http://www.mdpi.com/journal/ijerph Latest open access articles published in Int. J. Environ. Res. Public Health at http://www.mdpi.com/journal/ijerph http://www.mdpi.com/1660-4601/10/6/2578 Reducing human vulnerability to chemical hazards in the industrialized city is a matter of great urgency. Vulnerability mapping is an alternative approach for providing vulnerability-reducing interventions in a region. This study presents a method for mapping human vulnerability to chemical hazards by using clustering analysis for effective vulnerability reduction. Taking the city of Shanghai as the study area, we measure human exposure to chemical hazards by using the proximity model with additionally considering the toxicity of hazardous substances, and capture the sensitivity and coping capacity with corresponding indicators. We perform an improved k-means clustering approach on the basis of genetic algorithm by using a 500 m × 500 m geographical grid as basic spatial unit. The sum of squared errors and silhouette coefficient are combined to measure the quality of clustering and to determine the optimal clustering number. Clustering result reveals a set of six typical human vulnerability patterns that show distinct vulnerability dimension combinations. The vulnerability mapping of the study area reflects cluster-specific vulnerability characteristics and their spatial distribution. Finally, we suggest specific points that can provide new insights in rationally allocating the limited funds for the vulnerability reduction of each cluster. International Journal of Environmental Research and Public Health 2013-06-20 10 6 Article 10.3390/ijerph10062578 2578 2595 1660-4601 2013-06-20 doi: 10.3390/ijerph10062578 Weifang Shi Weihua Zeng http://www.mdpi.com/1660-4601/10/6/2560 Rather than conforming to the assumption of perfect rationality in neoclassical economic theory, decision behavior has been shown to display a host of systematic biases. Properly understood, these patterns can be instrumentalized to improve outcomes in the public realm. We conducted a laboratory experiment to study whether decisions over health insurance policies are subject to status quo bias and, if so, whether experience mitigates this framing effect. Choices in two treatment groups with status quo defaults are compared to choices in a neutrally framed control group. A two-step design features sorting of subjects into the groups, allowing us to control for selection effects due to risk preferences. The results confirm the presence of a status quo bias in consumer choices over health insurance policies. However, this effect of the default framing does not persist as subjects repeat this decision in later periods of the experiment. Our results have implications for health care policy, for example suggesting that the use of non-binding defaults in health insurance can facilitate the spread of co-insurance policies and thereby help contain health care expenditure. International Journal of Environmental Research and Public Health 2013-06-19 10 6 Addendum 10.3390/ijerph10062560 2560 2577 1660-4601 2013-06-19 doi: 10.3390/ijerph10062560 Miriam Krieger Stefan Felder http://www.mdpi.com/1660-4601/10/6/2544 This paper examines differences in work-family conflict and synergy among the four generational groups represented in the contemporary workforce: Generation Y Generation X, Baby Boomers, and Matures using data from the 2008 National Study of the Changing Workforce (n = 3,502). Significant generational differences were found for work-family conflict (work interfering with family and family interfering with work) but not for work-family synergy. Mental health and job pressure were the best predictors of work interfering with family conflict for each generational group. Work-family synergy presented a more complex picture. Work-family conflict and synergy were significantly related to job, marital, and life satisfaction. Implications and directions for future research are discussed. International Journal of Environmental Research and Public Health 2013-06-19 10 6 Article 10.3390/ijerph10062544 2544 2559 1660-4601 2013-06-19 doi: 10.3390/ijerph10062544 Nicholas Beutell http://www.mdpi.com/1660-4601/10/6/2515 Extreme heat is a significant public health concern in India; extreme heat hazards are projected to increase in frequency and severity with climate change. Few of the factors driving population heat vulnerability are documented, though poverty is a presumed risk factor. To facilitate public health preparedness, an assessment of factors affecting vulnerability among slum dwellers was conducted in summer 2011 in Ahmedabad, Gujarat, India. Indicators of heat exposure, susceptibility to heat illness, and adaptive capacity, all of which feed into heat vulnerability, was assessed through a cross-sectional household survey using randomized multistage cluster sampling. Associations between heat-related morbidity and vulnerability factors were identified using multivariate logistic regression with generalized estimating equations to account for clustering effects. Age, preexisting medical conditions, work location, and access to health information and resources were associated with self-reported heat illness. Several of these variables were unique to this study. As sociodemographics, occupational heat exposure, and access to resources were shown to increase vulnerability, future interventions (e.g., health education) might target specific populations among Ahmedabad urban slum dwellers to reduce vulnerability to extreme heat. Surveillance and evaluations of future interventions may also be worthwhile. International Journal of Environmental Research and Public Health 2013-06-18 10 6 Article 10.3390/ijerph10062515 2515 2543 1660-4601 2013-06-18 doi: 10.3390/ijerph10062515 Kathy Tran Gulrez Azhar Rajesh Nair Kim Knowlton Anjali Jaiswal Perry Sheffield Dileep Mavalankar Jeremy Hess http://www.mdpi.com/1660-4601/10/6/2500 Background: Although millions of people are using electronic cigarettes (ECs) and research on this topic has intensified in recent years, the pattern of EC use has not been systematically studied. Additionally, no comparative measure of exposure and nicotine delivery between EC and tobacco cigarette or nicotine replacement therapy (NRTs) has been established. This is important, especially in the context of the proposal for a new Tobacco Product Directive issued by the European Commission. Methods: A second generation EC device, consisting of a higher capacity battery and tank atomiser design compared to smaller cigarette-like batteries and cartomizers, and a 9 mg/mL nicotine-concentration liquid were used in this study. Eighty subjects were recruited; 45 experienced EC users and 35 smokers. EC users were video-recorded when using the device (ECIG group), while smokers were recorded when smoking (SM-S group) and when using the EC (SM-E group) in a randomized cross-over design. Puff, inhalation and exhalation duration were measured. Additionally, the amount of EC liquid consumed by experienced EC users was measured at 5 min (similar to the time needed to smoke one tobacco cigarette) and at 20 min (similar to the time needed for a nicotine inhaler to deliver 4 mg nicotine). Results: Puff duration was significantly higher in ECIG (4.2 ± 0.7 s) compared to SM-S (2.1 ± 0.4 s) and SM-E (2.3 ± 0.5 s), while inhalation time was lower (1.3 ± 0.4, 2.1 ± 0.4 and 2.1 ± 0.4 respectively). No difference was observed in exhalation duration. EC users took 13 puffs and consumed 62 ± 16 mg liquid in 5 min; they took 43 puffs and consumed 219 ± 56 mg liquid in 20 min. Nicotine delivery was estimated at 0.46 ± 0.12 mg after 5 min and 1.63 ± 0.41 mg after 20 min of use. Therefore, 20.8 mg/mL and 23.8 mg/mL nicotine-containing liquids would deliver 1 mg of nicotine in 5 min and 4 mg nicotine in 20 min, respectively. Since the ISO method significantly underestimates nicotine delivery by tobacco cigarettes, it seems that liquids with even higher than 24 mg/mL nicotine concentration would be comparable to one tobacco cigarette. Conclusions: EC use topography is significantly different compared to smoking. Four-second puffs with 20–30 s interpuff interval should be used when assessing EC effects in laboratory experiments, provided that the equipment used does not get overheated. Based on the characteristics of the device used in this study, a 20 mg/mL nicotine concentration liquid would be needed in order to deliver nicotine at amounts similar to the maximum allowable content of one tobacco cigarette (as measured by the ISO 3308 method). The results of this study do not support the statement of the European Commission Tobacco Product Directive that liquids with nicotine concentration of 4 mg/mL are comparable to NRTs in the amount of nicotine delivered to the user. International Journal of Environmental Research and Public Health 2013-06-18 10 6 Article 10.3390/ijerph10062500 2500 2514 1660-4601 2013-06-18 doi: 10.3390/ijerph10062500 Konstantinos Farsalinos Giorgio Romagna Dimitris Tsiapras Stamatis Kyrzopoulos Vassilis Voudris http://www.mdpi.com/1660-4601/10/6/2471 Tobacco use is inextricably linked to a number of health risks both in the general and HIV-infected populations. There is, however, a dearth of research on effective tobacco control programs among people living with HIV, and especially among adolescents, young adults and pregnant women, groups with heightened or increased vulnerability secondary to tobacco use. Adolescents and young adults constitute a growing population of persons living with HIV infection. Early and continued tobacco use in this population living with a disease characterized by premature onset multimorbidity and chronic inflammation is of concern. Additionally, there is an increased acuity for tobacco control among HIV-infected pregnant women to reduce pregnancy morbidity and improve fetal outcome. This review will provide an important summary of current knowledge of tobacco use among HIV-infected adolescents, young adults and pregnant women. The effects of tobacco use in these specific populations will be presented and the current state of tobacco control within these populations, assessed. International Journal of Environmental Research and Public Health 2013-06-18 10 6 Review 10.3390/ijerph10062471 2471 2499 1660-4601 2013-06-18 doi: 10.3390/ijerph10062471 Gerome Escota Nur Önen http://www.mdpi.com/1660-4601/10/6/2468 The authors wish to add the following amendments and corrections on their paper published in IJERPH [1]. International Journal of Environmental Research and Public Health 2013-06-14 10 6 Correction 10.3390/ijerph10062468 2468 2470 1660-4601 2013-06-14 doi: 10.3390/ijerph10062468 Yen-Chang Chen Hui-Chung Yeh Chiang Wei http://www.mdpi.com/1660-4601/10/6/2441 This paper presents a quantitative method for the risk-based evaluation of Total Petroleum Hydrocarbons (TPH) in vapor intrusion investigations. Vapors from petroleum fuels are characterized by a complex mixture of aliphatic and, to a lesser extent, aromatic compounds. These compounds can be measured and described in terms of TPH carbon ranges. Toxicity factors published by USEPA and other parties allow development of risk-based, air and soil vapor screening levels for each carbon range in the same manner as done for individual compounds such as benzene. The relative, carbon range makeup of petroleum vapors can be used to develop weighted, site-specific or generic screening levels for TPH. At some critical ratio of TPH to a targeted, individual compound, the overwhelming proportion of TPH will drive vapor intrusion risk over the individual compound. This is particularly true for vapors associated with diesel and other middle distillate fuels, but can also be the case for low-benzene gasolines or even for high-benzene gasolines if an adequately conservative, target risk is not applied to individually targeted chemicals. This necessitates a re-evaluation of the reliance on benzene and other individual compounds as a stand-alone tool to evaluate vapor intrusion risk associated with petroleum. International Journal of Environmental Research and Public Health 2013-06-13 10 6 Article 10.3390/ijerph10062441 2441 2467 1660-4601 2013-06-13 doi: 10.3390/ijerph10062441 Roger Brewer Josh Nagashima Michael Kelley Marvin Heskett Mark Rigby http://www.mdpi.com/1660-4601/10/6/2427 This 18-month longitudinal study examined the influence of adolescents’ sense of coherence (SOC) and exposure to household smoking on their commitment to a smoke-free lifestyle. This study investigated a representative sample of 8th graders from 21 randomly selected high schools in the rural Limpopo Province of South Africa (n = 2,119). Of the total sample of 2,119 participants, 294 (14%) reported smoking at baseline and were therefore excluded from further analysis. Of those who did not smoke at baseline, 98.1% (n = 1,767) reported no intention of smoking in the upcoming 12 months. Of those who completed follow-up and had no intention of smoking at baseline (n = 1,316), 89.1% still did not smoke and remained committed to being smoke-free. Having a lower SOC, reporting alcohol binge-drinking at baseline, and having a household member who regularly smokes indoors (OR = 0.46: 0.26–0.82), as compared to not having any smoker in the household, were associated with lower odds of honoring a commitment to a smoke-free lifestyle. Furthermore, those who identified themselves as black Africans, as opposed to belonging to other race groups, were more likely to maintain a smoke-free lifestyle. Our findings suggest that interventions to prevent adolescent smoking should prioritize stress-coping skills and promote smoke-free homes. International Journal of Environmental Research and Public Health 2013-06-13 10 6 Article 10.3390/ijerph10062427 2427 2440 1660-4601 2013-06-13 doi: 10.3390/ijerph10062427 Olalekan Ayo-Yusuf Masego Rantao http://www.mdpi.com/1660-4601/10/6/2412 This study focused on the presence of antibiotic-resistant bacteria in a metro system as an example of a public transportation system. The molecular characteristics of Staphylococcus were investigated to discern which strains were isolated from metro stations in Shanghai. These were compared with strains isolated from hospital treatment rooms and parks. Airborne Staphylococcus samples in the metro were resistant to an average of 2.64 antibiotic types, and 58.0% of the strain samples were resistant to at least three antibiotics; this was a significantly higher rate than strains from the park, but was lower than those from hospitals. The presence of two antibiotic resistance genes of Staphylococcus strains, mecA (28.0%) and qac (40.0%), were also found at significantly higher levels in metro samples than park samples, but did not differ significantly from hospital samples. Furthermore, 22.0% of the metro Staphylococcus samples were found to be biofilm-positive. The high rate of antibiotic resistance found in Staphylococcus samples collected from metro stations, and the discovery of antibiotic-resistant genes, indicate that the closed indoor environment and crowded passengers may accelerate the spread of antibiotic resistant strains. More attention should be paid to the inspection and control of antibiotic resistant strains in public transportation systems. International Journal of Environmental Research and Public Health 2013-06-13 10 6 Article 10.3390/ijerph10062412 2412 2426 1660-4601 2013-06-13 doi: 10.3390/ijerph10062412 Feng Zhou Yuyan Wang http://www.mdpi.com/1660-4601/10/6/2401 The aim of this study was to determine whether a high degree of dental caries severity is associated with the distal and proximal determinants of caries in a group of Brazilian adults aged 35 to 44 years. A population-based case-control study was conducted using two groups—a case group with high caries severity (DMFT ≥ 14) and a control group without high caries severity (DMFT < 14). The sample comprised adults from metropolitan Belo Horizonte, Brazil (180 cases and 180 controls matched for gender and age). The exam was performed by calibrated dentists using the DMFT index. The statistical analysis used the Mann-Whitney test and bivariate and multivariate logistic regression (the conditional backward stepwise method). The mean DMFT was 8.4 ± 3.9 in the control group and 20.1 ± 4.5 in the case group. High caries severity was associated with regular visits to the dentist, low income, use of private/supplementary dental service and not petitioning the