Most-cited articles · 2021

The 100 most-cited articles in International Journal of Environmental Research and Public Health, 2021

Ranked by OpenAlex citation count on 29 October 2026, out of 13,509 eligible articles International Journal of Environmental Research and Public Health published in 2021. Ranks are frozen; this page will not change. Number one, with 2,686 citations: Agriculture Development, Pesticide Application and Its Impact on the Environment.

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13,509 articles
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Top 100 (0.7%)
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100 of 100
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2026-10-29

The most-cited articles from this journal in 2021 cluster around several themes. Environmental health and exposure research features prominently, led by "Agriculture Development, Pesticide Application and Its Impact on the Environment" with 2686 citations, alongside reviews of pesticides in drinking water and volatile organic compounds. A second major group addresses COVID-19, including the mental health of children and adolescents during the pandemic and post-COVID symptom classification. A third cluster covers artificial intelligence in healthcare, skin cancer detection, and epileptic seizure detection.

Readers can use this ranked list to identify the individual articles that attracted the most citations in 2021, as counted by OpenAlex out of 13509 eligible papers. The ranking reflects citation counts only, not quality or importance, and citation practices vary across fields. The titles and abstracts indicate each paper's subject, allowing readers to locate work on topics of interest and to see which themes drew the most attention in this journal that year.

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  1. 1
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    Agriculture Development, Pesticide Application and Its Impact on the Environment

    Muyesaier Tudi, Huada Daniel Ruan, Li Wang, Jia Lyu, Ross Sadler and 3 more

    2,686 citationsOpen access (CC-BY)doi:10.3390/ijerph18031112OpenAlex

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    Pesticides are indispensable in agricultural production. They have been used by farmers to control weeds and insects, and their remarkable increases in agricultural products have been reported. The increase in the world's population in the 20th century could not have been possible without a parallel increase in food production. About one-third of agricultural products are produced depending on the application of pesticides. Without the use of pesticides, there would be a 78% loss of fruit production, a 54% loss of vegetable production, and a 32% loss of cereal production. Therefore, pesticides play a critical role in reducing diseases and increasing crop yields worldwide. Thus, it is essential to discuss the agricultural development process; the historical perspective, types and specific uses of pesticides; and pesticide behavior, its contamination, and adverse effects on the natural environment. The review study indicates that agricultural development has a long history in many places around the world. The history of pesticide use can be divided into three periods of time.…

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    Application of Artificial Intelligence-Based Technologies in the Healthcare Industry: Opportunities and Challenges

    DonHee Lee, Seong No Yoon

    1,014 citationsOpen access (CC-BY)doi:10.3390/ijerph18010271OpenAlex

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    This study examines the current state of artificial intelligence (AI)-based technology applications and their impact on the healthcare industry. In addition to a thorough review of the literature, this study analyzed several real-world examples of AI applications in healthcare. The results indicate that major hospitals are, at present, using AI-enabled systems to augment medical staff in patient diagnosis and treatment activities for a wide range of diseases. In addition, AI systems are making an impact on improving the efficiency of nursing and managerial activities of hospitals. While AI is being embraced positively by healthcare providers, its applications provide both the utopian perspective (new opportunities) and the dystopian view (challenges to overcome). We discuss the details of those opportunities and challenges to provide a balanced view of the value of AI applications in healthcare. It is clear that rapid advances of AI and related technologies will help care providers create new value for their patients and improve the efficiency of their operational processes.…

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    Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review

    Salima Moez Meherali, Neelam Saleem Punjani, Samantha Louie‐Poon, Komal Abdul Rahim, Jai K Das and 2 more

    898 citationsOpen access (CC-BY)doi:10.3390/ijerph18073432OpenAlex

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    Background: The COVID‑19 pandemic and associated public health measures have disrupted the lives of people around the world. It is already evident that the direct and indirect psychological and social effects of the COVID‑19 pandemic are insidious and affect the mental health of young children and adolescents now and will in the future. The aim and objectives of this knowledge-synthesis study were to identify the impact of the pandemic on children’s and adolescent’s mental health and to evaluate the effectiveness of different interventions employed during previous and the current pandemic to promote children’s and adolescents’ mental health. Methodology: We conducted the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included experimental randomized and nonrandomized controlled trials, observational studies, and qualitative studies. Results: Of the 5828 articles that we retrieved, 18 articles met the inclusion criteria. We thematically analyzed them and put the major findings under the thematic areas of…

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    Impact of COVID-19 on Mental Health in Adolescents: A Systematic Review

    Elizabeth A. Jones, Amal Krishna Mitra, Azad R. Bhuiyan

    857 citationsOpen access (CC-BY)doi:10.3390/ijerph18052470OpenAlex

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    Due to lack of sufficient data on the psychological toll of the COVID-19 pandemic on adolescent mental health, this systematic analysis aims to evaluate the impact of the pandemic on adolescent mental health. This study follows the PRISMA guidelines for systematic reviews of 16 quantitative studies conducted in 2019-2021 with 40,076 participants. Globally, adolescents of varying backgrounds experience higher rates of anxiety, depression, and stress due to the pandemic. Secondly, adolescents also have a higher frequency of using alcohol and cannabis during the COVID-19 pandemic. However, social support, positive coping skills, home quarantining, and parent-child discussions seem to positively impact adolescent mental health during this period of crisis. Whether in the United States or abroad, the COVID-19 pandemic has impacted adolescent mental health. Therefore, it is important to seek and to use all of the available resources and therapies to help adolescents mediate the adjustments caused by the pandemic.

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    Key Factors Associated with Adherence to Physical Exercise in Patients with Chronic Diseases and Older Adults: An Umbrella Review

    Daniel Collado‐Mateo, Ana Myriam Lavín Pérez, Cecilia Peñacoba, Juan Del Coso, Marta Leytón Román and 4 more

    788 citationsOpen access (CC-BY)doi:10.3390/ijerph18042023OpenAlex

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    Physical inactivity is a major concern and poor adherence to exercise programs is often reported. The aim of this paper was to systematically review published reviews on the study of adherence to physical exercise in chronic patients and older adults and to identify those adherence-related key factors more frequently suggested by reviews for that population. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results were classified considering the target population and participants' characteristics to identify the most repeated factors obtained for each condition. Fifty-five articles were finally included. Fourteen key factors were identified as relevant to increase adherence to physical exercise by at least ten reviews: (a) characteristics of the exercise program, (b) involvement of professionals from different disciplines, (c) supervision, (d) technology, (e) initial exploration of participant's characteristics, barriers, and facilitators, (f) participants education, adequate expectations and knowledge about risks and…

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    Pesticides in Drinking Water—A Review

    Muhammad Syafrudin, Risky Ayu Kristanti, Adhi Yuniarto, Tony Hadibarata, Jongtae Rhee and 4 more

    741 citationsOpen access (CC-BY)doi:10.3390/ijerph18020468OpenAlex

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    The ubiquitous problem of pesticide in aquatic environment are receiving worldwide concern as pesticide tends to accumulate in the body of the aquatic organism and sediment soil, posing health risks to the human. Many pesticide formulations had introduced due to the rapid growth in the global pesticide market result from the wide use of pesticides in agricultural and non-agricultural sectors. The occurrence of pesticides in the water body is derived by the runoff from the agricultural field and industrial wastewater. Soluble pesticides were carried away by water molecules especially during the precipitation event by percolating downward into the soil layers and eventually reach surface waters and groundwater. Consequently, it degrades water quality and reduces the supply of clean water for potable water. Long-time exposure to the low concentration of pesticides had resulted in non-carcinogenic health risks. The conventional method of pesticide treatment processes encompasses coagulation-flocculation, adsorption, filtration and sedimentation, which rely on the phase transfer of…

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    Associations between Nature Exposure and Health: A Review of the Evidence

    Marcia Pescador Jimenez, Nicole V. DeVille, Elise G. Elliott, Jessica E. Schiff, Grete E. Wilt and 2 more

    722 citationsOpen access (CC-BY)doi:10.3390/ijerph18094790OpenAlex

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    There is extensive empirical literature on the association between exposure to nature and health. In this narrative review, we discuss the strength of evidence from recent (i.e., the last decade) experimental and observational studies on nature exposure and health, highlighting research on children and youth where possible. We found evidence for associations between nature exposure and improved cognitive function, brain activity, blood pressure, mental health, physical activity, and sleep. Results from experimental studies provide evidence of protective effects of exposure to natural environments on mental health outcomes and cognitive function. Cross-sectional observational studies provide evidence of positive associations between nature exposure and increased levels of physical activity and decreased risk of cardiovascular disease, and longitudinal observational studies are beginning to assess long-term effects of nature exposure on depression, anxiety, cognitive function, and chronic disease. Limitations of current knowledge include inconsistent measures of exposure to nature,…

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    Measuring Subjective Sleep Quality: A Review

    Marco Fabbri, Alessia Beracci, Monica Martoni, Debora Meneo, Lorenzo Tonetti and 1 more

    609 citationsOpen access (CC-BY)doi:10.3390/ijerph18031082OpenAlex

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    Sleep quality is an important clinical construct since it is increasingly common for people to complain about poor sleep quality and its impact on daytime functioning. Moreover, poor sleep quality can be an important symptom of many sleep and medical disorders. However, objective measures of sleep quality, such as polysomnography, are not readily available to most clinicians in their daily routine, and are expensive, time-consuming, and impractical for epidemiological and research studies., Several self-report questionnaires have, however, been developed. The present review aims to address their psychometric properties, construct validity, and factorial structure while presenting, comparing, and discussing the measurement properties of these sleep quality questionnaires. A systematic literature search, from 2008 to 2020, was performed using the electronic databases PubMed and Scopus, with predefined search terms. In total, 49 articles were analyzed from the 5734 articles found. The psychometric properties and factor structure of the following are reported: Pittsburgh Sleep Quality…

  9. 9
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    Skin Cancer Detection: A Review Using Deep Learning Techniques

    Mehwish Dildar, Shumaila Akram, Muhammad Irfan, Hikmat Ullah Khan, Muhammad Ramzan and 5 more

    593 citationsOpen access (CC-BY)doi:10.3390/ijerph18105479OpenAlex

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    Skin cancer is one of the most dangerous forms of cancer. Skin cancer is caused by un-repaired deoxyribonucleic acid (DNA) in skin cells, which generate genetic defects or mutations on the skin. Skin cancer tends to gradually spread over other body parts, so it is more curable in initial stages, which is why it is best detected at early stages. The increasing rate of skin cancer cases, high mortality rate, and expensive medical treatment require that its symptoms be diagnosed early. Considering the seriousness of these issues, researchers have developed various early detection techniques for skin cancer. Lesion parameters such as symmetry, color, size, shape, etc. are used to detect skin cancer and to distinguish benign skin cancer from melanoma. This paper presents a detailed systematic review of deep learning techniques for the early detection of skin cancer. Research papers published in well-reputed journals, relevant to the topic of skin cancer diagnosis, were analyzed. Research findings are presented in tools, graphs, tables, techniques, and frameworks for better understanding.

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    Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities

    Alessandro Rigolon, Matthew H. E. M. Browning, Olivia McAnirlin, Hyun‐Seo Yoon

    556 citationsOpen access (CC-BY)doi:10.3390/ijerph18052563OpenAlex

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    Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. In this systematic review, we examine whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups. We hypothesize that disadvantaged groups have stronger protective effects from green space because of their greater dependency on proximate green space, as they tend to lack access to other health-promoting resources. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method and search five databases (CINAHL, Cochrane, PubMed, Scopus, and Web of Science) to look for articles that examine whether socioeconomic status (SES) or race/ethnicity modify the green space-health associations. Based on this search, we identify 90 articles meeting our inclusion criteria. We find lower-SES people show more beneficial…

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    Intestinal Barrier in Human Health and Disease

    Natalia Di Tommaso, Antonio Gasbarrini, Francesca Romana Ponziani

    538 citationsOpen access (CC-BY)doi:10.3390/ijerph182312836OpenAlex

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    The intestinal mucosa provides a selective permeable barrier for nutrient absorption and protection from external factors. It consists of epithelial cells, immune cells and their secretions. The gut microbiota participates in regulating the integrity and function of the intestinal barrier in a homeostatic balance. Pathogens, xenobiotics and food can disrupt the intestinal barrier, promoting systemic inflammation and tissue damage. Genetic and immune factors predispose individuals to gut barrier dysfunction, and changes in the composition and function of the gut microbiota are central to this process. The progressive identification of these changes has led to the development of the concept of 'leaky gut syndrome' and 'gut dysbiosis', which underlie the relationship between intestinal barrier impairment, metabolic diseases and autoimmunity. Understanding the mechanisms underlying this process is an intriguing subject of research for the diagnosis and treatment of various intestinal and extraintestinal diseases.

