Most-cited articles · 2023

The 100 most-cited articles in International Journal of Environmental Research and Public Health, 2023

Ranked by OpenAlex citation count on 29 October 2026, out of 6,367 eligible articles International Journal of Environmental Research and Public Health published in 2023. Ranks are frozen; this page will not change. Number one, with 938 citations: Digital Transformation in Healthcare: Technology Acceptance and Its Applications.

Cohort
6,367 articles
Listed
Top 100 (1.6%)
Open access
100 of 100
Snapshot
2026-10-29

The most-cited articles published in the International Journal of Environmental Research and Public Health in 2023 cluster around several themes. Digital health and artificial intelligence feature prominently, including the top paper, "Digital Transformation in Healthcare: Technology Acceptance and Its Applications" by Stoumpos, Kitsios and Talias, with 938 citations, alongside studies of ChatGPT diagnostic accuracy and technology acceptance models for personal health records. Environmental and public health topics also recur, such as antimicrobial resistance and climate change, wastewater copper removal, food waste utilization, and bioremediation of heavy metals.

This ranked list, drawn from 6367 eligible articles and ordered by OpenAlex citation counts, offers a neutral snapshot of which 2023 contributions attracted the most scholarly attention. Readers can use it to identify widely cited reviews, pilot studies, and exploratory work across health technology, environmental contamination, and clinical practice, while noting that citation counts reflect attention rather than quality or impact.

Introduction written from the titles and abstracts on this list. Every figure below is the source.

Ask about these papers

Grounded in this list only, with sources.

3 of 3 free questions left today, no account needed
  1. 1
    top 0.1%

    Digital Transformation in Healthcare: Technology Acceptance and Its Applications

    Angelos I. Stoumpos, Fotis Kitsios, Μichael A. Talias

    938 citationsOpen access (CC-BY)doi:10.3390/ijerph20043407OpenAlex

    Show abstract

    Technological innovation has become an integral aspect of our daily life, such as wearable and information technology, virtual reality and the Internet of Things which have contributed to transforming healthcare business and operations. Patients will now have a broader range and more mindful healthcare choices and experience a new era of healthcare with a patient-centric culture. Digital transformation determines personal and institutional health care. This paper aims to analyse the changes taking place in the field of healthcare due to digital transformation. For this purpose, a systematic bibliographic review is performed, utilising Scopus, Science Direct and PubMed databases from 2008 to 2021. Our methodology is based on the approach by Wester and Watson, which classify the related articles based on a concept-centric method and an ad hoc classification system which identify the categories used to describe areas of literature. The search was made during August 2022 and identified 5847 papers, of which 321 fulfilled the inclusion criteria for further process. Finally, by removing…

  2. 2
    top 0.1%

    How Antimicrobial Resistance Is Linked to Climate Change: An Overview of Two Intertwined Global Challenges

    Roberta Magnano San Lio, Giuliana Favara, Andrea Maugeri, Martina Barchitta, Antonella Agodi

    443 citationsOpen access (CC-BY)doi:10.3390/ijerph20031681OpenAlex

    Show abstract

    Globally, antimicrobial resistance (AMR) and climate change (CC) are two of the top health emergencies, and can be considered as two interlinked public health priorities. The complex commonalities between AMR and CC should be deeply investigated in a One Health perspective. Here, we provided an overview of the current knowledge about the relationship between AMR and CC. Overall, the studies included pointed out the need for applying a systemic approach to planetary health. Firstly, CC increasingly brings humans and animals into contact, leading to outbreaks of zoonotic and vector-borne diseases with pandemic potential. Although it is well-established that antimicrobial use in human, animal and environmental sectors is one of the main drivers of AMR, the COVID-19 pandemic is exacerbating the current scenario, by influencing the use of antibiotics, personal protective equipment, and biocides. This also results in higher concentrations of contaminants (e.g., microplastics) in natural water bodies, which cannot be completely removed from wastewater treatment plants, and which could…

  3. 3
    top 0.1%

    Diagnostic Accuracy of Differential-Diagnosis Lists Generated by Generative Pretrained Transformer 3 Chatbot for Clinical Vignettes with Common Chief Complaints: A Pilot Study

    Takanobu Hirosawa, Yukinori Harada, Masashi Yokose, Tetsu Sakamoto, Ren Kawamura and 1 more

    345 citationsOpen access (CC-BY)doi:10.3390/ijerph20043378OpenAlex

    Show abstract

    The diagnostic accuracy of differential diagnoses generated by artificial intelligence (AI) chatbots, including the generative pretrained transformer 3 (GPT-3) chatbot (ChatGPT-3) is unknown. This study evaluated the accuracy of differential-diagnosis lists generated by ChatGPT-3 for clinical vignettes with common chief complaints. General internal medicine physicians created clinical cases, correct diagnoses, and five differential diagnoses for ten common chief complaints. The rate of correct diagnosis by ChatGPT-3 within the ten differential-diagnosis lists was 28/30 (93.3%). The rate of correct diagnosis by physicians was still superior to that by ChatGPT-3 within the five differential-diagnosis lists (98.3% vs. 83.3%, p = 0.03). The rate of correct diagnosis by physicians was also superior to that by ChatGPT-3 in the top diagnosis (53.3% vs. 93.3%, p < 0.001). The rate of consistent differential diagnoses among physicians within the ten differential-diagnosis lists generated by ChatGPT-3 was 62/88 (70.5%). In summary, this study demonstrates the high diagnostic accuracy of…

  4. 4
    top 0.1%

    Removal of Copper Ions from Wastewater: A Review

    Yongming Liu, Haishuang Wang, Yuanyuan Cui, Nan Chen

    288 citationsOpen access (CC-BY)doi:10.3390/ijerph20053885OpenAlex

    Show abstract

    Copper pollution of the world's water resources is becoming increasingly serious and poses a serious threat to human health and aquatic ecosystems. With reported copper concentrations in wastewater ranging from approximately 2.5 mg/L to 10,000 mg/L, a summary of remediation techniques for different contamination scenarios is essential. Therefore, it is important to develop low-cost, feasible, and sustainable wastewater removal technologies. Various methods for the removal of heavy metals from wastewater have been extensively studied in recent years. This paper reviews the current methods used to treat Cu(II)-containing wastewater and evaluates these technologies and their health effects. These technologies include membrane separation, ion exchange, chemical precipitation, electrochemistry, adsorption, and biotechnology. Thus, in this paper, we review the efforts and technological advances made so far in the pursuit of more efficient removal and recovery of Cu(II) from industrial wastewater and compare the advantages and disadvantages of each technology in terms of research…

  5. 5
    top 0.1%

    Preeclampsia: Recent Advances in Predicting, Preventing, and Managing the Maternal and Fetal Life-Threatening Condition

    Kai-Jung Chang, Kok‐Min Seow, Kuo-Hu Chen

    268 citationsOpen access (CC-BY)doi:10.3390/ijerph20042994OpenAlex

    Show abstract

    Preeclampsia accounts for one of the most common documented gestational complications, with a prevalence of approximately 2 to 15% of all pregnancies. Defined as gestational hypertension after 20 weeks of pregnancy and coexisting proteinuria or generalized edema, and certain forms of organ damage, it is life-threatening for both the mother and the fetus, in terms of increasing the rate of mortality and morbidity. Preeclamptic pregnancies are strongly associated with significantly higher medical costs. The maternal costs are related to the extra utility of the healthcare system, more resources used during hospitalization, and likely more surgical spending due to an elevated rate of cesarean deliveries. The infant costs also contribute to a large percentage of the expenses as the babies are prone to preterm deliveries and relevant or causative adverse events. Preeclampsia imposes a considerable financial burden on our societies. It is important for healthcare providers and policy-makers to recognize this phenomenon and allocate enough economic budgets and medical and social resources…

  6. 6
    top 0.1%

    Food Waste Utilization for Reducing Carbon Footprints towards Sustainable and Cleaner Environment: A Review

    Latika Bhatia, Harit Jha, Tanushree Sarkar, Prakash Kumar Sarangi

    254 citationsOpen access (CC-BY)doi:10.3390/ijerph20032318OpenAlex

    Show abstract

    There is world-wide generation of food waste daily in significant amounts, leading to depletion of natural resources and deteriorating air quality. One-third of global food produced is wasted laterally with the food value chain. Carbon footprint is an efficient way of communicating the issues related to climate change and the necessity of changing behavior. Valorization or utilization of food wastes helps in resolving issues related to environment pollution. Reduction in the carbon footprint throughout the chain of food supply makes the whole process eco-friendly. Prevailing food waste disposal systems focus on their economic and environmental viability and are putting efforts into using food waste as a resource input to agriculture. Effective and advanced waste management systems are adopted to deal with massive waste production so as to fill the gap between the production and management of waste disposal. Food waste biorefineries are a sustainable, eco-friendly, and cost-effective approach for the production of platform chemicals, biofuels, and other bio-based materials. These…

  7. 7
    top 0.2%

    Environmental Consciousness, Purchase Intention, and Actual Purchase Behavior of Eco-Friendly Products: The Moderating Impact of Situational Context

    Nayeon Kim, Kyungtag Lee

    227 citationsOpen access (CC-BY)doi:10.3390/ijerph20075312OpenAlex

    Show abstract

    Recently, environmental issues have become major social concerns, and consumers are becoming increasingly aware of environmental matters; however, they remain hesitant to purchase eco-friendly products. This study examined consumers' environmental consciousness as a factor influencing the purchase of eco-friendly products, and investigated situational factors that induce hesitancy in purchasing eco-friendly products. We studied the moderating effects of these factors with regard to ease of purchase and eco label credibility. Our research model is validated using data from 220 consumers with experience in purchasing eco-friendly products in Korea. For the data analysis, we used SPSS 22.0 and AMOS 22.0 to perform confirmatory factor analysis and SEM. The specific verification results are as follows. First, environmental interest did not significantly impact the purchase intention of eco-friendly products. Second, consumers' environmental knowledge and consumer effectiveness perception both had a significant impact on the purchase intention of eco-friendly products. Third, the…

  8. 8
    top 0.2%

    Bioremediation of Heavy Metals by the Genus Bacillus

    Monika Wróbel, Wojciech Śliwakowski, Paweł Kowalczyk, Karol Kramkowski, Jakub Dobrzyński

    222 citationsOpen access (CC-BY)doi:10.3390/ijerph20064964OpenAlex

    Show abstract

    Environmental contamination with heavy metals is one of the major problems caused by human activity. Bioremediation is an effective and eco-friendly approach that can reduce heavy metal contamination in the environment. Bioremediation agents include bacteria of the genus Bacillus, among others. The best-described species in terms of the bioremediation potential of Bacillus spp. Are B. subtilis, B. cereus, or B. thuringiensis. This bacterial genus has several bioremediation strategies, including biosorption, extracellular polymeric substance (EPS)-mediated biosorption, bioaccumulation, or bioprecipitation. Due to the above-mentioned strategies, Bacillus spp. strains can reduce the amounts of metals such as lead, cadmium, mercury, chromium, arsenic or nickel in the environment. Moreover, strains of the genus Bacillus can also assist phytoremediation by stimulating plant growth and bioaccumulation of heavy metals in the soil. Therefore, Bacillus spp. is one of the best sustainable solutions for reducing heavy metals from various environments, especially soil.

  9. 9
    top 0.2%

    The Use of a Technology Acceptance Model (TAM) to Predict Patients’ Usage of a Personal Health Record System: The Role of Security, Privacy, and Usability

    Adi Alsyouf, Abdalwali Lutfi, Nizar Alsubahi, Fahad Nasser Alhazmi, Khalid Al‐Mugheed and 3 more

    215 citationsOpen access (CC-BY)doi:10.3390/ijerph20021347OpenAlex

    Show abstract

    Personal health records (PHR) systems are designed to ensure that individuals have access and control over their health information and to support them in being active participants rather than passive ones in their healthcare process. Yet, PHR systems have not yet been widely adopted or used by consumers despite their benefits. For these advantages to be realized, adoption of the system is necessary. In this study, we examined how self-determination of health management influences individuals' intention to implement a PHR system, i.e., their ability to actively manage their health. Using an extended technology acceptance model (TAM), the researchers developed and empirically tested a model explaining public adoption of PHRs. In total, 389 Saudi Arabian respondents were surveyed in a quantitative cross-sectional design. The hypotheses were analysed using structural equation modelling-partial least squares (SEM-PLS4). Results indicate that PHR system usage was influenced by three major factors: perceived ease of use (PEOU), perceived usefulness (PU), and security towards intention to…

  10. 10
    top 0.2%

    Prevalence of Body Area Work-Related Musculoskeletal Disorders among Healthcare Professionals: A Systematic Review

    Julien Jacquier-Bret, Philippe Gorce

    202 citationsOpen access (CC-BY)doi:10.3390/ijerph20010841OpenAlex

    Show abstract

    Healthcare professionals perform daily activities that can lead to musculoskeletal disorders (MSDs). The objective of this review was to summarize these MSDs by body areas in relation to healthcare professions. The underlying question is, worldwide, whether there are areas that are more exposed depending on the occupation or whether there are common areas that are highly exposed to MSDs. This issue has been extended to risk factors and responses to reduce MSDs. The review was conducted according to the PRISMA guidelines between February and May 2022. Google scholar and Science Direct databases were scanned to identify relevant studies. Two authors independently reviewed, critically appraised, and extracted data from these studies. Overall and body area prevalence, risk factors, and responses to MSDs were synthetized by occupational activity. Among the 21,766 records identified, 36 covering six healthcare professions were included. The lower back, neck, shoulder and hand/wrist were the most exposed areas for all healthcare professionals. Surgeons and dentists presented the highest…

  11. 11
    top 0.2%

    The Mental Health Costs of Armed Conflicts—A Review of Systematic Reviews Conducted on Refugees, Asylum-Seekers and People Living in War Zones

    Bernardo Carpiniello

    197 citationsOpen access (CC-BY)doi:10.3390/ijerph20042840OpenAlex

    Show abstract

    AIMS: Armed conflicts produce a wide series of distressing consequences, including death, all of which impact negatively on the lives of survivors. This paper focuses specifically on the mental health consequences of war on adults and child/adolescent refugees or those living in war zones through a review of all systematic reviews and/or meta-analyses published from 2005 up until the current time. RESULTS: Fifteen systematic reviews and/or meta-analyses conducted in adult populations, and seven relating to children and adolescents, were selected for the purpose of this review. Prevalence rates of anxiety, depression and post-traumatic stress disorder (PTSD) were two- to three-fold higher amongst people exposed to armed conflict compared to those who had not been exposed, with women and children being the most vulnerable to the outcome of armed conflicts. A series of war-related, migratory and post-migratory stressors contribute to short- and long-term mental health issues in the internally displaced, asylum seekers and refugees. CONCLUSION: It should be a required social…

  12. 12
    top 0.2%

    A Systematic Review of the Factors That Influence Teachers’ Occupational Wellbeing

