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Int. J. Environ. Res. Public Health, Volume 10, Issue 8 (August 2013), Pages 3089-3800

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Open AccessArticle Healthier Lives for European Minority Groups: School and Health Care, Lessons from the Roma
Int. J. Environ. Res. Public Health 2013, 10(8), 3089-3111; doi:10.3390/ijerph10083089
Received: 3 June 2013 / Revised: 12 July 2013 / Accepted: 16 July 2013 / Published: 24 July 2013
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Abstract
On average, the Roma in Europe can expect to die 10 years earlier than the rest of the population, given the health conditions they experience. EU-funded research has informed on successful actions (SA) that when implemented among the Roma provide them new forms
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On average, the Roma in Europe can expect to die 10 years earlier than the rest of the population, given the health conditions they experience. EU-funded research has informed on successful actions (SA) that when implemented among the Roma provide them new forms of educational participation which have a direct impact on improving their health status, regardless of their educational level. The findings from this research, unanimously endorsed by the European Parliament, have been included in several European Union recommendations and resolutions as part of the EU strategy on Roma inclusion. To analyze these SA, as well as the conditions that promote them and their impact on reducing health inequalities, communicative fieldwork has been conducted with Roma people from a deprived neighbourhood in the South of Spain, who are participating in the previously identified SA. The analysis reveals that these SA enable Roma people to reinforce and enrich specific strategies like improving family cohesion and strengthening their identity, which allow them to improve their overall health. These findings may inform public policies to improve the health condition of the Roma and other vulnerable groups, one goal of the Europe 2020 strategy for a healthier Europe. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessArticle Use of Competition ELISA for Monitoring of West Nile Virus Infections in Horses in Germany
Int. J. Environ. Res. Public Health 2013, 10(8), 3112-3120; doi:10.3390/ijerph10083112
Received: 14 June 2013 / Revised: 12 July 2013 / Accepted: 15 July 2013 / Published: 24 July 2013
Cited by 9 | PDF Full-text (246 KB) | HTML Full-text | XML Full-text
Abstract
West Nile virus (WNV) is a mosquito-borne viral pathogen of global importance and is considered to be the most widespread flavivirus in the World. Horses, as dead-end hosts, can be infected by bridge mosquito vectors and undergo either subclinical infections or develop severe
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West Nile virus (WNV) is a mosquito-borne viral pathogen of global importance and is considered to be the most widespread flavivirus in the World. Horses, as dead-end hosts, can be infected by bridge mosquito vectors and undergo either subclinical infections or develop severe neurological diseases. The aim of this study was to detect WNV specific antibodies in horses in Germany as an indicator for an endemic circulation of WNV. Sera from more than 5,000 horses (primarily fallen stock animals) were collected in eight different federal states of Germany from 2010 to 2012. Sera were screened by a competitive ELISA and positive reactions were verified by an indirect IgM ELISA and/or by virus neutralization tests (VNT) for WNV and Tick-borne encephalitis virus (TBEV) in order to exclude cross-reacting antibody reactions. In essence WNV specific antibodies could not be detected in any of the horse sera. Not surprisingly, a small number of sera contained antibodies against TBEV. It is noteworthy that equine sera were often collected from horse carcasses and therefore were of poor quality. Nonetheless, these sera were still suitable for WNV ELISA testing, i.e., they did not produce a high background reaction which is a frequently observed phenomenon. According to these data there is no evidence for indigenous WNV infections in horses in Germany at present. Full article
(This article belongs to the Special Issue Epidemiology of West Nile Virus)
Open AccessArticle Workplace Bullying among Healthcare Workers
Int. J. Environ. Res. Public Health 2013, 10(8), 3121-3139; doi:10.3390/ijerph10083121
Received: 6 May 2013 / Revised: 28 June 2013 / Accepted: 16 July 2013 / Published: 24 July 2013
Cited by 11 | PDF Full-text (249 KB) | HTML Full-text | XML Full-text
Abstract
This paper aims to assess consistent predictors through the use of a sample that includes different actors from the healthcare work force to identify certain key elements in a set of job-related organizational contexts. The utilized data were obtained from the 5th European
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This paper aims to assess consistent predictors through the use of a sample that includes different actors from the healthcare work force to identify certain key elements in a set of job-related organizational contexts. The utilized data were obtained from the 5th European Working Conditions Survey, conducted in 2010 by the European Foundation for the Improvement of Living and Working Conditions. In light of these objectives, we collected a subsample of 284 health professionals, some of them from the International Standard Classification of Occupations—subgroup 22—(ISCO-08). The results indicated that the chance of a healthcare worker referring to him/herself as bullied increases among those who work on a shift schedule, perform monotonous and rotating tasks, suffer from work stress, enjoy little satisfaction from their working conditions, and do not perceive opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes within the usual course of events that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist human resource managers in facilitating, to some extent, good social relationships among healthcare workers. Full article
(This article belongs to the Special Issue Job Stress and Health)
Open AccessArticle Study of Environmental Health Problems in Korea Using Integrated Environmental Health Indicators
Int. J. Environ. Res. Public Health 2013, 10(8), 3140-3156; doi:10.3390/ijerph10083140
Received: 29 May 2013 / Revised: 10 July 2013 / Accepted: 15 July 2013 / Published: 25 July 2013
Cited by 2 | PDF Full-text (965 KB) | HTML Full-text | XML Full-text
Abstract
We have investigated the usefulness of environmental health indicators for the evaluation of environmental health in Korea. We also assessed the association between environmental contamination and health outcomes by integrating indicators into a composite measure. We selected health-related environmental indicators and environment-related health
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We have investigated the usefulness of environmental health indicators for the evaluation of environmental health in Korea. We also assessed the association between environmental contamination and health outcomes by integrating indicators into a composite measure. We selected health-related environmental indicators and environment-related health status indicators. The data were obtained from published statistical data from the period 2008–2009. Both synthesized measures of environmental indicators and health status indicators were calculated using Strahll’s taxonometric methods. The range of values determined by this method is 0–1, with higher values representing a better situation in the given area. The study area consisted of 16 large administrative areas within Korea. The arithmetic mean of the synthesized measure of environmental indicators was 0.348 (SD = 0.151), and that of the synthesized measure of health status indicators was 0.708 (SD = 0.107). The correlation coefficient between the synthesized measures of environmental indicators and health status indicators was 0.69 (95% CI: 0.28–0.88). Comparisons between local communities based on integrated indicators may provide useful information for decision-makers, allowing them to identify priorities in pollutant mitigation policies or in improvement actions for public health. Integrated indicators are also useful to describe the relationships between environmental contamination and health effects. Full article
Open AccessArticle Developing a Semi-Quantitative Occupational Risk Prediction Model for Chemical Exposures and Its Application to a National Chemical Exposure Databank
Int. J. Environ. Res. Public Health 2013, 10(8), 3157-3171; doi:10.3390/ijerph10083157
Received: 13 June 2013 / Revised: 22 July 2013 / Accepted: 22 July 2013 / Published: 25 July 2013
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Abstract
In this study, a semi-quantitative occupational chemical exposure risk prediction model, based on the calculation of exposure hazard indexes, was proposed, corrected, and applied to a national chemical exposure databank. The model comprises one factor used to describe toxicity (i.e., the
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In this study, a semi-quantitative occupational chemical exposure risk prediction model, based on the calculation of exposure hazard indexes, was proposed, corrected, and applied to a national chemical exposure databank. The model comprises one factor used to describe toxicity (i.e., the toxicity index), and two factors used to reflect the exposure potential (i.e., the exposure index and protection deficiency index) of workers exposed to chemicals. An expert system was used to correct the above proposed model. By applying the corrected model to data obtained from a national occupational chemical hazard survey program, chemical exposure risks of various manufacturing industries were determined and a national control strategy for the abatement of occupational chemical exposures was proposed. The results of the present study would provide useful information for governmental agencies to allocate their limited resources effectively for reducing chemical exposures of workers. Full article
(This article belongs to the Special Issue Occupational Health)
Open AccessArticle Linking Climate to Incidence of Zoonotic Cutaneous Leishmaniasis (L. major) in Pre-Saharan North Africa
Int. J. Environ. Res. Public Health 2013, 10(8), 3172-3191; doi:10.3390/ijerph10083172
Received: 3 May 2013 / Revised: 12 July 2013 / Accepted: 13 July 2013 / Published: 31 July 2013
Cited by 11 | PDF Full-text (550 KB) | HTML Full-text | XML Full-text
Abstract
Shifts in surface climate may have changed the dynamic of zoonotic cutaneous leishmaniasis (ZCL) in the pre-Saharan zones of North Africa. Caused by Leishmania major, this form multiplies in the body of rodents serving as reservoirs of the disease. The parasite is
