Climate change impacts on human health span the trajectory of time—past, present, and future. The key finding from the Working Group II, Fifth Assessment Report (AR5) of the Intergovernmental Panel on Climate Change (IPCC) states that health impacts due to climate change have already occurred in the past, are currently occurring and will continue to occur, at least for the foreseeable future, even with immediate reductions in greenhouse gas emissions [1]. According to the IPCC, there has been increased heat-related mortality and decreased cold-related mortality in some regions as a result of warming (Box 1). Moreover, local changes in temperature and rainfall have altered the distribution of some water-borne illnesses and disease vectors. Impacts of climate-related extremes include alteration of ecosystems, disruption of food production and water supply, damage to infrastructure and settlements, morbidity and mortality, and consequences for mental health and human well-being [1]. [...] Full article

Concentrations of As, Cu, Fe, Hg, Pb and Zn and activity concentrations from ^234,238U and ²¹⁰Po in water, fillet, liver and gills were determined in three stocked fish species from the Luis L. Leon reservoir, located in Northern Mexico. The considered species were Lepomis cyanellus, Cyprinus carpio and Ictalurus furcatus. ²³⁸U and ²³⁴U activity concentration (AC) in fillet samples showed values of 0.007–0.014 and 0.01–0.02 Bq∙kg⁻¹ wet weight (ww), respectively. Liver samples for L. cyanellus, C. carpio and I. furcatus present ²¹⁰Po AC of 1.16–3.26, 0.70–1.13 and 0.93–1.37 Bq∙kg⁻¹ ww. Arsenic, mercury and lead concentration intervals in fillet samples were 0.13–0.39, 0.005–0.126 and 0.009–0.08 mg∙kg⁻¹ ww, respectively, while in gill samples they were 0.11–0.43, 0.002–0.039 and 0.02–0.26 mg∙kg⁻¹ ww. The elemental Bioaccumulation Factor (BAF) for fish tissues with respect to their concentrations in water was determined. L. cyanellus showed the highest BAF values for As and total U, being BAF_As = 37 and 40 L∙kg⁻¹ in fillet and gills, respectively, and BAF_{U total} = 1.5 L∙kg⁻¹ in fillet. I. furcatus showed the highest BAF values for Hg and Pb, being BAF_Hg = 40 and 13 L∙kg⁻¹ in fillet and gills, and BAF_Pb = 6.5 and 22 L∙kg⁻¹ in fillet and gills, respectively. Some metal(loid) concentrations are slightly higher than European regulations for fish fillets. The difference in concentrations of metal(loid)s in fillet among the studied species is probably due to their differences in diet and habitat. Full article

Studies of obesity and related health conditions among the Bhutanese, one of the largest refugee groups resettled in the United States in the past five years, are limited. This study examined the factors associated with excess body weight (body mass index ≥ 23 kg/m²) and abdominal obesity (waist circumference > 80 cm) in a community-based sample of 18–65 year old Bhutanese refugee women in Northeast Ohio. A Nepali-language questionnaire was used to measure socio-demographic and dietary factors. Height, weight, and waist circumference were measured to define excess body weight and abdominal obesity. The mean (±standard deviation) age of the 108 participants was 36.5 (±12.2) years and length of time in the U.S. was 19.4 (±11.9) months. Overall, 64.8% and 69.4% of the women had excess body weight and abdominal obesity, respectively. Age was significantly associated with both excess body weight (odds ratio: 1.10; 95% confidence interval: 1.05–1.16) and abdominal obesity (1.09; 1.04–1.14). Consuming meat (4.01; 1.14–14.60) was significantly associated with excess body weight but not abdominal obesity. These findings suggest the need for lifestyle and dietary change education programs among this new and vulnerable group to reduce the prevalence of excess body weight and abdominal obesity and their health consequences. Full article

Objective: This study was conducted to determine whether installation of sit-stand desks (SSDs) could lead to decreased sitting time during the workday among sedentary office workers. Methods: A randomized cross-over trial was conducted from January to April, 2012 at a business in Minneapolis. 28 (nine men, 26 full-time) sedentary office workers took part in a 4 week intervention period which included the use of SSDs to gradually replace 50% of sitting time with standing during the workday. Physical activity was the primary outcome. Mood, energy level, fatigue, appetite, dietary intake, and productivity were explored as secondary outcomes. Results: The intervention reduced sitting time at work by 21% (95% CI 18%–25%) and sedentary time by 4.8 min/work-hr (95% CI 4.1–5.4 min/work-hr). For a 40 h work-week, this translates into replacement of 8 h of sitting time with standing and sedentary time being reduced by 3.2 h. Activity level during non-work hours did not change. The intervention also increased overall sense of well-being, energy, decreased fatigue, had no impact on productivity, and reduced appetite and dietary intake. The workstations were popular with the participants. Conclusion: The SSD intervention was successful in increasing work-time activity level, without changing activity level during non-work hours. Full article

Leptospirosis is a zoonosis of global distribution that affects tropical and temperate areas. Under suitable conditions, Leptospira can survive in water and soil and contribute to human and animal infections. The objective of this study was to describe the presence of pathogenic Leptospira in peri-domestic water samples from rural households in southern Chile. Water samples, including puddles, containers, animal troughs, rivers, canals, and drinking water were collected from 236 households and tested for Leptospira using a PCR assay targeting the lipL32 gene. Evidence of Leptospira presence was detected in all sample types; overall, 13.5% (77/570) samples tested positive. A total of 10/22 (45.5%) open containers, 12/83 (14.5%) animal drinking sources, 9/47 (19.1%) human drinking sources, and 36/306 (19.3%) puddles tested positive. Lower income (OR = 4.35, p = 0.003), increased temperature (OR = 1.23, p < 0.001), and presence of dogs (OR = 15.9, p = 0.022) were positively associated with positive puddles. Increased number of rodent signs was associated with positive puddles in the household (OR = 3.22); however, only in the lower income households. There was no association between PCR positive rodents and puddles at the household level. Results revealed the ubiquity of Leptospira in the household environment and highlight the need to develop formal approaches for systematic monitoring. Full article

The objective of this study was to demonstrate the use of the Rasch model by assessing the appropriateness of the demographic, social-economic and geographic factors in providing a total score in malaria RDT in accordance with the model’s expectations. The baseline malaria indicator survey was conducted in Amhara, Oromiya and Southern Nation Nationalities and People (SNNP) regions of Ethiopia by The Carter Center in 2007. The result shows high reliability and little disordering of thresholds with no evidence of differential item functioning. Full article

Numerous studies show that changes occurring in a woman’s organism during menopause may lower her quality of life. This study involved 630 healthy postmenopausal women from Poland. Its purpose was to assess their quality of life in relation to socio-demographic variables, medical data and personality profiles. The authors used the Short Form Health Survey (SF-36) to assess quality of life, the NEO-Five Factor Inventory to measure personality traits, and the Blatt-Kupperman Menopausal Index to estimate severity of climacteric symptoms. The study demonstrated significant relationships between quality of life and variables such as: age, education, employment status, and the use of menopausal hormone therapy. An analysis of personality traits revealed correlations between the openness to experience scores and the quality of life within physical functioning, vitality, and mental health. Neuroticism, agreeableness and extroversion significantly correlated with all quality of life domains. Conclusions: (1) Age, education and employment status have significant effects on the selected quality of life domains after menopause. (2) Quality of life within the general health domain was assessed lower by MHT-users (Menopausal hormone theraphy (MHT)). (3) Health-related quality of life is also influenced by personality traits, which are relatively stable throughout life. Full article