    Joy C. Nwoko, Theophilus I. Emeto, A.E.O. Malau‐Aduli, Bunmi S. Malau‐Aduli

    190 citationsOpen access (CC-BY)doi:10.3390/ijerph20126070OpenAlex

    Show abstract

    Teachers belong to a high-demand occupational group and experience work-related challenges and discretely diverse emotional turmoils of varying intensity while teaching and interacting with students. These experiences often result in high stress levels that contribute to burnout and, consequently, a breach of teachers' occupational wellbeing. Promoting positive teacher wellbeing substantially influences teaching quality, with a flow-on effect on student wellbeing and academic development. This literature review utilised a framework to systematically explore the factors that impact the occupational wellbeing of kindergarten, primary, and secondary schoolteachers. Thirty-eight (38) studies from an initial 3766 peer-reviewed articles sourced from various databases (CINAHL, Emcare, PychINFO, Scopus, ERIC, and PsycARTICLES) were utilized for this systematic review. Four major factors were identified, including personal capabilities, socioemotional competence, personal responses to work conditions, and professional relationships. Findings highlight the importance of teachers' occupational…

  13. 13
    top 0.3%

    Gender and Media Representations: A Review of the Literature on Gender Stereotypes, Objectification and Sexualization

    Fabrizio Santoniccolo, Tommaso Trombetta, María Noemí Paradiso, Luca Rollè

    181 citationsOpen access (CC-BY)doi:10.3390/ijerph20105770OpenAlex

    Show abstract

    Media representations play an important role in producing sociocultural pressures. Despite social and legal progress in civil rights, restrictive gender-based representations appear to be still very pervasive in some contexts. The article explores scientific research on the relationship between media representations and gender stereotypes, objectification and sexualization, focusing on their presence in the cultural context. Results show how stereotyping, objectifying and sexualizing representations appear to be still very common across a number of contexts. Exposure to stereotyping representations appears to strengthen beliefs in gender stereotypes and endorsement of gender role norms, as well as fostering sexism, harassment and violence in men and stifling career-related ambitions in women. Exposure to objectifying and sexualizing representations appears to be associated with the internalization of cultural ideals of appearance, endorsement of sexist attitudes and tolerance of abuse and body shame. In turn, factors associated with exposure to these representations have been linked…

  14. 14
    top 0.3%

    Digital Health Interventions to Improve Access to and Quality of Primary Health Care Services: A Scoping Review

    Daniel Erku, Resham Bahadur Khatri, Aklilu Endalamaw, Eskinder Wolka, Frehiwot Nigatu and 2 more

    179 citationsOpen access (CC-BY)doi:10.3390/ijerph20196854OpenAlex

    Show abstract

    Global digital technology advances offer the potential to enhance primary health care (PHC) quality, reach, and efficiency, driving toward universal health coverage (UHC). This scoping review explored how digital health solutions aid PHC delivery and UHC realization by examining the context, mechanisms, and outcomes of eHealth interventions. A comprehensive literature search was conducted, capturing qualitative and quantitative studies, process evaluations, and systematic or scoping reviews. Our analysis of 65 articles revealed that a well-functioning digital ecosystem-featuring adaptable, interoperable digital tools, robust Information and Communications Technology foundations, and enabling environments-is pivotal for eHealth interventions' success. Facilities with better digital literacy, motivated staff, and adequate funding demonstrated a higher adoption of eHealth technologies, leading to improved, coordinated service delivery and higher patient satisfaction. However, eHealth's potential is often restricted by existing socio-cultural norms, geographical inequities in technology…

  15. 15
    top 0.3%

    Early Gastric Cancer: Update on Prevention, Diagnosis and Treatment

    Clara Benedetta Conti, Stefano Agnesi, Miki Scaravaglio, Pietro Masseria, Marco Emilio Dinelli and 2 more

    178 citationsOpen access (CC-BY)doi:10.3390/ijerph20032149OpenAlex

    Show abstract

    Gastric cancer (GC) is a relevant public health issue as its incidence and mortality rates are growing worldwide. There are recognized carcinogen agents, such as obesity, tobacco, meat, alcohol consumption and some dietary protective factors. Strategies of early diagnosis through population-based surveillance programs have been demonstrated to be effective in lowering the morbidity and mortality related to GC in some countries. Indeed, the detection of early lesions is very important in order to offer minimally invasive treatments. Endoscopic resection is the gold standard for lesions with a low risk of lymph node metastasis, whereas surgical mini-invasive approaches can be considered in early lesions when endoscopy is not curative. This review outlines the role of lifestyle and prevention strategies for GC, in order to reduce the patients' risk factors, implement the surveillance of precancerous conditions and, therefore, improve the diagnosis of early lesions. Furthermore, we summarize the available treatments for early gastric cancer.

  16. 16
    top 0.3%

    A Review of the Relationship between Socioeconomic Status Change and Health

    Caroline Barakat, Theodore Konstantinidis

    177 citationsOpen access (CC-BY)doi:10.3390/ijerph20136249OpenAlex

    Show abstract

    OBJECTIVES: This review aimed to identify and synthesize the existing literature on the effects of socioeconomic status (SES) changes on health. METHODS: A review was conducted using Medline, Cochrane library, and CINAHL (Cumulative Index to Nursing and Allied Health Literature). All longitudinal or cross-sectional studies that examined links between changes to SES across different time periods and measured health outcomes were included. Screening was conducted using select inclusion and exclusion criteria in order of title, abstract, and full text. Two independent reviewers assessed the quality of the full text articles using the Downs and Black checklist. RESULTS: Our literature search led to 2719 peer reviewed articles, 2639 of which were title screened after duplicates were removed. A total of 117 abstracts and 12 full text articles were screened. Overall, findings from 11 articles form the basis of this review. Eight different types of measures of changes to SES were identified. These include education, occupation, economic security, income sufficiency, home ownership, car…

  17. 17
    top 0.3%

    The Role of Bacterial Polyhydroalkanoate (PHA) in a Sustainable Future: A Review on the Biological Diversity

    Diogo Vicente, Diogo Neves Proença, Paula Vasconcelos Morais

    168 citationsOpen access (CC-BY)doi:10.3390/ijerph20042959OpenAlex

    Show abstract

    Environmental challenges related to the mismanagement of plastic waste became even more evident during the COVID-19 pandemic. The need for new solutions regarding the use of plastics came to the forefront again. Polyhydroxyalkanoates (PHA) have demonstrated their ability to replace conventional plastics, especially in packaging. Its biodegradability and biocompatibility makes this material a sustainable solution. The cost of PHA production and some weak physical properties compared to synthetic polymers remain as the main barriers to its implementation in the industry. The scientific community has been trying to solve these disadvantages associated with PHA. This review seeks to frame the role of PHA and bioplastics as substitutes for conventional plastics for a more sustainable future. It is focused on the bacterial production of PHA, highlighting the current limitations of the production process and, consequently, its implementation in the industry, as well as reviewing the alternatives to turn the production of bioplastics into a sustainable and circular economy.

  18. 18
    top 0.3%

    Enhancing Equitable Access to Rare Disease Diagnosis and Treatment around the World: A Review of Evidence, Policies, and Challenges

    Takeya Adachi, Ayman W. El‐Hattab, Ritu Jain, Katya A. Nogales Crespo, Camila Ignacia Quirland Lazo and 3 more

    167 citationsOpen access (CC-BY)doi:10.3390/ijerph20064732OpenAlex

    Show abstract

    This document provides a comprehensive summary of evidence on the current situation of rare diseases (RDs) globally and regionally, including conditions, practices, policies, and regulations, as well as the challenges and barriers faced by RD patients, their families, and caregivers. The document builds on a review of academic literature and policies and a process of validation and feedback by a group of seven experts from across the globe. Panelists were selected based on their academic merit, expertise, and knowledge regarding the RD environment. The document is divided into five main sections: (1) methodology and objective; (2) background and context; (3) overview of the current situation and key challenges related to RDs covering six dimensions: burden of disease, patient journey, social impact, disease management, RD-related policies, and research and development; (4) recommendations; and (5) conclusions. The recommendations are derived from the discussion undertaken by the experts on the findings of this review and provide a set of actionable solutions to the challenges and…

  19. 19
    top 0.3%

    Artificial Intelligence and Public Health: An Exploratory Study

    David Jungwirth, Daniela Haluza

    167 citationsOpen access (CC-BY)doi:10.3390/ijerph20054541OpenAlex

    Show abstract

    Artificial intelligence (AI) has the potential to revolutionize research by automating data analysis, generating new insights, and supporting the discovery of new knowledge. The top 10 contribution areas of AI towards public health were gathered in this exploratory study. We utilized the "text-davinci-003" model of GPT-3, using OpenAI playground default parameters. The model was trained with the largest training dataset any AI had, limited to a cut-off date in 2021. This study aimed to test the ability of GPT-3 to advance public health and to explore the feasibility of using AI as a scientific co-author. We asked the AI asked for structured input, including scientific quotations, and reviewed responses for plausibility. We found that GPT-3 was able to assemble, summarize, and generate plausible text blocks relevant for public health concerns, elucidating valuable areas of application for itself. However, most quotations were purely invented by GPT-3 and thus invalid. Our research showed that AI can contribute to public health research as a team member. According to authorship…

  20. 20
    top 0.4%

    How Can Climate Change Anxiety Induce Both Pro-Environmental Behaviours and Eco-Paralysis? The Mediating Role of General Self-Efficacy

    Matteo Innocenti, Gabriele Santarelli, Gaia Surya Lombardi, Lorenzo Ciabini, Doris Zjalic and 2 more

    162 citationsOpen access (CC-BY)doi:10.3390/ijerph20043085OpenAlex

    Show abstract

    While it has been shown that climate change anxiety (emotional distress response to climate change) can enhance pro-environmental behaviours (PEBs) in some subjects, in others it can induce eco-paralysis, thus leading individuals to avoid any form of engagement in actions against climate change. This study aims to clarify which factors influence the relationship between climate change anxiety and the disposition to PEBs, focusing on the role of self-efficacy as a mediating factor. A cross-sectional study was conducted on 394 healthy subjects living in Italy who completed the Pro-Environmental Behaviours Scale (PEBS), the General Self-Efficacy scale (GSE), and the Climate Change Anxiety Scale (CCAS). As a result, the mediation model showed a positive direct effect of the cognitive impairment subscale of CCAS on PEBS and an indirect negative effect of the cognitive impairment subscale of CCAS on PEBS mediated by GSE. These findings show that climate change anxiety has simultaneously two different effects on individuals: it directly encourages PEBs, and indirectly may have detrimental…

  21. 21
    top 0.4%

    Heart Rate Variability Measurement through a Smart Wearable Device: Another Breakthrough for Personal Health Monitoring?

    Ke Li, Cristiano de Oliveira Cardoso, Angel Moctezuma-Ramirez, Abdelmotagaly Elgalad, Emerson C. Perin

    160 citationsOpen access (CC-BY)doi:10.3390/ijerph20247146OpenAlex

    Show abstract

    Heart rate variability (HRV) is a measurement of the fluctuation of time between each heartbeat and reflects the function of the autonomic nervous system. HRV is an important indicator for both physical and mental status and for broad-scope diseases. In this review, we discuss how wearable devices can be used to monitor HRV, and we compare the HRV monitoring function among different devices. In addition, we have reviewed the recent progress in HRV tracking with wearable devices and its value in health monitoring and disease diagnosis. Although many challenges remain, we believe HRV tracking with wearable devices is a promising tool that can be used to improve personal health.

  22. 22
    top 0.4%

    A Comprehensive Review on Wastewater Nitrogen Removal and Its Recovery Processes

    Yifan Zhou, Yingying Zhu, Jinyuan Zhu, Chaoran Li, Geng Chen

    153 citationsOpen access (CC-BY)doi:10.3390/ijerph20043429OpenAlex

    Show abstract

    Discharging large amounts of domestic and industrial wastewater drastically increases the reactive nitrogen content in aquatic ecosystems, which causes severe ecological stress and biodiversity loss. This paper reviews three common types of denitrification processes, including physical, chemical, and biological processes, and mainly focuses on the membrane technology for nitrogen recovery. The applicable conditions and effects of various treatment methods, as well as the advantages, disadvantages, and influencing factors of membrane technologies, are summarized. Finally, it is proposed that developing effective combinations of different treatment methods and researching new processes with high efficiency, economy, and energy savings, such as microbial fuel cells and anaerobic osmotic membrane bioreactors, are the research and development directions of wastewater treatment processes.

  23. 23
    top 0.4%

    Interventions to Reduce Stress and Burnout among Teachers: A Scoping Review

    Belinda Agyapong, Pamela Brett-MacLean, Lisa Burback, Vincent I. O. Agyapong, Yifeng Wei

    152 citationsOpen access (CC-BY)doi:10.3390/ijerph20095625OpenAlex

    Show abstract

    Background: Teaching is recognized as a highly challenging profession. Experience of chronic stress is a risk factor for poor mental and physical well-being, and burnout. There is limited knowledge regarding optimal interventions to address stress and burnout among teachers. Objective: To undertake a scoping review of the literature in the last five years to determine various psychological interventions to address stress and burnout among teachers. Method: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was followed. Relevant search terms were used to determine different interventions adopted to reduce teachers’ stress and burnout. Articles published between 2018 and 2022 were identified using five bibliographic databases. Relevant articles were extracted, reviewed, collated, and thematically analyzed, and findings s were summarized. Results: Forty studies conducted in Asia, North America, Oceania, Europe, and Africa, met the inclusion criteria. Sixteen kinds of burnout and stress-reduction interventions were…

  24. 24
    top 0.4%

    Automated Monkeypox Skin Lesion Detection Using Deep Learning and Transfer Learning Techniques

    Ameera Saleh Jaradat, Rabia Emhamed Al Mamlook, Naif Mana Almakayeel, Nawaf Alharbe, Ali Saeed Almuflih and 5 more

    151 citationsOpen access (CC-BY)doi:10.3390/ijerph20054422OpenAlex

    Show abstract

    The current outbreak of monkeypox (mpox) has become a major public health concern because of the quick spread of this disease across multiple countries. Early detection and diagnosis of mpox is crucial for effective treatment and management. Considering this, the purpose of this research was to detect and validate the best performing model for detecting mpox using deep learning approaches and classification models. To achieve this goal, we evaluated the performance of five common pretrained deep learning models (VGG19, VGG16, ResNet50, MobileNetV2, and EfficientNetB3) and compared their accuracy levels when detecting mpox. The performance of the models was assessed with metrics (i.e., the accuracy, recall, precision, and F1-score). Our experimental results demonstrate that the MobileNetV2 model had the best classification performance with an accuracy level of 98.16%, a recall of 0.96, a precision of 0.99, and an F1-score of 0.98. Additionally, validation of the model with different datasets showed that the highest accuracy of 0.94% was achieved using the MobileNetV2 model. Our…

