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Int. J. Environ. Res. Public Health, Volume 7, Issue 4 (April 2010), Pages 1248-1871

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Research

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Open AccessArticle Barriers to Health Care among the Elderly in Japan
Int. J. Environ. Res. Public Health 2010, 7(4), 1330-1341; doi:10.3390/ijerph7041330
Received: 21 December 2009 / Revised: 9 March 2010 / Accepted: 15 March 2010 / Published: 26 March 2010
Cited by 20 | PDF Full-text (177 KB) | HTML Full-text | XML Full-text
Abstract
Japan is undergoing a set of health care reforms aimed at cutting rising health care costs and increasing the efficiency of health care delivery. This empirical study used a large-scale community survey on 15,302 elderly people 65 years and older (56.0% women) [...] Read more.
Japan is undergoing a set of health care reforms aimed at cutting rising health care costs and increasing the efficiency of health care delivery. This empirical study used a large-scale community survey on 15,302 elderly people 65 years and older (56.0% women) conducted in seven municipalities in 2006, to reveal clear-cut evidence of barriers to necessary care. The reasons for not getting health care is attributed to health care cost for the elderly with lower income, while higher income counterparts reported being busy or having a condition not serious enough to seek care. Full article
(This article belongs to the Special Issue Health Behavior and Public Health)
Open AccessArticle Alcohol and HCV Chronic Infection Are Risk Cofactors of Type 2 Diabetes Mellitus for Hepatocellular Carcinoma in Italy
Int. J. Environ. Res. Public Health 2010, 7(4), 1366-1378; doi:10.3390/ijerph7041366
Received: 3 December 2009 / Revised: 8 February 2010 / Accepted: 15 March 2010 / Published: 29 March 2010
Cited by 9 | PDF Full-text (170 KB) | HTML Full-text | XML Full-text
Abstract
Type 2 diabetes mellitus (DM2) has been associated with hepatocellular carcinoma (HCC) development. To study this relationship, we enrolled 465 HCC patients compared with 618 Cirrhotic cases and 490 Controls. The prevalence of DM2 is significantly higher in HCC patients with an [...] Read more.
Type 2 diabetes mellitus (DM2) has been associated with hepatocellular carcinoma (HCC) development. To study this relationship, we enrolled 465 HCC patients compared with 618 Cirrhotic cases and 490 Controls. The prevalence of DM2 is significantly higher in HCC patients with an Odds Ratio of 3.12 versus Controls. In HCC cases with alcohol abuse, the frequency of DM2 is the highest. In our HCC patients, when HCV infection is associated with alcohol abuse, the liver cancer develops earlier. In addition, multivariate analysis shows that alcohol consumption is an independent risk factor for HCC more relevant than HCV infection. Full article
(This article belongs to the Special Issue Alcohol and Public Health)
Open AccessArticle Prevalence of Ocular, Respiratory and Cutaneous Symptoms in Indoor Swimming Pool Workers and Exposure to Disinfection By-Products (DBPs)
Int. J. Environ. Res. Public Health 2010, 7(4), 1379-1391; doi:10.3390/ijerph7041379
Received: 12 January 2010 / Revised: 5 February 2010 / Accepted: 9 March 2010 / Published: 29 March 2010
Cited by 24 | PDF Full-text (130 KB) | HTML Full-text | XML Full-text
Abstract
The objective of this cross-sectional study was to investigate the prevalence of self-reported respiratory, ocular and cutaneous symptoms in subjects working at indoor swimming pools and to assess the relationship between frequency of declared symptoms and occupational exposure to disinfection by-products (DBPs). [...] Read more.
The objective of this cross-sectional study was to investigate the prevalence of self-reported respiratory, ocular and cutaneous symptoms in subjects working at indoor swimming pools and to assess the relationship between frequency of declared symptoms and occupational exposure to disinfection by-products (DBPs). Twenty indoor swimming pools in the Emilia Romagna region of Italy were included in the study. Information about the health status of 133 employees was collected using a self-administered questionnaire. Subjects working at swimming pools claimed to frequently experience the following symptoms: cold (65.4%), sneezing (52.6%), red eyes (48.9%) and itchy eyes (44.4%). Only 7.5% claimed to suffer from asthma. Red eyes, runny nose, voice loss and cold symptoms were declared more frequently by pool attendants (lifeguards and trainers) when compared with employees working in other areas of the facility (office, cafe, etc.). Pool attendants experienced generally more verrucas, mycosis, eczema and rash than others workers; however, only the difference in the frequency of self-declared mycosis was statistically significant (p = 0.010). Exposure to DBPs was evaluated using both environmental and biological monitoring. Trihalomethanes (THMs), the main DBPs, were evaluated in alveolar air samples collected from subjects. Swimming pool workers experienced different THM exposure levels: lifeguards and trainers showed the highest mean values of THMs in alveolar air samples (28.5 ± 20.2 µg/m3), while subjects working in cafe areas (17.6 ± 12.1 µg/m3), offices (14.4 ± 12.0 µg/m3) and engine rooms (13.6 ± 4.4 µg/m3) showed lower exposure levels. Employees with THM alveolar air values higher than 21 µg/m3 (median value) experienced higher risks for red eyes (OR 6.2; 95% CI 2.6–14.9), itchy eyes (OR 3.5; 95% CI 1.5–8.0), dyspnea/asthma (OR 5.1; 95% CI 1.0–27.2) and blocked nose (OR 2.2; 95% CI 1.0–4.7) than subjects with less exposure. This study confirms that lifeguards and trainers are more at risk for respiratory and ocular irritative symptoms and cutaneous diseases than subjects with other occupations at swimming pool facilities. Full article
Open AccessArticle Suicidal Behavior and Alcohol Abuse
Int. J. Environ. Res. Public Health 2010, 7(4), 1392-1431; doi:10.3390/ijerph7041392
Received: 19 January 2010 / Revised: 15 March 2010 / Accepted: 19 March 2010 / Published: 29 March 2010
Cited by 39 | PDF Full-text (228 KB) | HTML Full-text | XML Full-text
Abstract
Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to [...] Read more.
Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to ease the distress associated with committing an act of suicide. We reviewed evidence of the relationship between alcohol use and suicide through a search of MedLine and PsychInfo electronic databases. Multiple genetically-related intermediate phenotypes might influence the relationship between alcohol and suicide. Psychiatric disorders, including psychosis, mood disorders and anxiety disorders, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking patterns. Increased suicide risk may be heralded by social withdrawal, breakdown of social bonds, and social marginalization, which are common outcomes of untreated alcohol abuse and dependence. People with alcohol dependence or depression should be screened for other psychiatric symptoms and for suicidality. Programs for suicide prevention must take into account drinking habits and should reinforce healthy behavioral patterns. Full article
Open AccessArticle Alcohol Trajectories over Three Years in a Swedish Residence Hall Student Population
Int. J. Environ. Res. Public Health 2010, 7(4), 1432-1447; doi:10.3390/ijerph7041432
Received: 8 January 2010 / Revised: 9 February 2010 / Accepted: 10 March 2010 / Published: 29 March 2010
Cited by 3 | PDF Full-text (372 KB) | HTML Full-text | XML Full-text
Abstract
Although it is known that college students have a high alcohol consumption, less is known about the long-term drinking trajectories amongst college students and, in particular, students living in residence halls, known to be high-risk drinkers. Over four consecutive years, the drinking [...] Read more.
Although it is known that college students have a high alcohol consumption, less is known about the long-term drinking trajectories amongst college students and, in particular, students living in residence halls, known to be high-risk drinkers. Over four consecutive years, the drinking habits of 556 Swedish residence hall students were analyzed. The main instruments for measuring outcome were AUDIT (Alcohol Use Identification Disorders Test), SIP (Short Index of Problems) and eBAC (estimated Blood Alcohol Concentration). The drinking trajectories among Swedish residence hall students showed stable and decreasing drinking patterns, with age and gender being predictors of group membership. Full article
(This article belongs to the Special Issue Alcohol and Public Health)
Open AccessArticle Implementation of a 3D Coupled Hydrodynamic and Contaminant Fate Model for PCDD/Fs in Thau Lagoon (France): The Importance of Atmospheric Sources of Contamination
Int. J. Environ. Res. Public Health 2010, 7(4), 1467-1485; doi:10.3390/ijerph7041467
Received: 21 January 2010 / Revised: 8 March 2010 / Accepted: 9 March 2010 / Published: 30 March 2010
Cited by 6 | PDF Full-text (752 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
A 3D hydrodynamic and contaminant fate model was implemented for polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in Thau lagoon. The hydrodynamic model was tested against temperature and salinity measurements, while the contaminant fate model was assessed against available data collected at [...] Read more.
A 3D hydrodynamic and contaminant fate model was implemented for polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in Thau lagoon. The hydrodynamic model was tested against temperature and salinity measurements, while the contaminant fate model was assessed against available data collected at different stations inside the lagoon. The model results allow an assessment of the spatial and temporal variability of the distribution of contaminants in the lagoon, the seasonality of loads and the role of atmospheric deposition for the input of PCDD/Fs. The outcome suggests that air is an important source of PCDD/Fs for this ecosystem, therefore the monitoring of air pollution is very appropriate for assessing the inputs of these contaminants. These results call for the development of integrated environmental protection policies. Full article
(This article belongs to the Special Issue Recent Advances in Environmental Research)
Open AccessArticle Air Pollution Exposure—A Trigger for Myocardial Infarction?
Int. J. Environ. Res. Public Health 2010, 7(4), 1486-1499; doi:10.3390/ijerph7041486
Received: 18 January 2010 / Revised: 26 March 2010 / Accepted: 28 March 2010 / Published: 31 March 2010
Cited by 10 | PDF Full-text (181 KB) | HTML Full-text | XML Full-text
Abstract
The association between ambient air pollution exposure and hospitalization for cardiovascular events has been reported in several studies with conflicting results. A case-crossover design was used to investigate the effects of air pollution in 660 first-time myocardial infarction cases in Stockholm in [...] Read more.
The association between ambient air pollution exposure and hospitalization for cardiovascular events has been reported in several studies with conflicting results. A case-crossover design was used to investigate the effects of air pollution in 660 first-time myocardial infarction cases in Stockholm in 1993–1994, interviewed shortly after diagnosis using a standard protocol. Air pollution data came from central urban background monitors. No associations were observed between the risk for onset of myocardial infarction and two-hour or 24-hour air pollution exposure. No evidence of susceptible subgroups was found. This study provides no support that moderately elevated air pollution levels trigger first-time myocardial infarction. Full article
Open AccessArticle Sitting Time and Body Mass Index, in a Portuguese Sample of Men: Results from the Azorean Physical Activity and Health Study (APAHS)
Int. J. Environ. Res. Public Health 2010, 7(4), 1500-1507; doi:10.3390/ijerph7041500
Received: 2 February 2010 / Revised: 13 March 2010 / Accepted: 21 March 2010 / Published: 31 March 2010
Cited by 19 | PDF Full-text (127 KB) | HTML Full-text | XML Full-text
Abstract
The aim of this study was to verify the relation between body mass index (BMI) and sitting time in a sample of 4,091 Azorean men. BMI was calculated from self-reported weight and height. Total physical activity (PA) time and total sitting time were assessed with the IPAQ (short version). Linear Regression analysis showed that total sitting time (hours/day) was positively associated with BMI (B = 0.078; p < 0.001) after adjustments for age, meal frequency, alcohol and tobacco consumptions, island of residence, education level and total PA time. Although the cross sectional design precludes us from establishing causality, our findings emphasize the importance of reducing sedentary behavior to decrease the risk of obesity. Full article
(This article belongs to the Special Issue Obesity and Public Health)
Open AccessArticle Blood Lead Levels Among Pregnant Women: Historical Versus Contemporaneous Exposures
Int. J. Environ. Res. Public Health 2010, 7(4), 1508-1519; doi:10.3390/ijerph7041508
Received: 18 January 2010 / Revised: 23 March 2010 / Accepted: 29 March 2010 / Published: 1 April 2010
Cited by 15 | PDF Full-text (297 KB) | HTML Full-text | XML Full-text
Abstract
Blood lead among pregnant women, even at modest levels, may impair offspring cognitive development. We examine whether blood lead levels (BLLs) result from current versus historic exposures, among a cohort of pregnant women. Cumulative logit models were used to characterize the relationship [...] Read more.
