Most-cited articles · 2018

The 100 most-cited articles in International Journal of Environmental Research and Public Health, 2018

Ranked by OpenAlex citation count on 29 October 2026, out of 2,931 eligible articles International Journal of Environmental Research and Public Health published in 2018. Ranks are frozen; this page will not change. Number one, with 1,573 citations: Drinking Water Nitrate and Human Health: An Updated Review.

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2,931 articles
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2026-10-29

The most-cited articles from this journal in 2018 cluster around several themes, including environmental contaminants and human health, mental health and suicide, and the health effects of urban and physical environments. The top paper, "Drinking Water Nitrate and Human Health: An Updated Review" by Ward, Jones, Brender and colleagues, has 1573 citations. Other highly cited works address urban green space and health, arsenic toxicity in plants, and virtual reality in construction engineering education.

Readers can use this ranked list to see which topics attracted the most scholarly attention among the 2931 eligible articles. The rankings reflect citation counts recorded by OpenAlex and do not by themselves indicate study quality or importance. The list may be useful for identifying influential reviews and research areas within environmental and public health.

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    Drinking Water Nitrate and Human Health: An Updated Review

    Mary H. Ward, Rena R. Jones, Jean D. Brender, Theo M. C. M. de Kok, Peter J. Weyer and 3 more

    1,573 citationsOpen access (CC-BY)doi:10.3390/ijerph15071557OpenAlex

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    Nitrate levels in our water resources have increased in many areas of the world largely due to applications of inorganic fertilizer and animal manure in agricultural areas. The regulatory limit for nitrate in public drinking water supplies was set to protect against infant methemoglobinemia, but other health effects were not considered. Risk of specific cancers and birth defects may be increased when nitrate is ingested under conditions that increase formation of N-nitroso compounds. We previously reviewed epidemiologic studies before 2005 of nitrate intake from drinking water and cancer, adverse reproductive outcomes and other health effects. Since that review, more than 30 epidemiologic studies have evaluated drinking water nitrate and these outcomes. The most common endpoints studied were colorectal cancer, bladder, and breast cancer (three studies each), and thyroid disease (four studies). Considering all studies, the strongest evidence for a relationship between drinking water nitrate ingestion and adverse health outcomes (besides methemoglobinemia) is for colorectal cancer,…

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    Epidemiology of Suicide and the Psychiatric Perspective

    Silke Bachmann

    1,371 citationsOpen access (CC-BY)doi:10.3390/ijerph15071425OpenAlex

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    Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are…

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    Urban Green Space and Its Impact on Human Health

    Michelle C. Kondo, Jaime Fluehr, Thomas P. McKeon, Charles C. Branas

    1,184 citationsOpen access (CC-BY)doi:10.3390/ijerph15030445OpenAlex

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    Background: Over half of the world’s population now lives in urban areas, and this proportion is expected to increase. While there have been numerous reviews of empirical studies on the link between nature and human health, very few have focused on the urban context, and most have examined almost exclusively cross-sectional research. This review is a first step toward assessing the possibility of causal relationships between nature and health in urban settings. Methods: Through systematic review of published literature, we explored the association between urban green space and human health. Results: We found consistent negative association between urban green space exposure and mortality, heart rate, and violence, and positive association with attention, mood, and physical activity. Results were mixed, or no association was found, in studies of urban green space exposure and general health, weight status, depression, and stress (via cortisol concentration). The number of studies was too low to generalize about birth outcomes, blood pressure, heart rate variability, cancer, diabetes,…

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    Arsenic Uptake, Toxicity, Detoxification, and Speciation in Plants: Physiological, Biochemical, and Molecular Aspects

    Ghulam Abbas, Behzad Murtaza, Irshad Bibi, Muhammad Abdul Rehman Shahid, Nabeel Khan Niazi and 4 more

    890 citationsOpen access (CC-BY)doi:10.3390/ijerph15010059OpenAlex

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    Environmental contamination with arsenic (As) is a global environmental, agricultural and health issue due to the highly toxic and carcinogenic nature of As. Exposure of plants to As, even at very low concentration, can cause many morphological, physiological, and biochemical changes. The recent research on As in the soil-plant system indicates that As toxicity to plants varies with its speciation in plants (e.g., arsenite, As(III); arsenate, As(V)), with the type of plant species, and with other soil factors controlling As accumulation in plants. Various plant species have different mechanisms of As(III) or As(V) uptake, toxicity, and detoxification. This review briefly describes the sources and global extent of As contamination and As speciation in soil. We discuss different mechanisms responsible for As(III) and As(V) uptake, toxicity, and detoxification in plants, at physiological, biochemical, and molecular levels. This review highlights the importance of the As-induced generation of reactive oxygen species (ROS), as well as their damaging impacts on plants at biochemical,…

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    A Critical Review of the Use of Virtual Reality in Construction Engineering Education and Training

    Peng Wang, Peng Wu, Jun Wang, Hung-Lin Chi, Xiangyu Wang

    782 citationsOpen access (CC-BY)doi:10.3390/ijerph15061204OpenAlex

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    Virtual Reality (VR) has been rapidly recognized and implemented in construction engineering education and training (CEET) in recent years due to its benefits of providing an engaging and immersive environment. The objective of this review is to critically collect and analyze the VR applications in CEET, aiming at all VR-related journal papers published from 1997 to 2017. The review follows a three-stage analysis on VR technologies, applications and future directions through a systematic analysis. It is found that the VR technologies adopted for CEET evolve over time, from desktop-based VR, immersive VR, 3D game-based VR, to Building Information Modelling (BIM)-enabled VR. A sibling technology, Augmented Reality (AR), for CEET adoptions has also emerged in recent years. These technologies have been applied in architecture and design visualization, construction health and safety training, equipment and operational task training, as well as structural analysis. Future research directions, including the integration of VR with emerging education paradigms and visualization technologies,…

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    A Review of the Processes, Parameters, and Optimization of Anaerobic Digestion

    Jay N. Meegoda, Brian Li, Kush Patel, Lily B. Wang

    726 citationsOpen access (CC-BY)doi:10.3390/ijerph15102224OpenAlex

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    Anaerobic digestion is a technology that has been used by humans for centuries. Anaerobic digestion is considered to be a useful tool that can generate renewable energy and significant research interest has arisen recently. The underlying theory of anaerobic digestion has been established for decades; however, a great deal of current research is directed towards the optimization of anaerobic digestion under diverse digestion conditions. This review provides a summary of the processes underlying anaerobic digestion, commonly-utilized measurements of anaerobic sludge, operating parameters of anaerobic digesters, and methods of acceleration and optimization used to improve process efficiency. Recent developments in addition to older research are considered to provide a general but comprehensive summary of accumulated knowledge in the theory of anaerobic digestion, as well as considerations in the efficient operation of digesters. We have determined that the numerous factors pertinent to the design and operation of batch-based anaerobic digesters must each be considered to ensure the…

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    WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep

    Mathias Basner, Sarah McGuire

    634 citationsOpen access (CC-BY)doi:10.3390/ijerph15030519OpenAlex

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    To evaluate the quality of available evidence on the effects of environmental noise exposure on sleep a systematic review was conducted. The databases PSYCINFO, PubMed, Science Direct, Scopus, Web of Science and the TNO Repository were searched for non-laboratory studies on the effects of environmental noise on sleep with measured or predicted noise levels and published in or after the year 2000. The quality of the evidence was assessed using GRADE criteria. Seventy four studies predominately conducted between 2000 and 2015 were included in the review. A meta-analysis of surveys linking road, rail, and aircraft noise exposure to self-reports of sleep disturbance was conducted. The odds ratio for the percent highly sleep disturbed for a 10 dB increase in Lnight was significant for aircraft (1.94; 95% CI 1.61–2.3), road (2.13; 95% CI 1.82–2.48), and rail (3.06; 95% CI 2.38–3.93) noise when the question referred to noise, but non-significant for aircraft (1.17; 95% CI 0.54–2.53), road (1.09; 95% CI 0.94–1.27), and rail (1.27; 95% CI 0.89–1.81) noise when the question did not refer to…

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    Tobacco Smoke Induces and Alters Immune Responses in the Lung Triggering Inflammation, Allergy, Asthma and Other Lung Diseases: A Mechanistic Review

    Agnieszka Strzelak, Aleksandra Ratajczak, Aleksander Adamiec, Wojciech Feleszko

    622 citationsOpen access (CC-BY)doi:10.3390/ijerph15051033OpenAlex

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    Many studies have been undertaken to reveal how tobacco smoke skews immune responses contributing to the development of chronic obstructive pulmonary disease (COPD) and other lung diseases. Recently, environmental tobacco smoke (ETS) has been linked with asthma and allergic diseases in children. This review presents the most actual knowledge on exact molecular mechanisms responsible for the skewed inflammatory profile that aggravates inflammation, promotes infections, induces tissue damage, and may promote the development of allergy in individuals exposed to ETS. We demonstrate how the imbalance between oxidants and antioxidants resulting from exposure to tobacco smoke leads to oxidative stress, increased mucosal inflammation, and increased expression of inflammatory cytokines (such as interleukin (IL)-8, IL-6 and tumor necrosis factor α ([TNF]-α). Direct cellular effects of ETS on epithelial cells results in increased permeability, mucus overproduction, impaired mucociliary clearance, increased release of proinflammatory cytokines and chemokines, enhanced recruitment of macrophages…

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    WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Cardiovascular and Metabolic Effects: A Summary

    Elise van Kempen, Maribel Casas, Göran Pershagen, María Foraster

    620 citationsOpen access (CC-BY)doi:10.3390/ijerph15020379OpenAlex

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    To update the current state of evidence and assess its quality, we conducted a systematic review on the effects of environmental noise exposure on the cardio-metabolic systems as input for the new WHO environmental noise guidelines for the European Region. We identified 600 references relating to studies on effects of noise from road, rail and air traffic, and wind turbines on the cardio-metabolic system, published between January 2000 and August 2015. Only 61 studies, investigating different end points, included information enabling estimation of exposure response relationships. These studies were used for meta-analyses, and assessments of the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). A majority of the studies concerned traffic noise and hypertension, but most were cross-sectional and suffering from a high risk of bias. The most comprehensive evidence was available for road traffic noise and Ischeamic Heart Diseases (IHD). Combining the results of 7 longitudinal studies revealed a Relative Risk (RR) of 1.08 (95% CI:…

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    Campylobacteriosis, Salmonellosis, Yersiniosis, and Listeriosis as Zoonotic Foodborne Diseases: A Review

    Agnieszka Chlebicz-Wójcik, Katarzyna Śliżewska

    544 citationsOpen access (CC-BY)doi:10.3390/ijerph15050863OpenAlex

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    Zoonoses are diseases transmitted from animals to humans, posing a great threat to the health and life of people all over the world. According to WHO estimations, 600 million cases of diseases caused by contaminated food were noted in 2010, including almost 350 million caused by pathogenic bacteria. Campylobacter, Salmonella, as well as Yersinia enterocolitica and Listeria monocytogenes may dwell in livestock (poultry, cattle, and swine) but are also found in wild animals, pets, fish, and rodents. Animals, often being asymptomatic carriers of pathogens, excrete them with faeces, thus delivering them to the environment. Therefore, pathogens may invade new individuals, as well as reside on vegetables and fruits. Pathogenic bacteria also penetrate food production areas and may remain there in the form of a biofilm covering the surfaces of machines and equipment. A common occurrence of microbes in food products, as well as their improper or careless processing, leads to common poisonings. Symptoms of foodborne infections may be mild, sometimes flu-like, but they also may be accompanied…

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    The Epidemiology of Food Allergy in the Global Context

    Wenyin Loh, Mimi L.K. Tang

    543 citationsOpen access (CC-BY)doi:10.3390/ijerph15092043OpenAlex

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    There is a lack of high-quality evidence based on the gold standard of oral food challenges to determine food allergy prevalence. Nevertheless, studies using surrogate measures of food allergy, such as health service utilization and clinical history, together with allergen-specific immunoglobulin E (sIgE), provide compelling data that the prevalence of food allergy is increasing in both Western and developing countries. In Western countries, challenge-diagnosed food allergy has been reported to be as high as 10%, with the greatest prevalence noted among younger children. There is also growing evidence of increasing prevalence in developing countries, with rates of challenge-diagnosed food allergy in China and Africa reported to be similar to that in Western countries. An interesting observation is that children of East Asian or African descent born in a Western environment are at higher risk of food allergy compared to Caucasian children; this intriguing finding emphasizes the importance of genome-environment interactions and forecasts future increases in food allergy in Asia and…

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    An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach to Public Health

    Wullianallur Raghupathi, Viju Raghupathi

    533 citationsOpen access (CC-BY)doi:10.3390/ijerph15030431OpenAlex

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    In this research we explore the current state of chronic diseases in the United States, using data from the Centers for Disease Control and Prevention and applying visualization and descriptive analytics techniques. Five main categories of variables are studied, namely chronic disease conditions, behavioral health, mental health, demographics, and overarching conditions. These are analyzed in the context of regions and states within the U.S. to discover possible correlations between variables in several categories. There are widespread variations in the prevalence of diverse chronic diseases, the number of hospitalizations for specific diseases, and the diagnosis and mortality rates for different states. Identifying such correlations is fundamental to developing insights that will help in the creation of targeted management, mitigation, and preventive policies, ultimately minimizing the risks and costs of chronic diseases. As the population ages and individuals suffer from multiple conditions, or comorbidity, it is imperative that the various stakeholders, including the government,…

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    Range Expansion of Tick Disease Vectors in North America: Implications for Spread of Tick-Borne Disease

    Daniel E. Sonenshine

    510 citationsOpen access (CC-BY)doi:10.3390/ijerph15030478OpenAlex

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    Ticks are the major vectors of most disease-causing agents to humans, companion animals and wildlife. Moreover, ticks transmit a greater variety of pathogenic agents than any other blood-feeding arthropod. Ticks have been expanding their geographic ranges in recent decades largely due to climate change. Furthermore, tick populations in many areas of their past and even newly established localities have increased in abundance. These dynamic changes present new and increasing severe public health threats to humans, livestock and companion animals in areas where they were previously unknown or were considered to be of minor importance. Here in this review, the geographic status of four representative tick species are discussed in relation to these public health concerns, namely, the American dog tick, Dermacentor variabilis, the lone star tick, Amblyomma americanum, the Gulf Coast Tick, Amblyomma maculatum and the black-legged tick, Ixodes scapularis. Both biotic and abiotic factors that may influence future range expansion and successful colony formation in new habitats are discussed.