  25. 25
    top 0.4%

    Adolescent Pregnancy Outcomes and Risk Factors

    Jana Diabelková, Kvetoslava Rimárová, Erik Dorko, Peter Urdzík, Andrea Houžvičková and 1 more

    147 citationsOpen access (CC-BY)doi:10.3390/ijerph20054113OpenAlex

    Show abstract

    One of the major social and public health problems in the world is adolescent pregnancy. Adolescent pregnancy is strongly associated to less favorable results for both the mother and the newborn. We conducted this research to ascertain the impact of teenage age on neonatal outcomes and also observed the lifestyles of pregnant teenage girls. We conducted a study of 2434 mothers aged ≤19 years (n = 294) or 20–34 years (n = 2140) who gave birth in 2019–2020 at the Department of Gynaecology and Obstetrics of Louis Pasteur University Hospital in Košice. The data on mothers and newborn infants have been reported from the reports on mothers at childbirth. Women between the ages of 20 and 34 served as the reference group. The teenage mothers were more likely to become pregnant if they were unmarried (OR = 14.2; 95% CI = 9.3–21.6; p < 0.001) and had a basic education or lack of education (OR = 16.8; 95% CI = 11.5–24.6; p < 0.001). Additionally, they were more likely to smoke when pregnant (OR = 5.0; 95% CI = 3.8–6.6; p < 0.001). Low birth weight was more common in newborns born to adolescent…

  26. 26
    top 0.5%

    Plastics and Micro/Nano-Plastics (MNPs) in the Environment: Occurrence, Impact, and Toxicity

    Edith Dube, Grace Emily Okuthe

    146 citationsOpen access (CC-BY)doi:10.3390/ijerph20176667OpenAlex

    Show abstract

    Plastics, due to their varied properties, find use in different sectors such as agriculture, packaging, pharmaceuticals, textiles, and construction, to mention a few. Excessive use of plastics results in a lot of plastic waste buildup. Poorly managed plastic waste (as shown by heaps of plastic waste on dumpsites, in free spaces, along roads, and in marine systems) and the plastic in landfills, are just a fraction of the plastic waste in the environment. A complete picture should include the micro and nano-plastics (MNPs) in the hydrosphere, biosphere, lithosphere, and atmosphere, as the current extreme weather conditions (which are effects of climate change), wear and tear, and other factors promote MNP formation. MNPs pose a threat to the environment more than their pristine counterparts. This review highlights the entry and occurrence of primary and secondary MNPs in the soil, water and air, together with their aging. Furthermore, the uptake and internalization, by plants, animals, and humans are discussed, together with their toxicity effects. Finally, the future perspective and…

  27. 27
    top 0.5%

    Suicide before and during the COVID-19 Pandemic: A Systematic Review with Meta-Analysis

    Yifei Yan, Jianhua Hou, Qing Li, Nancy Xiaonan Yu

    146 citationsOpen access (CC-BY)doi:10.3390/ijerph20043346OpenAlex

    Show abstract

    Synthesizing evidence to examine changes in suicide-related outcomes before and during the pandemic can inform suicide management during the COVID-19 crisis. We searched 13 databases as of December 2022 for studies reporting both the pre- and peri-pandemic prevalence of suicidal ideation, suicide attempts, or rate of death by suicide. A random-effects model was used to pool the ratio of peri- and pre-pandemic prevalence of suicidal ideation and attempt (Prevalence Ratio—PR) and rate of death by suicide (Rate Ratio; RR). We identified 51, 55, and 25 samples for suicidal ideation, attempt, and death by suicide. The prevalence of suicidal ideation increased significantly among non-clinical (PR = 1.142; 95% CI: 1.018–1.282; p = 0.024; k = 28) and clinical (PR = 1.134; 95% CI: 1.048–1.227; p = 0.002; k = 23) samples, and pooled estimates differed by population and study design. Suicide attempts were more prevalent during the pandemic among non-clinical (PR = 1.14; 95% CI: 1.053–1.233; p = 0.001; k = 30) and clinical (PR = 1.32; 95% CI: 1.17–1.489; p = 0.000; k = 25) participants. The…

  28. 28
    top 0.5%

    The Effects of Exercise for Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    Liya Xu, Hongyi Gu, Xiaowan Cai, Yimin Zhang, Xiao Hou and 2 more

    144 citationsOpen access (CC-BY)doi:10.3390/ijerph20021088OpenAlex

    Show abstract

    BACKGROUND: Physical exercise can slow down the decline of the cognitive function of the older adults, yet the review evidence is not conclusive. The purpose of this study was to compare the effects of aerobic and resistance training on cognitive ability. METHODS: A computerized literature search was carried out using PubMed, Cochrane Library, Embase SCOPUS, Web of Science, CNKI (China National Knowledge Infrastructure), Wanfang, and VIP database to identify relevant articles from inception through to 1 October 2022. Based on a preliminary search of the database and the references cited, 10,338 records were identified. For the measured values of the research results, the standardized mean difference (SMD) and 95% confidence interval (CI) were used to synthesize the effect size. RESULTS: Finally, 10 studies were included in this meta-analysis. Since the outcome indicators of each literature are different in evaluating the old cognitive ability, a subgroup analysis was performed on the included literature. The study of results suggests that aerobic or resistance training interventions…

  29. 29
    top 0.5%

    The Rise of Gastrointestinal Cancers as a Global Phenomenon: Unhealthy Behavior or Progress?

    Sílvia Rodrigues Jardim, Lucila Marieta Perrotta de Souza, Heitor Siffert Pereira de Souza

    143 citationsOpen access (CC-BY)doi:10.3390/ijerph20043640OpenAlex

    Show abstract

    The overall burden of cancer is rapidly increasing worldwide, reflecting not only population growth and aging, but also the prevalence and spread of risk factors. Gastrointestinal (GI) cancers, including stomach, liver, esophageal, pancreatic, and colorectal cancers, represent more than a quarter of all cancers. While smoking and alcohol use are the risk factors most commonly associated with cancer development, a growing consensus also includes dietary habits as relevant risk factors for GI cancers. Current evidence suggests that socioeconomic development results in several lifestyle modifications, including shifts in dietary habits from local traditional diets to less-healthy Western diets. Moreover, recent data indicate that increased production and consumption of processed foods underlies the current pandemics of obesity and related metabolic disorders, which are directly or indirectly associated with the emergence of various chronic noncommunicable conditions and GI cancers. However, environmental changes are not restricted to dietary patterns, and unhealthy behavioral features…

  30. 30
    top 0.5%

    Sense of Belonging, Meaningful Daily Life Participation, and Well-Being: Integrated Investigation

    Dorit Haim-Litevsky, Reut Komemi, Lena Lipskaya‐Velikovsky

    142 citationsOpen access (CC-BY)doi:10.3390/ijerph20054121OpenAlex

    Show abstract

    The association between well-being, sense of belonging, connectedness to community, and meaningful participation in daily life occupations was theoretically proved and demonstrated in several health conditions or specific age groups. This study aimed to investigate an interplay between well-being, sense of belonging, and connectedness, and meaningful participation in a range of daily life occupations among healthy adults of working age in Israel. Participants (N = 121; age: M = 30.8, SD = 10.1; women: N = 94, 77.7%) completed standard instruments to evaluate the main constructs through an internet survey. A variety of communities, that the participants reported to belong to, were not different in the sense of belonging and connectedness, participation dimensions, and well-being. An association was found between sense of belonging and connectedness, the participation subjective dimension, and well-being (0.18 < rp < 0.47, p < 0.05). Sense of belonging explained in a significant way the variance in well-being (F(3) = 14.7, p < 0.001; R2 = 0.274) and was found to be a mediator between…

  31. 31
    top 0.5%

    Food Selectivity in Children with Autism: Guidelines for Assessment and Clinical Interventions

    Marco Esposito, Paolo Mirizzi, Roberta Fadda, Chiara Pirollo, Orlando Ricciardi and 2 more

    141 citationsOpen access (CC-BY)doi:10.3390/ijerph20065092OpenAlex

    Show abstract

    Autisms Spectrum Disorders (ASD) are characterized by core symptoms (social communication and restricted and repetitive behaviors) and related comorbidities, including sensory anomalies, feeding issues, and challenging behaviors. Children with ASD experience significantly more feeding problems than their peers. In fact, parents and clinicians have to manage daily the burden of various dysfunctional behaviors of children at mealtimes (food refusal, limited variety of food, single food intake, or liquid diet). These dysfunctional behaviors at mealtime depend on different factors that are either medical/sensorial or behavioral. Consequently, a correct assessment is necessary in order to program an effective clinical intervention. The aim of this study is to provide clinicians with a guideline regarding food selectivity concerning possible explanations of the phenomenon, along with a direct/indirect assessment gathering detailed and useful information about target feeding behaviors. Finally, a description of evidence-based sensorial and behavioral strategies useful also for…

  32. 32
    top 0.6%

    Biochar for the Removal of Emerging Pollutants from Aquatic Systems: A Review

    Mingying Dong, Lizhi He, Mengyuan Jiang, Yi Song Zhu, Jie Wang and 5 more

    141 citationsOpen access (CC-BY)doi:10.3390/ijerph20031679OpenAlex

    Show abstract

    Water contaminated with emerging pollutants has become a serious environmental issue globally. Biochar is a porous and carbon-rich material produced from biomass pyrolysis and has the potential to be used as an integrated adsorptive material. Many studies have shown that biochar is capable to adsorb emerging pollutants from aquatic systems and could be used to solve the water pollution problem. Here, we provided a dual perspective on removing emerging pollutants from aquatic systems using biochar and analyzed the emerging pollutant removal efficiency from the aspects of biochar types, pollutant types and coexistence with heavy metals, as well as the associated mechanisms. The potential risks and future research directions of biochar utilization are also presented. This review aims to assist researchers interested in using biochar for emerging pollutants remediation in aquatic systems and facilitate research on emerging pollutants removal, thereby reducing their environmental risk.

  33. 33
    top 0.6%

    Evaluating the Influences of Health Expenditure, Energy Consumption, and Environmental Pollution on Life Expectancy in Asia

    Jan Polcyn, Liton Chandra Voumik, Mohammad Ridwan, Samrat Ray, Viktoriia Vovk

    134 citationsOpen access (CC-BY)doi:10.3390/ijerph20054000OpenAlex

    Show abstract

    This study examines the effects of health expenditure, energy consumption, CO2 emissions, population size, and income on health outcomes in 46 Asian nations between 1997 and 2019. Cross-sectional dependence (CSD) and slope heterogeneity (SH) tests are utilized due to the close linkages between Asian nations as a result of commerce, tourism, religion, and international agreements. The research uses unit root and cointegration tests of the second generation after validating CSD and SH issues. Due to the results of the CSD and SH tests, it is clear that conventional methods of estimation are inappropriate, so a new panel method, the inter autoregressive distributive lag (CS-ARDL) model, is used instead. In addition to CS-ARDL, the study’s results were checked with a common correlated effects mean group (CCEMG) method and an augmented mean group (AMG) method. According to the CS-ARDL study, higher rates of energy use and healthcare spending lead to better health outcomes for Asian countries over the long run. CO2 emissions are shown to be harmful to human health, according to the study.…

  34. 34
    top 0.6%

    Effects of Medical Education Program Using Virtual Reality: A Systematic Review and Meta-Analysis

    Hyeon‐Young Kim, Eun-Young Kim

    131 citationsOpen access (CC-BY)doi:10.3390/ijerph20053895OpenAlex

    Show abstract

    Several studies have examined the effect of virtual reality (VR) education. However, they are mostly systematic reviews or meta-analyses focusing on doctors and residents; they fail to consider VR medical education for a broader range of learners. We evaluated the effectiveness of VR education for health professionals and identified the essential features of education. Randomized controlled trials published from January 2000 to April 2020 were identified from PubMed, Embase, CINAHL, and the Cochrane Library (n = 299). The randomized studies’ bias risk was evaluated using Cochrane’s Risk of Bias tool. Meta- and subgroup-analyses were conducted using Review Manager 5.4.1. The overall effect was measured using Hedges’ g and determined using Z-statistics (p < 0.05). Heterogeneity was assessed using X2 and I2 statistics. Among the identified records, 25 studies were selected through systematic review, and 18 studies were included in the meta-analysis. We identified a significant improvement in the VR group’s skill and satisfaction levels, and that less immersive VR was more efficacious…

  35. 35
    top 0.6%

    Changes in Gut Microbiota and Multiple Sclerosis: A Systematic Review

    Alba Ordoñez-Rodriguez, Pablo Román, Lola Rueda‐Ruzafa, Ana Campos-Ríos, Diana Cardona

    128 citationsOpen access (CC-BY)doi:10.3390/ijerph20054624OpenAlex

    Show abstract

    Introduction: Multiple sclerosis (MS) is a chronic inflammatory neurodegenerative disease mediated by autoimmune reactions against myelin proteins and gangliosides in the grey and white matter of the brain and spinal cord. It is considered one of the most common neurological diseases of non-traumatic origin in young people, especially in women. Recent studies point to a possible association between MS and gut microbiota. Intestinal dysbiosis has been observed, as well as an alteration of short-chain fatty acid-producing bacteria, although clinical data remain scarce and inconclusive. Objective: To conduct a systematic review on the relationship between gut microbiota and multiple sclerosis. Method: The systematic review was conducted in the first quarter of 2022. The articles included were selected and compiled from different electronic databases: PubMed, Scopus, ScienceDirect, Proquest, Cochrane, and CINAHL. The keywords used in the search were: “multiple sclerosis”, “gut microbiota”, and “microbiome”. Results: 12 articles were selected for the systematic review. Among the studies…

  36. 36
    top 0.6%

    Towards Green and Sustainable Healthcare: A Literature Review and Research Agenda for Green Leadership in the Healthcare Sector

    Justyna Berniak‐Woźny, Małgorzata Rataj

    128 citationsOpen access (CC-BY)doi:10.3390/ijerph20020908OpenAlex

    Show abstract

    The health sector is one of the keys to sustainable development. Although it is directly related to only one Sustainable Development Goal (Goal 3, "Ensuring a healthy life and promoting well-being at all ages"), the sector itself, which aims to protect health, is paradoxically at the same time the main emitter of environmental pollutants that have a negative impact on health itself. Therefore, sustainability has become a key priority for health sector organizations, and leadership in this area is essential at all levels. Scientific research plays a particular role here, helping to more clearly define the links between environmental sustainability and the health effects of a polluted environment and climate change as well as indicating the direction of actions needed and disseminating good practices that can help accelerate the adoption of efforts towards climate neutrality and sustainable development of health sector organizations. The aim of this article is to present the current state of the art and future research scenarios in the field of green and sustainable healthcare through…

  37. 37
    top 0.6%

    Microplastic Pollution: Chemical Characterization and Impact on Wildlife

    Sumon Sarkar, Hanin Diab, Jonathan E. Thompson

    125 citationsOpen access (CC-BY)doi:10.3390/ijerph20031745OpenAlex

    Show abstract

    Microplastics are small pieces of plastic that are less than 5 mm in size and can be found in most environments, including the oceans, rivers, and air. These small plastic particles can have negative impacts on wildlife and the environment. In this review of the literature, we analyze the presence of microplastics in various species of wildlife, including fish, birds, and mammals. We describe a variety of analytical techniques, such as microscopy and spectrometry, which identify and quantify the microplastics in the samples. In addition, techniques of sample preparation are discussed. Summary results show that microplastics are present in all the wildlife species studied, with the highest concentrations often found in fish and birds. The literature suggests that microplastics are widely distributed in the environment and have the potential to affect a wide range of species. Further research is required to fully understand the impacts of microplastics on wildlife and the environment.