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    Volatile Organic Compounds (VOCs) as Environmental Pollutants: Occurrence and Mitigation Using Nanomaterials

    Elena David, Violeta‐Carolina Niculescu

    516 citationsOpen access (CC-BY)doi:10.3390/ijerph182413147OpenAlex

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    Volatile organic compounds (VOCs) comprise various organic chemicals which are released as gases from different liquids or solids. The nature and impact of the health effects are dependent on the VOCs concentrations and, also, on the exposure time. VOCs are present in different household, industrial or commercial and products, but their accumulation in air and water has primarily gained attention. Among VOCs, trichloroethylene and vinyl chloride are the most toxic and carcinogenic compounds. In order to improve the indoor air and water quality, VOCs can be removed via efficient approaches involving nanomaterials, by using techniques such as adsorption, catalysis or photocatalysis. In the recent years, the development of manufacturing procedures, characterization techniques and testing processes has resulted in the growth of na-nomaterials obtaining and applications, creating great possibilities and also a tremendous prov-ocation in applying them for highly efficient VOCs removal. This review is intended to contrib-ute to the improvement of awareness and knowledge on the great…

  13. 13
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    Climate Change and Mental Health: A Scoping Review

    Fiona Charlson, Suhailah Ali, Tarik Benmarhnia, M. Gardner, Alessandro Massazza and 2 more

    506 citationsOpen access (CC-BY)doi:10.3390/ijerph18094486OpenAlex

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    Climate change is negatively impacting the mental health of populations. This scoping review aims to assess the available literature related to climate change and mental health across the World Health Organisation’s (WHO) five global research priorities for protecting human health from climate change. We conducted a scoping review to identify original research studies related to mental health and climate change using online academic databases. We assessed the quality of studies where appropriate assessment tools were available. We identified 120 original studies published between 2001 and 2020. Most studies were quantitative (n = 67), cross-sectional (n = 42), conducted in high-income countries (n = 87), and concerned with the first of the WHO global research priorities—assessing the mental health risks associated with climate change (n = 101). Several climate-related exposures, including heat, humidity, rainfall, drought, wildfires, and floods were associated with psychological distress, worsened mental health, and higher mortality among people with pre-existing mental health…

  14. 14
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    Six Key Advantages and Disadvantages of Working from Home in Europe during COVID-19

    Christine Ipsen, Marc J. P. M. van Veldhoven, Kathrin Kirchner, John Paulin Hansen

    502 citationsOpen access (CC-BY)doi:10.3390/ijerph18041826OpenAlex

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    The number of people working from home (WFH) increased radically during the coronavirus (COVID-19) pandemic. The purpose of this study was therefore to investigate people’s experiences of WFH during the pandemic and to identify the main factors of advantages and disadvantages of WFH. Data from 29 European countries on the experiences of knowledge workers (N = 5748) WFH during the early stages of lockdown (11 March to 8 May 2020) were collected. A factor analysis showed the overall distribution of people’s experiences and how the advantages and disadvantages of WFH during the early weeks of the pandemic can be grouped into six key factors. The results indicated that most people had a more positive rather than negative experience of WFH during lockdown. Three factors represent the main advantages of WFH: (i) work–life balance, (ii) improved work efficiency and (iii) greater work control. The main disadvantages were (iv) home office constraints, (v) work uncertainties and (vi) inadequate tools. Comparing gender, number of children at home, age and managers versus employees in relation…

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    How Toxic Workplace Environment Effects the Employee Engagement: The Mediating Role of Organizational Support and Employee Wellbeing

    Samma Faiz Rasool, Mansi Wang, Minze Tang, Amir Saeed, Javed Iqbal

    498 citationsOpen access (CC-BY)doi:10.3390/ijerph18052294OpenAlex

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    This study explores the effects of a toxic workplace environment (TWE) on employee engagement (EE). Building on conservation of resources (COR) theory and organizational support theory (OST), this study proposed a research model. In this research model, a toxic workplace environment negatively affected employee engagement, directly and indirectly, through organizational support (OS) and employee well-being (EW). In this study, we used a quantitative research approach, and data were collected from 301 workers employed in the small and medium-size enterprises of China. To estimate the proposed relationships of the research model, we used partial least squares structural equation modeling (PLS-SEM 3.2.2). The results of this study confirmed that a toxic workplace environment has a negative impact on employee engagement. Moreover, the findings of this research confirm that organizational support and employee well-being significantly mediate a toxic workplace environment and employee engagement. The conclusions of this study are as follows: First, the direct relationship between a toxic…

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    Defining Post-COVID Symptoms (Post-Acute COVID, Long COVID, Persistent Post-COVID): An Integrative Classification

    César Fernández‐de‐las‐Peñas, Domingo Palacios‐Ceña, Víctor Gómez‐Mayordomo, María L. Cuadrado, Lidiane Lima Florêncio

    474 citationsOpen access (CC-BY)doi:10.3390/ijerph18052621OpenAlex

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    The pandemic of the coronavirus disease 2019 (COVID-19) has provoked a second pandemic, the "long-haulers", i.e., individuals presenting with post-COVID symptoms. We propose that to determine the presence of post-COVID symptoms, symptoms should appear after the diagnosis of SARS-CoV-2 infection; however, this situation has some problems due to the fact that not all people infected by SARS-CoV-2 receive such diagnosis. Based on relapsing/remitting nature of post-COVID symptoms, the following integrative classification is proposed: potentially infection related-symptoms (up to 4-5 weeks), acute post-COVID symptoms (from week 5 to week 12), long post-COVID symptoms (from week 12 to week 24), and persistent post-COVID symptoms (lasting more than 24 weeks). The most important topic is to establish the time reference points. The classification also integrates predisposing intrinsic and extrinsic factors and hospitalization data which could promote post-COVID symptoms. The plethora of symptoms affecting multiple systems exhibited by "long-haulers" suggests the presence of different…

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    Microbial Biofilms in the Food Industry—A Comprehensive Review

    Conrado Carrascosa, Dele Raheem, Fernando Ramos, Ariana Saraiva, António Raposo

    465 citationsOpen access (CC-BY)doi:10.3390/ijerph18042014OpenAlex

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    Biofilms, present as microorganisms and surviving on surfaces, can increase food cross-contamination, leading to changes in the food industry's cleaning and disinfection dynamics. Biofilm is an association of microorganisms that is irreversibly linked with a surface, contained in an extracellular polymeric substance matrix, which poses a formidable challenge for food industries. To avoid biofilms from forming, and to eliminate them from reversible attachment and irreversible stages, where attached microorganisms improve surface adhesion, a strong disinfectant is required to eliminate bacterial attachments. This review paper tackles biofilm problems from all perspectives, including biofilm-forming pathogens in the food industry, disinfectant resistance of biofilm, and identification methods. As biofilms are largely responsible for food spoilage and outbreaks, they are also considered responsible for damage to food processing equipment. Hence the need to gain good knowledge about all of the factors favouring their development or growth, such as the attachment surface, food matrix…

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    Epileptic Seizures Detection Using Deep Learning Techniques: A Review

    Afshin Shoeibi, Marjane Khodatars, Navid Ghassemi, Mahboobeh Jafari, Parisa Moridian and 12 more

    462 citationsOpen access (CC-BY)doi:10.3390/ijerph18115780OpenAlex

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    A variety of screening approaches have been proposed to diagnose epileptic seizures, using electroencephalography (EEG) and magnetic resonance imaging (MRI) modalities. Artificial intelligence encompasses a variety of areas, and one of its branches is deep learning (DL). Before the rise of DL, conventional machine learning algorithms involving feature extraction were performed. This limited their performance to the ability of those handcrafting the features. However, in DL, the extraction of features and classification are entirely automated. The advent of these techniques in many areas of medicine, such as in the diagnosis of epileptic seizures, has made significant advances. In this study, a comprehensive overview of works focused on automated epileptic seizure detection using DL techniques and neuroimaging modalities is presented. Various methods proposed to diagnose epileptic seizures automatically using EEG and MRI modalities are described. In addition, rehabilitation systems developed for epileptic seizures using DL have been analyzed, and a summary is provided. The…

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    Indoor Air Quality in Buildings: A Comprehensive Review on the Factors Influencing Air Pollution in Residential and Commercial Structure

    Mehzabeen Mannan, Sami G. Al‐Ghamdi

    460 citationsOpen access (CC-BY)doi:10.3390/ijerph18063276OpenAlex

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    Worldwide people tend to spend approximately 90% of their time in different indoor environments. Along with the penetration of outside air pollutants, contaminants are produced in indoor environments due to different activities such as heating, cooling, cooking, and emissions from building products and the materials used. As people spend most of their lives in indoor environments, this has a significant influence on human health and productivity. Despite the two decades of indoor air quality (IAQ) research from different perspectives, there is still a lack of comprehensive evaluation of peer-reviewed IAQ studies that specifically covers the relationship between the internal characteristics of different types of building environments with IAQ to help understand the progress and limitations of IAQ research worldwide. Therefore, this review of scientific studies presents a broad spectrum of pollutants identified in both residential and commercial indoor environments, highlighting the trends and gaps in IAQ research. Moreover, analysis of literature data enabled us to assess the…

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    Trends in the Regulation of Per- and Polyfluoroalkyl Substances (PFAS): A Scoping Review

    Nicole Marie Brennan, Abigail T. Evans, Meredith Fritz, Stephanie Allison Peak, Haley von Holst

    421 citationsOpen access (CC-BY)doi:10.3390/ijerph182010900OpenAlex

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    Products containing per- and polyfluoroalkyl substances (PFAS) have been used for decades in industrial and consumer products. These compounds are persistent in the environment, bioaccumulative, and some are toxic to humans and other animals. Since the early 2000s, laws, policies, and regulations have been implemented to reduce the prevalence of PFAS in the environment and exposures to PFAS. We conducted a scoping literature review to identify how PFAS are regulated internationally, at the U.S. national level, and at the U.S. state level, as well as drivers of and challenges to implementing PFAS regulations in the U.S. This review captured peer-reviewed scientific literature (e.g., PubMed), grey literature databases (e.g., SciTech Premium Collection), Google searches, and targeted websites (e.g., state health department websites). We identified 454 relevant documents, of which 61 discussed the non-U.S. PFAS policy, 214 discussed the U.S. national-level PFAS policy, and 181 discussed the U.S. state-level PFAS policy. The drivers of and challenges to PFAS regulation were identified…

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    Green Space Quality and Health: A Systematic Review

    Phi‐Yen Nguyen, Thomas Astell‐Burt, Hania Rahimi‐Ardabili, Xiaoqi Feng

    420 citationsOpen access (CC-BY)doi:10.3390/ijerph182111028OpenAlex

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    (1) Background: As cities densify, researcher and policy focus is intensifying on which green space types and qualities are important for health. We conducted a systematic review to examine whether particular green space types and qualities have been shown to provide health benefits and if so, which specific types and qualities, and which health outcomes. (2) Methods: We searched five databases from inception up to June 30, 2021. We included all studies examining a wide range of green space characteristics on various health outcomes. (3) Results: 68 articles from 59 studies were found, with a high degree of heterogeneity in study designs, definitions of quality and outcomes. Most studies were cross-sectional, ecological or cohort studies. Environment types, vegetation types, and the size and connectivity of green spaces were associated with improved health outcomes, though with contingencies by age and gender. Health benefits were more consistently observed in areas with greater tree canopy, but not grassland. The main outcomes with evidence of health benefits included allergic…

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    Early Impacts of the COVID-19 Pandemic on the United States Construction Industry

    Abdullah F. Alsharef, Siddharth Banerjee, S M Jamil Uddin, Alex Albert, Edward J. Jaselskis

    400 citationsOpen access (CC-BY)doi:10.3390/ijerph18041559OpenAlex

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    The COVID-19 pandemic has been the largest global health crisis in decades. Apart from the unprecedented number of deaths and hospitalizations, the pandemic has resulted in economic slowdowns, widespread business disruptions, and significant hardships. This study focused on investigating the early impacts of the COVID-19 pandemic on the U.S. construction industry since the declaration of the national emergency on 13 March 2020. The study objectives were achieved through 34 telephone interviews with project managers, engineers, designers, and superintendents that represented different states and distinct industry sectors in the United States (U.S.). The interviewees offered information on their experience with the pandemic, including the general and adverse effects experienced, new opportunities created, and risk management efforts being undertaken. The reported adverse effects included significant delays on projects, inability to secure materials on time, reduction in productivity rates, material price escalations, and others. The new opportunities that were created included…

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    Nutritional Composition and Bioactive Compounds in Three Different Parts of Mango Fruit

    Veeranjaneya Reddy Lebaka, Young‐Jung Wee, Weibing Ye, Mallikarjuna Korivi

    400 citationsOpen access (CC-BY)doi:10.3390/ijerph18020741OpenAlex

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    L.), known as the king of fruits, has an attractive taste and fragrance and high nutritional value. Mango is commercially important in India, where ~55% of the global crop is produced. The fruit has three main parts: pulp, peel, and kernel. The pulp is the most-consumed part, while the peel and kernel are usually discarded. Mango pulp is a source of a variety of reducing sugars, amino acids, aromatic compounds, and functional compounds, such as pectin, vitamins, anthocyanins, and polyphenols. Mango processing generates peels and kernels as bio-wastes, though they also have nutraceutical significance. Functional compounds in the peel, including protocatechuic acids, mangiferin and β-carotene are known for their antimicrobial, anti-diabetic, anti-inflammatory, and anti-carcinogenic properties. The mango kernel has higher antioxidant and polyphenolic contents than the pulp and peel and is used for oil extraction; it's possible usage in combination with corn and wheat flour in preparing nutraceuticals is being increasingly emphasized. This review aims to provide nutraceutical and…

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    Benefits and Drawbacks of Ultrasound-Assisted Extraction for the Recovery of Bioactive Compounds from Marine Algae

    Anxo Carreira-Casais, Paz Otero, Pascual García-Pérez, Paula Garcia‐Oliveira, Antia Gonzalez Pereira and 4 more

    391 citationsOpen access (CC-BY)doi:10.3390/ijerph18179153OpenAlex

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    The increase in life expectancy has led to the appearance of chronic diseases and interest in healthy aging, in turn promoting a growing interest in bioactive compounds (BCs) and functional ingredients. There are certain foods or products rich in functional ingredients, and algae are one of them. Algae consumption has been nominal in Europe until now. However, in recent years, it has grown significantly, partly due to globalization and the adoption of new food trends. With the aim of obtaining BCs from foods, multiple methods have been proposed, ranging from conventional ones, such as maceration or Soxhlet extraction, to more innovative methods, e.g., ultrasound-assisted extraction (UAE). UAE constitutes a novel method, belonging to so-called green chemistry, that enables the extraction of BCs requiring lower amounts of solvent and energy costs, preserving the integrity of such molecules. In recent years, this method has been often used for the extraction of different BCs from a wide range of algae, especially polysaccharides, such as carrageenans and alginate; pigments, including…

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    Climate Change and Health Preparedness in Africa: Analysing Trends in Six African Countries

    Samuel Kwasi Opoku, Walter Leal Filho, Hubert Fudjumdjum, Oluwabunmi Opeyemi Adejumo

    390 citationsOpen access (CC-BY)doi:10.3390/ijerph18094672OpenAlex

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    Climate change is a global problem, which affects the various geographical regions at different levels. It is also associated with a wide range of human health problems, which pose a burden to health systems, especially in regions such as Africa. Indeed, across the African continent public health systems are under severe pressure, partly due to their fragile socioeconomic conditions. This paper reports on a cross-sectional study in six African countries (Ghana, Nigeria, South Africa, Namibia, Ethiopia, and Kenya) aimed at assessing their vulnerabilities to climate change, focusing on its impacts on human health. The study evaluated the levels of information, knowledge, and perceptions of public health professionals. It also examined the health systems' preparedness to cope with these health hazards, the available resources, and those needed to build resilience to the country's vulnerable population, as perceived by health professionals. The results revealed that 63.1% of the total respondents reported that climate change had been extensively experienced in the past years, while 32%…