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Shifts in surface climate may have changed the dynamic of zoonotic cutaneous leishmaniasis (ZCL) in the pre-Saharan zones of North Africa. Caused by Leishmania major, this form multiplies in the body of rodents serving as reservoirs of the disease. The parasite is then transmitted to human hosts by the bite of a Phlebotomine sand fly (Diptera: Psychodidae) that was previously fed by biting an infected reservoir. We examine the seasonal and interannual dynamics of the incidence of this ZCL as a function of surface climate indicators in two regions covering a large area of the semi-arid Pre-Saharan North Africa. Results suggest that in this area, changes in climate may have initiated a trophic cascade that resulted in an increase in ZCL incidence. We find the correlation between the rainy season precipitation and the same year Normalized Difference Vegetation Index (NDVI) to be strong for both regions while the number of cases of ZCL incidence lags the precipitation and NDVI by 2 years. The zoonotic cutaneous leishmaniasis seasonal dynamic appears to be controlled by minimum temperatures and presents a 2-month lag between the reported infection date and the presumed date when the infection actually occurred. The decadal increase in the number of ZCL occurrence in the region suggests that changes in climate increased minimum temperatures sufficiently and created conditions suitable for endemicity that did not previously exist. We also find that temperatures above a critical range suppress ZCL incidence by limiting the vector’s reproductive activity. Full article
Open AccessArticle Using Undergraduate Researchers to Build Vector and West Nile Virus Surveillance Capacity
Int. J. Environ. Res. Public Health 2013, 10(8), 3192-3202; doi:10.3390/ijerph10083192
Received: 28 May 2013 / Revised: 23 July 2013 / Accepted: 25 July 2013 / Published: 31 July 2013
Cited by 1 | PDF Full-text (300 KB) | HTML Full-text | XML Full-text
Abstract
Vector surveillance for infectious diseases is labor intensive and constantly threatened by budget decisions. We report on outcomes of an undergraduate research experience designed to build surveillance capacity for West Nile Virus (WNV) in Montana (USA). Students maintained weekly trapping stations for mosquitoes
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Vector surveillance for infectious diseases is labor intensive and constantly threatened by budget decisions. We report on outcomes of an undergraduate research experience designed to build surveillance capacity for West Nile Virus (WNV) in Montana (USA). Students maintained weekly trapping stations for mosquitoes and implemented assays to test for WNV in pools of Culex tarsalis. Test results were verified in a partnership with the state health laboratory and disseminated to the ArboNET Surveillance System. Combined with prior surveillance data, Cx. tarsalis accounted for 12% of mosquitoes with a mean capture rate of 74 (±SD = 118) Cx. tarsalis females per trap and a minimum infection rate of 0.3 infected mosquitoes per 1000 individuals. However, capture and infection rates varied greatly across years and locations. Infection rate, but not capture rate, was positively associated with the number of WNV human cases (Spearman’s rho = 0.94, p < 0.001). In most years, detection of the first positive mosquito pool occurred at least a week prior to the first reported human case. We suggest that undergraduate research can increase vector surveillance capacity while providing effective learning opportunities for students. Full article
(This article belongs to the Special Issue Epidemiology of West Nile Virus)
Open AccessArticle Sun Protection Preferences and Behaviors among Young Adult Males during Maximum Ultraviolet Radiation Exposure Activities
Int. J. Environ. Res. Public Health 2013, 10(8), 3203-3216; doi:10.3390/ijerph10083203
Received: 30 April 2013 / Revised: 22 July 2013 / Accepted: 22 July 2013 / Published: 31 July 2013
Cited by 4 | PDF Full-text (206 KB) | HTML Full-text | XML Full-text
Abstract
This study explores sun protection attitudes, preferences, and behaviors among young adult males participating in an open-field activity with extreme ultraviolet radiation exposure. Male drum corps members (n = 137) responded to survey questions regarding their behavior and willingness to engage in
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This study explores sun protection attitudes, preferences, and behaviors among young adult males participating in an open-field activity with extreme ultraviolet radiation exposure. Male drum corps members (n = 137) responded to survey questions regarding their behavior and willingness to engage in sun protection and barriers to sunscreen usage. A subset of members (n = 31) participated in cognitive interviews exploring various sunscreen products and intervention techniques. Participants were knowledgeable about health risks and protection benefits regarding sun exposure. Generally, males had positive attitudes and normative beliefs about using sunscreen. A barrier to sunscreen re-application was lack of adequate time to reapply sunscreen during the open field activity. Males preferred a towelette application method, but were unfamiliar with its efficacy and proper use. Thus, they were more likely to use the more familiar sunscreen spray. To increase sun protection behaviors and lower skin cancer risk for males participating in open-field activities, breaks must be allotted every 2 h and have sufficient time to allow sunscreen application. Future development and research into delivery systems that rapidly and evenly apply sunscreen may help lower exposure in this population. Full article
Open AccessArticle Investigating Social Ecological Contributors to Diabetes within Hispanics in an Underserved U.S.-Mexico Border Community
Int. J. Environ. Res. Public Health 2013, 10(8), 3217-3232; doi:10.3390/ijerph10083217
Received: 18 June 2013 / Revised: 22 July 2013 / Accepted: 23 July 2013 / Published: 31 July 2013
Cited by 1 | PDF Full-text (334 KB) | HTML Full-text | XML Full-text
Abstract
Hispanics bear a disproportionate burden of diabetes in the United States, yet relations of structural, socio-cultural and behavioral factors linked to diabetes are not fully understood across all of their communities. The current study examines disparities and factors associated with diabetes in adult
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Hispanics bear a disproportionate burden of diabetes in the United States, yet relations of structural, socio-cultural and behavioral factors linked to diabetes are not fully understood across all of their communities. The current study examines disparities and factors associated with diabetes in adult Hispanics of Mexican-descent (N = 648) participating in a population survey of an underserved rural U.S.-Mexico border community. The overall rate of diabetes prevalence rate in the sample, based on self-report and a glucose testing, was 21%; much higher than rates reported for U.S. adults overall, for all Hispanic adults, or for Mexican American adults specifically. Acculturation markers and social determinants of health indicators were only significantly related to diabetes in models not accounting for age. Older age, greater BMI (>30), greater waist-to-hip ratio as well as lower fruit and vegetable consumption were significantly related to increased likelihood of diabetes when all structural, cultural, behavioral, and biological factors were considered. Models with sets of behavioral factors and biological factors each significantly improved explanation of diabetes relative to prior social ecological theory-guided models. The findings show a critical need for diabetes prevention efforts in this community and suggest that health promotion efforts should particularly focus on increasing fruit and vegetable consumption. Full article
Open AccessArticle Hypothyroxinemia Induced by Mild Iodine Deficiency Deregulats Thyroid Proteins during Gestation and Lactation in Dams
Int. J. Environ. Res. Public Health 2013, 10(8), 3233-3245; doi:10.3390/ijerph10083233
Received: 21 June 2013 / Revised: 24 July 2013 / Accepted: 26 July 2013 / Published: 2 August 2013
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Abstract
The main object of the present study was to explore the effect on thyroidal proteins following mild iodine deficiency (ID)-induced maternal hypothyroxinemia during pregnancy and lactation. In the present study, we established a maternal hypothyroxinemia model in female Wistar rats by using a
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The main object of the present study was to explore the effect on thyroidal proteins following mild iodine deficiency (ID)-induced maternal hypothyroxinemia during pregnancy and lactation. In the present study, we established a maternal hypothyroxinemia model in female Wistar rats by using a mild ID diet. Maternal thyroid iodine content and thyroid weight were measured. Expressions of thyroid-associated proteins were analyzed. The results showed that the mild ID diet increased thyroid weight, decreased thyroid iodine content and increased expressions of thyroid transcription factor 1, paired box gene 8 and Na+/I symporter on gestational day (GD) 19 and postpartum days (PN) 21 in the maternal thyroid. Moreover, the up-regulated expressions of type 1 iodothyronine deiodinase (DIO1) and type 2 iodothyronine deiodinase (DIO2) were detected in the mild ID group on GD19 and PN21. Taken together, our data indicates that during pregnancy and lactation, a maternal mild ID could induce hypothyroxinemia and increase the thyroidal DIO1 and DIO2 levels. Full article
Open AccessArticle A Seamless Ubiquitous Telehealthcare Tunnel
Int. J. Environ. Res. Public Health 2013, 10(8), 3246-3262; doi:10.3390/ijerph10083246
Received: 20 June 2013 / Revised: 22 July 2013 / Accepted: 24 July 2013 / Published: 2 August 2013
Cited by 2 | PDF Full-text (631 KB) | HTML Full-text | XML Full-text
Abstract
Mobile handheld devices are rapidly using to implement healthcare services around the World. Fundamentally, these services utilize telemedicine technologies. A disconnection of a mobile telemedicine system usually results in an interruption, which is embarrassing, and reconnection is necessary during the communication session. In
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Mobile handheld devices are rapidly using to implement healthcare services around the World. Fundamentally, these services utilize telemedicine technologies. A disconnection of a mobile telemedicine system usually results in an interruption, which is embarrassing, and reconnection is necessary during the communication session. In this study, the Stream Control Transmission Protocol (SCTP) is adopted to build a stable session tunnel to guarantee seamless switching among heterogeneous wireless communication standards, such as Wi-Fi and 3G. This arrangement means that the telemedicine devices will not be limited by a fixed wireless connection and can switch to a better wireless channel if necessary. The tunnel can transmit plain text, binary data, and video streams. According to the evaluation of the proposed software-based SCTP-Tunnel middleware shown, the performance is lower than anticipated and is slightly slower than a fixed connection. However, the transmission throughput is still acceptable for healthcare professionals in a healthcare enterprise or home care site. It is necessary to build more heterogeneous wireless protocols into the proposed tunnel-switching scheme to support all possible communication protocols. In addition, SCTP is another good choice for promoting communication in telemedicine and healthcare fields. Full article