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    Physical Activity and Cognitive Functioning of Children: A Systematic Review

    Ilona Bidzan-Bluma, Małgorzata Lipowska

    491 citationsOpen access (CC-BY)doi:10.3390/ijerph15040800OpenAlex

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    Childhood is an important and sensitive period for cognitive development. There is limited published research regarding the relationship between sports and cognitive functions in children. We present studies that demonstrate the influence of physical activity on health, especially a positive correlation between sports and cognitive functions. The keywords “children, cognition, cognitive function, physical activity, and brain” were searched for using PsycInfo, Medline, and Google Scholar, with publication dates ranging from January 2000 to November 2017. Of the 617 results, 58 articles strictly connected to the main topics of physical activity and cognitive functioning were then reviewed. The areas of attention, thinking, language, learning, and memory were analyzed relative to sports and childhood. Results suggest that engaging in sports in late childhood positively influences cognitive and emotional functions. There is a paucity of publications that investigate the impact of sports on pre-adolescents’ cognitive functions, or explore which cognitive functions are developed by which…

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    Association between Internet Gaming Disorder or Pathological Video-Game Use and Comorbid Psychopathology: A Comprehensive Review

    Vega González-Bueso, Juan Santamaría, Daniel Fernández, Laura Merino, Elena Montero and 1 more

    487 citationsOpen access (CC-BY)doi:10.3390/ijerph15040668OpenAlex

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    The addictive use of video games is recognized as a problem with clinical relevance and is included in international diagnostic manuals and classifications of diseases. The association between "Internet addiction" and mental health has been well documented across a range of investigations. However, a major drawback of these studies is that no controls have been placed on the type of Internet use investigated. The aim of this study is to review systematically the current literature in order to explore the association between Internet Gaming Disorder (IGD) and psychopathology. An electronic literature search was conducted using PubMed, PsychINFO, ScienceDirect, Web of Science and Google Scholar (r.n. CRD42018082398). The effect sizes for the observed correlations were identified or computed. Twenty-four articles met the eligibility criteria. The studies included comprised 21 cross-sectional and three prospective designs. Most of the research was conducted in Europe. The significant correlations reported comprised: 92% between IGD and anxiety, 89% with depression, 85% with symptoms of…

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    Suicide Risk and Mental Disorders

    Louise Brådvik

    483 citationsOpen access (CC-BY)doi:10.3390/ijerph15092028OpenAlex

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    Suicide is a major health problem, and the global suicide mortality rate amounts to 1.4% of all deaths worldwide.Most suicides are related to psychiatric disease, with depression, substance use disorders and psychosis being the most relevant risk factors [1].However, anxiety, personality-, eating-, and trauma-related disorders, as well as organic mental disorders, also contribute.Psychological autopsies from the middle of the previous century and onwards have revealed that most people who have died by suicide have suffered from mental disorders [2].A recent figure suggests this number could be at least 90% [3,4].On the other hand, most people with mental disorders do not die by their own hand.The risk of suicide has been estimated to be 5-8% for several mental disorders, such as depression, alcoholism and schizophrenia [5,6].A stress-diathesis model has been proposed in which the risk for suicidal acts is determined not merely by a psychiatric illness (the stressor) but also by a diathesis, such as a tendency to experience more suicidal ideation and to be more likely to act on…

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    Environmental Risk Factors for Developing Type 2 Diabetes Mellitus: A Systematic Review

    Tashi Dendup, Xiaoqi Feng, Stephanie Clingan, Thomas Astell‐Burt

    445 citationsOpen access (CC-BY)doi:10.3390/ijerph15010078OpenAlex

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    Different elements of the environment have been posited to influence type 2 diabetes mellitus (T2DM). This systematic review summarizes evidence on the environmental determinants of T2DM identified in four databases. It proposes a theoretical framework illustrating the link between environment and T2DM, and briefly discusses some methodological challenges and potential solutions, and opportunities for future research. Walkability, air pollution, food and physical activity environment and roadways proximity were the most common environmental characteristics studied. Of the more than 200 reported and extracted relationships assessed in 60 studies, 82 showed significant association in the expected direction. In general, higher levels of walkability and green space were associated with lower T2DM risk, while increased levels of noise and air pollution were associated with greater risk. Current evidence is limited in terms of volume and study quality prohibiting causal inferences. However, the evidence suggests that environmental characteristics may influence T2DM prevention, and also…

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    A Review of Environmental Contamination and Health Risk Assessment of Wastewater Use for Crop Irrigation with a Focus on Low and High-Income Countries

    Sana Khalid, Muhammad Abdul Rehman Shahid, Natasha Natasha, Irshad Bibi, Tania Sarwar and 2 more

    443 citationsOpen access (CC-BY)doi:10.3390/ijerph15050895OpenAlex

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    Population densities and freshwater resources are not evenly distributed worldwide. This has forced farmers to use wastewater for the irrigation of food crops. This practice presents both positive and negative effects with respect to agricultural use, as well as in the context of environmental contamination and toxicology. Although wastewater is an important source of essential nutrients for plants, many environmental, sanitary, and health risks are also associated with the use of wastewater for crop irrigation due to the presence of toxic contaminants and microbes. This review highlights the harmful and beneficial impacts of wastewater irrigation on the physical, biological, and chemical properties of soil (pH, cations and anions, organic matter, microbial activity). We delineate the potentially toxic element (PTEs) build up in the soil and, as such, their transfer into plants and humans. The possible human health risks associated with the use of untreated wastewater for crop irrigation are also predicted and discussed. We compare the current condition of wastewater reuse in…

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    Effect of Drought on Agronomic Traits of Rice and Wheat: A Meta-Analysis

    Jinmeng Zhang, Shiqiao Zhang, Min Cheng, Hong Tao Jiang, Xiuying Zhang and 4 more

    430 citationsOpen access (CC-BY)doi:10.3390/ijerph15050839OpenAlex

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    Drought has been one of the most important limiting factors for crop production, which deleteriously affects food security worldwide. The main objective of the present study was to quantitatively assess the effect of drought on the agronomic traits (e.g., plant height, biomass, yield, and yield components) of rice and wheat in combination with several moderators (e.g., drought stress intensity, rooting environment, and growth stage) using a meta-analysis study. The database was created from 55 published studies on rice and 60 published studies on wheat. The results demonstrated that drought decreased the agronomic traits differently between rice and wheat among varying growth stages. Wheat and rice yields decreased by 27.5% and 25.4%, respectively. Wheat grown in pots showed greater decreases in agronomic traits than those grown in the field. Rice showed opposite growing patterns when compared to wheat in rooting environments. The effect of drought on rice increased with plant growth and drought had larger detrimental influences during the reproductive phase (e.g., blooming stage,…

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    Prevalence and Risk Factors of Depression, Anxiety, and Stress in a Cohort of Australian Nurses

    Shamona Maharaj, Ty Lees, Lal S

    420 citationsOpen access (CC-BY)doi:10.3390/ijerph16010061OpenAlex

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    Nurses remain at the forefront of patient care. However, their heavy workload as a career can leave them overworked and stressed. The demanding nature of the occupation exposes nurses to a higher risk of developing negative mental states such as depression, anxiety, and stress. Hence, the current study aimed to assess the prevalence and risk factors of these mental states in a representative sample of Australian nurses. The Depression Anxiety Stress Scale was administered to 102 nurses. Information about demographic and work characteristics were obtained using lifestyle and in-house designed questionnaires. Prevalence rates of depression, anxiety, and stress were found to be 32.4%, 41.2%, and 41.2% respectively. Binominal logistic regressions for depression and stress were significant (p = 0.007, p = 0.009). Job dissatisfaction significantly predicted a higher risk of nurses developing symptoms of depression and stress respectively (p = 0.009, p = 0.011). Poor mental health among nurses may not only be detrimental to the individual but may also hinder professional performance and in…

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    Air Pollution Forecasts: An Overview

    Lu Bai, Jianzhou Wang, Xuejiao Ma, Haiyan Lu

    414 citationsOpen access (CC-BY)doi:10.3390/ijerph15040780OpenAlex

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    Air pollution is defined as a phenomenon harmful to the ecological system and the normal conditions of human existence and development when some substances in the atmosphere exceed a certain concentration. In the face of increasingly serious environmental pollution problems, scholars have conducted a significant quantity of related research, and in those studies, the forecasting of air pollution has been of paramount importance. As a precaution, the air pollution forecast is the basis for taking effective pollution control measures, and accurate forecasting of air pollution has become an important task. Extensive research indicates that the methods of air pollution forecasting can be broadly divided into three classical categories: statistical forecasting methods, artificial intelligence methods, and numerical forecasting methods. More recently, some hybrid models have been proposed, which can improve the forecast accuracy. To provide a clear perspective on air pollution forecasting, this study reviews the theory and application of those forecasting models. In addition, based on a…

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    Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity

    Wendy M. Wolf, Rachel A. Wattick, Olivia N. Kinkade, Melissa Diann Olfert

    413 citationsOpen access (CC-BY)doi:10.3390/ijerph15112589OpenAlex

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    Polycystic ovarian syndrome (PCOS) is thought to be the most common endocrine disorder found in women. Common symptoms include irregular menstrual cycle, polycystic ovaries, and hirsutism, as well as an increased risk for a multitude of conditions, including insulin resistance, dyslipidemia and infertility. The prevalence of polycystic ovarian syndrome is generally thought to be between 3% and 10% but it is widely unknown for specific subpopulations based on geographical location and race/ethnicity. Based on the high degree of variability and inconsistencies between the different diagnostic criteria, there is a unique challenge that exists when determining the prevalence of this syndrome. There are a large percentage of individuals that remain undiagnosed even after visiting multiple health care providers. Most studies conducted across the world are limited by small sample size, selection bias, and lack of comparability across studies. There have been very few studies that have examined the prevalence of polycystic ovary syndrome across the United States. Based on the National…

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    Fear of Missing Out as a Predictor of Problematic Social Media Use and Phubbing Behavior among Flemish Adolescents

    Vittoria Franchina, Mariek Vanden Abeele, Antonius J. van Rooij, Gianluca Lo Coco, Lieven De Marez

    410 citationsOpen access (CC-BY)doi:10.3390/ijerph15102319OpenAlex

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    Fear-of-missing-out (FOMO) refers to feelings of anxiety that arise from the realization that you may be missing out on rewarding experiences that others are having. FOMO can be identified as an intra-personal trait that drives people to stay up to date of what other people are doing, among others on social media platforms. Drawing from the findings of a large-scale survey study among 2663 Flemish teenagers, this study explores the relationships between FOMO, social media use, problematic social media use (PSMU) and phubbing behavior. In line with our expectations, FOMO was a positive predictor of both how frequently teenagers use several social media platforms and of how many platforms they actively use. FOMO was a stronger predictor of the use of social media platforms that are more private (e.g., Facebook, Snapchat) than platforms that are more public in nature (e.g., Twitter, Youtube). FOMO predicted phubbing behavior both directly and indirectly via its relationship with PSMU. These findings support extant research that points towards FOMO as a factor explaining teenagers'…

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    The Zika Virus Epidemic in Brazil: From Discovery to Future Implications

    Rachel Lowe, Christovam Barcellos, Patrícia Brasil, Oswaldo Gonçalves Cruz, Nildimar Alves Honório and 2 more

    398 citationsOpen access (CC-BY)doi:10.3390/ijerph15010096OpenAlex

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    The first confirmed case of Zika virus infection in the Americas was reported in Northeast Brazil in May 2015, although phylogenetic studies indicate virus introduction as early as 2013. Zika rapidly spread across Brazil and to more than 50 other countries and territories on the American continent. The Aedes aegypti mosquito is thought to be the principal vector responsible for the widespread transmission of the virus. However, sexual transmission has also been reported. The explosively emerging epidemic has had diverse impacts on population health, coinciding with cases of Guillain–Barré Syndrome and an unexpected epidemic of newborns with microcephaly and other neurological impairments. This led to Brazil declaring a national public health emergency in November 2015, followed by a similar decision by the World Health Organization three months later. While dengue virus serotypes took several decades to spread across Brazil, the Zika virus epidemic diffused within months, extending beyond the area of permanent dengue transmission, which is bound by a climatic barrier in the south…

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    Impact of Green Space Exposure on Children’s and Adolescents’ Mental Health: A Systematic Review

    Gert‐Jan Vanaken, Marina Danckaerts

    397 citationsOpen access (CC-BY)doi:10.3390/ijerph15122668OpenAlex

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    In recent years, the interest in the relationship between exposure to green spaces and children's and adolescents' mental health has risen. This systematic review aims to provide an overview of observational studies assessing the association between empirical green space exposure with standardized outcome measures of mental health problems, mental well-being and developmental problems in children, adolescents and young adults. The PRISMA statement guidelines for reporting systematic reviews were followed. A PubMed and Scopus search resulted in the inclusion of 21 studies. The evidence consistently suggests a beneficial association between green space exposure and children's emotional and behavioral difficulties, particularly with hyperactivity and inattention problems. Limited evidence suggests a beneficial association with mental well-being in children and depressive symptoms in adolescents and young adults. These beneficial associations are resistant to adjustment for demographic and socio-economic confounders, which thus may represent independent links. Mediating factors and the…