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    Leadership Styles and Nurses’ Job Satisfaction. Results of a Systematic Review

    Maria Lucia Specchia, Maria Rosaria Cozzolino, Elettra Carini, Andrea Di Pilla, Caterina Galletti and 2 more

    387 citationsOpen access (CC-BY)doi:10.3390/ijerph18041552OpenAlex

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    Healthcare organisations are social systems in which human resources are the most important factor. Leadership plays a key role, affecting outcomes for professionals, patients and work environment. The aim of this research was to identify and analyse the knowledge present to date concerning the correlation between leadership styles and nurses' job satisfaction. A systematic review was carried out on PubMed, CINAHL and Embase using the following inclusion criteria: impact of different leadership styles on nurses' job satisfaction; secondary care; nursing setting; full-text available; English or Italian language. From 11,813 initial titles, 12 studies were selected. Of these, 88% showed a significant correlation between leadership style and nurses' job satisfaction. Transformational style had the highest number of positive correlations followed by authentic, resonant and servant styles. Passive-avoidant and laissez-faire styles, instead, showed a negative correlation with job satisfaction in all cases. Only the transactional style showed both positive and negative correlation. In this…

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    Psychological Wellbeing and Academic Experience of University Students in Australia during COVID-19

    Rachael Helen Dodd, Kevin Dadaczynski, Orkan Okan, Kirsten J. McCaffery, Kristen M Pickles

    376 citationsOpen access (CC-BY)doi:10.3390/ijerph18030866OpenAlex

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    COVID-19 has created significant challenges for higher education institutions and major disruptions in teaching and learning. To explore the psychological wellbeing of domestic and international university students during the COVID-19 pandemic, an online cross-sectional survey recruited 787 university students (18+ years) currently studying at an Australian university. In total, 86.8% reported that COVID-19 had significantly impacted their studies. Overall, 34.7% of students reported a sufficient level of wellbeing, while 33.8% showed low wellbeing and 31.5% very low wellbeing. Wellbeing was significantly higher in postgraduate students compared with undergraduate students. Future anxiety was significantly greater among undergraduate than postgraduate students. Multivariable regression models showed female gender, low subjective social status, negative overall learning experience or reporting COVID-19 having a huge impact on study, were associated with lower wellbeing in the first few months (May-July) of the pandemic. Supporting the health, wellbeing, and learning experiences of…

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    The Impact of Menstrual Cycle Phase on Athletes’ Performance: A Narrative Review

    Mikaeli A. Carmichael, Rebecca Louise Thomson, Lisa Moran, Thomas Philip Wycherley

    366 citationsOpen access (CC-BY)doi:10.3390/ijerph18041667OpenAlex

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    The effect of the menstrual cycle on physical performance is being increasingly recognised as a key consideration for women's sport and a critical field for further research. This narrative review explores the findings of studies investigating the effects of menstrual cycle phase on perceived and objectively measured performance in an athletic population. Studies examining perceived performance consistently report that female athletes identify their performance to be relatively worse during the early follicular and late luteal phases. Studies examining objective performance (using anaerobic, aerobic or strength-related tests) do not report clear, consistent effects of the impact of menstrual cycle phase on physical performance. Overall sport performance can be influenced by both perceived and physical factors. Hence, to optimise performance and management of eumenorrheic female athletes, there is a need for further research to quantify the impact of menstrual cycle phase on perceived and physical performance outcomes and to identify factors affecting variability in objective…

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    Post-COVID-19 Syndrome and the Potential Benefits of Exercise

    Amaya Jimeno‐Almazán, Jesús G. Pallarés, Ángel Buendía‐Romero, Alejandro Martínez-Cava, Francisco Franco‐López and 3 more

    352 citationsOpen access (CC-BY)doi:10.3390/ijerph18105329OpenAlex

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    The coronavirus disease (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, is leading to unknown and unusual health conditions that are challenging to manage. Post-COVID-19 syndrome is one of those challenges, having become increasingly common as the pandemic evolves. The latest estimates suggest that 10 to 20% of the SARS-CoV-2 patients who undergo an acute symptomatic phase are experiencing effects of the disease beyond 12 weeks after diagnosis. Although research is beginning to examine this new condition, there are still serious concerns about the diagnostic identification, which limits the best therapeutic approach. Exercise programs and physical activity levels are well-known modulators of the clinical manifestations and prognosis in many chronic diseases. This narrative review summarizes the up-to-date evidence on post-COVID-19 syndrome to contribute to a better knowledge of the disease and explains how regular exercise may improve many of these symptoms and could reduce the long-term effects of COVID-19.

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    Factors That Influence Participation in Physical Activity in School-Aged Children and Adolescents: A Systematic Review from the Social Ecological Model Perspective

    Donglin Hu, Shi Zhou, Zachary J. Crowley‐McHattan, Zhiyun Liu

    341 citationsOpen access (CC-BY)doi:10.3390/ijerph18063147OpenAlex

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    High prevalence of physical inactivity and obesity in children and adolescents has become a global problem. This systematic review aimed to examine the existing literature regarding the factors that influence participation in physical activity (PA) in children and adolescents with reference to the social ecological model (SEM) proposed by McLeroy et al. (1988). The SEM provides a framework under which the influencing factors are categorized into five levels: intrapersonal, interpersonal, organizational, community, and public policy. A systematic search of relevant literature published before July 2020 was conducted through Ebsco, ProQuest, PubMed Central, Scopus, and Web of Science. A total of fourteen studies met the inclusion criteria. The selected articles were all of high quality as assessed using the Mixed Methods Appraisal Tool (2018). The results indicated that gender, age, ethnicity, and self-concept were the most common influencing factors at the intrapersonal level. At the interpersonal and organization levels, supports from friends, parents, and teachers were positive…

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    Staphylococcus aureus Biofilm: Morphology, Genetics, Pathogenesis and Treatment Strategies

    Muhammad Mubashar Idrees, Sheeba Sawant, Nazira Karodia, Ayesha Rahman

    340 citationsOpen access (CC-BY)doi:10.3390/ijerph18147602OpenAlex

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    Staphylococcus aureus is a nosocomial bacterium causing different infectious diseases, ranging from skin and soft tissue infections to more serious and life-threatening infections such as septicaemia. S. aureus forms a complex structure of extracellular polymeric biofilm that provides a fully secured and functional environment for the formation of microcolonies, their sustenance and recolonization of sessile cells after its dispersal. Staphylococcus aureus biofilm protects the cells against hostile conditions, i.e., changes in temperature, limitations or deprivation of nutrients and dehydration, and, more importantly, protects the cells against antibacterial drugs. Drugs are increasingly becoming partially or fully inactive against S. aureus as they are either less penetrable or totally impenetrable due to the presence of biofilms surrounding the bacterial cells. Other factors, such as evasion of innate host immune system, genome plasticity and adaptability through gene evolution and exchange of genetic material, also contribute to the ineffectiveness of antibacterial drugs. This…

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    Social Media Use and Body Image Disorders: Association between Frequency of Comparing One’s Own Physical Appearance to That of People Being Followed on Social Media and Body Dissatisfaction and Drive for Thinness

    Barbara Jiotsa, Benjamin Naccache, Mélanie Duval, Bruno Rocher, Marie Grall‐Bronnec

    337 citationsOpen access (CC-BY)doi:10.3390/ijerph18062880OpenAlex

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    (1) Summary: Many studies have evaluated the association between traditional media exposure and the presence of body dissatisfaction and body image disorders. The last decade has borne witness to the rise of social media, predominantly used by teenagers and young adults. This study's main objective was to investigate the association between how often one compares their physical appearance to that of the people they follow on social media, and one's body dissatisfaction and drive for thinness. (2) Method: A sample composed of 1331 subjects aged 15 to 35 (mean age = 24.2), including 1138 subjects recruited from the general population and 193 patients suffering from eating disorders, completed an online questionnaire assessing social media use (followed accounts, selfies posted, image comparison frequency). This questionnaire incorporated two items originating from the Eating Disorder Inventory Scale (Body Dissatisfaction: EDI-BD and Drive for Thinness: EDI-DT). (3) Results: We found an association between the frequency of comparing one's own physical appearance to that of people…

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    Physical Activity of Children and Adolescents during the COVID-19 Pandemic—A Scoping Review

    Lea Rossi, Nick Behme, Christoph Breuer

    330 citationsOpen access (CC-BY)doi:10.3390/ijerph182111440OpenAlex

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    To counteract the COVIC-19 pandemic, many governments have introduced social distancing measures. While these restrictions helped contain the virus, it had adverse effects on individuals' mental and physical health-especially children. The aim of the present study is to review the evidence on the effects of COVID-19 restrictions on children's physical activity and their determinants. A scoping review was conducted in the databases PubMed, Web of Science, SportDiscus, and BISp-Surf. Inclusion criteria were empirical and peer-reviewed studies, youth samples, investigation of COVID-19 restrictions, and investigating changes and/or determinants of physical activity before and during the COVID-19 pandemic. Risk of bias was assessed using the checklist by Downs and Black. The search resulted in 1672 studies, of which 84 studies were included in the analysis. The results highlighted a decrease in physical activity during the pandemic, ranging between -10.8 min/day and -91 min/day. If an increase was detected, it related to unstructured and outdoor activities. The main determinants of…

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    Impact of Educational Technology on Teacher Stress and Anxiety: A Literature Review

    José María Fernández‐Batanero, Pedro Román Graván, Miguel María Reyes Rebollo, Marta Montenegro Rueda

    315 citationsOpen access (CC-BY)doi:10.3390/ijerph18020548OpenAlex

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    Educational technology has become an increasingly important element for improving the teaching and learning process of students. To achieve these goals, it is essential that teachers have the skills they need to be able to introduce technology into their teaching practice. However, this is often overwhelming and stressful for many of them. The aim of this review was to find out how research on teacher stress and anxiety associated with the use of educational technology was proceeding. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through the following bibliographic databases: PubMed, Web of Science, and Scopus. Sixteen articles were found from the review. The main findings show that teachers present high levels of anxiety or stress due to their use of educational technology in the classroom. Among the conclusions, the need for research on different strategies to prevent the emergence of these anxiety and stress symptoms in teachers stands out.

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    Functional Food—Consumer Motivations and Expectations

    Kinga Topolska, Adam Florkiewicz, Agnieszka Filipiak‐Florkiewicz

    304 citationsOpen access (CC-BY)doi:10.3390/ijerph18105327OpenAlex

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    This review provides insight into consumer attitudes toward functional food (FF), with the purpose of better understanding the needs and behavior regarding this kind of product. A total of 47 articles were selected for this paper. The available studies from last 20 years differ according to the focus (awareness, attitudes, motivations, willingness, acceptance by consumers) and methodologies used. Several factors, including socio-demographic, cognitive and attitudinal ones, seem to be serve as the basis for the acceptance of functional products. The research papers showed that nutritional knowledge is the most important of these. Older people are more interested in functional products than younger consumers, because of their stronger belief in the health benefits of FF. Moreover, women are more open to compromise between taste and health properties. Claims concerning the disease preventative properties of FF are the most attractive for consumers. This review focuses also on future perspectives for the functional food market. Adequate knowledge and evidence-based communication seem to…

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    Non-Alcoholic Fatty Liver Disease: Metabolic, Genetic, Epigenetic and Environmental Risk Factors

    Oriol Juanola, Sebastián Martínez‐López, Rubén Francés, Isabel Gómez‐Hurtado

    303 citationsOpen access (CC-BY)doi:10.3390/ijerph18105227OpenAlex

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    Non-alcoholic fatty liver disease (NAFLD) is one of the most frequent causes of chronic liver disease in the Western world, probably due to the growing prevalence of obesity, metabolic diseases, and exposure to some environmental agents. In certain patients, simple hepatic steatosis can progress to non-alcoholic steatohepatitis (NASH), which can sometimes lead to liver cirrhosis and its complications including hepatocellular carcinoma. Understanding the mechanisms that cause the progression of NAFLD to NASH is crucial to be able to control the advancement of the disease. The main hypothesis considers that it is due to multiple factors that act together on genetically predisposed subjects to suffer from NAFLD including insulin resistance, nutritional factors, gut microbiota, and genetic and epigenetic factors. In this article, we will discuss the epidemiology of NAFLD, and we overview several topics that influence the development of the disease from simple steatosis to liver cirrhosis and its possible complications.