(This article belongs to the Special Issue Advances in Telehealthcare)
Open AccessArticle Risk of Spina Bifida and Maternal Cigarette, Alcohol, and Coffee Use during the First Month of Pregnancy
Int. J. Environ. Res. Public Health 2013, 10(8), 3263-3281; doi:10.3390/ijerph10083263
Received: 19 June 2013 / Revised: 23 July 2013 / Accepted: 24 July 2013 / Published: 2 August 2013
Cited by 5 | PDF Full-text (708 KB) | HTML Full-text | XML Full-text
Abstract
This study was conducted to assess the association between the risks of spina bifida (SB) in relation to cigarette, alcohol, and caffeine consumption by women during the first month of pregnancy. Between 1988–2012, this multi-center case-control study interviewed mothers of 776 SB cases
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This study was conducted to assess the association between the risks of spina bifida (SB) in relation to cigarette, alcohol, and caffeine consumption by women during the first month of pregnancy. Between 1988–2012, this multi-center case-control study interviewed mothers of 776 SB cases and 8,756 controls about pregnancy events and exposures. We evaluated cigarette smoking, frequency of alcohol drinking, and caffeine intake during the first lunar month of pregnancy in relation to SB risk. Logistic regression models were used to calculate adjusted odds ratios and 95% confidence intervals. Levels of cigarette smoking (1–9 and ≥10/day), alcohol intake (average ≥4 drinks/day) and caffeine intake (<1, 1, and ≥2 cups/day) were not likely to be associated with increased risk of SB. Further, results were similar among women who ingested less than the recommended amount of folic acid (400 μg/day). Full article
(This article belongs to the Special Issue Birth Defect Prevention)
Open AccessArticle Antimicrobial Activity of a Neem Cake Extract in a Broth Model Meat System
Int. J. Environ. Res. Public Health 2013, 10(8), 3282-3295; doi:10.3390/ijerph10083282
Received: 29 March 2013 / Revised: 10 July 2013 / Accepted: 23 July 2013 / Published: 2 August 2013
Cited by 9 | PDF Full-text (328 KB) | HTML Full-text | XML Full-text
Abstract
This work reports on the antimicrobial activity of an ethyl acetate extract of neem (Azadirachta indica) cake (NCE) against bacteria affecting the quality of retail fresh meat in a broth model meat system. NCE (100 µg) was also tested by the
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This work reports on the antimicrobial activity of an ethyl acetate extract of neem (Azadirachta indica) cake (NCE) against bacteria affecting the quality of retail fresh meat in a broth model meat system. NCE (100 µg) was also tested by the agar disc diffusion method. It inhibited the growth of all tested microorganisms. The NCE growth inhibition zone (IZ) ranged 11.33–22.67 mm while the ciprofloxacin (10 µg) IZ ranged from 23.41–32.67 mm. There was no significant difference (p ≤ 0.05) between the antimicrobial activity of NCE and ciprofloxacin vs. C. jejuni and Leuconostoc spp. The NCE antibacterial activity was moreover determined at lower concentrations (1:10–1:100,000) in micro-assays. The percent growth reduction ranged from 61 ± 2.08–92 ± 3.21. The higher bacterial growth reduction was obtained at 10 µg concentration of NCE. Species-specific PCR and multiplex PCR with the DNA dye propidium monoazide were used to directly detect viable bacterial cells from experimentally contaminated meat samples. The numbers of bacterial cells never significantly (p ≤ 0.05) exceeded the inocula concentration used to experimentally contaminate the NCE treated meat. This report represents a screening methodology to evaluate the antimicrobial capability of a herbal extract to preserve meat. Full article
(This article belongs to the Special Issue Food Safety and Public Health)
Open AccessArticle An Assessment of Food Safety Needs of Restaurants in Owerri, Imo State, Nigeria
Int. J. Environ. Res. Public Health 2013, 10(8), 3296-3309; doi:10.3390/ijerph10083296
Received: 18 June 2013 / Revised: 17 July 2013 / Accepted: 23 July 2013 / Published: 2 August 2013
Cited by 5 | PDF Full-text (219 KB) | HTML Full-text | XML Full-text
Abstract
One hundred and forty five head chefs and catering managers of restaurants in Owerri, Nigeria were surveyed to establish their knowledge of food safety hazards and control measures. Face-to-face interviews were conducted and data collected on their knowledge of risk perception, food handling
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One hundred and forty five head chefs and catering managers of restaurants in Owerri, Nigeria were surveyed to establish their knowledge of food safety hazards and control measures. Face-to-face interviews were conducted and data collected on their knowledge of risk perception, food handling practices, temperature control, foodborne pathogens, and personal hygiene. Ninety-two percent reported that they cleaned and sanitized food equipment and contact surfaces while 37% engaged in cross-contamination practices. Forty-nine percent reported that they would allow a sick person to handle food. Only 70% reported that they always washed their hands while 6% said that they continued cooking after cracking raw eggs. All respondents said that they washed their hands after handling raw meat, chicken or fish. About 35% lacked knowledge of ideal refrigeration temperature while 6% could not adjust refrigerator temperature. Only 40%, 28%, and 21% had knowledge of Salmonella, E. coli, and Hepatitis A, respectively while 8% and 3% had knowledge of Listeria and Vibrio respectively, as pathogens. Open markets and private bore holes supplied most of their foods and water, respectively. Pearson’s Correlation Coefficient analysis revealed almost perfect linear relationship between education and knowledge of pathogens (r = 0.999), cooking school attendance and food safety knowledge (r = 0.992), and class of restaurant and food safety knowledge (r = 0.878). The lack of current knowledge of food safety among restaurant staff highlights increased risk associated with fast foods and restaurants in Owerri. Full article
(This article belongs to the Special Issue Food Safety and Public Health)
Open AccessArticle Case-Control Study of Arsenic in Drinking Water and Lung Cancer in California and Nevada
Int. J. Environ. Res. Public Health 2013, 10(8), 3310-3324; doi:10.3390/ijerph10083310
Received: 29 May 2013 / Revised: 25 July 2013 / Accepted: 26 July 2013 / Published: 2 August 2013
Cited by 8 | PDF Full-text (339 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Millions of people are exposed to arsenic in drinking water, which at high concentrations is known to cause lung cancer in humans. At lower concentrations, the risks are unknown. We enrolled 196 lung cancer cases and 359 controls matched on age and gender
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Millions of people are exposed to arsenic in drinking water, which at high concentrations is known to cause lung cancer in humans. At lower concentrations, the risks are unknown. We enrolled 196 lung cancer cases and 359 controls matched on age and gender from western Nevada and Kings County, California in 2002–2005. After adjusting for age, sex, education, smoking and occupational exposures, odds ratios for arsenic concentrations ≥85 µg/L (median = 110 µg/L, mean = 173 µg/L, maximum = 1,460 µg/L) more than 40 years before enrollment were 1.39 (95% CI = 0.55–3.53) in all subjects and 1.61 (95% CI = 0.59–4.38) in smokers. Although odds ratios were greater than 1.0, these increases may have been due to chance given the small number of subjects exposed more than 40 years before enrollment. This study, designed before research in Chile suggested arsenic-related cancer latencies of 40 years or more, illustrates the enormous sample sizes needed to identify arsenic-related health effects in low-exposure countries with mobile populations like the U.S. Nonetheless, our findings suggest that concentrations near 100 µg/L are not associated with markedly high relative risks. Full article
Open AccessArticle A Food Retail-Based Intervention on Food Security and Consumption
Int. J. Environ. Res. Public Health 2013, 10(8), 3325-3346; doi:10.3390/ijerph10083325
Received: 30 May 2013 / Revised: 18 July 2013 / Accepted: 27 July 2013 / Published: 5 August 2013
Cited by 14 | PDF Full-text (855 KB) | HTML Full-text | XML Full-text
Abstract
The effect of the built environment on diet (and ensuing health outcomes) is less understood than the effect of diet on obesity. Natural experiments are increasingly advocated in place of cross-sectional studies unable to suggest causality. The central research question of this paper,
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The effect of the built environment on diet (and ensuing health outcomes) is less understood than the effect of diet on obesity. Natural experiments are increasingly advocated in place of cross-sectional studies unable to suggest causality. The central research question of this paper, therefore, asks whether a neighborhood-level food retail intervention will affect dietary habits or food security. The intervention did not have a significant impact on fruit and vegetable consumption, and the intervention population actually purchased prepared meals more frequently. More problematic, only 8% of respondents overall regularly consumed enough fruits and vegetables, and 34% were food insecure. Further complicating this public health issue, the new grocery store closed after 17 months of operation. Results indicate that geographic access to food is only one element of malnutrition, and that multi-pronged dietary interventions may be more effective. The economic failure of the store also suggests the importance of non-retail interventions to combat malnutrition. Full article
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Open AccessArticle Resistance Genes, Phage Types and Pulsed Field Gel Electrophoresis Pulsotypes in Salmonella enterica Strains from Laying Hen Farms in Southern Italy
Int. J. Environ. Res. Public Health 2013, 10(8), 3347-3362; doi:10.3390/ijerph10083347
Received: 13 May 2013 / Revised: 11 July 2013 / Accepted: 29 July 2013 / Published: 6 August 2013
Cited by 2 | PDF Full-text (261 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Twenty-four Salmonella enterica isolates (13 serovar Enteritidis and 11 Typhimurium) isolated from 5,600 samples from intensive laying hen farms in Italy in 1998–2007 were characterized for antimicrobial resistance genes, pulsotype and phage type. Most of S. Typhimurium strains were pulsotype STYMXB.0147 (81.8%), phage
[...] Read more.