  38. 38
    top 0.6%

    Procrastination and Stress: A Conceptual Review of Why Context Matters

    Fuschia M. Sirois

    124 citationsOpen access (CC-BY)doi:10.3390/ijerph20065031OpenAlex

    Show abstract

    Research over the past two decades has continued to highlight the robust associations between procrastination and stress across multiple populations and contexts. Despite this burgeoning evidence base and theory linking procrastination to higher levels of stress, as well as the reverse, the role of context in this potentially dynamic association has received relatively little attention. In this conceptual review I argue that from a mood regulation perspective of procrastination, stressful contexts necessarily increase risk for procrastination because they deplete coping resources and lower the threshold for tolerating negative emotions. Drawing on insights from coping and emotion regulation theory, the new stress context vulnerability model of procrastination proposes that the risk for procrastination increases in stressful contexts primarily because procrastination is a low-resource means of avoiding aversive and difficult task-related emotions. The new model is then applied to evidence on the primary and secondary sources of stress during the COVID-19 pandemic and how they may…

  39. 39
    top 0.7%

    Occupational Burnout in Healthcare Workers, Stress and Other Symptoms of Work Overload during the COVID-19 Pandemic in Poland

    Zbigniew Izdebski, Alicja Kozakiewicz, Maciej Białorudzki, Joanna Dec-Pietrowska, Joanna Mazur

    122 citationsOpen access (CC-BY)doi:10.3390/ijerph20032428OpenAlex

    Show abstract

    This study explored the level and selected determinants of burnout among five groups of healthcare workers (physicians, nurses, paramedics, other medical and nonmedical staff) working during the COVID-19 pandemic in Poland. This cross-sectional study was conducted from February to April 2022, with the use of a self-administered mostly online survey. The BAT-12 scale was used to measure burnout, and the PSS-4 scale was used to measure stress. The sample was limited to 2196 individuals who worked with patients during the COVID-19 pandemic. A series of multivariate logistic regression models with three to nine predictors was estimated. The prevalence of burnout ranged from 27.7% in other nonmedical staff to 36.5% in nurses. Adjusting for age and gender, both physicians (p = 0.011) and nurses (p < 0.001) were at higher risk of burnout. In the final model, elevated stress most likely increased the risk of burnout (OR = 3.88; 95%CI <3.13–3.81>; p < 0,001). Other significant predictors of burnout included traumatic work-related experience (OR =1.91, p < 0.001), mobbing (OR = 1.83, p <…

  40. 40
    top 0.7%

    The Significance of Cooperation in Interdisciplinary Health Care Teams as Perceived by Polish Medical Students

    Aleksandra Bendowska, Ewa Baum

    122 citationsOpen access (CC-BY)doi:10.3390/ijerph20020954OpenAlex

    Show abstract

    Teamwork, as the preferred method of cooperation in healthcare, became prevalent in the 1960s, and since then has been universally recognized as a measure to improve the quality of healthcare. Research indicates that medical care based on interdisciplinary cooperation is associated with increased patient safety, lower hospitalization rates, and reduced rates of complications and medical errors. Furthermore, it enhances the coordination of care and improves patient access to medical services. This model of providing medical care also results in considerable benefits for medical professionals. These include greater job satisfaction and a reduced risk of professional burnout syndrome. AIM: The aim of the study was to explore the opinions of medical students with regard to cooperation in the interdisciplinary team, as well as the factors affecting the formation of opinions. MATERIAL AND METHODS: = 294). RESULTS: According to the opinions of the students participating in the study, the therapeutic process based on the interdisciplinary model improves the quality of medical care provided,…

  41. 41
    top 0.7%

    The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review

    Reuben Kindred, Glen William Bates

    119 citationsOpen access (CC-BY)doi:10.3390/ijerph20032362OpenAlex

    Show abstract

    The COVID-19 pandemic has resulted in negative mental health outcomes throughout the world, and its impact on social interactions and relationships is likely to be evident in problematic social anxiety. This systematic review qualitatively synthesized data from studies that have reported on the effects of the pandemic on social anxiety. A systematic search of Web of Science Core Collection, Embase, PsychINFO, Scopus, EBSCOhost, Cochrane Central Register of Controlled Trials, and Proquest Central-Dissertations and Theses was conducted, with thirty-three studies meeting the inclusion criteria. The results suggest that social anxiety has been heightened in the general population due to the pandemic, with women and low-income earners being especially vulnerable. Other contributing factors include impaired coping strategies, lower socio-emotional well-being, limited support networks, and contraction of the SARS-CoV-2 virus. Individuals with a Social Anxiety Disorder diagnosis may be at risk of a deterioration of mental health in general. Limitations of the literature reviewed include the…

  42. 42
    top 0.7%

    Trends in Serum Per- and Polyfluoroalkyl Substance (PFAS) Concentrations in Teenagers and Adults, 1999–2018 NHANES

    Nilisha Khadgi Sonnenberg, Akinloye Emmanuel Ojewole, Catherine Oluwalopeye Ojewole, Otite P Lucky, Joseph Kusi

    118 citationsOpen access (CC-BY)doi:10.3390/ijerph20216984OpenAlex

    Show abstract

    Some types of per- and poly-fluoroalkyl substances (PFAS) have been banned over the last two decades, but millions of Americans continue to have exposure to the compounds through drinking water and consumer products. Therefore, understanding the changes in serum PFAS concentrations after their limited use is necessary to protect public health. In this study, we evaluated trends of serum PFAS compounds (PFOS, PFOA, PFHxS, PFDA, and PFNA) to determine their distribution among the United States general population. We analyzed serum concentrations of PFAS measured from random subsamples of the National Health and Nutrition Examination Survey (NHANES) participants. The study results demonstrated that demographic factors such as race/ethnicity, age, and sex may influence the levels of serum PFAS over time. Adults, males, Asians, Non-Hispanic Blacks, and Non-Hispanic Whites had high risks of exposure to the selected PFAS. Overall, serum PFAS levels declined continuously in the studied population from 1999 to 2018. Among the studied population, PFOS and PFDA were the most and least…

  43. 43
    top 0.7%

    Validating an Instrument for Measuring Newly Graduated Nurses’ Adaptation

    Hafidza Baharum, Aniza Ismail, Zainudin Awang, Lisa McKenna, Roszita Ibrahim and 2 more

    118 citationsOpen access (CC-BY)doi:10.3390/ijerph20042860OpenAlex

    Show abstract

    A long-established approach, Confirmatory Factor Analysis (CFA) is used to validate measurement models of latent constructs. Employing CFA can be useful for assessing the validity and reliability of such models. The study adapted previous instruments and modified them to suit the current setting. The new measurement model is termed NENA-q. Exploratory factor analysis (EFA) revealed the instruments of the NENA-q model formed a construct of the second order with four dimensions, namely organizational contribution (OC), academic institution contribution (AIC), personality traits (PT), and newly employed nurses' adaptation (NENA). Researchers administered the questionnaires to a sample of 496 newly employed nurses working in hospitals under the Ministry of Health (MOH) for the confirmation of the extracted dimensions. The study performed a two-step CFA procedure to validate NENA-q since the model involves higher-order constructs. The first step was individual CFA, while the second step was pooled CFA. The validation procedure through confirmatory factor analysis (CFA) found the model…

  44. 44
    top 0.7%

    Can Smart Home Technologies Help Older Adults Manage Their Chronic Condition? A Systematic Literature Review

    Gabriella Facchinetti, Giorgia Petrucci, Beatrice Albanesi, Maria Grazia De Marinis, Michela Piredda

    118 citationsOpen access (CC-BY)doi:10.3390/ijerph20021205OpenAlex

    Show abstract

    The management of chronic diseases requires personalized healthcare that allows older adults to manage their diseases at home. This systematic review aimed to describe the smart home technologies used in the management of chronic diseases in older people. A systematic literature review was conducted on four databases and was reported following the PRISMA statement. Nineteen articles were included. The intervention technologies were classified into three groups: smart home, characterized by environmental sensors detecting motion, contact, light, temperature, and humidity; external memory aids, characterized by a partnership between mobile apps and smart home-based activity learning; and hybrid technology, with the integration of multiple technologies, such as devices installed at patients' homes and telemedicine. The health outcomes evaluated are vital signs, medication management, ADL-IADL, mobility, falls, and quality of life. Smart homes show great potential in the management of chronic diseases by favouring the control of exacerbations and increasing patients' safety by providing…

  45. 45
    top 0.8%

    Cortisol as a Stress Indicator in Fish: Sampling Methods, Analytical Techniques, and Organic Pollutant Exposure Assessments

    Leila Soledade Lemos, Leo Angarica, Rachel Ann Hauser‐Davis, Natalia Quinete

    117 citationsOpen access (CC-BY)doi:10.3390/ijerph20136237OpenAlex

    Show abstract

    Cortisol is the main glucocorticoid released during stress responses in most fish and has been employed to investigate different stressors, including organic pollutants. This review discusses shifts in cortisol concentrations and examines different matrix sampling methods (invasive vs. minimally or non-invasive) and the main analytical cortisol determination techniques (immunoassays and liquid chromatography-tandem mass spectrometry). Assessments on organic pollutant exposure in fish and associated adverse effects are also discussed. Studies in this regard may aid in identifying organic pollutant toxicological modes of action, mechanistic response, toxicokinetics, and toxicodynamics, as well as pollution sources and associated health risks in fish, ultimately aiding in the development of effective management strategies to mitigate the impacts of organic pollutants on fish populations and their associated ecosystems.

  46. 46
    top 0.8%

    Effect of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Fat Loss and Cardiorespiratory Fitness in the Young and Middle-Aged a Systematic Review and Meta-Analysis

    Zhicheng Guo, Meng Li, Jianguang Cai, Weiqi Gong, Yin Liu and 1 more

    116 citationsOpen access (CC-BY)doi:10.3390/ijerph20064741OpenAlex

    Show abstract

    Objectives: This systematic review is conducted to evaluate the effect of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on body composition and cardiorespiratory fitness (CRF) in the young and middle-aged. Methods: Seven databases were searched from their inception to 22 October 2022 for studies (randomized controlled trials only) with HIIT and MICT intervention. Meta-analysis was carried out for within-group (pre-intervention vs. post-intervention) and between-group (HIIT vs. MICT) comparisons for change in body mass (BM), body mass index (BMI), waist circumference (WC), percent fat mass (PFM), fat mass (FM), fat-free mass (FFM), and CRF. Results: A total of 1738 studies were retrieved from the database, and 29 studies were included in the meta-analysis. Within-group analyses indicated that both HIIT and MICT can bring significant improvement in body composition and CRF, except for FFM. Between-group analyses found that compared to MICT, HIIT brings significant benefits to WC, PFM, and VO2peak. Conclusions: The effect of HIIT on fat loss…

  47. 47
    top 0.8%

    Digital Addiction Intervention for Children and Adolescents: A Scoping Review

    Keya Ding, Hui Li

    115 citationsOpen access (CC-BY)doi:10.3390/ijerph20064777OpenAlex

    Show abstract

    Digital devices play a significant role in the learning and living of children and adolescents, whose overuse or addiction has become a global concern. This scoping review seeks to synthesize existing studies to investigate relevant interventions and their effects on digital addiction in children (ages 0-18). To understand the latest advances, we have identified 17 studies published in international peer-reviewed journals between 2018-2022. The findings revealed that, first, most interventions for digital addiction in children and adolescents were cognitive-behavioral therapies (CBT) or CBT-based interventions, which could improve anxiety, depression, and related symptoms of digital addiction. Second, rather than directly targeting addictive behaviors, some family-based interventions aim to strengthen family functions and relationships. Finally, digital-based interventions, such as website-based, application-based, and virtual reality interventions, are promising in adolescent digital addiction interventions. However, these studies shared the same limitations: small sample sizes,…

  48. 48
    top 0.8%

    Myopia and Near Work: A Systematic Review and Meta-Analysis

    Frédéric Dutheil, Tharwa Oueslati, Louis Delamarre, Joris Castanon, Caroline Maurin and 7 more

    115 citationsOpen access (CC-BY)doi:10.3390/ijerph20010875OpenAlex

    Show abstract

    BACKGROUND: Myopia is a global public health problem affecting quality of life and work productivity. Data is scarce regarding the effects of near work on myopia. Providing a larger meta-analysis with life-long perspective, including adults and occupational exposure seemed needed. METHODS: We searched PubMed, Cochrane Library, Embase and Science Direct for studies reporting myopia prevalence in near work. Myopia was defined as a mean spherical equivalent ≤ -0.50 diopter. We performed a meta-analysis using random-effects model on myopia prevalence, myopia progression per year, and odds ratio (OR) of myopia in near work, completed by subgroup analyses and meta-regressions on patients' characteristics, type of work in adults, geographic zones, time and characteristics of near work. RESULTS: We included 78 studies, representing a total of 254,037 participants, aged from 6 to 39 years. The global prevalence of myopia in near work was 35% (95% CI: 30 to 41%), with a prevalence of 31% (95% CI: 26 to 37%) in children and 46% (95% CI: 30 to 62%) in adults. Myopia progression was -0.39…

  49. 49
    top 0.8%

    Telerehabilitation as a Therapeutic Exercise Tool versus Face-to-Face Physiotherapy: A Systematic Review

    Maria-Teresa Muñoz-Tomás, Mario Burillo-Lafuente, Araceli Vicente-Parra, Ma Concepción Sanz-Rubio, Carmen Suárez-Serrano and 2 more

    111 citationsOpen access (CC-BY)doi:10.3390/ijerph20054358OpenAlex

    Show abstract

    Digital physiotherapy, often referred to as "Telerehabilitation", consists of applying rehabilitation using telecommunication technologies. The objective is to evaluate the effectiveness of therapeutic exercise when it is telematically prescribed. METHODS: We searched PubMed, Embase, Scopus, SportDiscus and PEDro (30 December 2022). The results were obtained by entering a combination of MeSH or Emtree terms with keywords related to telerehabilitation and exercise therapy. RCTs on patients over 18 years and two groups were included, one working with therapeutic exercise through telerehabilitation and one working with conventional physiotherapy group. RESULTS: a total of 779 works were found. However, after applying the inclusion criteria, only 11 were selected. Telerehabilitation is most frequently used to treat musculoskeletal, cardiac and neurological pathologies. The preferred telerehabilitation tools are videoconferencing systems, telemonitoring and online platforms. Exercise programs ranged from 10 to 30 min and were similar in both intervention and control groups. In all the…