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    Antibiotic-Resistant Bacteria in Aquaculture and Climate Change: A Challenge for Health in the Mediterranean Area

    Milva Pepi, Silvano Ettore Focardi

    301 citationsOpen access (CC-BY)doi:10.3390/ijerph18115723OpenAlex

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    Aquaculture is the productive activity that will play a crucial role in the challenges of the millennium, such as the need for proteins that support humans and the respect for the environment. Aquaculture is an important economic activity in the Mediterranean basin. A great impact is presented, however, by aquaculture practices as they involve the use of antibiotics for treatment and prophylaxis. As a consequence of the use of antibiotics in aquaculture, antibiotic resistance is induced in the surrounding bacteria in the column water, sediment, and fish-associated bacterial strains. Through horizontal gene transfer, bacteria can diffuse antibiotic-resistance genes and mobile resistance genes further spreading genetic determinants. Once triggered, antibiotic resistance easily spreads among aquatic microbial communities and, from there, can reach human pathogenic bacteria, making vain the use of antibiotics for human health. Climate change claims a significant role in this context, as rising temperatures can affect cell physiology in bacteria in the same way as antibiotics, causing…

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    Anxiety, Depression and Quality of Life—A Systematic Review of Evidence from Longitudinal Observational Studies

    Johanna Katharina Hohls, Hans‐Helmut König, Eleanor Quirke, André Hajek

    296 citationsOpen access (CC-BY)doi:10.3390/ijerph182212022OpenAlex

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    This review aimed to systematically review observational studies investigating the longitudinal association between anxiety, depression and quality of life (QoL). A systematic search of five electronic databases (PubMed, PsycINFO, PSYNDEX, NHS EED and EconLit) as well as forward/backward reference searches were conducted to identify observational studies on the longitudinal association between anxiety, depression and QoL. Studies were synthesized narratively. Additionally, a random-effects meta-analysis was performed using studies applying the mental and physical summary scores (MCS, PCS) of the Short Form Health Survey. The review was prospectively registered with PROSPERO and a study protocol was published. n = 47 studies on heterogeneous research questions were included, with sample sizes ranging from n = 28 to 43,093. Narrative synthesis indicated that QoL was reduced before disorder onset, dropped further during the disorder and improved with remission. Before onset and after remission, QoL was lower in comparison to healthy comparisons. n = 8 studies were included in…

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    COVID-19 Misinformation Online and Health Literacy: A Brief Overview

    Salman Bin Naeem, Maged N. Kamel Boulos

    295 citationsOpen access (CC-BY)doi:10.3390/ijerph18158091OpenAlex

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    Low digital health literacy affects large percentages of populations around the world and is a direct contributor to the spread of COVID-19-related online misinformation (together with bots). The ease and 'viral' nature of social media sharing further complicate the situation. This paper provides a quick overview of the magnitude of the problem of COVID-19 misinformation on social media, its devastating effects, and its intricate relation to digital health literacy. The main strategies, methods and services that can be used to detect and prevent the spread of COVID-19 misinformation, including machine learning-based approaches, health literacy guidelines, checklists, mythbusters and fact-checkers, are then briefly reviewed. Given the complexity of the COVID-19 infodemic, it is very unlikely that any of these approaches or tools will be fully effective alone in stopping the spread of COVID-19 misinformation. Instead, a mixed, synergistic approach, combining the best of these strategies, methods, and services together, is highly recommended in tackling online health misinformation,…

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    Smartphone Addiction and Associated Health Outcomes in Adult Populations: A Systematic Review

    Zubair Ahmed Ratan, Anne‐Maree Parrish, Sojib Bin Zaman, Mohammad Saud Alotaibi, Hassan Hosseinzadeh

    287 citationsOpen access (CC-BY)doi:10.3390/ijerph182212257OpenAlex

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    BACKGROUND: Smartphones play a critical role in increasing human-machine interactions, with many advantages. However, the growing popularity of smartphone use has led to smartphone overuse and addiction. This review aims to systematically investigate the impact of smartphone addiction on health outcomes. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to carry out the systematic review. Five electronic databases including Medline, Web of Science, PsycINFO, PubMed, and Scopus were searched to identify eligible studies. Eligible studies were screened against predetermined inclusion criteria and data were extracted according to the review questions. This review is registered in PROSPERO (CRD42020181404). The quality of the articles was assessed using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: A total of 27 of 2550 articles met the inclusion criteria. All of the studies were cross-sectional and focused on physical, mental, and neurological…

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    Psychometric Properties of the Climate Change Worry Scale

    Alan E. Stewart

    286 citationsOpen access (CC-BY)doi:10.3390/ijerph18020494OpenAlex

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    Climate change worry involves primarily verbal-linguistic thoughts about the changes that may occur in the climate system and the possible effects of these changes. Such worry is one of several possible psychological responses (e.g., fear, anxiety, depression, and trauma) to climate change. Within this article, the psychometric development of the ten-item Climate Change Worry Scale (CCWS) is detailed in three studies. The scale was developed to assess proximal worry about climate change rather than social or global impacts. Study 1 provided evidence that the CCWS items were internally consistent, constituted a single factor, and that the facture structure of the items was invariant for men and women. The results from Study 1 also indicated a good fit with a Rasch model of the items. Study 2 affirmed the internal consistency of the CCWS items and indicated that peoples’ responses to the measure were temporally stable over a two-week test–retest interval (r = 0.91). Study 3 provided support for the convergent and divergent validity of the CCWS through its pattern of correlations with…

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    Implementing Anti-Racism Interventions in Healthcare Settings: A Scoping Review

    Nadha Hassen, Aïsha Lofters, Sinit Michael, Amita Mall, Andrew David Pinto and 1 more

    285 citationsOpen access (CC-BY)doi:10.3390/ijerph18062993OpenAlex

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    Racism towards Black, Indigenous and people of colour continues to exist in the healthcare system. This leads to profound harm for people who use and work within these settings. This is a scoping review to identify anti-racism interventions in outpatient healthcare settings. Searching the peer-reviewed and grey literature, articles were screened for inclusion by at least two independent reviewers. Synthesizing the socio-ecological levels of interventions with inductively identifying themes, a conceptual model for implementing anti-racism interventions in healthcare settings is presented. In total, 37 peer-reviewed articles were included in the review, with 12 empirical studies and 25 theoretical or conceptual papers. Six grey literature documents were also included. Healthcare institutions need to incorporate an explicit, shared language of anti-racism. Anti-racism action should incorporate leadership buy-in and commitment with dedicated resources, support and funding; a multi-level approach beginning with policy and organizational interventions; transparent accountability…

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    Definitions of Culturally and Linguistically Diverse (CALD): A Literature Review of Epidemiological Research in Australia

    Thi Thu Le Pham, Janneke Berecki‐Gisolf, Angela Clapperton, Kerry O’Brien, Sara Liu and 1 more

    284 citationsOpen access (CC-BY)doi:10.3390/ijerph18020737OpenAlex

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    Objective: To identify how Culturally and Linguistically Diverse (CALD) communities are defined in epidemiological research in Australia and provide a definition of CALD status that aids the consistency and interpretability of epidemiological studies. Methods: Peer-reviewed literature from January 2015 to May 2020 was searched via four databases (Ovid Medline combined with PubMed, Embase, Emcare, and CINAHL) to identify quantitative studies of CALD people in Australia. Results: A total of 108 studies met the criteria for inclusion in the review. Country of birth was the most commonly used CALD definition (n = 33, 30.6%), with combinations of two or more components also frequently used (n = 31, 28.7%). No studies used all the components suggested as core to defining CALD status. including country of birth, languages other than English spoken at home, English proficiency, and indigenous status. Conclusions: There was considerable inconsistency in how CALD status was defined. The review suggests that CALD status would best be defined as people born in non-English speaking countries,…

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    A Qualitative Study of Child and Adolescent Mental Health during the COVID-19 Pandemic in Ireland

    Katriona O’Sullivan, Serena Clark, Amy McGrane, Nicole Rock, Lydia E. Carol-Ann Burke and 3 more

    283 citationsOpen access (CC-BY)doi:10.3390/ijerph18031062OpenAlex

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    Mitigating the adverse physical health risks associated with COVID-19 has been a priority of public health incentives. Less attention has been placed on understanding the psychological factors related to the global pandemic, especially among vulnerable populations. This qualitative study sought to understand the experiences of children and adolescents during COVID-19. This study interviewed 48 families during the COVID-19 pandemic restrictions, and a national lockdown, to understand its impacts. The study used an Interpretative Phenomenological Analysis (IPA) methodology. Parents and children discussed the negative impact of the restrictions on young people's wellbeing. Children and adolescents experienced adverse mental health effects, including feelings of social isolation, depression, anxiety, and increases in maladaptive behaviour. Families with children with Autism Spectrum Disorders reported increased mental health difficulties during this period mostly due to changes to routine. The findings highlight the impact of severe restrictions on vulnerable populations' wellbeing and…

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    Integrating Digital Technologies and Public Health to Fight Covid-19 Pandemic: Key Technologies, Applications, Challenges and Outlook of Digital Healthcare

    Qiang Wang, Min Su, Min Zhang, Rongrong Li

    277 citationsOpen access (CC-BY)doi:10.3390/ijerph18116053OpenAlex

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    Integration of digital technologies and public health (or digital healthcare) helps us to fight the Coronavirus Disease 2019 (COVID-19) pandemic, which is the biggest public health crisis humanity has faced since the 1918 Influenza Pandemic. In order to better understand the digital healthcare, this work conducted a systematic and comprehensive review of digital healthcare, with the purpose of helping us combat the COVID-19 pandemic. This paper covers the background information and research overview of digital healthcare, summarizes its applications and challenges in the COVID-19 pandemic, and finally puts forward the prospects of digital healthcare. First, main concepts, key development processes, and common application scenarios of integrating digital technologies and digital healthcare were offered in the part of background information. Second, the bibliometric techniques were used to analyze the research output, geographic distribution, discipline distribution, collaboration network, and hot topics of digital healthcare before and after COVID-19 pandemic. We found that the…

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    Resilience, Coping Strategies and Posttraumatic Growth in the Workplace Following COVID-19: A Narrative Review on the Positive Aspects of Trauma

    Georgia Libera Finstad, Gabriele Giorgi, Lucrezia Ginevra Lulli, Caterina Pandolfi, Giulia Foti and 3 more

    273 citationsOpen access (CC-BY)doi:10.3390/ijerph18189453OpenAlex

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    The COVID-19 pandemic represents a traumatic event that has profoundly changed working conditions with detrimental consequences for workers' health, in particular for the healthcare population directly involved in addressing the emergency. Nevertheless, previous research has demonstrated that traumatic experiences can also lead to positive reactions, stimulating resilience and feelings of growth. The aim of this narrative review is to investigate the positive aspects associated with the COVID-19 pandemic and the possible health prevention and promotion strategies by analyzing the available scientific evidence. In particular, we focus on the constructs of resilience, coping strategies and posttraumatic growth (PTG). A literature search was performed on the PubMed, EMBASE, Scopus, Web of Science, Google Scholar and Psycinfo databases. Forty-six articles were included in the literature synthesis. Psychological resilience is a fundamental variable for reducing and preventing the negative psychological effects of the pandemic and is associated with lower levels of depression, anxiety and…

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    A Scoping Review of Interventions for the Treatment of Eco-Anxiety

    Pauline Baudon, Liza Jachens

    269 citationsOpen access (CC-BY)doi:10.3390/ijerph18189636OpenAlex

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    As climate change worsens and public awareness of its grave impact increases, individuals are increasingly experiencing distressing mental health symptoms which are often grouped under the umbrella term of eco-anxiety. Clear guidance is needed to enable mental health professionals to make informed choices of appropriate interventions and approaches in their eco-anxiety treatment plans. A scoping review was conducted to examine the current understanding of eco-anxiety and related intervention options and recommendations. The review included 34 records, 13 of which reflected specific psychological approaches. A thematic analysis of the content of the selected records yielded five major themes across interventions for individual and group treatment of eco-anxiety: practitioners' inner work and education, fostering clients' inner resilience, encouraging clients to take action, helping clients find social connection and emotional support by joining groups, and connecting clients with nature. Recommendations for treatment plans are to focus on holistic, multi-pronged, and grief-informed…

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    Post-Traumatic Stress Symptoms in Healthcare Workers Dealing with the COVID-19 Pandemic: A Systematic Review

    Gabriele d’Ettorre, Giancarlo Ceccarelli, Letizia Santinelli, Paolo Vassalini, Giuseppe Pietro Innocenti and 5 more

    269 citationsOpen access (CC-BY)doi:10.3390/ijerph18020601OpenAlex

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    Prevention of post-traumatic stress symptoms (PTSS) in healthcare workers (HCWs) facing the current COVID-19 pandemic is a challenge worldwide as HCWs are likely to experience acute and chronic, often unpredictable, occupational stressors leading to PTSS. This review aims to analyze the literature to discover which topics have been focused on and what the latest developments are in managing the occupational risk of PTSS in HCWs during the current pandemic. For the purpose of this review, we searched for publications in MEDLINE/Pubmed using selected keywords. The articles were reviewed and categorized into one or more of the following categories based on their subject matter: risk assessment, risk management, occurrence rates. A total of 16 publications matched our inclusion criteria. The topics discussed were: "Risk Assessment", "Occurrence Rates", and "Risk Management". Young age, low work experience, female gender, heavy workload, working in unsafe settings, and lack of training and social support were found to be predictors of PTSS. This review's findings showed the need for…

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    A Pandemic within the Pandemic? Physical Activity Levels Substantially Decreased in Countries Affected by COVID-19

    Jan Wilke, Lisa Mohr, Adam Sebastian Tenforde, Pascal Édouard, Chiara FOSSATI and 19 more

    266 citationsOpen access (CC-BY)doi:10.3390/ijerph18052235OpenAlex

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    Governments have restricted public life during the COVID-19 pandemic, inter alia closing sports facilities and gyms. As regular exercise is essential for health, this study examined the effect of pandemic-related confinements on physical activity (PA) levels. A multinational survey was performed in 14 countries. Times spent in moderate-to-vigorous physical activity (MVPA) as well as in vigorous physical activity only (VPA) were assessed using the Nordic Physical Activity Questionnaire (short form). Data were obtained for leisure and occupational PA pre- and during restrictions. Compliance with PA guidelines was calculated based on the recommendations of the World Health Organization (WHO). In total, n = 13,503 respondents (39 ± 15 years, 59% females) were surveyed. Compared to pre-restrictions, overall self-reported PA declined by 41% (MVPA) and 42.2% (VPA). Reductions were higher for occupational vs. leisure time, young and old vs. middle-aged persons, previously more active vs. less active individuals, but similar between men and women. Compared to pre-pandemic, compliance with…

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    Prevalence, Risk Factors and Burnout Levels in Intensive Care Unit Nurses: A Systematic Review and Meta-Analysis

    Santiago Ramírez-Elvira, José Luis Romero‐Béjar, Nora Suleiman‐Martos, José Luis Gómez‐Urquiza, Carolina S. Monsalve-Reyes and 2 more

    265 citationsOpen access (CC-BY)doi:10.3390/ijerph182111432OpenAlex

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    Nursing is considered to be an at-risk profession of burnout due to daily exposure to difficult situations such as death and pain care. In addition, some units such as the intensive care unit (ICU), can be stressful due to high levels of morbidity and mortality and ethical dilemmas. Burnout causes a deterioration in quality of care, increasing the risk of mortality in patients due to poor performance and errors in the healthcare environment. The aim of this study was to analyse the levels, prevalence and related factors of burnout in ICU nurses. A systematic review and meta-analysis were carried out in the Medline, Scopus and CINAHL databases. Fifteen articles were found for the systematic review and four for the meta-analysis. With a sample of n = 1986 nurses, the meta-analytic estimate prevalence for high emotional exhaustion was 31% (95% CI, 8–59%), for high depersonalization was 18% (95% CI, 8–30%), and for low personal accomplishment was 46% (95% CI, 20–74%). Within the dimensions of burnout, emotional exhaustion had a significant relationship with depression and personality…

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    Pharmaceuticals Market, Consumption Trends and Disease Incidence Are Not Driving the Pharmaceutical Research on Water and Wastewater