Twenty-four Salmonella enterica isolates (13 serovar Enteritidis and 11 Typhimurium) isolated from 5,600 samples from intensive laying hen farms in Italy in 1998–2007 were characterized for antimicrobial resistance genes, pulsotype and phage type. Most of S. Typhimurium strains were pulsotype STYMXB.0147 (81.8%), phage type DT143 and resistant to sulfamethoxazole encoded by sul2. Two multidrug resistant (MDR) strains were identified. One strain, STYMXB.0061, was resistant to ampicillin (A), chloramphenicol (C), streptomycin (S), sulfamethoxazole (Su) and tetracycline (T) encoded by the Salmonella Genomic Island SGI1. The second MDR strain, STYMXB.0110, was resistant to SSuT encoded by sul1 and sul2, aadA1 and tet(C)-flanked by an IS26 element, respectively. The tet(C) gene has been reported to confer low levels of resistance and it has very rarely been detected in S. Typhimurium from poultry. In the current study, the MIC value (32 µg/mL) was consistent with the breakpoint (³16 µg/mL) reported for Enterobacteriaceae. Most of the S. Enteritidis strains were resistant to Su (encoded by sul2). One MDR strain (ANxSSuT) was identified. With the exception of nalidixic acid (Nx), the resistances were respectively encoded by blaTEM, strAB, sul2 and tet(A) harbored by an IncN conjugative plasmid. All isolates were pulsotype SENTXB.0001 with PT14b being the most prevalent identified phage type (57.1%). In Europe, SENTXB.0001 is the predominant PFGE profile from clinical cases and the identification of PT14b has steadily been on the increase since 2001. The findings presented in this study highlight the potential spread of S. Enteritidis phage types PT14b and S. Typhimurium DT143 in a field of particular relevance for zoonoses. Additional, the presence of resistance genes and genetic elements (conjugative plasmid and IS element) underlines the need to assess routinely studies in field, such as poultry farms, relevant fot the public health and suitable for the storage and diffusion of antimicrobial resistance. Full article
(This article belongs to the Special Issue Antimicrobial Resistance Prevention and Control)
Open AccessArticle Resistance and Inactivation Kinetics of Bacterial Strains Isolated from the Non-Chlorinated and Chlorinated Effluents of a WWTP
Int. J. Environ. Res. Public Health 2013, 10(8), 3363-3383; doi:10.3390/ijerph10083363
Received: 15 June 2013 / Revised: 25 July 2013 / Accepted: 26 July 2013 / Published: 6 August 2013
Cited by 3 | PDF Full-text (408 KB) | HTML Full-text | XML Full-text
Abstract
The microbiological quality of water from a wastewater treatment plant that uses sodium hypochlorite as a disinfectant was assessed. Mesophilic aerobic bacteria were not removed efficiently. This fact allowed for the isolation of several bacterial strains from the effluents. Molecular identification indicated that
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The microbiological quality of water from a wastewater treatment plant that uses sodium hypochlorite as a disinfectant was assessed. Mesophilic aerobic bacteria were not removed efficiently. This fact allowed for the isolation of several bacterial strains from the effluents. Molecular identification indicated that the strains were related to Aeromonas hydrophila, Escherichia coli (three strains), Enterobacter cloacae, Kluyvera cryocrescens (three strains), Kluyvera intermedia, Citrobacter freundii (two strains), Bacillus sp. and Enterobacter sp. The first five strains, which were isolated from the non-chlorinated effluent, were used to test resistance to chlorine disinfection using three sets of variables: disinfectant concentration (8, 20 and 30 mg·L−1), contact time (0, 15 and 30 min) and water temperature (20, 25 and 30 °C). The results demonstrated that the strains have independent responses to experimental conditions and that the most efficient treatment was an 8 mg·L−1 dose of disinfectant at a temperature of 20 °C for 30 min. The other eight strains, which were isolated from the chlorinated effluent, were used to analyze inactivation kinetics using the disinfectant at a dose of 15 mg·L−1 with various retention times (0, 10, 20, 30, 60 and 90 min). The results indicated that during the inactivation process, there was no relationship between removal percentage and retention time and that the strains have no common response to the treatments. Full article
Open AccessArticle Relationship between Retinal Vascular Caliber and Coronary Artery Disease in Patients with Non-Alcoholic Fatty Liver Disease (NAFLD)
Int. J. Environ. Res. Public Health 2013, 10(8), 3409-3423; doi:10.3390/ijerph10083409
Received: 22 May 2013 / Revised: 11 July 2013 / Accepted: 31 July 2013 / Published: 6 August 2013
Cited by 9 | PDF Full-text (384 KB) | HTML Full-text | XML Full-text
Abstract
Objective: To evaluate the relationship between retinal vascular caliber and cardiovascular disease in non-alcoholic fatty liver disease (NAFLD) patients without diabetes and hypertension. Methods: Intention to treat study of individuals who underwent cardiac computed tomography (CT) during a two year period.
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Objective: To evaluate the relationship between retinal vascular caliber and cardiovascular disease in non-alcoholic fatty liver disease (NAFLD) patients without diabetes and hypertension. Methods: Intention to treat study of individuals who underwent cardiac computed tomography (CT) during a two year period. Coronary artery disease (CAD) was defined as stenosis of >50% in at least one major coronary artery. Liver and spleen density were measured by abdominal (CT); intima-media thickness (IMT) by Doppler ultrasound; retinal artery and vein diameter by colored-retinal angiography; and metabolic syndrome by ATP III guidelines. Serum biomarkers of insulin resistance, inflammation, and oxidant-antioxidant status were assessed. Results: Compared with 22 gender and age matched controls, the 29 NAFLD patients showed higher prevalence of coronary plaques (70% vs. 30%, p < 0.001), higher prevalence of coronary stenosis (30% vs. 15%, p < 0.001), lower retinal arteriole-to-venule ratio (AVR) (0.66 ± 0.06 vs. 0.71 ± 0.02, p < 0.01), higher IMT (0.98 ± 0.3 vs. 0.83 ± 0.1, p < 0.04), higher carotid plaques (60% vs. 40%, p < 0.001), higher homeostasis model assessment of insulin resistance (HOMA) (4.0 ± 3.4 vs. 2.0 ± 1.0, p < 0.005), and higher triglyceride levels (200 ± 80 vs. 150 ± 60, p < 0.005) than controls. Multivariate analysis showed fatty liver (OR 2.5; p < 0.01), IMT (OR 2.3 p < 0.001), and retinal AVR ratio (OR 1.5, p < 0.01) to be strongly associated with CAD independent of metabolic syndrome (OR 1.2, p < 0.05). Conclusions: Patients with smaller retinal AVR (<0.7) are likely to be at increased risk for CAD and carotid atherosclerosis in patients with NAFLD even without hypertension or diabetes. Full article
Open AccessArticle Supporting Pacific Island Countries to Strengthen Their Resistance to Tobacco Industry Interference in Tobacco Control: A Case Study of Papua New Guinea and Solomon Islands
Int. J. Environ. Res. Public Health 2013, 10(8), 3424-3434; doi:10.3390/ijerph10083424
Received: 13 June 2013 / Revised: 24 July 2013 / Accepted: 29 July 2013 / Published: 6 August 2013
Cited by 5 | PDF Full-text (202 KB) | HTML Full-text | XML Full-text
Abstract
Tobacco use is the biggest single preventable cause of non-communicable diseases (NCDs) in the Western Pacific region. Currently, 14 Pacific Island countries have ratified the WHO Framework Convention on Tobacco Control (FCTC) and, in having done so, are committed to implementing tobacco control
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Tobacco use is the biggest single preventable cause of non-communicable diseases (NCDs) in the Western Pacific region. Currently, 14 Pacific Island countries have ratified the WHO Framework Convention on Tobacco Control (FCTC) and, in having done so, are committed to implementing tobacco control measures aligned with the FCTC. Progressing strong and effective tobacco control legislation is essential to achieving long term gains in public health in small island countries. However, survey evidence suggests that pervasive tobacco industry interference serves to undermine tobacco control and public policy in several Pacific countries. An initiative was developed to provide dedicated, in-country technical support for developing legislation and policy to support implementation of Article 5.3 of the FCTC in the Solomon Islands and Papua New Guinea. This paper examines the factors that have assisted the two Pacific countries to make progress in implementing Article 5.3 and what this might mean for supporting progress in other Pacific settings. A document analysis was undertaken to identify the process and outcome of the intervention. Two significant outputs from the project including having identified and documented specific examples of TII and the development of draft legislation for Article 5.3 and other key resources for public servants both within and outside the health sector. Key determinants of progress included a motivated and engaged Ministry of Health, active civil society group or champion and access to media to prepare tobacco industry related material to stimulate public and policy sector debate. Full article
(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)
Open AccessArticle Focusing Resource Allocation-Wellbeing as a Tool for Prioritizing Interventions for Communities at Risk
Int. J. Environ. Res. Public Health 2013, 10(8), 3435-3452; doi:10.3390/ijerph10083435
Received: 3 April 2013 / Revised: 23 July 2013 / Accepted: 25 July 2013 / Published: 6 August 2013
Cited by 1 | PDF Full-text (337 KB) | HTML Full-text | XML Full-text
Abstract
Objective: This study examined whether a wellbeing approach to resilience and adaptation would provide practical insights for prioritizing support to communities experiencing environmental and socio-economic stressors. Methods: A cross-sectional survey, based on a purposive sample of 2,196 stakeholders (landholders, hobby farmers,
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Objective: This study examined whether a wellbeing approach to resilience and adaptation would provide practical insights for prioritizing support to communities experiencing environmental and socio-economic stressors. Methods: A cross-sectional survey, based on a purposive sample of 2,196 stakeholders (landholders, hobby farmers, town resident and change agents) from three irrigation-dependent communities in Australia’s Murray-Darling Basin. Respondents’ adaptive capacity and wellbeing (individual and collective adaptive capacity, subjective wellbeing, social support, community connectivity, community leadership, in the context of known life stressors) were examined using chi-square, comparison of mean scores, hierarchical regression and factor-cluster analysis. Results: Statistically significant correlations (p < 0.05) were observed between individual (0.331) and collective (0.318) adaptive capacity and wellbeing. Taking into account respondents’ self-assessed health and socio-economic circumstances, perceptions of individual (15%) and collective adaptive capacity (10%) as well as community connectivity (13%) were associated with wellbeing (R2 = 0.36; F (9, 2099) = 132.9; p < 0.001). Cluster analysis found that 11% of respondents were particularly vulnerable, reporting below average scores on all indicators, with 56% of these reporting below threshold scores on subjective wellbeing. Conclusions: Addressing the capacity of individuals to work with others and to adapt to change, serve as important strategies in maintaining wellbeing in communities under stress. The human impacts of exogenous stressors appear to manifest themselves in poorer health outcomes; addressing primary stressors may in turn aid wellbeing. Longitudinal studies are indicated to verify these findings. Wellbeing may serve as a useful and parsimonious proxy measure for resilience and adaptive capacity. Full article