Mercury exposure through the consumption of fish and shellfish represents a significant public health concern in the United States. Recent research has demonstrated higher seafood consumption and subsequent increased risk of methylmercury exposure among subpopulations living in coastal areas. The identification of high concentrations of total mercury in blood and skin among resident Atlantic bottlenose dolphins (Tursiops truncatus) in the Indian River Lagoon (IRL), a coastal estuary in Florida, alerted us to a potential public health hazard in the contiguous human population. Therefore, we analyzed hair mercury concentrations of residents living along the IRL and ascertained their sources and patterns of seafood consumption. The total mean mercury concentration for 135 residents was 1.53 ± 1.89 µg/g. The concentration of hair mercury among males (2.02 ± 2.38 µg/g) was significantly higher than that for females (0.96 ± 0.74 µg/g) (p < 0.01). Log transformed hair mercury concentration was significantly associated with the frequency of total seafood consumption (p < 0.01). Individuals who reported consuming seafood once a day or more were 3.71 (95% CI 0.84–16.38) times more likely to have a total hair mercury concentration over 1.0 µg/g, which corresponds approximately to the U.S. EPA reference dose, compared to those who consumed seafood once a week or less. Hair mercury concentration was also significantly higher among individuals who obtained all or most of their seafood from local recreational sources (p < 0.01). The elevated human mercury concentrations mirror the elevated concentrations observed in resident dolphins in the same geographical region. The current study is one of the first to apply the concept of a sentinel animal to a contiguous human population. Full article

Background: Chinese immigrants have been disproportionally affected by type 2 diabetes. This paper presents the state of science regarding the factors that may influence diabetes self-management among Chinese immigrants in the US and the potential health outcomes. Design: Using Walker and Avant’s techniques, a search of the literature was conducted from CINAHL, PubMed, OVID, and Web of Science. Findings: Factors most relevant to diabetes self-management were grouped under five categories: socio-demographic characteristics, behavioral and psychological characteristics, social support, linguistic barriers, and cultural characteristics. Potential outcomes derived from improved diabetes self-management include quality of life, glycosylated hemoglobin, and blood pressure and other cardiovascular risk factors. Discussion: A conceptual model was provided to guide future research. Based on the review of the literature, specific research topics that need to fill the gaps in the literature were provided, including family-focused interventions for Chinese immigrant patients with diabetes and the effectiveness of these interventions to improve family functioning. Full article

Although there is some evidence supporting the existence of an association between prenatal maternal or postnatal child’s urine phthalate metabolite concentrations and poor attentional performances, the interaction between urine phthalate metabolite levels and genetic variation for neuropsychological deficit of attention-deficit hyperactivity disorder (ADHD) has not been examined. The aim of this study was to determine whether phthalate metabolites in urine are associated with poor neuropsychological performance in children with ADHD, and whether such association is affected by genotype-phthalate interaction. A cross-sectional examination of urine phthalate metabolite concentrations and the continuous performance test (CPT) were performed in 179 Korean children with ADHD recruited from department of psychiatry of university hospital. Correlations between urine phthalate metabolite concentrations and the CPT scores were investigated, and the interaction of phthalate metabolite levels with the selected polymorphisms at major candidate genes for ADHD, namely dopamine receptor D4 (DRD4), dopamine transporter, α-2A-adrenergic receptor, and norepinephrine transporter genes. For the subjects with the DRD4 4/4 genotype, there were significant associations of the urine phthalate metabolite concentrations with the number of omission errors, the number of commission errors, and the response time variability scores on the CPT. However, for the subjects without the DRD4 4/4 genotype, no significant associations were found. The results of this study suggest a possible association between phthalate metabolite concentrations and poor attentional performances of ADHD as well as a genetic influence on this association. Further prospective and epigenetic studies are needed to investigate causality and pathophysiological mechanisms. Full article

This study investigated the effects of the proximity to city parks and the influence of residential greenness on children’s emotional and behavioral problems. This cross-sectional study included 1,468 mothers of children (ages 4 to 6) who were residents of the city of Kaunas, Lithuania. The mothers and their children were enrolled in the FP7 PHENOTYPE project study. The mothers reported on their parenting stress and their children’s mental health. Residential greenness was characterized as an average of the satellite-derived normalized difference vegetation index (NDVI) in a 300 m buffer around each home address, and the proximity to city parks was defined as the distance from the subject’s residence to the nearest park. Linear regression models were used to investigate the association among the residence distances from city parks, greenness and children’s mental health problems. Farther residential distance from city parks was associated with worse mental health (except for the emotional problems subscale) in children whose mothers had a lower education level. More residential greenness was associated with worse mental health (more conditional problems and less prosocial behavior) in children whose mothers had a higher education level. These relationships have important implications for the prevention of emotional and behavioral problems in children. Full article

The risk of mercury exposure through consumption of fish from Lake Phewa, Nepal was investigated. A total of 170 people were surveyed to know their fish consumption levels. The weekly mercury (Hg) intake in the form of methylmercury (MeHg) through fish was calculated by using the data on average MeHg concentrations in fish, the average consumption of fish per week, and an average body weight of the people. Hotel owners were consuming significantly high amounts of fish, followed by fishermen, in comparison to the government staff, army/police, locals and others (visitors). Some individuals exceeded the Provisional Tolerable Weekly Intake (PTWI) of 1.6 µg per kg body weight of MeHg (FAO/WHO). The minimum intake of MeHg (0.05 µg/kg/week) was found in the visitors (others) category, whereas the hotel owners had the maximum intake (3.71 µg/kg/week). In general, it was found that a person of 60 kg can consume at least 2 kg of fish per week without exceeding PTWI such that it does not pose any health risk associated with Hg poisoning at the present contamination level. Hg based PTWI values for Nepal has not been proposed yet in fishery resources so as to reduce health risk of the people. Full article

A community-based intervention study was conducted to assess a nutrition education intervention on western style fast food consumption among Chinese children and parents. Eight kindergartens from three district areas of Hefei City (a total of 1252 children aged 4–6 years and their parents) were randomly selected. Descriptive and analytical statistical methods were used to evaluate the baseline, midterm, and final western style fast food knowledge, attitude, and practice in both parents and children were used to identify and compare the knowledge, attitude, and practice in the parents and children. Parents and children were divided into “intervention” and “control” groups based on nutrition education status. Consumption of western style fast food at breakfast in Chinese children and parents is not high. The main reasons for this in children is that consumption of western style fast food is not viewed as “food”, but rather as a “gift” or “interesting”. The time of children’s consumption of western style fast food is mostly likely to be in the weekends. The nutrition education modified the parents’ western style fast food behavior (p < 0.01), although it did not change significantly in children. The healthy nutrition concept should be built up among Chinese, especially in children. Insights from the families provide leads for future research and ideas for the nutrition education. Full article

Establishing effective toothbrushing routines using fluoridated toothpaste in infancy has been suggested as important to dental health throughout childhood and into adulthood. However, previous studies have revealed a number of potential barriers to, and facilitators of caregivers ability to establish early dyadic toothbrushing routines with pre-schoolers. However, as yet no qualitative research has been conducted to ascertain potential barriers and facilitators of the earliest dyadic toothbrushing in infancy, and nor has any previous research specifically focused on how novice mothers of first-born infants and preschoolers manage this task. This study therefore outlines findings from a qualitative interview study with first-time mothers of children aged 24–30 months (n = 16) exploring perceived barriers to and facilitators of early dyadic toothbrushing routines with infants and preschoolers. A number of key themes were identified from interview transcripts and an ‘ecological’ approach conceptualised maternally perceived barriers to and facilitators of dyadic toothbrushing. Proximal influences were found to be located within the caregiver-child relationship (‘micro-system’), including parental cognitions (e.g., PSE), parental behaviours (e.g., parenting practices) and infant and preschooler temperament and behaviours (e.g., tantrums). Distal factors were also identified as relevant to the establishment and maintenance of these routines, such as social support (‘exosystem’) and family history of tooth-brushing (‘chronosystem’). Full article