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    Drivers of Irrational Use of Antibiotics in Europe

    Anna Machowska, Cecilia Stålsby Lundborg

    383 citationsOpen access (CC-BY)doi:10.3390/ijerph16010027OpenAlex

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    The unnecessary use of antibiotics and concomitant rapid growth of antibiotic resistance (ABR) is a widely acknowledged threat to global health, development, and sustainability. While the underlying cause of ABR is undoubtedly the overall volume of antibiotic use in general, irrational antibiotic use, which is influenced by several interrelated factors, is a major contributory factor. Here, we aimed to present and describe selected main drivers of irrational use of antibiotics in Europe. We performed a broad search of the current literature in databases such as PubMed, Google Scholar, Cochrane, as well as various institutional websites (World Health Organization, European Observatory, European Commission) to provide a new perspective on selected drivers of irrational antibiotic use in Europe. We also searched for relevant literature using snowballing, i.e., using reference lists of papers to identify additional papers. In this narrative review, we present that major factors among the general public driving antibiotic resistance are lack of public knowledge and awareness, access to…

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    Phenolic Compounds Diminish Antibiotic Resistance of Staphylococcus Aureus Clinical Strains

    Maria Miklasińska‐Majdanik, Małgorzata Kępa, Robert Dariusz Wojtyczka, Danuta Idzik, Tomasz J. Wąsik

    369 citationsOpen access (CC-BY)doi:10.3390/ijerph15102321OpenAlex

    Show abstract

    There is a growing body of evidence that flavonoids show antibacterial activity against both Gram-positive and Gram-negative bacteria. The mechanisms of action of phenolic compounds on bacterial cell have been partially attributed to damage to the bacterial membrane, inhibition of virulence factors such as enzymes and toxins, and suppression of bacterial biofilm formation. What is more, some natural polyphenols, aside from direct antibacterial activity, exert a synergistic effect when combined with common chemotherapeutics. Many studies have proved that in synergy with antibiotics plant flavonoids pose a promising alternative for therapeutic strategies against drug resistant bacteria. In this review most recent reports on antimicrobial action of polyphenols on Staphylococcus aureus strains are described, highlighting where proven, the mechanisms of action and the structure–activity relationships. Since many reports in this field are, to some extent, conflicting, a unified in vitro and in vivo susceptibility testing algorithms should be introduced to ensure the selection of effective…

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    Media Health Literacy, eHealth Literacy, and the Role of the Social Environment in Context

    Diane Levin‐Zamir, Isabella C. Bertschi

    363 citationsOpen access (CC-BY)doi:10.3390/ijerph15081643OpenAlex

    Show abstract

    Health literacy describes skills and competencies that enable people to gain access to, understand and apply health information to positively influence their own health and the health of those in their social environments. In an increasingly media saturated and digitized world, these skill sets are necessary for accessing and navigating sources of health information and tools, such as television, the Internet, and mobile apps. The concepts of Media Health Literacy (MHL) and eHealth Literacy (eHL) describe the specific competencies such tasks require. This article introduces the two concepts, and then reviews findings on the associations of MHL and eHL with several contextual variables in the social environment such as socio-demographics, social support, and system complexity, as a structural variable. As eHL and MHL are crucial for empowering people to actively engage in their own health, there is a growing body of literature reporting on the potential and the effectiveness of intervention initiatives to positively influence these competencies. From an ethical standpoint, equity is…

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    Loneliness at Universities: Determinants of Emotional and Social Loneliness among Students

    Katharina Diehl, Charlotte Jansen, Kamila Ishchanova, Jennifer Hilger-Kolb

    352 citationsOpen access (CC-BY)doi:10.3390/ijerph15091865OpenAlex

    Show abstract

    The transition from school to university is associated with social, structural, and behavioral changes. These changes may be related to feelings of loneliness, which are in turn related to morbidity. The authors' aim was to quantify loneliness among students and to identify its determinants and its relation to transition-related variables (e.g., changes in weight, diet, or physical activity since the transition from high school to university). Coming from across Germany, 689 students participated in the Nutrition and Physical Activity in Adolescence (NuPhA) survey (16⁻29 years; 69.5% female). Associations of loneliness with the above-mentioned aspects were analyzed using descriptive statistics and linear regressions. Altogether, 32.4% felt moderately lonely and 3.2%, severely lonely. Emotional loneliness was more common than social loneliness (severe loneliness: 7.7% vs. 3.2%). Both were positively associated with feelings of depression and anxiety. Being married or in a committed relationship seemed to be protective factors for emotional loneliness. Physical inactivity, an…

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    Breast Cancer and Its Relationship with the Microbiota

    Mariana Fátima Fernández, Iris Reina-Pérez, Juan Manuel Astorga, Andrea Rodríguez‐Carrillo, Julio Plaza‐Díaz and 1 more

    349 citationsOpen access (CC-BY)doi:10.3390/ijerph15081747OpenAlex

    Show abstract

    The microorganisms that live symbiotically in human beings are increasingly recognized as important players in health and disease. The largest collection of these microorganisms is found in the gastrointestinal tract. Microbial composition reflects both genetic and lifestyle variables of the host. This microbiota is in a dynamic balance with the host, exerting local and distant effects. Microbial perturbation (dysbiosis) could contribute to the risk of developing health problems. Various bacterial genes capable of producing estrogen-metabolizing enzymes have been identified. Accordingly, gut microbiota is capable of modulating estrogen serum levels. Conversely, estrogen-like compounds may promote the proliferation of certain species of bacteria. Therefore, a crosstalk between microbiota and both endogenous hormones and estrogen-like compounds might synergize to provide protection from disease but also to increase the risk of developing hormone-related diseases. Recent research suggests that the microbiota of women with breast cancer differs from that of healthy women, indicating…

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    The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies

    Brandon A. Kohrt, Laura Asher, Anvita Bhardwaj, Mina S. Fazel, Mark J. D. Jordans and 5 more

    348 citationsOpen access (CC-BY)doi:10.3390/ijerph15061279OpenAlex

    Show abstract

    , and the Action Plan of the World Psychiatric Association. There is increasing evidence for effectiveness of mental health interventions delivered by non-specialists in community platforms in low- and middle-income countries (LMIC). However, the role of community components has yet to be summarized. Our objective was to map community interventions in LMIC, identify competencies for community-based providers, and highlight research gaps. Using a review-of-reviews strategy, we identified 23 reviews for the narrative synthesis. Motivations to employ community components included greater accessibility and acceptability compared to healthcare facilities, greater clinical effectiveness through ongoing contact and use of trusted local providers, family involvement, and economic benefits. Locations included homes, schools, and refugee camps, as well as technology-aided delivery. Activities included awareness raising, psychoeducation, skills training, rehabilitation, and psychological treatments. There was substantial variation in the degree to which community components were integrated…

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    Rebuilding the Gut Microbiota Ecosystem

    Antonella Gagliardi, Valentina Totino, Fatima Cacciotti, Valerio Iebba, Bruna Neroni and 5 more

    340 citationsOpen access (CC-BY)doi:10.3390/ijerph15081679OpenAlex

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    A microbial ecosystem in which bacteria no longer live in a mutualistic association is called dysbiotic. Gut microbiota dysbiosis is a condition related with the pathogenesis of intestinal illnesses (irritable bowel syndrome, celiac disease, and inflammatory bowel disease) and extra-intestinal illnesses (obesity, metabolic disorder, cardiovascular syndrome, allergy, and asthma). Dysbiosis status has been related to various important pathologies, and many therapeutic strategies aimed at restoring the balance of the intestinal ecosystem have been implemented. These strategies include the administration of probiotics, prebiotics, and synbiotics; phage therapy; fecal transplantation; bacterial consortium transplantation; and a still poorly investigated approach based on predatory bacteria. This review discusses the various aspects of these strategies to counteract intestinal dysbiosis.

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    Wound Healing Properties of Selected Natural Products

    Nurul ‘Izzah Ibrahim, Sok Kuan Wong, Isa Naina Mohamed, Norazlina Mohamed, Kok‐Yong Chin and 2 more

    339 citationsOpen access (CC-BY)doi:10.3390/ijerph15112360OpenAlex

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    Wound healing is a complex process of recovering the forms and functions of injured tissues. The process is tightly regulated by multiple growth factors and cytokines released at the wound site. Any alterations that disrupt the healing processes would worsen the tissue damage and prolong repair process. Various conditions may contribute to impaired wound healing, including infections, underlying diseases and medications. Numerous studies on the potential of natural products with anti-inflammatory, antioxidant, antibacterial and pro-collagen synthesis properties as wound healing agents have been performed. Their medicinal properties can be contributed by the content of bioactive phytochemical constituents such as alkaloids, essential oils, flavonoids, tannins, saponins, and phenolic compounds in the natural products. This review highlights the in vitro, in vivo and clinical studies on wound healing promotions by the selected natural products and the mechanisms involved.

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    A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries

    Tess M. Bright, Sarah Wallace, Hannah Kuper

    339 citationsOpen access (CC-BY)doi:10.3390/ijerph15102165OpenAlex

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    Rehabilitation seeks to optimize functioning of people with impairments and includes a range of specific health services-diagnosis, treatment, surgery, assistive devices, and therapy. Evidence on access to rehabilitation services for people with disabilities in low- and middle-income countries (LMICs) is limited. A systematic review was conducted to examine this in depth. In February 2017, six databases were searched for studies measuring access to rehabilitation among people with disabilities in LMICs. Eligible measures of access to rehabilitation included: use of assistive devices, use of specialist health services, and adherence to treatment. Two reviewers independently screened titles, abstracts, and full texts. Data was extracted by one reviewer and checked by a second. Of 13,048 screened studies, 77 were eligible for inclusion. These covered a broad geographic area. 17% of studies measured access to hearing-specific services; 22% vision-specific; 31% physical impairment-specific; and 44% measured access to mental impairment-specific services. A further 35% measured access to…

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    Cycling for Transportation in Sao Paulo City: Associations with Bike Paths, Train and Subway Stations

    Alex Antônio Florindo, Lígia Vizeu Barrozo, Gavin Turrell, João Paulo dos Anjos Souza Barbosa, William Cabral‐Miranda and 2 more

    337 citationsOpen access (CC-BY)doi:10.3390/ijerph15040562OpenAlex

    Show abstract

    Cities that support cycling for transportation reap many public health benefits. However, the prevalence of this mode of transportation is low in Latin American countries and the association with facilities such as bike paths and train/subway stations have not been clarified. We conducted a cross-sectional analysis of the relationship between bike paths, train/subway stations and cycling for transportation in adults from the city of Sao Paulo. We used data from the Sao Paulo Health Survey (n = 3145). Cycling for transportation was evaluated by a questionnaire and bike paths and train/subway stations were geocoded using the geographic coordinates of the adults’ residential addresses in 1500-m buffers. We used multilevel logistic regression, taking account of clustering by census tract and households. The prevalence of cycling for transportation was low (5.1%), and was more prevalent in males, singles, those active in leisure time, and in people with bicycle ownership in their family. Cycling for transportation was associated with bike paths up to a distance of 500 m from residences…

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    Governance on the Drug Supply Chain via Gcoin Blockchain

    Jen-Hung Tseng, Yen-Chih Liao, Bin Chong, Shih-Wei Liao

    335 citationsOpen access (CC-BY)doi:10.3390/ijerph15061055OpenAlex

    Show abstract

    As a trust machine, blockchain was recently introduced to the public to provide an immutable, consensus based and transparent system in the Fintech field. However, there are ongoing efforts to apply blockchain to other fields where trust and value are essential. In this paper, we suggest Gcoin blockchain as the base of the data flow of drugs to create transparent drug transaction data. Additionally, the regulation model of the drug supply chain could be altered from the inspection and examination only model to the surveillance net model, and every unit that is involved in the drug supply chain would be able to participate simultaneously to prevent counterfeit drugs and to protect public health, including patients.

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    Artificial Intelligence and Big Data in Public Health

    Kurt K. Benke, Geza Benke

    331 citationsOpen access (CC-BY)doi:10.3390/ijerph15122796OpenAlex

    Show abstract

    Artificial intelligence and automation are topics dominating global discussions on the future of professional employment, societal change, and economic performance. In this paper, we describe fundamental concepts underlying AI and Big Data and their significance to public health. We highlight issues involved and describe the potential impacts and challenges to medical professionals and diagnosticians. The possible benefits of advanced data analytics and machine learning are described in the context of recently reported research. Problems are identified and discussed with respect to ethical issues and the future roles of professionals and specialists in the age of artificial intelligence.