(This article belongs to the collection Climate Change and Human Health)
Open AccessArticle Arsenic Resistance and Prevalence of Arsenic Resistance Genes in Campylobacter jejuni and Campylobacter coli Isolated from Retail Meats
Int. J. Environ. Res. Public Health 2013, 10(8), 3453-3464; doi:10.3390/ijerph10083453
Received: 17 May 2013 / Revised: 2 July 2013 / Accepted: 29 July 2013 / Published: 7 August 2013
Cited by 2 | PDF Full-text (320 KB) | HTML Full-text | XML Full-text
Abstract
Studies that investigate arsenic resistance in the foodborne bacterium Campylobacter are limited. A total of 552 Campylobacter isolates (281 Campylobacter jejuni and 271 Campylobacter coli) isolated from retail meat samples were subjected to arsenic resistance profiling using the following arsenic compounds: arsanilic
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Studies that investigate arsenic resistance in the foodborne bacterium Campylobacter are limited. A total of 552 Campylobacter isolates (281 Campylobacter jejuni and 271 Campylobacter coli) isolated from retail meat samples were subjected to arsenic resistance profiling using the following arsenic compounds: arsanilic acid (4–2,048 μg/mL), roxarsone (4–2048 μg/mL), arsenate (16–8,192 μg/mL) and arsenite (4–2,048 μg/mL). A total of 223 of these isolates (114 Campylobacter jejuni and 109 Campylobacter coli) were further analyzed for the presence of five arsenic resistance genes (arsP, arsR, arsC, acr3, and arsB) by PCR. Most of the 552 Campylobacter isolates were able to survive at higher concentrations of arsanilic acid (512–2,048 μg/mL), roxarsone (512–2,048 μg/mL), and arsenate (128–1,024 μg/mL), but at lower concentrations for arsenite (4–16 μg/mL). Ninety seven percent of the isolates tested by PCR showed the presence of arsP and arsR genes. While 95% of the Campylobacter coli isolates contained a larger arsenic resistance operon that has all of the four genes (arsP, arsR, arsC and acr3), 85% of the Campylobacter jejuni isolates carried the short operon (arsP, and arsR). The presence of arsC and acr3 did not significantly increase arsenic resistance with the exception of conferring resistance to higher concentrations of arsenate to some Campylobacter isolates. arsB was prevalent in 98% of the tested Campylobacter jejuni isolates, regardless of the presence or absence of arsC and acr3, but was completely absent in Campylobacter coli. To our knowledge, this is the first study to determine arsenic resistance and the prevalence of arsenic resistance genes in such a large number of Campylobacter isolates. Full article
(This article belongs to the Special Issue Antimicrobial Resistance Prevention and Control)
Open AccessArticle Insights from Parents about Caring for a Child with Birth Defects
Int. J. Environ. Res. Public Health 2013, 10(8), 3465-3482; doi:10.3390/ijerph10083465
Received: 7 June 2013 / Revised: 26 July 2013 / Accepted: 29 July 2013 / Published: 7 August 2013
Cited by 3 | PDF Full-text (286 KB) | HTML Full-text | XML Full-text
Abstract
Birth defects affect 1 in 33 babies. Having a child with a birth defect impacts the whole family. Parents of children who have birth defects face unique challenges and desire to make life better for their kids. They also want to help to
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Birth defects affect 1 in 33 babies. Having a child with a birth defect impacts the whole family. Parents of children who have birth defects face unique challenges and desire to make life better for their kids. They also want to help to prevent birth defects in the future. Some of the challenges parents face involve communication with healthcare professionals, quality of life issues, creating awareness and advocating for research and funding, finding resources and support, and helping teens transition to appropriate, specialized adult care. This paper addresses these issues and their sub-issues, provides examples, and makes suggestions for improvement and research. Full article
(This article belongs to the Special Issue Birth Defect Prevention)
Open AccessArticle Communication by Mothers with Breast Cancer or Melanoma with Their Children
Int. J. Environ. Res. Public Health 2013, 10(8), 3483-3501; doi:10.3390/ijerph10083483
Received: 5 May 2013 / Revised: 26 July 2013 / Accepted: 30 July 2013 / Published: 8 August 2013
Cited by 3 | PDF Full-text (259 KB) | HTML Full-text | XML Full-text
Abstract
Communication of familial risk of breast cancer and melanoma has the potential to educate relatives about their risk, and may also motivate them to engage in prevention and early detection practices. With the Health Insurance Portability and Accountability Act (HIPAA) privacy laws, the
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Communication of familial risk of breast cancer and melanoma has the potential to educate relatives about their risk, and may also motivate them to engage in prevention and early detection practices. With the Health Insurance Portability and Accountability Act (HIPAA) privacy laws, the patient often becomes the sole communicator of such risks to family members. This study surveys mothers diagnosed with either breast cancer or melanoma and their adult children about their family communication style, knowledge of increased risk, and early detection practices. In both cancer groups, most mothers alerted their children of the risk and need for early detection practices. Breast cancer mothers communicated risk and secondary prevention with early detection by breast self-examination and mammograms whereas the melanoma mothers communicated risk and primary prevention strategies like applying sunscreen and avoiding deliberate tanning. Open communication about health matters significantly increased the likelihood that children engaged in early detection and/or primary prevention behaviors. Examining the information conveyed to at-risk family members, and whether such information motivated them to engage in early detection/prevention behaviors, is key to guiding better cancer prevention communication between doctors and patients. Full article
Open AccessArticle Female University Students’ Physical Activity Levels and Associated Factors—A Cross-Sectional Study in Southwestern Saudi Arabia
Int. J. Environ. Res. Public Health 2013, 10(8), 3502-3517; doi:10.3390/ijerph10083502
Received: 25 April 2013 / Revised: 1 August 2013 / Accepted: 1 August 2013 / Published: 9 August 2013
Cited by 14 | PDF Full-text (284 KB) | HTML Full-text | XML Full-text
Abstract
Background: The high prevalence of physical inactivity in Saudi Arabia is a growing challenge to public health. This study aimed to examine the prevalence of physical activity (PA) and associated factors among female university students. Methods: This cross-sectional study involved 663
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Background: The high prevalence of physical inactivity in Saudi Arabia is a growing challenge to public health. This study aimed to examine the prevalence of physical activity (PA) and associated factors among female university students. Methods: This cross-sectional study involved 663 randomly selected female university students who completed the Arab Teens Life Style questionnaire. Data included measurements of anthropometric, socioeconomic and environmental factors, as well as self-reported PA. Ordinal regression was used to identify associated factors with low, moderate and high PA levels. Results: The mean age of participants was 20.4 years (SD 1.5). Mean BMI of the students in relation to PA were 23.0, 22.9, 22.1 for high, moderate and low levels of activity, respectively. The analysis revealed significantly higher PA levels among married students, those with high educated mothers, and those who lived far from parks, and lower activity levels among underweight students. Conclusions: This study raises four important determinants for female university students’ PA levels. These factors could be of great importance in the endeavor to prevent the health-threatening increase in physical inactivity patterns and thus non-communicable diseases and obesity where the focus should be on the specific situation and needs of women in Saudi Arabia. Full article
(This article belongs to the Special Issue Health Behavior and Public Health)
Open AccessArticle A Review of Programs That Targeted Environmental Determinants of Aboriginal and Torres Strait Islander Health
Int. J. Environ. Res. Public Health 2013, 10(8), 3518-3542; doi:10.3390/ijerph10083518
Received: 21 June 2013 / Revised: 2 August 2013 / Accepted: 5 August 2013 / Published: 9 August 2013
Cited by 6 | PDF Full-text (439 KB) | HTML Full-text | XML Full-text
Abstract
Objective: Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and
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Objective: Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and Torres Strait Islanders, colonisation has made the physical and social environment particularly detrimental for health. Methods and Results: We conducted a literature review to identify Aboriginal health interventions that targeted environmental determinants of health, identifying 21 different health programs. Program activities that targeted environmental determinants of health included: Caring for Country; changes to food supply and/or policy; infrastructure for physical activity; housing construction and maintenance; anti-smoking policies; increased workforce capacity; continuous quality improvement of clinical systems; petrol substitution; and income management. Targets were categorised according to Miller’s Living Systems Theory. Researchers using an Indigenous community based perspective more often identified interpersonal and community-level targets than were identified using a Western academic perspective. Conclusions: Although there are relatively few papers describing interventions that target environmental determinants of health, many of these addressed such determinants at multiple levels, consistent to some degree with an ecological approach. Interpretation of program targets sometimes differed between academic and community-based perspectives, and was limited by the type of data reported in the journal articles, highlighting the need for local Indigenous knowledge for accurate program evaluation. Implications: While an ecological approach to Indigenous health is increasingly evident in the health research literature, the design and evaluation of such programs requires a wide breadth of expertise, including local Indigenous knowledge. Full article