    Omar Israel González Peña, Miguel Ángel López Zavala, Héctor Cabral Ruelas

    264 citationsOpen access (CC-BY)doi:10.3390/ijerph18052532OpenAlex

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    Pharmaceuticals enhance our quality of life; consequently, their consumption is growing as a result of the need to treat ageing-related and chronic diseases and changes in the clinical practice. The market revenues also show an historic growth worldwide motivated by the increase on the drug demand. However, this positivism on the market is fogged because the discharge of pharmaceuticals and their metabolites into the environment, including water, also increases due to their inappropriate management, treatment and disposal; now, worldwide, this fact is recognized as an environmental concern and human health risk. Intriguingly, researchers have studied the most effective methods for pharmaceutical removal in wastewater; however, the types of pharmaceuticals investigated in most of these studies do not reflect the most produced and consumed pharmaceuticals on the market. Hence, an attempt was done to analyze the pharmaceutical market, drugs consumption trends and the pharmaceutical research interests worldwide. Notwithstanding, the intensive research work done in different…

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    Predicting Type 2 Diabetes Using Logistic Regression and Machine Learning Approaches

    Ram D. Joshi, Chandra Dhakal

    261 citationsOpen access (CC-BY)doi:10.3390/ijerph18147346OpenAlex

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    Diabetes mellitus is one of the most common human diseases worldwide and may cause several health-related complications. It is responsible for considerable morbidity, mortality, and economic loss. A timely diagnosis and prediction of this disease could provide patients with an opportunity to take the appropriate preventive and treatment strategies. To improve the understanding of risk factors, we predict type 2 diabetes for Pima Indian women utilizing a logistic regression model and decision tree-a machine learning algorithm. Our analysis finds five main predictors of type 2 diabetes: glucose, pregnancy, body mass index (BMI), diabetes pedigree function, and age. We further explore a classification tree to complement and validate our analysis. The six-fold classification tree indicates glucose, BMI, and age are important factors, while the ten-node tree implies glucose, BMI, pregnancy, diabetes pedigree function, and age as the significant predictors. Our preferred specification yields a prediction accuracy of 78.26% and a cross-validation error rate of 21.74%. We argue that our…

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    Prediction of Type 2 Diabetes Based on Machine Learning Algorithm

    Henock M. Deberneh, Intaek Kim

    261 citationsOpen access (CC-BY)doi:10.3390/ijerph18063317OpenAlex

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    Prediction of type 2 diabetes (T2D) occurrence allows a person at risk to take actions that can prevent onset or delay the progression of the disease. In this study, we developed a machine learning (ML) model to predict T2D occurrence in the following year (Y + 1) using variables in the current year (Y). The dataset for this study was collected at a private medical institute as electronic health records from 2013 to 2018. To construct the prediction model, key features were first selected using ANOVA tests, chi-squared tests, and recursive feature elimination methods. The resultant features were fasting plasma glucose (FPG), HbA1c, triglycerides, BMI, gamma-GTP, age, uric acid, sex, smoking, drinking, physical activity, and family history. We then employed logistic regression, random forest, support vector machine, XGBoost, and ensemble machine learning algorithms based on these variables to predict the outcome as normal (non-diabetic), prediabetes, or diabetes. Based on the experimental results, the performance of the prediction model proved to be reasonably good at forecasting the…

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    Self-Efficacy, Job Satisfaction and Teacher Well-Being in the K-12 Educational System

    Florica Orţan, Ciprian Simuţ, Ramona Simuț

    260 citationsOpen access (CC-BY)doi:10.3390/ijerph182312763OpenAlex

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    Teacher job satisfaction and well-being have a significant impact on educational outcomes, considering that teaching is the main objective of the educational process. The aim of this study is to examine the relationship between teacher job satisfaction and four main categories of determinants: self-efficacy, relational aspects (colleague collaboration, student behavior, school management), work-related aspects (administrative workload, teaching tasks), and working conditions, in order to identify various implications for teachers' well-being. The study employs a survey delivered to 658 K-12 (pre-university) teachers, from the North-West region of Romania. We used factorial analysis and a structural equation model to test eight proposed hypotheses. The results showed that self-efficacy, promotion, positive student behavior, and working conditions have significant effects on job satisfaction. These factors influence job satisfaction and well-being in the teaching profession because they ensure a positive work environment in which teachers and students thrive, thus leading to higher…

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    Evidence-Based Effects of High-Intensity Interval Training on Exercise Capacity and Health: A Review with Historical Perspective

    Muhammed Mustafa ATAKAN, Yanchun Li, Şükran Nazan Koşar, Hüseyin Hüsrev Turnagöl, Xu Yan

    257 citationsOpen access (CC-BY)doi:10.3390/ijerph18137201OpenAlex

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    Engaging in regular exercise results in a range of physiological adaptations offering benefits for exercise capacity and health, independent of age, gender or the presence of chronic diseases. Accumulating evidence shows that lack of time is a major impediment to exercise, causing physical inactivity worldwide. This issue has resulted in momentum for interval training models known to elicit higher enjoyment and induce adaptations similar to or greater than moderate-intensity continuous training, despite a lower total exercise volume. Although there is no universal definition, high-intensity interval exercise is characterized by repeated short bursts of intense activity, performed with a "near maximal" or "all-out" effort corresponding to ≥90% of maximal oxygen uptake or >75% of maximal power, with periods of rest or low-intensity exercise. Research has indicated that high-intensity interval training induces numerous physiological adaptations that improve exercise capacity (maximal oxygen uptake, aerobic endurance, anaerobic capacity etc.) and metabolic health in both clinical and…

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    Outdoor Activity Participation Improves Adolescents’ Mental Health and Well-Being during the COVID-19 Pandemic

    S. Brent Jackson, Kathryn Tate Stevenson, Lincoln R. Larson, Markus Nils Peterson, Erin Seekamp

    253 citationsOpen access (CC-BY)doi:10.3390/ijerph18052506OpenAlex

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    COVID-19 is reshaping human interactions with the natural environment, potentially generating profound consequences for health and well-being. To assess the effects of COVID-19 on the outdoor recreation participation and subjective well-being of adolescents, as well as how participation in outdoor activities may mitigate declines in subjective well-being, we used a Qualtrics XM panel to conduct a nationally representative survey of youth ages 10–18 across the United States (n = 624) between 30 April and 15 June 2020. Survey questions focused on frequency of participation in outdoor activities before and during the pandemic, as well as changes in subjective well-being. Paired t-tests revealed decreases in both outdoor recreation participation (64% reported declines) and subjective well-being (52% reported declines). A regression model examining correlates of changes in subjective well-being (R2 = 0.42) revealed strong associations with changes in outdoor play (B = 0.44, p < 0.001) and nature-based (B = 0.21, p = 0.016) activities. Adolescents’ from all backgrounds who participated in…

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    Secondary Traumatic Stress and Burnout in Healthcare Workers during COVID-19 Outbreak

    Francesca Marzetti, G. Vagheggini, Ciro Conversano, M. Miccoli, A. Gemignani and 3 more

    251 citationsOpen access (CC-BY)doi:10.3390/ijerph18010337OpenAlex

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    (1) Background: The present study aims to assess the level of professional burnout and secondary traumatic stress (STS), and to identify potential risk or protective factors among health care workers (HCWs) during the coronavirus disease 2019 (COVID-19) outbreak.; (2) Methods: This cross-sectional study, based on an online survey, collected demographic data and mental distress outcomes from 184 HCWs from 1 May 2020, to 15 June 2020, from 45 different countries. The degree of STS, perceived stress and burnout was assessed using the Secondary Traumatic Stress Scale (STSS), the Perceived Stress Scale (PSS) and Maslach Burnout Inventory Human Service Survey (MBI-HSS) respectively. Stepwise multiple regression analysis was performed to identify potential risk and protective factors for STS; (3) Results: 184 HCWs (M = 90; Age mean: 46.45; SD: 11.02) completed the survey. A considerable proportion of HCWs had symptoms of STS (41.3%), emotional exhaustion (56.0%), and depersonalization (48.9%). The prevalence of STS was 47.5% in frontline HCWs while in HCWs working in other units it was…

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    The Impact of the COVID-19 Pandemic on Immunization Campaigns and Programs: A Systematic Review

    Zohra S Lassi, Rabia Naseem, Rehana A Salam, Faareha A Siddiqui, Jai K Das

    250 citationsOpen access (CC-BY)doi:10.3390/ijerph18030988OpenAlex

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    The COVID-19 pandemic has had an impact on health service delivery, including immunization programs, and this review assesses the impact on vaccine coverage across the globe and identifies the potential underlying factors. A systematic search strategy was employed on PubMed, Embase, MedRxiv, BioRxiv, and WHO COVID-19 databases from December 2019 till 15 September 2020. Two review authors independently assessed studies for inclusion, assessed quality, and extracted the data (PROSPERO registration #CRD42020182363). A total of 17 observational studies were included. The findings suggest that there was a reduction in the vaccination coverage and decline in total number of vaccines administered, which led to children missing out on their vaccine doses. An approximately fourfold increase was also observed in polio cases in polio endemic countries. Factors contributing to low vaccine coverage included fear of being exposed to the virus at health care facilities, restriction on city-wide movements, shortage of workers, and diversion of resources from child health to address the pandemic. As…

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    Access to Healthcare during COVID-19

    Alicia Núñez, S. D. Sreeganga, Arkalgud Ramaprasad

    247 citationsOpen access (CC-BY)doi:10.3390/ijerph18062980OpenAlex

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    Ensuring access to healthcare is critical to prevent illnesses and deaths from COVID-19 and non-COVID-19 cases in health systems that have deteriorated during the pandemic. This study aims to map the existing literature on healthcare access after the appearance of COVID-19 using an ontological framework. This will help us to formalize, standardize, visualize and assess the barriers to and drivers of access to healthcare, and how to continue working towards a more accessible health system. A total of 131 articles are included and considered for mapping in the framework. The results were also compared to the World Health Organization guidelines on maintaining essential health services to determine the overlapping and nonoverlapping areas. We showed the benefits of using ontology to promote a systematic approach to address healthcare problems of access during COVID-19 or other pandemics and set public policies. This systematic approach will provide feedback to study the existing guidelines to make them more effective, learn about the existing gaps in research, and the relationship…

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    Health Literacy, Digital Health Literacy, and COVID-19 Pandemic Attitudes and Behaviors in U.S. College Students: Implications for Interventions

    Uday P. Patil, Uliana Kostareva, Molly Hadley, Jennifer A. Manganello, Orkan Okan and 4 more

    245 citationsOpen access (CC-BY)doi:10.3390/ijerph18063301OpenAlex

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    The COVID-19 pandemic has been accompanied by rapidly emerging evidence, changing guidance, and misinformation, which present new challenges for health literacy (HL) and digital health literacy (DHL) skills. This study explored whether COVID-19-related information access, attitudes, and behaviors were associated with health literacy and digital health literacy among college students in the United States. Self-reported measures of health literacy, along with items on pandemic-related attitudes, behaviors, information sources, and social networks, were collected online using a managed research panel. In July 2020, 256 responses were collected, which mirrored the racial/ethnic and gender diversity of U.S. colleges. Only 49% reported adequate HL, and 57% found DHL tasks easy overall. DHL did not vary by HL level. In multivariable models, both HL and DHL were independently associated with overall compliance with basic preventive practices. Higher DHL, but not HL, was significantly associated with greater willingness to get a COVID-19 vaccine and the belief that acquiring the disease…

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    Ecological Grief as a Response to Environmental Change: A Mental Health Risk or Functional Response?

    Hannah Comteße, Verena Ertl, Sophie M. C. Hengst, Rita Rosner, Geert Edzko Smid

    244 citationsOpen access (CC-BY)doi:10.3390/ijerph18020734OpenAlex

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    The perception of the impact of climate change on the environment is becoming a lived experience for more and more people. Several new terms for climate change-induced distress have been introduced to describe the long-term emotional consequences of anticipated or actual environmental changes, with ecological grief as a prime example. The mourning of the loss of ecosystems, landscapes, species and ways of life is likely to become a more frequent experience around the world. However, there is a lack of conceptual clarity and systematic research efforts with regard to such ecological grief. This perspective article introduces the concept of ecological grief and contextualizes it within the field of bereavement. We provide a case description of a mountaineer in Central Europe dealing with ecological grief. We introduce ways by which ecological grief may pose a mental health risk and/or motivate environmental behavior and delineate aspects by which it can be differentiated from related concepts of solastalgia and eco-anxiety. In conclusion, we offer a systematic agenda for future…

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    The Burden of Burnout among Healthcare Professionals of Intensive Care Units and Emergency Departments during the COVID-19 Pandemic: A Systematic Review

    Maria Rosaria Gualano, Tiziana Sinigaglia, Giuseppina Lo Moro, Stefano Rousset, Agnese Cremona and 2 more

    241 citationsOpen access (CC-BY)doi:10.3390/ijerph18158172OpenAlex

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    The primary aim was to evaluate the burnout prevalence among healthcare workers (HCWs) in intensive care units (ICUs) and emergency departments (EDs) during the COVID-19 pandemic. The secondary aim was to identify factors associated with burnout in this population. A systematic review was conducted following PRISMA guidelines by searching PubMed, Embase, PsychINFO, and Scopus from 1 January to 24 November 2020. Studies with information about burnout prevalence/level during the pandemic regarding ICU/ED HCWs were eligible. A total of 927 records were identified. The selection resulted in 11 studies. Most studies were conducted in April/May 2020. Samples ranged from 15 to 12,596 participants. The prevalence of overall burnout ranged from 49.3% to 58%. Nurses seemed to be at higher risk. Both socio-demographic and work-related features were associated with burnout. Many pandemic-related variables were associated with burnout, e.g., shortage in resources, worry regarding COVID-19, and stigma. This review highlighted a substantial burnout prevalence among ICU/ED HCWs. However, this…

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    Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic

    Stella E. Hines, Katherine H. Chin, D.R. Glick, Emerson M. Wickwire

    238 citationsOpen access (CC-BY)doi:10.3390/ijerph18020488OpenAlex

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    The coronavirus severe acute respiratory syndrome (COVID-19) pandemic has placed increased stress on healthcare workers (HCWs). While anxiety and post-traumatic stress have been evaluated in HCWs during previous pandemics, moral injury, a construct historically evaluated in military populations, has not. We hypothesized that the experience of moral injury and psychiatric distress among HCWs would increase over time during the pandemic and vary with resiliency factors. From a convenience sample, we performed an email-based, longitudinal survey of HCWs at a tertiary care hospital between March and July 2020. Surveys measured occupational and resilience factors and psychiatric distress and moral injury, assessed by the Impact of Events Scale-Revised and the Moral Injury Events Scale, respectively. Responses were assessed at baseline, 1-month, and 3-month time points. Moral injury remained stable over three months, while distress declined. A supportive workplace environment was related to lower moral injury whereas a stressful, less supportive environment was associated with increased…