To investigate the association between the ambient air pollution levels during the prenatal and postnatal stages and early childhood neurobehavioral development, our study recruited 533 mother-infant pairs from 11 towns in Taiwan. All study subjects were asked to complete childhood neurobehavioral development scales and questionnaires at 6 and 18 months. Air pollution, including particulate matter ≤10 μm (PM₁₀), carbon monoxide (CO), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and hydrocarbons, was measured at air quality monitoring stations in the towns where the subjects lived. Multilevel analyses were applied to assess the association between air pollution and childhood neurobehavioral development during pregnancy and when the children were 0 to 6 months, 7 to 12 months, and 13 to 18 months old. At 18 months, poor subclinical neurodevelopment in early childhood is associated with the average SO₂ exposure of prenatal, during all trimesters of pregnancy and at postnatal ages up to 12 months (first trimester β = −0.083, se = 0.030; second and third trimester β = −0.114, se = 0.045; from birth to 12 months of age β = −0.091, se = 0.034). Furthermore, adverse gross motor below average scores at six months of age were associated with increased average non-methane hydrocarbon, (NMHC) levels during the second and third trimesters (β = −8.742, se = 3.512). Low-level SO₂ exposure prenatally and up to twelve months postnatal could cause adverse neurobehavioral effects at 18 months of age. Maternal NMHC exposure during the 2nd and 3rd trimesters of pregnancy would be also associated with poor gross motor development in their children at 6 months of age. Full article

This study demonstrates an application of cluster analysis to constant ambient air monitoring data of four pollutants in the Kanto region: NO_x, photochemical oxidant (O_x), suspended particulate matter, and non-methane hydrocarbons. Constant ambient air monitoring can provide important information about the surrounding atmospheric pollution. However, at the same time, ambient air monitoring can place a significant financial burden on some autonomous communities. Thus, it has been necessary to reduce both the number of monitoring stations and the number of chemicals monitored. To achieve this, it is necessary to identify those monitoring stations and pollutants that are least significant, while minimizing the loss of data quality and mitigating the effects on the determination of any spatial and temporal trends of the pollutants. Through employing cluster analysis, it was established that the ambient monitoring stations in the Kanto region could be clustered topologically for NO_x and O_x into eight groups. From the results of this analysis, it was possible to identify the similarities in site characteristics and pollutant behaviors. Full article

Biogas slurry has become a serious pollution problem and anaerobic digestion is widely applied to pig manure treatment for environmental protection and energy recovery. To evaluate environmental risk of the emission of biogas slurry, luminescent bacteria (Vibrio fischeri), larvae and embryos of zebrafish (Danio rerio) were used to detect the acute and development toxicity of digested and post-treated slurry. Then the ability of treatment process was evaluated. The results showed that digested slurry displayed strong toxicity to both zebrafish and luminescent bacteria, while the EC₅₀ for luminescent bacteria and the LC₅₀ for larvae were only 6.81% (v/v) and 1.95% (v/v) respectively, and embryonic development was inhibited at just 1% (v/v). Slurry still maintained a high level of toxicity although it had been treated by membrane bioreactor (MBR), while the LC₅₀ of larvae was 75.23% (v/v) and there was a little effect on the development of embryos and V. fischeri; the results also revealed that the zebrafish larvae are more sensitive than embryos and luminescent bacteria to pig slurry. Finally, we also found the toxicity removal rate was higher than 90% after the treatment of MBR according to toxicity tests. In conclusion, further treatment should be used in pig slurry disposal or reused of final effluent. Full article

Particulate air pollution is linked to impaired respiratory health. We analyzed particle emissions from common indoor sources (candles burning (CB), toasting bread (TB), frying sausages (FS)) and lung function in 55 healthy volunteers (mean age 33.0 years) in a randomized cross-over controlled exposure study. Lung-deposited particle surface area concentration (PSC), size-specific particle number concentration (PNC) up to 10 µm, and particle mass concentration (PMC) of PM₁, PM_2.5 and PM₁₀ were determined during exposure (2 h). FEV₁, FVC and MEF_25%–75% was measured before, 4 h and 24 h after exposure. Wilcoxon-rank sum tests (comparing exposure scenarios) and mixed linear regression using particle concentrations and adjusting for personal characteristics, travel time and transportation means before exposure sessions were performed. While no effect was seen comparing the exposure scenarios and in the unadjusted model, inverse associations were found for PMC from CB and FS in relation to FEV₁ and MEF_25%–75%. with a change in 10 µg/m³ in PM_2.5 from CB being associated with a change in FEV₁ of −19 mL (95%-confidence interval:−43; 5) after 4 h. PMC from TB and PNC of UFP were not associated with lung function changes, but PSC from CB was. Elevated indoor fine particles from certain sources may be associated with small decreases in lung function in healthy adults. Full article

The willingness to pay (WTP) for mortality risk reduction from four causes (lung cancer, other type of cancer, respiratory disease, traffic accident) are estimated using random parameter logit model with data from choice experiment for three regions in Turkey. The value of statistical life (VSL) estimated for Afsin-Elbistan, Kutahya-Tavsanli, Ankara and the pooled case are found as 0.56, 0.35, 0.46 and 0.49 million Purchasing Power Parity (PPP) adjusted 2012 US dollars (USD). Different types of risk cause different VSL estimates and we found the lung cancer premium of 213% against traffic accident. The effects of one-year-delayed provision of risk-reduction service are the reduction of WTP by 482 TL ($318 in PPP adjusted USD) per person on average, and the disutility from status-quo (zero risk reduction) against alternative is found to be 891 TL ($589 in PPP adjusted USD) per person on average. Senior discounts of VSL are partially determined by status-quo preference and the amount of discount decreases once the status-quo bias is removed. The peak VSL is found to be for the age group 30–39 and the average VSL for the age group is 0.8 million PPP adjusted USD). Turkey’s compliance to European Union (EU) air quality standard will cause welfare gains of total 373 million PPP adjusted USD for our study areas in terms of reduced number of premature mortality. Full article

Cerebrospinal meningitis (CSM) is one of the infectious diseases likely to be affected by climate change. Although there are a few studies on the climate change-CSM nexus, none has considered perceptions of community members. However, understanding public perception in relation to a phenomenon is very significant for the design of effective communication and mitigation strategies as well as coping and adaptation strategies. This paper uses focus group discussions (FGDs) to fill this knowledge lacuna. Results show that although a few elderly participants ascribed fatal causes (disobedience to gods, ancestors, and evil spirits) to CSM infections during FGDs, majority of participants rightly linked CSM infections to dry, very hot and dusty conditions experienced during the dry season. Finally, community members use a suite of adaptation options to curb future CSM epidemics. Full article

Background and aims: Little is known about health impacts of climate in pre-industrial societies. We used historical data to investigate the association of temperature and precipitation with total and age-specific mortality in Skellefteå, northern Sweden, between 1749 and 1859. Methods: We retrieved digitized aggregated population data of the Skellefteå parish, and monthly temperature and precipitation measures. A generalized linear model was established for year to year variability in deaths by annual and seasonal average temperature and cumulative precipitation using a negative binomial function, accounting for long-term trends in population size. The final full model included temperature and precipitation of all four seasons simultaneously. Relative risks (RR) with 95% confidence intervals (CI) were calculated for total, sex- and age-specific mortality. Results: In the full model, only autumn precipitation proved statistically significant (RR 1.02; CI 1.00–1.03, per 1cm increase of autumn precipitation), while winter temperature (RR 0.98; CI 0.95–1.00, per 1 °C increase in temperature) and spring precipitation (RR 0.98; CI 0.97–1.00 per 1 cm increase in precipitation) approached significance. Similar effects were observed for men and women. The impact of climate variability on mortality was strongest in children aged 3–9, and partly also in older children. Infants, on the other hand, appeared to be less affected by unfavourable climate conditions. Conclusions: In this pre-industrial rural region in northern Sweden, higher levels of rain during the autumn increased the annual number of deaths. Harvest quality might be one critical factor in the causal pathway, affecting nutritional status and susceptibility to infectious diseases. Autumn rain probably also contributed to the spread of air-borne diseases in crowded living conditions. Children beyond infancy appeared most vulnerable to climate impacts. Full article

