International Journal of Environmental Research and Public Health

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ISSN / EISSN : 1661-7827 / 1660-4601
Current Publisher: MDPI (10.3390)
Total articles ≅ 22,061
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Perpetua Modjadji, Josephine Mashishi
International Journal of Environmental Research and Public Health, Volume 17; doi:10.3390/ijerph17207580

Despite years of interventions intended to reduce child malnutrition in South Africa, its negative effects, stunting in particular, persist mainly among children under five years old living in under-resourced regions. A cross-sectional study was conducted to determine the prevalence of malnutrition and associated factors among 404 children under age five attending childcare services with their mothers in selected healthcare facilities of Limpopo Province, South Africa. Anthropometry, socio-demographics and obstetric history were collected. Height-for-age, weight-for-age and body mass index-for-age Z-scores were used to determine stunting, underweight and thinness among children, respectively. Logistic regression analyses were performed to generate the factors associated with malnutrition. Stunting (45.3%) was the prevalent form of malnutrition among children under age five, affecting boys (51.7%) more than girls (38.8%) and children aged 12–23 months (62.4%) more than those p = 0.004) and underweight (AOR = 2.17, 95% CI: 1.32–3.57, p = 0.002) than girls. Children aged 12–23 months were more likely to be stunted (AOR = 4.79, 95% CI: 2.36–9.75, p ≤ 0.0001) than children aged ≤11 months. Delayed introduction of solid foods increased the odds of stunting (AOR = 5.77, 95% CI: 2.63–12.64, p ≤ 0.0001) and underweight (AOR = 2.05, 95% CI: 1.08–3.89, p = 0.028). Children with normal birth weight were less likely to be thin (AOR = 0.42, 95% CI: 0.19–0.92, p = 0.029) and underweight (AOR = 0.34, 95% CI: 0.17–0.68, p = 0.003) than children who had low birth weight. Children whose mothers had obtained secondary school education (AOR = 0.39, 95% CI: 0.16–0.97, p = 0.044), and Grade 12 or post-Grade 12 education (AOR = 0.32, 95% CI: 0.12–0.83, p = 0.020) were less likely to be stunted than were children of mothers who had only primary school education. Suboptimal complementary feeding predisposed children to stunting and underweight. National nutrition programs should be context-specific to improve the introduction of complementary foods among children, especially in the remote and poor areas.
Filippo Quattrone, Gabriele Donzelli, Sara D’Arienzo, Marco Fornili, Francesco Innocenti, Silvia Forni, Laura Baglietto, Lara Tavoschi, Pier Lopalco
International Journal of Environmental Research and Public Health, Volume 17; doi:10.3390/ijerph17207581

Invasive pneumococcal disease (IPD) is a vaccine-preventable disease characterized by the presence of Streptococcus pneumoniae in normally sterile sites. Since 2007, Italy has implemented an IPD national surveillance system (IPD-NSS). This system suffers from high rates of underreporting. To estimate the level of underreporting of IPD in 2016–2017 in Tuscany (Italy), we integrated data from IPD-NSS and two other regional data sources, i.e., Tuscany regional microbiological surveillance (Microbiological Surveillance and Antibiotic Resistance in Tuscany, SMART) and hospitalization discharge records (HDRs). We collected (1) notifications to IPD-NSS, (2) SMART records positive for S. pneumoniae from normally sterile sites, and (3) hospitalization records with IPD-related International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9) codes in discharge diagnoses. We performed data linkage of the three sources to obtain a combined surveillance system (CSS). Using the CSS, we calculated the completeness of the three sources and performed a three-source log-linear capture–recapture analysis to estimate total IPD underreporting. In total, 127 IPD cases were identified from IPD-NSS, 320 were identified from SMART, and 658 were identified from HDRs. After data linkage, a total of 904 unique cases were detected. The average yearly CSS notification rate was 12.1/100,000 inhabitants. Completeness was 14.0% for IPD-NSS, 35.4% for SMART, and 72.8% for HDRs. The capture–recapture analysis suggested a total estimate of 3419 cases of IPD (95% confidence interval (CI): 1364–5474), corresponding to an underreporting rate of 73.7% (95% CI: 34.0–83.6) for CSS. This study shows substantial underreporting in the Tuscany IPD surveillance system. Integration of available data sources may be a useful approach to complement notification-based surveillance and provide decision-makers with better information to plan effective control strategies against IPD.
Simone Schiavo, Carine Djaiani, Julian Debacker, Lisa Albertini, Daniel Santa Mina, Stephanie Buryk-Iggers, Marcus De Moraes, Mohammad Kanj, Rita Katznelson
International Journal of Environmental Research and Public Health, Volume 17; doi:10.3390/ijerph17207586