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    Cortisol on Circadian Rhythm and Its Effect on Cardiovascular System

    Nor Amira Syahira Mohd Azmi, Norsham Juliana, Sahar Azmani, Nadia Mohd Effendy, Izuddin Fahmy Abu and 2 more

    233 citationsOpen access (CC-BY)doi:10.3390/ijerph18020676OpenAlex

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    The synthesis and secretion of cortisol are controlled by the hypothalamic-pituitary-adrenal axis. Cortisol exhibits a proper 24-h circadian rhythm that affects the brain, the autonomic nervous system, the heart, and the vasculature that prepares the cardiovascular system for optimal function during these anticipated behavioral cycles. A literature search was conducted using databases such as Google Scholar, PubMed, and Scopus. Relevant search terms included "circadian rhythm and cardiovascular", "cortisol", "cortisol and acute coronary syndrome", "cortisol and arrhythmias", "cortisol and sudden cardiac death", "cortisol and stroke", and "cardioprotective agents". A total of 120 articles were obtained on the basis of the above search. Lower levels of cortisol were seen at the beginning of sleep, while there was a rise towards the end of sleep, with the highest level reached at the moment the individual wakes up. In the present review, we discuss the role of 11β-hydroxysteroid dehydrogenase (11β-HSD1), which is a novel molecular target of interest for treating metabolic syndrome and…

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    Health Inequities in LGBT People and Nursing Interventions to Reduce Them: A Systematic Review

    Jorge Medina-Martínez, Carlos Saus‐Ortega, Montserrat Sánchez-Lorente, Eva María Sosa-Palanca, Pedro García-Martínez and 1 more

    232 citationsOpen access (CC-BY)doi:10.3390/ijerph182211801OpenAlex

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    BACKGROUND: Lesbian, gay, bisexual, and transgender (LGBT) people present poorer mental and physical health results compared to the heterosexual and cisgender population. There are barriers in the healthcare system that increase these health inequities. OBJECTIVE: To synthesise the available evidence on how nurses can intervene in reducing health inequities in LGBT people, identifying their specific health needs and describing their experiences and perceptions of the barriers they face in the healthcare system. METHODS: Systematic review. Between March and April 2021, a bibliographic search was carried out in the Cuiden, LILACS, PubMed, Dialnet, SciELO, Trip Database, and Web of Science databases and metasearch engines. INCLUSION CRITERIA: Articles published in the last 5 years that address the specific health needs of LGBT people, their experiences and perceptions, or interventions in this group in which nurses may engage. RESULTS: A total of 16 articles were selected. Health disparities were detected in the LGBT community, which exhibited higher rates of mental health problems,…

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    Predictors of Vaccine Hesitancy: Implications for COVID-19 Public Health Messaging

    Amanda Hudson, William J. Montelpare

    232 citationsOpen access (CC-BY)doi:10.3390/ijerph18158054OpenAlex

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    OBJECTIVES: Successful immunization programs require strategic communication to increase confidence among individuals who are vaccine-hesitant. This paper reviews research on determinants of vaccine hesitancy with the objective of informing public health responses to COVID-19. METHOD: A literature review was conducted using a broad search strategy. Articles were included if they were published in English and relevant to the topic of demographic and individual factors associated with vaccine hesitancy. RESULTS AND DISCUSSION: Demographic determinants of vaccine hesitancy that emerged in the literature review were age, income, educational attainment, health literacy, rurality, and parental status. Individual difference factors included mistrust in authority, disgust sensitivity, and risk aversion. CONCLUSION: Meeting target immunization rates will require robust public health campaigns that speak to individuals who are vaccine-hesitant in their attitudes and behaviours. Based on the assortment of demographic and individual difference factors that contribute to vaccine hesitancy,…

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    Cardiovascular Risk Factors and Physical Activity for the Prevention of Cardiovascular Diseases in the Elderly

    Lorena Ciumărnean, Mircea Vasile Milaciu, Vasile Negrean, Olga Hilda Orasan, Ștefan Cristian Vesa and 3 more

    231 citationsOpen access (CC-BY)doi:10.3390/ijerph19010207OpenAlex

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    Cardiovascular diseases create an important burden on the public health systems, especially in the elderly, mostly because this group of patients frequently suffer from multiple comorbidities. Accumulating cardiovascular risk factors during their lifetime has a detrimental effect on an older adult's health status. The modifiable and non-modifiable cardiovascular risk factors are very diverse, and are frequently in a close relationship with the metabolic comorbidities of the elderly, mainly obesity and Diabetes Mellitus. In this review, we aim to present the most important cardiovascular risk factors which link aging and cardiovascular diseases, starting from the pathophysiological links between these factors and the aging process. Next, we will further review the main interconnections between obesity and Diabetes Mellitus and cardiovascular diseases of the elderly. Lastly, we consider the most important aspects related to prevention through lifestyle changes and physical activity on the occurrence of cardiovascular diseases in the elderly.

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    Prevalence of Sexual Abuse in Adults with Intellectual Disability: Systematic Review and Meta-Analysis

    Raluca Tomşa, Smaranda Guțu, Daniel Cojocaru, Belén Gutiérrez-Bermejo, Noelia Flores and 1 more

    230 citationsOpen access (CC-BY)doi:10.3390/ijerph18041980OpenAlex

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    This study presents the results of a systematic review on the prevalence of sexual abuse experienced in adulthood by individuals with intellectual disability. An electronic and manual search of academic journals was performed on four databases via EBSCO Host: Academic Search Complete, PsycINFO, Medline, CINAHL Full-Text. In addition, PubMed, ProQuest, and Web of Science (core collection) were searched. After an initial selection of 1037 documents, 25 articles remained for quantitative synthesis. The combined prevalence of sexual abuse in adults with intellectual disability was 32.9% (95% CI: 22.7-43.0) and sensitivity analysis revealed that the prevalence was not outweighed by a single study. Overall, the United Kingdom had the highest prevalence (r = 34.1%), and the USA had the lowest (r = 15.2%). The overall prevalence in females was lower (r = 31.8%) than that in males (r = 39.9%). Subgroup analyses revealed that prevalence of sexual abuse was higher in institutionalized individuals. The most prevalent profile of abuser is of a peer with intellectual disability. Prevalence…

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    Alice in Suicideland: Exploring the Suicidal Ideation Mechanism through the Sense of Connectedness and Help-Seeking Behaviors

    Minh‐Hoang Nguyen, Tam-Tri Le, Hong‐Kong T. Nguyen, Manh‐Toan Ho, Nguyễn Thanh Thanh Huyền and 1 more

    229 citationsOpen access (CC-BY)doi:10.3390/ijerph18073681OpenAlex

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    On average, one person dies by suicide every 40 s. However, extant studies have largely focused on the risk factors for suicidal behaviors, not so much on the formation of suicidal thoughts. Therefore, we attempt to explain how suicidal thoughts arise and persist inside one's mind using a multifiltering information mechanism called Mindsponge. Bayesian analysis with Hamiltonian Markov Chain Monte Carlo (MCMC) technique was run on a dataset of multinational students (N = 268) of an international university in Japan. Item 9 in the PHQ-9 was used to survey suicidal ideation. The associations among four main variables, namely, (i) suicidal ideation, (ii) help-seeking willingness (informal and formal sources), (iii) sense of connectedness, and (iv) information inaccessibility (represented by being international students), were tested in four models. Sense of connectedness is negatively associated with suicidal ideation, but its effect becomes less impactful when interacting with international students. The impact of a sense of connectedness on informal help-seeking willingness (toward…

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    Economic Burden of Stroke Disease: A Systematic Review

    Thinni Nurul Rochmah, Indana Tri Rahmawati, Maznah Dahlui, Wasis Budiarto, Nabilah Bilqis

    228 citationsOpen access (CC-BY)doi:10.3390/ijerph18147552OpenAlex

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    Globally, one of the main causes of non-communicable disease as a cause of death every year is stroke. The objective of this study was to analyze the burden in consequence of stroke. This research used a systematic review method. Furthermore, a search for articles was carried out in June-July 2020. Four databases were used to search articles from 2015 to 2020. Eligible studies were identified, analyzed, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The inclusion criteria were prospective cost studies, retrospective cost studies, database analysis, mathematical models, surveys, and COI studies that assess burden of stroke in primary and referral healthcare (hospital-based). The results showed that from four databases, 9270 articles were obtained, and 13 articles were qualified. A total of 9270 articles had the identified search keywords, but only 13 articles met the set criteria for inclusion. The criteria for inclusion were stroke patients, the economic burden of stroke disease based on cost of illness method,…

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    Short Physical Performance Battery as a Measure of Physical Performance and Mortality Predictor in Older Adults: A Comprehensive Literature Review

    Caroline de Fátima Ribeiro Silva, Daniela Gonçalves Ohara, Areolino Pena Matos, Ana Carolina Pereira Nunes Pinto, Maycon Sousa Pegorari

    225 citationsOpen access (CC-BY)doi:10.3390/ijerph182010612OpenAlex

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    The association between the Short Physical Performance Battery (SPPB) score and several adverse health outcomes, including mortality, has been reported in the scientific literature. We conducted a comprehensive literature review of studies on the relationship between SPPB and mortality. The current paper synthesizes the characteristics and main findings of longitudinal studies available in the literature that investigated the role of the SPPB in predicting mortality in older adults. The studies (n = 40) are from North America, South America, Europe, and Asia; the majority (n = 16) were conducted with community-dwelling older adults and reported an association between lower SPPB scores and a higher risk of mortality, and between higher SPPB scores and higher survival. Nevertheless, few studies have analyzed the accuracy of the instrument to predict mortality. The only study that established cut-off points was conducted with older adults discharged from an acute care hospital. Although an SPPB score lower than 10 seems to predict all-cause mortality, further studies showing cut-off…

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    Municipal Solid Waste Management and Adverse Health Outcomes: A Systematic Review

    Giovanni Vinti, Valerie Bauza, Thomas Clasen, Kate O. Medlicott, Terry Louis Tudor and 2 more

    225 citationsOpen access (CC-BY)doi:10.3390/ijerph18084331OpenAlex

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    Municipal solid waste (MSW) can pose a threat to public health if it is not safely managed. Despite prior research, uncertainties remain and refurbished evidence is needed along with new approaches. We conducted a systematic review of recently published literature to update and expand the epidemiological evidence on the association between MSW management practices and resident populations' health risks. Studies published from January 2005 to January 2020 were searched and reviewed following PRISMA guidelines. Eligible MSW treatment or disposal sites were defined as landfills, dumpsites, incinerators, waste open burning, transfer stations, recycling sites, composting plants, and anaerobic digesters. Occupational risks were not assessed. Health effects investigated included mortality, adverse birth and neonatal outcomes, cancer, respiratory conditions, gastroenteritis, vector-borne diseases, mental health conditions, and cardiovascular diseases. Studies reporting on human biomonitoring for exposure were eligible as well. Twenty-nine studies were identified that met the inclusion…

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    Do the Green Credit Guidelines Affect Corporate Green Technology Innovation? Empirical Research from China

    Min Hong, Zhenghui Li, Benjamin M. Drakeford

    225 citationsOpen access (CC-BY)doi:10.3390/ijerph18041682OpenAlex

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    Green technology innovation is regarded as an important means to achieve sustainable development. Countries all over the world mainly implement green technology innovation policies from the aspects of environmental regulation and financing constraints. The effect of financing constraint policy on enterprise green technology innovation remains to be investigated. Based on the event of "green credit guidelines" issued by China Banking Regulatory Commission in 2012, this paper collects the panel data of China's 2825 listed companies from 2007 to 2018, constructs a difference-in-difference model, and studies the impact of green credit guidelines on corporate green technology innovation and its mechanism. The empirical results show: First, green credit guidelines can promote corporate green technology innovation on the whole. Second, the mechanism of green credit on enterprise green technology innovation is identified. Green credit guidelines mainly limited green technology innovation through reducing debt financing, rather than through financing constraints. Third, the impact of green…

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    Medical Studies during the COVID-19 Pandemic: The Impact of Digital Learning on Medical Students’ Burnout and Mental Health

    Panagiotis Zis, Artemios Artemiadis, Panagiotis Bargiotas, Antonios Nteveros, Georgios M. Hadjigeorgiou

    225 citationsOpen access (CC-BY)doi:10.3390/ijerph18010349OpenAlex

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    Objectives: The aim of this ecological study was to investigate what the impact of digital learning due to the COVID-19 pandemic was on the burnout and overall mental health (MH) of medical students. Background: During the unprecedented era of the COVID-19 pandemic, the majority of countries worldwide adopted very strong measures. Universities closed their doors, and education continued through digital learning lectures. Methods: An anonymous questionnaire was administered to all 189 eligible candidates before and during the COVID-19 pandemic. Mental health was assessed via the MH domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory—Student Survey (MBI-SS). Results: The overall response rate was 81.5%. The overall burnout prevalence did not differ significantly between the two periods (pre-COVID-19 18.1% vs. COVID-19 18.2%). However, the burnout prevalence dropped significantly in year 4 (pre-COVID-19 40.7% vs. COVID-19 16.7%, p = 0.011), whereas it increased significantly in year 6 (pre-COVID-19 27.6% vs. COVID-19 50%, p = 0.01).…

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    Physical Activity and Physical Fitness among University Students—A Systematic Review

    Vidran Kljajević, Mima N. Stanković, Dušan Đorđević, Drena Trkulja Petković, Rade Jovanović and 4 more

    220 citationsOpen access (CC-BY)doi:10.3390/ijerph19010158OpenAlex

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    The aim of this systematic review was to examine the scientific evidence regarding physical activity and physical fitness among university students. The search and analysis of the studies were done in accordance with the PRISMA guidelines. An electronic databases search (Google Scholar, PubMed, Science Direct, and Scopus) yielded 11,839 studies. Subsequently, the identified studies had to be published in English between 2011 and 2021, the experimental study had to have included males and females attending a faculty, and the participants had to have been evaluated for physical activity and fitness. A total of 21 studies were included in the quantitative synthesis, with a total of 7306 participants, both male and female. After analyzing the obtained results, it could be concluded that university students show a satisfactory level of physical activity and physical fitness. However, the results vary due to different factors involved, mostly related to the cultural differences and educational systems in different countries. As this study observes mediocre results of physical activity and…