This study investigated the potential of aeration control for the achievement of N-removal over nitrite with aerobic granular sludge in sequencing batch reactors. N-removal over nitrite requires less COD, which is particularly interesting if COD is the limiting parameter for nutrient removal. The nutrient removal performances for COD, N and P have been analyzed as well as the concentration of nitrite-oxidizing bacteria in the granular sludge. Aeration phase length control combined with intermittent aeration or alternate high-low DO, has proven to be an efficient way to reduce the nitrite-oxidizing bacteria population and hence achieve N-removal over nitrite. N-removal efficiencies of up to 95% were achieved for an influent wastewater with COD:N:P ratios of 20:2.5:1. The total N-removal rate was 0.18 kgN·m⁻³·d⁻¹. With N-removal over nitrate the N-removal was only 74%. At 20 °C, the nitrite-oxidizing bacteria concentration decreased by over 95% in 60 days and it was possible to switch from N-removal over nitrite to N-removal over nitrate and back again. At 15 °C, the nitrite-oxidizing bacteria concentration decreased too but less, and nitrite oxidation could not be completely suppressed. However, the combination of aeration phase length control and high-low DO was also at 15 °C successful to maintain the nitrite pathway despite the fact that the maximum growth rate of nitrite-oxidizing bacteria at temperatures below 20 °C is in general higher than the one of ammonium-oxidizing bacteria. Full article

Growth in the first year of life may already be predictive of obesity later in childhood. The objective was to assess the association between prenatal exposure to various endocrine disrupting chemicals (EDCs) and child growth during the first year. Dichloro-diphenyldichloroethylene (DDE), mono(2-ethyl-5-carboxypentyl)phthalate (MECPP), mono(2-ethyl-5-hydroxyhexyl)phthalate (MEHHP), mono(2-ethyl-5-oxohexyl)phthalate (MEOHP), polychlorinated biphenyl-153, perfluorooctanesulfonic acid, and perfluoro-octanoic acid were measured in cord plasma or breast milk. Data on weight, length, and head circumference (HC) until 11 months after birth was obtained from 89 mother-child pairs. Mixed models were composed for each health outcome and exposure in quartiles. For MEOHP, boys in quartile 1 had a higher BMI than higher exposed boys (p = 0.029). High DDE exposure was associated with low BMI over time in boys (0.8 kg/m² difference at 11 m). Boys with high MECPP exposure had a greater HC (1.0 cm difference at 11 m) than other boys (p = 0.047), as did girls in the second quartile of MEHHP (p = 0.018) and DDE (p < 0.001) exposure. In conclusion, exposure to phthalates and DDE was associated with BMI as well as with HC during the first year after birth. These results should be interpreted with caution though, due to the limited sample size. Full article

Limited data are available from Jordan examining patterns of tobacco use among adolescents, or how use is related to health perceptions. This study aims to estimate the prevalence of tobacco use and to assess the relationship between use and health-related perceptions. A cross-sectional survey was conducted among a sample of 11–18 year old school students from a major governorate in Jordan. Using a multistage random sampling 1050 students were selected. Students were categorized as non-smokers, cigarette-only smokers, waterpipe-only smokers, or dual smokers. Rates of waterpipe-only and cigarette-only smoking were 7% and 3%, respectively, and were similar for boys and girls. In contrast, the rate of dual use was much higher than for single product use and was double in girls compared to boys (34% vs. 17%). Dual-smokers were significantly more likely to think that it is safe to smoke as long as the person intends to quit within two years compared to non-smokers, and had lower self-rated health status than other groups. This is the first study among Arab adolescents to document high rates of dual tobacco use, especially pronounced among girls. The study findings have significant implications for designing tobacco smoking prevention programs for school health settings. Full article

The urinary excretion rate is calculated based on short-term, defined time sample collections with a known sample mass, and this measurement can be used to remove the variability in urine concentrations due to urine dilution. Adjustment to the urinary excretion rate of hippuric acid was evaluated in 31 healthy volunteers (14 males and 17 females). Urine was collected as short-term or spot samples and tested for specific gravity, creatinine and hippuric acid. Hippuric acid values were unadjusted or adjusted to measurements of specific gravity, creatinine or urinary excretion rate. Hippuric acid levels were partially independent of urinary volume and urinary flow rate, in contrast to specific gravity and creatinine, which were both highly dependent on the hippuric acid level. Accordingly, hippuric acid was independent on urinary specific gravity and creatinine excretion. Unadjusted and adjusted values for specific gravity or creatinine were generally closely correlated, especially in spot samples. Values adjusted to the urinary excretion rate appeared well correlated to those unadjusted and adjusted to specific gravity or creatinine values. Thus, adjustment of crude hippuric acid values to the urinary excretion rate is a valid procedure but is difficult to apply in the field of occupational medicine and does not improve the information derived from values determined in spot urine samples, either unadjusted or adjusted to specific gravity and creatinine. Full article

Since reforms carried out in the late 1970s, China has experienced unprecedented rates of urban growth. Remote sensing data and surface observational data are used to investigate the urbanization process and related environmental consequences, focusing on extreme heat events and air pollution, in Zhejiang Province (ZJP, East China). Examination of satellite-measured nighttime light data indicates rapid urbanization in ZJP during the past decade, initially forming three urban clusters. With rapid urban sprawl, a significant Urban Heat Island (UHI) effect has emerged. During extreme heat events in summer, the UHI effect significantly exacerbates nocturnal heat stress in highly urbanized areas. Taking a long-term view, urbanization also causes additional hot days and hot degree days in urban areas. Urbanization also imposes a heavy burden on local and regional air quality in ZJP. Degraded visibility and an increase in haze days are observed at most meteorological stations, especially in the three urban clusters. The results show that urbanization has led to serious environmental problems in ZJP, not only on the city scale, but also on the regional scale. Maintaining a balance between the continuing process of urbanization and environmental sustainability is a major issue facing the local government. Full article

Background: The understanding of the complex relationship between the home environment, well-being and daily functioning in the third age is currently weak. The aim of this paper is to present the methodological background of the Home and Health in the Third Age Study, and describe a sample of men and women in relation to their home and health situation. Methods and Design: The study sample included 371 people aged 67–70, living in ordinary housing in the south of Sweden. Structured interviews and observations were conducted to collect data about objective and perceived aspects of home and health. Results: The majority of the participants were in good health and had few functional limitations. Women had more functional limitations and reported more symptoms than men. Environmental barriers were found in every home investigated; the most were found in the kitchen and hygiene area. Environmental barriers were more common in multi-family than in one-family dwellings. Discussion: This study will increase our knowledge on home and health dynamics among people in the third age. The results have potential to contribute to societal planning related to housing provision, home care and social services for senior citizens. Full article

This study evaluated the indoor air quality in Brazilian universities by comparing thirty air-conditioned (AC) (n = 15) and naturally ventilated (NV) (n = 15) classrooms. The parameters of interest were indoor carbon dioxide (CO₂), temperature, relative humidity (RH), wind speed, viable mold, and airborne dust levels. The NV rooms had larger concentration of mold than the AC rooms (1001.30 ± 125.16 and 367.00 ± 88.13 cfu/m³, respectively). The average indoor airborne dust concentration exceeded the Brazilian standards (<80 µg/m³) in both NV and AC classrooms. The levels of CO₂ in the AC rooms were significantly different from the NV rooms (1433.62 ± 252.80 and 520.12 ± 37.25 ppm, respectively). The indoor air quality in Brazilian university classrooms affects the health of students. Therefore, indoor air pollution needs to be considered as an important public health problem. Full article

This paper presents findings from real life situations, a longitudinal single case study on the role of natural environments in nature-based rehabilitation (NBR) for individuals with stress-related mental disorders, at the Alnarp Rehabilitation Garden in Sweden. A sample of 43 former clients voluntarily participated in semi-structured interview, and the data were analyzed according to interpretative phenomenological analysis (IPA). Three main superordinate themes were identified as the three phases of NBR—Prelude, Recuperating and Empowerment—explaining and illuminating the role of the natural environments in each phase. An explanatory model of NBR in this context is presented including the three phases of NBR, IRP supportive occupations and a pyramid of supporting environments. A new component of supportive environments was identified and herby named, Social quietness, an important component facilitating personal and intimate engagement with the natural environments. Full article