Open AccessArticle Travel Mode and Physical Activity at Sydney University
Int. J. Environ. Res. Public Health 2013, 10(8), 3563-3577; doi:10.3390/ijerph10083563
Received: 1 July 2013 / Revised: 1 August 2013 / Accepted: 6 August 2013 / Published: 9 August 2013
Cited by 6 | PDF Full-text (318 KB) | HTML Full-text | XML Full-text
Abstract
How staff and students travel to university can impact their physical activity level. An online survey of physical activity and travel behaviour was conducted in early November 2012 to inform planning of physical activity and active travel promotion programs at the University of
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How staff and students travel to university can impact their physical activity level. An online survey of physical activity and travel behaviour was conducted in early November 2012 to inform planning of physical activity and active travel promotion programs at the University of Sydney, Australia as part of the “Sit Less, Move More” sub-committee of the Healthy University Initiative, and as baseline data for evaluation. There were 3,737 useable responses, 60% of which were from students. Four out of five respondents travelled to the University on the day of interest (Tuesday, November 30, 2012). The most frequently used travel modes were train (32%), car as driver (22%), bus (17%), walking (17%) and cycling (6%). Staff were twice as likely to drive as students, and also slightly more likely to use active transport, defined as walking and cycling (26% versus 22%). Overall, 41% of respondents were sufficiently active (defined by meeting physical activity recommendations of 150 min per week). Participants were more likely to meet physical activity recommendations if they travelled actively to the University. With a high proportion of respondents using active travel modes or public transport already, increasing the physical activity levels and increasing the use of sustainable travel modes would mean a mode shift from public transport to walking and cycling for students is needed and a mode shift from driving to public transport or active travel for University staff. Strategies to achieve this are discussed. Full article
Open AccessArticle Sexual and Reproductive Health among Unmarried Rural-Urban Female Migrants in Shanghai China: A Comparative Analysis
Int. J. Environ. Res. Public Health 2013, 10(8), 3578-3589; doi:10.3390/ijerph10083578
Received: 24 May 2013 / Revised: 12 July 2013 / Accepted: 31 July 2013 / Published: 9 August 2013
Cited by 3 | PDF Full-text (236 KB) | HTML Full-text | XML Full-text
Abstract
We compared sexual and reproductive health (SRH)-related knowledge, attitude and behavior among unmarried rural-urban female migrants in Shanghai coming from different regions of China. A total of 944 unmarried rural-urban female migrants were recruited from three districts of Shanghai. We used an interviewer-administered
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We compared sexual and reproductive health (SRH)-related knowledge, attitude and behavior among unmarried rural-urban female migrants in Shanghai coming from different regions of China. A total of 944 unmarried rural-urban female migrants were recruited from three districts of Shanghai. We used an interviewer-administered structured questionnaire to collect information from each participant and a multivariate logistic regression to examine the association between premarital sex and risk factors. We found the rates of premarital sex, pregnancy and abortion among unmarried rural-urban female migrants were 28.2%, 5.2% and 5.0%, respectively. Participants from the east of China were more likely to engage in premarital sex than those from the mid-west (p < 0.001). The analysis showed premarital sex was associated with age, hometown, education, current residential type, knowledge of sexual physiology and safe sex, attitude to SRH and safe sex, and permissive attitude to sex. Unmarried rural-urban female migrants lack SRH related knowledge and the data suggests high levels of occurrence of premarital sex. The results indicate that programs to promote safe sex, especially to those migrants coming from eastern China, should be a priority. Full article
Open AccessArticle Effects of Compulsory Schooling on Mortality: Evidence from Sweden
Int. J. Environ. Res. Public Health 2013, 10(8), 3596-3618; doi:10.3390/ijerph10083596
Received: 24 June 2013 / Accepted: 2 August 2013 / Published: 13 August 2013
Cited by 4 | PDF Full-text (347 KB) | HTML Full-text | XML Full-text
Abstract
Theoretically, there are several reasons to expect education to have a positive effect on health. Empirical research suggests that education can be an important health determinant. However, it has not yet been established whether education and health are indeed causally related, and the
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Theoretically, there are several reasons to expect education to have a positive effect on health. Empirical research suggests that education can be an important health determinant. However, it has not yet been established whether education and health are indeed causally related, and the effects found in previous studies may be partially attributable to methodological weaknesses. Moreover, existing evidence on the education-health relationship generally uses information of fairly recent schooling reforms, implying that health outcomes are observed only over a limited time period. This paper examines the effect of education on mortality using information on a national roll-out of a reform leading to one extra year of compulsory schooling in Sweden. In 1936, the national government made a seventh school year compulsory; however, the implementation was decided at the school district level, and the reform was implemented over 12 years. Taking advantage of the variation in the timing of the implementation across school districts, by using county-level proportions of reformed districts, census data and administrative mortality data, we find that the extra compulsory school year reduced mortality. In fact, the mortality reduction is discernible already before the age of 30 and then grows in magnitude until the age of 55–60. Full article
(This article belongs to the Special Issue Inequalities in Health)
Open AccessArticle Performance Evaluation of Public Non-Profit Hospitals Using a BP Artificial Neural Network: The Case of Hubei Province in China
Int. J. Environ. Res. Public Health 2013, 10(8), 3619-3633; doi:10.3390/ijerph10083619
Received: 5 June 2013 / Revised: 1 August 2013 / Accepted: 5 August 2013 / Published: 15 August 2013
Cited by 1 | PDF Full-text (289 KB) | HTML Full-text | XML Full-text
Abstract
To provide a reference for evaluating public non-profit hospitals in the new environment of medical reform, we established a performance evaluation system for public non-profit hospitals. The new “input-output” performance model for public non-profit hospitals is based on four primary indexes (input, process,
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To provide a reference for evaluating public non-profit hospitals in the new environment of medical reform, we established a performance evaluation system for public non-profit hospitals. The new “input-output” performance model for public non-profit hospitals is based on four primary indexes (input, process, output and effect) that include 11 sub-indexes and 41 items. The indicator weights were determined using the analytic hierarchy process (AHP) and entropy weight method. The BP neural network was applied to evaluate the performance of 14 level-3 public non-profit hospitals located in Hubei Province. The most stable BP neural network was produced by comparing different numbers of neurons in the hidden layer and using the “Leave-one-out” Cross Validation method. The performance evaluation system we established for public non-profit hospitals could reflect the basic goal of the new medical health system reform in China. Compared with PLSR, the result indicated that the BP neural network could be used effectively for evaluating the performance public non-profit hospitals. Full article
(This article belongs to the Special Issue Public Health Informatics)
Open AccessArticle Effectiveness of the Gold Standard Programmes (GSP) for Smoking Cessation in Pregnant and Non-Pregnant Women
Int. J. Environ. Res. Public Health 2013, 10(8), 3653-3666; doi:10.3390/ijerph10083653
Received: 5 June 2013 / Revised: 2 August 2013 / Accepted: 12 August 2013 / Published: 16 August 2013
Cited by 3 | PDF Full-text (233 KB) | HTML Full-text | XML Full-text
Abstract
Background: Smoking is considered the most important preventable risk factor in relation to the development of complications during pregnancy and delivery. The aim of this study was to evaluate the effectiveness of an intensive 6-week gold standard programme (GSP) on pregnant women
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Background: Smoking is considered the most important preventable risk factor in relation to the development of complications during pregnancy and delivery. The aim of this study was to evaluate the effectiveness of an intensive 6-week gold standard programme (GSP) on pregnant women in real life. Methods: This was a prospective cohort study based on data from a national Danish registry on smoking cessation interventions. The study population included 10,682 women of a fertile age. The pregnancy status of the study population was identified using the National Patient Registry. Results: The response rate to follow up was 76%. The continuous abstinence rate for both pregnant and non-pregnant smokers was 24–32%. The following prognostic factors for continuous abstinence were identified: programme format (individual/group), older age, heavy smoking, compliance with the programme, health professional recommendation, and being a disadvantaged smoker. Conclusions: The GSP seems to be as effective among pregnant smokers as among non-pregnant smoking women. Due to the relatively high effect and clinical significance, the GSP would be an attractive element in smoking cessation intervention among pregnant women. Full article
(This article belongs to the Special Issue Tobacco Control in Vulnerable Population Groups)
Open AccessArticle Longitudinal 2-Year Follow-up on the Effect of a Non-Randomised School-Based Physical Activity Intervention on Reducing Overweight and Obesity of Czech Children Aged 10–12 Years
Int. J. Environ. Res. Public Health 2013, 10(8), 3667-3683; doi:10.3390/ijerph10083667
Received: 28 June 2013 / Revised: 13 August 2013 / Accepted: 14 August 2013 / Published: 16 August 2013
Cited by 5 | PDF Full-text (232 KB) | HTML Full-text | XML Full-text
Abstract
Background: This study assessed whether the benefits of a 2-year longitudinal non-randomised school-based physical activity (PA) intervention programme to reduce overweight and obesity were still apparent two years after completion of the controlled intervention. Methods: The study involved 84 girls (G) and 92