Blood lead among pregnant women, even at modest levels, may impair offspring cognitive development. We examine whether blood lead levels (BLLs) result from current versus historic exposures, among a cohort of pregnant women. Cumulative logit models were used to characterize the relationship between maternal risk factors and higher BLLs. Maternal blood lead levels more likely result from lead remobilization from historic versus contemporaneous exposures. Even if all lead sources were abated immediately, women and their fetuses would experience lead exposure for decades. This work emphasizes the importance of addressing sources of environmental lead exposure in the United States and internationally. Full article
(This article belongs to the Special Issue Heavy Metals and Health)
Open AccessArticle A Comparison of Two Motion Sensors for the Assessment of Free-Living Physical Activity of Adolescents
Int. J. Environ. Res. Public Health 2010, 7(4), 1558-1576; doi:10.3390/ijerph7041558
Received: 5 February 2010 / Revised: 16 March 2010 / Accepted: 25 March 2010 / Published: 6 April 2010
Cited by 10 | PDF Full-text (409 KB) | HTML Full-text | XML Full-text
Abstract
This study assessed and compared the daily step counts recorded by two different motion sensors in order to estimate the free-living physical activity of 135 adolescent girls. Each girl concurrently wore a Yamax pedometer and an ActiGraph accelerometer (criterion measure) every day [...] Read more.
This study assessed and compared the daily step counts recorded by two different motion sensors in order to estimate the free-living physical activity of 135 adolescent girls. Each girl concurrently wore a Yamax pedometer and an ActiGraph accelerometer (criterion measure) every day for seven consecutive days. The convergent validity of the pedometer can be considered intermediate when used to measure the step counts in free-living physical activity; but should be considered with caution when used to classify participants’ step counts into corresponding physical activity categories because of a likelihood of ‘erroneous’ classification in comparison with the accelerometer. Full article
(This article belongs to the Special Issue Health and Wellbeing of Children, Adolescents and Young Adults)
Open AccessArticle Bayesian Variable Selection in Cost-Effectiveness Analysis
Int. J. Environ. Res. Public Health 2010, 7(4), 1577-1596; doi:10.3390/ijerph7041577
Received: 22 January 2010 / Revised: 28 March 2010 / Accepted: 29 March 2010 / Published: 6 April 2010
PDF Full-text (408 KB) | HTML Full-text | XML Full-text
Abstract
Linear regression models are often used to represent the cost and effectiveness of medical treatment. The covariates used may include sociodemographic variables, such as age, gender or race; clinical variables, such as initial health status, years of treatment or the existence of [...] Read more.
Linear regression models are often used to represent the cost and effectiveness of medical treatment. The covariates used may include sociodemographic variables, such as age, gender or race; clinical variables, such as initial health status, years of treatment or the existence of concomitant illnesses; and a binary variable indicating the treatment received. However, most studies estimate only one model, which usually includes all the covariates. This procedure ignores the question of uncertainty in model selection. In this paper, we examine four alternative Bayesian variable selection methods that have been proposed. In this analysis, we estimate the inclusion probability of each covariate in the real model conditional on the data. Variable selection can be useful for estimating incremental effectiveness and incremental cost, through Bayesian model averaging, as well as for subgroup analysis. Full article
(This article belongs to the Special Issue Health Economics)
Open AccessArticle Incidence and Distribution of Microfungi in a Treated Municipal Water Supply System in Sub-Tropical Australia
Int. J. Environ. Res. Public Health 2010, 7(4), 1597-1611; doi:10.3390/ijerph7041597
Received: 25 February 2010 / Revised: 29 March 2010 / Accepted: 31 March 2010 / Published: 6 April 2010
Cited by 16 | PDF Full-text (521 KB) | HTML Full-text | XML Full-text
Abstract
Drinking water quality is usually determined by its pathogenic bacterial content. However, the potential of water-borne spores as a source of nosocomial fungal infection is increasingly being recognised. This study into the incidence of microfungal contaminants in a typical Australian municipal water [...] Read more.
Drinking water quality is usually determined by its pathogenic bacterial content. However, the potential of water-borne spores as a source of nosocomial fungal infection is increasingly being recognised. This study into the incidence of microfungal contaminants in a typical Australian municipal water supply was carried out over an 18 month period. Microfungal abundance was estimated by the membrane filtration method with filters incubated on malt extract agar at 25 °C for seven days. Colony forming units were recovered from all parts of the system and these were enumerated and identified to genus level. The most commonly recovered genera were Cladosporium, Penicillium, Aspergillus and Fusarium.Nonparametric multivariate statistical analyses of the data using MDS, PCA, BEST and bubble plots were carried out with PRIMER v6 software. Positive and significant correlations were found between filamentous fungi, yeasts and bacteria. This study has demonstrated that numerous microfungal genera, including those that contain species which are opportunistic human pathogens, populate a typical treated municipal water supply in sub-tropical Australia. Full article
(This article belongs to the Special Issue Drinking Water and Health)
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Open AccessArticle Effects of Soil Oxygen Conditions and Soil pH on Remediation of DDT-contaminated Soil by Laccase from White Rot Fungi
Int. J. Environ. Res. Public Health 2010, 7(4), 1612-1621; doi:10.3390/ijerph7041612
Received: 25 February 2010 / Revised: 25 March 2010 / Accepted: 2 April 2010 / Published: 7 April 2010
Cited by 8 | PDF Full-text (206 KB) | HTML Full-text | XML Full-text
Abstract
High residues of DDT in agricultural soils are of concern because they present serious threats to food security and human health. This article focuses on remediation of DDT-contaminated soil using laccase under different soil oxygen and soil pH conditions. The laboratory experiment [...] Read more.
High residues of DDT in agricultural soils are of concern because they present serious threats to food security and human health. This article focuses on remediation of DDT-contaminated soil using laccase under different soil oxygen and soil pH conditions. The laboratory experiment results showed significant effects of soil oxygen conditions and soil pH on remediation of DDT-contaminated soil by laccase at the end of a 25-d incubation period. This study found the positive correlation between the concentration of oxygen in soil and the degradation of DDT by laccase. The residue of DDTs in soil under the atmosphere of oxygen decreased by 28.1% compared with the atmosphere of nitrogen at the end of the incubation with laccase. A similar pattern was observed in the remediation of DDT-contaminated soil by laccase under different flooding conditions, the higher the concentrations of oxygen in soil, the lower the residues of four DDT components and DDTs in soils. The residue of DDTs in the nonflooding soil declined by 16.7% compared to the flooded soil at the end of the incubation. The residues of DDTs in soils treated with laccase were lower in the pH range 2.5–4.5. Full article
Open AccessArticle Associations between Physical Activity and Health Parameters in Adolescent Pupils in Egypt
Int. J. Environ. Res. Public Health 2010, 7(4), 1649-1669; doi:10.3390/ijerph7041649
Received: 17 March 2010 / Revised: 30 March 2010 / Accepted: 31 March 2010 / Published: 12 April 2010
Cited by 8 | PDF Full-text (992 KB) | HTML Full-text | XML Full-text
Abstract
Physical activity (PA) could be protective against hypertension, atherosclerosis, coronary heart disease and cardiovascular disease. This quantitative study assessed the association between a PA intervention and three anthropometric parameters (weight, body mass index, body fat) and four physiological parameters (cholesterol level, systolic [...] Read more.