  50. 50
    top 0.8%

    Physiotherapists Using the Biopsychosocial Model for Chronic Pain: Barriers and Facilitators—A Scoping Review

    Han van Dijk, Albere J. A. Köke, Stefan Elbers, Jürgen Mollema, Rob Smeets and 1 more

    111 citationsOpen access (CC-BY)doi:10.3390/ijerph20021634OpenAlex

    Show abstract

    The use of the biopsychosocial model in primary care physiotherapy for chronic pain is far from the recommendations given in research and current guidelines. To understand why physiotherapists have difficulty implementing a biopsychosocial approach, more insight is needed on the barriers and facilitators. This scoping review aimed to investigate and map these barriers and facilitators that physiotherapists working in primary care reportedly face when treating patients with chronic musculoskeletal pain from a biopsychosocial perspective. Four electronic databases (PubMed, Embase, CINAHL and ERIC) and the grey literature were searched. Studies were included if they investigated the experiences of physiotherapists in the treatment of chronic pain from a biopsychosocial perspective in primary care. Extracted data were discussed and sub grouped in themes following a qualitative content analysis approach. To align with current use of theories on behavior change, the resulting themes were compared to the Theoretical Domains Framework. After screening, twenty-four studies were included.…

  51. 51
    top 0.9%

    A Brief Overview: Sex Differences in Prevalent Chronic Musculoskeletal Conditions

    Demario S. Overstreet, Larissa J. Strath, Mackensie Jordan, Indonesia A. Jordan, Joanna M. Hobson and 4 more

    110 citationsOpen access (CC-BY)doi:10.3390/ijerph20054521OpenAlex

    Show abstract

    Musculoskeletal (MSK) pain disorders are some of the most prevalent and disabling chronic pain conditions worldwide. These chronic conditions have a considerable impact on the quality of life of individuals, families, communities, and healthcare systems. Unfortunately, the burden of MSK pain disorders does not fall equally across the sexes. Females consistently demonstrate more prevalent and severe clinical presentations of MSK disorders, and this disparity increases in magnitude with age. The aim of the present article is to review recent studies that have examined sex differences between males and females in four of the most common MSK pain disorders: neck pain, low back pain, osteoarthritis, and rheumatoid arthritis.

  52. 52
    top 0.9%

    Lipoprotein(a) as a Risk Factor for Cardiovascular Diseases: Pathophysiology and Treatment Perspectives

    Pierandrea Vinci, Filippo Giorgio Di Girolamo, Emiliano Panizon, Letizia Maria Tosoni, Carla Cerrato and 10 more

    109 citationsOpen access (CC-BY)doi:10.3390/ijerph20186721OpenAlex

    Show abstract

    Cardiovascular disease (CVD) is still a leading cause of morbidity and mortality, despite all the progress achieved as regards to both prevention and treatment. Having high levels of lipoprotein(a) [Lp(a)] is a risk factor for cardiovascular disease that operates independently. It can increase the risk of developing cardiovascular disease even when LDL cholesterol (LDL-C) levels are within the recommended range, which is referred to as residual cardiovascular risk. Lp(a) is an LDL-like particle present in human plasma, in which a large plasminogen-like glycoprotein, apolipoprotein(a) [Apo(a)], is covalently bound to Apo B100 via one disulfide bridge. Apo(a) contains one plasminogen-like kringle V structure, a variable number of plasminogen-like kringle IV structures (types 1-10), and one inactive protease region. There is a large inter-individual variation of plasma concentrations of Lp(a), mainly ascribable to genetic variants in the Lp(a) gene: in the general po-pulation, Lp(a) levels can range from <1 mg/dL to >1000 mg/dL. Concentrations also vary between different ethnicities.…

  53. 53
    top 0.9%

    Green Management and Sustainable Performance of Small- and Medium-Sized Hospitality Businesses: Moderating the Role of an Employee’s Pro-Environmental Behaviour

    Ibrahim Abdelhamid Elshaer, Alaa M. S. Azazz, Sameh Fayyad

    106 citationsOpen access (CC-BY)doi:10.3390/ijerph20032244OpenAlex

    Show abstract

    As green management practices (GMPs) matter not only for improving the organizations' tribble line performance (environmental, economic, and social) but also can sustain a competitive advantage. Since the tourism and hospitality industry is subject to environmental expectations from visitors, governments, and the community, it is vital to understand what motivates GMPs to overcome environmental obstacles and satisfy those demands. However, the current literature fails to comprehensively justify how small- and medium-sized businesses (SMEs) tackle green management difficulties when implementing their plans, even though these SMEs could be a leading contributor to environmental concerns. Although many scholars assert that employees' pro-environmental behaviours are decisive in boosting efforts of green management to improve corporate sustainable performance, only limited studies probed the importance of employees' pro-environmental behaviours in SMEs in developing countries. To fill this research gap, the data was gathered from 304 small- and medium-sized hotels and travel agency…

  54. 54
    top 0.9%

    The Relationship between Energy Consumption, CO2 Emissions, Economic Growth, and Health Indicators

    Jing Li, Muhammad Irfan, Sarminah Samad, Basit Ali, Yao Zhang and 2 more

    104 citationsOpen access (CC-BY)doi:10.3390/ijerph20032325OpenAlex

    Show abstract

    The health and wellness of people through life expectancy, mortality rate improvement, and sustaining the productivity of labor contributes a lot to national income. Infrastructure development consumes energy and releases carbon dioxide at different stages of the construction process. The current study explores the nexus between CO2 emission, energy consumption, mortality, life expectancy, and GDP in the top five carbon-emitting countries by using time series data from 1975 to 2015. The study used a cointegration technique to find the long- and short-run relationships between study variables. The study also used a structural break test to identify the break time. The results of the correlation matrix show strong positive correlation between CO2 emissions and energy consumption. It also reflects a weak correlation with mortality and life expectancy in Japan and Russia. The results of the ADF test indicated that the series are stationary at first difference and provided evidence to use Johansen cointegration test for long- and short-run relationships between independent series. Vector…

  55. 55
    top 0.9%

    The Role of Trust in Disaster Risk Reduction: A Critical Review

    Rubinia Celeste Bonfanti, Benedetta Oberti, Elisa Ravazzoli, Anna Rinaldi, Stefano A. Ruggieri and 1 more

    101 citationsOpen access (CC-BY)doi:10.3390/ijerph21010029OpenAlex

    Show abstract

    In recent years, there has been a growing interest in the concept of trust within the domain of natural disaster management. Trust can be defined as a state of vulnerability where one party relies on another party with the expectation that the latter will carry out entrusted responsibilities without exploiting this inherent vulnerability. This comprehensive literature review is dedicated to the examination of research concerning community and institutional trust in the field of disaster risk reduction (DRR). Particular emphasis is placed on elucidating the influence of trust throughout the distinct phases of natural disaster management, namely prevention, preparedness, response, and recovery. The critical examination of the pertinent body of the literature demonstrates that trust plays a central role across the different phases of DRR, being positively associated with effective community responses and resilience. Hence, it becomes imperative to actively foster the development of trust at both institutional and community levels within the realm of DRR. This endeavor is essential for…

  56. 56
    top 0.9%

    Speech Emotion Recognition Using Attention Model

    Jagjeet Singh, Lakshmi Babu Saheer, Oliver Faust

    100 citationsOpen access (CC-BY)doi:10.3390/ijerph20065140OpenAlex

    Show abstract

    Speech emotion recognition is an important research topic that can help to maintain and improve public health and contribute towards the ongoing progress of healthcare technology. There have been several advancements in the field of speech emotion recognition systems including the use of deep learning models and new acoustic and temporal features. This paper proposes a self-attention-based deep learning model that was created by combining a two-dimensional Convolutional Neural Network (CNN) and a long short-term memory (LSTM) network. This research builds on the existing literature to identify the best-performing features for this task with extensive experiments on different combinations of spectral and rhythmic information. Mel Frequency Cepstral Coefficients (MFCCs) emerged as the best performing features for this task. The experiments were performed on a customised dataset that was developed as a combination of RAVDESS, SAVEE, and TESS datasets. Eight states of emotions (happy, sad, angry, surprise, disgust, calm, fearful, and neutral) were detected. The proposed attention-based…

  57. 57
    top 0.9%

    Effectiveness of Pain Neuroscience Education in Patients with Chronic Musculoskeletal Pain and Central Sensitization: A Systematic Review

    Beatrice Lepri, Daniele Romani, Lorenzo Storari, Valerio Barbari

    100 citationsOpen access (CC-BY)doi:10.3390/ijerph20054098OpenAlex

    Show abstract

    OBJECTIVE: To collect the available evidence about the effectiveness of pain neuroscience education (PNE) on pain, disability, and psychosocial factors in patients with chronic musculoskeletal (MSK) pain and central sensitization (CS). METHODS: A systematic review was conducted. Searches were performed on Pubmed, PEDro, and CINAHL, and only randomized controlled trials (RCTs) enrolling patients ≥18 years of age with chronic MSK pain due to CS were included. No meta-analysis was conducted, and qualitative analysis was realized. RESULTS: 15 RCTs were included. Findings were divided for diagnostic criteria (fibromyalgia-FM, chronic fatigue syndrome-CFS, low back pain-LBP, chronic spinal pain-CSP). PNE has been proposed as a single intervention or associated with other approaches, and different measures were used for the main outcomes considered. Conclusions, practice implication: PNE is effective in improving pain, disability, and psychosocial factors in patients with fibromyalgia, chronic low back pain (CLBP)-especially if associated with other therapeutic approaches-and also in…

  58. 58
    top 1%

    Determinants of Sleep Quality: A Cross-Sectional Study in University Students

    Johanna M. Schmickler, Simon Blaschke, Rebecca Robbins, Filip Mess

    100 citationsOpen access (CC-BY)doi:10.3390/ijerph20032019OpenAlex

    Show abstract

    When entering the university setting, poor sleep quality is reportedly prevalent among students and has been linked to a range of adverse health outcomes, including reduced academic performance. Moreover, determinants of sleep quality are not yet fully understood. This study was designed to (1) assess the prevalence of poor sleep quality and (2) identify determinants of sleep quality in German university students. In total, 1,684 undergraduate and graduate students (50.6% female, mean age 22.87 ± 3.15 years) from multiple academic disciplines completed a cross-sectional online survey assessing socio-demographic, health, and study-related indicators and sleep quality using the Pittsburgh Sleep Quality Index (PSQI). In our sample, 820 (48.7%) met the PSQI cut-off score (>5) for poor sleep quality. Multiple regression analysis showed that older age, being a business student, lower subjective social status, poorer self-rated health, stress, exhaustion, and poor academic performance significantly predicted poor sleep quality. Our findings document a high prevalence of poor sleep quality…

  59. 59
    top 1%

    Near-Suicide Phenomenon: An Investigation into the Psychology of Patients with Serious Illnesses Withdrawing from Treatment

    Quan‐Hoang Vuong, Tam-Tri Le, Ruining Jin, Quy Van Khuc, Hong-Son Nguyen and 2 more

    99 citationsOpen access (CC-BY)doi:10.3390/ijerph20065173OpenAlex

    Show abstract

    Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon "near-suicide". This study attempted to explore this phenomenon by examining how the seriousness of the patient's illness or injury and the subjective evaluation of the patient's and family's financial situation after paying treatment fees affect the final decision on the treatment process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families' financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment.…

  60. 60
    top 1%

    Analysing the Influence of Green Marketing Communication in Consumers’ Green Purchase Behaviour

    Elisabete Correia, Sara Sousa, Clara Viseu, Manuela Larguinho

    99 citationsOpen access (CC-BY)doi:10.3390/ijerph20021356OpenAlex

    Show abstract

    This study aims to explore whether consumers' attention to companies' green marketing communication influences their green purchase behaviour. It also analyses the importance of consumers' characteristics, namely gender, education, and green attitudes, in their attention to companies' green marketing communication. An online survey was carried out on the population residing in Portugal over 18 years of age, allowing us to collect 690 valid responses. Data analysis techniques including descriptive analyses, parametric and non-parametric tests, linear correlation, and regression analysis were used. The achieved results allow us to conclude that consumers are attentive to companies' green marketing communication. A strong correlation between consumers' attention to companies' green marketing communication and green purchasing behaviour was identified. The results also confirm that individuals with higher educational levels and green attitudes and females are the most attentive to companies' green marketing communication.

  61. 61
    top 1%

    Microplastics and Antibiotic Resistance: The Magnitude of the Problem and the Emerging Role of Hospital Wastewater

    Benedetta Tuvo, Michela Scarpaci, Sara Bracaloni, Enrica Esposito, Anna Laura Costa and 2 more

    97 citationsOpen access (CC-BY)doi:10.3390/ijerph20105868OpenAlex

    Show abstract

    The role of microplastics (MPs) in the spread of antibiotic resistance genes (ARGs) is increasingly attracting global research attention due to their unique ecological and environmental effects. The ubiquitous use of plastics and their release into the environment by anthropic/industrial activities are the main sources for MP contamination, especially of water bodies. Because of their physical and chemical characteristics, MPs represent an ideal substrate for microbial colonization and formation of biofilm, where horizontal gene transfer is facilitated. In addition, the widespread and often injudicious use of antibiotics in various human activities leads to their release into the environment, mainly through wastewater. For these reasons, wastewater treatment plants, in particular hospital plants, are considered hotspots for the selection of ARGs and their diffusion in the environment. As a result, the interaction of MPs with drug-resistant bacteria and ARGs make them vectors for the transport and spread of ARGs and harmful microorganisms. Microplastic-associated antimicrobial…

  62. 62
    top 1%

    Effects of Mindfulness-Based Interventions on Promoting Athletic Performance and Related Factors among Athletes: A Systematic Review and Meta-Analysis of Randomized Controlled Trial

    Yan Wang, Siman Lei, Jingjing Fan

    97 citationsOpen access (CC-BY)doi:10.3390/ijerph20032038OpenAlex

    Show abstract

    In recent years, mindfulness-based interventions (MBIs) have been widely applied in competition sports with respect to athletic performance and mental health promotion, whereas evidence of randomized controlled trials (RCTs) has not been well summarized. Therefore, this study aimed to systematically review and meta-analyze the existing evidence on the effects of MBIs on improving athletic performance, mindfulness level, mindfulness-related psychological components (e.g., acceptance, self-compassion, flow), and mental health (e.g., burnout, stress, psychological well-being) among athletes. Following the PRISMA guidelines, a literature search was implemented on five electronic databases (Web of Science, PubMed, Scopus, ProQuest, and ScienceDirect) and relevant review papers. The article selection, risk of bias assessment, and data extraction were performed by two investigators independently. The standardized mean difference (SMD) was calculated to evaluate the effects of interventions using the random effect model. Among the 1897 original hits, thirty-two eligible RCT studies were…