authorities for community benefits. The results of the study underscore the importance of considering distal and proximal factors in the assessment of the severity of dental caries. Greater caries severity persists among low-income families and among groups with a low degree of social cohesion. International Journal of Environmental Research and Public Health 2013-06-07 10 6 Article 10.3390/ijerph10062401 2401 2411 1660-4601 2013-06-07 doi: 10.3390/ijerph10062401 Simone Costa Mara Vasconcelos Mauro Abreu http://www.mdpi.com/1660-4601/10/6/2384 Concentrations of four typical heavy metals (Cu; Zn; Cd and Pb) in roadside soils close to three lakes in the Tibetan Plateau were investigated in this study. The hierarchical tree-based regression method was applied to classify concentrations of the heavy metals and analyze their potential influencing factors. It was found that the Tibetan Plateau meadow soils with higher content of sand lead to higher concentrations of Cu; Zn and Pb. The concentrations of Cd and Pb increase with road traffic volume; and for the road segments with higher traffic volume; the Cd and Pb concentrations significantly decrease with the roadside distance. Additionally; the concentrations of Zn and Pb increase as the altitude of sampling site increases. Furthermore; the Hakanson potential ecological risk index method was used to assess the contamination degree of the heavy metals for the study regions. The results show that accumulations of Cu; Zn and Pb in roadside soils remain an unpolluted level at all sites. However; the Cd indices in the regions with higher traffic volume have reached a strong potential ecological risk level; and some spots with peak concentrations have even been severely polluted due to traffic activities. International Journal of Environmental Research and Public Health 2013-06-07 10 6 Article 10.3390/ijerph10062384 2384 2400 1660-4601 2013-06-07 doi: 10.3390/ijerph10062384 Xuedong Yan Fan Zhang Dan Gao Chen Zeng Wang Xiang Man Zhang http://www.mdpi.com/1660-4601/10/6/2370 Objective: To evaluate the association between smoke-free regulations in public places and secondhand smoke exposure and related beliefs, awareness, attitudes, and behavior among urban residents in China. Methods: We selected one city (Hangzhou) as the intervention city and another (Jiaxing) as the comparison. A structured self-administered questionnaire was used for data collection, and implemented at two time points across a 20-month interval. Both unadjusted and adjusted logistic methods were considered in analyses. Multiple regression procedures were performed in examining variation between final and baseline measures. Results: Smoke-free regulations in the intervention city were associated with a significant decline in personal secondhand smoke exposure in government buildings, buses or taxis, and restaurants, but there was no change in such exposure in healthcare facilities and schools. In terms of personal smoking beliefs, awareness, attitudes, and practices, the only significant change was in giving quitting advice to proximal family members. Conclusions: There was a statistically significant association between implementation of smoke-free regulations in a city and inhibition of secondhand tobacco smoking exposure in public places. However, any such impact was limited. Effective tobacco control in China will require a combination of strong public health education and enforcement of regulations. International Journal of Environmental Research and Public Health 2013-06-07 10 6 Article 10.3390/ijerph10062370 2370 2383 1660-4601 2013-06-07 doi: 10.3390/ijerph10062370 Tingzhong Yang Abu Abdullah Li Li Ian Rockett Yan Lin Jun Ying Wei Guo Dan Wu Mu Li http://www.mdpi.com/1660-4601/10/6/2348 Urban parks play an important role in preserving and promoting the health of citizens who are often exposed to noise pollution and the stress of daily life. The present study describes the main results obtained from a survey performed in five urban parks in Milan. Measurements of the acoustic environment were carried out in 29 sites together with interviews with 231 users on certain aspects of the parks not limited to merely sound. Acoustic data show that the surveyed parks mostly do not comply with the noise limit issued by the Italian legislation on protected areas. The unweighted 1/3-octave spectrum centre of gravity G and LA50 perform satisfactorily in discriminating among the acoustic environments. Such clear distinction was not observed in the subjective ratings on the perceived quality of the soundscape, likely due to the influence by non-acoustic factors that act as mediators in the assessment. This hypothesis is supported by the collected data on the perceived quality of quietness, which was rated worse than that of the soundscape. Comparing acoustic data with ratings, the perceived quality of the total environment was found to be less dependent on LAeq than soundscape and quietness. International Journal of Environmental Research and Public Health 2013-06-06 10 6 Article 10.3390/ijerph10062348 2348 2369 1660-4601 2013-06-06 doi: 10.3390/ijerph10062348 Giovanni Brambilla Veronica Gallo Giovanni Zambon http://www.mdpi.com/1660-4601/10/6/2336 It is unclear whether the socioeconomic inequality in prevalence of overweight and obesity is already present among very young children. This study investigates the association between overweight and socioeconomic status (SES, with maternal educational level as an indicator of SES) among 5-year-old children. This cross-sectional study uses baseline data from 5-year-olds of Dutch ethnicity (n = 5,582) and their mothers collected for the “Be active, eat right” study. Compared to children of mothers with the highest educational level, for children of mothers with the lowest educational level the odds ratio (adjusted for demographic characteristics) for having overweight was 2.10 (95% confidence interval: 1.57–2.82), and for having obesity was 4.18 (95% confidence interval: 2.32–7.55). Addition of maternal and child lifestyle-related characteristics decreased the odds ratios for overweight and obesity by 26.4% and 42.1%, respectively. The results show that an inverse SES-overweight/obesity association is already present at elementary school entry, and that watching TV by mother and child, the child consuming breakfast and, especially maternal weight status, are contributing factors in this association. These results should be taken into account when developing policies to reduce inequalities in (childhood) health. International Journal of Environmental Research and Public Health 2013-06-06 10 6 Article 10.3390/ijerph10062336 2336 2347 1660-4601 2013-06-06 doi: 10.3390/ijerph10062336 Lydian Veldhuis Ineke Vogel Lenie van Rossem Carry Renders Remy HiraSing Johan Mackenbach Hein Raat http://www.mdpi.com/1660-4601/10/6/2296 Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within the United States of America (USA) and Western Europe (WE), by conceptualizing a social determinants of IM/birth outcomes framework, and systematically reviewing the empirical literature on hypothesized social determinants (e.g., social policies, neighbourhood deprivation, individual socioeconomic status (SES)) and intermediary determinants (e.g., health behaviours). To date, the evidence suggests that income inequality and social policies (e.g., maternal leave policies) may help to explain cross-country variations in IM/birth outcomes. Within countries, the evidence also supports neighbourhood SES (USA, WE) and income inequality (USA) as social determinants. By contrast, within-country social cohesion/social capital has been underexplored. At the individual level, mixed associations have been found between individual SES, race/ethnicity, and selected intermediary factors (e.g., psychosocial factors) with IM/birth outcomes. Meanwhile, this review identifies several methodological gaps, including the underuse of prospective designs and the presence of residual confounding in a number of studies. Ultimately, addressing such gaps including through novel approaches to strengthen causal inference and implementing both health and non-health policies may reduce inequities in IM/birth outcomes across the western developed world. International Journal of Environmental Research and Public Health 2013-06-05 10 6 Review 10.3390/ijerph10062296 2296 2335 1660-4601 2013-06-05 doi: 10.3390/ijerph10062296 Daniel Kim Adrianna Saada http://www.mdpi.com/1660-4601/10/6/2282 This study assessed the knowledge, attitude and practices (KAP) of learners on issues related to water, sanitation and hygiene in selected schools in Vhembe District, South Africa. The methodology relied on a questionnaire, an inspection of sanitary facilities and discussion with the school authorities. The data was analyzed using the Statistical Package for Social Science. The study revealed that the level of knowledge about waterborne diseases was relatively high (76.7 ± 1.75%), but knowledge on transmission routes was inadequate. The majority of the respondents had no knowledge when it comes to water-based diseases and their prevention (78.4 ± 1.71%).The attitude and practice on hygiene was also found to be high (91.40 ± 1.16%). Some schools from the urban area had proper handwashing facilities, but there was no soap available. The borehole water quality for rural schools appeared clear, but the microbial quality was unknown. The water supply and sanitation facilities were inadequate in rural schools, with no handwashing areas and no sanitary bins for girls. Some schools had toilets with broken doors which did not offer privacy. The only water tap, located at the centre of the school premises, was not enough for the whole school community. International Journal of Environmental Research and Public Health 2013-06-04 10 6 Article 10.3390/ijerph10062282 2282 2295 1660-4601 2013-06-04 doi: 10.3390/ijerph10062282 Jerry Sibiya Jabulani Gumbo http://www.mdpi.com/1660-4601/10/6/2271 Concentrations of pesticides and selected metabolites in rat urine and amniotic fluid were determined as biomarker upon oral administration of Wistar rats to two pesticide mixtures consisting of three to five pesticides (bitertanol, propiconazole, cypermethrin, malathion, and terbuthylazine). The pesticides and their metabolites were found in rat amniotic fluid and urine, generally in dose-response concentrations in relation to dosage. The measurement of the substances in the amniotic fluid indicated that the fetus was exposed to the pesticides as well as their metabolites. Moreover, the pesticides detected in urine demonstrated the exposure as well as the ability of the rat to excrete these compounds. International Journal of Environmental Research and Public Health 2013-06-04 10 6 Article 10.3390/ijerph10062271 2271 2281 1660-4601 2013-06-04 doi: 10.3390/ijerph10062271 Rossana Bossi Anne Vinggaard Camilla Taxvig Julie Boberg Eva Bonefeld-Jørgensen http://www.mdpi.com/1660-4601/10/6/2258 Previous studies indicate that residents may benefit from a “quiet side” to their dwellings. The influence of the level of road traffic noise exposure at the least exposed side on road traffic noise annoyance was studied in Amsterdam, The Netherlands. Road traffic noise exposure was assessed at the most and least exposed façade (Lden,most and Lden,least respectively) of dwellings for subjects in a population based survey (N = 1,967). It was investigated if and to what extent relative quietness at the least exposed façade affected the level of road traffic noise annoyance by comparing two groups: (1) The subgroup with a relatively quiet façade; (2) the subgroup without a relatively quiet façade (large versus small difference in exposure between most and least exposed façade; DIF ≥ 10 dB and DIF < 10 dB respectively). In addition, it was investigated if and to what extent Lden,least affected the level of road traffic noise annoyance. Results indicate a significantly lower road traffic noise annoyance score at a given Lden,most, in the subgroup with DIF ≥ 10 dB versus DIF < 10 dB. Furthermore, results suggest an effect of Lden,least independent of Lden,most. The estimated size of the effect expressed in an equivalent change in Lden,most approximated 5 dB for both the difference between the two subgroups (DIF ≥ 10 dB and DIF < 10 dB), and for a 10 dB change in Lden,least. International Journal of Environmental Research and Public Health 2013-06-03 10 6 Article 10.3390/ijerph10062258 2258 2270 1660-4601 2013-06-03 doi: 10.3390/ijerph10062258 Yvonne de Kluizenaar Sabine Janssen Henk Vos Erik Salomons Han Zhou Frits van den Berg http://www.mdpi.com/1660-4601/10/6/2241 This study aimed to investigate the direct and indirect effects of environmental pollutants on child development and parental concerns. It focused on the pathway relationships among the following factors: living within three kilometers of an incinerator, breastfeeding, place of residence, parental concerns about development, and parent-perceived child development. The Taiwan Birth Cohort Study (TBCS) dataset includes randomized community data on 21,248 children at six, 18, and 36 months of age. The Parental Concern Checklist and the Taiwan Birth Cohort Study-Developmental Instrument were used to measure parental concern and parent-perceived child development. Living within three kilometers of an incinerator increased the risk of children showing delayed development in the gross motor domain at six and 36 months. Although breastfeeding is a protective factor against uneven/delayed developmental disability (U/DDD), children living near an incinerator who were breastfed had an increased risk of U/DDD compared with those who did not live near incinerators. The presence of a local incinerator affected parent-perceived child development directly and indirectly through the mediating factor of breastfeeding. Further follow-up of these children to investigate the long-term effects of specific toxins on their development and later diagnostic categorization is necessary. International Journal of Environmental Research and Public Health 2013-05-31 10 6 Article 10.3390/ijerph10062241 2241 2257 1660-4601 2013-05-31 doi: 10.3390/ijerph10062241 For-Wey Lung Tung-Liang Chiang Shio-Jean Lin Bih-Ching Shu http://www.mdpi.com/1660-4601/10/6/2214 Nurses have been found to experience higher levels of stress-related burnout compared to other health care professionals. Despite studies showing that both job satisfaction and burnout are effects of exposure to stressful working environments, leading to poor health among nurses, little is known about the causal nature and direction of these relationships. The aim of this systematic review is to identify published research that has formally investigated relationships between these variables. Six databases (including CINAHL, COCHRANE, EMBASE, MEDLINE, PROQUEST and PsyINFO) were searched for combinations of keywords, a manual search was conducted and an independent reviewer was asked to cross validate all the electronically identified articles. Of the eighty five articles that were identified from these databases, twenty one articles were excluded based on exclusion criteria; hence, a total of seventy articles were included in the study sample. The majority of identified studies exploring two and three way relationships (n = 63) were conducted in developed countries. Existing research includes predominantly cross-sectional studies (n = 68) with only a few longitudinal studies (n = 2); hence, the evidence base for causality is still very limited. Despite minimal availability of research concerning the small number of studies to investigate the relationships between work-related stress, burnout, job satisfaction and the general health of nurses, this review has identified some contradictory evidence for the role of job satisfaction. This emphasizes the need for further research towards understanding causality. International Journal of Environmental Research and Public Health 2013-05-31 10 6 Review 10.3390/ijerph10062214 2214 2240 1660-4601 2013-05-31 doi: 10.3390/ijerph10062214 Natasha Khamisa Karl Peltzer Brian Oldenburg http://www.mdpi.com/1660-4601/10/6/2198 Canadian healthcare insurance is not universal for all newcomer populations. New immigrant, refugee claimant, and migrant women face various barriers to healthcare due to the lack of public health insurance coverage. This retrospective study explored the relationships between insurance status and various perinatal