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Background: This study assessed whether the benefits of a 2-year longitudinal non-randomised school-based physical activity (PA) intervention programme to reduce overweight and obesity were still apparent two years after completion of the controlled intervention. Methods: The study involved 84 girls (G) and 92 boys (B) aged 10–12 years who had participated in the PA intervention in 2006–2008 as 6- to 9-year olds and were included in the intervention (I) (43 G and 45 B) and the control (C) groups (41 G and 47 B). Participants’ overweight/obesity was assessed using the percentile graph of Body Mass Index (BMI) from the World Health Organization for girls and boys aged 5–19. Logistic regression (Enter method) determined the overweight/obesity occurrence in a follow-up measurement (2010) two years after completion of the controlled intervention was used. Results: Two years after the controlled PA intervention had finished, the intervention children were less likely to be overweight/obese than the control children (2.3%GI vs. 17.1%GC, 6.7%BI vs. 23.4%BC, odds ratio: 0.25; 95% confidence interval: 0.12; 0.53; p < 0.001). Conclusions: The current study indicates favourable effects of an everyday school-based PA intervention programme on lower overweight/obesity incidence, which was maintained two years after the end of the direct involvement of the researchers. Full article
Open AccessArticle Reporting of Foodborne Illness by U.S. Consumers and Healthcare Professionals
Int. J. Environ. Res. Public Health 2013, 10(8), 3684-3714; doi:10.3390/ijerph10083684
Received: 30 June 2013 / Revised: 7 August 2013 / Accepted: 8 August 2013 / Published: 19 August 2013
Cited by 5 | PDF Full-text (257 KB) | HTML Full-text | XML Full-text
Abstract
During 2009–2010, a total of 1,527 foodborne disease outbreaks were reported by the Centers for Disease Control and Prevention (CDC) (2013). However, in a 2011 CDC report, Scallan et al. estimated about 48 million people contract a foodborne illness annually in the United
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During 2009–2010, a total of 1,527 foodborne disease outbreaks were reported by the Centers for Disease Control and Prevention (CDC) (2013). However, in a 2011 CDC report, Scallan et al. estimated about 48 million people contract a foodborne illness annually in the United States. Public health officials are concerned with this under-reporting; thus, the purpose of this study was to identify why consumers and healthcare professionals don’t report foodborne illness. Focus groups were conducted with 35 consumers who reported a previous experience with foodborne illness and with 16 healthcare professionals. Also, interviews with other healthcare professionals with responsibility of diagnosing foodborne illness were conducted. Not knowing who to contact, being too ill, being unsure of the cause, and believing reporting would not be beneficial were all identified by consumers as reasons for not reporting foodborne illness. Healthcare professionals that participated in the focus groups indicated the amount of time between patients’ consumption of food and seeking treatment and lack of knowledge were barriers to diagnosing foodborne illness. Issues related to stool samples such as knowledge, access and cost were noted by both groups. Results suggest that barriers identified could be overcome with targeted education and improved access and information about the reporting process. Full article
(This article belongs to the Special Issue Food Safety and Public Health)
Open AccessArticle Infertility and Its Treatments in Association with Autism Spectrum Disorders: A Review and Results from the CHARGE Study
Int. J. Environ. Res. Public Health 2013, 10(8), 3715-3734; doi:10.3390/ijerph10083715
Received: 28 June 2013 / Revised: 31 July 2013 / Accepted: 9 August 2013 / Published: 19 August 2013
Cited by 6 | PDF Full-text (367 KB) | HTML Full-text | XML Full-text
Abstract
Previous findings on relationships between infertility, infertility therapies, and autism spectrum disorders (ASD) have been inconsistent. The goals of this study are first, to briefly review this evidence and second, to examine infertility and its treatments in association with having a child with
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Previous findings on relationships between infertility, infertility therapies, and autism spectrum disorders (ASD) have been inconsistent. The goals of this study are first, to briefly review this evidence and second, to examine infertility and its treatments in association with having a child with ASD in newly analyzed data. In review, we identified 14 studies published as of May 2013 investigating infertility and/or its treatments and ASD. Overall, prior results showed little support for a strong association, though some increases in risk with specific treatments were found; many limitations were noted. In new analyses of the CHildhood Autism Risk from Genetics and the Environment (CHARGE) population-based study, cases with autism spectrum disorder (ASD, n = 513) and controls confirmed to have typical development (n = 388) were compared with regard to frequencies of infertility diagnoses and treatments overall and by type. Infertility diagnoses and treatments were also grouped to explore potential underlying pathways. Logistic regression was used to obtain crude and adjusted odds ratios overall and, in secondary analyses, stratified by maternal age (≥35 years) and diagnostic subgroups. No differences in infertility, infertility treatments, or hypothesized underlying pathways were found between cases and controls in crude or adjusted analyses. Numbers were small for rarer therapies and in subgroup analyses; thus the potential for modest associations in specific subsets cannot be ruled out. However, converging evidence from this and other studies suggests that assisted reproductive technology is not a strong independent risk factor for ASD. Recommendations for future studies of this topic are provided. Full article
(This article belongs to the Special Issue The Environment Risk of Autism)
Open AccessArticle The Contribution of Childhood Parental Rejection and Early Androgen Exposure to Impairments in Socio-Cognitive Skills in Intimate Partner Violence Perpetrators with High Alcohol Consumption
Int. J. Environ. Res. Public Health 2013, 10(8), 3753-3770; doi:10.3390/ijerph10083753
Received: 5 July 2013 / Revised: 5 August 2013 / Accepted: 9 August 2013 / Published: 20 August 2013
Cited by 9 | PDF Full-text (293 KB) | HTML Full-text | XML Full-text
Abstract
Alcohol consumption, a larger history of childhood parental rejection, and high prenatal androgen exposure have been linked with facilitation and high risk of recidivism in intimate partner violence (IPV) perpetrators. Participants were distributed into two groups according to their alcohol consumption scores as
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Alcohol consumption, a larger history of childhood parental rejection, and high prenatal androgen exposure have been linked with facilitation and high risk of recidivism in intimate partner violence (IPV) perpetrators. Participants were distributed into two groups according to their alcohol consumption scores as high (HA) and low (LA). HA presented a higher history of childhood parental rejection, prenatal masculinization (smaller 2D:4D ratio), and violence-related scores than LA IPV perpetrators. Nonetheless, the former showed poor socio-cognitive skills performance (cognitive flexibility, emotional recognition and cognitive empathy). Particularly in HA IPV perpetrators, the history of childhood parental rejection was associated with high hostile sexism and low cognitive empathy. Moreover, a masculinized 2D:4D ratio was associated with high anger expression and low cognitive empathy. Parental rejection during childhood and early androgen exposure are relevant factors for the development of violence and the lack of adequate empathy in adulthood. Furthermore, alcohol abuse plays a key role in the development of socio-cognitive impairments and in the proneness to violence and its recidivism. These findings contribute to new coadjutant violence intervention programs, focused on the rehabilitation of basic executive functions and emotional decoding processes and on the treatment of alcohol dependence. Full article
(This article belongs to the Special Issue Trauma, Addiction and Criminality)

Review

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Open AccessReview The Dynamics of Autism Spectrum Disorders: How Neurotoxic Compounds and Neurotransmitters Interact
Int. J. Environ. Res. Public Health 2013, 10(8), 3384-3408; doi:10.3390/ijerph10083384
Received: 1 July 2013 / Revised: 23 July 2013 / Accepted: 23 July 2013 / Published: 6 August 2013
Cited by 17 | PDF Full-text (280 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
In recent years concern has risen about the increasing prevalence of Autism Spectrum Disorders (ASD). Accumulating evidence shows that exposure to neurotoxic compounds is related to ASD. Neurotransmitters might play a key role, as research has indicated a connection between neurotoxic compounds, neurotransmitters
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In recent years concern has risen about the increasing prevalence of Autism Spectrum Disorders (ASD). Accumulating evidence shows that exposure to neurotoxic compounds is related to ASD. Neurotransmitters might play a key role, as research has indicated a connection between neurotoxic compounds, neurotransmitters and ASD. In the current review a literature overview with respect to neurotoxic exposure and the effects on neurotransmitter systems is presented. The aim was to identify mechanisms and related factors which together might result in ASD. The literature reported in the current review supports the hypothesis that exposure to neurotoxic compounds can lead to alterations in the GABAergic, glutamatergic, serotonergic and dopaminergic system which have been related to ASD in previous work. However, in several studies findings were reported that are not supportive of this hypothesis. Other factors also might be related, possibly altering the mechanisms at work, such as time and length of exposure as well as dose of the compound. Future research should focus on identifying the pathway through which these factors interact with exposure to neurotoxic compounds making use of human studies. Full article
(This article belongs to the Special Issue The Environment Risk of Autism)
Open AccessReview Environmental Drivers of West Nile Fever Epidemiology in Europe and Western Asia—A Review
Int. J. Environ. Res. Public Health 2013, 10(8), 3543-3562; doi:10.3390/ijerph10083543
Received: 1 June 2013 / Revised: 25 July 2013 / Accepted: 1 August 2013 / Published: 9 August 2013
Cited by 31 | PDF Full-text (641 KB) | HTML Full-text | XML Full-text
Abstract