After decades of strict pollution control and municipal sewage treatment, the water quality of the Tanshui River increased significantly after pollution mitigation as indicated by the River Pollution Index (RPI). The pollution level of the estuarine region decreased from severe pollution to mostly moderately impaired. The most polluted waters are presently restricted to a flow track length between 15–35 km relative to the river mouth. From July 2011 to September 2012, four surveys of fish and benthic macroinvertebrates were conducted at 45 sampling sites around the Tanshui River basin. The pollution level of all the study area indicated by the RPI could also be explained by the Family Biotic Index (FBI) and Biotic Index (BI) from the benthic macroinvertebrate community, and the Index of Biotic Integrity (IBI) of the fish community. The result of canonical correlation analysis between aquatic environmental factors and community structure indicated that the community structure was closely related to the level of water pollution. Fish species richness in the estuarine area has increased significantly in recent years. Some catadromous fish and crustaceans could cross the moderate polluted water into the upstream freshwater, and have re-colonized their populations. The benthic macroinvertebrate community relying on the benthic substrate of the estuarine region is still very poor, and the water layer was still moderately polluted. Full article

The Czech government has identified commercial health insurance as one of the major problems for migrants’ access to health care. Non-EU immigrants are eligible for public health insurance only if they have employee status or permanent residency. The present study examined migrants’ access to the public health insurance system in Czechia. A cross-sectional survey of 909 immigrants from Ukraine and Vietnam was conducted in March and May 2013, and binary logistic regression was applied in data analysis. Among immigrants entitled to Czech public health insurance due to permanent residency/asylum, 30% were out of the public health insurance system, and of those entitled by their employment status, 50% were out of the system. Migrants with a poor knowledge of the Czech language are more likely to remain excluded from the system of public health insurance. Instead, they either remain in the commercial health insurance system or they simultaneously pay for both commercial and public health insurance, which is highly disadvantageous. Since there are no reasonable grounds to stay outside the public health insurance, it is concluded that it is lack of awareness that keeps eligible immigrants from entering the system. It is suggested that no equal access to health care exists without sufficient awareness about health care system. Full article

This study investigates whether more physically active parents bring up more physically active children and whether parents’ level of physical activity helps children achieve step count recommendations on weekdays and weekends. The participants (388 parents aged 35–45 and their 485 children aged 9–12) were randomly recruited from 21 Czech government-funded primary schools. The participants recorded pedometer step counts for seven days (≥10 h a day) during April–May and September–October of 2013. Logistic regression (Enter method) was used to examine the achievement of the international recommendations of 11,000 steps/day for girls and 13,000 steps/day for boys. The children of fathers and mothers who met the weekend recommendation of 10,000 steps were 5.48 (95% confidence interval: 1.65; 18.19; p < 0.01) and 3.60 times, respectively (95% confidence interval: 1.21; 10.74; p < 0.05) more likely to achieve the international weekend recommendation than the children of less active parents. The children of mothers who reached the weekday pedometer-based step count recommendation were 4.94 times (95% confidence interval: 1.45; 16.82; p < 0.05) more likely to fulfil the step count recommendation on weekdays than the children of less active mothers. Full article

Anaerobic digestion of animal manure in biogas digesters has shown promise as a technology in reducing the microbial load to safe and recommended levels. We sought to treat dairy manure obtained from the Fort Hare Dairy Farm by investigating the survival rates of bacterial pathogens, through a total viable plate count method, before, during and after mesophilic anaerobic digestion. Different microbiological media were inoculated with different serial dilutions of manure samples that were withdrawn from the biogas digester at 3, 7 and 14 day intervals to determine the viable cells. Data obtained indicated that the pathogens of public health importance were 90%–99% reduced in the order: Campylobacter sp. (18 days) < Escherichia coli sp. (62 days) < Salmonella sp. (133 days) from a viable count of 10.1 × 10³, 3.6 × 10⁵, 7.4 × 10³ to concentrations below the detection limit (DL = 10² cfu/g manure), respectively. This disparity in survival rates may be influenced by the inherent characteristics of these bacteria, available nutrients as well as the stages of the anaerobic digestion process. In addition, the highest p-value i.e., 0.957 for E. coli showed the statistical significance of its model and the strongest correlation between its reductions with days of digestion. In conclusion, the results demonstrated that the specific bacterial pathogens in manure can be considerably reduced through anaerobic digestion after 133 days. Full article

Differences in recess physical activity (PA) according to perceived school environment among elementary school children were examined. Participants were 103 children from two schools in Japan. PA was measured using accelerometry for seven consecutive days. Time spent in sedentary or PA (light, moderate, or vigorous) during their morning recess (25 min) and lunch recess (15 min) was determined. The School Physical Activity Environment Scale (three factors: equipment, facility, and safety) was used to investigate perceived school environment. Environmental factor scores were assigned to low or high groups for each factor by median. An analysis of covariance, with grade as the covariate, was conducted separately by gender to examine differences in PA between two groups. During lunch recess, boys in the high-equipment group spent significantly more time in moderate PA (high: 1.5; low: 0.8 min) whereas girls in this group spent less time in light PA (9.3, 11.0). Boys in the high-facility group spent significantly less time in sedentary (2.3, 3.9) and more time in vigorous PA (2.4, 1.4) during lunch recess, and girls spent more time in moderate (2.1, 1.2) and vigorous PA (1.9, 1.3) during morning recess. Differences were observed in recess PA according to school environment perceptions. The present study may be useful for further intervention studies for the promotion of PA during recess. Full article

The present study investigated the well-being effects of short-term forest walking and viewing (“forest bathing”). The hypothesis in our study was that both environment (forest vs. urban) and activity (walking and viewing) would influence psychological outcomes. An additional aim was to enhance basic research using several psychological methods. We conducted the experiments using 45 respondents in four areas of Japan from August to September, 2011. The hypothesis in our study was supported, because significant interaction terms between the environment and activity were confirmed regarding the Profile of Mood States (POMS) indexes, Restorative Outcome Scale (ROS) and Subjective Vitality Scale (SVS). No statistical differences between the two experimental groups in any of the ten scales were found before the experiment. However, feelings of vigor and positive effects, as well as feelings of subjective recovery and vitality were stronger in the forest environment than in the urban environment. Full article

Following few decades of commercial use, perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) have been found in human blood and serum. We determined the amounts of PFOA and PFOS in human plasma (n = 183) and the effects of multiple uses of food-contact materials and smoking habits and alcohol consumption using liquid chromatography time-of-flight mass spectrometry (LC/TOF-MS). For the paper cups, the PFOA level in the plasma of the heavy user group was 1.37 times higher than that of the light user group. However, no association between the effects of multiple uses of food-contact materials and the plasma levels of PFOA and PFOS was found, except for paper cups. Active smokers had lower plasma levels of PFOA and PFOS than non-smokers. We show that multiple uses of food-contact materials do not appear to be a significant source of PFOA and PFOS. Full article

A marked increase in canine leptospirosis was observed in Switzerland over 10 years with a peak incidence of 28.1 diagnosed cases/100,000 dogs/year in the most affected canton. With 95% affected dogs living at altitudes <800 m, the disease presented a seasonal pattern associated with temperature (r² 0.73) and rainfall (r² 0.39), >90% cases being diagnosed between May and October. The increasing yearly incidence however was only weakly correlated with climatic data including number of summer (r² 0.25) or rainy days (r² 0.38). Serovars Australis and Bratislava showed the highest seropositivity rates with 70.5% and 69.1%, respectively. Main clinical manifestations included renal (99.6%), pulmonary (76.7%), hepatic (26.0%), and hemorrhagic syndromes (18.2%), leading to a high mortality rate (43.3%). Similar to the human disease, liver involvement had the strongest association with negative outcome (OR 16.3). Based on these data, canine leptospirosis presents similar features and severity as the human infection for which it therefore can be considered a model. Its re-emergence in a temperate country with very high incidence rates in canines should thus be viewed as a warning and emphasize the need for increased awareness in other species. Full article