outcomes. Researchers examined and compared perinatal outcomes for 453 uninsured and provincially insured women who delivered at two general hospitals in the Greater Toronto Area between 2007 and 2010. Data on key perinatal health indicators were collected via chart review of hospital medical records. Comparisons were made with regional statistics and professional guidelines where available. Four-in-five uninsured pregnant women received less-than-adequate prenatal care. More than half of them received clearly inadequate prenatal care, and 6.5% received no prenatal care at all. Insurance status was also related to the type of health care provider, reason for caesarean section, neonatal resuscitation rates, and maternal length of hospital stay. Uninsured mothers experienced a higher percentage of caesarian sections due to abnormal fetal heart rates and required more neonatal resuscitations. No significant difference was found for low birth weight, preterm birth, NCIU admissions, postpartum hemorrhage, breast feeding, or intrapartum care provided. International Journal of Environmental Research and Public Health 2013-05-31 10 6 Article 10.3390/ijerph10062198 2198 2213 1660-4601 2013-05-31 doi: 10.3390/ijerph10062198 Karline Wilson-Mitchell Joanna Rummens http://www.mdpi.com/1660-4601/10/6/2185 Background: There is very little evidence globally on tobacco use and nicotine dependence among civilian populations affected by armed conflict, despite key vulnerability factors related to elevated mental disorders and socio-economic stressors. The study aim was to describe patterns of smoking and nicotine dependence among conflict-affected civilian men in the Republic of Georgia and associations with mental disorders. Methods: A cross-sectional household survey using multistage random sampling was conducted in late 2011 among conflict-affected populations in Georgia. Respondents included in this paper were 1,248 men aged ≥18 years who were internally displaced persons (IDPs) and former IDPs who had returned in their home areas. Outcomes of current tobacco use, heavy use (≥20 cigarettes per day), and nicotine dependence (using the Fagerström Test for Nicotine Dependence) were used. PTSD, depression, anxiety and hazardous alcohol use were also measured, along with exposure to traumatic events and a range of demographic and socio-economic characteristics. Results: Of 1,248 men, 592 (47.4%) smoked and 70.9% of current smokers were heavy smokers. The mean nicotine dependence score was 5.0 and the proportion with high nicotine dependence (≥6) was 41.4%. In multivariate regression analyses, nicotine dependence was significantly associated with PTSD (β 0.74) and depression (β 0.85), along with older age (except 65+ years), and being a returnee (compared to IDPs). Conclusions: The study reveals very high levels of heavy smoking and nicotine dependence among conflict-affected persons in Georgia. The associations between nicotine dependence, PTSD and depression suggest interventions could yield synergistic benefits. International Journal of Environmental Research and Public Health 2013-05-29 10 6 Article 10.3390/ijerph10062185 2185 2197 1660-4601 2013-05-29 doi: 10.3390/ijerph10062185 Bayard Roberts Ivdity Chikovani Nino Makhashvili Vikram Patel Martin McKee http://www.mdpi.com/1660-4601/10/6/2164 Heat waves are considered a health risk and they are likely to increase in frequency, intensity and duration as a consequence of climate change. The effects of heat waves on human health could be reduced if individuals recognise the risks and adopt healthy behaviours during a heat wave. The purpose of this study was to determine the predictors of risk perception using a heat wave scenario and identify the constructs of the health belief model that could predict adaptive behaviours during a heat wave. A cross-sectional study was conducted during the summer of 2012 among a sample of persons aged between 30 to 69 years in Adelaide. Participants’ perceptions were assessed using the health belief model as a conceptual frame. Their knowledge about heat waves and adaptive behaviours during heat waves was also assessed. Logistic regression analyses were performed to determine the predictors of risk perception to a heat wave scenario and adaptive behaviours during a heat wave. Of the 267 participants, about half (50.9%) had a high risk perception to heat waves while 82.8% had good adaptive behaviours during a heat wave. Multivariate models found that age was a significant predictor of risk perception. In addition, participants who were married (OR = 0.21; 95% CI, 0.07–0.62), who earned a gross annual household income of ≥$60,000 (OR = 0.41; 95% CI, 0.17–0.94) and without a fan (OR = 0.29; 95% CI, 0.11–0.79) were less likely to have a high risk perception to heat waves. Those who were living with others (OR = 2.87; 95% CI, 1.19–6.90) were more likely to have a high risk perception to heat waves. On the other hand, participants with a high perceived benefit (OR = 2.14; 95% CI, 1.00–4.58), a high “cues to action” (OR = 3.71; 95% CI, 1.63–8.43), who had additional training or education after high school (OR = 2.65; 95% CI, 1.25–5.58) and who earned a gross annual household income of ≥$60,000 (OR = 2.66; 95% CI, 1.07–6.56) were more likely to have good adaptive behaviours during a heat wave. The health belief model could be useful to guide the design and implementation of interventions to promote adaptive behaviours during heat waves. International Journal of Environmental Research and Public Health 2013-05-29 10 6 Article 10.3390/ijerph10062164 2164 2184 1660-4601 2013-05-29 doi: 10.3390/ijerph10062164 Derick Akompab Peng Bi Susan Williams Janet Grant Iain Walker Martha Augoustinos http://www.mdpi.com/1660-4601/10/6/2150 Birth weight can be a predictor of maternal health issues related to nutrition and environmental contaminants. Total hair mercury (HHg) concentration was studied as an indicator of both fish consumption and methylmercury exposure in mothers (and newborns) living in selected low income areas of the Madeira River basin, Amazonia, Brazil. This cohort study (n = 1,433) consisted of traditional riverines (n = 396), riverines who had moved to urban (n = 676) and rural (n = 67) settings, and tin miner settlers (n = 294). Median maternal HHg was significantly different (p = 0.00001) between riverine (12.1 µg·g−1), rural (7.82 µg·g−1), urban (5.4 µg·g−1), and tin miner (4.5 µg·g−1) groups studied. The same trend (of medians) was observed for newborns’ HHg which also showed significant differences between riverine (3.0 µg·g−1), rural (2.0 µg·g−1), urban (1.5 µg·g−1), and tin miner (0.8 µg·g−1) groups. The correlation between maternal and newborn HHg was statistically significant in the riverine (r = 0.8952; p = 0.0001), urban (r = 0.6744; p = 0.0001), and rural (r = 0.8416; p = 0.0001) groups but not in the mother-infant pairs in the tin miner group (r = 0.0638; p = 0.2752). Birth weight was significantly different among groups but did not show a pattern consistent with that of fish consumption (and HHg). A multiple regression analysis showed that only family income and gestational age had a significant impact on birth weight. Conclusions: Maternal HHg is an important biomarker of maternal fish consumption and of methylmercury exposure during pregnancy. However, in these Amazonian groups, only maternal education and gestational age seemed to affect birth weight positively. International Journal of Environmental Research and Public Health 2013-05-28 10 6 Article 10.3390/ijerph10062150 2150 2163 1660-4601 2013-05-28 doi: 10.3390/ijerph10062150 Rejane Marques José Bernardi José Dórea Katiane Brandão Lucélia Bueno Renata Leão Olaf Malm http://www.mdpi.com/1660-4601/10/6/2133 The present survey was designed to investigate the perception of health risks among college students in China. The data are the responses of a sample of 3,069 college students at one university to surveys that include measures of several dimensions of public judgments about fifteen specific hazards. Chinese college students conveyed their concerns as falling into three broad categories: Environmental (e.g., global warming, natural catastrophes, the ozone hole, air pollution, chemical pollution, pesticides in food), Technological (e.g., nuclear power stations, thermal power, genetically modified food, medical X-rays), and Social (cigarette smoking, drinking alcohol, overtime study or work, mental stress, motor vehicle accidents). The data were collected with a self-report questionnaire. Descriptive statistics were used to illustrate the levels of perceived risk according to the percent of “high risk” responses as well as the mean response values. Generally, the hazards that were perceived as posing the greatest health risk were those belonging to the social health risks; items related to technology risks received the lowest percentage of “high health risk” rankings. Traditional environmental risks such as natural catastrophes, pollution issues (chemical pollution, air pollution), and pesticides in food were ranked as being relatively high risks. The respondents were less concerned about new emerging issues and long-term environmental risks (global warming). In this survey, motor vehicle accidents were considered to be a “high health risk” by the greatest percentage of respondents. Generally speaking, the female respondents’ degree of recognition of health risks is higher than that of male respondents. Only for the item of smoking was the male respondents’ degree higher than that of females. There is also a geographic imbalance in the health risk perceptions. The degree of recognition of health risks from respondents in municipalities is generally lower than that of respondents from other areas except for items such as natural disasters, smoking, medical X-rays, and mental stress, which are exceptions. International Journal of Environmental Research and Public Health 2013-05-27 10 6 Article 10.3390/ijerph10062133 2133 2149 1660-4601 2013-05-27 doi: 10.3390/ijerph10062133 Chenggang Zhang Jingbo Fan http://www.mdpi.com/1660-4601/10/6/2120 To date, the sharing behaviors associated with the homemade tobacco waterpipe used in rural areas of the Western Pacific Region have not been studied. Evidence from studies of manufactured waterpipes raises the possibility of infectious disease transmission due to waterpipe sharing. The objective of our pilot study in rural Lao People’s Democratic Republic (PDR) was to identify and measure the prevalence of waterpipe sharing behaviors. We first conducted ethnographic studies to investigate waterpipe-smoking behaviors. These findings were then used to develop an interviewer-administered household survey that was used in a sampling of waterpipe smokers from three villages of the Luang Namtha province of Lao PDR (n = 43). Sampled waterpipe smokers were predominantly male (90.7%), older (mean age 49, SD 13.79), married (95.4%), farmers (78.6%), and had completed no primary education. Pipes were primarily made from bamboo (92.9%). Almost all (97.6%) smokers were willing to share their pipe with others. At the last time they smoked, smokers shared a pipe with at least one other person (1.2 ± 0.5 persons). During the past week, they had shared a pipe with five other persons (5.2 ± 3.8 persons). The high prevalence of sharing behaviors among waterpipe smokers in rural Southeast Asia raises the possibility that this behavior provides important and unmeasured social network pathways for the transmission of infectious agents. International Journal of Environmental Research and Public Health 2013-05-24 10 6 Article 10.3390/ijerph10062120 2120 2132 1660-4601 2013-05-24 doi: 10.3390/ijerph10062120 Robyn Martin Sahar Safaee Khamphithoun Somsamouth Boualoy Mounivong Ryan Sinclair Shweta Bansal Pramil Singh http://www.mdpi.com/1660-4601/10/6/2109 The purpose of this study was to investigate the oxidative damage induced by dietary nickel chloride (NiCl2) in the intestinal mucosa of different parts of the intestine of broilers, including duodenum, jejunum and ileum. A total of 240 one-day-old broilers were divided into four groups and fed on a corn-soybean basal diet as control diet or the same basal diet supplemented with 300, 600 or 900 mg/kg NiCl2 during a 42-day experimental period. The results showed that the activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px), and the ability to inhibit hydroxy radical and glutathione (GSH) content were significantly (p < 0.05 or p < 0.01) decreased in the 300, 600 and 900 mg/kg groups in comparison with those of the control group. In contrast, malondialdehyde (MDA) content was significantly (p < 0.05 or p < 0.01) higher in the 300, 600 and 900 mg/kg groups than that in the control group. It was concluded that dietary NiCl2 in excess of 300 mg/kg could cause oxidative damage in the intestinal mucosa in broilers, which finally impaired the intestinal functions including absorptive function and mucosal immune function. The oxidative damage might be a main mechanism on the effects of NiCl2 on the intestinal health of broilers. International Journal of Environmental Research and Public Health 2013-05-23 10 6 Article 10.3390/ijerph10062109 2109 2119 1660-4601 2013-05-23 doi: 10.3390/ijerph10062109 Bangyuan Wu Hengmin Cui Xi Peng Jing Fang Zhicai Zuo Junliang Deng Jianying Huang http://www.mdpi.com/1660-4601/10/5/2084 Selecting indicators based on the characteristics and development trends of a given study area is essential for building a framework for assessing urban ecological security. However, few studies have focused on how to select the representative indicators systematically, and quantitative research is lacking. We developed an innovative quantitative modeling approach called the grey dynamic hierarchy analytic system (GDHAS) for both the procedures of indicator selection and quantitative assessment of urban ecological security. Next, a systematic methodology based on the GDHAS is developed to assess urban ecological security comprehensively and dynamically. This assessment includes indicator selection, driving force-pressure-state-impact-response (DPSIR) framework building, and quantitative evaluation. We applied this systematic methodology to assess the urban ecological security of Tianjin, which is a typical coastal super megalopolis and the industry base in China. This case study highlights the key features of our approach. First, 39 representative indicators are selected for the evaluation index system from 62 alternative ones available through the GDHAS. Second, the DPSIR framework is established based on the indicators selected, and the quantitative assessment of the eco-security of Tianjin is conducted. The results illustrate the following: urban ecological security of Tianjin in 2008 was in alert level but not very stable; the driving force and pressure subsystems were in good condition, but the eco-security levels of the remainder of the subsystems were relatively low; the pressure subsystem was the key to urban ecological security; and 10 indicators are defined as the key indicators for five subsystems. These results can be used as the basis for urban eco-environmental management. International Journal of Environmental Research and Public Health 2013-05-21 10 5 Article 10.3390/ijerph10052084 2084 2108 1660-4601 2013-05-21 doi: 10.3390/ijerph10052084 Chaofeng Shao Xiaogang Tian Yang Guan Meiting Ju Qiang Xie http://www.mdpi.com/1660-4601/10/5/2069 This environmental telephone interview scan was designed to identify: (1) how hospitals in one Canadian province incorporated tobacco use identification/documentation systems into practice; and, (2) challenges/issues with tobacco identification/documentation. Participants included 36/139 hospitals previously identified to offer cessation services. Results showed hospitals aided by researchers monitored and tracked tobacco use; those not aligned with researchers did not. The wording of tobacco items most commonly included use within the last 6-months (42%), 30-days (39%), or 7-days (33%), or use without reference to time (e.g., “Do you smoke?”; 39%); wording sometimes depended on admitting form space limitations. The admission process determined where the tobacco item appeared, which differed by hospital—75% included it on an admitting form (75%) and/or nursing assessment (56%); the item sometimes varied by unit. There were also different processes by which the item triggered delivery of cessation interventions; most frequently (69%), staff nurses were triggered to provide an intervention. The findings suggest that adding a tobacco use question to a hospital’s admitting process is potentially not that simple. Deciding on the purpose of the question, when it will be asked and by whom, space allotted on the form, and how it will trigger an intervention are important considerations that can affect the question wording, form/location, systems required, data extraction, and resources. International Journal of Environmental Research and Public Health 2013-05-21 10 5 Article 10.3390/ijerph10052069 2069 2083 1660-4601 2013-05-21 doi: 10.3390/ijerph10052069 Patricia Smith Nancy Cobb Linda Corso http://www.mdpi.com/1660-4601/10/5/2058 The objectives of this study were to determine the prevalence of Campylobacter jejuni and Campylobacter coli in retail beef, beef livers, and pork meats purchased from the Tulsa (OK, USA) area and to further characterize the isolates obtained through antimicrobial susceptibility testing. A total of 97 chilled retail beef (50 beef livers and 47 other cuts), and 100 pork samples were collected. The prevalence of Campylobacter in beef livers was 39/50 (78%), while no Campylobacter was isolated from the other beef cuts. The prevalence in pork samples was 2/100 (2%). A total of 108 Campylobacter isolates (102 beef livers isolates and six pork isolates) were subjected to antimicrobial resistance profiling against sixteen different antimicrobials that belong to eight different antibiotic classes. Of the six pork Campylobacter coli isolates, four showed resistance to all antimicrobials tested. Among the beef liver isolates, the highest antibiotic resistances were to tetracyclines and β-lactams, while the lowest resistances were to macrolides, aminoglycosides, lincosamides, and phenicols. Resistances to the fluoroquinolone, macrolide, aminoglycoside, tetracycline, b-lactam, lincosamide, and phenicol antibiotic classes were significantly higher in Campylobacter coli than Campylobacter jejuni isolates. Multidrug Resistance (MDR) among the 102 Campylobacter (33 Campylobacter jejuni and 69 Campylobacter coli) beef liver isolates was significantly higher in Campylobacter coli (62%) than Campylobacter jejuni (39%). The high prevalence of Campylobacter in retail beef livers and their antimicrobial resistance raise concern about the safety of these retail products. International Journal of Environmental Research and Public Health 2013-05-21 10 5 Article 10.3390/ijerph10052058 2058 2068 1660-4601 2013-05-21 doi: 10.3390/ijerph10052058 Aneesa Noormohamed Mohamed Fakhr http://www.mdpi.com/1660-4601/10/5/2043 The aim of this study was to assess the effectiveness of Screening and Brief Intervention (SBI) for alcohol problems among university students in South Africa. The study design for this efficacy study is a randomized controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by hazardous and harmful drinkers in a university setting. The unit of randomization is the individual university student identified as a hazardous or harmful drinker attending public recruitment venues in a university campus. University students were screened for alcohol problems, and those identified as hazardous or harmful drinkers were randomized into an experimental or control group. The experimental group received one brief counseling session on alcohol risk reduction, while the control group received a health education leaflet. Results indicate that of the 722 screened for alcohol and who agreed to participate in the trial 152 (21.1%) tested positive for the Alcohol Use Disorder Identification Test (AUDIT) (score 8 or more). Among the 147 (96.7%) university students who also attended the 12-month follow-up session, the intervention effect on the AUDIT score was −1.5, which was statistically significant (P = 0.009). Further, the depression scores marginally significantly decreased over time across treatment groups, while other substance use (tobacco and cannabis use), self-rated health status and Posttraumatic Stress Disorder (PTSD) scores did not change over time across treatment groups. The study provides evidence of effective brief intervention by assistant nurses with hazardous and harmful drinkers in a university setting in South Africa. The short duration of the brief intervention makes it a realistic candidate for use in a university setting. International Journal of Environmental Research and Public Health 2013-05-21 10 5 Article 10.3390/ijerph10052043 2043 2057 1660-4601 2013-05-21 doi: 10.3390/ijerph10052043 Supa Pengpid Karl Peltzer Hendry van der Heever Linda Skaal http://www.mdpi.com/1660-4601/10/5/2028 Recent studies have suggested the importance of the neighborhood environment in determining the specific type of physical activity. However, few studies on this topic have been undertaken in Japan. This study examined the association of three types of physical activity and their associations with individual and neighborhood environmental factors among middle-aged and elderly Japanese. Participants were 2,449 adults aged 40–69 living in Fujisawa city who had undergone health checkups and responded to our survey by mail. Individual factors, the International Physical Activity Questionnaire (long form), and its environmental module acted as inputs to the study. The adjusted odds ratios (ORs) of high levels of moderate-to-vigorous intensity leisure-time physical activity (LTPA), walking for active recreation, and transportation were calculated in relation to individual and neighborhood environmental factors through multiple logistic regression models. Not working and good self-rated health were significantly associated with a higher level of each physical activity outcome. According to the adjusted ORs, higher educational attainment, higher economic status, good access to exercise facilities, and owning motor vehicles were associated with longer LTPA time. However, different sets of factors were associated with longer walking times for recreation and transportation. The results suggest that diverse individual and neighborhood environmental characteristics are associated with different physical activity outcomes. Therefore, customizing environments to become activity-friendly is necessary to increase physical activity effectively among middle-aged and elderly Japanese. International Journal of Environmental Research and Public Health 2013-05-17 10 5 Article 10.3390/ijerph10052028 2028 2042 1660-4601 2013-05-17 doi: 10.3390/ijerph10052028 Yoshinobu Saito Yuko Oguma Shigeru Inoue Ayumi Tanaka Yoshitaka Kobori http://www.mdpi.com/1660-4601/10/5/2017 Unmet health care needs are determined as the difference between the services judged necessary and the services actually received, and stem from barriers related to accessibility, availability and acceptability. This study aims to examine the prevalence of unmet needs and to identify the socioeconomic and health status factors that are associated with unmet needs. A cross-sectional study was conducted in Greece in 2010 and involved data from 1,000 consenting subjects (>18 years old). Multiple binary logistic regression analysis was applied to investigate the predictors of unmet needs and to determine the relation between the socio-demographic characteristics and the accessibility, availability and acceptability barriers. Ninety nine participants (9.9%) reported unmet health needs during the 12 months prior to the research. The most frequently self-reported reasons were cost and lack of time. Youth, parenthood, physician consultations, and poor mental health increased the likelihood of unmet needs. Women were less likely to report accessibility and availability than acceptability barriers. Educational differences were evident and individuals with primary and secondary education were associated with significantly more accessibility and availability barriers compared with those with tertiary education. Unmet health needs pose a significant challenge to the health care system, especially given the difficult current financial situation in Greece. It is believed that unmet health needs will continue to increase, which will widen inequalities in health and health care access. International Journal of Environmental Research and Public Health 2013-05-17 10 5 Article 10.3390/ijerph10052017 2017 2027 1660-4601 2013-05-17 doi: 10.3390/ijerph10052017 Evelina Pappa Nick Kontodimopoulos Angelos Papadopoulos Yannis Tountas Dimitris Niakas http://www.mdpi.com/1660-4601/10/5/1977 Water-related parasitic diseases are directly dependent on water bodies for their spread or as a habitat for indispensable intermediate or final hosts. Along with socioeconomic development and improvement of sanitation, overall prevalence is declining in the China. However, the heterogeneity in economic development and the inequity of access to public services result in considerable burden due to parasitic diseases in certain areas and populations across the country. In this review, we demonstrated three aspects of ten major water-related parasitic diseases, i.e., the biology and pathogenicity, epidemiology and recent advances in research in China. General measures for diseases control and special control strategies are summarized. International Journal of Environmental Research and Public Health 2013-05-17 10 5 Review 10.3390/ijerph10051977 1977 2016 1660-4601 2013-05-17 doi: 10.3390/ijerph10051977 Shan Lv Li-Guang Tian Qin Liu Men-Bao Qian Qing Fu Peter Steinmann Jia-Xu Chen Guo-Jing Yang Kun Yang Xiao-Nong Zhou http://www.mdpi.com/1660-4601/10/5/1963 Background: Health-related Habits (HrH) are a major priority in healthcare. However there is little agreement on whether exercise, diet, smoking or dental hygiene are better described as lifestyles, habits or behaviors, and on what is their hierarchical relationship. This research is aimed at representing the basic concepts which are assumed to constitute the conceptual framework enabling us to interpret and organize the field of HrH. Methods: A group of 29 experts with different backgrounds agreed on the definition and hierarchy of HrH following an iterative process which involved framing analysis and nominal group techniques. Results: Formal definitions of health-related behavior, habit, life-style and life-style profile were produced. In addition a series of basic descriptors were identified: health reserve, capital, risk and load. Six main categories of HrH were chosen based on relevance to longevity: diet/exercise, vitality/stress, sleep, cognition, substance use and other risk. Attributes of HrH are clinical meaningfulness, quantifiability, temporal stability, associated morbidity, and unitarity (non-redundancy). Two qualifiers (polarity and stages of change) have also been described. Conclusions: The concepts represented here lay the groundwork for the development of clinical and policy tools related to HrH and lifestyle. An adaptation of this system to define targets of health interventions and to develop the classification of person factors in ICF may be needed in the future. International Journal of Environmental Research and Public Health 2013-05-13 10 5 Article 10.3390/ijerph10051963 1963 1976 1660-4601 2013-05-13 doi: 10.3390/ijerph10051963 Luis Salvador-Carulla Federico Alonso Rafael Gomez Carolyn Walsh José Almenara Mencía Ruiz María Abellán eVITAL group http://www.mdpi.com/1660-4601/10/5/1948 Developed countries are experiencing high levels of mental and physical illness associated with long term health conditions, unhealthy lifestyles and an ageing population. Given the limited capacity of the formal health care sector to address these public health issues, attention is turning to the role of agencies active in civil society. This paper sought to evaluate the associations between participation in community centre activities, the psycho-social wellbeing and health related behaviours. This was based on an evaluation of the South West Well-being programme involving ten organisations delivering leisure, exercise, cooking, befriending, arts and crafts activities. The evaluation consisted of a before-and-after study with 687 adults. The results showed positive changes in self-reported general health, mental health, personal and social well-being. Positive changes were associated with diet and physical activity. Some activities were different in their outcomes—especially in cases where group activities were combined with one-to-one support. The results suggest that community centre activities of this nature offer benefits that are generically supportive of health behaviour changes. Such initiatives can perform an important role in supporting the health improvement objectives of formal health care services. For commissioners and partner agencies, accessibility and participation are attractive features that are particularly pertinent to the current public health context. International Journal of Environmental Research and Public Health 2013-05-10 10 5 Article 10.3390/ijerph10051948 1948 1962 1660-4601 2013-05-10 doi: 10.3390/ijerph10051948 Mat Jones Richard Kimberlee Toity Deave Simon Evans http://www.mdpi.com/1660-4601/10/5/1927 Swine Dysentery (SD) is a severe mucohaemorhagic enteric disease of pigs caused by Brachyspira hyodysenteriae, which has a large impact on pig production and causes important losses due to mortality and sub-optimal performance. Although B. hyodysenteriae has been traditionally considered a pathogen mainly transmitted by direct contact, through the introduction of subclinically infected animals into a previously uninfected herd, recent findings position B. hyodysenteriae as a potential threat for indirect transmission between farms. This article summarizes the knowledge available on the etiological agent of SD and its virulence traits, and reviews the determinants of SD transmission. The between-herds and within-herd transmission routes are addressed. The factors affecting disease transmission are thoroughly discussed, i.e., environmental survival of the pathogen, husbandry factors (production system, production stage, farm management), role of vectors, diet influence and interaction of the microorganism with gut microbiota. Finally, prophylactic and therapeutic approaches to fight against the disease are briefly described. International Journal of Environmental Research and Public Health 2013-05-10 10 5 Review 10.3390/ijerph10051927 1927 1947 1660-4601 2013-05-10 doi: 10.3390/ijerph10051927 Avelino Alvarez-Ordóez Francisco Martínez-Lobo Héctor Arguello Ana Carvajal Pedro Rubio http://www.mdpi.com/1660-4601/10/5/1916 Long-term exposure to elevated indoor radon concentrations has been determined to be the second leading cause of lung cancer in adults after tobacco smoking. With the establishment of a National Radon Program in Canada in 2007 thousands of homes across the country have been tested for radon. Although the vast majority of people are exposed to low or moderate radon concentrations; from time to time; there are homes found with very high concentrations of radon. Among those living in homes with very high radon concentrations, it is typically parents of young children that demonstrate a great deal of concern. They want to know the equivalent risk in terms of the lifetime relative risk of developing lung cancer when a child has lived in a home with high radon for a few years. An answer to this question of risk equivalency is proposed in this paper. The results demonstrate clearly that the higher the radon concentration; the sooner remedial measures should be undertaken; as recommended by Health Canada in the Canadian radon guideline. International Journal of Environmental Research and Public Health 2013-05-08 10 5 Technical Note 10.3390/ijerph10051916 1916 1926 1660-4601 2013-05-08 doi: 10.3390/ijerph10051916 Jing Chen http://www.mdpi.com/1660-4601/10/5/1895 The primary purpose of this study was to explore the link between rail and road traffic noise and overall life satisfaction. While the negative relationship between residential satisfaction and traffic noise is relatively well-established, much less is known about the effect of traffic noise on overall life satisfaction. Based on results of previous studies, we propose a model that links objective noise levels, noise sensitivity, noise annoyance, residential satisfaction and life satisfaction. Since it is not clear whether a bottom-up or top-down relationship between residential satisfaction and life satisfaction holds, we specify models that incorporate both of these