Abiotic and biotic conditions are both important determinants of West Nile Fever (WNF) epidemiology. Ambient temperature plays an important role in the growth rates of vector populations, the interval between blood meals, viral replication rates and transmission of West Nile Virus (WNV). The
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Abiotic and biotic conditions are both important determinants of West Nile Fever (WNF) epidemiology. Ambient temperature plays an important role in the growth rates of vector populations, the interval between blood meals, viral replication rates and transmission of West Nile Virus (WNV). The contribution of precipitation is more complex and less well understood. In this paper we discuss impacts of climatic parameters (temperature, relative humidity, precipitation) and other environmental drivers (such as bird migration, land use) on WNV transmission in Europe. WNV recently became established in southeastern Europe, with a large outbreak in the summer of 2010 and recurrent outbreaks in 2011 and 2012. Abundant competent mosquito vectors, bridge vectors, infected (viremic) migrating and local (amplifying) birds are all important characteristics of WNV transmission. In addition, certain key climatic factors, such as increased ambient temperatures, and by extension climate change, may also favor WNF transmission, and they should be taken into account when evaluating the risk of disease spread in the coming years. Monitoring epidemic precursors of WNF, such as significant temperature deviations in high risk areas, could be used to trigger vector control programs and public education campaigns. Full article
(This article belongs to the Special Issue Epidemiology of West Nile Virus)
Figures

Open AccessReview Foodborne Illness Incidence Rates and Food Safety Risks for Populations of Low Socioeconomic Status and Minority Race/Ethnicity: A Review of the Literature
Int. J. Environ. Res. Public Health 2013, 10(8), 3634-3652; doi:10.3390/ijerph10083634
Received: 1 July 2013 / Revised: 7 August 2013 / Accepted: 8 August 2013 / Published: 15 August 2013
Cited by 17 | PDF Full-text (244 KB) | HTML Full-text | XML Full-text
Abstract
While foodborne illness is not traditionally tracked by race, ethnicity or income, analyses of reported cases have found increased rates of some foodborne illnesses among minority racial/ethnic populations. In some cases (Listeria, Yersinia) increased rates are due to unique food
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While foodborne illness is not traditionally tracked by race, ethnicity or income, analyses of reported cases have found increased rates of some foodborne illnesses among minority racial/ethnic populations. In some cases (Listeria, Yersinia) increased rates are due to unique food consumption patterns, in other cases (Salmonella, Shigella, Campylobacter) it is unclear why this health disparity exists. Research on safe food handling knowledge and behaviors among low income and minority consumers suggest that there may be a need to target safe food handling messages to these vulnerable populations. Another possibility is that these populations are receiving food that is less safe at the level of the retail outlet or foodservice facility. Research examining the quality and safety of food available at small markets in the food desert environment indicates that small corner markets face unique challenges which may affect the quality and potential safety of perishable food. Finally, a growing body of research has found that independent ethnic foodservice facilities may present increased risks for foodborne illness. This review of the literature will examine the current state of what is known about foodborne illness among, and food safety risks for, minority and low socioeconomic populations, with an emphasis on the United States and Europe. Full article
(This article belongs to the Special Issue Food Safety and Public Health)
Open AccessReview The Role of Australian Mosquito Species in the Transmission of Endemic and Exotic West Nile Virus Strains
Int. J. Environ. Res. Public Health 2013, 10(8), 3735-3752; doi:10.3390/ijerph10083735
Received: 17 July 2013 / Revised: 7 August 2013 / Accepted: 7 August 2013 / Published: 19 August 2013
Cited by 5 | PDF Full-text (260 KB) | HTML Full-text | XML Full-text
Abstract
Recent epidemic activity and its introduction into the Western Hemisphere have drawn attention to West Nile virus (WNV) as an international public health problem. Of particular concern has been the ability for the virus to cause outbreaks of disease in highly populated urban
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Recent epidemic activity and its introduction into the Western Hemisphere have drawn attention to West Nile virus (WNV) as an international public health problem. Of particular concern has been the ability for the virus to cause outbreaks of disease in highly populated urban centers. Incrimination of Australian mosquito species is an essential component in determining the receptivity of Australia to the introduction and/or establishment of an exotic strain of WNV and can guide potential management strategies. Based on vector competence experiments and ecological studies, we suggest candidate Australian mosquito species that would most likely be involved in urban transmission of WNV, along with consideration of the endemic WNV subtype, Kunjin. We then examine the interaction of entomological factors with virological and vertebrate host factors, as well as likely mode of introduction, which may influence the potential for exotic WNV to become established and be maintained in urban transmission cycles in Australia. Full article
(This article belongs to the Special Issue Epidemiology of West Nile Virus)
Open AccessReview Thimerosal Exposure and the Role of Sulfation Chemistry and Thiol Availability in Autism
Int. J. Environ. Res. Public Health 2013, 10(8), 3771-3800; doi:10.3390/ijerph10083771
Received: 14 May 2013 / Revised: 10 July 2013 / Accepted: 11 July 2013 / Published: 20 August 2013
Cited by 13 | PDF Full-text (285 KB) | HTML Full-text | XML Full-text
Abstract
Autism spectrum disorder (ASD) is a neurological disorder in which a significant number of the children experience a developmental regression characterized by a loss of previously acquired skills and abilities. Typically reported are losses of verbal, nonverbal, and social abilities. Several recent studies
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Autism spectrum disorder (ASD) is a neurological disorder in which a significant number of the children experience a developmental regression characterized by a loss of previously acquired skills and abilities. Typically reported are losses of verbal, nonverbal, and social abilities. Several recent studies suggest that children diagnosed with an ASD have abnormal sulfation chemistry, limited thiol availability, and decreased glutathione (GSH) reserve capacity, resulting in a compromised oxidation/reduction (redox) and detoxification capacity. Research indicates that the availability of thiols, particularly GSH, can influence the effects of thimerosal (TM) and other mercury (Hg) compounds. TM is an organomercurial compound (49.55% Hg by weight) that has been, and continues to be, used as a preservative in many childhood vaccines, particularly in developing countries. Thiol-modulating mechanisms affecting the cytotoxicity of TM have been identified. Importantly, the emergence of ASD symptoms post-6 months of age temporally follows the administration of many childhood vaccines. The purpose of the present critical review is provide mechanistic insight regarding how limited thiol availability, abnormal sulfation chemistry, and decreased GSH reserve capacity in children with an ASD could make them more susceptible to the toxic effects of TM routinely administered as part of mandated childhood immunization schedules. Full article
(This article belongs to the Special Issue Environmental Health Risk Assessment)

Other

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Open AccessCorrection Varela-Mato, V.; Cancela, J.M.; Ayan, C.; Molina, A.; Martín, V. Lifestyle and Health among Spanish University Students: Differences by Gender and Academic Discipline. Int. J. Environ. Res. Public Health 2012, 9, 2728–2741
Int. J. Environ. Res. Public Health 2013, 10(8), 3590; doi:10.3390/ijerph10083590
Received: 22 July 2013 / Accepted: 29 July 2013 / Published: 13 August 2013
Cited by 2 | PDF Full-text (103 KB) | HTML Full-text | XML Full-text
Abstract
The authors wish to make the following correction to this paper [1]. In the article it is mentioned that “the study obtained the approval of the university’s Students Vice-Chancellery and the government bodies of the involved academic centers and also by the Ethics
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The authors wish to make the following correction to this paper [1]. In the article it is mentioned that “the study obtained the approval of the university’s Students Vice-Chancellery and the government bodies of the involved academic centers and also by the Ethics Committee of the University of Vigo.” However, it should read: “The study obtained the approval of the university’s Students Vice-Chancellery and the government bodies of the involved academic centers” only. Full article
Open AccessComment Comments on Varela-Mato, V.; Cancela, J.M.; Ayan, C.; Martín, V.; Molina, A. Lifestyle and Health among Spanish University Students: Differences by Gender and Academic Discipline. Int. J. Environ. Res. Public Health 2012, 9, 2728–2741
Int. J. Environ. Res. Public Health 2013, 10(8), 3591-3592; doi:10.3390/ijerph10083591
Received: 14 June 2013 / Accepted: 29 July 2013 / Published: 13 August 2013
Cited by 2 | PDF Full-text (107 KB) | HTML Full-text | XML Full-text
Abstract
In regard to the article entitled “Lifestyle and health among Spanish university students: differences by gender and academic discipline” by Varela-Mato et al. [1] which analyzes the lifestyles of a group of students from the University of Vigo (Galicia, Spain), we would like
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In regard to the article entitled “Lifestyle and health among Spanish university students: differences by gender and academic discipline” by Varela-Mato et al. [1] which analyzes the lifestyles of a group of students from the University of Vigo (Galicia, Spain), we would like to draw your attention to a series of disagreements with certain statements that are made therein: Full article
Open AccessReply Response to Crespo et al. Comments on: Varela-Mato, V.; et al. Lifestyle and Health among Spanish University Students: Differences by Gender and Academic Discipline. Int. J. Environ. Res. Public Health 2012, 9, 2728–2741
Int. J. Environ. Res. Public Health 2013, 10(8), 3593-3595; doi:10.3390/ijerph10083593
Received: 22 July 2013 / Accepted: 29 July 2013 / Published: 13 August 2013
PDF Full-text (107 KB) | HTML Full-text | XML Full-text
Abstract We thank Dr. Crespo [1] for his interest in reading our article and his time in writing his comments on work [2]. However, we have to respectfully point out our disagreement and a few comments of our own: Full article

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