Physical activity (PA) could be protective against hypertension, atherosclerosis, coronary heart disease and cardiovascular disease. This quantitative study assessed the association between a PA intervention and three anthropometric parameters (weight, body mass index, body fat) and four physiological parameters (cholesterol level, systolic blood pressure, diastolic blood pressure, heart rate) among secondary school pupils (N = 160) in Egypt through the school term. The pupils were randomised to an intervention group (80 pupils) and controls (80 pupils). Measurements were obtained for all pupils twice: at baseline; and then again after three months. The PA intervention programme comprised an ‘afterschool’ one hour of moderate exercise three times a week for three months. Both the controls and the intervention pupils attended the ‘normal’ exercise schedule provided by the school; in addition, the intervention group attended afterschool PA programme from about 2–3 o’clock in the afternoon. At baseline, employing pupil’s BMI, 27.5% and 28.8% of the intervention and control pupils respectively were classified as overweight. After three months, the percentage of overweight decreased to 12.5% in the intervention pupils, while it increased to 37.3% in the controls. At the end of the three months period, there were significant improvements across most anthropometric and physiological parameters of the intervention pupils when compared with the control children. The correlation coefficient of the improvements for the boys and the girls was 0.97, indicating clearly that the intervention was having nearly the same beneficial effect for boys and girls. A moderate PA programme for a modest period of 3 months could be effective in maintaining or enhancing pupil’s anthropometric and physiological parameters in comparison to the controls where there was deterioration in both parameters. Policy makers and secondary schools in Egypt might need to pay more attention to PA programmes conducted on school days, in order to motivate pupils to attend such programmes. There is also an urgent need to look at current PA systems within schools in Egypt in order to assess PA outside school times. Full article
(This article belongs to the Special Issue Health and Wellbeing of Children, Adolescents and Young Adults)
Open AccessArticle Obesity in Tibetans Aged 30–70 Living at Different Altitudes under the North and South Faces of Mt. Everest
Int. J. Environ. Res. Public Health 2010, 7(4), 1670-1680; doi:10.3390/ijerph7041670
Received: 11 March 2010 / Revised: 8 April 2010 / Accepted: 9 April 2010 / Published: 13 April 2010
Cited by 22 | PDF Full-text (419 KB) | HTML Full-text | XML Full-text
Abstract
Risk factors for chronic diseases in Tibetans may be modified due to hypobaric hypoxia. The objectives of this study were to determine the prevalence of obesity at varying altitudes of 1,200, 2,900 and 3,700 meters above sea-level in Tibet and Nepal; to [...] Read more.
Risk factors for chronic diseases in Tibetans may be modified due to hypobaric hypoxia. The objectives of this study were to determine the prevalence of obesity at varying altitudes of 1,200, 2,900 and 3,700 meters above sea-level in Tibet and Nepal; to estimate the effect of altitude on body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). Three cross-sectional studies with simple random sampling were performed on 617 men and women. BMI, WC and WHtR decreased with increasing altitude. It is likely that the physical conditions such as low temperatures and low oxygen levels have a direct catabolic effect. Full article
(This article belongs to the Special Issue Obesity and Public Health)
Open AccessArticle Determination of para-Phenylenediamine (PPD) in Henna in the United Arab Emirates
Int. J. Environ. Res. Public Health 2010, 7(4), 1681-1693; doi:10.3390/ijerph7041681
Received: 8 February 2010 / Revised: 4 April 2010 / Accepted: 7 April 2010 / Published: 13 April 2010
Cited by 12 | PDF Full-text (567 KB) | HTML Full-text | XML Full-text
Abstract
Henna is very popular in the United Arab Emirates (UAE); it is part of the culture and traditions. Allergy to natural henna is not usual; however the addition of para-phenylenediamine (PPD) to the natural henna increases the risk of allergic contact [...] Read more.
Henna is very popular in the United Arab Emirates (UAE); it is part of the culture and traditions. Allergy to natural henna is not usual; however the addition of para-phenylenediamine (PPD) to the natural henna increases the risk of allergic contact dermatitis. The objectives of the study were to identify the presence and concentration of PPD in henna available in UAE. Fifteen henna salons were selected randomly from three cities in UAE. Twenty five henna samples were acquired from these selected salons. The presence of PPD in henna samples was determined qualitatively and quantitatively using High Performance Liquid Chromatography (HPLC). The study showed that PPD was present in all of the black henna samples at concentrations ranging between 0.4% and 29.5% and higher than that recommended for hair dyes in most of the black henna samples. The presence of PPD in the black henna increases the risk of allergic contact dermatitis among users of black henna and a number of cases have already been reported in UAE. Full article
Open AccessArticle Are Adolescents with ADHD Interested in Genetic Testing for Nicotine Addiction Susceptibility?
Int. J. Environ. Res. Public Health 2010, 7(4), 1694-1707; doi:10.3390/ijerph7041694
Received: 4 February 2010 / Revised: 11 March 2010 / Accepted: 9 April 2010 / Published: 14 April 2010
Cited by 3 | PDF Full-text (120 KB) | HTML Full-text | XML Full-text
Abstract
It has been well-established that some adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking. Current research on the genetic basis of this association could ultimately translate into genetic tests capable of identifying smoking-prone adolescents with ADHD. In [...] Read more.