There is evidence that cardiorespiratory fitness and physical activity significantly reduce cardiovascular risks in adults. A better understanding of the association between cardiorespiratory fitness, physical activity, and childhood obesity is vital in assessing the benefits of interventions to prevent obesity. This study was to examine the relationship between physical activity, body mass index, and cardiorespiratory fitness levels in Taiwanese children. A cross-sectional study was designed. Study participants consisted of 2419 school children (1230 males and 1189 females) aged 12 years old living in a southern Taiwan county with one the highest countrywide rates of childhood obesity. The weight status of the participants was defined as underweight, normal, overweight, or obese according to specific criteria. Cardiorespiratory fitness was then assessed by an 800-m run. Participants were queried on their physical activity habits via a questionnaire survey. The overall prevalence of overweight/obesity was 29.6%. Normal, underweight and overweight boys and girls had an increased odds ratio of being categorized with higher cardiorespiratory fitness than obese one for both gender. A significantly higher level of cardiorespiratory fitness was found in children who engaged in regular physical activity than in children who engaged only in irregular physical activity. Obese children are more likely to lack cardiorespiratory fitness. Physically active children have significantly better cardiorespiratory fitness levels than inactive children. This study supports the conclusion that BMI and physical activity are significantly correlated with cardiorespiratory fitness levels. Findings may provide educational professionals with information to assist their developing effective health promotion programs to healthy weight and improving cardiorespiratory fitness for children. Full article

Industrial and mining activities have been recognized as the major sources of soil heavy metal contamination. This study introduced an improved Nemerow index method based on the Nemerow and geo-accumulation index. Taking a typical industrial and mining gathering area in Tianjin (China) as example, this study then analyzed the contamination sources as well as the ecological and integrated risks. The spatial distribution of the contamination level and ecological risk were determined using Geographic Information Systems. The results are as follows: (1) Zinc showed the highest contaminant level in the study area; the contamination levels of the other seven heavy metals assessed were relatively lower. (2) The combustion of fossil fuels and emissions from industrial and mining activities were the main sources of contamination in the study area. (3) The overall contamination level of heavy metals in the study area ranged from heavily contaminated to extremely contaminated and showed an uneven distribution. (4) The potential ecological risk showed an uneven distribution, and the overall ecological risk level ranged from low to moderate. This study also emphasized the importance of partition in industrial and mining areas, the extensive application of spatial analysis methods, and the consideration of human health risks in future studies. Full article

The global financial crisis of 2008 has led to the reinforcement of patient cost sharing in health care policy. This study aimed to explore the impact of direct out-of pocket payments (OOPs) on health care utilization and the resulting financial burden across income groups under the South Korean National Health Insurance (NHI) program with universal population coverage. We used the fourth Korean National Health and Nutrition Examination Survey (KNHNES-IV) and the Korean Household Income and Expenditure Survey (KHIES) of 2007, 2008 and 2009. The Horizontal Inequity Index (HIwv) and the average unit OOPs were used to measure income-related inequity in the quantitative and qualitative aspects of health care utilization, respectively. For financial burden, the incidence rates of catastrophic health expenditure (CHE) were compared across income groups. For outpatient and hospital visits, there was neither pro-poor or pro-rich inequality. The average unit OOPs of the poorest quintile was approximately 75% and 60% of each counterpart in the richest quintile in the outpatient and inpatient services. For the CHE threshold of 40%, the incidence rates were 5.7%, 1.67%, 0.72%, 0.33% and 0.27% in quintiles I (the poorest quintile), II, III, IV and V, respectively. Substantial OOPs under the NHI are disadvantageous, particularly for the lowest income group in terms of health care quality and financial burden. Full article

Incomplete arsenic (As) methylation has been considered a risk factor of As-related diseases. This study aimed to examine the difference of urinary As metabolites and the methylation capacity between subjects with and without skin lesions. Urinary inorganic arsenic (iAs), monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) were analyzed. The percentage of each As species (iAs%, MMA%, and DMA%), the primary methylation index (PMI) and secondary methylation index (SMI) were calculated. The results showed that subjects with skin lesions have higher levels of urinary iAs (99.08 vs. 70.63 μg/g Cr, p = 0.006) and MMA (69.34 vs. 42.85 μg/g Cr, p = 0.016) than subjects without skin lesions after adjustment for several confounders. Significant differences of urianry MMA% (15.49 vs. 12.11, p = 0.036) and SMI (0.74 vs. 0.81, p = 0.025) were found between the two groups. The findings of the present study suggest that subjects with skin lesions may have a lower As methylation capacity than subjects without skin lesions. Full article

Drinking water quality monitoring programs aim to support provision of safe drinking water by informing water quality management. Little evidence or guidance exists on best monitoring practices for low resource settings. Lack of financial, human, and technological resources reduce a country’s ability to monitor water supply. Monitoring activities were characterized in Cambodia, Colombia, India (three states), Jordan, Peru, South Africa, and Uganda according to water sector responsibilities, monitoring approaches, and marginal cost. The seven study countries were selected to represent a range of low resource settings. The focus was on monitoring of microbiological parameters, such as E. coli, coliforms, and H₂S-producing microorganisms. Data collection involved qualitative and quantitative methods. Across seven study countries, few distinct approaches to monitoring were observed, and in all but one country all monitoring relied on fixed laboratories for sample analysis. Compliance with monitoring requirements was highest for operational monitoring of large water supplies in urban areas. Sample transport and labor for sample collection and analysis together constitute approximately 75% of marginal costs, which exclude capital costs. There is potential for substantive optimization of monitoring programs by considering field-based testing and by fundamentally reconsidering monitoring approaches for non-piped supplies. This is the first study to look quantitatively at water quality monitoring practices in multiple developing countries. Full article

The issue of drinking water quality compliance in small and medium scale water services is of paramount importance in relation to the 98/83/CE European Drinking Water Directive (DWD). Additionally, concerns are being expressed over the implementation of the DWD with respect to possible impacts on water quality from forecast changes in European climate with global warming and further anticipated reductions in north European acid emissions. Consequently, we have developed a decision support system (DSS) named ARTEM-WQ (AwaReness Tool for the Evaluation and Mitigation of drinking Water Quality issues resulting from environmental changes) to support decision making by small and medium plant operators and other water stakeholders. ARTEM-WQ is based on a sequential risk analysis approach that includes consideration of catchment characteristics, climatic conditions and treatment operations. It provides a holistic evaluation of the water system, while also assessing human health risks of organic contaminants potentially present in treated waters (steroids, pharmaceuticals, pesticides, bisphenol-a, polychlorobiphenyls, polycyclic aromatic hydrocarbons, petrochemical hydrocarbons and disinfection by-products; n = 109). Moreover, the system provides recommendations for improvement while supporting decision making in its widest context. The tool has been tested on various European catchments and shows a promising potential to inform water managers of risks and appropriate mitigative actions. Further improvements should include toxicological knowledge advancement, environmental background pollutant concentrations and the assessment of the impact of distribution systems on water quality variation. Full article

Although small, rural water supplies may present elevated microbial risks to consumers in some settings, characterizing exposures through representative point-of-consumption sampling is logistically challenging. In order to evaluate the usefulness of consumer self-reported data in predicting measured water quality and risk factors for contamination, we compared matched consumer interview data with point-of-survey, household water quality and pressure data for 910 households served by 14 small water systems in rural Alabama. Participating households completed one survey that included detailed feedback on two key areas of water service conditions: delivery conditions (intermittent service and low water pressure) and general aesthetic characteristics (taste, odor and color), providing five condition values. Microbial water samples were taken at the point-of-use (from kitchen faucets) and as-delivered from the distribution network (from outside flame-sterilized taps, if available), where pressure was also measured. Water samples were analyzed for free and total chlorine, pH, turbidity, and presence of total coliforms and Escherichia coli. Of the 910 households surveyed, 35% of participants reported experiencing low water pressure, 15% reported intermittent service, and almost 20% reported aesthetic problems (taste, odor or color). Consumer-reported low pressure was associated with lower gauge-measured pressure at taps. While total coliforms (TC) were detected in 17% of outside tap samples and 12% of samples from kitchen faucets, no reported water service conditions or aesthetic characteristics were associated with presence of TC. We conclude that consumer-reported data were of limited utility in predicting potential microbial risks associated with small water supplies in this setting, although consumer feedback on low pressure—a risk factor for contamination—may be relatively reliable and therefore useful in future monitoring efforts. Full article

