroprotective factor in the hippocampus of obese mice. Lithium treatment alone inhibited the activity of GSK3β. This can be interpreted as a positive indication of applicability of the two factors in the prevention of neurodegenerative diseases. Full article

(This article belongs to the Special Issue Exercise Medicine in Health and Disease)

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Hematoxylin and eosin staining in kidney and liver tissue. (Histological changes were evaluated in nonconsecutive histological fields, randomly chosen at a magnification of 100×. Scale bar, 100 μm; black arrow indicates a normal state that cannot confirm the degeneration of the tubule in kidney). Full article ">Figure 2
Level of BDNF protein expression. a: Significantly different from CC (p < 0.05). b: Significantly different from FC (p < 0.05). c: Significantly different from Li (p < 0.05). d: Significantly different from Ex (p < 0.05). Full article ">Figure 3
GSK3β/p-GSK3β protein expression ratio. a: Significantly different from CC (p < 0.05). c: Significantly different from Li (p < 0.05). e: Significantly different from LEx (p < 0.05). Full article ">

8 pages, 1787 KiB

Open AccessCase Report

Comparison of Skin Lesions Caused by Ixodes ricinus Ticks and Lipoptena cervi Deer Keds Infesting Humans in the Natural Environment

by Weronika Buczek, Alicja M. Buczek, Katarzyna Bartosik and Alicja Buczek

Int. J. Environ. Res. Public Health 2020, 17(9), 3316; https://doi.org/10.3390/ijerph17093316 - 10 May 2020

Cited by 18 | Viewed by 7641

Abstract

Background: The territorial expansion and increased population size of haematophagous arthropods (i.e., the castor bean tick Ixodes ricinus (Ixodida: Ixodidae) and the deer ked Lipoptena cervi (Diptera: Hippoboscidae)) has enhanced the risk of human infestations in Europe. The aim of our study was to present skin lesions induced by tick and deer ked bites in patients from recreational forest regions in southeastern Poland and pay attention to features of skin changes that may be useful in differential diagnosis. Methods: We compare the skin lesions after I. ricinus and L. cervi bite and draw attention to the biological and ecological traits of both ectoparasites, which may be diagnostically relevant for determination of the cause of skin symptoms reported by patients. Results: I. ricinus bites lead to development of erythematous-infiltrative poorly demarcated lesions with a centrally located bite mark, which usually disappears within one to several days. In turn, L. cervi bites leave irregularly shaped scattered erythematous papules. The papules may persist for up to one year and are accompanied by itching. Conclusions: Correct assessment of the clinical picture and its association with an arthropod bite (e.g., tick or deer ked) is highly important for further diagnostic procedures (i.e., differentiation of skin lesions developing in tick-borne diseases and, consequently, correct choice of pharmacological therapy). I. ricinus and L. cervi differ in their developmental cycles and rhythms of activity, which indicates that both species should be considered potential causative agents in the differential diagnosis of skin lesions when the patient has been bitten by an arthropod in autumn and winter months. Full article

(This article belongs to the Section Environment and Applied Ecology)

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(A) A site of an Ixodes ricinus tick bite in the central part of the erythematous-infiltrative lesion, not sharply demarcated from the surrounding normal skin just after tick removal. (B) Lesion erythematous-infiltrative lesion with a diameter of 3 cm clearly demarcated from the surrounding normal skin. In the central part the infiltration decreased 48 h after tick removal. Full article ">Figure 2
Scattered papules on an erythematous, irregular base after feeding of deer ked Lipoptena cervi, four weeks after the bite. Full article ">Figure 3
Ixodes ricinus female. Dorsal side (A) and ventral side (B). Nymph. Dorsal side (C) and ventral side (D). Full article ">Figure 4
Female Lipoptena cervi. Ventral side (A) and dorsal side (B). Full article ">

17 pages, 5205 KiB

Open AccessArticle

Evaluation of Functional Abilities in 0–6 Year Olds: An Analysis with the eEarlyCare Computer Application

by María Consuelo Sáiz-Manzanares, Raúl Marticorena-Sánchez and Álvar Arnaiz-González

Int. J. Environ. Res. Public Health 2020, 17(9), 3315; https://doi.org/10.3390/ijerph17093315 - 9 May 2020

Cited by 3 | Viewed by 3512

Abstract

The application of Industry 4.0 to the field of Health Sciences facilitates precise diagnosis and therapy determination. In particular, its effectiveness has been proven in the development of personalized therapeutic intervention programs. The objectives of this study were (1) to develop a computer application that allows the recording of the observational assessment of users aged 0–6 years old with impairment in functional areas and (2) to assess the effectiveness of computer application. We worked with a sample of 22 users with different degrees of cognitive disability at ages 0–6. The eEarlyCare computer application was developed with the aim of allowing the recording of the results of an evaluation of functional abilities and the interpretation of the results by a comparison with "normal development". In addition, the Machine Learning techniques of supervised and unsupervised learning were applied. The most relevant functional areas were predicted. Furthermore, three clusters of functional development were found. These did not always correspond to the disability degree. These data were visualized with distance map techniques. The use of computer applications together with Machine Learning techniques was shown to facilitate accurate diagnosis and therapeutic intervention. Future studies will address research in other user cohorts and expand the functionality of their application to personalized therapeutic programs. Full article

(This article belongs to the Special Issue Children Development and Health Care in Stress and Wellbeing Contexts)

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21 pages, 2476 KiB

Open AccessArticle

Neural Responses to Infant Emotions and Emotional Self-Awareness in Mothers and Fathers during Pregnancy

by Cristina Trentini, Marco Pagani, Marco Lauriola and Renata Tambelli

Int. J. Environ. Res. Public Health 2020, 17(9), 3314; https://doi.org/10.3390/ijerph17093314 - 9 May 2020

Cited by 6 | Viewed by 4828

Abstract

Neuroscientific research has largely investigated the neurobiological correlates of maternal and (to a much lesser extent) paternal responsiveness in the post-partum period. In contrast, much less is known about the neural processing of infant emotions during pregnancy. Twenty mothers and 19 fathers were recruited independently during the third trimester of pregnancy. High-density electroencephalography (hdEEG) was recorded while expectant parents passively viewed images representing distressed, ambiguous, happy, and neutral faces of unknown infants. Correlational analyses were performed to detect a link between neural responses to infant facial expressions and emotional self-awareness. In response to infant emotions, mothers and fathers showed similar cerebral activity in regions involved in high-order socio-affective processes. Mothers and fathers also showed different brain activity in premotor regions implicated in high-order motor control, in occipital regions involved in visuo-spatial information processing and visual mental imagery, as well as in inferior parietal regions involved in attention allocation. Low emotional self-awareness negatively correlated with activity in parietal regions subserving empathy in mothers, while it positively correlated with activity in temporal and occipital areas implicated in mentalizing and visual mental imagery in fathers. This study may enlarge knowledge on the neural response to infant emotions during pregnancy. Full article

(This article belongs to the Special Issue Parent-Child Interactions: Paths of Intergenerational Transmission of Psychopathological Risk)

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Example of a set of infant facial expressions shown to the parents. (Distress (a); Happy emotions (b); Ambiguous emotions (c); Neutral expressions (d)). Full article ">Figure 2
Cortical representation of the cluster of voxels in which the high-density electroencephalography (hdEEG) signal was higher in response to infant distressed emotions (D) than in response to neutral faces (N), in mothers (a) and fathers (b) respectively. Regional details are presented in <a href="#ijerph-17-03314-t001" class="html-table">Table 1</a>. Full article ">

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