theoretical propositions. Empirical models are tested using structural equation modeling and data from a survey among residents of areas with high levels of road traffic noise (n1 = 354) and rail traffic noise (n2 = 228). We find that traffic noise has a negative effect on residential satisfaction, but no significant direct or indirect effects on overall life satisfaction. Noise annoyance due to road and rail traffic noise has strong negative effect on residential satisfaction rather than on overall life satisfaction. These results are very similar for the road and railway traffic contexts and regardless of whether the model assumes the top-down or bottom-up direction of the causation between life satisfaction and residential satisfaction. International Journal of Environmental Research and Public Health 2013-05-07 10 5 Article 10.3390/ijerph10051895 1895 1915 1660-4601 2013-05-07 doi: 10.3390/ijerph10051895 Jan Urban Vojtěch Máca http://www.mdpi.com/1660-4601/10/5/1882 During past decades, the number of dentists has continuously increased in Iran. Beside the quantity, the distribution of dentists affects the oral health status of population. The current study aimed to assess the pure and social disparities in distribution of dentists across the provinces in Iran in 2009. Data on provinces’ characteristics, including population and social situation, were obtained from multiple sources. The disparity measures (including Gini coefficient, index of dissimilarity, Gaswirth index of disparity and relative index of inequality (RII)) and pairwise correlations were used to evaluate the pure and social disparities in the number of dentists in Iran. On average, there were 28 dentists per 100,000 population in the country. There were substantial pure disparities in the distribution of dentists across the provinces in Iran. The unadjusted and adjusted RII values were 3.82 and 2.13, respectively; indicating area social disparity in favor of people in better-off provinces. There were strong positive correlations between density of dentists and better social rank. It is suggested that the results of this study should be considered in conducting plans for redistribution of dentists in the country. In addition, further analyses are needed to explain these disparities. International Journal of Environmental Research and Public Health 2013-05-06 10 5 Article 10.3390/ijerph10051882 1882 1894 1660-4601 2013-05-06 doi: 10.3390/ijerph10051882 Aliasghar Kiadaliri Reza Hosseinpour Hassan Haghparast-Bidgoli Ulf-G Gerdtham http://www.mdpi.com/1660-4601/10/5/1861 Groundwater chemistry of small tropical islands is influenced by many factors, such as recharge, weathering and seawater intrusion, among others, which interact with each other in a very complex way. In this work, multivariate statistical analysis was used to evaluate the factors controlling the groundwater chemistry of Kapas Island (Malaysia). Principal component analysis (PCA) was applied to 17 hydrochemical parameters from 108 groundwater samples obtained from 18 sampling sites. PCA extracted four PCs, namely seawater intrusion, redox reaction, anthropogenic pollution and weather factors, which collectively were responsible for more than 87% of the total variance of the island’s hydrochemistry. The cluster analysis indicated that three factors (weather, redox reaction and seawater intrusion) controlled the hydrochemistry of the area, and the variables were allocated to three groups based on similarity. A Piper diagram classified the island’s water types into Ca-HCO3 water type, Na-HCO3 water type, Na-SO4-Cl water type and Na-Cl water type, indicating recharge, mixed, weathering and leached from sewage and seawater intrusion, respectively. This work will provide policy makers and land managers with knowledge of the precise water quality problems affecting the island and can also serve as a guide for hydrochemistry assessments of other islands that share similar characteristics with the island in question. International Journal of Environmental Research and Public Health 2013-05-06 10 5 Article 10.3390/ijerph10051861 1861 1881 1660-4601 2013-05-06 doi: 10.3390/ijerph10051861 Nura Kura Mohammad Ramli Wan Sulaiman Shaharin Ibrahim Ahmad Aris Adamu Mustapha http://www.mdpi.com/1660-4601/10/5/1845 Leptospirosis is a serious public health concern in the Philippines, not only because of its increasing incidence rate, but also because of its significant health and economic impacts. Despite its relatively high seroprevalence, knowledge on the economic burden of disease, particularly on the value that the society places on disease prevention remains limited. Obtaining such information is important within the context of public health policy. This study was conducted in Metro Manila to determine the economic burden of leptospirosis, by asking respondents about their willingness to contribute to labor (WTCL) for the prevention of leptospirosis. The respondents pledged an average labor contribution of 10.66 h/month. The average WTCL corresponded to a monetary value of US$4.01 per month when valued using the opportunity cost of labor (leisure rate of time). From the monetized labor contribution, the total economic value of preventing leptospirosis was estimated at US$124.97 million per annum, which represents 1.13% of Metro Manila’s gross domestic product (GDP). Estimates from a Tobit regression model identified the respondents’ knowledge regarding leptospirosis, the susceptibility of their homes to flooding, and the proximity of their homes to sewers as significant factors to consider when developing resource contribution programs for leptospirosis prevention. More efforts need to be made in developing community level preventive programs, and in improving public’s knowledge and awareness about leptospirosis. International Journal of Environmental Research and Public Health 2013-05-03 10 5 Article 10.3390/ijerph10051845 1845 1860 1660-4601 2013-05-03 doi: 10.3390/ijerph10051845 Joseph Arbiol Maridel Borja Mitsuyasu Yabe Hisako Nomura Nina Gloriani Shin-ichi Yoshida http://www.mdpi.com/1660-4601/10/5/1831 Japanese encephalitis (JE) is one of the most important mosquito-borne viral diseases in Asia. Pigs are a natural host and the amplifier of JE virus. The sero-conversion rate to JE virus in sentinel pigs reflects the activity of JE virus in the region. We analyzed whether precipitation has any effect on the sero-conversion rate to JE virus in sentinel pigs. Linear regression analysis was performed to determine the correlations between the levels of precipitation and sero-conversion rates to JE virus, in the entire year and during summertime over the period of 32 years from 1969 to 2000. The levels of the annual and summertime precipitation demonstrated statistically significant positive correlations with sero-conversion rates for the whole of the country and for some regions in Japan. The levels of the summertime precipitation, on the other hand, demonstrated statistically significant inverse correlations with the sero-conversion rates in other regions. Further, the levels of precipitation during preceding 10-day periods from days 1–40 before blood collection showed inverse correlation with antibody-positive rates in some regions. The results indicate that the relationship between the annual and summertime precipitation, and the sero-conversion rate to JE virus is complex; both positive and inverse effects are demonstrated depending on the regions. International Journal of Environmental Research and Public Health 2013-05-03 10 5 Article 10.3390/ijerph10051831 1831 1844 1660-4601 2013-05-03 doi: 10.3390/ijerph10051831 Ichiro Kurane Ken-ichi Shibasaki Akira Kotaki Yasuaki Hijioka Tomohiko Takasaki http://www.mdpi.com/1660-4601/10/5/1815 Research shows that one in four migrant farmworkers experienced an episode of one or more mental health disorders such as stress, depression, or anxiety in their lifetime. The purpose of this mixed methods study was to explore experiences and perceptions related to stress and depression among Latino migrant and seasonal farmworkers (MSFWs), and to identify their coping behaviors for dealing with these mental health conditions. Using a mixed methods research approach, three focus group interviews of a sample of Latino MSFWs (N = 29) were conducted and a quantitative survey was implemented (N = 57) at community sites in eastern North Carolina. Four major themes emerged from the focus group data: (1) physical stress related to working conditions; (2) mental stress related to family situations, work environment, documentation status, and lack of resources; (3) depression related to separation from family and the lack of resources; and (4) use of positive and negative mechanisms for coping with stress and depression. A discussion of these themes, results from the survey findings, implications for intervention and outreach programs, along with recommendations for further research, are provided. International Journal of Environmental Research and Public Health 2013-05-03 10 5 Article 10.3390/ijerph10051815 1815 1830 1660-4601 2013-05-03 doi: 10.3390/ijerph10051815 Sloane Winkelman Elizabeth Chaney Jeffrey Bethel http://www.mdpi.com/1660-4601/10/5/1786 The “Hispanic Paradox” suggests that despite rates of poverty similar to African Americans, Hispanics have far better health and mortality outcomes, more comparable to non-Hispanic White Americans. Three prominent possible explanations for the Hispanic Paradox have emerged. The “Healthy Migrant Effect” suggests a health selection effect due to the demands of migration. The Hispanic lifestyle hypothesis focuses on Hispanics’ strong social ties and better health behaviors. The reverse migration argument suggests that the morbidity profile in the USA is affected when many Hispanic immigrants return to their native countries after developing a serious illness. We analyzed data from respondents aged 55 and over from the nationally representative 2006 American Community Survey including Mexican Americans (13,167 U.S. born; 11,378 immigrants), Cuban Americans (314 U.S. born; 3,730 immigrants), and non-Hispanic White Americans (629,341 U.S. born; 31,164 immigrants). The healthy migrant effect was supported with SES-adjusted disability comparable between Mexican, Cuban and non-Hispanic Whites born in the USA and all immigrants having lower adjusted odds of functional limitations than U.S. born non-Hispanic Whites. The reverse migration hypothesis was partially supported, with citizenship and longer duration in the USA associated with higher rates of SES-adjusted disability for Mexican Americans. The Hispanic healthy life-style explanation had little support in this study. Our findings underline the importance of considering nativity when planning for health interventions to address the needs of the growing Hispanic American older adult population. International Journal of Environmental Research and Public Health 2013-05-03 10 5 Article 10.3390/ijerph10051786 1786 1814 1660-4601 2013-05-03 doi: 10.3390/ijerph10051786 Esme Thomson Amani Nuru-Jeter Dawn Richardson Ferrah Raza Meredith Minkler http://www.mdpi.com/1660-4601/10/5/1775 Fluoride is an environmental and industrial pollutant that affects various organs in humans and animals. The cecal tonsil is an important component of the mucosal immune system and performs important and unique immune functions. In the present study, we investigated the effects of dietary high fluorine on the quantities of IgA+ B cells in the cecal tonsil by immunohistochemistry, and the immunoglobulin A (IgA), immunoglobulin G (IgG) and immunoglobulin M (IgM) contents in the cecal tonsil by ELISA. A total of 280 one-day-old avian broilers were divided into four groups and fed on a corn-soybean basal diet as control diet (fluorine 22.6 mg/kg) or the same diet supplemented with 400, 800 and 1,200 mg/kg fluorine (high fluorine groups I, II and III) in the form of sodium fluoride, respectively, throughout a 42-day experimental period. The results showed that the quantities of IgA+ B cells were lower (p < 0.05 or p < 0.01) and the IgA, IgG, and IgM contents were decreased (p < 0.05 or p < 0.01) in high fluorine groups II and III in comparison with those of control group. It was concluded that dietary fluorine, in the 800–1,200 mg/kg range, could reduce the numbers of the IgA+ B cells and immunoglobulin contents in the cecal tonsil, implying the local mucosal immune function was ultimately impacted in broilers. International Journal of Environmental Research and Public Health 2013-05-02 10 5 Article 10.3390/ijerph10051775 1775 1785 1660-4601 2013-05-02 doi: 10.3390/ijerph10051775 Juan Liu Hengmin Cui Xi Peng Jing Fang Zhicai Zuo Junliang Deng Hesong Wang Bangyuan Wu Yuanxin Deng Kangping Wang http://www.mdpi.com/1660-4601/10/5/1763 We investigated the relationship between being bullied and measured body weight and perceived body weight among adolescents of a middle-income sub Saharan African country. Our data originated from the Global School-based Health Survey, which targets adolescents aged 13–15 years. Student weights and heights were measured before administrating the questionnaire which included questions about personal data, health behaviors and being bullied. Standard criteria were used to assess thinness, overweight and obesity. Among 1,006 participants who had complete data, 16.5% (95%CI 13.3–20.2) reported being bullied ≥3 days during the past 30 days; 13.4% were thin, 16.8% were overweight and 7.6% were obese. Categories of actual weight and of perceived weight correlated only moderately (Spearman correlation coefficient 0.37 for boys and 0.57 for girls; p < 0.001). In univariate analysis, both actual obesity (OR 1.76; p = 0.051) and perception of high weight (OR 1.63 for “slightly overweight”; OR 2.74 for “very overweight”, both p < 0.05) were associated with being bullied. In multivariate analysis, ORs for categories of perceived overweight were virtually unchanged while ORs for actual overweight and obesity were substantially attenuated, suggesting a substantial role of perceived weight in the association with being bullied. Actual underweight and perceived thinness also tended to be associated with being bullied, although not significantly. Our findings suggest that more research attention be given to disentangling the significant association between body image, overweight and bullying among adolescents. Further studies in diverse populations are warranted. International Journal of Environmental Research and Public Health 2013-05-02 10 5 Article 10.3390/ijerph10051763 1763 1774 1660-4601 2013-05-02 doi: 10.3390/ijerph10051763 Michael Wilson Bharathi Viswanathan Valentin Rousson Pascal Bovet http://www.mdpi.com/1660-4601/10/5/1747 The consequences of starting smoking by age 18 are significant. Early smoking initiation is associated with higher tobacco dependence, increased difficulty in smoking cessation and more negative health outcomes. The purpose of this study is to examine how closely smoking initiation in a well-defined population of American Indians (AI) resembles a group of Non-Hispanic white (NHW) populations born over an 80 year period. We obtained data on age of smoking initiation among 7,073 AIs who were members of 13 tribes in Arizona, Oklahoma and North and South Dakota from the 1988 Strong Heart Study (SHS) and the 2001 Strong Heart Family Study (SHFS) and 19,747 NHW participants in the 2003 National Health Interview Survey. The participants were born as early as 1904 and as late as 1985. We classified participants according to birth cohort by decade, sex, and for AIs, according to location. We estimated the cumulative incidence of smoking initiation by age 18 in each sex and birth cohort group in both AIs and NHWs and used Cox regression to estimate hazard ratios for the association of birth cohort, sex and region with the age at smoking initiation. We found that the cumulative incidence of smoking initiation by age 18 was higher in males than females in all SHS regions and in NHWs (p < 0.001). Our results show regional variation of age of initiation significant in the SHS (p < 0.001). Our data showed that not all AIs (in this sample) showed similar trends toward increased earlier smoking. For instance, Oklahoma SHS male participants born in the 1980s initiated smoking before age 18 less often than those born before 1920 by a ratio of 0.7. The results showed significant variation in age of initiation across sex, birth cohort, and location. Our