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    Mobile Phone Use and Mental Health. A Review of the Research That Takes a Psychological Perspective on Exposure

    Sara Thomée

    324 citationsOpen access (CC-BY)doi:10.3390/ijerph15122692OpenAlex

    Show abstract

    The purpose of this study was to carry out a review of observational studies that consider links between mobile phone use and mental health from a psychological or behavioral perspective. Systematic literature searches in PubMed and PsycINFO for articles published until 2017 were done. Exclusion criteria included: papers that considered radiofrequency fields, attention, safety, relational consequences, sexual behavior, cyberbullying, and reviews, qualitative, and case or experimental studies. A total of 4738 papers were screened by title and abstract, 404 were retrieved in full text, and 290 were included. Only 5% had any longitudinal design. Self-reporting was the dominating method of measurement. One third of the studies included children or youth. A majority of adult populations consisted of university students and/or self-selected participants. The main research results included associations between frequent mobile phone use and mental health outcomes, such as depressive symptoms and sleep problems. Mobile phone use at bedtime was associated with, e.g., shorter sleep duration…

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    Predicting Infectious Disease Using Deep Learning and Big Data

    Sangwon Chae, Sungjun Kwon, Dong-Hyun Lee

    323 citationsOpen access (CC-BY)doi:10.3390/ijerph15081596OpenAlex

    Show abstract

    Infectious disease occurs when a person is infected by a pathogen from another person or an animal. It is a problem that causes harm at both individual and macro scales. The Korea Center for Disease Control (KCDC) operates a surveillance system to minimize infectious disease contagions. However, in this system, it is difficult to immediately act against infectious disease because of missing and delayed reports. Moreover, infectious disease trends are not known, which means prediction is not easy. This study predicts infectious diseases by optimizing the parameters of deep learning algorithms while considering big data including social media data. The performance of the deep neural network (DNN) and long-short term memory (LSTM) learning models were compared with the autoregressive integrated moving average (ARIMA) when predicting three infectious diseases one week into the future. The results show that the DNN and LSTM models perform better than ARIMA. When predicting chickenpox, the top-10 DNN and LSTM models improved average performance by 24% and 19%, respectively. The DNN model…

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    Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture

    Christina L. Ekegren, Elton R. Edwards, Richard Noel de Steiger, Belinda J. Gabbe

    306 citationsOpen access (CC-BY)doi:10.3390/ijerph15122845OpenAlex

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    Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9…

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    Modern Compact Cities: How Much Greenery Do We Need?

    Alessio Russo, Giuseppe T. Cirella

    306 citationsOpen access (CC-BY)doi:10.3390/ijerph15102180OpenAlex

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    The modern compact city is identified as a high-density and mixed-use pattern. Its features are believed to contribute to a form of functional urban design that supports sustainability and, restresses, the importance of ecosystem services. Urban green space (UGS) plays a vital role in the design and impact on how compact cities have developed and triggered a scientific discord on the amount of greenery individuals require and to what extent contemporary approaches address the question. Research points to at least 9 m² of green space per individual with an ideal UGS value of 50 m² per capita. An examination on the perception, use, quality, accessibility and health risks of urban green and blue spaces is explored, alongside the availability of novel UGS and greenery-related approaches that investigate compact city design and planning for health and wellbeing. The amount of 'green' and relating UGS availability in cities indicates vital knowledge modern compact cities must consider.

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    WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Quality of Life, Wellbeing and Mental Health

    Charlotte Clark, Katarina Paunović

    300 citationsOpen access (CC-BY)doi:10.3390/ijerph15112400OpenAlex

    Show abstract

    This systematic review assesses the quality of the evidence across studies on the effect of environmental noise (road traffic noise, aircraft noise, railway noise, wind-turbine noise) on quality of life, wellbeing and mental health. Quantitative studies of noise effects on children and adults published from January 2005 up to October 2015 were reviewed. A total of 29 papers were identified. 90% of the papers were of cross-sectional design, with fewer studies of longitudinal or intervention design. Outcomes included depression and anxiety, medication use and childhood emotional problems. The quality of the evidence across the studies for each individual noise source was assessed using an adaptation of the GRADE methodology. Overall, given the predominance of cross-sectional studies, most evidence was rated as very low quality, with evidence of effects only being observed for some noise sources and outcomes. These ratings reflect inconsistent findings across studies, the small number of studies and a lack of methodological robustness within some domains. Overall, there are few studies…

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    Aedes Mosquitoes and Aedes-Borne Arboviruses in Africa: Current and Future Threats

    David Weetman, Basile Kamgang, Athanase Badolo, Catherine L. Moyes, Freya M. Shearer and 4 more

    290 citationsOpen access (CC-BY)doi:10.3390/ijerph15020220OpenAlex

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    The Zika crisis drew attention to the long-overlooked problem of arboviruses transmitted by Aedes mosquitoes in Africa. Yellow fever, dengue, chikungunya and Zika are poorly controlled in Africa and often go unrecognized. However, to combat these diseases, both in Africa and worldwide, it is crucial that this situation changes. Here, we review available data on the distribution of each disease in Africa, their Aedes vectors, transmission potential, and challenges and opportunities for Aedes control. Data on disease and vector ranges are sparse, and consequently maps of risk are uncertain. Issues such as genetic and ecological diversity, and opportunities for integration with malaria control, are primarily African; others such as ever-increasing urbanization, insecticide resistance and lack of evidence for most control-interventions reflect problems throughout the tropics. We identify key knowledge gaps and future research areas, and in particular, highlight the need to improve knowledge of the distributions of disease and major vectors, insecticide resistance, and to develop…

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    Food Insecurity and Mental Health among Females in High-Income Countries

    Merryn Sanders Maynard, Lesley Andrade, Sara R. Packull-McCormick, Christopher M. Perlman, Cesar Leos‐Toro and 1 more

    285 citationsOpen access (CC-BY)doi:10.3390/ijerph15071424OpenAlex

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    Food insecurity is a persistent concern in high-income countries, and has been associated with poor mental health, particularly among females. We conducted a scoping review to characterize the state of the evidence on food insecurity and mental health among women in high-income countries. The research databases PubMed, EMBASE, and psycINFO were searched using keywords capturing food insecurity, mental health, and women. Thirty-nine articles (representing 31 unique studies/surveys) were identified. Three-quarters of the articles drew upon data from a version of the United States Department of Agriculture Household Food Security Survey Module. A range of mental health measures were used, most commonly to measure depression and depressive symptoms, but also anxiety and stress. Most research was cross-sectional and showed associations between depression and food insecurity; longitudinal analyses suggested bidirectional relationships (with food insecurity increasing the risk of depressive symptoms or diagnosis, or depression predicting food insecurity). Several articles focused on…

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    Groundwater Arsenic Contamination in the Ganga River Basin: A Future Health Danger

    Dipankar Chakraborti, Sushant Kumar Singh, Mohammad Mahmudur Rahman‬, Rathindra Nath Dutta, Subhas Mukherjee and 2 more

    282 citationsOpen access (CC-BY)doi:10.3390/ijerph15020180OpenAlex

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    This study highlights the severity of arsenic contamination in the Ganga River basin (GRB), which encompasses significant geographic portions of India, Bangladesh, Nepal, and Tibet. The entire GRB experiences elevated levels of arsenic in the groundwater (up to 4730 µg/L), irrigation water (~1000 µg/L), and in food materials (up to 3947 µg/kg), all exceeding the World Health Organization's standards for drinking water, the United Nations Food and Agricultural Organization's standard for irrigation water (100 µg/L), and the Chinese Ministry of Health's standard for food in South Asia (0.15 mg/kg), respectively. Several individuals demonstrated dermal, neurological, reproductive, cognitive, and cancerous effects; many children have been diagnosed with a range of arsenicosis symptoms, and numerous arsenic-induced deaths of youthful victims are reported in the GRB. Victims of arsenic exposure face critical social challenges in the form of social isolation and hatred by their respective communities. Reluctance to establish arsenic standards and unsustainable arsenic mitigation programs…

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    Assessing Vulnerability to Urban Heat: A Study of Disproportionate Heat Exposure and Access to Refuge by Socio-Demographic Status in Portland, Oregon

    Jackson L Voelkel, Dana Hellman, Ryu Sakuma, Vivek Shandas

    278 citationsOpen access (CC-BY)doi:10.3390/ijerph15040640OpenAlex

    Show abstract

    Extreme urban heat is a powerful environmental stressor which poses a significant threat to human health and well-being. Exacerbated by the urban heat island phenomenon, heat events are expected to become more intense and frequent as climate change progresses, though we have limited understanding of the impact of such events on vulnerable populations at a neighborhood or census block group level. Focusing on the City of Portland, Oregon, this study aimed to determine which socio-demographic populations experience disproportionate exposure to extreme heat, as well as the level of access to refuge in the form of public cooling centers or residential central air conditioning. During a 2014 heat wave, temperature data were recorded using a vehicle-traverse collection method, then extrapolated to determine average temperature at the census block group level. Socio-demographic factors including income, race, education, age, and English speaking ability were tested using statistical assessments to identify significant relationships with heat exposure and access to refuge from extreme heat.…

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    Rhizosphere Microbiome Modulators: Contributions of Nitrogen Fixing Bacteria towards Sustainable Agriculture

    Ozede Nicholas Igiehon, Olubukola Oluranti Babalola

    275 citationsOpen access (CC-BY)doi:10.3390/ijerph15040574OpenAlex

    Show abstract

    Rhizosphere microbiome which has been shown to enhance plant growth and yield are modulated or influenced by a few environmental factors such as soil type, plant cultivar, climate change and anthropogenic activities. In particular, anthropogenic activity, such as the use of nitrogen-based chemical fertilizers, is associated with environmental destruction and this calls for a more ecofriendly strategy to increase nitrogen levels in agricultural land. This feat is attainable by harnessing nitrogen-fixing endophytic and free-living rhizobacteria. Rhizobium, Pseudomonas, Azospirillum and Bacillus, have been found to have positive impacts on crops by enhancing both above and belowground biomass and could therefore play positive roles in achieving sustainable agriculture outcomes. Thus, it is necessary to study this rhizosphere microbiome with more sophisticated culture-independent techniques such as next generation sequencing (NGS) with the prospect of discovering novel bacteria with plant growth promoting traits. This review is therefore aimed at discussing factors that can modulate…

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    Internet Risks: An Overview of Victimization in Cyberbullying, Cyber Dating Abuse, Sexting, Online Grooming and Problematic Internet Use

    Juan Manuel Machimbarrena, Esther Calvete, Liria Fernández‐González, Aitor Álvarez-Bardón, Lourdes Álvarez-Fernández and 1 more

    272 citationsOpen access (CC-BY)doi:10.3390/ijerph15112471OpenAlex

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    The advance of digital media has created risks that affect the bio-psycho-social well-being of adolescents. Some of these risks are cyberbullying, cyber dating abuse, sexting, online grooming and problematic Internet use. These risks have been studied individually or through associations of some of them but they have not been explored conjointly. The main objective is to determine the comorbidity between the described Internet risks and to identify the profiles of victimized adolescents. An analytical and cross-sectional study with 3212 participants (46.3% males) from 22 Spanish schools was carried out. Mean age was 13.92 ± 1.44 years (range 11⁻21). Assessment tools with adequate standards of reliability and validity were used. The main results indicate that the most prevalent single risk is cyberbullying victimization (30.27%). The most prevalent two-risk associations are cyberbullying-online grooming (12.61%) and cyberbullying-sexting (5.79%). The three-risk combination of cyberbullying-sexting-grooming (7.12%) is highlighted, while 5.49% of the adolescents present all the risks.…

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    The Challenges of Urban Ageing: Making Cities Age-Friendly in Europe

    Joost van Hoof, Jan K. Kazak, Jolanta M. Perek-Białas, Sebastiaan Theodorus Michaël Peek

    270 citationsOpen access (CC-BY)doi:10.3390/ijerph15112473OpenAlex

    Show abstract

    Urban ageing is an emerging domain that deals with the population of older people living in cities. The ageing of society is a positive yet challenging phenomenon, as population ageing and urbanisation are the culmination of successful human development. One could argue whether the city environment is an ideal place for people to grow old and live at an old age compared to rural areas. This viewpoint article explores and describes the challenges that are encountered when making cities age-friendly in Europe. Such challenges include the creation of inclusive neighbourhoods and the implementation of technology for ageing-in-place. Examples from projects in two age-friendly cities in The Netherlands (The Hague) and Poland (Cracow) are shown to illustrate the potential of making cities more tuned to the needs of older people and identify important challenges for the next couple of years. Overall, the global ageing of urban populations calls for more age-friendly approaches to be implemented in our cities. It is a challenge to prepare for these developments in such a way that both…

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    Microalgae Characterization for Consolidated and New Application in Human Food, Animal Feed and Nutraceuticals

    Antonio Molino, Angela Iovine, Patrizia Casella, Sanjeet Mehariya, Simeone Chianese and 3 more

    264 citationsOpen access (CC-BY)doi:10.3390/ijerph15112436OpenAlex

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    The exploration of new food sources and natural products is the result of the increase in world population as well as the need for a healthier diet; in this context, microalgae are undoubtedly an interesting solution. With the intent to enhance their value in new commercial applications, this paper aims to characterize microalgae that have already been recognized as safe or authorized as additives for humans and animals (Chlorella vulgaris, Arthrospira platensis, Haematococcus pluvialis, Dunaliella salina) as well as those that have not yet been marketed (Scenedesmus almeriensis and Nannocholoropsis sp.). In this scope, the content of proteins, carbohydrates, lipids, total dietary fiber, humidity, ash, and carotenoids has been measured via standard methods. In addition, individual carotenoids (beta-carotene, astaxanthin, and lutein) as well as individual saturated, monounsaturated, and polyunsaturated fatty acids have been identified and quantified chromatographically. The results confirm the prerogative of some species to produce certain products such as carotenoids,…

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    Heavy Metal Accumulation in Water, Soil, and Plants of Municipal Solid Waste Landfill in Vientiane, Laos

    Vongdala Noudeng, Hoang-Dung Tran, Tran Dang Xuan, Rolf Teschke, Tran Dang Khanh

    263 citationsOpen access (CC-BY)doi:10.3390/ijerph16010022OpenAlex

    Show abstract

    The municipal solid waste (MSW) landfill in Vientiane, Laos, which receives > 300 tons of waste daily, of which approximately 50% is organic matter, has caused serious environmental problems. This study was conducted to investigate the accumulated levels of heavy metals (HMs) (cadmium (Cd), chromium (Cr), copper (Cu), nickel (Ni), lead (Pb), and zinc (Zn)) in water (surface and groundwater), soil, and plants between dry and wet seasons according to the standards of the Agreement on the National Environmental Standards of Laos (ANESs), Dutch Pollutant Standards (DPSs), and the World Health Organization (WHO), respectively. Although no impact of pollution on the surface water was observed, the levels of Cr and Pb in the groundwater significantly exceeded the basics of ANESs and WHO in both seasons. The pollution caused by Cd and Cu reached the eco-toxicological risk level in the landfill soils and its vicinity. The vegetable Ipomoea aquatica, which is consumed by the nearby villagers, was seriously contaminated by Cr, Pb, Cu, and Zn, as the accumulation of these toxic metals was…