  63. 63
    top 1%

    Impacts of Air Pollution on Health and Cost of Illness in Jakarta, Indonesia

    Ginanjar Syuhada, Adhadian Akbar, Donny Hardiawan, Vivian Chit Pun, Adi Darmawan and 7 more

    96 citationsOpen access (CC-BY)doi:10.3390/ijerph20042916OpenAlex

    Show abstract

    (1) Background: This study aimed to quantify the health and economic impacts of air pollution in Jakarta Province, the capital of Indonesia. (2) Methods: We quantified the health and economic burden of fine particulate matter (PM2.5) and ground-level Ozone (O3), which exceeds the local and global ambient air quality standards. We selected health outcomes which include adverse health outcomes in children, all-cause mortality, and daily hospitalizations. We used comparative risk assessment methods to estimate health burdens attributable to PM2.5 and O3, linking the local population and selected health outcomes data with relative risks from the literature. The economic burdens were calculated using cost-of-illness and the value of the statistical life-year approach. (3) Results: Our results suggest over 7000 adverse health outcomes in children, over 10,000 deaths, and over 5000 hospitalizations that can be attributed to air pollution each year in Jakarta. The annual total cost of the health impact of air pollution reached approximately USD 2943.42 million. (4) Conclusions: By using…

  64. 64
    top 1.1%

    The Association between Artificial Intelligence Awareness and Employee Depression: The Mediating Role of Emotional Exhaustion and the Moderating Role of Perceived Organizational Support

    Guanglu Xu, Ming Xue, Jidi Zhao

    95 citationsOpen access (CC-BY)doi:10.3390/ijerph20065147OpenAlex

    Show abstract

    The combination of artificial intelligence (AI) technology with the real economy has dramatically improved the efficiency of enterprises. However, the replacement of AI for employment also significantly impacts employees' cognition and psychological state. Based on the Conservation of Resources Theory, the relationship between AI awareness and employee depression is explored in this article while examining the mediating role of emotional exhaustion, as well as the moderating role of perceived organizational support. Based on a sample of 321 respondents, the empirical results show that (1) AI awareness is significantly positively correlated with depression; (2) emotional exhaustion plays a mediating role between AI awareness and depression; (3) perceived organizational support negatively moderates the relationship between emotional exhaustion and depression; (4) perceived organizational support negatively moderates the mediating role of emotional exhaustion between AI awareness and depression. The research conclusions provide a theoretical basis for organizations to take measures to…

  65. 65
    top 1.1%

    The Role of “Physiologically Based Pharmacokinetic Model (PBPK)” New Approach Methodology (NAM) in Pharmaceuticals and Environmental Chemical Risk Assessment

    Deepika Deepika, Vikas Kumar

    94 citationsOpen access (CC-BY)doi:10.3390/ijerph20043473OpenAlex

    Show abstract

    Physiologically Based Pharmacokinetic (PBPK) models are mechanistic tools generally employed in the pharmaceutical industry and environmental health risk assessment. These models are recognized by regulatory authorities for predicting organ concentration-time profiles, pharmacokinetics and daily intake dose of xenobiotics. The extension of PBPK models to capture sensitive populations such as pediatric, geriatric, pregnant females, fetus, etc., and diseased populations such as those with renal impairment, liver cirrhosis, etc., is a must. However, the current modelling practices and existing models are not mature enough to confidently predict the risk in these populations. A multidisciplinary collaboration between clinicians, experimental and modeler scientist is vital to improve the physiology and calculation of biochemical parameters for integrating knowledge and refining existing PBPK models. Specific PBPK covering compartments such as cerebrospinal fluid and the hippocampus are required to gain mechanistic understanding about xenobiotic disposition in these sub-parts. The PBPK…

  66. 66
    top 1.1%

    The Implications of Climate Change on Health among Vulnerable Populations in South Africa: A Systematic Review

    Myo Myo Khine, Uma Langkulsen

    93 citationsOpen access (CC-BY)doi:10.3390/ijerph20043425OpenAlex

    Show abstract

    Climate change poses numerous threats to human life, including physical and mental health, the environment, housing, food security, and economic growth. People who already experience multidimensional poverty with the disparity in social, political, economic, historical, and environmental contexts are more vulnerable to these impacts. The study aims to identify the role of climate change in increasing multidimensional inequalities among vulnerable populations and analyze the strengths and limitations of South Africa's National Climate Change Adaptation Strategy. A systematic review was applied, and literature from Google, Google Scholar, and PubMed, as well as relevant gray literature from 2014-2022 were reviewed. Out of 854 identified sources, 24 were included in the review. Climate change has exacerbated multidimensional inequalities among vulnerable populations in South Africa. Though the National Climate Change Adaptation Strategy has paid attention to health issues and the needs of vulnerable groups, the adaptation measures appear to focus less on mental and occupational health.…

  67. 67
    top 1.1%

    Application of Natural Language Processing (NLP) in Detecting and Preventing Suicide Ideation: A Systematic Review

    Abayomi Arowosegbe, Tope Oyelade

    92 citationsOpen access (CC-BY)doi:10.3390/ijerph20021514OpenAlex

    Show abstract

    (1) Introduction: Around a million people are reported to die by suicide every year, and due to the stigma associated with the nature of the death, this figure is usually assumed to be an underestimate. Machine learning and artificial intelligence such as natural language processing has the potential to become a major technique for the detection, diagnosis, and treatment of people. (2) Methods: PubMed, EMBASE, MEDLINE, PsycInfo, and Global Health databases were searched for studies that reported use of NLP for suicide ideation or self-harm. (3) Result: The preliminary search of 5 databases generated 387 results. Removal of duplicates resulted in 158 potentially suitable studies. Twenty papers were finally included in this review. (4) Discussion: Studies show that combining structured and unstructured data in NLP data modelling yielded more accurate results than utilizing either alone. Additionally, to reduce suicides, people with mental problems must be continuously and passively monitored. (5) Conclusions: The use of AI&ML opens new avenues for considerably guiding risk prediction…

  68. 68
    top 1.1%

    Microplastic Pollution Prevention: The Need for Robust Policy Interventions to Close the Loopholes in Current Waste Management Practices

    Hiroshan Hettiarachchi, Jay N. Meegoda

    91 citationsOpen access (CC-BY)doi:10.3390/ijerph20146434OpenAlex

    Show abstract

    Plastic materials that are less than 5 mm in size are defined as Microplastics (MPs). MPs that are intentionally produced are called primary MPs; however, the most abundant type in the environment consists of the remainder created by the fragmentation of large plastic debris through physical, chemical, and oxidative processes, which are called secondary MPs. Due to their abundance in the environment, poor degradability, toxicological properties, and negative impact on aquatic and terrestrial organisms, including humans, MP pollution has become a global environmental issue. Combatting MP pollution requires both remediation and preventive measures. Although remediation is a must, considering where the technology stands today, it may take long time to make it happen. Prevention, on the other hand, can be and should be done now. However, the effectiveness of preventive measures depends heavily on how well MP escape routes are researched and understood. In this research, we argue that such escape routes (rather, loopholes) exist not only due to mismanaged plastic waste, but also due to…

  69. 69
    top 1.1%

    Lessons Learned from Natural Disasters around Digital Health Technologies and Delivering Quality Healthcare

    Zerina Lokmic‐Tomkins, Dinesh Bhandari, Chris Bain, Ann Borda, Timothy Charles Kariotis and 1 more

    91 citationsOpen access (CC-BY)doi:10.3390/ijerph20054542OpenAlex

    Show abstract

    As climate change drives increased intensity, duration and severity of weather-related events that can lead to natural disasters and mass casualties, innovative approaches are needed to develop climate-resilient healthcare systems that can deliver safe, quality healthcare under non-optimal conditions, especially in remote or underserved areas. Digital health technologies are touted as a potential contributor to healthcare climate change adaptation and mitigation, through improved access to healthcare, reduced inefficiencies, reduced costs, and increased portability of patient information. Under normal operating conditions, these systems are employed to deliver personalised healthcare and better patient and consumer involvement in their health and well-being. During the COVID-19 pandemic, digital health technologies were rapidly implemented on a mass scale in many settings to deliver healthcare in compliance with public health interventions, including lockdowns. However, the resilience and effectiveness of digital health technologies in the face of the increasing frequency and…

  70. 70
    top 1.1%

    Prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among Substance Use Disorder (SUD) Populations: Meta-Analysis

    Henrik Rohner, Nikolas Gaspar, Alexandra Philipsen, Marcel Schulze

    91 citationsOpen access (CC-BY)doi:10.3390/ijerph20021275OpenAlex

    Show abstract

    (1) Background: Attention deficit hyperactivity disorder (ADHD) is characterized by a persistent pattern of age-inappropriate levels of inattention and/or hyperactivity/impulsivity that results in functional impairment at work, education, or hobbies and affects family life, social contacts, and self-confidence. ADHD is a comorbid condition associated with a prognosis of severe substance use disorder (SUD) and the early onset of such. The aim of this meta-analysis was to obtain the best estimate of the prevalence of ADHD in SUD populations. (2) Methods: A literature research was conducted using PUBMED® and Web of Science®. The following search terms were used: [ADHD], [prevalence], and [substance use disorder]. RStudio® was used for meta-analysis methods. (3) Results: In total, 31 studies were included. We estimate the prevalence of ADHD among SUD patients at 21%.

  71. 71
    top 1.2%

    Gender Differences in Coping and Psychological Adaptation during the COVID-19 Pandemic

    Rosann T. Cholankeril, Ellen Xiang, Hoda Badr

    91 citationsOpen access (CC-BY)doi:10.3390/ijerph20020993OpenAlex

    Show abstract

    This population-based study investigated gender differences in the use of coping strategies and their relationship to anxiety symptoms during the initial COVID-19 lockdown period in the United States. A national online survey was administered between 13 April 2020 and 8 June 2020. The study sample comprised 1673 respondents (66% women). Overall, 46% reported high levels of anxiety, and women experienced significantly (p < 0.001) higher levels of anxiety than men. Women were significantly (p < 0.05) more likely to use acceptance, self-distraction, positive reframing, and emotional support than men. Significant interactions between gender and coping strategies were also identified. Women engaging in high (+1SD) vs. low (−1SD) levels of active coping were not found to have significantly different anxiety levels. In contrast, men reported higher levels of anxiety when they engaged in high levels of active coping and lower levels of anxiety when they engaged in low levels of active coping (b2 = 0.88, t = 3.33, p = 0.001). Additionally, women engaging in high levels of acceptance and…

  72. 72
    top 1.2%

    Problematic Media Use among Children up to the Age of 10: A Systematic Literature Review

    Valeria Rega, Francesca Gioia, Valentina Boursier

    90 citationsOpen access (CC-BY)doi:10.3390/ijerph20105854OpenAlex

    Show abstract

    INTRODUCTION: Digital screen media use has significantly grown in all age groups and at an increasingly young age, including toddlers, schoolers, and primary school children. Although there is evidence that excessive early childhood media exposure can lead to several negative developmental outcomes, no systematic review on Problematic Media Use (PMU) of children under 10 years old have been provided. The aim of the present systematic review was to identify (i) the main instruments used to measure children's PMU across different studies; (ii) the risk and protective factors which might increase or reduce children's PMU; and (iii) the negative outcomes associated with children's PMU. METHODS: This study was conducted following the systematic review guidelines proposed in the PRISMA statement. A total of 35 studies published between 2012-2022 and with a mean sample age between 0 and 10 years old were ultimately included in this literature review. RESULTS: Use of media for more than 2 h a day, male gender, and higher age increased the risk of developing PMU among children. PMU led to…

  73. 73
    top 1.2%

    Integrated Impact of Circular Economy, Industry 4.0, and Lean Manufacturing on Sustainability Performance of Manufacturing Firms

    Ahmed M. Ghaithan, Yasser Alshammakhi, Awsan Mohammed, Khwaja Mateen Mazher

    90 citationsOpen access (CC-BY)doi:10.3390/ijerph20065119OpenAlex

    Show abstract

    In today's business environment, contributions made by the manufacturing sector to the economy and social development is evident. With a focus on long-term development, the manufacturing sector has adopted advanced operating strategies, such as lean manufacturing, industry 4.0, and green practices in an integrated manner. The integrated impact of circular economy, industry 4.0, and lean manufacturing on sustainability performance has not been adequately addressed and investigated. Therefore, the aim of this study is to investigate the integrated impact of circular economy, industry 4.0, and lean manufacturing on the sustainability performance of organizations in Saudi Arabia. Data were collected through a questionnaire-based survey as a primary data instrument. A total of 486 organizations have responded to the survey within the timeframe. Moreover, the structural equation modeling method is utilized for data analysis through SmartPLS tool for the developed hypotheses of the research. The findings highlight the positive impact of circular economy on the sustainability of the…

  74. 74
    top 1.2%

    Automatic Detection of Oral Squamous Cell Carcinoma from Histopathological Images of Oral Mucosa Using Deep Convolutional Neural Network

    Madhusmita Das, Rasmita Dash, Sambit Kumar Mishra

    90 citationsOpen access (CC-BY)doi:10.3390/ijerph20032131OpenAlex

    Show abstract

    Worldwide, oral cancer is the sixth most common type of cancer. India is in 2nd position, with the highest number of oral cancer patients. To the population of oral cancer patients, India contributes to almost one-third of the total count. Among several types of oral cancer, the most common and dominant one is oral squamous cell carcinoma (OSCC). The major reason for oral cancer is tobacco consumption, excessive alcohol consumption, unhygienic mouth condition, betel quid eating, viral infection (namely human papillomavirus), etc. The early detection of oral cancer type OSCC, in its preliminary stage, gives more chances for better treatment and proper therapy. In this paper, author proposes a convolutional neural network model, for the automatic and early detection of OSCC, and for experimental purposes, histopathological oral cancer images are considered. The proposed model is compared and analyzed with state-of-the-art deep learning models like VGG16, VGG19, Alexnet, ResNet50, ResNet101, Mobile Net and Inception Net. The proposed model achieved a cross-validation accuracy of…

  75. 75
    top 1.2%

    Food Insecurity in Higher Education: A Contemporary Review of Impacts and Explorations of Solutions

    Brittany M. Loofbourrow, Rachel Erin Scherr

    89 citationsOpen access (CC-BY)doi:10.3390/ijerph20105884OpenAlex

    Show abstract

    Food insecurity is a global phenomenon which impacts a variety of social, economic, and life-stage groups. One such group affected by food insecurity is college students, who tend to experience food insecurity at a prevalence which exceeds the average of their local communities. The impacts of food insecurity in this population are multifaceted and have implications for their college experience and beyond. Food insecurity has been observed to have negative effects on college student academic performance, physical health, and mental health. This review explores the impacts of and solutions for food insecurity in this population globally, with particular emphasis on the United States, and specifically California.