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    Mechanisms of Impact of Blue Spaces on Human Health: A Systematic Literature Review and Meta-Analysis

    Michail Georgiou, Gordon Morison, Niamh Smith, Zoë Tieges, SEBASTIEN F. M. CHASTIN

    220 citationsOpen access (CC-BY)doi:10.3390/ijerph18052486OpenAlex

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    Blue spaces have been found to have significant salutogenic effects. However, little is known about the mechanisms and pathways that link blue spaces and health. The purpose of this systematic review and meta-analysis is to summarise the evidence and quantify the effect of blue spaces on four hypothesised mediating pathways: physical activity, restoration, social interaction and environmental factors. Following the PRISMA guidelines, a literature search was conducted using six databases (PubMed, Scopus, PsycInfo, Web of Science, Cochrane Library, EBSCOHOST/CINAHL). Fifty studies were included in our systematic review. The overall quality of the included articles, evaluated with the Qualsyst tool, was judged to be very good, as no mediating pathway had an average article quality lower than 70%. Random-effects meta-analyses were conducted for physical activity, restoration and social interaction. Living closer to blue space was associated with statistically significantly higher physical activity levels (Cohen's d = 0.122, 95% CI: 0.065, 0.179). Shorter distance to blue space was not…

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    Eating Behaviour Changes during the COVID-19 Pandemic: A Systematic Review of Longitudinal Studies

    Cristina González-Monroy, Irene Gómez‐Gómez, Cristian M. Olarte‐Sánchez, Emma Motrico

    215 citationsOpen access (CC-BY)doi:10.3390/ijerph182111130OpenAlex

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    Eating behaviour is a complex construct that is liable to be modified by external factors. Due to the outbreak of coronavirus disease 2019 (COVID-19), many restrictive measures were carried out with the aim of reducing the impact of this disease. As a result, lifestyles were disrupted, which could affect eating behaviours. The aim of this systematic review of longitudinal studies was to assess changes in eating behaviour during the COVID-19 pandemic by establishing a comparison of eating behaviours before and after the outbreak of the pandemic. This study followed the PRISMA guidelines (PROSPERO: CRD42020203246), whereas to assess the quality of the studies, the Newcastle-Ottawa Quality Assessment Scale (NOS) was applied. Out of a set of 826 studies, 23 were included in this systematic review. The main findings provided information about a shift towards modified eating behaviours, characterized by an increased snack frequency and a preference for sweets and ultra-processed food rather than fruits, vegetables, and fresh food. Additionally, an increased alcohol consumption was found…

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    Impact of the COVID-19 Pandemic on Sedentary Time and Behaviour in Children and Adults: A Systematic Review and Meta-Analysis

    Adam Runacres, Kelly Alexandra Mackintosh, Rachel L. Knight, Liba Sheeran, Rhys Thatcher and 2 more

    214 citationsOpen access (CC-BY)doi:10.3390/ijerph182111286OpenAlex

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    The aim of this meta-analysis was to quantify the change in sedentary time during the COVID-19 pandemic and its effect on health outcomes in the general population. One thousand six hundred and one articles published after 2019 were retrieved from five databases, of which 64 and 40 were included in the systematic review and meta-analysis, respectively. Studies were grouped according to population: children (<18 years), adults (18–64 years) and older adults (>65 years). Average sedentary time was calculated, with sub-analyses performed by country, behaviour type and health outcomes. Children were most affected, increasing their sedentary time by 159.5 ± 142.6 min day−1, followed by adults (+126.9 ± 42.2 min day−1) and older adults (+46.9 ± 22.0 min day−1). There were no sex differences in any age group. Screen time was the only consistently measured behaviour and accounted for 46.8% and 57.2% of total sedentary time in children and adults, respectively. Increases in sedentary time were negatively correlated with global mental health, depression, anxiety and quality of life,…

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    Food Insecurity and Child Development: A State-of-the-Art Review

    Danielle Gallegos, Areana R. Eivers, Peter Sondergeld, Cassandra L. Pattinson

    213 citationsOpen access (CC-BY)doi:10.3390/ijerph18178990OpenAlex

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    Converging research indicates that household food insecurity impedes children from reaching their full physical, cognitive, and psychosocial potential. This state-of-the-art review examines the last decade of research to: (1) describe the impact of the severity and persistence of food insecurity on child development; (2) use a socio-ecological framework to examine significant proximal and distal factors which may interplay; and (3) outline directions for future research. We conducted a systematic review of six databases of published papers from 2011 to June 2021. The search was limited to high-income countries and children aged from birth to 12 years. From 17,457 papers, 17 studies were included in the final review. Transitioning between food security and food insecurity had a significant and lasting effect on academic/cognitive function and behavior (i.e., externalizing), however less clear relationships were seen for psychosocial outcomes and other behaviors examined (i.e., internalizing). There was significant variation in the measurement and thresholds used to define both food…

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    Time Spent in Nature Is Associated with Increased Pro-Environmental Attitudes and Behaviors

    Nicole V. DeVille, Linda Powers Tomasso, Olivia P. Stoddard, Grete E. Wilt, Teresa H. Horton and 4 more

    212 citationsOpen access (CC-BY)doi:10.3390/ijerph18147498OpenAlex

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    Urbanization, screen dependency, and the changing nature of childhood and parenting have led to increased time indoors, creating physical and emotional distancing from nature and time spent in natural environments. Substantial evidence from observational and intervention studies indicates that overall time spent in nature leads to increased perceived value for connectedness to nature and, subsequently, greater pro-environmental attitudes and behaviors (PEAB). This narrative review of the recent literature evaluates associations between time spent in nature with values ascribed to nature and nature connectedness, as well as PEAB. We discuss the influence of nature exposure and education in childhood on subsequent development of PEAB in adulthood. We analyze theoretical frameworks applied to this research as well as metrics employed, populations studied, and individual and societal values before presenting limitations of this research. We conclude with suggestions for future research directions based on current knowledge, underscoring the importance of promoting time spent in nature…

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    Stiff Landings, Core Stability, and Dynamic Knee Valgus: A Systematic Review on Documented Anterior Cruciate Ligament Ruptures in Male and Female Athletes

    Joseph Larwa, Conrad Stoy, Ross S. Chafetz, Michael R. Boniello, Corinna C. Franklin

    212 citationsOpen access (CC-BY)doi:10.3390/ijerph18073826OpenAlex

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    Anterior cruciate ligament (ACL) injuries are the most common ligament injury of the knee, accounting for between 100,000 and 200,000 injuries among athletes per year. ACL injuries occur via contact and non-contact mechanisms, with the former being more common in males and the later being more common in females. These injuries typically require surgical repair and have relatively high re-rupture rates, resulting in a significant psychological burden for these individuals and long rehabilitation times. Numerous studies have attempted to determine risk factors for ACL rupture, including hormonal, biomechanical, and sport- and gender-specific factors. However, the incidence of ACL injuries continues to rise. Therefore, we performed a systematic review analyzing both ACL injury video analysis studies and studies on athletes who were pre-screened with eventual ACL injury. We investigated biomechanical mechanisms contributing to ACL injury and considered male and female differences. Factors such as hip angle and strength, knee movement, trunk stability, and ankle motion were considered to…

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    Are There Differences in Video Gaming and Use of Social Media among Boys and Girls?—A Mixed Methods Approach

    Marja Leonhardt, Stian Overå

    210 citationsOpen access (CC-BY)doi:10.3390/ijerph18116085OpenAlex

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    Gaming is widespread among adolescents and has typically been viewed as an activity for boys. There are however a growing number of female gamers and we need to learn more about how gender affects gaming. The aim of this study is to both quantify gaming among Norwegian adolescents and explore how gender differences are perceived. A mixed method approach was used to capture gaming experiences among boys and girls. Survey data (N = 5607) was analyzed descriptively, and five focus groups were conducted, applying thematic analysis. Statistics showed that boys from the age of 14 use video games up to 5 times more than girls, while girls are much more on social media. From the focus groups, we found that boys did not view social media as socially significant as gaming and that there is a greater social acceptance of gaming among boys than among girls. Gender differences in video gaming are not necessarily a problem per se, as they may reflect gender-specific motivations and interests. However, the study also finds that girls feel less encouraged than boys to play video games due to…

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    Emotional Labor and Burnout among Teachers: A Systematic Review

    Anna Kariou, Panagiota Koutsimani, Anthony Montgomery, Olga Lainidi

    209 citationsOpen access (CC-BY)doi:10.3390/ijerph182312760OpenAlex

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    A significant amount of emotional labor takes place during teaching. Teaching is a multitasking profession that consists of both cognitive and emotional components, with teachers engaging in emotional labor on a daily basis as an instrumental part of achieving teaching goals and positive learning outcomes. The purpose of the present review was to explore the relationship between emotional labor and burnout in school settings. The review focused specifically on teachers from elementary and high schools, between January 2006 and August 2021, and 21 studies fit the inclusion criteria. Overall, the review of the literature supports the significant associations between burnout and emotional labor with the majority of results pointing to the consistent relationship between surface acting and burnout. However, the results regarding the association of deep acting and naturally felt emotions with burnout were mixed. There is considerable scope for improvement in our study of emotional labor in terms of the study designs we employ, the variables we study and our appreciation of the historical…

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    Will Nothing Be the Same Again?: Changes in Lifestyle during COVID-19 Pandemic and Consequences on Mental Health

    Emanuele Caroppo, Marianna Mazza, Alessandra Sannella, Giuseppe Marano, Carla Avallone and 5 more

    209 citationsOpen access (CC-BY)doi:10.3390/ijerph18168433OpenAlex

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    Social isolation caused by the COVID-19 pandemic has drastically affected lifestyles: from sedentary behaviors to reduced physical activity, from disrupted sleep patterns to altered dietary habits. As a consequence, serious mental and emotional responses have been registered. There was a significant decline in physical and other meaningful activities of daily living, leisure, social activity, and education. In children, collateral effects of the pandemic include inadequate nutrition with a risk of both overweight and underweight, addiction to screens, lack of schooling, and psychosocial difficulties. Older adults are frequently unable to adapt to lockdown measures and suffer from depression and cognitive complaints. Recent studies focusing on changes in lifestyle during the Covid-19 pandemic and consequences on mental health have been identified in PubMed/Medline, Scopus, Embase, and ScienceDirect. All the available literature has been retrospectively reviewed. The results of the present narrative review suggest that mental distress caused by social isolation seems to be linked not…

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    Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

    Antoni Sisó‐Almirall, Pilar Brito‐Zerón, Laura Conangla, Belchin Kostov, Ana Moragas and 8 more

    207 citationsOpen access (CC-BY)doi:10.3390/ijerph18084350OpenAlex

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    Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors' clinical experience. Patients…

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    Towards Achieving Sustainable Development: Role of Technology Innovation, Technology Adoption and CO2 Emission for BRICS

    Chi‐Wei Su, Yannong Xie, Sadaf Shahab, C. M. Nadeem Faisal, Muhammad Hafeez and 1 more

    207 citationsOpen access (CC-BY)doi:10.3390/ijerph18010277OpenAlex

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    In the digital era, technology innovation and adoption trigger economic growth and enhance CO2 emissions through productivity, which places it in the mainstream policy debate. For BRICS economies, this paper uses the first method proposed in the literature to quantify their information and communication technology (ICT) and innovatively links each country to their information technology adoption rate, as a surrogate indicator for measuring information and communication technology. Environmental Kuznets curve evidence is also examined, using technology innovation, technology adoption, and trade openness as the control variables for sustainable development. The results show that two out of three technology innovation instruments, fixed telephone, and broadband subscriptions increase CO2 emissions. Simultaneously, mobile cellular subscriptions have a lowering effect on CO2 emission in BRICS. The technology adoption indicators, high-technology exports, and electric power consumption also cause an upsurge in CO2 emission. Moreover, trade openness also enriches the level of CO2 emission…

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    Prevalence of Work-Related Musculoskeletal Disorders: Psychological and Physical Risk Factors

    K. Saraswathi Krishnan, Gunasunderi Raju, Omar Shawkataly

    206 citationsOpen access (CC-BY)doi:10.3390/ijerph18179361OpenAlex

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    Purpose-This study aimed to estimate the prevalence and risk factors of MSD pain in various anatomical regions among nurses. Method-A cross-sectional study involving a self-administered questionnaire by registered nurses with clinical experience. Data was collected using convenience sampling after obtaining informed consent. The results were drawn from a total of 300 nurses. Results-The nurses presented with occasional mental exhaustion (44.3%) and often physical exhaustion (44.0%). Almost all (97.3%) the nurses complained of having work-related pain during the last 12 months. Body parts with the most pain were the lower back (86.7%), ankles (86.7%), neck (86.0%), shoulders (85.0%), lower legs (84.7%) and upper back (84.3%). The pain frequency was rated as occasional pain for the neck and upper back, pain was often felt for the rest of the parts. Nurses complained of severe pain in the lower back (19.7%), right shoulder (29.7%) and left shoulder (30.3%). The frequency of having musculoskeletal symptoms in any body region was increased with age, lower education level, female gender,…

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    Bioremediation of Total Petroleum Hydrocarbons (TPH) by Bioaugmentation and Biostimulation in Water with Floating Oil Spill Containment Booms as Bioreactor Basin

    Khalid Sayed, Lavania Baloo, Naresh Kumar Sharma

    206 citationsOpen access (CC-BY)doi:10.3390/ijerph18052226OpenAlex

    Show abstract

    A crude oil spill is a common issue during offshore oil drilling, transport and transfer to onshore. Second, the production of petroleum refinery effluent is known to cause pollution due to its toxic effluent discharge. Sea habitats and onshore soil biota are affected by total petroleum hydrocarbons (TPH) as a pollutant in their natural environment. Crude oil pollution in seawater, estuaries and beaches requires an efficient process of cleaning. To remove crude oil pollutants from seawater, various physicochemical and biological treatment methods have been applied worldwide. A biological treatment method using bacteria, fungi and algae has recently gained a lot of attention due to its efficiency and lower cost. This review introduces various studies related to the bioremediation of crude oil, TPH and related petroleum products by bioaugmentation and biostimulation or both together. Bioremediation studies mentioned in this paper can be used for treatment such as emulsified residual spilled oil in seawater with floating oil spill containment booms as an enclosed basin such as a…