Inhalation of potable water presents a potential route of exposure to opportunistic pathogens and hence warrants significant public health concern. This study used qPCR to detect opportunistic pathogens Legionella spp., L. pneumophila and MAC at multiple points along two potable water distribution pipelines. One used chlorine disinfection and the other chloramine disinfection. Samples were collected four times over the year to provide seasonal variation and the chlorine or chloramine residual was measured during collection. Legionella spp., L. pneumophila and MAC were detected in both distribution systems throughout the year and were all detected at a maximum concentration of 10³ copies/mL in the chlorine disinfected system and 10⁶, 10³ and 10⁴ copies/mL respectively in the chloramine disinfected system. The concentrations of these opportunistic pathogens were primarily controlled throughout the distribution network through the maintenance of disinfection residuals. At a dead-end and when the disinfection residual was not maintained significant (p < 0.05) increases in concentration were observed when compared to the concentration measured closest to the processing plant in the same pipeline and sampling period. Total coliforms were not present in any water sample collected. This study demonstrates the ability of Legionella spp., L. pneumophila and MAC to survive the potable water disinfection process and highlights the need for greater measures to control these organisms along the distribution pipeline and at point of use. Full article

This study describes alcohol consumption in five Western Cape Province communities. Cross-sectional data from a community household sample (n = 591) describe the alcohol use patterns of adult males and females, and farm workers vs. others. Data reveal that men were more likely to be current drinkers than women, 75.1% vs. 65.8% (p = 0.033); farm laborers were more likely to be current drinkers than individuals in other occupations 83.1% vs. 66.8% (p = 0.004). Group, binge drinking on weekends was the norm; men were more likely to be binge drinkers in the past week than women 59.8% vs. 48.8% (p = 0.086); farm workers were more likely to binge than others 75.0% vs. 47.5% (p < 0.001). The legacy of “Dop” contributes to current risky drinking behaviors. Farm owners or managers were interviewed on 11 farms, they described working conditions on their farms and how the legacy of “Dop” is reflected in the current use of alcohol by their workers. “Dop” was given to farm workers in the past on six of the 11 farms, but was discontinued for different reasons. There is zero tolerance for coming to work intoxicated; farm owners encourage responsible use of alcohol and assist farm workers in getting help for alcohol problems when necessary. The farm owners report some positive initiatives, were ahead of the movement to provide meaningful wages, and provide other important amenities. Further research is needed to assess whether progressive practices on some farms will reduce harmful alcohol use. Full article

Obesity among young people increases lifetime cardiovascular risk. This study assesses the prevalence of overweight/obesity and its associated factors among a random sample of university students from 22 universities in 22 low, middle income and emerging economy countries. This cross-sectional survey comprised of a self-administered questionnaire and collected anthropometric measurements. The study population was 6773 (43.2%) males and 8913 (56.8%) females, aged 16 to 30 years (mean 20.8 years, SD = 2.6). Body mass index (BMI) was used for weight status. Among men, the prevalence of underweight was 10.8%, normal weight 64.4%, overweight 18.9% and obesity 5.8%, while among women, the prevalence of underweight was 17.6%, normal weight 62.1%, overweight 14.1% and obesity 5.2%. Overall, 22% were overweight or obese (24.7% men and 19.3% women). In multivariate regression among men, younger age, coming from a higher income country, consciously avoiding fat and cholesterol, physically inactivity, current tobacco use and childhood physical abuse, and among women older age, coming from a higher income country, frequent organized religious activity, avoiding fat and cholesterol, posttraumatic stress symptoms and physical childhood abuse were associated overweight or obesity. Several gender specific risk factors identified can be utilized in health promotion programmes. Full article

The cardiovascular and stroke mortality rates in Arkansas are among the highest in the USA. The annual trends of stroke and cardiovascular mortality are barely correlated to smoking cessation; while the prevalence of risk factors such as obesity; cholesterol and hypertension increased over the 1979–2007 period. The study determined the effect of chronic exposure to PM_2.5 on non-accidental; cardiovascular; stroke and lung cancer mortality in Arkansas over the 2000–2010 period using the World Health Organization’s log-linear health impact model. County chronic exposures to PM_2.5 were computed by averaging spatially-resolved gridded concentrations using PM_2.5 observations. A spatial uniformity was observed for PM_2.5 mass levels indicating that chronic exposures were comparable throughout the state. The reduction of PM_2.5 mass levels by 3.0 μg/m³ between 2000 and 2010 explained a significant fraction of the declining mortality. The effect was more pronounced in southern and eastern rural Arkansas as compared to the rest of the state. This study provides evidence that the implementation of air pollution regulations has measurable effects on mortality even in regions with high prevalence of major risk factors such as obesity and smoking. These outcomes are noteworthy as efforts to modify the major risk factors require longer realization times. Full article

A synthetic tripodal-based thiourea receptor (PNTTU) was used to explore the receptor/ligand binding affinity using CTB cells. The human extravillous CTB cells (Sw.71) used in this study were derived from first trimester chorionic villus tissue. The cell proliferation, migration and angiogenic factors were evaluated in PNTTU-treated CTB cells. The PNTTU inhibited the CTBs proliferation and migration. The soluble fms-like tyrosine kinase-1 (sFlt-1) secretion was increased while vascular endothelial growth factor (VEGF) was decreased in the culture media of CTB cells treated with ≥1 nM PNTTU. The angiotensin II receptor type 2 (AT₂) expression was significantly upregulated in ≥1 nM PNTTU-treated CTB cells in compared to basal; however, the angiotensin II receptor, type 1 (AT₁) and vascular endothelial growth factor receptor 1 (VEGFR-1) expression was downregulated. The anti-proliferative and anti-angiogenic effect of this compound on CTB cells are similar to the effect of CTSs. The receptor/ligand affinity of PNTTU on CTBs provides us the clue to design a potent inhibitor to prevent the CTS-induced impairment of CTB cells. Full article

Mortality represents an important outcome measure following coronary artery bypass grafting. Shorter survival times may reflect poor surgical quality and an increased number of costly postoperative complications. Quality control efforts aimed at increasing survival times may be misleading if not properly adjusted for case-mix severity. This paper demonstrates how to construct and cross-validate efficiency-outcome plots for a specified time (e.g., 6-month and 1-year survival) after coronary artery bypass grafting, accounting for baseline cardiovascular risk factors. The application of this approach to regional centers allows for the localization of risk stratification rather than applying overly broad and non-specific models to their patient populations. Full article

Induced pluripotent stem cells (IPS) are an artificially derived type of pluripotent stem cell, showing many of the same characteristics as natural pluripotent stem cells. IPS are a hopeful therapeutic model; however there is a critical need to determine their response to environmental toxins. Effects of arsenic on cells have been studied extensively; however, its effect on IPS is yet to be elucidated. Arsenic trioxide (ATO) has been shown to inhibit cell proliferation, induce apoptosis and genotoxicity in many cells. Based on ATOs action in other cells, we hypothesize that it will induce alterations in morphology, inhibit cell viability and induce a genotoxic effect on IPS. Cells were treated for 24 hours with ATO (0–9 µg/mL). Cell morphology, viability and DNA damage were documented. Results indicated sufficient changes in morphology of cell colonies mainly in cell ability to maintain grouping and ability to remain adherent. Cell viability decreased in a dose dependent manner. There were significant increases in tail length and moment as well as destruction of intact DNA as concentration increased. Exposure to ATO resulted in a reproducible dose dependent sequence of events marked by changes in morphology, decrease of cell viability, and induction of genotoxicity in IPS. Full article

The aim of this paper is to analyse the current status and scientific value of malaria vaccine approaches and to provide a realistic prognosis for future developments. We systematically review previous approaches to malaria vaccination, address how vaccine efforts have developed, how this issue may be fixed, and how external forces shape vaccine development. Our analysis provides significant information on the various aspects and on the external factors that shape malaria vaccine development and reveal the importance of vaccine development in our society. Full article