Hyperbaric oxygen therapy (HBOT) is widely used to treat several pathologies. The hemodynamic changes during HBOT, particularly the magnitude of arterial blood pressure (ABP) increase, are not completely understood. No clinical predictors for HBOT-induced ABP increase have been described. The purpose of this study was to quantify ABP changes in patients undergoing HBOT and to examine their predictors. This retrospective longitudinal cohort study examined 3291 elective HBOT sessions. Non-invasive ABP was recorded before and after each session. The primary outcome was to quantify the HBOT-induced ABP rise. The secondary outcome was to determine the ABP-rise predictors among demographic and clinical variables. Overall, ABP increased significantly after HBOT; this finding was more evident in the hypertensive subgroup compared to the normotensive one (+6 vs. +16.2 mmHg). Clinical predictors of significant post-HBOT ABP change were history of hypertension and pre-session baseline ABP classification. This study demonstrates an absolute HBOT-induced ABP rise. This change is clinically relevant in patients with history of hypertension. A higher baseline ABP seems a risk factor for clinically relevant ABP change. Pre-session ABP should be used clinically as an indicator for strict ABP monitoring during HBOT; future studies are recommended to explore the ABP optimization before starting an HBO treatment.
Klára Boruzs, Viktor Dombrádi, János Sándor, Gábor Bányai, Robert Horne, Klára Bíró, Attila Nagy
International Journal of Environmental Research and Public Health, Volume 17; doi:10.3390/ijerph17207616

The goal of this study was to translate the Beliefs about Medicines Questionnaire – Specific (BMQ-Specific) for cholesterol-lowering drugs, into the Hungarian, Slovak, Czech and Polish languages and test their reliability with statistical methods. For this purpose, Cronbach’s alpha, confirmatory and exploratory factor analyses were conducted. The analyses included 235 Czech, 205 Hungarian, 200 Polish, and 200 Slovak respondents, all of whom were taking cholesterol-lowering drugs. The translations from English into the target languages were always done by two independent translators. As part of the validation process these translations were pilot tested and after the necessary alterations, they were translated back into English by a third translator. After the approval by the creator of the questionnaire, nationwide surveys were conducted in all four countries. The results of the confirmatory factor analysis were exceptionally good for the Czech and Slovak translations, while the Polish and Hungarian translations marginally crossed the predetermined thresholds. With the exception of a single Polish question, the results of the exploratory factor analysis were deemed acceptable. The translated versions of BMQ-Specific are reliable and valid tools to assess patients’ beliefs about medication, especially medication adherence among patients taking cholesterol-lowering medication. A comparison between the four countries with this questionnaire is now possible.
Rosalba Company-Córdoba, Diego Gómez-Baya, Francisca López-Gaviño, Joaquín A. Ibáñez-Alfonso
International Journal of Environmental Research and Public Health, Volume 17; doi:10.3390/ijerph17207620

Growing up in vulnerable conditions has an impact on children and adolescents’ mental health and well-being outcomes. However, this evidence has rarely been obtained in middle and low-income countries like Guatemala, where food insecurity and exposure to violence frequently threaten childhood development. The aim of this study was to analyse the relations that sociodemographic and socioeconomic factors have with psychological adjustment of low-socioeconomic status (SES) Guatemalan children and adolescents, and how these relations were mediated by food insecurity and exposure to violence. A total of 185 participants (50.8% girls; aged between 6 to 17, M = 11.82, SD = 3.7) from three vulnerable schools located in rural and urban areas of Guatemala were assessed. The results indicated that exposure to violence significantly moderates the effect of sociodemographic and socioeconomic variables in measures of depression, anxiety and health-related quality of life. Adolescents more exposed to violence reported higher levels of depression and anxiety, as well as lower levels of health-related quality of life. In contrast, food insecurity did not seem to influence psychological adjustment outcomes in this low-SES sample. These findings highlight the relevance of exposure to violence for mental health and well-being, and is a factor that should be considered when designing public health policies to promote children and adolescents’ welfare.
Jacqueline Francis, Tan-Chyuan Chin, Dianne Vella-Brodrick
International Journal of Environmental Research and Public Health, Volume 17; doi:10.3390/ijerph17207612

Wellbeing literacy (WL) may be the missing ingredient required to optimally enhance or enable positive psychology intervention (PPI) effectiveness. This study involved Victorian government funded primary schools, including two rural, two regional, and two city schools; participants included 20 classroom teachers and 131 grade five and six primary school students. A brief online PPI was implemented by teachers for 10–15 min, three times per week, for six weeks. This paper examines quantitative data collected pre and post the six week intervention, and qualitative data gathered in week one of the intervention regarding intervention effectiveness. The aim is to examine if a brief online PPI effectively builds intentional emotional vocabulary use, and to discuss how on-line PPIs can be used in public health to improve young people’s WL. Considering evaluations of process effectiveness and outcome measures related to student emotional vocabulary use, results tentatively suggest that online PPIs can positively impact emotional vocabulary capability and intentionality. Multimodal communication was exercised during the PPI, suggesting that the brief online PPI format may provide a valuable tool to promote student WL.
Christopher Rugg, Laura Tiefenthaler, Simon Rauch, Hannes Gatterer, Peter Paal, Mathias Ströhle
International Journal of Environmental Research and Public Health, Volume 17; doi:10.3390/ijerph17207596