It has been well-established that some adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking. Current research on the genetic basis of this association could ultimately translate into genetic tests capable of identifying smoking-prone adolescents with ADHD. In this study we examined 81 ADHD affected adolescents’ (age 13–21) interest in genetic testing for nicotine addiction susceptibility. Fifty-seven percent of adolescents indicated a fair amount of interest or more in testing. Most adolescents indicated that the personal information revealed from testing would be either useful (29%) or interesting (37%). Implications for genetically-informed smoking prevention and cessation interventions in high risk adolescents with ADHD are discussed. Full article
(This article belongs to the Special Issue Health Behavior and Public Health)
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Open AccessArticle Updating the Northern Tsetse Limit in Burkina Faso (1949–2009): Impact of Global Change
Int. J. Environ. Res. Public Health 2010, 7(4), 1708-1719; doi:10.3390/ijerph7041708
Received: 22 January 2010 / Revised: 4 March 2010 / Accepted: 12 March 2010 / Published: 15 April 2010
Cited by 14 | PDF Full-text (761 KB) | HTML Full-text | XML Full-text
Abstract
The northern distribution limit of tsetse flies was updated in Burkina Faso and compared to previous limits to revise the existing map of these vectors of African trypanosomiases dating from several decades ago. From 1949 to 2009, a 25- to 150-km shift [...] Read more.
The northern distribution limit of tsetse flies was updated in Burkina Faso and compared to previous limits to revise the existing map of these vectors of African trypanosomiases dating from several decades ago. From 1949 to 2009, a 25- to 150-km shift has appeared toward the south. Tsetse are now discontinuously distributed in Burkina Faso with a western and an eastern tsetse belt. This range shift can be explained by a combination of decreased rainfall and increased human density. Within a context of international control, this study provides a better understanding of the factors influencing the distribution of tsetse flies. Full article
(This article belongs to the Special Issue Climate Change and Human Health Impacts and Adaptation)
Open AccessArticle Measurement of Ultrafine Particles and Other Air Pollutants Emitted by Cooking Activities
Int. J. Environ. Res. Public Health 2010, 7(4), 1744-1759; doi:10.3390/ijerph7041744
Received: 28 February 2010 / Revised: 3 April 2010 / Accepted: 14 April 2010 / Published: 16 April 2010
Cited by 36 | PDF Full-text (885 KB) | HTML Full-text | XML Full-text
Abstract
Cooking emissions show a strong dependence on cooking styles and parameters. Measurements of the average ultrafine particle (UFP) concentration, PM2.5 and black carbon concentrations emitted by cooking activities ranged from 1.34 × 104 to 6.04 × 105 particles/cm3 [...] Read more.
Cooking emissions show a strong dependence on cooking styles and parameters. Measurements of the average ultrafine particle (UFP) concentration, PM2.5 and black carbon concentrations emitted by cooking activities ranged from 1.34 × 104 to 6.04 × 105 particles/cm3, 10.0 to 230.9 μg/m3 and 0.1 to 0.8 μg/m3, respectively. Lower UFP concentrations were observed during boiling, while higher levels were emitted during frying. The highest UFP concentrations were observed when using a gas stove at high temperature with the kitchen exhaust fan turned off. The observed UFP profiles were similar in the kitchen and in another room, with a lag of approximately 10 min. Full article
(This article belongs to the Special Issue Indoor Air Pollution and Human Health)
Open AccessArticle Public Health Nutrition: The Accord of Dietitian Providers in Managing Medicare Chronic Care Outpatients in Australia
Int. J. Environ. Res. Public Health 2010, 7(4), 1841-1854; doi:10.3390/ijerph7041841
Received: 29 March 2010 / Revised: 16 April 2010 / Accepted: 19 April 2010 / Published: 20 April 2010
Cited by 3 | PDF Full-text (74 KB) | HTML Full-text | XML Full-text
Abstract
Medicare Australia: Chronic Disease Management program subsidizes allied health consultations for eligible outpatients with chronic disease or complex needs. In an evaluation study, private practice dietitians (n = 9) were interviewed to explore their patient management strategies including consultation time-allocation and fees. [...] Read more.
Medicare Australia: Chronic Disease Management program subsidizes allied health consultations for eligible outpatients with chronic disease or complex needs. In an evaluation study, private practice dietitians (n = 9) were interviewed to explore their patient management strategies including consultation time-allocation and fees. Time allocation was fee-based. Short first consultations were seen as meeting patients’ needs for low-cost services but were regarded by dietitians as ineffective, however longer initial consultations increased cost to patients. No strategy in use was optimal. There is a need for change in Medicare policy to meet the needs of both dietitians and patients in achieving the behaviour change goals of patients. Full article
Open AccessCommunication The Drinker’s Effect on the Social Environment: A Conceptual Framework for Studying Alcohol’s Harm to Others
Int. J. Environ. Res. Public Health 2010, 7(4), 1855-1871; doi:10.3390/ijerph7041855
Received: 22 January 2010 / Revised: 11 April 2010 / Accepted: 17 April 2010 / Published: 21 April 2010
Cited by 20 | PDF Full-text (83 KB) | HTML Full-text | XML Full-text
Abstract
The paper considers conceptual and methodological issues in studying the scope of alcohol’s harm to others. Reasons are suggested for the relative neglect of the topic. The approaches in two relevant research traditions are considered: population surveys on alcohol problems, and economic [...] Read more.
The paper considers conceptual and methodological issues in studying the scope of alcohol’s harm to others. Reasons are suggested for the relative neglect of the topic. The approaches in two relevant research traditions are considered: population surveys on alcohol problems, and economic cost of alcohol studies. Ways of conceptualizing and measuring aspects of the drinker’s effects on others are considered, in terms of main types of relationship with the other, and in terms of major societal response institutions. The main types of data tend to measure different levels of severity, with population survey data dominated by less severe problems, and response institution data by more severe problems; so both are needed for a three-dimensional view. Research questions for the field and its policy significance are noted. Full article
(This article belongs to the Special Issue Environmental Research on Alcohol: Public Health Perspectives)

Review

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Open AccessReview Disturbance and Plant Succession in the Mojave and Sonoran Deserts of the American Southwest
Int. J. Environ. Res. Public Health 2010, 7(4), 1248-1284; doi:10.3390/ijerph7041248
Received: 22 December 2009 / Revised: 23 March 2010 / Accepted: 24 March 2010 / Published: 25 March 2010
Cited by 37 | PDF Full-text (1233 KB) | HTML Full-text | XML Full-text
Abstract
Disturbances such as fire, land clearing, and road building remove vegetation and can have major influences on public health through effects on air quality, aesthetics, recreational opportunities, natural resource availability, and economics. Plant recovery and succession following disturbance are poorly understood in [...] Read more.