The aetiology and pathogenesis of bacterial vaginosis (BV) is unclear but it appears to be associated with factors that disrupt the normal acidity of the vagina thus altering the equilibrium between the normal vaginal microbiota. BV has serious implications for female morbidity, including reports of pelvic inflammatory disease, adverse pregnancy outcomes, increased susceptibility to sexually transmitted infections and infertility. This paper reviewed new available information regarding possible factors contributing to the establishment of the BV vaginal biofilm, examined the proposed role of anaerobic microbial species recently detected by new culture-independent methods and discusses developments related to the effects of BV on human pregnancy. The literature search included Pubmed (NLM), LISTA (EBSCO), and Web of Science. Because of the complexity and diversity of population groups, diagnosis and methodology used, no meta-analysis was performed. Several anaerobic microbial species previously missed in the laboratory diagnosis of BV have been revealed while taking cognisance of newly proposed theories of infection, thereby improving our understanding and knowledge of the complex aetiology and pathogenesis of BV and its perceived role in adverse pregnancy outcomes. Full article

Traditionally, nicotine from second hand smoke (SHS), active or passive, has been considered the most prevalent substance of abuse used during pregnancy in industrialized countries. Exposure to environmental tobacco smoke (ETS) is associated with a variety of health effects, including lung cancer and cardiovascular diseases. Tobacco is also a major burden to people who do not smoke. As developing individuals, newborns and children are particularly vulnerable to the negative effects of SHS. In particular, prenatal ETS has adverse consequences during the entire childhood causing an increased risk of abortion, low birth weight, prematurity and/or nicotine withdrawal syndrome. Over the last years, a decreasing trend in smoking habits during pregnancy has occurred, along with the implementation of laws requiring smoke free public and working places. The decrease in the incidence of prenatal tobacco exposure has usually been assessed using maternal questionnaires. In order to diminish bias in self-reporting, objective biomarkers have been developed to evaluate this exposure. The measurement of nicotine and its main metabolite, cotinine, in non-conventional matrices such as cord blood, breast milk, hair or meconium can be used as a non-invasive measurement of prenatal SMS in newborns. The aim of this review is to highlight the prevalence of ETS (prenatal and postnatal) using biomarkers in non-conventional matrices before and after the implementation of smoke free policies and health effects related to this exposure during foetal and/or postnatal life. Full article

In 2012 the U.S. Centers for Disease Control (CDC) set the blood Pb reference value at ≥5 µg/dL. Clinical analysis of children’s blood Pb levels is the common way to diagnose environmental Pb contamination, and intervention ensues with education and household dust cleanup. Recent review indicates that education and household dust cleanup are not effective at reducing children’s Pb exposure. Here we review mapping environmental Pb and children’s blood Pb response as an alternative approach for proactive Pb dust intervention. New Orleans was divided into a high (≥100 mg/kg) and low (<100 mg/kg) soil Pb communities. The children’s blood Pb prevalence ≥5 µg/dL for the high and low Pb domains were 58.5% and 24.8% respectively pre-Katrina vs. 29.6% and 7.5% post-Katrina. Elevated soil Pb (mg/kg) and consequently Pb loading (µg/square area) permeates the high Pb domain and outdoor locations lack Pb dust safe play areas. The U.S. EPA 400 mg/kg soil Pb standard poses an outside Pb dust loading burden >37 times larger than allowed on interior residential floor environments. Environmental Pb dust is decreasing because of the transfer of large quantities of low Pb soil into selected communities. City-scale soil Pb mapping is an alternative diagnostic tool that provides information for planning proactive medicine to prevent clinical Pb exposure in the first place. Full article

Recently the existence and prevalence of health and health care disparities has increased with accompanying research showing that minorities (African Americans, Hispanics/Latinos, Native Americans, and Pacific Islanders) are disproportionately affected resulting in poorer health outcomes compared to non-minority populations (whites). This is due to multiple factors including and most importantly the social determinants of health which includes lower levels of education, overall lower socioeconomic status, inadequate and unsafe housing, and living in close proximity to environmental hazards; all contributing to poor health. Given the ever widening gap in health and health care disparities, the growing number of individuals living at or below the poverty level, the low number of college graduates and the growing shortage of health care professionals (especially minority) the goals of this paper are to: (1) Define diversity and inclusion as interdependent entities. (2) Review the health care system as it relates to barriers/problems within the system resulting in the unequal distribution of quality health care. (3) Examine institutional and global benefits of increasing diversity in research. (4) Provide recommendations on institutional culture change and developing a diverse culturally competent healthcare workforce. Full article

Bisphenol A (BPA) is a synthetic compound used in the production of many polycarbonate plastics and epoxy resins. It is one of the most widely produced chemicals in the world today and is found in most canned goods, plastics, and even household dust. Exposure to BPA is almost universal: most people have measurable amounts of BPA in both urine and serum. BPA is similar in structure to estradiol and can bind to multiple targets both inside and outside the nucleus, in effect acting as an endocrine disruptor. Research on BPA exposure has accelerated in the past decade with findings suggesting that perinatal exposure to BPA can negatively impact both male and female reproduction, create alterations in behavior, and act as a carcinogen. BPA can have both short term and long term effects with the latter typically occurring through epigenetic mechanisms such as DNA methylation. This review will draw on both human and animal studies in an attempt to synthesize the literature and examine the effects of BPA exposure on reproduction, behavior, and carcinogenesis with a focus on the potential epigenetic mechanisms by which it acts. Full article

Bruun and colleagues [1] provide a timely and thorough insight into the potential health opportunities on offer via the structural organisation of football associations, football clubs and the global grip of the beautiful game. Their extensive evaluation framework represents an important clarion call for those concerned with football-led health improvement. At the same time, it is wise to consider how this can be made realistic and relevant to those who may regard the football-led ‘concept’ as too alternative or even inappropriate, in the contemporary socio-political and economic context. [...] Full article

Campylobacter jejuni is the most common food-borne zoonotic pathogen causing human gastroenteritis worldwide and has assumed more importance in Italy following the increased consumption of raw milk. Our objectives were to get an overview of genotypes and antibiotic resistances in C. jejuni isolated from milk, cattle feces, and pigeons in dairy herds of Northern Italy. flaB-typing was applied to 78 C. jejuni isolates, previously characterized by Multi-Locus Sequence Typing, and genotypic resistances towards macrolides and quinolones based on point mutations in the 23S rRNA and gyrA genes, respectively, were determined. flaB-typing revealed 22 different types with one of them being novel and was useful to further differentiate strains with an identical Sequence Type (ST) and to identify a pigeon-specific clone. Macrolide resistance was not found, while quinolone resistance was detected in 23.3% of isolates. A relationship between specific genotypes and antibiotic resistance was observed, but was only significant for the Clonal Complex 206. Our data confirm that pigeons do not play a role in the spread of C. jejuni among cattle and they are not responsible for milk contamination. A relevant number of bulk milk samples were contaminated by C. jejuni resistant to quinolones, representing a possible source of human resistant strains. Full article

Increasing urbanization across the globe, combined with an increased use of chemicals in various regions, contributes to several environmental events that influence environmental health. Measures that identify environmental factors and events should be introduced to facilitate epidemiological investigations by health services. The Brazilian Ministry of Health published a new list of notifiable diseases on 25 January 2011 and introduced environmental events as a new category of notifiable occurrences. The Center for Epidemiologic Surveillance in State of Sao Paulo, Brazil, created an online notification system that highlights “environmental events”, such as exposure to chemical contaminants, drinking water with contaminants outside of the recommended range, contaminated air, and natural or anthropogenic disasters. This paper analyzed 300 notifications received between May 2011 and May 2012. It reports the number of notifications with event classifications and analyzes the events relating to accidents with chemical substances. This paper describes the characteristics of the accidents that involved chemical substances, methods used, types of substances, exposed population, and measures adopted. The online notification of environmental events increases the analysis of the main events associated with diseases related to environmental chemicals; thus, it facilitates the adoption of public policies to prevent environmental health problems. Full article