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    Gcd Gene Diversity of Quinoprotein Glucose Dehydrogenase in the Sediment of Sancha Lake and Its Response to the Environment

    Yong Li, Jianqiang Zhang, Zhiliang Gong, Wenlai Xu, Zishen Mou

    261 citationsOpen access (CC-BY)doi:10.3390/ijerph16010001OpenAlex

    Show abstract

    Quinoprotein glucose dehydrogenase (GDH) is the most important enzyme of inorganic phosphorus-dissolving metabolism, catalyzing the oxidation of glucose to gluconic acid. The insoluble phosphate in the sediment is converted into soluble phosphate, facilitating mass reproduction of algae. Therefore, studying the diversity of gcd genes which encode GDH is beneficial to reveal the microbial group that has a significant influence on the eutrophication of water. Taking the eutrophic Sancha Lake sediments as the research object, we acquired samples from six sites in the spring and autumn. A total of 219,778 high-quality sequences were obtained by DNA extraction of microbial groups in sediments, PCR amplification of the gcd gene, and high-throughput sequencing. Six phyla, nine classes, 15 orders, 29 families, 46 genera, and 610 operational taxonomic units (OTUs) were determined, suggesting the high genetic diversity of gcd. Gcd genes came mainly from the genera of Rhizobium (1.63–77.99%), Ensifer (0.13–56.95%), Shinella (0.32–25.49%), and Sinorhizobium (0.16–11.88%) in the phylum of…

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    Credit Evaluation System Based on Blockchain for Multiple Stakeholders in the Food Supply Chain

    Dianhui Mao, Fan Wang, Zhihao Hao, Haisheng Li

    258 citationsOpen access (CC-BY)doi:10.3390/ijerph15081627OpenAlex

    Show abstract

    The food supply chain is a complex system that involves a multitude of "stakeholders" such as farmers, production factories, distributors, retailers and consumers. "Information asymmetry" between stakeholders is one of the major factors that lead to food fraud. Some current researches have shown that applying blockchain can help ensure food safety. However, they tend to study the traceability of food but not its supervision. This paper provides a blockchain-based credit evaluation system to strengthen the effectiveness of supervision and management in the food supply chain. The system gathers credit evaluation text from traders by smart contracts on the blockchain. Then the gathered text is analyzed directly by a deep learning network named Long Short Term Memory (LSTM). Finally traders' credit results are used as a reference for the supervision and management of regulators. By applying blockchain, traders can be held accountable for their actions in the process of transaction and credit evaluation. Regulators can gather more reliable, authentic and sufficient information about…

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    Gender, Marital Status, and Children as Risk Factors for Burnout in Nurses: A Meta-Analytic Study

    Guillermo A. Cañadas‐De la Fuente, Elena Martín Ortega, Lucía Ramírez‐Baena, Emilia Inmaculada De La Fuente-Solana, Cristina Vargas and 1 more

    257 citationsOpen access (CC-BY)doi:10.3390/ijerph15102102OpenAlex

    Show abstract

    The correlation between the burnout syndrome and sociodemographic variables in nursing professionals has been widely studied though research results are contradictory. The aim of this study was to assess the impact of gender, marital status, and children on the dimensions of the burnout syndrome (emotional exhaustion, depersonalization, and personal accomplishment) in nursing professionals, as measured with the Maslach Burnout Inventory. The search was performed in May 2018 in the next databases: CINAHL, CUIDEN, Dialnet, Psicodoc, ProQuest Platform, OVID Platform, and Scopus with the search equation (“Maslach Burnout Inventory” OR “MBI”) AND “nurs*”, without using any search restriction. The sample was n = 78 studies: 57 studies for gender; 32 for marital status; 13 for having children. A statistically significant relation between depersonalization and gender (r = 0.078), marital status (r = 0.047), and children (r = 0.053) was found. A significant relation was also found between emotional exhaustion and children (r = 0.048). The results showed that being male, being single or…

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    Protozoan Parasites in Drinking Water: A System Approach for Improved Water, Sanitation and Hygiene in Developing Countries

    Alua Oralovna Omarova, Kamshat Tussupova, Ronny Berndtsson, Marat Kalishev, Kulyash Sharapatova

    252 citationsOpen access (CC-BY)doi:10.3390/ijerph15030495OpenAlex

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    Improved water, sanitation and hygiene (WASH) are significant in preventing diarrhea morbidity and mortality caused by protozoa in low- and middle-income countries. Due to the intimate and complex relationships between the different WASH components, it is often necessary to improve not just one but all of these components to have sustainable results. The objective of this paper was to review the current state of WASH-related health problems caused by parasitic protozoa by: giving an overview and classification of protozoa and their effect on people’s health, discussing different ways to improve accessibility to safe drinking water, sanitation services and personal hygiene behavior; and suggesting an institutional approach to ensure improved WASH. The findings indicate that Giardia and Cryptosporidium are more often identified during waterborne or water-washed outbreaks and they are less sensitive than most of the bacteria and viruses to conventional drinking water and wastewater treatment methods. There are various institutions of control and prevention of water-related diseases…

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    Social Frailty Leads to the Development of Physical Frailty among Physically Non-Frail Adults: A Four-Year Follow-Up Longitudinal Cohort Study

    Hyuma Makizako, Hiroyuki Shimada, Takehiko Doi, Kota Tsutsumimoto, Ryo Hotta and 3 more

    251 citationsOpen access (CC-BY)doi:10.3390/ijerph15030490OpenAlex

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    Social frailty domains may play an important role in preventing physical decline and disability. The aim of this study is to examine the impact of social frailty as a risk factor for the future development of physical frailty among community-dwelling older adults who are not yet physically frail. A total of 1226 physically non-frail older adults were analyzed to provide a baseline. Participants completed a longitudinal assessment of their physical frailty 48 months later. Their baseline social frailty was determined based on their responses to five questions, which identified participants who went out less frequently, rarely visited friends, felt less like helping friends or family, lived alone and did not talk to another person every day. Participants with none of these characteristics were considered not to be socially frail; those with one characteristic were considered socially pre-frail; and those with two or more characteristics were considered socially frail. At the four-year follow-up assessment, 24 participants (2.0%) had developed physical frailty and 440 (35.9%) had…

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    Associations between Positive Health-Related Effects and Soundscapes Perceptual Constructs: A Systematic Review

    Francesco Aletta, Tin Oberman, Jian Kang

    249 citationsOpen access (CC-BY)doi:10.3390/ijerph15112392OpenAlex

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    In policy-making and research alike, environmental sounds are often considered only as psychophysical stressors, leading to adverse health effects. The soundscape approach, on the other hand, aims to extend the scope of sound-related research to consider sounds as resources, promoting healthy and supportive environments. The ISO 12913-1 standard defined soundscapes as acoustic environments "as perceived by people, in context." The aim of this study was assessing associations between positive soundscapes (e.g., pleasant, calm, less annoying) and positive health-related effects (e.g., increased restoration, reduced stress-inducing mechanisms, etc.). Studies collecting data about individual responses to urban acoustic environments, and individual responses on psychophysical well-being were selected, looking at cases where positive effects were observed. The Web of Science, Scopus and PubMed databases were searched for peer-reviewed journal papers published in English between 1 January 1991 and 31 May 2018, with combinations of the keywords "soundscape" and at least one among "health",…

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    Global Asbestos Disaster

    Sugio Furuya, Odgerel Chimed‐Ochir, Ken Takahashi, Annette M. David, Jukka Takala

    244 citationsOpen access (CC-BY)doi:10.3390/ijerph15051000OpenAlex

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    Background. Asbestos has been used for thousands of years but in a large industrial scale for about 100–150 years. The first identified disease was asbestosis, a type of incurable pneumoconiosis caused by asbestos dust and fibres. The latest estimate of global number of asbestosis deaths from the Global Burden of Disease estimate 2016 is 3495. Asbestos caused cancer was identified in the late 1930’s but despite of today’s overwhelming evidence of the strong carcinogenicity of all asbestos types including chrysotile it is still widely used globally. Various estimates have been made over time including those of WHO and ILO 107,000–112,000 deaths. Present estimates are radically higher. This special edition of the Journal summarizes key aspects of the past and present of the asbestos problem globally. Methods. Documentation on milestones of asbestos related diseases, ARDs, their recognition, reporting, compensation and prevention efforts were examined, in particular from the regulatory and prevention point of view. Estimated global numbers of incidence and mortality of ARDs were looked…

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    WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Cognition

    Charlotte Clark, Katarina Paunović

    244 citationsOpen access (CC-BY)doi:10.3390/ijerph15020285OpenAlex

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    This systematic review assesses the quality of the evidence across individual studies on the effect of environmental noise (road traffic, aircraft, and train and railway noise) on cognition. Quantitative non-experimental studies of the association between environmental noise exposure on child and adult cognitive performance published up to June 2015 were reviewed: no limit was placed on the start date for the search. A total of 34 papers were identified, all of which were of child populations. 82% of the papers were of cross-sectional design, with fewer studies of longitudinal or intervention design. A range of cognitive outcomes were examined. The quality of the evidence across the studies for each individual noise source and cognitive outcome was assessed using an adaptation of GRADE methodology. This review found, given the predominance of cross-sectional studies, that the quality of the evidence across studies ranged from being of moderate quality for an effect for some outcomes, e.g., aircraft noise effects on reading comprehension and on long-term memory, to no effect for…

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    Risk Factors for Abdominal Aortic Aneurysm in Population-Based Studies: A Systematic Review and Meta-Analysis

    Emma Altobelli, Leonardo Rapacchietta, Valerio Filippo Profeta, Roberto Fagnano

    243 citationsOpen access (CC-BY)doi:10.3390/ijerph15122805OpenAlex

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    Abdominal aortic aneurysm (AAA) represents an important public health problem with a prevalence between 1.3% and 12.5%. Several population-based randomized trials have evaluated ultrasound screening for AAA providing evidence of a reduction in aneurysm-related mortality in the screened population. The aim of our study was to perform a systematic review and meta-analysis of the risk factors for AAA. We conducted a systematic review of observational studies and we performed a meta-analysis that evaluated the following risk factors: gender, smoking habits, hypertension, coronary artery disease and family history of AAA. Respect to a previous a meta-analysis we added the funnel plot to examine the effect sizes estimated from individual studies as measure of their precision; sensitivity analysis to check the stability of study findings and estimate how the overall effect size would be modified by removal of one study; cumulative analysis to evaluate the trend between studies in relation to publication year. Abdominal aortic aneurysm prevalence is higher in smokers and in males. On the…

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    Generalized Unsafety Theory of Stress: Unsafe Environments and Conditions, and the Default Stress Response

    JOS F. BROSSCHOT, Bart Verkuil, Julian Francis Thayer

    243 citationsOpen access (CC-BY)doi:10.3390/ijerph15030464OpenAlex

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    Prolonged physiological stress responses form an important risk factor for disease. According to neurobiological and evolution-theoretical insights the stress response is a default response that is always "on" but inhibited by the prefrontal cortex when safety is perceived. Based on these insights the Generalized Unsafety Theory of Stress (GUTS) states that prolonged stress responses are due to generalized and largely unconsciously perceived unsafety rather than stressors. This novel perspective necessitates a reconstruction of current stress theory, which we address in this paper. We discuss a variety of very common situations without stressors but with prolonged stress responses, that are not, or not likely to be caused by stressors, including loneliness, low social status, adult life after prenatal or early life adversity, lack of a natural environment, and less fit bodily states such as obesity or fatigue. We argue that in these situations the default stress response may be chronically disinhibited due to unconsciously perceived generalized unsafety. Also, in chronic stress…

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    Problematic Use of the Internet and Smartphones in University Students: 2006–2017

    Xavier Carbonell, Andrés Chamarro Lusar, Ursula E. Oberst, Beatriz Rodrigo, Mariona Prades

    240 citationsOpen access (CC-BY)doi:10.3390/ijerph15030475OpenAlex

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    It has been more than a decade since a concern about the addictive use of the Internet and mobile phones was first expressed, and its possible inclusion into the lists of mental disorders has recently become a popular topic of scientific discussion. Thus, it seems to be a fitting moment to investigate the prevalence of this issue over time. The aim of the present study was to analyze the prevalence of the perception of problematic Internet and smartphone use in young people over the period 2006-2017. To this end, a questionnaire on Internet use habits and two questionnaires on the negative consequences of Internet and smartphone use were administered to a sample of 792 university students. The scores were then compared with the results of former studies that had used these questionnaires. The perception of problematic Internet and mobile phone use has increased over the last decade, social networks are considered responsible for this increase, and females are perceived to be more affected than males. The current study shows how strong smartphone and Internet addiction and social…

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    Assessing Heat Stress and Health among Construction Workers in a Changing Climate: A Review

    Payel Acharya, Bethany Boggess, Kai Zhang

    237 citationsOpen access (CC-BY)doi:10.3390/ijerph15020247OpenAlex

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    Construction workers are at an elevated risk of heat stress, due to the strenuous nature of the work, high temperature work condition, and a changing climate. An increasing number of workers are at risk, as the industry's growth has been fueled by high demand and vast numbers of immigrant workers entering into the U.S., the Middle East and Asia to meet the demand. The risk of heat-related illnesses is increased by the fact that little to no regulations are present and/or enforced to protect these workers. This review recognizes the issues by summarizing epidemiological studies both in the U.S. and internationally. These studies have assessed the severity with which construction workers are affected by heat stress, risk factors and co-morbidities associated with heat-related illnesses in the construction industry, vulnerable populations, and efforts in implementing preventive measures.