Disturbances such as fire, land clearing, and road building remove vegetation and can have major influences on public health through effects on air quality, aesthetics, recreational opportunities, natural resource availability, and economics. Plant recovery and succession following disturbance are poorly understood in arid lands relative to more temperate regions. This study quantitatively reviewed vegetation reestablishment following a variety of disturbances in the Mojave and Sonoran Deserts of southwestern North America. A total of 47 studies met inclusion criteria for the review. The time estimated by 29 individual studies for full reestablishment of total perennial plant cover was 76 years. Although long, this time was shorter than an estimated 215 years (among 31 individual studies) required for the recovery of species composition typical of undisturbed areas, assuming that recovery remains linear following the longest time since disturbance measurement made by the studies. Full article
(This article belongs to the Special Issue Recent Advances in Environmental Research)
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Open AccessReview Alcohol and Acetaldehyde in Public Health: From Marvel to Menace
Int. J. Environ. Res. Public Health 2010, 7(4), 1285-1301; doi:10.3390/ijerph7041285
Received: 11 January 2010 / Revised: 23 February 2010 / Accepted: 12 March 2010 / Published: 25 March 2010
Cited by 40 | PDF Full-text (148 KB) | HTML Full-text | XML Full-text
Abstract
Alcohol abuse is a serious medical and social problem. Although light to moderate alcohol consumption is beneficial to cardiovascular health, heavy drinking often results in organ damage and social problems. In addition, genetic susceptibility to the effect of alcohol on cancer and [...] Read more.
Alcohol abuse is a serious medical and social problem. Although light to moderate alcohol consumption is beneficial to cardiovascular health, heavy drinking often results in organ damage and social problems. In addition, genetic susceptibility to the effect of alcohol on cancer and coronary heart disease differs across the population. A number of mechanisms including direct the toxicity of ethanol, its metabolites [e.g., acetaldehyde and fatty acid ethyl esters (FAEEs)] and oxidative stress may mediate alcoholic complications. Acetaldehyde, the primary metabolic product of ethanol, is an important candidate toxin in developing alcoholic diseases. Meanwhile, free radicals produced during ethanol metabolism and FAEEs are also important triggers for alcoholic damages. Full article
(This article belongs to the Special Issue Alcohol and Public Health)
Open AccessReview Spatial Modeling in Environmental and Public Health Research
Int. J. Environ. Res. Public Health 2010, 7(4), 1302-1329; doi:10.3390/ijerph7041302
Received: 31 December 2009 / Revised: 20 February 2010 / Accepted: 16 March 2010 / Published: 26 March 2010
Cited by 29 | PDF Full-text (1590 KB) | HTML Full-text | XML Full-text
Abstract
This paper has two aims: (1) to summarize various geographic information science methods; and (2) to provide a review of studies that have employed such methods. Though not meant to be a comprehensive review, this paper explains when certain methods are useful [...] Read more.
This paper has two aims: (1) to summarize various geographic information science methods; and (2) to provide a review of studies that have employed such methods. Though not meant to be a comprehensive review, this paper explains when certain methods are useful in epidemiological studies and also serves as an overview of the growing field of spatial epidemiology. Full article
(This article belongs to the Special Issue Advances in Epidemiology)
Open AccessReview The Essential Toxin: Impact of Zinc on Human Health
Int. J. Environ. Res. Public Health 2010, 7(4), 1342-1365; doi:10.3390/ijerph7041342
Received: 27 January 2010 / Revised: 8 March 2010 / Accepted: 10 March 2010 / Published: 26 March 2010
Cited by 137 | PDF Full-text (396 KB) | HTML Full-text | XML Full-text
Abstract
Compared to several other metal ions with similar chemical properties, zinc is relatively harmless. Only exposure to high doses has toxic effects, making acute zinc intoxication a rare event. In addition to acute intoxication, long-term, high-dose zinc supplementation interferes with the uptake [...] Read more.
Compared to several other metal ions with similar chemical properties, zinc is relatively harmless. Only exposure to high doses has toxic effects, making acute zinc intoxication a rare event. In addition to acute intoxication, long-term, high-dose zinc supplementation interferes with the uptake of copper. Hence, many of its toxic effects are in fact due to copper deficiency. While systemic homeostasis and efficient regulatory mechanisms on the cellular level generally prevent the uptake of cytotoxic doses of exogenous zinc, endogenous zinc plays a significant role in cytotoxic events in single cells. Here, zinc influences apoptosis by acting on several molecular regulators of programmed cell death, including caspases and proteins from the Bcl and Bax families. One organ where zinc is prominently involved in cell death is the brain, and cytotoxicity in consequence of ischemia or trauma involves the accumulation of free zinc. Rather than being a toxic metal ion, zinc is an essential trace element. Whereas intoxication by excessive exposure is rare, zinc deficiency is widespread and has a detrimental impact on growth, neuronal development, and immunity, and in severe cases its consequences are lethal. Zinc deficiency caused by malnutrition and foods with low bioavailability, aging, certain diseases, or deregulated homeostasis is a far more common risk to human health than intoxication. Full article
(This article belongs to the Special Issue Heavy Metals and Health)
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Open AccessReview Alcoholism and Alternative Splicing of Candidate Genes
Int. J. Environ. Res. Public Health 2010, 7(4), 1448-1466; doi:10.3390/ijerph7041448
Received: 26 February 2010 / Revised: 21 March 2010 / Accepted: 23 March 2010 / Published: 30 March 2010
Cited by 6 | PDF Full-text (214 KB) | HTML Full-text | XML Full-text
Abstract
Gene expression studies have shown that expression patterns of several genes have changed during the development of alcoholism. Gene expression is regulated not only at the level of transcription but also through alternative splicing of pre-mRNA. In this review, we discuss some [...] Read more.