preliminary analyses suggest that AI smoking trends are not uniform across region or gender but are likely shaped by local context. If tobacco prevention and control programs depend in part on addressing the origin of AI smoking it may be helpful to increase the awareness in regional differences. International Journal of Environmental Research and Public Health 2013-05-02 10 5 Article 10.3390/ijerph10051747 1747 1762 1660-4601 2013-05-02 doi: 10.3390/ijerph10051747 Raymond Orr Darren Calhoun Carolyn Noonan Ron Whitener Jeff Henderson Jack Goldberg Patrica Henderson http://www.mdpi.com/1660-4601/10/5/1735 Drawing upon a sample of 296 new immigrant women in Hong Kong, this study investigated how social service utilization, family functioning, and sense of community influenced the depressive symptoms of new immigrant women. Results of the structural equation modeling suggested that family functioning and sense of community were both significantly and negatively associated with the depression of new immigrant women. Utilization of community services also influenced the depression of immigrant women indirectly through the mediating effect of sense of community. Implications of the research findings for mental health intervention were discussed. International Journal of Environmental Research and Public Health 2013-04-29 10 5 Article 10.3390/ijerph10051735 1735 1746 1660-4601 2013-04-29 doi: 10.3390/ijerph10051735 Qiaobing Wu Julian Chow http://www.mdpi.com/1660-4601/10/5/1720 Fish consumption has established benefits, including the promotion of cardiovascular health and pre- and neonatal brain and eye development, but local freshwater fish may be a source of contaminants that are especially harmful to fetuses and young children, such as the neurotoxic and developmentally toxic methylmercury and polychlorinated biphenyls. Fish consumption advisories may be issued by state health departments to limit human exposure to these and other toxicants. This study examined the efficacy of a sign designed by the North Carolina Division of Public Health that was posted along a reservoir (Badin Lake) in central North Carolina, USA, for increasing anglers’ awareness of a fish consumption advisory, with a special focus on anglers who share their catch with women and children. In this study, 109 anglers were interviewed about their awareness of fish consumption advisories in general and their knowledge of the Badin Lake fish advisory in particular. Shore anglers were significantly less likely to be aware of the term “fish consumption advisory” and of the specific advisory for Badin Lake than boat anglers. Although a significant increase in knowledge of the specific fish consumption advisory was found for the entire sample of study participants after the sign intervention, a commensurate increase in knowledge was not found for a subsample of anglers who reported sharing their catch with women and children. Study findings underscore differences in fish consumption advisory awareness among subpopulations. Specifically, the study revealed the importance of characterizing the communication needs of shore anglers and anglers who share their catch with sensitive subpopulations (e.g., women and children) for the creation of more targeted communications of fish consumption advisories. International Journal of Environmental Research and Public Health 2013-04-29 10 5 Article 10.3390/ijerph10051720 1720 1734 1660-4601 2013-04-29 doi: 10.3390/ijerph10051720 Catherine LePrevost Kathleen Gray Mercedes Hernández-Pelletier Brennan Bouma Consuelo Arellano W. Cope http://www.mdpi.com/1660-4601/10/5/1698 The mosquito Aedes (Stegomyia) albopictus (Skuse) (Diptera: Culicidae) is an invasive species which has colonized Southern Europe in the last two decades. As it is a competent vector for several arboviruses, its spread is of increasing public health concern, and there is a need for appropriate monitoring tools. In this paper, we have developed a modelling approach to predict mosquito abundance over time, and identify the main determinants of mosquito population dynamics. The model is temperature- and rainfall-driven, takes into account egg diapause during unfavourable periods, and was used to model the population dynamics of Ae. albopictus in the French Riviera since 2008. Entomological collections of egg stage from six locations in Nice conurbation were used for model validation. We performed a sensitivity analysis to identify the key parameters of the mosquito population dynamics. Results showed that the model correctly predicted entomological field data (Pearson r correlation coefficient values range from 0.73 to 0.93). The model’s main control points were related to adult’s mortality rates, the carrying capacity in pupae of the environment, and the beginning of the unfavourable period. The proposed model can be efficiently used as a tool to predict Ae. albopictus population dynamics, and to assess the efficiency of different control strategies. International Journal of Environmental Research and Public Health 2013-04-26 10 5 Article 10.3390/ijerph10051698 1698 1719 1660-4601 2013-04-26 doi: 10.3390/ijerph10051698 Annelise Tran Grégory L'Ambert Guillaume Lacour Romain Benoît Marie Demarchi Myriam Cros Priscilla Cailly Mélaine Aubry-Kientz Thomas Balenghien Pauline Ezanno http://www.mdpi.com/1660-4601/10/5/1681 Preserving the soundscape and geographic extension of quiet areas is a great challenge against the wide-spreading of environmental noise. The E.U. Environmental Noise Directive underlines the need to preserve quiet areas as a new aim for the management of noise in European countries. At the same time, due to their low population density, rural areas characterized by suitable wind are considered appropriate locations for installing wind farms. However, despite the fact that wind farms are represented as environmentally friendly projects, these plants are often viewed as visual and audible intruders, that spoil the landscape and generate noise. Even though the correlations are still unclear, it is obvious that visual impacts of wind farms could increase due to their size and coherence with respect to the rural/quiet environment. In this paper, by using the Immersive Virtual Reality technique, some visual and acoustical aspects of the impact of a wind farm on a sample of subjects were assessed and analyzed. The subjects were immersed in a virtual scenario that represented a situation of a typical rural outdoor scenario that they experienced at different distances from the wind turbines. The influence of the number and the colour of wind turbines on global, visual and auditory judgment were investigated. The main results showed that, regarding the number of wind turbines, the visual component has a weak effect on individual reactions, while the colour influences both visual and auditory individual reactions, although in a different way. International Journal of Environmental Research and Public Health 2013-04-26 10 5 Article 10.3390/ijerph10051681 1681 1697 1660-4601 2013-04-26 doi: 10.3390/ijerph10051681 Luigi Maffei Tina Iachini Massimiliano Masullo Francesco Aletta Francesco Sorrentino Vincenzo Senese Francesco Ruotolo http://www.mdpi.com/1660-4601/10/5/1665 The Nasorosso project of the Italian Youth Department and the National Institute of Health, aimed to raise awareness about drinking and driving under the influence of alcohol among club goers with a series of initiatives. Within the framework of the project, blood alcohol concentration (BAC) was measured on 106,406 individuals before and after clubbing in 66 different recreational sites from 11 Italian provinces, over 16 months. Participating individuals were interviewed regarding sociodemographic and environmental characteristics and alcohol intoxicated people were offered to be taken home. The BAC median at the club entry was 0.26 g/L with 65.3% subjects showing a BAC value under the driving legal limit of 0.5g/L. At the exit from clubs, BAC median value rose to 0.44 g/L and subjects with BAC value under the legal limit decreased to 54.9%. Being male, aged between 18 and 34 years with a diploma, being a drinker and entering the disco with a BAC already beyond the legal limit predicted a BAC value beyond 0.5 g/L at exit from the recreational place. Conversely, being a driver, being a student and exiting from the disco before 4 a.m. reduced the probability of having a BAC higher than 0.5 g/L at the end of the night.  Health policies to prevent harmful use of alcohol in young people should continue to offer targeted information/ prevention; in order to steadily increase the awareness of the dangers and the damages of excessive use of alcohol. International Journal of Environmental Research and Public Health 2013-04-24 10 5 Article 10.3390/ijerph10051665 1665 1680 1660-4601 2013-04-24 doi: 10.3390/ijerph10051665 Roberta Pacifici Andrea Pierantozzi Rita Giovannandrea Ilaria Palmi Luisa Mastrobattista Claudia Mortali Simona Pichini http://www.mdpi.com/1660-4601/10/5/1647 Young children being injured at home is a perennial problem. When parents of young children and family workers discussed what influenced parents’ perceptions and responses to child injury risk at home, both “upstream” and “downstream” causal factors were identified. Among the former, complex and interactive facets of society and contemporary living emerged as potentially critical features. The “wicked problems” model arose from the need to find resolutions for complex problems in multidimensional environments and it proved a useful analogy for child injury. Designing dynamic strategies to provide resolutions to childhood injury, may address our over-dependence on ‘tame solutions’ that only deal with physical cause-and-effect relationships and which cannot address the complex interactive contexts in which young children are often injured. International Journal of Environmental Research and Public Health 2013-04-24 10 5 Article 10.3390/ijerph10051647 1647 1664 1660-4601 2013-04-24 doi: 10.3390/ijerph10051647 Jean Simpson Geoff Fougere Rob McGee http://www.mdpi.com/1660-4601/10/4/1631 This work assesses the environmental impact from chemical emissions due to military tests and routine activities in the area occupied by the Italian Inter-force Test Range (PISQ), located at Salto di Quirra, Sardinia, Italy. After reviewing the military activities carried out at PISQ, such as rocket launching, blasting and armament destruction, projectile and mortar fire impact, the associated pollution is evaluated. Chemical analyses were performed by means of Scanning Electronic Microscopy and Energy Dispersion Spectrometry on biotic and abiotic matrices. Residues of Rb, Tl, W, Ti and Al were found in matrices collected in the PISQ areas and environs. A review of experimental data on air, water, soil, milk, forage and animal tissues obtained by various Public Agencies of Sardinia proved that toxic element residues often exceeded the legal limits. PM10 and PM2.5 air concentrations also exceeded the legal limits after military blasting. Cd and Pb contents in the liver and kidneys of sheep living in farms at PISQ and in control farms that were located more than 20 km away from PISQ were higher than the legal limits. This work was performed to investigate concentration of xenobiotics in ecosystems emitted from PISQ activities. This assessment could be useful to focus future epidemiological studies carried out in PISQ and its neighbouring areas. International Journal of Environmental Research and Public Health 2013-04-19 10 4 Article 10.3390/ijerph10041631 1631 1646 1660-4601 2013-04-19 doi: 10.3390/ijerph10041631 Mauro Cristaldi Cristiano Foschi Germana Szpunar Carlo Brini Fiorenzo Marinelli Lucio Triolo http://www.mdpi.com/1660-4601/10/4/1609 Chemical industry parks in China are considered high-risk areas because they present numerous risks that can damage the environment, such as pollution incidents. In order to identify the environmental risks and the principal risk factors in these areas, we have developed a simple physical model of a regional environmental risk field (ERF) using existing dispersal patterns and migration models. The regional ERF zoning was also conducted and a reference value for diagnostic methods was developed to determine risk-acceptable, risk-warning, and risk-mitigation zones, which can provide a risk source layout for chemical industry parks. In accordance with the environmental risk control requirements, this study focused on the three stages of control and management of environmental risk and established an environmental risk management system including risk source identification and assessment, environmental safety planning, early risk warning, emergency management, assessment of environmental effects, and environmental remediation of pollution accidents. By using this model, the environmental risks in Tianjin Binhai New Area, the largest chemical industry park in China, were assessed and the environmental risk zoning map was drawn, which suggested the existence of many unacceptable environmental risks in this area. Thus, relevant suggestions have been proposed from the perspective of the adjustment of risk source layout, intensified management of environmental risk control and so on. International Journal of Environmental Research and Public Health 2013-04-19 10 4 Article 10.3390/ijerph10041609 1609 1630 1660-4601 2013-04-19 doi: 10.3390/ijerph10041609 Chaofeng Shao Juan Yang Xiaogang Tian Meiting Ju Lei Huang http://www.mdpi.com/1660-4601/10/4/1598 A sensitive and specific monoclonal antibody-based sandwich enzyme-linked immunosorbent assay (ELISA) was established and validated for the detection of staphylococcal enterotoxin A (SEA). After routine fusion and selection, 10 monoclonal antibodies showed high affinity for SEA. An optimal pair for sandwich ELISA was selected by pairwise interaction analysis. After optimization, the limit of detection (LOD) and linear dynamic range of the method were established, and were found to be 0.0282 ng/mL and 0.06–2 ng/mL, respectively. The recovery in pure milk ranged from 82.67% to 111.95% and the intra- and inter-assay coefficients of variation ranged from 3.16% to 6.05% and from 5.16% to 10.79%, respectively. Cross-reactivity with staphylococcal enterotoxin B (SEB), staphylococcal enterotoxin C (SEC), staphylococcal enterotoxin D (SED), and staphylococcal enterotoxin E (SEE) in this method were insignificant. These results indicate that the sandwich ELISA method developed in our study is effective for routine identification of SEA in food samples. International Journal of Environmental Research and Public Health 2013-04-19 10 4 Article 10.3390/ijerph10041598 1598 1608 1660-4601 2013-04-19 doi: 10.3390/ijerph10041598 Hua Kuang Wenbing Wang Liguang Xu Wei Ma Liqiang Liu Libing Wang Chuanlai Xu http://www.mdpi.com/1660-4601/10/4/1586 There is growing evidence that household water treatment interventions improve microbiological water quality and reduce diarrheal disease risk. Few studies have examined, however, the impact of water treatment interventions on household-level hygiene and sanitation. This study examined the association of four water and sanitation conditions (access to latrines, improved sanitation, improved water and the plastic biosand filter) on the levels of total coliforms and E. coli on existing and introduced toys during an on-going randomized controlled trial of the plastic biosand filter (plastic BSF). The following conditions were associated with decreased bacterial contamination on children’s toys: access to a latrine, access to improved sanitation and access to the plastic BSF. Overall, compared to existing toys, introduced toys had significantly lower levels of both E. coli and total coliforms. Results suggest that levels of fecal indicator bacteria contamination on children’s toys may be associated with access to improved water and sanitation conditions in the home. In addition, the fecal indicator bacteria levels on toys probably vary with duration in the household. Additional information on how these toys become contaminated is needed to determine the usefulness of toys as indicators or sentinels of water, sanitation and hygiene conditions, behaviors and risks. International Journal of Environmental Research and Public Health 2013-04-18 10 4 Article 10.3390/ijerph10041586 1586 1597 1660-4601 2013-04-18 doi: 10.3390/ijerph10041586 Christine Stauber Adam Walters Anna de Aceituno Mark Sobsey http://www.mdpi.com/1660-4601/10/4/1572 