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    Mobile App-Based Health Promotion Programs: A Systematic Review of the Literature

    Mikyung Lee, Hyeonkyeong Lee, Youlim Kim, Jung-Hee Kim, Mikyeong Cho and 2 more

    235 citationsOpen access (CC-BY)doi:10.3390/ijerph15122838OpenAlex

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    This study investigated the features and usefulness of mobile app-based health promotion programs for the general population. A comprehensive bibliographic search of studies on health promotion programs using mobile apps in peer-reviewed journals published in English up to November 2017 was performed using the PubMed, Embase, and CINAHL databases. The inclusion criteria were (1) randomized control trial designs; (2) assessed mobile app-based interventions to promote adult health conditions; 12 studies were ultimately included. The most common topics were diet and physical activity (n = 8) and overall healthy lifestyle improvement (n = 4). The purpose of the apps included providing feedback on one’s health status (n = 9) and monitoring individual health status or behavior change (n = 9). Across all studies, health outcomes were shown to be better for mobile app users compared to non-users. Mobile app-based health interventions may be an effective strategy for improving health promotion behaviors in the general population without diseases. This study suggests that mobile app use is…

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    The Impacts of Transportation Infrastructure on Sustainable Development: Emerging Trends and Challenges

    Luqi Wang, Xiaolong Xue, Zebin Zhao, Zeyu Wang

    232 citationsOpen access (CC-BY)doi:10.3390/ijerph15061172OpenAlex

    Show abstract

    Transportation infrastructure has an enormous impact on sustainable development. To identify multiple impacts of transportation infrastructure and show emerging trends and challenges, this paper presents a scientometric review based on 2543 published articles from 2000 to 2017 through co-author, co-occurring and co-citation analysis. In addition, the hierarchy of key concepts was analyzed to show emerging research objects, methods and levels according to the clustering information, which includes title, keyword and abstract. The results expressed by visual graphs compared high-impact authors, collaborative relationships among institutions in developed and developing countries. In addition, representative research issues related to the economy, society and environment were identified such as cost overrun, spatial economy, prioritizing structure, local development and land value. Additionally, two future directions, integrated research of various effects and structure analysis of transportation network, are recommended. The findings of this study provide researchers and practitioners…

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    Solar Radiation Exposure and Outdoor Work: An Underestimated Occupational Risk

    Alberto Modenese, Leena H. Korpinen, Fabriziomaria Gobba

    223 citationsOpen access (CC-BY)doi:10.3390/ijerph15102063OpenAlex

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    A considerably high number of outdoor workers worldwide are constantly exposed for the majority of their working life to solar radiation (SR); this exposure is known to induce various adverse health effects, mainly related to its ultraviolet (UV) component. The skin and the eye are the principal target organs for both acute and long-term exposure. Actinic keratosis, non-melanoma skin cancers, and malignant melanoma are the main long-term adverse skin effects, whereas in the eye pterygium, cataracts, and according to an increasing body of evidence, macular degeneration may be induced. Despite this, SR exposure risk is currently undervalued, if not neglected, as an occupational risk factor for outdoor workers. SR exposure is influenced by various environmental and individual factors, and occupation is one of the most relevant. For a better understanding of this risk and for the development of more effective prevention strategies, one of the main problems is the lack of available and adequate methods to estimate SR worker exposure, especially long-term exposure. The main aims of this…

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    A Systematic Review of Sexual and Reproductive Health Knowledge, Experiences and Access to Services among Refugee, Migrant and Displaced Girls and Young Women in Africa

    Olena Ivanova, Masna Rai, Elizabeth Kemigisha

    219 citationsOpen access (CC-BY)doi:10.3390/ijerph15081583OpenAlex

    Show abstract

    Adolescent girls and young women are an overlooked group within conflict- or disaster-affected populations, and their sexual and reproductive health (SRH) needs are often neglected. Existing evidence shows that forced migration and human mobility make girls and women more vulnerable to poor SRH outcomes such as high risk sexual behaviors, lack of contraception use, STIs and HIV/AIDS. We performed a systematic literature review to explore knowledge, experiences and access to SRH services in this population group across the African continent. Two databases (PubMed and Web of Science) were searched and from 896 identified publications, 15 peer-reviewed articles published in English met the inclusion criteria for this review. These consisted of eight applied qualitative, five quantitative and two mixed-method study designs. The quality of the studies was evaluated by the mixed-methods appraisal tool (MMAT) using scores in percentages (0⁻100%). Available evidence indicates that knowledge of young women and girls regarding contraceptive methods, STIs and HIV/AIDS are limited. This…

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    A Comparison of the Health Effects of Ambient Particulate Matter Air Pollution from Five Emission Sources

    Neil J. Hime, Guy Barrington Marks, Christine T. Cowie

    216 citationsOpen access (CC-BY)doi:10.3390/ijerph15061206OpenAlex

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    This article briefly reviews evidence of health effects associated with exposure to particulate matter (PM) air pollution from five common outdoor emission sources: traffic, coal-fired power stations, diesel exhaust, domestic wood combustion heaters, and crustal dust. The principal purpose of this review is to compare the evidence of health effects associated with these different sources with a view to answering the question: Is exposure to PM from some emission sources associated with worse health outcomes than exposure to PM from other sources? Answering this question will help inform development of air pollution regulations and environmental policy that maximises health benefits. Understanding the health effects of exposure to components of PM and source-specific PM are active fields of investigation. However, the different methods that have been used in epidemiological studies, along with the differences in populations, emission sources, and ambient air pollution mixtures between studies, make the comparison of results between studies problematic. While there is some evidence…

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    Microplastics in Sediment and Surface Water of West Dongting Lake and South Dongting Lake: Abundance, Source and Composition

    Changbo Jiang, Lingshi Yin, Xiaofeng Wen, Chunyan Du, Lixue Wu and 6 more

    215 citationsOpen access (CC-BY)doi:10.3390/ijerph15102164OpenAlex

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    Microplastic pollution was investigated in sediment and surface water in West Dongting Lake and South Dongting Lake for the first time. The abundance of microplastics ranged from 616.67 to 2216.67 items/m³ and 716.67 to 2316.67 items/m³ in the lakeshore surface water of West Dongting Lake and South Dongting Lake, respectively. The highest levels of microplastic pollution were found in the lakes' outlets. In the lake center sites of the West Dongting Lake and South Dongting Lake, the abundance of microplastics ranged from 433.33 to 1500 items/m³ and 366.67 to 1566.67 items/m³, respectively. Meanwhile, the study found that in lakeshore sediment of West Dongting Lake and South Dongting Lake, microplastic concentrations ranged from 320 to 480 items/m³ and 200⁻1150 items/m³. Polystyrene (PS) and polyethylene terephthalate (PET) were most common in the surface water and sediment samples, respectively. In addition, we suggest that the effects of polymer types in microplastics should be taken into account when considering abundance. This study can provide valuable points of reference to…

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    Improved Prediction of Harmful Algal Blooms in Four Major South Korea’s Rivers Using Deep Learning Models

    Sang Mok Lee, Dong-Hyun Lee

    213 citationsOpen access (CC-BY)doi:10.3390/ijerph15071322OpenAlex

    Show abstract

    Harmful algal blooms are an annual phenomenon that cause environmental damage, economic losses, and disease outbreaks. A fundamental solution to this problem is still lacking, thus, the best option for counteracting the effects of algal blooms is to improve advance warnings (predictions). However, existing physical prediction models have difficulties setting a clear coefficient indicating the relationship between each factor when predicting algal blooms, and many variable data sources are required for the analysis. These limitations are accompanied by high time and economic costs. Meanwhile, artificial intelligence and deep learning methods have become increasingly common in scientific research; attempts to apply the long short-term memory (LSTM) model to environmental research problems are increasing because the LSTM model exhibits good performance for time-series data prediction. However, few studies have applied deep learning models or LSTM to algal bloom prediction, especially in South Korea, where algal blooms occur annually. Therefore, we employed the LSTM model for algal…

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    Relationships between Microbial Indicators and Pathogens in Recreational Water Settings

    Asja Korajkic, Brian R. McMinn, Valerie J. Harwood

    212 citationsOpen access (CC-BY)doi:10.3390/ijerph15122842OpenAlex

    Show abstract

    Fecal pollution of recreational waters can cause scenic blight and pose a threat to public health, resulting in beach advisories and closures. Fecal indicator bacteria (total and fecal coliforms, Escherichia coli, and enterococci), and alternative indicators of fecal pollution (Clostridium perfringens and bacteriophages) are routinely used in the assessment of sanitary quality of recreational waters. However, fecal indicator bacteria (FIB), and alternative indicators are found in the gastrointestinal tract of humans, and many other animals and therefore are considered general indicators of fecal pollution. As such, there is room for improvement in terms of their use for informing risk assessment and remediation strategies. Microbial source tracking (MST) genetic markers are closely associated with animal hosts and are used to identify fecal pollution sources. In this review, we examine 73 papers generated over 40 years that reported the relationship between at least one indicator and one pathogen group or species. Nearly half of the reports did not include statistical analysis,…

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    Are Differences in Physical Activity across Socioeconomic Groups Associated with Choice of Physical Activity Variables to Report?

    Ragna Stalsberg, Arve Vorland Pedersen

    210 citationsOpen access (CC-BY)doi:10.3390/ijerph15050922OpenAlex

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    Despite being challenged in recent years, the hypothesis that individuals of higher socioeconomic status (SES) are more physically active than their lower SES counterparts is generally considered a fact. Recent reviews, however, have suggested that differences across groups might be related to which physical activity (PA) domains have been investigated. In the present review, searches for relevant studies were performed in the MEDLINE, ISI Web of Knowledge and SPORTDiscus databases. Search terms included “socioeconomic”, “socio-economic”, “socio economic” and “social class” to meet all variations of the variable “socioeconomic status” in combination with the term “physical activity”. Studies were included when applying the dimensions of intensity, frequency, type/mode, and duration in measuring PA. Fifty-six studies were included and were subsequently split into four PA domains: transport PA (TPA), occupational PA (OPA), housing PA (HPA) and leisure time PA (LTPA). It turned out that the positive relationship held only for LTPA, whereas the relationship was non-existent or even…

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    Menstrual Hygiene Management and Waste Disposal in Low and Middle Income Countries—A Review of the Literature

    Myles F. Elledge, Arundati Muralidharan, Alison Parker, Kristin T. Ravndal, Mariam Siddiqui and 2 more

    208 citationsOpen access (CC-BY)doi:10.3390/ijerph15112562OpenAlex

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    Menstrual hygiene management (MHM) has gained some attention and several literature reviews have been published. However, both original papers and reviews tend to focus on absorbent access and use and not on the disposal of menstrual waste. This review aims to fill a gap in the water, sanitation and hygiene (WASH) sector by bringing a focus specifically on menstrual hygiene safe disposal in low- and middle-income countries (LMIC). We reviewed published literature since 2002 on menstrual hygiene with a focus on menstrual waste management and menstrual absorbent disposal in LMIC. Database searches were conducted of both peer reviewed literature and grey literature, in addition to hand searching of references of relevant earlier literature reviews. In total 152 articles and reports were identified and 75 met the inclusion criteria and was included in the final review. Existing polices on MHM was also reviewed with a focus on India and South Africa. The review showed that disposal of menstrual waste is often neglected MHM and sanitation value chains, leading to improper disposal and…

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    Improving Sexual Health Education Programs for Adolescent Students through Game-Based Learning and Gamification

    Hussein Haruna, Xiao Hu, Samuel Kai Wah Chu, Robin R. Mellecker, Goodluck Gabriel and 1 more

    208 citationsOpen access (CC-BY)doi:10.3390/ijerph15092027OpenAlex

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    An effective innovative pedagogy for sexual health education is required to meet the demands of technology savvy digital natives. This study investigates the extent to which game-based learning (GBL) and gamification could improve the sexual health education of adolescent students. We conducted a randomized control trial of GBL and gamification experimental conditions. We made a comparison with traditional teaching as a control condition in order to establish differences between the three teaching conditions. The sexual health education topics were delivered in a masked fashion, 40-min a week for five weeks. A mixed-method research approach was uses to assess and analyze the results for 120 students from a secondary school in Dar Es Salaam, Tanzania. Students were divided into groups of 40 for each of the three teaching methods: GBL, gamification, and the control group (the traditional teaching method). The average post-test scores for GBL (Mean = 79.94, SD = 11.169) and gamification (Mean = 79.23, SD = 9.186) were significantly higher than the control group Mean = 51.93, SD =…

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    Biochar from Biosolids Pyrolysis: A Review

    Jorge Paz‐Ferreiro, Aurora Nieto, Ana Méndez, Matthew Askeland, Gabriel Gascó

    208 citationsOpen access (CC-BY)doi:10.3390/ijerph15050956OpenAlex

    Show abstract

    Ever increasing volumes of biosolids (treated sewage sludge) are being produced by municipal wastewater facilities. This is a consequence of the continued expansion of urban areas, which in turn require the commissioning of new treatment plants or upgrades to existing facilities. Biosolids contain nutrients and energy which can be used in agriculture or waste-to-energy processes. Biosolids have been disposed of in landfills, but there is an increasing pressure from regulators to phase out landfilling. This article performs a critical review on options for the management of biosolids with a focus on pyrolysis and the application of the solid fraction of pyrolysis (biochar) into soil.

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    A Review of Recent Advances in Research on PM2.5 in China

    Yaolin Lin, Jiale Zou, Wei Hsuin Yang, Chun‐Qing Li

    208 citationsOpen access (CC-BY)doi:10.3390/ijerph15030438OpenAlex

    Show abstract

    PM2.5 pollution has become a severe problem in China due to rapid industrialization and high energy consumption. It can cause increases in the incidence of various respiratory diseases and resident mortality rates, as well as increase in the energy consumption in heating, ventilation, and air conditioning (HVAC) systems due to the need for air purification. This paper reviews and studies the sources of indoor and outdoor PM2.5, the impact of PM2.5 pollution on atmospheric visibility, occupational health, and occupants’ behaviors. This paper also presents current pollution status in China, the relationship between indoor and outdoor PM2.5, and control of indoor PM2.5, and finally presents analysis and suggestions for future research.