Gene expression studies have shown that expression patterns of several genes have changed during the development of alcoholism. Gene expression is regulated not only at the level of transcription but also through alternative splicing of pre-mRNA. In this review, we discuss some of the evidence suggesting that alternative splicing of candidate genes such as DRD2 (encoding dopamine D2 receptor) may form the basis of the mechanisms underlying the pathophysiology of alcoholism. These reports suggest that aberrant expression of splice variants affects alcohol sensitivities, and alcohol consumption also regulates alternative splicing. Thus, investigations of alternative splicing are essential for understanding the molecular events underlying the development of alcoholism. Full article
Open AccessReview Probabilistic Approaches to Better Quantifying the Results of Epidemiologic Studies
Int. J. Environ. Res. Public Health 2010, 7(4), 1520-1539; doi:10.3390/ijerph7041520
Received: 12 February 2010 / Revised: 26 March 2010 / Accepted: 29 March 2010 / Published: 1 April 2010
Cited by 11 | PDF Full-text (258 KB) | HTML Full-text | XML Full-text
Abstract
Typical statistical analysis of epidemiologic data captures uncertainty due to random sampling variation, but ignores more systematic sources of variation such as selection bias, measurement error, and unobserved confounding. Such sources are often only mentioned via qualitative caveats, perhaps under the heading [...] Read more.
Typical statistical analysis of epidemiologic data captures uncertainty due to random sampling variation, but ignores more systematic sources of variation such as selection bias, measurement error, and unobserved confounding. Such sources are often only mentioned via qualitative caveats, perhaps under the heading of ‘study limitations.’ Recently, however, there has been considerable interest and advancement in probabilistic methodologies for more integrated statistical analysis. Such techniques hold the promise of replacing a confidence interval reflecting only random sampling variation with an interval reflecting all, or at least more, sources of uncertainty. We survey and appraise the recent literature in this area, giving some prominence to the use of Bayesian statistical methodology. Full article
(This article belongs to the Special Issue Advances in Epidemiology)
Open AccessReview Ethanol and Cognition: Indirect Effects, Neurotoxicity and Neuroprotection: A Review
Int. J. Environ. Res. Public Health 2010, 7(4), 1540-1557; doi:10.3390/ijerph7041540
Received: 8 February 2010 / Accepted: 1 April 2010 / Published: 4 April 2010
Cited by 53 | PDF Full-text (315 KB) | HTML Full-text | XML Full-text
Abstract
Ethanol affects cognition in a number of ways. Indirect effects include intoxication, withdrawal, brain trauma, central nervous system infection, hypoglycemia, hepatic failure, and Marchiafava-Bignami disease. Nutritional deficiency can cause pellagra and Wernicke-Korsakoff disorder. Additionally, ethanol is a direct neurotoxin and in sufficient [...] Read more.
Ethanol affects cognition in a number of ways. Indirect effects include intoxication, withdrawal, brain trauma, central nervous system infection, hypoglycemia, hepatic failure, and Marchiafava-Bignami disease. Nutritional deficiency can cause pellagra and Wernicke-Korsakoff disorder. Additionally, ethanol is a direct neurotoxin and in sufficient dosage can cause lasting dementia. However, ethanol also has neuroprotectant properties and in low-to-moderate dosage reduces the risk of dementia, including Alzheimer type. In fetuses ethanol is teratogenic, and whether there exists a safe dose during pregnancy is uncertain and controversial. Full article
(This article belongs to the Special Issue Alcohol and Public Health)
Open AccessReview Economic Evaluation and Transferability of Physical Activity Programmes in Primary Prevention: A Systematic Review
Int. J. Environ. Res. Public Health 2010, 7(4), 1622-1648; doi:10.3390/ijerph7041622
Received: 18 February 2010 / Revised: 29 March 2010 / Accepted: 6 April 2010 / Published: 9 April 2010
Cited by 8 | PDF Full-text (318 KB) | HTML Full-text | XML Full-text
Abstract
This systematic review aims to assess the characteristics of, and the clinical and economic evidence provided by, economic evaluations of primary preventive physical exercise interventions, and to analyse their transferability to Germany using recommended checklists. Fifteen economic evaluations from seven different countries [...] Read more.
This systematic review aims to assess the characteristics of, and the clinical and economic evidence provided by, economic evaluations of primary preventive physical exercise interventions, and to analyse their transferability to Germany using recommended checklists. Fifteen economic evaluations from seven different countries met eligibility criteria, with seven of the fifteen providing high economic evidence in the special country context. Most of the identified studies conclude that the investigated intervention provide good value for money compared with alternatives. However, this review shows a high variability of the costing methods between the studies, which limits comparability, generalisability and transferability of the results. Full article
(This article belongs to the Special Issue Health Economics)
Open AccessReview Improving Physical Activity and Dietary Behaviours with Single or Multiple Health Behaviour Interventions? A Synthesis of Meta-Analyses and Reviews
Int. J. Environ. Res. Public Health 2010, 7(4), 1720-1743; doi:10.3390/ijerph7041720
Received: 9 March 2010 / Revised: 9 April 2010 / Accepted: 15 April 2010 / Published: 16 April 2010
Cited by 17 | PDF Full-text (145 KB) | HTML Full-text | XML Full-text
Abstract
Since multiple health behaviour interventions have gained popularity, it is important to investigate their effectiveness compared to single health behaviour interventions. This synthesis aims to determine whether single intervention (physical activity or dietary) or multiple interventions (physical activity and dietary) are more [...] Read more.
Since multiple health behaviour interventions have gained popularity, it is important to investigate their effectiveness compared to single health behaviour interventions. This synthesis aims to determine whether single intervention (physical activity or dietary) or multiple interventions (physical activity and dietary) are more effective at increasing these behaviours by synthesizing reviews and meta-analyses. A sub-purpose also explored their impact on weight. Overall, reviews/meta-analyses showed that single health behaviour interventions were more effective at increasing the targeted behaviours, while multiple health behaviour interventions resulted in greater weight loss. This review may assist policies aiming at improving physical activity and nutrition and reversing the obesity epidemic. Full article
(This article belongs to the Special Issue Health Behavior and Public Health)
Open AccessReview Maternal Diet, Behaviour and Offspring Skeletal Health
Int. J. Environ. Res. Public Health 2010, 7(4), 1760-1772; doi:10.3390/ijerph7041760
Received: 24 December 2009 / Revised: 10 March 2010 / Accepted: 15 April 2010 / Published: 16 April 2010
Cited by 12 | PDF Full-text (137 KB) | HTML Full-text | XML Full-text
Abstract
Osteoporotic fracture has a major impact upon health, both in terms of acute and long term disability and economic cost. Peak bone mass, achieved in early adulthood, is a major determinant of osteoporosis risk in later life. Poor early growth predicts reduced [...] Read more.