Food safety is essential in mass catering. In Europe, Regulation (EC) No. 852/2004 requires food business operators to put in place, implement and maintain permanent procedures based on Hazard Analysis and Critical Control Point (HACCP) principles. Each HACCP plan is specifically implemented for the processing plant and processing methods and requires a systematic collection of data on the incidence, elimination, prevention, and reduction of risks. In this five-year-study, the effectiveness of the HACCP plan of a University canteen was verified through periodic internal auditing and microbiological monitoring of meals, small equipment, cooking tools, working surfaces, as well as hands and white coats of the canteen staff. The data obtained revealed no safety risks for the consumers, since Escherichia coli, Salmonella spp. and Listeria monocytogenes were never detected; however, a quite discontinuous microbiological quality of meals was revealed. The fluctuations in the microbial loads of mesophilic aerobes, coliforms, Staphylococcus aureus, Bacillus cereus, and sulphite-reducing clostridia were mainly ascribed to inadequate handling or processing procedures, thus suggesting the need for an enhancement of staff training activities and for a reorganization of tasks. Due to the wide variety of the fields covered by internal auditing, the full conformance to all the requirements was never achieved, though high scores, determined by assigning one point to each answer which matched with the requirements, were achieved in all the years. International Journal of Environmental Research and Public Health 2013-04-17 10 4 Communication 10.3390/ijerph10041572 1572 1585 1660-4601 2013-04-17 doi: 10.3390/ijerph10041572 Andrea Osimani Lucia Aquilanti Stefano Tavoletti Francesca Clementi http://www.mdpi.com/1660-4601/10/4/1562 Tobacco smoking is a major health issue for Indigenous Australians, however there are few interventions with demonstrated efficacy in this population. The Transtheoretical Model may provide a useful framework for describing smoking behaviour and assessing readiness to quit, with the aim of developing better interventions. Interviews were conducted with 593 Indigenous Australians in eight rural and remote communities in north Queensland, to examine stages of change and smoking behaviour. Among current smokers, 39.6% and 43.4% were in Precontemplation and Contemplation stages respectively. A further 13.9% were making preparations to quit (Preparation) whilst only 3.2% said they were actively trying to quit (Action). When analysed by stage of change, the pattern of smoking-related behaviours conformed to the results of past research using the model. Importantly however, distribution of individuals across the stages opposes those observed in investigations of smoking behaviour in non-Indigenous Australian populations. The Transtheoretical Model can be used to meaningfully classify Indigenous smokers in remote north Queensland according to stages along the behaviour change continuum. Importantly, in this large sample across eight communities, most Indigenous smokers were not making preparations to change their smoking behaviour. This suggests that interventions should focus on promoting movement toward the Preparation and Action stages of change. International Journal of Environmental Research and Public Health 2013-04-16 10 4 Article 10.3390/ijerph10041562 1562 1571 1660-4601 2013-04-16 doi: 10.3390/ijerph10041562 Sandra Campbell India Bohanna Anne Swinbourne Yvonne Cadet-James Dallas McKeown Robyn McDermott http://www.mdpi.com/1660-4601/10/4/1547 Fetal alcohol syndrome (FAS) is a congenital syndrome caused by maternal alcohol consumption during pregnancy and is entirely preventable by abstinence from alcohol drinking during this time. Little is known about the prevalence of FAS and maternal alcohol consumption during pregnancy in Western countries. We present the results of FAS/partial fetal alcohol syndrome (PFAS) prevalence study and maternal characteristics in a sample of schoolchildren from a rural province of Croatia. This study involved seven elementary schools with 1,110 enrolled children attending 1st to 4th grade and their mothers. We used an active case ascertainment method with passive parental consent and Clarified IOM criteria. The investigation protocol involved maternal data collection and clinical examination of children. Out of 1,110 mothers, 917 (82.6%) answered the questionnaire. Alcohol exposure during pregnancy was admitted by 11.5%, regular drinking by 4.0% and binge drinking by 1.4% of questioned mothers. Clinical examination involved 824 (74.2%) schoolchildren and disclosed 14 (1.7%) with clinical signs of FAS and 41 (5.0%) of PFAS. The observed FAS prevalence, based on 74.2% participation rate, was 16.9, PFAS 49.7 and combined prevalence was 66.7/1,000 examined schoolchildren. This is the first FAS prevalence study based on active ascertainment among schoolchildren and pregnancy alcohol drinking analysis performed in a rural community of Croatia and Europe. High prevalence of FAS/PFAS and pregnancy alcohol consumption observed in this study revealed that FAS is serious health problem in rural regions as well as a need to develop future studies and preventive measures for pregnancy alcohol drinking and FASD. International Journal of Environmental Research and Public Health 2013-04-16 10 4 Article 10.3390/ijerph10041547 1547 1561 1660-4601 2013-04-16 doi: 10.3390/ijerph10041547 Giorgie Petković Ingeborg Barišić http://www.mdpi.com/1660-4601/10/4/1527 The arsenic (As) exposure represents an important problem in many parts of the World. Indeed, it is estimated that over 100 million individuals are exposed to arsenic, mainly through a contamination of groundwaters. Chronic exposure to As is associated with adverse effects on human health such as cancers, cardiovascular diseases, neurological diseases and the rate of morbidity and mortality in populations exposed is alarming. The purpose of this review is to summarize the genotoxic effects of As in the cells as well as to discuss the importance of signaling and repair of arsenic-induced DNA damage. The current knowledge of specific polymorphisms in candidate genes that confer susceptibility to arsenic exposure is also reviewed. We also discuss the perspectives offered by the determination of biological markers of early effect on health, incorporating genetic polymorphisms, with biomarkers for exposure to better evaluate exposure-response clinical relationships as well as to develop novel preventative strategies for arsenic- health effects. International Journal of Environmental Research and Public Health 2013-04-12 10 4 Review 10.3390/ijerph10041527 1527 1546 1660-4601 2013-04-12 doi: 10.3390/ijerph10041527 Francesca Faita Liliana Cori Fabrizio Bianchi Maria Andreassi http://www.mdpi.com/1660-4601/10/4/1505 Mosquito-vectored pathogens are responsible for devastating human diseases and are (re)emerging in many urban environments. Effective mosquito control in urban landscapes relies on improved understanding of the complex interactions between the ecological and social factors that define where mosquito populations can grow. We compared the density of mosquito habitat and pupae production across economically varying neighborhoods in two temperate U.S. cities (Baltimore, MD and Washington, DC). Seven species of mosquito larvae were recorded. The invasive Aedes albopictus was the only species found in all neighborhoods. Culex pipiens, a primary vector of West Nile virus (WNV), was most abundant in Baltimore, which also had more tire habitats. Both Culex and Aedes pupae were more likely to be sampled in neighborhoods categorized as being below median income level in each city and Aedes pupae density was also greater in container habitats found in these lower income neighborhoods. We infer that lower income residents may experience greater exposure to potential disease vectors and Baltimore residents specifically, were at greater risk of exposure to the predominant WNV vector. However, we also found that resident-reported mosquito nuisance was not correlated with our measured risk index, indicating a potentially important mismatch between motivation needed to engage participation in control efforts and the relative importance of control among neighborhoods. International Journal of Environmental Research and Public Health 2013-04-12 10 4 Article 10.3390/ijerph10041505 1505 1526 1660-4601 2013-04-12 doi: 10.3390/ijerph10041505 Shannon LaDeau Paul Leisnham Dawn Biehler Danielle Bodner http://www.mdpi.com/1660-4601/10/4/1489 This study assessed subjective symptoms related to indoor concentrations of chemicals among residents in a housing estate in Dalian, China, where indoor air pollution by interior decoration materials has recently become a major health problem. Fifty-nine males and 50 females were surveyed for their symptoms related to sick building syndrome. Formaldehyde (HCHO), NO2, and volatile organic compounds (VOCs) in their dwellings were collected using a diffusion sampler and measured by GC/MS. For residents with one or more symptoms in the past, HCHO, butanol or 1,2-dichloroethane concentrations were significantly greater in their bedrooms or kitchens compared with those of subjects without previous symptoms. For residents with one or more symptoms at the time of the study, 1,1,1-trichloroethane, xylene, butanol, methyl isobutyl ketone, and styrene concentrations in their bedrooms or kitchens were significantly greater compared with those of residents without symptoms. HCHO, NO2, and VOCs were detected in all rooms, but their levels were lower than the guideline values except for HCHO in two rooms. Chemical substances from interior decoration materials at indoor air levels lower than their guideline values might have affected the health status of residents. International Journal of Environmental Research and Public Health 2013-04-11 10 4 Article 10.3390/ijerph10041489 1489 1504 1660-4601 2013-04-11 doi: 10.3390/ijerph10041489 Peng Guo Kazuhito Yokoyama Fengyuan Piao Kiyoshi Sakai Md Khalequzzaman Michihiro Kamijima Tamie Nakajima Fumihiko Kitamura http://www.mdpi.com/1660-4601/10/4/1474 Objective: To compare immigrants’ and natives’ perceptions of relational, managerial and informational continuity of care and to explore the influence of the length of stay on immigrants’ perceptions of continuity. Methods: Cross-sectional study based on a survey of a random sample of 1,500 patients, of which 22% (331) were immigrants. The study area was made up by three healthcare areas of the Catalan healthcare system. To collect data, the CCAENA questionnaire was applied. Multivariate logistic regression models were conducted. Results: Like natives, immigrants perceive high levels of managerial continuity (88.5%) and relational continuity with primary and secondary care physicians (86.7 and 81.8%), and lower levels of informational continuity (59.1%). There were no statistically significant differences in managerial and informational continuity between immigrants and natives. However, immigrants perceive a worse relational continuity with primary care physicians in terms of trust, communication and clinical responsibility. Conversely, immigrants perceive higher relational continuity with secondary care physicians in terms of effective communication and clinical responsibility. Discussion: Similar managerial and informational continuity perceptions seem to point towards a similar treatment of patients, regardless of their immigrant status. However, differences in relational continuity highlight the need for improvements in professionals’ skills in treating immigrants’ patients. International Journal of Environmental Research and Public Health 2013-04-09 10 4 Article 10.3390/ijerph10041474 1474 1488 1660-4601 2013-04-09 doi: 10.3390/ijerph10041474 Marta-Beatriz Aller Josep Colomé Sina Waibel Ingrid Vargas María Vázquez http://www.mdpi.com/1660-4601/10/4/1462 This study investigated the changes in resistance of Acinetobacter baumannii complex and the association of carbapenem-resistant A. baumannii complex (CRAB) infection and hospital antimicrobial usage from 2003 to 2011 in a tertiary care hospital in northeast China. In vitro susceptibilities were determined by disk diffusion test and susceptibility profiles were determined using zone diameter interpretive criteria, as recommended by the Clinical and Laboratory Standards Institute (CLSI). Data on consumption of various antimicrobial agents, expressed as defined daily dose/1,000 patients/day, were collected retrospectively from hospital pharmacy computer database. Most of 2,485 strains of A. baumannii complex were collected from respiratory samples (1,618 isolates, 65.1%), secretions and pus (465, 18.7%) over the years. The rates of antimicrobial resistance in A. baumannii complex increased significantly over the years. The rates of CRAB were between 11.3% and 59.1% over the years. The quarterly use of anti-pseudomonal carbapenems, but not other classes of antibiotics, was strongly correlated with the increase of quarterly CRAB (β  = 1.661; p < 0.001). Dedicated use of anti-pseudomonal carbapenems would be an important intervention to control the increase of CRAB. International Journal of Environmental Research and Public Health 2013-04-09 10 4 Article 10.3390/ijerph10041462 1462 1473 1660-4601 2013-04-09 doi: 10.3390/ijerph10041462 Jiancheng Xu Zhihui Sun Yanyan Li Qi Zhou http://www.mdpi.com/1660-4601/10/4/1439 This theoretical paper addresses the cognitive functions via which quiet and in general pleasurable sounds promote and annoying sounds impede health. The article comprises a literature analysis and an interpretation of how the bidirectional influence of appraising the environment and the feelings of the perceiver can be understood in terms of core affect and motivation. This conceptual basis allows the formulation of a detailed cognitive model describing how sonic content, related to indicators of safety and danger, either allows full freedom over mind-states or forces the activation of a vigilance function with associated arousal. The model leads to a number of detailed predictions that can be used to provide existing soundscape approaches with a solid cognitive science foundation that may lead to novel approaches to soundscape design. These will take into account that louder sounds typically contribute to distal situational awareness while subtle environmental sounds provide proximal situational awareness. The role of safety indicators, mediated by proximal situational awareness and subtle sounds, should become more important in future soundscape research. International Journal of Environmental Research and Public Health 2013-04-08 10 4 Article 10.3390/ijerph10041439 1439 1461 1660-4601 2013-04-08 doi: 10.3390/ijerph10041439 Tjeerd Andringa J. Lanser http://www.mdpi.com/1660-4601/10/4/1418 In 1992, 1998, and 2006, questionnaires were sent to stratified samples of residents aged 18–75 years living near petrochemical industries (n = 600–800 people on each occasion) and in a control area (n = 200–1,000). The aims were to estimate the long-term prevalence and change over time of annoyance caused by industrial odour, industrial noise, and worries about possible health effects, and to identify risk indicators. In 2006, 20% were annoyed by industrial odour, 27% by industrial noise (1–4% in the control area), and 40–50% were worried about health effects or industrial accidents (10–20% in the control area). Multiple logistic regression analyses revealed significantly lower prevalence of odour annoyance in 1998 and 2006 than in 1992, while industrial noise annoyance increased significantly over time. The prevalence of worry remained constant. Risk of odour annoyance increased with female sex, worry of health effects, annoyance by motor vehicle exhausts and industrial noise. Industrial noise annoyance was associated with traffic noise annoyance and worry of health effects of traffic. Health-risk worry due to industrial air pollution was associated with female sex, having children, annoyance due to dust/soot in the air, and worry of traffic air pollution. International Journal of Environmental Research and Public Health 2013-04-03 10 4 Article 10.3390/ijerph10041418 1418 1438 1660-4601 2013-04-03 doi: 10.3390/ijerph10041418 Gösta Axelsson Leo Stockfelt Eva Andersson Anita Gidlof-Gunnarsson Gerd Sallsten Lars Barregard http://www.mdpi.com/1660-4601/10/4/1406 