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    Climate Change Adaptation through the Water-Energy-Food Nexus in Southern Africa

    Sylvester Mpandeli, Dhesigen Naidoo, Tafadzwanashe Mabhaudhi, Charles Nhemachena, Luxon Nhamo and 3 more

    206 citationsOpen access (CC-BY)doi:10.3390/ijerph15102306OpenAlex

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    Climate change is a complex and cross-cutting problem that needs an integrated and transformative systems approach to respond to the challenge. Current sectoral approaches to climate change adaptation initiatives often create imbalances and retard sustainable development. Regional and international literature on climate change adaptation opportunities and challenges applicable to southern Africa from a water-energy-food (WEF) nexus perspective was reviewed. Specifically, this review highlights climate change impacts on water, energy, and food resources in southern Africa, while exploring mitigation and adaptation opportunities. The review further recommends strategies to develop cross-sectoral sustainable measures aimed at building resilient communities. Regional WEF nexus related institutions and legal frameworks were also reviewed to relate the WEF nexus to policy. Southern Africa is witnessing an increased frequency and intensity in climate change-associated extreme weather events, causing water, food, and energy insecurity. A projected reduction of 20% in annual rainfall by 2080…

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    The Neighborhood Effect Averaging Problem (NEAP): An Elusive Confounder of the Neighborhood Effect

    Mei‐Po Kwan

    202 citationsOpen access (CC-BY)doi:10.3390/ijerph15091841OpenAlex

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    Ignoring people's daily mobility and exposures to nonresidential contexts may lead to erroneous results in epidemiological studies of people's exposures to and the health impact of environmental factors. This paper identifies and describes a phenomenon called neighborhood effect averaging, which may significantly confound the neighborhood effect as a result of such neglect when examining the health impact of mobility-dependent exposures (e.g., air pollution). Several recent studies that provide strong evidence for the neighborhood effect averaging problem (NEAP) are discussed. The paper concludes that, due to the observed attenuation of the neighborhood effect associated with people's daily mobility, increasing the mobility of those who live in disadvantaged neighborhoods may be helpful for improving their health outcomes.

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    The Role of Gender in Preparedness and Response Behaviors towards Flood Risk in Serbia

    Vladimir Miroljub Cvetković, Giulia Roder, Adem Öcal, Paolo Tarolli, Slavoljub Dragićević

    201 citationsOpen access (CC-BY)doi:10.3390/ijerph15122761OpenAlex

    Show abstract

    Adverse outcomes from 2014 flooding in Serbia indicated problematic response phase management accentuated by a gender imbalance. For this reason, we investigated the risk perceptions and preparedness of women and men regarding these types of events in Serbia. Face-to-face interviews, administered to 2500 participants, were conducted across 19 of 191 municipalities. In light of the current findings, men seemed to be more confident in their abilities to cope with flooding, perceiving greater individual and household preparedness. By contrast, women displayed a deeper understanding of these events. Perhaps owing to a deeper level of understanding, women demonstrated more household-caring attitudes and behaviors and were more prone to report a willingness to help flood victims at reception centers. Emergency management agencies and land planners should account for these differences in gender awareness and preparedness. Based on these findings, doing so may increase citizen participation and shared responsibility under flood hazard scenarios.

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    Climate Change, Health and Existential Risks to Civilization: A Comprehensive Review (1989–2013)

    Colin David Butler

    201 citationsOpen access (CC-BY)doi:10.3390/ijerph15102266OpenAlex

    Show abstract

    Background: Anthropogenic global warming, interacting with social and other environmental determinants, constitutes a profound health risk. This paper reports a comprehensive literature review for 1989–2013 (inclusive), the first 25 years in which this topic appeared in scientific journals. It explores the extent to which articles have identified potentially catastrophic, civilization-endangering health risks associated with climate change. Methods: PubMed and Google Scholar were primarily used to identify articles which were then ranked on a three-point scale. Each score reflected the extent to which papers discussed global systemic risk. Citations were also analyzed. Results: Of 2143 analyzed papers 1546 (72%) were scored as one. Their citations (165,133) were 82% of the total. The proportion of annual papers scored as three was initially high, as were their citations but declined to almost zero by 1996, before rising slightly from 2006. Conclusions: The enormous expansion of the literature appropriately reflects increased understanding of the importance of climate change to…

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    Suicide Risk among Immigrants and Ethnic Minorities: A Literature Overview

    Alberto Maria Forte, Federico Trobia, Flavia Gualtieri, Dorian A. Lamis, Giuseppe Cardamone and 4 more

    198 citationsOpen access (CC-BY)doi:10.3390/ijerph15071438OpenAlex

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    Recent studies have demonstrated that immigrants and ethnic minorities may be at higher risk of suicidal behaviour as compared to the general population. We conducted a literature search to identify studies in English from 1980 to 2017 related to suicide risk among immigrants and ethnic minorities. Six hundred and seventy-eight reports were screened, and 43 articles were included in the qualitative synthesis of the review. Some studies reported lower rates of suicide attempts, while other findings suggested higher rates of suicidal behaviour and deaths among immigrants as compared to the native population. Also, a positive correlation was found between suicidal behaviour and specific countries of origin. Non-European immigrant women were at the highest risk for suicide attempts, a group which included young women of South Asian and black African origin. Risk factors among migrants and ethnic minorities were found to be: language barriers, worrying about family back home, and separation from family. The lack of information on health care system, loss of status, loss of social…

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    Heavy Metal and Metalloid Pollution of Soil, Water and Foods in Bangladesh: A Critical Review

    Maidul Islam, Md. Rezaul Karim, Xin Sen Zheng, Xiaofang Li

    196 citationsOpen access (CC-BY)doi:10.3390/ijerph15122825OpenAlex

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    Bangladesh is a densely populated developing country. Both industrialization and geological sources have caused widespread heavy metal and metalloid pollution in Bangladesh, which is now posing substantial threats to the local people. In this review, we carried out one of the most exhaustive literature analyses on the current status of Bangladesh heavy metal and metalloid pollution, covering water, soil, and foods. Analysis showed that soils near high traffic and industrial areas contain high concentrations of heavy metals and metalloids. Agricultural land and vegetables in sewage-irrigated areas were also found to be heavy metal- and metalloid-contaminated. River water, sediment, and fish from the Buriganga, Turag, Shitalakhya, and Karnaphuli rivers are highly contaminated with cadmium (Cd), lead (Pb), and chromium (Cr). Particularly, groundwater arsenic (As) pollution associated with high geological background levels in Bangladesh is well reported and is hitherto the largest mass poisoning in the world. Overall, the contamination levels of heavy metals and metalloids vary among…

  83. 83
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    In Vitro and In Vivo Experimental Studies of PM2.5 on Disease Progression

    Ching‐Chang Cho, Wen‐Yeh Hsieh, Chin-Hung Tsai, Cheng‐Yi Chen, Hui-Fang Chang and 1 more

    195 citationsOpen access (CC-BY)doi:10.3390/ijerph15071380OpenAlex

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    Air pollution is a very critical issue worldwide, particularly in developing countries. Particulate matter (PM) is a type of air pollution that comprises a heterogeneous mixture of different particle sizes and chemical compositions. There are various sources of fine PM (PM2.5), and the components may also have different effects on people. The pathogenesis of PM2.5 in several diseases remains to be clarified. There is a long history of epidemiological research on PM2.5 in several diseases. Numerous studies show that PM2.5 can induce a variety of chronic diseases, such as respiratory system damage, cardiovascular dysfunction, and diabetes mellitus. However, the epidemiological evidence associated with potential mechanisms in the progression of diseases need to be proved precisely through in vitro and in vivo investigations. Suggested mechanisms of PM2.5 that lead to adverse effects and chronic diseases include increasing oxidative stress, inflammatory responses, and genotoxicity. The aim of this review is to provide a brief overview of in vitro and in vivo experimental studies of…

  84. 84
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    Neighbourhood Built Environment Influences on Physical Activity among Adults: A Systematized Review of Qualitative Evidence

    Grazia Salvo, Bonnie Lashewicz, Patricia K. Doyle–Baker, Gavin R. McCormack

    195 citationsOpen access (CC-BY)doi:10.3390/ijerph15050897OpenAlex

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    Qualitative studies can provide important information about how and why the built environment impacts physical activity decision-making—information that is important for informing local urban policies. We undertook a systematized literature review to synthesize findings from qualitative studies exploring how the built environment influences physical activity in adults. Our review included 36 peer-reviewed qualitative studies published from 1998 onwards. Our findings complemented existing quantitative evidence and provided additional insight into how functional, aesthetic, destination, and safety built characteristics influence physical activity decision-making. Sociodemographic characteristics (age, sex, ethnicity, and socioeconomic status) also impacted the BE’s influence on physical activity. Our review findings reinforce the need for synergy between transportation planning, urban design, landscape architecture, road engineering, parks and recreation, bylaw enforcement, and public health to be involved in creating neighbourhood environments that support physical activity. Our…

  85. 85
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    The Role of Vitamin D in Fertility and during Pregnancy and Lactation: A Review of Clinical Data

    Stefan Pilz, Armin Zittermann, Rima Obeid, Andreas Hahn, Paweł Płudowski and 5 more

    193 citationsOpen access (CC-BY)doi:10.3390/ijerph15102241OpenAlex

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    Vitamin D deficiency is common and there exists a huge gap between recommended dietary vitamin D intakes and the poor vitamin D supply in the general population. While vitamin D is important for musculoskeletal health, there are accumulating data suggesting that vitamin D may also be important for fertility, pregnancy outcomes and lactation. Significant changes in vitamin D metabolism during pregnancy such as increased production of the "active vitamin D hormone" calcitriol support the important role of vitamin D in this setting. Observational studies show that vitamin D deficiency is a risk marker for reduced fertility and various adverse pregnancy outcomes and is associated with a low vitamin D content of breast milk. Meta-analyses of randomized controlled trials (RCTs) document that physiological vitamin D supplementation during pregnancy is safe and improves vitamin D and calcium status, thereby protecting skeletal health. Although certain RCTs and/or meta-analyses reported some other beneficial effects, it is still not clear whether vitamin D supplementation improves fertility…

  86. 86
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    Correlation Analysis to Identify the Effective Data in Machine Learning: Prediction of Depressive Disorder and Emotion States

    Sunil Kumar, Ilyoung Chong

    191 citationsOpen access (CC-BY)doi:10.3390/ijerph15122907OpenAlex

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    Correlation analysis is an extensively used technique that identifies interesting relationships in data. These relationships help us realize the relevance of attributes with respect to the target class to be predicted. This study has exploited correlation analysis and machine learning-based approaches to identify relevant attributes in the dataset which have a significant impact on classifying a patient's mental health status. For mental health situations, correlation analysis has been performed in Weka, which involves a dataset of depressive disorder symptoms and situations based on weather conditions, as well as emotion classification based on physiological sensor readings. Pearson's product moment correlation and other different classification algorithms have been utilized for this analysis. The results show interesting correlations in weather attributes for bipolar patients, as well as in features extracted from physiological data for emotional states.

  87. 87
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    Recommendations for Improving the Quality of Rare Disease Registries

    Yllka Kodra, Jérôme Weinbach, Manuel Posada de la Paz, Alessio Coi, S. Lydie Lemonnier and 24 more

    190 citationsOpen access (CC-BY)doi:10.3390/ijerph15081644OpenAlex

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    Rare diseases (RD) patient registries are powerful instruments that help develop clinical research, facilitate the planning of appropriate clinical trials, improve patient care, and support healthcare management. They constitute a key information system that supports the activities of European Reference Networks (ERNs) on rare diseases. A rapid proliferation of RD registries has occurred during the last years and there is a need to develop guidance for the minimum requirements, recommendations and standards necessary to maintain a high-quality registry. In response to these heterogeneities, in the framework of RD-Connect, a European platform connecting databases, registries, biobanks and clinical bioinformatics for rare disease research, we report on a list of recommendations, developed by a group of experts, including members of patient organizations, to be used as a framework for improving the quality of RD registries. This list includes aspects of governance, Findable, Accessible, Interoperable and Reusable (FAIR) data and information, infrastructure, documentation, training, and…

  88. 88
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    Health and Well-Being of Cisgender, Transgender and Non-Binary Young People

    Marta Evelia Aparicio García, Eva María Díaz-Ramiro, Susana Rubio-Valdehita, María Inmaculada López-Núñez, Isidro García Nieto

    189 citationsOpen access (CC-BY)doi:10.3390/ijerph15102133OpenAlex

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    Young transgender and non-binary individuals (TNBI) are exposed to situations of discrimination and have a greater risk of violence. The purpose of this study is to analyze which protective, violence and health and well-being factors have more influence on TNBI compared to cisgender people. The sample comprised 856 youth between 14 and 25 years old. A survey including questions about sociodemographic information and protective, violence and health and well-being factors was designed ad hoc for this study. The results show the non-binary group received the least support from family and friends, higher risk of suffering cyberbullying, and many feel isolated and unhappy. TNBI have suffered more verbal attacks both inside and outside their school and physical attacks at school than cisgender young. These results are important because they may contribute to the promotion of public policies and clinical interventions that favor the integration of TNBI in our society.

  89. 89
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    Is Nature Relatedness Associated with Better Mental and Physical Health?