To elucidate patterns of and risk factors for acute traumatic injuries in climbers in need of professional rescue, a retrospective evaluation was performed of the Austrian National Registry of Mountain Accidents regarding rock climbing incidents over a 13-year timeframe from 2005 to 2018. From 2992 recorded incidents, 1469 were uninjured but in need of recovery, mainly when alpine climbing. Acute traumatic injuries (n = 1217) were often classified as severe (UIAA ≥ 3; n = 709), and commonly involved fractures (n = 566). Main injury causes were falls (n = 894) frequently preceded by rockfall (n = 229), a stumble (n = 146), a grip or foothold break-out (n = 143), or a belaying error (n = 138). In fatal cases (n = 140), multiple trauma (n = 105) or head injuries (n = 56) were most common, whereas lower extremity injuries (n = 357) were most common in severely injured patients. The risk for severe or fatal injuries increased with age and fall height when ascending or bouldering, during the morning hours, and when climbing without a helmet or rope. The case fatality rate was 4.7%, and the estimated total mortality rate was 0.003–0.007 per 1000 h of rock climbing. Acute traumatic injuries requiring professional rescue when rock climbing are often severe or fatal. Consequent use of a helmet when sport climbing, consistent use of a rope (particularly when ascending), proper spotting when bouldering, and proper training, as well as high vigilance when belaying are likely to help prevent such injuries.
Eerika Finell, Annukka Vainio
International Journal of Environmental Research and Public Health, Volume 17; doi:10.3390/ijerph17207623

It has been well documented that both risk perception and group identification are related to psychosocial well-being. However, their combined effect has rarely been analyzed. We examined the combined effect of perceived risk associated with COVID-19 infection at work and work community identification on psychosocial well-being (i.e., frequency of stress symptoms) among health care and social sector workers in Finland (N = 1 279). Data were collected via an online questionnaire in June 2020 and analyses of covariance were conducted. Perceived COVID-19 infection risk at work was classified into high, medium and low risk. In total, 41% of participants reported a high risk. After all background variables were included, participants who reported high perceived infection risk and low work community identification reported stress symptoms more often than those who reported high perceived risk and high identification (p = 0.010). Similarly, the former differed significantly from all other comparison groups (medium and low risk, p < 0.001), being the most stressed. We found that perceived infection risk and work community identification were not related to each other. Our conclusion is that high work community identification can buffer employee stress when faced with a high perceived health risk. In the context of the COVID-19 pandemic, work organizations with a high infection risk should advance the possibility of employees’ identification with their work community.
Jing Shen, Yang Zhang, Benhai Guo, Suli Zheng
International Journal of Environmental Research and Public Health, Volume 17; doi:10.3390/ijerph17207611

Long-term improvement of ecological environment quality (EEQ) is a hotspot and urgent topic in the context of high-quality and sustainable development. It is urgent to look for methods that could support EEQ improvement in a high-quality and sustainable way. Owing to its natural supporting and guaranteeing functions for enhancing quality, quality infrastructure (QI) is a fundamental and critical element in promoting EEQ, but a neglected one. In this paper, we analyzed the coupling structure between QI and EEQ and applied an improved coupling model to recognize contributed and weakened indicators that affected the coupling relationship. We also examined this coupling relationship in the Yangtze River Delta (YRD) from 2012 to 2017, which proved the current situation where QI construction cannot satisfy the practical needs of EEQ improvement. Results showed that the important supporting role of QI in EEQ improvement should be valued for long-term sustainable development. Meanwhile, equilibrium and consistency of indicators in the QI and EEQ systems determined the coupling state. EEQ improvement countermeasures were also provided according to the coupling relationship analysis results. This study provided a scientific basis and guidance for EEQ improvement and sustainable development.
Ku-Yuan Lee, Chien-Yu Wei, Min-Hua Wu, Chi-Ming Hsieh
International Journal of Environmental Research and Public Health, Volume 17; doi:10.3390/ijerph17207604

Researchers believe that health foods can promote health and that the consumption of health foods can effectively help people to maintain their health. This study mainly adopted the health belief model (HBM) integrated with perceived behavioral control to investigate the repurchase behavior of consumers with regard to health foods that improve gastrointestinal functions. We obtained 550 valid questionnaires from consumers who had purchased gastrointestinal health foods and conducted structural equation modeling. Results from our analysis revealed that perceived susceptibility, perceived severity, perceived benefits of action, and perceived behavioral control exert a positive influence on repurchase intention and that perceived barriers of action exerts a negative influence on repurchase intention. Furthermore, repurchase intention was found to have a positive impact on repurchase behavior. The results of this study can be used as a reference for health food marketing strategies and public health behavior promotions.
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