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    Impact of the COVID-19 Pandemic on Loneliness and Social Isolation: A Multi-Country Study

    Roger O’Sullivan, Annette Burns, Gerard Leavey, Iracema Leroi, Vanessa Burholt and 12 more

    205 citationsOpen access (CC-BY)doi:10.3390/ijerph18199982OpenAlex

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    The COVID-19 global pandemic and subsequent public health social measures have challenged our social and economic life, with increasing concerns around potentially rising levels of social isolation and loneliness. This paper is based on cross-sectional online survey data (available in 10 languages, from 2 June to 16 November 2020) with 20,398 respondents from 101 different countries. It aims to help increase our understanding of the global risk factors that are associated with social isolation and loneliness, irrespective of culture or country, to support evidence-based policy, services and public health interventions. We found the prevalence of severe loneliness was 21% during COVID-19 with 6% retrospectively reporting severe loneliness prior to the pandemic. A fifth were defined as isolated based on their usual connections, with 13% reporting a substantial increase in isolation during COVID-19. Personal finances and mental health were overarching and consistently cross-cutting predictors of loneliness and social isolation, both before and during the pandemic. With the likelihood…

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    Effect of COVID-19 on Health-Related Quality of Life in Adolescents and Children: A Systematic Review

    Hadi Nobarı, Mohamad Fashi, Arezoo Eskandari, Santos Villafaina, Álvaro Murillo-García and 1 more

    204 citationsOpen access (CC-BY)doi:10.3390/ijerph18094563OpenAlex

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    The aim of the present systematic review was to assess and provide an up-to-date analysis of the impact of coronavirus disease 2019 (COVID-19) pandemic on the health-related quality of life (HRQoL) of children and adolescents. Thus, an electronic search of the literature, in two well-known databases (PubMed and Web of Science), was performed until February 2021 (without date restriction). PRISMA guideline methodology was employed and data regarding the HRQoL were extracted from eligible studies. Articles were included if they met the following inclusion criteria: (a) children and/or adolescent population (4 to 19 years old); (b) HRQoL as a main assessment; (c) German, Spanish, Portuguese, French, and English language; and (d) pre-pandemic and during pandemic HRQoL data. Following the initial search, 241 possible related articles were identified. A total of 79 articles were identified as duplicates. Moreover, 129 articles were removed after reading the title and abstract. Of the remaining 33 articles, 27 were removed since they were not focused on children or adolescents (n = 19),…

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    Association between Urban Greenspace and Health: A Systematic Review of Literature

    Vincenza Gianfredi, Maddalena Buffoli, Andrea Rebecchi, Roberto Croci, Aurea Oradini‐Alacreu and 5 more

    203 citationsOpen access (CC-BY)doi:10.3390/ijerph18105137OpenAlex

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    The current review aimed to explore the association between urban greenspaces and health indicators. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure and two selected health outcomes (objectively measured physical activity (PA) and mental health outcomes (MH)). Two electronic databases-PubMed/Medline and Excerpta Medica dataBASE (EMBASE)-were searched from 1 January 2000 to 30 September 2020. Only articles in English were considered. Out of 356 retrieved articles, a total of 34 papers were included in our review. Of those, 15 assessed the association between urban greenspace and PA and 19 dealt with MH. Almost all the included studies found a positive association between urban greenspace and both PA and MH, while a few demonstrated a non-effect or a negative effect on MH outcomes. However, only guaranteeing access is not enough. Indeed, important elements are maintenance, renovation, closeness to residential areas, planning of interactive activities, and perceived security aspects. Overall, despite some methodological…

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    Effects of Gamification on Behavioral Change in Education: A Meta-Analysis

    Ji-Hoon Kim, Darla M. Castelli

    203 citationsOpen access (CC-BY)doi:10.3390/ijerph18073550OpenAlex

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    BACKGROUND: Gamified reward systems, such as providing digital badges earned for specific accomplishments, are related to student engagement in educational settings. The purpose of this study was to conduct a meta-analytic review to quantify the effects of gamified interventions on student behavioral change. METHODS: A meta-analysis was performed using the following databases: The Academic Search Complete, Communication & Mass Media Complete, Education Source, ERIC, Library Information Science & Technology Abstracts, and PsycINFO. Inclusion in the review required: (a) peer-reviewed conducted between 2010 and 2019, (b) experimental controlled design, (c) gamification elements, and (d) educational setting. RESULTS: Using a random-effects model, a statistically significant (Cohen's d (ES) = 0.48, 95% CI = 0.33, 0.62) gamification effect was evidenced by moderate and positive grand effects sizes (ES). Gamification effects were higher with adults in higher education (ES = 0.95) than K-12 students (ES = 0.92). Brief interventions delivered in days or less than 1 week were significantly…

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    Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low- and Middle-Income Countries

    Laura Rossouw, Hana Ross

    203 citationsOpen access (CC-BY)doi:10.3390/ijerph18052571OpenAlex

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    Menstrual hygiene management and health is increasingly gaining policy importance in a bid to promote dignity, gender equality and reproductive health. Effective and adequate menstrual hygiene management requires women and girls to have access to their menstrual health materials and products of choice, but also extends into having private, clean and safe spaces for using these materials. The paper provides empirical evidence of the inequality in menstrual hygiene management in Kinshasa (DRC), Ethiopia, Ghana, Kenya, Rajasthan (India), Indonesia, Nigeria and Uganda using concentration indices and decomposition methods. There is consistent evidence of wealth-related inequality in the conditions of menstrual hygiene management spaces as well as access to sanitary pads across all countries. Wealth, education, the rural-urban divide and infrastructural limitations of the household are major contributors to these inequalities. While wealth is identified as one of the key drivers of unequal access to menstrual hygiene management, other socio-economic, environmental and household factors…

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    Endocrine Disruptors Acting on Estrogen and Androgen Pathways Cause Reproductive Disorders through Multiple Mechanisms: A Review

    Saira Amir, Syed Tahir Abbas Shah, Charalampos Mamoulakis, Anca Oana Docea, Olga‐Ioanna Kalantzi and 6 more

    203 citationsOpen access (CC-BY)doi:10.3390/ijerph18041464OpenAlex

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    Increasing contamination of the environment by toxic compounds such as endocrine disrupting chemicals (EDCs) is one of the major causes of reproductive defects in both sexes. Estrogen/androgen pathways are of utmost importance in gonadal development, determination of secondary sex characteristics and gametogenesis. Most of the EDCs mediate their action through respective receptors and/or downstream signaling. The purpose of this review is to highlight the mechanism by which EDCs can trigger antagonistic or agonistic response, acting through estrogen/androgen receptors causing reproductive defects that lead to infertility. In vitro, in vivo and in silico studies focusing on the impact of EDCs on estrogen/androgen pathways and related proteins published in the last decade were considered for the review. PUBMED and PUBCHEM were used for literature search. EDCs can bind to estrogen receptors (ERα and ERβ) and androgen receptors or activate alternative receptors such as G protein-coupled receptors (GPCR), GPR30, estrogen-related receptor (ERRγ) to activate estrogen signaling via…

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    Low COVID-19 Vaccine Acceptance Is Correlated with Conspiracy Beliefs among University Students in Jordan

    Malik Sallam, Deema Dababseh, Huda Eid, Hanan Hasan, Duaa Taim and 8 more

    200 citationsOpen access (CC-BY)doi:10.3390/ijerph18052407OpenAlex

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    Vaccination to prevent coronavirus disease 2019 (COVID-19) emerged as a promising measure to overcome the negative consequences of the pandemic. Since university students could be considered a knowledgeable group, this study aimed to evaluate COVID-19 vaccine acceptance among this group in Jordan. Additionally, we aimed to examine the association between vaccine conspiracy beliefs and vaccine hesitancy. We used an online survey conducted in January 2021 with a chain-referral sampling approach. Conspiracy beliefs were evaluated using the validated Vaccine Conspiracy Belief Scale (VCBS), with higher scores implying embrace of conspiracies. A total of 1106 respondents completed the survey with female predominance (n = 802, 72.5%). The intention to get COVID-19 vaccines was low: 34.9% (yes) compared to 39.6% (no) and 25.5% (maybe). Higher rates of COVID-19 vaccine acceptance were seen among males (42.1%) and students at Health Schools (43.5%). A Low rate of influenza vaccine acceptance was seen as well (28.8%), in addition to 18.6% of respondents being anti-vaccination altogether. A…

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    Assessment of the Quality of Life during COVID-19 Pandemic: A Cross-Sectional Survey from the Kingdom of Saudi Arabia

    Fahad D. Algahtani, Sehar-un-Nisa Hassan, Bandar S. Alsaif, Rafat Mohammad Zrieq

    199 citationsOpen access (CC-BY)doi:10.3390/ijerph18030847OpenAlex

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    The COVID-19 outbreak emerged as an ongoing crisis at the beginning of the year 2020. Its horrific manifestation at the community level significantly affects various dimensions of the quality of life (QoL) of all individuals. The study aimed to examine some of the predictors of the QoL during the first wave of the COVID-19 pandemic in Saudi Arabia. A cross-sectional online survey questionnaire was used to gather data on the participants’ sociodemographic backgrounds, physical health status, psychological reactions, and QoL. We adapted 12 items from the World Health Organization Quality of Life Instruments (WHOQOL-BREF) to assess the QoL. The Depression, Anxiety and Stress Scale–21 (DASS-21) was used to assess depression, anxiety, and stress. The median and inter-quartile range were used to describe the QoL scores. A multinomial regression analysis was computed between QoL score quartiles and associated factors, and the statistical significance was set at p < 0.05. The results of the multinomial regression analysis demonstrated that males (OR = 1.96; 95% CI = 1.31–2.94); participants…

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    Impact of the COVID-19 Pandemic on Teacher Quality of Life: A Longitudinal Study from before and during the Health Crisis

    Pablo A. Lizana, Gustavo Vega-Fernández, Alejandro Gómez‐Bruton, Bárbara D. Leyton, Lydia Lera

    198 citationsOpen access (CC-BY)doi:10.3390/ijerph18073764OpenAlex

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    Background: Prior to the COVID-19 pandemic, teachers were already reporting a low quality of life (QoL) perception, with a significant impact on mental and physical health due to various stress factors associated with work overload. The objective of this study was to evaluate the QoL impact on Chilean teachers before and during the COVID-19 pandemic. The analysis was performed following a longitudinal design on a sample of 63 Chilean teachers in pre-pandemic and COVID-19 pandemic timeframes. QoL perception, along with teachers’ sociodemographic data, was evaluated via the Short-Form 36 Health Survey (SF-36) questionnaire. Sociodemographic variables presented no significant variations in pre-pandemic and pandemic comparisons. QoL, however, showed a significant decrease during the pandemic compared to the pre-pandemic measurement (p < 0.01). In each gender, there were significant differences between pre-pandemic and pandemic timeframes, with a greater impact among women in the mental and physical component summary variables and seven of the eight QoL scales (p < 0.01). Between age…

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    Vegetarian Diet: An Overview through the Perspective of Quality of Life Domains

    Shila Minari Hargreaves, António Raposo, Ariana Saraiva, Renata Puppin Zandonadi

    196 citationsOpen access (CC-BY)doi:10.3390/ijerph18084067OpenAlex

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    Vegetarianism has gained more visibility in recent years. Despite the well-described effects of a vegetarian diet on health, its influence on the quality of life of the individuals who follow it still needs to be properly investigated. Quality of life relates to a subjective perception of well-being and functionality, and encompasses four main life domains: physical, psychological, social, and environmental. The adoption of a vegetarian diet, despite being a dietary pattern, could potentially influence and be influenced by all of these domains, either positively or negatively. This review aims to present an overview of the background, conceptualization, features, and potential effects of vegetarianism in all quality of life domains. The choice of adopting a vegetarian diet could have positive outcomes, such as better physical health, positive feelings related to the adoption of a morally correct attitude, an increased sense of belonging (to a vegetarian community), and lower environmental impact. Other factors, however, could have a negative impact on the quality of life of those…

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    Discrete-Event Simulation Modeling in Healthcare: A Comprehensive Review

    Jesús Isaac Vázquez-Serrano, Rodrigo E. Peimbert-García, Leopoldo Eduardo Cárdenas‐Barrón

    194 citationsOpen access (CC-BY)doi:10.3390/ijerph182212262OpenAlex

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    Discrete-event simulation (DES) is a stochastic modeling approach widely used to address dynamic and complex systems, such as healthcare. In this review, academic databases were systematically searched to identify 231 papers focused on DES modeling in healthcare. These studies were sorted by year, approach, healthcare setting, outcome, provenance, and software use. Among the surveys, conceptual/theoretical studies, reviews, and case studies, it was found that almost two-thirds of the theoretical articles discuss models that include DES along with other analytical techniques, such as optimization and lean/six sigma, and one-third of the applications were carried out in more than one healthcare setting, with emergency departments being the most popular. Moreover, half of the applications seek to improve time- and efficiency-related metrics, and one-third of all papers use hybrid models. Finally, the most popular DES software is Arena and Simul8. Overall, there is an increasing trend towards using DES in healthcare to address issues at an operational level, yet less than 10% of DES…

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    Chemical Contamination Pathways and the Food Safety Implications along the Various Stages of Food Production: A Review

    Kgomotso Lebelo, Ntsoaki Joyce Malebo, Mokgaotsa Jonas Mochane, Muthoni Masinde

    194 citationsOpen access (CC-BY)doi:10.3390/ijerph18115795OpenAlex

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    Historically, chemicals exceeding maximum allowable exposure levels have been disastrous to underdeveloped countries. The global food industry is primarily affected by toxic chemical substances because of natural and anthropogenic factors. Food safety is therefore threatened due to contamination by chemicals throughout the various stages of food production. Persistent Organic Pollutants (POPs) in the form of pesticides and other chemical substances such as Polychlorinated Biphenyls (PCBs) have a widely documented negative impact due to their long-lasting effect on the environment. This present review focuses on the chemical contamination pathways along the various stages of food production until the food reaches the consumer. The contamination of food can stem from various sources such as the agricultural sector and pollution from industrialized regions through the air, water, and soil. Therefore, it is imperative to control the application of chemicals during food packaging, the application of pesticides, and antibiotics in the food industry to prevent undesired residues on…

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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 2021, 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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