    Julie Dean, Danielle F. Shanahan, Robert A. Baruch Bush, Kevin J. Gaston, Brenda B. Lin and 3 more

    189 citationsOpen access (CC-BY)doi:10.3390/ijerph15071371OpenAlex

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    Nature relatedness is a psychological characteristic with the potential to drive interaction with nature and influence well-being. We surveyed 1538 people in Brisbane, Australia to investigate how nature relatedness varies among socio-demographic groups. We determined whether people with higher nature relatedness reported fewer symptoms of depression, anxiety, stress and better overall health, controlling for potentially confounding socio-demographic and health-related variables. Overall nature relatedness was higher in older people, females, those without children living at home, not working, and people speaking English at home. Aspects of nature relatedness reflecting enjoyment of nature were consistently associated with reduced ill health, consistent with widespread evidence of the health and well-being benefits of experiencing nature. In contrast, aspects of nature relatedness reflecting self-identification with nature, and a conservation worldview, were associated with increased depression, anxiety or stress, after accounting for potential confounding factors. Detailed…

  90. 90
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    Self-Reported vs. Measured Height, Weight, and BMI in Young Adults

    Melissa Diann Olfert, Makenzie L. Barr, Camille M Charlier, Oluremi A. Famodu, Wenjun Zhou and 3 more

    188 citationsOpen access (CC-BY)doi:10.3390/ijerph15102216OpenAlex

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    Self-reported height and weight, if accurate, provide a simple and economical method to track changes in body weight over time. Literature suggests adults tend to under-report their own weight and that the gap between self-reported weight and actual weight increases with obesity. This study investigates the extent of discrepancy in self-reported height, weight, and subsequent Body Mass Index (BMI) versus actual measurements in young adults. Physically measured and self-reported height and weight were taken from 1562 students. Male students marginally overestimated height, while females were closer to target. Males, on average, closely self-reported weight. Self-reported anthropometrics remained statistically correlated to actual measures in both sexes. Categorical variables of calculated BMI from both self-reported and actual height and weight resulted in significant agreement for both sexes. Researcher measured BMI (via anthropometric height and weight) and sex were both found to have association with self-reported weight while only sex was related to height difference. Regression…

  91. 91
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    Levels of Burnout and Risk Factors in Medical Area Nurses: A Meta-Analytic Study

    Jesús Molina-Praena, Lucía Ramírez‐Baena, José Luis Gómez‐Urquiza, Gustavo R. Cañadas, Emilia I. De la Fuente and 1 more

    187 citationsOpen access (CC-BY)doi:10.3390/ijerph15122800OpenAlex

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    Research findings concerning burnout prevalence rate among nurses from the medical area are contradictory. The aim of this study was to analyse associated factors, to determine nurse burnout levels and to meta-analyse the prevalence rate of each burnout dimension. A systematic review, with meta-analysis, was conducted in February 2018, consulting the next scientific databases: PubMed, CUIDEN, CINAHL, Scopus, LILACS, PsycINFO and ProQuest Health & Medical Complete. In total, 38 articles were extracted, using a double-blinded procedure. The studies were classified by the level of evidence and degrees of recommendation. The 63.15% (n = 24) of the studies used the MBI. High emotional exhaustion was found in the 31% of the nurses, 24% of high depersonalisation and low personal accomplishment was found in the 38%. Factors related to burnout included professional experience, psychological factors and marital status. High emotional exhaustion prevalence rates, high depersonalisation and inadequate personal accomplishment are present among medical area nurses. The risk profile could be a…

  92. 92
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    The Short Term Musculoskeletal and Cognitive Effects of Prolonged Sitting During Office Computer Work

    Richelle Baker, Pieter Coenen, Erin Kaye Howie, Ann M. Williamson, Leon Melville Straker

    186 citationsOpen access (CC-BY)doi:10.3390/ijerph15081678OpenAlex

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    Office workers are exposed to high levels of sedentary time. In addition to cardio-vascular and metabolic health risks, this sedentary time may have musculoskeletal and/or cognitive impacts on office workers. Participants (n = 20) undertook two hours of laboratory-based sitting computer work to investigate changes in discomfort and cognitive function (sustained attention and problem solving), along with muscle fatigue, movement and mental state. Over time, discomfort increased in all body areas (total body IRR [95% confidence interval]: 1.43 [1.33⁻1.53]) reaching clinically meaningful levels in the low back and hip/thigh/buttock areas. Creative problem solving errors increased (β = 0.25 [0.03⁻1.47]) while sustained attention did not change. There was no change in erector spinae, trapezius, rectus femoris, biceps femoris and external oblique median frequency or amplitude; low back angle changed towards less lordosis, pelvis movement increased, and mental state deteriorated. There were no substantial correlations between discomfort and cognitive function. The observed changes suggest…

  93. 93
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    Exercise Early and Often: Effects of Physical Activity and Exercise on Women’s Bone Health

    Karen L. Troy, Megan E. Mancuso, Tiffiny A. Butler, Joshua E. Johnson

    185 citationsOpen access (CC-BY)doi:10.3390/ijerph15050878OpenAlex

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    In 2011 over 1.7 million people were hospitalized because of a fragility fracture, and direct costs associated with osteoporosis treatment exceeded 70 billion dollars in the United States. Failure to reach and maintain optimal peak bone mass during adulthood is a critical factor in determining fragility fracture risk later in life. Physical activity is a widely accessible, low cost, and highly modifiable contributor to bone health. Exercise is especially effective during adolescence, a time period when nearly 50% of peak adult bone mass is gained. Here, we review the evidence linking exercise and physical activity to bone health in women. Bone structure and quality will be discussed, especially in the context of clinical diagnosis of osteoporosis. We review the mechanisms governing bone metabolism in the context of physical activity and exercise. Questions such as, when during life is exercise most effective, and what specific types of exercises improve bone health, are addressed. Finally, we discuss some emerging areas of research on this topic, and summarize areas of need and…

  94. 94
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    An Empirical Study Analyzing Job Productivity in Toxic Workplace Environments

    Amna Anjum, Xu Ming, Ahmed Faisal Siddiqi, Samma Faiz Rasool

    183 citationsOpen access (CC-BY)doi:10.3390/ijerph15051035OpenAlex

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    Purpose: This empirical study aims to determine the effects of a toxic workplace environment, which can negatively impact the job productivity of an employee. Methodology: Three hundred questionnaires were randomly distributed among the staff members of seven private universities in Pakistan with a final response rate of 89%. For analysis purposes, AMOS 22 was used to study the direct and indirect effects of the toxic workplace environment on job productivity. Confirmatory Factor Analysis (CFA) was conducted to ensure the convergent and discriminant validity of the factors, while the Hayes mediation approach was used to verify the mediating role of job burnout between the four dimensions of toxic workplace environment and job productivity. A toxic workplace with multiple dimensions, such as workplace ostracism, workplace incivility, workplace harassment, and workplace bullying, was used in this study. Findings: By using the multiple statistical tools and techniques, it has been proven that ostracism, incivility, harassment, and bullying have direct negative significant effects on…

  95. 95
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    Optimization of Location–Routing Problem for Cold Chain Logistics Considering Carbon Footprint

    Songyi Wang, Fengming Tao, Yuhe Shi

    183 citationsOpen access (CC-BY)doi:10.3390/ijerph15010086OpenAlex

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    In order to solve the optimization problem of logistics distribution system for fresh food, this paper provides a low-carbon and environmental protection point of view, based on the characteristics of perishable products, and combines with the overall optimization idea of cold chain logistics distribution network, where the green and low-carbon location-routing problem (LRP) model in cold chain logistics is developed with the minimum total costs as the objective function, which includes carbon emission costs. A hybrid genetic algorithm with heuristic rules is designed to solve the model, and an example is used to verify the effectiveness of the algorithm. Furthermore, the simulation results obtained by a practical numerical example show the applicability of the model while provide green and environmentally friendly location-distribution schemes for the cold chain logistics enterprise. Finally, carbon tax policies are introduced to analyze the impact of carbon tax on the total costs and carbon emissions, which proves that carbon tax policy can effectively reduce carbon dioxide…

  96. 96
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    Prevalence and Consequences of Aggression and Violence towards Nursing and Care Staff in Germany—A Survey

    Anja Schablon, Dana Wendeler, Agnessa Kozak, Albert Nienhaus, Susanne Steinke

    181 citationsOpen access (CC-BY)doi:10.3390/ijerph15061274OpenAlex

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    Acts of aggression by patients or clients are a part of the average working day for many Health care employees. The objective of the survey was to study the frequency and nature of violence and the handling of aggressive behavior by facility management. The cross-sectional study was conducted in 2017, 81 different healthcare facilities and 1984 employees participated. The questionnaire encompassed socio-demographic details, the frequency of physical violence and verbal abuse, consequences of violence and the stress of employees. In the previous twelve months, 94.1% of the employees in the survey had experienced verbal abuse and 69.8% had experienced physical aggression. Acts of aggression were most commonly encountered in hospitals and residential facilities for the disabled. One third of the employees felt under high levels of stress as a result of the incidents. If the workplace prepares effectively, however, this reduces the perceived stress odds ratio (OR) 0.6, 95% CI 0.4⁻0.8). Violence and aggression are very common. Healthcare facilities are increasingly dealing with this…

  97. 97
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    Synergistic Effects of Ambient Temperature and Air Pollution on Health in Europe: Results from the PHASE Project

    Antonis Analitis, Francesca Katherine de'Donato, Matteo Scortichini, Timo Lanki, Xavier Basagaña and 7 more

    180 citationsOpen access (CC-BY)doi:10.3390/ijerph15091856OpenAlex

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    We studied the potential synergy between air pollution and meteorology and their impact on mortality in nine European cities with data from 2004 to 2010. We used daily series of Apparent Temperature (AT), measurements of particulate matter (PM10), ozone (O3), and nitrogen dioxide (NO2) and total non-accidental, cardiovascular, and respiratory deaths. We applied Poisson regression for city-specific analysis and random effects meta-analysis to combine city-specific results, separately for the warm and cold seasons. In the warm season, the percentage increase in all deaths from natural causes per °C increase in AT tended to be greater during high ozone days, although this was only significant for all ages when all causes were considered. On low ozone days, the increase in the total daily number of deaths was 1.84% (95% CI 0.87, 2.82), whilst it was 2.20% (95% CI 1.28, 3.13) in the high ozone days per 1 °C increase in AT. Interaction with PM10 was significant for cardiovascular (CVD) causes of death for all ages (2.24% on low PM10 days (95% CI 1.01, 3.47) whilst it is 2.63% (95% CI…

  98. 98
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    Possible Biological Mechanisms Linking Mental Health and Heat—A Contemplative Review

    Mare Lõhmus

    178 citationsOpen access (CC-BY)doi:10.3390/ijerph15071515OpenAlex

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    This review provides examples of possible biological mechanisms that could, at least partly, explain the existing epidemiological evidence of heatwave-related exacerbation of mental disease morbidity. The author reviews the complicated central processes involved in the challenge of maintaining a stable body temperature in hot environments, and the maladaptive effects of certain psychiatric medicines on thermoregulation. In addition, the author discusses some alternative mechanisms, such as interrupted functional brain connectivity and the effect of disrupted sleep, which may further increase the vulnerability of mental health patients during heatwaves.

  99. 99
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    Association between Social Activities and Cognitive Function among the Elderly in China: A Cross-Sectional Study

    Chang Fu, Zhen Li, Zongfu Mao

    178 citationsOpen access (CC-BY)doi:10.3390/ijerph15020231OpenAlex

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    Participation in social activities is one of important factors for older adults’ health. The present study aims to examine the cross-sectional association between social activities and cognitive function among Chinese elderly. A total of 8966 individuals aged 60 and older from the 2015 China Health and Retirement Longitudinal Study were obtained for this study. Telephone interviews of cognitive status, episodic memory, and visuospatial abilities were assessed by questionnaire. We used the sum of all three of the above measures to represent the respondent’s cognitive status as a whole. Types and frequencies of participation in social groups were used to measure social activities. Multiple linear regression analysis was used to explore the relationship between social activities and cognitive function. After adjustment for demographics, smoking, drinking, depression, hypertension, diabetes, basic activities of daily living, instrumental activities of daily living, and self-rated health, multiple linear regression analysis revealed that interaction with friends, participating in hobby…

  100. 100
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    Perceptions and Reasons Regarding E-Cigarette Use among Users and Non-Users: A Narrative Literature Review

    Kim A. G. J. Romijnders, Liesbeth van Osch, Hein de Vries, Reinskje Talhout

    177 citationsOpen access (CC-BY)doi:10.3390/ijerph15061190OpenAlex

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    This paper aims to provide an in-depth understanding of the attractiveness of e-cigarettes for several different groups. For this purpose, perceptions of and reasons for e-cigarette use were systematically reviewed as reported by e-cigarette users, cigarette smokers, dual users, and non-users, among both adults and youth. MEDLINE® and Scopus were used to search for relevant articles, and references of included studies were also investigated. Two reviewers screened all titles and abstracts independently, blinded to authors and journal titles (Cohen’s Kappa = 0.83), resulting in 72 eligible articles. Risk perceptions, perceived benefits, and reasons for e-cigarette use were categorized in themes and sub-themes. Risk perceptions included harmfulness in general, and specific health risks. Perceived benefits included improved taste and smell, and safety for bystanders. Reasons for use included (health) benefits, curiosity, smoking cessation, and friends using e-cigarettes. The findings highlight that there is a variety of perceptions and reasons mentioned by adult and youth e-cigarette…

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The cohort is every article, review and book chapter OpenAlex attributes to International Journal of Environmental Research and Public Health with publication year 2018, excluding retracted works and paratext such as editorials and errata. The top 100 by citation count are listed; the percentile is the rank divided by the cohort size. 100 of the 100 entries have an abstract in OpenAlex. Counts were read on 29 October 2026 and will not be updated on this page, so a quoted rank stays verifiable. Full rules on the methodology page.

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