Osteoporotic fracture has a major impact upon health, both in terms of acute and long term disability and economic cost. Peak bone mass, achieved in early adulthood, is a major determinant of osteoporosis risk in later life. Poor early growth predicts reduced bone mass, and so risk of fracture in later life. Maternal lifestyle, body build and 25(OH) vitamin D status predict offspring bone mass. Recent work has suggested epigenetic mechanisms as key to these observations. This review will explore the role of the early environment in determining later osteoporotic fracture risk. Full article
(This article belongs to the Special Issue Health Behavior and Public Health)
Open AccessReview A Systematic Review of Occupational Exposure to Particulate Matter and Cardiovascular Disease
Int. J. Environ. Res. Public Health 2010, 7(4), 1773-1806; doi:10.3390/ijerph7041773
Received: 4 March 2010 / Revised: 31 March 2010 / Accepted: 16 April 2010 / Published: 19 April 2010
Cited by 42 | PDF Full-text (405 KB) | HTML Full-text | XML Full-text
Abstract
Exposure to ambient particulate air pollution is a recognized risk factor for cardiovascular disease; however the link between occupational particulate exposures and adverse cardiovascular events is less clear. We conducted a systematic review, including meta-analysis where appropriate, of the epidemiologic association between [...] Read more.
Exposure to ambient particulate air pollution is a recognized risk factor for cardiovascular disease; however the link between occupational particulate exposures and adverse cardiovascular events is less clear. We conducted a systematic review, including meta-analysis where appropriate, of the epidemiologic association between occupational exposure to particulate matter and cardiovascular disease. Out of 697 articles meeting our initial criteria, 37 articles published from January 1990 to April 2009 (12 mortality; 5 morbidity; and 20 intermediate cardiovascular endpoints) were included. Results suggest a possible association between occupational particulate exposures and ischemic heart disease (IHD) mortality as well as non-fatal myocardial infarction (MI), and stronger evidence of associations with heart rate variability and systemic inflammation, potential intermediates between occupational PM exposure and IHD. In meta-analysis of mortality studies, a significant increase in IHD was observed (meta-IRR = 1.16; 95% CI: 1.06–1.26), however these data were limited by lack of adequate control for smoking and other potential confounders. Further research is needed to better clarify the magnitude of the potential risk of the development and aggravation of IHD associated with short and long-term occupational particulate exposures and to clarify the clinical significance of acute and chronic changes in intermediate cardiovascular outcomes. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and Public Health)
Open AccessReview The Heart Failure Epidemic
Int. J. Environ. Res. Public Health 2010, 7(4), 1807-1830; doi:10.3390/ijerph7041807
Received: 1 March 2010 / Revised: 14 April 2010 / Accepted: 14 April 2010 / Published: 19 April 2010
Cited by 35 | PDF Full-text (171 KB) | HTML Full-text | XML Full-text
Abstract
Heart failure has been singled out as an emerging epidemic, which could be the result of increased incidence and/or increased survival leading to increased prevalence. Knowledge of the responsibility of each factor in the genesis of the epidemic is crucial for prevention. [...] Read more.
Heart failure has been singled out as an emerging epidemic, which could be the result of increased incidence and/or increased survival leading to increased prevalence. Knowledge of the responsibility of each factor in the genesis of the epidemic is crucial for prevention. Population-based studies have shown that, over time, the incidence of heart failure remained overall stable, while survival improved. Therefore, the heart failure epidemic is chiefly one of hospitalizations. Data on temporal trends in the incidence and prevalence of heart failure according to ejection fraction and how it may have changed over time are needed while interventions should focus on reducing the burden of hospitalizations in hear failure. Full article
(This article belongs to the Special Issue Advances in Epidemiology)

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Open AccessCommentary Comments on “Simoens, S. Health Economic Assessment: A Methodological Primer. Int. J. Environ. Res. Public Health 2009, 6, 2950-2966”—New Zealand in Fact Has No Cost-Effectiveness Threshold
Int. J. Environ. Res. Public Health 2010, 7(4), 1831-1834; doi:10.3390/ijerph7041831
Received: 16 March 2010 / Accepted: 13 April 2010 / Published: 20 April 2010
Cited by 6 | PDF Full-text (121 KB) | HTML Full-text | XML Full-text
Abstract
The Journal recently incorrectly ascribed cost-effectiveness thresholds to New Zealand, alongside other countries. New Zealand has no such thresholds when deciding the funding of pharmaceuticals. As we fund pharmaceuticals within a fixed budget, and cost-effectiveness is only one of nine decision criteria [...] Read more.
The Journal recently incorrectly ascribed cost-effectiveness thresholds to New Zealand, alongside other countries. New Zealand has no such thresholds when deciding the funding of pharmaceuticals. As we fund pharmaceuticals within a fixed budget, and cost-effectiveness is only one of nine decision criteria used to inform decisions, thresholds cannot be inferred or calculated. Thresholds inadequately account for opportunity cost and affordability, and are incompatible with budgets and maximising health gains. In New Zealand, pharmaceutical investments can only be considered ‘cost-effective’ when prioritised against other proposals at the time, and threshold levels must inevitably vary with available funds and the other criteria. Full article
(This article belongs to the Special Issue Health Economics)
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Open AccessReply Health Economic Assessment: Cost-Effectiveness Thresholds and Other Decision Criteria
Int. J. Environ. Res. Public Health 2010, 7(4), 1835-1840; doi:10.3390/ijerph7041835
Received: 2 April 2010 / Accepted: 13 April 2010 / Published: 20 April 2010
Cited by 7 | PDF Full-text (88 KB) | HTML Full-text | XML Full-text
Abstract
An article published in this Journal argued that New Zealand does not apply a cost-effectiveness threshold because medicines are funded within a fixed budget and because cost-effectiveness is only one of nine criteria that inform decisions. This Comment has explained that, from [...] Read more.
An article published in this Journal argued that New Zealand does not apply a cost-effectiveness threshold because medicines are funded within a fixed budget and because cost-effectiveness is only one of nine criteria that inform decisions. This Comment has explained that, from a theoretical perspective, the cost-effectiveness threshold model is not inconsistent with these two arguments. The observed annual variation in incremental cost-effectiveness ratios in New Zealand may originate from yearly differences in new medicines that request reimbursement and in the budget size, and from the fact that decision makers take into account other decision criteria in addition to cost-effectiveness. Full article
(This article belongs to the Special Issue Health Economics)

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