  76. 76
    top 1.2%

    The Utility of Language Models in Cardiology: A Narrative Review of the Benefits and Concerns of ChatGPT-4

    Dhir Gala, Amgad N. Makaryus

    88 citationsOpen access (CC-BY)doi:10.3390/ijerph20156438OpenAlex

    Show abstract

    Artificial intelligence (AI) and language models such as ChatGPT-4 (Generative Pretrained Transformer) have made tremendous advances recently and are rapidly transforming the landscape of medicine. Cardiology is among many of the specialties that utilize AI with the intention of improving patient care. Generative AI, with the use of its advanced machine learning algorithms, has the potential to diagnose heart disease and recommend management options suitable for the patient. This may lead to improved patient outcomes not only by recommending the best treatment plan but also by increasing physician efficiency. Language models could assist physicians with administrative tasks, allowing them to spend more time on patient care. However, there are several concerns with the use of AI and language models in the field of medicine. These technologies may not be the most up-to-date with the latest research and could provide outdated information, which may lead to an adverse event. Secondly, AI tools can be expensive, leading to increased healthcare costs and reduced accessibility to the…

  77. 77
    top 1.3%

    Promising Sources of Plant-Derived Polyunsaturated Fatty Acids: A Narrative Review

    Gianluca Rizzo, Luciana Baroni, Mauro Lombardo

    87 citationsOpen access (CC-BY)doi:10.3390/ijerph20031683OpenAlex

    Show abstract

    (1) Background: Polyunsaturated fatty acids (PUFAs) are known for their ability to protect against numerous metabolic disorders. The consumption of oily fish is the main source of PUFAs in human nutrition and is commonly used for supplement production. However, seafood is an overexploited source that cannot be guaranteed to cover the global demands. Furthermore, it is not consumed by everyone for ecological, economic, ethical, geographical and taste reasons. The growing demand for natural dietary sources of PUFAs suggests that current nutritional sources are insufficient to meet global needs, and less and less will be. Therefore, it is crucial to find sustainable sources that are acceptable to all, meeting the world population's needs. (2) Scope: This review aims to evaluate the recent evidence about alternative plant sources of essential fatty acids, focusing on long-chain omega-3 (n-3) PUFAs. (3) Method: A structured search was performed on the PubMed search engine to select available human data from interventional studies using omega-3 fatty acids of non-animal origin. (4)…

  78. 78
    top 1.3%

    Antibiotics in Dentistry: A Narrative Review of the Evidence beyond the Myth

    Maria Contaldo, Francesco D’Ambrosio, Giuseppe Andrea Ferraro, Dario Di Stasio, Maria Pia Di Palo and 2 more

    86 citationsOpen access (CC-BY)doi:10.3390/ijerph20116025OpenAlex

    Show abstract

    Antibiotics have undoubtedly revolutionized medicine and the health and survival of patients with life-threatening infections, being nonetheless free from potential adverse effects, and the risk of intestinal dysbiosis, antimicrobial resistance, and the resulting consequences for the patient's health and the public purse. The present study narratively reviewed the epidemiological data on worldwide antibiotic consumption and administration in dental practice, patients' adherence to prescriptions, the antimicrobial resistance phenomenon in dentistry, and the evidence supporting and recommending appropriate antibiotic use in dental care. Eligible systematic reviews and original studies in humans published in the English language from January 2000 to 26 January 2023 were considered. A total of 78 studies, 47 on the epidemiology of antibiotic use and prescription in dentistry, 6 on antibiotic therapy in dentistry, 12 on antibiotic prophylaxis in dentistry, 0 on adherence of dental patients to antibiotic prescription, and 13 on antimicrobial resistance in dentistry, were presently…

  79. 79
    top 1.3%

    Iron, Zinc, Copper, Cadmium, Mercury, and Bone Tissue

    Żaneta Ciosek, Karolina Kot, Iwona Rotter

    86 citationsOpen access (CC-BY)doi:10.3390/ijerph20032197OpenAlex

    Show abstract

    The paper presents the current understanding on the effects of five metals on bone tissue, namely iron, zinc, copper, cadmium, and mercury. Iron, zinc, and copper contribute significantly to human and animal metabolism when present in sufficient amounts, but their excess or shortage increases the risk of developing bone disorders. In contrast, cadmium and mercury serve no physiological purpose and their long-term accumulation damages the osteoarticular system. We discuss the methods of action and interactions between the discussed elements as well as the concentrations of each element in distinct bone structures.

  80. 80
    top 1.3%

    The Nexus between Environmental Corporate Social Responsibility, Green Intellectual Capital and Green Innovation towards Business Sustainability: An Empirical Analysis of Chinese Automobile Manufacturing Firms

    Wenjie Li, Muhammad Yaseen Bhutto, Idrees Waris, Tianyang Hu

    86 citationsOpen access (CC-BY)doi:10.3390/ijerph20031851OpenAlex

    Show abstract

    Manufacturing organizations have a pivotal role in reducing the adverse impact of global warming by adopting sustainable practices and producing environmentally-friendly products. Organizations are engaged in environmental corporate social responsibility (ECSR) and emphasize green intellectual capital (GIC), green innovative products and support for business sustainability (BUS). The current study aims to analyze the impact of organizational ECSR and GIC on green innovation (GIN) and BUS. The data for 237 participants from the manufacturing firms were analyzed via partial least square structural equation modelling (PLS-SEM). The study results revealed that ECSR and GIC are crucial for GIN and BUS. The study's findings revealed that ECSR positively and significantly impacts green relational capital (GRC) and green structural capital (GSC). However, ECSR's positive impact on green human capital (GHC) was insignificant. Further, the results of the mediation analysis show that GIN serves as a full mediator between GIC's two components, GRC and GSC and a partial mediator between GHC and…

  81. 81
    top 1.3%

    Parentification Vulnerability, Reactivity, Resilience, and Thriving: A Mixed Methods Systematic Literature Review

    Jacinda K. Dariotis, Frances R. Chen, Ye Rang Park, Montana K. Nowak, Katherine French and 1 more

    85 citationsOpen access (CC-BY)doi:10.3390/ijerph20136197OpenAlex

    Show abstract

    Parentification occurs when youth are forced to assume developmentally inappropriate parent- or adult-like roles and responsibilities. This review thoroughly examines current empirical research on parentification, its outcomes, and related mechanisms to outline patterns of findings and significant literature gaps. This review is timely in the large context of the COVID-19 pandemic, when pandemic-induced responsibilities and demands on youth, and the shifting family role may exacerbate parentification and its consequences. We used the 2020 updated Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) framework to identify 95 studies (13 qualitative, 81 quantitative, 1 mixed methods) meeting eligibility criteria. Representation from six continents highlights parentification as a global phenomenon. Using thematic analysis, we identified five themes from qualitative studies and five from quantitative studies. These were further integrated into four common themes: (1) some parentified youth experienced positive outcomes (e.g., positive coping), albeit constructs…

  82. 82
    top 1.3%

    Professional Interpreter Services and the Impact on Hospital Care Outcomes: An Integrative Review of Literature

    Michelle Ho-Wing Kwan, Zakia Jeemi, Richard Norman, Jaya A. R. Dantas

    85 citationsOpen access (CC-BY)doi:10.3390/ijerph20065165OpenAlex

    Show abstract

    Migration patterns have rapidly changed in Australia and elsewhere, which have contributed to increasingly culturally and linguistically diverse societies. This requires healthcare sectors to provide professional interpreter services for patients with a language barrier to eliminate healthcare disparities. This integrative review aimed to investigate the impact of professional interpreter services on hospital care outcomes and the associated cost of service provision. A systematic search of five databases was conducted for peer-reviewed articles from January 1996 to December 2020. Data were extracted for the hospital setting, intervention, population, study design, outcomes and key findings. Following the PRISMA guidelines, full-text screening identified 37 articles that were analysed and included. Communication quality, hospital care outcomes and hospital costs were the three main themes identified. Closing the language gap should be a primary consideration to prevent adverse events that affect patient safety and the standard of care in hospitals. The findings of this review…

  83. 83
    top 1.4%

    Importance of Soft Skills in Health Sciences Students and Their Repercussion after the COVID-19 Epidemic: Scoping Review

    David Sancho-Cantus, Laura Cubero-Plazas, Marta Botella-Navas, Elena Castellano-Rioja, Montserrat Cañabate Ros

    85 citationsOpen access (CC-BY)doi:10.3390/ijerph20064901OpenAlex

    Show abstract

    Soft skills (SKs) are skills related to the interaction among people and their way of dealing with tasks. Increasingly valued in the workplace, they are especially relevant in health professionals due to the importance of the relationship among them and their patients and families. Given their importance, the university training of healthcare professionals must promote the development of SKs. The COVID-19 pandemic has been a turning point in many areas, changing the learning process and, even more, the use of these soft skills as a fundamental ingredient in human relationships. The aim of this study was to analyse the available evidence regarding SKs in health science students, specifically nursing students, and to describe whether there is a worsening in the development of such skills after the COVID-19 pandemic. According to the PRISMA-ScR methodology for systematic reviews, this study included articles on social skills and possible changes in these skills as a consequence of the pandemic in health sciences students The results highlight the importance of these emotional…

  84. 84
    top 1.4%

    Self-Rated Health as a Predictor of Mortality in Older Adults: A Systematic Review

    Moustapha Dramé, Eléonore Cantegrit, Lidvine Godaert

    85 citationsOpen access (CC-BY)doi:10.3390/ijerph20053813OpenAlex

    Show abstract

    The aim of this study was to investigate the link between self-reported health (SRH) and mortality in older adults. In total, 505 studies were found in PubMed and Scopus, of which 26 were included in this review. In total, 6 of the 26 studies included did not find any evidence of an association between SRH and mortality. Of the 21 studies that included community dwellers, 16 found a significant relationship between SRH and mortality. In total, 17 studies involved patients with no specific medical conditions; among these, 12 found a significant link between SRH and mortality. Among the studies in adults with specific medical conditions, eight showed a significant association between SRH and mortality. Among the 20 studies that definitely included people younger than 80 years, 14 found a significant association between SRH and mortality. Of the twenty-six studies, four examined short-term mortality; seven, medium-term mortality; and eighteen, long-term mortality. Among these, a significant association between SRH and mortality was found in 3, 7, and 12 studies, respectively. This…

  85. 85
    top 1.4%

    Groundwater Quality, Health Risk Assessment, and Source Distribution of Heavy Metals Contamination around Chromite Mines: Application of GIS, Sustainable Groundwater Management, Geostatistics, PCAMLR, and PMF Receptor Model

    Abdur Rashid, Muhammad Ayub, Zahid Ullah, Asmat Ali, Tariq Sardar and 9 more

    85 citationsOpen access (CC-BY)doi:10.3390/ijerph20032113OpenAlex

    Show abstract

    Groundwater contamination by heavy metals (HMs) released by weathering and mineral dissolution of granite, gneisses, ultramafic, and basaltic rock composition causes human health concerns worldwide. This paper evaluated the heavy metals (HMs) concentrations and physicochemical variables of groundwater around enriched chromite mines of Malakand, Pakistan, with particular emphasis on water quality, hydro-geochemistry, spatial distribution, geochemical speciation, and human health impacts. To better understand the groundwater hydrogeochemical profile and HMs enrichment, groundwater samples were collected from the mining region (n = 35), non-mining region (n = 20), and chromite mines water (n = 5) and then analyzed using ICPMS (Agilent 7500 ICPMS). The ranges of concentrations in the mining, non-mining, and chromite mines water were 0.02–4.5, 0.02–2.3, and 5.8–6.0 mg/L for CR, 0.4–3.8, 0.05–3.6, and 3.2–5.8 mg/L for Ni, and 0.05–0.8, 0.05–0.8, and 0.6–1.2 mg/L for Mn. Geochemical speciation of groundwater variables such as OH−, H+, Cr+2, Cr+3, Cr+6, Ni+2, Mn+2, and Mn+3 was assessed by…

  86. 86
    top 1.4%

    Risk Factors for Stunting among Children under Five Years in the Province of East Nusa Tenggara (NTT), Indonesia

    Made Ayu Lely Suratri, Gurendro Putro, Basuki Rachmat, Nurhayati Nurhayati, Ristrini Ristrini and 5 more

    85 citationsOpen access (CC-BY)doi:10.3390/ijerph20021640OpenAlex

    Show abstract

    In East Nusa Tenggara Province, Indonesia, 42.6% of children under five had stunted growth in 2018, which affects both individual and communal levels. The first step in creating effective interventions is identifying the risk factors for stunting. This study aims to pinpoint the stunting risk factors in East Nusa Tenggara Province, Indonesia, by incorporating secondary data from the 2018 Indonesia Basic Health Research (RISKESDAS). This study implemented a cross-sectional design by utilizing the data of individuals who were successfully visited during the survey. Initial data screening in East Nusa Tenggara Province based on the criteria for children aged 0−59 months and stunting showed as many as 1643. Multivariate logistic regression analysis was performed to evaluate the relationship between children’s characteristics and stunting. There was a significant relationship between age group variables for younger children (aged 12−23, 24−35, and 36−47 months), mothers with low education, and children living in rural areas with the incidence of stunting in children (p-value < 0.05). The…

  87. 87
    top 1.4%

    The Impact of Financial Development on Renewable Energy Consumption: A Multidimensional Analysis Based on Global Panel Data

    Zhongye Sun, Xin Zhang, Yifei Gao

    84 citationsOpen access (CC-BY)doi:10.3390/ijerph20043124OpenAlex

    Show abstract

    In this paper, we examined the impact of financial development on renewable energy consumption from a global perspective based on a dynamic panel model and panel data of 103 economies. We conducted the research from the different levels of financial development using an index system including nine variables, and also explored national heterogeneity by dividing samples into developed economies and developing economies. The empirical results indicated that the financial development had a positive impact on renewable energy consumption from the macro perspective, and this effect was mainly driven by the development of a financial institution (mainly including bank). Further analysis on the depth, access, and efficiency of a financial institution and financial market (mainly including stock market and bond market) revealed that all three aspects of a financial institution had a positive influence on renewable energy consumption, while this effect only existed in the aspect of efficiency for a financial market. The investigation of national heterogeneity showed that the financial…

  88. 88
    top 1.4%

    The Role of Leadership and Digital Transformation in Higher Education Students’ Work Engagement

    Valentin Niţă, Ioana Guțu

    83 citationsOpen access (CC-BY)doi:10.3390/ijerph20065124OpenAlex

    Show abstract

    Teaching and learning processes should be subject to continuous change due to the constant evolution of social, educational and technological environments, which ultimately results in higher levels of student engagement. The current paper describes the technological changes faced by higher education institutions as a result of digital transformation challenges. Further, transformational and transactional leadership styles' effectiveness is regarded within the context of higher education institutions' digital enhancements. Over time, these factors have led to contextual shifts that have disengaged students from learning and thus self-development. The current research aimed to examine how higher education institutions should apply different leadership styles within digitally transformed contexts so as to increase students' learning engagement and reduce the risk of failure in their future developments within (inter)national labor markets. Data gathering and analysis involved a qualitative approach: an online survey was distributed, resulting in 856 responses. Through structural…

  89. 89
    top 1.4%

    Plant Based Diet and Its Effect on Cardiovascular Disease

    Salman Salehin, Peter Rasmussen, steven mai, Muhammad Mushtaq, Mayank Agarwal and 5 more

    83 citationsOpen access (CC-BY)doi:10.3390/ijerph20043337OpenAlex

    Show abstract

    Cardiovascular disease remains the leading cause of death globally and here in the United States. Diet has a major impact on the pathogenesis of atherosclerosis and subsequent cardiovascular morbidity and mortality. An unhealthy diet is the most significant potential behavioral and modifiable risk factor for ischemic heart disease. Despite these established facts, dietary interventions are far less frequent than pharmaceutical and procedural interventions in the management of cardiovascular disease. The beneficial effects of a plant-based diet on cardiovascular morbidity and mortality have been demonstrated in a number of recent clinical studies. The significant findings of each study are discussed in this review article, highlighting the role of a healthy plant-based diet in improving cardiovascular outcomes. From a clinician's standpoint, the knowledge and understanding of the facts and data points from these recent clinical studies would ensure more effective patient counseling on the substantial benefits of dietary interventions.

  90. 90
    top 1.5%

    Cooling Effect of Urban Blue and Green Spaces: A Case Study of Changsha, China

    Xinyi Qiu, Sung–Ho Kil, Hyun-Kil Jo, Chan Park, Wonkyong Song and 1 more

    83 citationsOpen access (CC-BY)doi:10.3390/ijerph20032613OpenAlex

    Show abstract

    The cooling effects of blue-green spaces on the urban heat island effect are complex and different. The purpose of this study is to simulate how the cooling effect of blue-green space changes with its size and shape. The cooling effects of 53 green patches and 28 water bodies in Changsha were extracted based on Landsat images. A surface fitting model was used to quantitatively reveal the relationship between the cooling effect of blue-green space and its size and shape. The results show that the cooling effects of blue-green spaces were enhanced with the increasing size, and then would become stable after a certain range (threshold). Certain thresholds were identified between the blue and green space areas (2.98 ha and 3.15 ha, respectively) and the cooling distance, and between the blue and green space areas (4.84 ha and 4.92 ha, respectively) and the cooling magnitude. In addition, the green space with an area of 9.08 ha and landscape shape index (LSI) of 2.97 could achieve a better cooling distance (413.46 m); and the blue space with an area of 29.4 ha and LSI of 1.75 could…

  91. 91
    top 1.5%

    Slow Sand Filters for the 21st Century: A Review

    Jonah K Maiyo, Sruthi Dasika, Chad T. Jafvert

    83 citationsOpen access (CC-BY)doi:10.3390/ijerph20021019OpenAlex

    Show abstract

    Safe drinking water remains a major global challenge, especially in rural areas where, according to UNICEF, 80% of those without access to improved water systems reside. While water, sanitation, and hygiene (WASH)-related diseases and deaths are common outcomes of unsafe water, there is also an economic burden associated with unsafe water. These burdens are most prominent in rural areas in less-developed nations. Slow sand filters (SSFs), or biological sand filters (BSFs), are ideal water treatment solutions for these low-resource regions. SSFs are the oldest municipal drinking water treatment systems and improve water quality by removing suspended particles, dissolved organic chemicals, and other contaminants, effectively reducing turbidity and associated taste and odor problems. The removal of turbidity and dissolved organic compounds from the water enables the use of low-cost disinfection methods, such as chlorination. While the working principles of slow sand filtration have remained the same for over two centuries, the design, sizes, and application of slow sand filters have…

  92. 92
    top 1.5%

    Meaningful Work, Happiness at Work, and Turnover Intentions

    Humberto Charles‐Leija, Carlos G. Castro, Mario Toledo, Rosalinda Ballesteros-Valdés

    82 citationsOpen access (CC-BY)doi:10.3390/ijerph20043565OpenAlex

    Show abstract

    It has been documented that there is a positive relationship between a worker's subjective well-being and productivity, and individuals who are happy in their work have a better attitude when performing activities: happier employees are more productive. Turnover intention, on the other hand, may arise from various factors rather than merely the need to increase a salary, as the traditional economic theory states. The fact that the work performed does not contribute to the worker's life purpose, that there might be a bad relationship with colleagues, or else might play a role in the search for a new job. This study aims to show the relevance of meaningful work in happiness at work and turnover intention. Data from 937 professionals, in 2019, in Mexico were analyzed. Regression analyses were used to assess the impact of meaningful work on happiness at work and turnover intention. Results show that meaningful work, feeling appreciated by coworkers, and enjoyment of daily tasks significantly predict happiness at work. A logit model showed that having a job that contributes to people's…

  93. 93
    top 1.5%

    The Association of Social Support and Loneliness with Symptoms of Depression, Anxiety, and Posttraumatic Stress during the COVID-19 Pandemic: A Meta-Analysis

    Aina Gabarrell‐Pascuet, Helena García‐Mieres, Iago Giné-Vázquez, María Victoria Moneta, Ai Koyanagi and 2 more

    82 citationsOpen access (CC-BY)doi:10.3390/ijerph20042765OpenAlex

    Show abstract

    BACKGROUND: Research suggests that changes in social support and loneliness have affected mental disorder symptoms during the COVID-19 pandemic. However, there are a lack of studies comparing the robustness of these associations. AIMS: The aims were to estimate the strength of the associations of loneliness and social support with symptoms of depression, anxiety, and posttraumatic stress during the COVID-19 pandemic (2020-2022) in the general population. METHOD: The method entailed a systematic review and random-effects meta-analysis of quantitative studies. RESULTS: Seventy-three studies were included in the meta-analysis. The pooled correlations of the effect size of the association of loneliness with symptoms of depression, anxiety, and posttraumatic stress were 0.49, 0.40, and 0.38, respectively. The corresponding figures for social support were 0.29, 0.19, and 0.18, respectively. Subgroup analyses revealed that the strength of some associations could be influenced by the sociodemographic characteristics of the study samples, such as age, gender, region, and COVID-19 stringency…

  94. 94
    top 1.5%

    Quality of Life in Caregivers of Cancer Patients: A Literature Review

    María Dolores Guerra-Martín, María Del Rocío Casado-Espinosa, Yelena Gavira-López, Cristina Holgado-Castro, Inmaculada López-Latorre and 1 more

    82 citationsOpen access (CC-BY)doi:10.3390/ijerph20021570OpenAlex

    Show abstract

    (1) Background: Cancer constitutes one of the principal causes of morbi-mortality in the world and generates an important loss of patients' self-sufficiency. People who are their caregivers usually become the main care providers, which impacts their quality of life; (2) Aim: Analyze the different problems (physical, emotional, social, and financial) faced by people who are caregivers of adults with cancer and describe the strategies required to improve their quality of life; (3) Method: A literature review was conducted on the following database: PubMed, Cinahl, PsycINFO, and Scopus. The following eligibility criteria were specified: (a) research studies of quantitative, qualitative, or mixed methods, (b) consistent with objective, and (c) published in the English language or Spanish during the last five years; (4) Results: 36 studies were selected from those found in the literature. Regarding the problems mentioned: eight studies described physical issues, 26 emotional effects, 10 social implications, and seven financial strains. Twenty-eight studies described strategies to improve…

  95. 95
    top 1.5%

    Transformational Leadership, Employee Engagement, Job Satisfaction, and Psychological Well-Being among Hotel Employees after the Height of the COVID-19 Pandemic: A Serial Mediation Model

    Magdy Sayed Ahmed Abolnasser, Ahmed Hassan Abdou, Thowayeb H. Hassan, Amany E. Salem

    81 citationsOpen access (CC-BY)doi:10.3390/ijerph20043609OpenAlex

    Show abstract

    Over the past few years, great attention has been given to the impacts of the COVID-19 pandemic and its consequences on employee psychological well-being (PWB), particularly in the hospitality industry. Like many aspects of human life, employee PWB is influenced by multiple factors. One of the factors that may affect employee PWB is transformational leadership (TLS). Accordingly, we aim through this study to empirically (1) examine the direct effect of transformational leadership on employee PWB and (2) investigate the potential independent and serial mediation effects of employee engagement (EEG) and job satisfaction (JS) on the TLS-PWB relationship after the height of the COVID-19 pandemic. Data were gathered using an online questionnaire from a convenience sample of 403 front-line employees from five-star hotels in Saudi Arabia. The partial least squares structural equation modeling (PLS-SEM) with the bootstrapping technique was utilized to test the study hypotheses. Based on the demands-resources (JD-R) theory, the findings of this study reveal a significant positive effect of…

  96. 96
    top 1.6%

    Physical Demands during Official Competitions in Elite Handball: A Systematic Review

    Carlos García-Sánchez, Rafael Manuel Navarro, Claude Karcher, Alfonso de la Rubia

    81 citationsOpen access (CC-BY)doi:10.3390/ijerph20043353OpenAlex

    Show abstract

    An understanding of physical demands during official competitions is essential to achieving the highest performance in handball. The aim of this systematic review was to summarise the available scientific evidence associated with physical demands during official competitions in elite handball according to playing positions, competition level and gender. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 17 studies were selected after a systematic search and selection process of three digital databases: PubMed, Web of Science and Sport Discus. The quality of the selected studies was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology checklist; the average score was 18.47 points. The sample consisted of 1175 handball players, of whom 1042 were men (88.68%) and 133 were women (11.32%). The results show that an elite handball player covered on average 3664.4 ± 1121.6 m during a match. The average running pace was 84.8 ± 17.2 m∙min−1. The total distance covered was largely greater in national competitions…

  97. 97
    top 1.6%

    The Relationship between Social Media and the Increase in Mental Health Problems

    Hasan Beyari

    81 citationsOpen access (CC-BY)doi:10.3390/ijerph20032383OpenAlex

    Show abstract

    Social media has become an indispensable aspect of young people's digital interactions, as they use it mostly for entertainment and communication purposes. Consequently, it has the potential to have both positive and negative effects on them. Deterioration in mental health is one of the side effects stemming from social media overuse. This study investigates the relationship between social media and the increase in mental health problems in Saudi Arabia. The population considered for analysis includes young people from Saudi Arabia, with a sample size of 385. A closed-ended survey questionnaire was used to collect data on different social media features and criteria. Using the Analytical Hierarchical Process (AHP), the researcher analyzed data to compare the effect of different social media features on mental health. The social media features included in this paper are private chats and calls, group chats and calls, browsing posts, games, media sharing, adverts, likes/comments/followers, and pages. The researcher adopted entertainment, information, social interaction, privacy,…

  98. 98
    top 1.6%

    Impact of 3D Printing on the Overall Project Success of Residential Construction Projects Using Structural Equation Modelling

    Ahsan Waqar, Idris Othman, Juan Carlos Pomares Torres

    80 citationsOpen access (CC-BY)doi:10.3390/ijerph20053800OpenAlex

    Show abstract

    After a decade of research and development, 3D printing is now an established technique in the construction sector, complete with its own set of accepted standards. The use of 3D printing in construction might potentially improve the outcome of the project as a whole. However, traditional strategies are often used in the residential construction industry in Malaysia, which causes serious public safety and health issues along with a negative impact on the environment. In the context of project management, overall project success (OPS) has five dimensions, such as cost, time, quality, safety, and environment. Understanding the role of 3D printing in relation to OPS dimensions in Malaysian residential construction projects would allow construction professionals to adopt 3D printing more easily. The aim of the study was to find the impact of 3D construction printing on OPS while considering the implications for all five dimensions. Fifteen professionals were interviewed to first evaluate and summarise the impact factors of 3D printing using the current literature. Then, a pilot survey…

  99. 99
    top 1.6%

    Immunomodulatory Effects of SGLT2 Inhibitors—Targeting Inflammation and Oxidative Stress in Aging

    Ema Schönberger, Vjera Mihaljević, Kristina Steiner, Sandra Šarić, Tomislav Kurevija and 3 more

    79 citationsOpen access (CC-BY)doi:10.3390/ijerph20176671OpenAlex

    Show abstract

    Given that the increase in the aging population has grown into one of the largest public health issues, inflammation and oxidative stress, which are closely associated with the aging process, became a focus of recent research. Sodium-glucose co-transporter 2 (SGLT2) inhibitors, a group of drugs initially developed as oral antidiabetics, have shown many beneficial effects over time, including improvement in renal function and cardioprotective effects. It has been shown that SGLT2 inhibitors, as a drug class, have an immunomodulatory and antioxidative effect, affecting endothelial function as well as metabolic parameters. Therefore, it is not surprising that various studies have investigated the potential mechanisms of action of SGLT2 inhibitors in age-related diseases. The proposed mechanisms by which SGLT2 inhibitors can achieve their anti-inflammatory effects include influence on AMPK/SIRT1/PGC-1α signaling, various cytokines, and the NLRP3 inflammasome. The antioxidative effect is related to their action on mitochondria and their influence on the signaling pathways of transforming…

  100. 100
    top 1.6%

    Physician’s Burnout during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

    Abdulmajeed A. Alkhamees, Moath Aljohani, Simindokht Kalani, Amira Mohammed Ali, Fahad Abdullah Almatham and 3 more

    79 citationsOpen access (CC-BY)doi:10.3390/ijerph20054598OpenAlex

    Show abstract

    The burnout rate among physicians is expected to be higher during COVID-19 period due to the additional sources of physical and emotional stressors. Throughout the current COVID-19 pandemic, numerous studies have evaluated the impacts of COVID-19 on physicians' burnout, but the reported results have been inconsistent. This current systematic review and meta-analysis aims to assess and estimate the epidemiology of burnout and the associated risk factors during the COVID-19 pandemic among physicians. A systematic search for studies targeting physicians' burnout was conducted using PubMed, Scopus, ProQuest, Cochrane COVID-19 registry, and pre-print services (PsyArXiv and medRχiv) for English language studies published within the time period of 1 January 2020 to 1 September 2021. Search strategies resulted in 446 possible eligible studies. The titles and abstracts of these studies were screened, which resulted in 34 probable studies for inclusion, while 412 studies were excluded based on the predetermined inclusion criteria. These 34 studies went through a full-text screening for…

How to read this list

The cohort is every article, review and book chapter OpenAlex attributes to International Journal of Environmental Research and Public Health with publication year 2023, 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.

Other journals, same idea

Work with these 25 papers in Kahubi

  • The papers land in your library with their DOIs
  • Ask anything across all of them, with citations
  • Draft a literature review from the same sources

Free plan, no card. Your files stay private unless you share them.

Reading several of these?

Kahubi reads papers with you, keeps every citation traceable and drafts with sources you can check. Free plan, no card.