Background: Liquid crystal display (LCD) manufacturing involves three fabrication processes: array, panel and module processes, which result in different levels of volatile organic compound (VOC) exposure. The aim of this study was to assess the potential reproductive endocrine effects of occupational exposures during LCD manufacturing predictive of menstrual cycles as subclinical markers of female reproductive dysfunction effects of low-dose exposures. Methods: A total of 94 fabrication workers were followed for one complete menstrual cycle using daily urine samples: 23 were from the array, 53 from the panel, and 18 from the module work areas. The menstrual cycle characteristics of the study population were measured using a self-administered questionnaire. Urine samples were collected during the first urination in the morning for at least one complete menstrual cycle. The urine was then analyzed to determine the urinary concentrations of follicular stimulating hormone (FSH), estrone conjugates (E1C), and pregnanediol-3-glucuronide (PdG). The results of this analysis were used to assess the potential effects of chemical exposure as determined by handheld volatile organic compound (VOC) monitors and 24 h canisters. Results: The concentration of total VOCs was much higher in the module making area (ND–21,000 ppb) than in panel (ND–766 ppb) and array (58–1,472 ppb) making areas. The concentrations of ethanol and acetone were much higher in the module (1,974.9 and 2,283.2 ppb, respectively) and panel (2256.9 and 592.2 ppb, respectively) making areas. Compared to those in the array making area, we found that E1C (12.55, 95% confidence interval (CI): 8.49, 16.61 μg/mg Cr) and PdG (0.53, 95% CI: 0.29, 0.77 μg/mg Cr) levels in the module group were significantly higher in the early follicular phase; E1C (11.93, 95% CI: 6.21, 17.65 μg/mg Cr) and PdG (0.53, 95% CI: 0.29, 0.77 μg/mg Cr) levels were significantly higher in the periovulatory phase; and all the hormone levels, FSH (1.48, 95% CI: 0.81, 2.15 μg/mg Cr), E1C (9.29, 95% CI: 4.92, 13.66 μg/mg Cr), and PdG (1.01, 95% CI: 0.42, 1.60 μg/mg Cr) were also significantly higher in the luteal phase. In addition, the FSH (0.89, 95% CI: 0.07, 1.71 μg/mg Cr) level in the panel group was significantly higher but E1C (−4.49, 95% CI: −7.90, −1.08 μg/mg Cr) was lower in the early follicular phase; and E1C (−5.16, 95% CI: −9.61, −0.71 μg/mg Cr) level was significantly lower in the periovulatory phase. Conclusions: Our findings add to the evidence that exposure to multiple low-level chemicals is associated with modest changes in reproductive hormone urinary concentrations in healthy premenopausal women. In addition, the FSH (0.89, 95% CI: 0.07, 1.71 μg/mg Cr) level in the panel group was significantly higher but E1C (−4.49, 95% CI: −7.90, −1.08 μg/mg Cr) lower in the early follicular phase; and E1C (−5.16, 95% CI: −9.61, −0.71 μg/mg Cr) level was significantly lower in the periovulatory phase. International Journal of Environmental Research and Public Health 2013-04-03 10 4 Article 10.3390/ijerph10041406 1406 1417 1660-4601 2013-04-03 doi: 10.3390/ijerph10041406 Ching-Chun Lin Chia-Ni Huang Jung-Der Wang Yaw-Huei Hwang Ruei-Hao Shie Yu-Yin Chang Shao-Ping Weng Pau-Chung Chen http://www.mdpi.com/1660-4601/10/4/1392 The Manila clam Ruditapes philippinarum is one of the most important commercial bivalve species consumed in China. Evaluated metal burden in bivalve molluscs can pose potential risks to public health as a result of their frequent consumption. In this study, concentrations of 10 trace elements (Cu, Zn, Mn, Se, Ni, Cd, Cr, Pb, Hg and As) were determined in samples of the bivalve Ruditapes philippinarum, collected from nine mariculture zones along the coast of China between November and December in 2010, in order to evaluate the status of elemental metal pollution in these areas. Also, a public health risk assessment was untaken to assess the potential risks associated with the consumption of clams. The ranges of concentrations found for Cu, Zn, Mn, Se, Ni, Cd, Cr, Pb, Hg and As in R. philippinarum were 12.1–38.0, 49.5–168.3, 42.0–68.0, 4.19–8.71, 4.76–14.32, 0.41–1.11, 0.94–4.74, 0.32–2.59, 0.03–0.23 and 0.46–11.95 mg·kg−1 dry weight, respectively. Clear spatial variations were found for Cu, Zn, Cr, Pb, Hg and As, whereas Mn, Se, Ni, and Cd did not show significant spatial variation. Hotspots of trace element contamination in R. philippinarum can be found along the coast of China, from the north to the south, especially in the Bohai and Yellow Seas. Based on a 58.1 kg individual consuming 29 g of bivalve molluscs per day, the values of the estimated daily intake (EDI) of trace elements analyzed were significantly lower than the values of the accepted daily intake (ADI) established by Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives (JFAO/WHO) and the guidelines of the reference does (RfD) established by the United States Environmental Protection Agency (USEPA). Additionally, the risk of trace elements to humans through R. philippinarum consumption was also assessed. The calculated hazard quotients (HQ) of all trace elements were less than 1. Consequently, there was no obvious public risk from the intake of these trace elements through R. philippinarum consumption. International Journal of Environmental Research and Public Health 2013-04-02 10 4 Article 10.3390/ijerph10041392 1392 1405 1660-4601 2013-04-02 doi: 10.3390/ijerph10041392 Feng Yang Liqiang Zhao Xiwu Yan Yuan Wang http://www.mdpi.com/1660-4601/10/4/1378 Background: We examined the incremental influence on survival of neighbourhood material and social deprivation while accounting for individual level socioeconomic status in a large population-based cohort of Canadians. Methods: More than 500,000 adults were followed for 22 years between 1982 and 2004. Tax records provided information on sex, income, marital status and postal code while a linkage was used to determine vital status. Cox models were used to estimate hazard ratios (HR) for quintiles of neighbourhood material and social deprivation. Results: There were 180,000 deaths over the follow-up period. In unadjusted analyses, those living in the most materially deprived neighbourhoods had elevated risks of mortality (HRmales 1.37, 95% CI: 1.33–1.41; HRfemales 1.20, 95% CI: 1.16–1.24) when compared with those living in the least deprived neighbourhoods. Mortality risk was also elevated for those living in socially deprived neighbourhoods (HRmales 1.15, CI: 1.12–1.18; HRfemales 1.15, CI: 1.12–1.19). Mortality risk associated with material deprivation remained elevated in models that adjusted for individual factors (HRmales 1.20, CI: 1.17–1.24; HRfemales 1.16, CI: 1.13–1.20) and this was also the case for social deprivation (HRmales 1.12, CI: 1.09–1.15; HRfemales 1.09, CI: 1.05–1.12). Immigrant neighbourhoods were protective of mortality risk for both sexes. Being poor and living in the most socially advantageous neighbourhoods translated into a survival gap of 10% over those in the most socially deprived neighbourhoods. The gap for material neighbourhood deprivation was 7%. Conclusions: Living in socially and materially deprived Canadian neighbourhoods was associated with elevated mortality risk while we noted a “healthy immigrant neighbourhood effect”. For those with low family incomes, living in socially and materially deprived areas negatively affected survival beyond their individual circumstances. International Journal of Environmental Research and Public Health 2013-04-02 10 4 Article 10.3390/ijerph10041378 1378 1391 1660-4601 2013-04-02 doi: 10.3390/ijerph10041378 Nancy Ross Lisa Oliver Paul Villeneuve http://www.mdpi.com/1660-4601/10/4/1356 It is clear that high-dose radiation is harmful. However, despite extensive research, assessment of potential health-risks associated with exposure to low-dose radiation (at doses below or equal to 0.1 Gy) is still challenging. Recently, we reported that 0.05 Gy of 137Cs gamma rays (the existing limit for radiation-exposure in the workplace) was incapable of inducing significant in vivo genomic instability (measured by the presence of late-occurring chromosomal damage at 6 months post-irradiation) in bone marrow (BM) cells of two mouse strains, one with constitutively high and one with intermediate levels of the repair enzyme DNA-dependent protein-kinase catalytic-subunit (DNA-PKcs). In this study, we present evidence for a lack of genomic instability in BM cells of the severely combined-immunodeficiency (SCID/J) mouse (which has an extremely low-level of DNA-PKcs activity) exposed whole-body to low-dose radiation (0.05 Gy). Together with our previous report, the data indicate that low-dose radiation (0.05 Gy) is incapable of inducing genomic instability in vivo (regardless of the levels of DNA-PKcs activity of the exposed mice), yet higher doses of radiation (0.1 and 1 Gy) do induce genomic instability in mice with intermediate and extremely low-levels of DNA-PKcs activity (indicating an important role of DNA-PKcs in DNA repair). International Journal of Environmental Research and Public Health 2013-04-02 10 4 Article 10.3390/ijerph10041356 1356 1377 1660-4601 2013-04-02 doi: 10.3390/ijerph10041356 Kanokporn Rithidech Chatchanok Udomtanakunchai Louise Honikel Elbert Whorton http://www.mdpi.com/1660-4601/10/4/1342 Estimating the benefits of preventing child maltreatment (CM) is essential for policy makers to determine whether there are significant returns on investment from interventions to prevent CM. The aim of this study was to estimate the benefits of preventing CM deaths in an Ecuadorian population, and to compare the results to a similar study in a US population. The study used the contingent valuation method to elicit respondents’ willingness to pay (WTP) for a 1 in 100,000 reduction in the risk of CM mortality. After adjusting for differences in purchasing power, the WTP to prevent the CM mortality risk reduction in the Ecuador population was $237 and the WTP for the same risk reduction in the US population was $175. In the pooled analysis, WTP for a reduction in CM mortality was significantly impacted by country (p = 0.03), history of CM (p = 0.007), payment mechanism (p < 0.001), confidence in response (p = 0.014), and appropriateness of the payment mechanism (p < 0.001). These findings suggest that estimating benefits from one culture may not be transferable to another, and that low- and middle-income countries, such as Ecuador, may be better served by developing their own benefits estimates for use in future benefit-cost analyses of interventions designed to prevent CM. International Journal of Environmental Research and Public Health 2013-03-28 10 4 Article 10.3390/ijerph10041342 1342 1355 1660-4601 2013-03-28 doi: 10.3390/ijerph10041342 Phaedra Corso Justin Ingels M. Roldos http://www.mdpi.com/1660-4601/10/4/1324 Using the 2002 World Health Survey, we examine the association between welfare state regimes, gender and mental health among 26 countries classified into seven distinct regimes: Conservative, Southeast Asian, Eastern European, Latin American, Liberal, Southern/Ex-dictatorship, and Social Democratic. A two-level hierarchical model found that the odds of experiencing a brief depressive episode in the last 12 months was significantly higher for Southern/Ex- dictatorship countries than for Southeast Asian (odds ratio (OR) = 0.12, 95% confidence interval (CI) 0.05–0.27) and Eastern European (OR = 0.36, 95% CI 0.22–0.58) regimes after controlling for gender, age, education, marital status, and economic development. In adjusted interaction models, compared to Southern/Ex-dictatorship males (reference category), the odds ratios of depression were significantly lower among Southeast Asian males (OR = 0.16, 95% CI 0.08–0.34) and females (OR = 0.23, 95% CI 0.10–0.53) and Eastern European males (OR = 0.41, 95% CI 0.26–0.63) and significantly higher among females in Liberal (OR = 2.00, 95% CI 1.14–3.49) and Southern (OR = 2.42, 95% CI 1.86–3.15) regimes. Our results highlight the importance of incorporating middle-income countries into comparative welfare regime research and testing for interactions between welfare regimes and gender on mental health. International Journal of Environmental Research and Public Health 2013-03-28 10 4 Article 10.3390/ijerph10041324 1324 1341 1660-4601 2013-03-28 doi: 10.3390/ijerph10041324 Haejoo Chung Edwin Ng Selahadin Ibrahim Björn Karlsson Joan Benach Albert Espelt Carles Muntaner http://www.mdpi.com/1660-4601/10/4/1312 Objective: A significant decline in the prevalence of neural tube defects (NTD) through food fortification has been reported. Questions remain, however, about the effectiveness of this intervention in reducing the gap in prevalence across socioeconomic status (SES). Study Design: Using health number and through record linkage, children born in Ontario hospitals between 1994 and 2009 were followed for the diagnosis of congenital anomalies. SES quintiles were assigned to each child using census information at the time of birth. Adjusted rates and multivariate models were used to compare trends among children born in different SES groups. Results: Children born in low SES areas had significantly higher rates of NTDs (RR = 1.25, CI: 1.14–1.37). Prevalence of NTDs among children born in low and high SES areas declined since food fortification began in 1999 although has started rising again since 2006. While the crude decline was greater in low SES areas, after adjustment for maternal age, the slope of decline and SES gap in prevalence rates remained unchanged overtime. Conclusions: While food fortification is successful in reducing the prevalence of NTDs, it was not associated with removing the gap between high and low SES groups. International Journal of Environmental Research and Public Health 2013-03-28 10 4 Article 10.3390/ijerph10041312 1312 1323 1660-4601 2013-03-28 doi: 10.3390/ijerph10041312 Mohammad Agha Richard Glazier Rahim Moineddin Aideen Moore Astrid Guttmann http://www.mdpi.com/1660-4601/10/4/1304 In this study, in vitro formed Cd-phytochelatin (PC2) complexes were characterized using ion exchange chromatography (IEC) and matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. The ratio of both studied compounds as well as experimental conditions were optimized. The highest yield of the complex was observed under an applied concentration of 100 µg·mL−1 PC2 and 100 µg·mL−1 of CdCl2. The data obtained show that IEC in combination with MALDI-TOF is a reliable and fast method for the determination of these complexes. International Journal of Environmental Research and Public Health 2013-03-28 10 4 Article 10.3390/ijerph10041304 1304 1311 1660-4601 2013-03-28 doi: 10.3390/ijerph10041304 Miguel Rodrigo Natalia Cernei Marketa Kominkova Ondrej Zitka Miroslava Beklova Josef Zehnalek Rene Kizek Vojtech Adam http://www.mdpi.com/1660-4601/10/4/1284 People typically choose to live in quiet areas in order to safeguard their health and wellbeing. However, the benefits of living in quiet areas are relatively understudied compared to the burdens associated with living in noisy areas. Additionally, research is increasingly focusing on the relationship between the human response to noise and measures of health and wellbeing, complementing traditional dose-response approaches, and further elucidating the impact of noise and health by incorporating human factors as mediators and moderators. To further explore the benefits of living in quiet areas, we compared the results of health-related quality of life (HRQOL) questionnaire datasets collected from households in localities differentiated by their soundscapes and population density: noisy city, quiet city, quiet rural, and noisy rural. The dose-response relationships between noise annoyance and HRQOL measures indicated an inverse relationship between the two. Additionally, quiet areas were found to have higher mean HRQOL domain scores than noisy areas. This research further supports the protection of quiet locales and ongoing noise abatement in noisy areas. International Journal of Environmental Research and Public Health 2013-03-27 10 4 Article 10.3390/ijerph10041284 1284 1303 1660-4601 2013-03-27 doi: 10.3390/ijerph10041284 Daniel Shepherd David Welch Kim Dirks David McBride http://www.mdpi.com/1660-4601/10/4/1268 Earth is a finite system with a limited supply of resources. As the human population grows, so does the appropriation of Earth’s natural capital, thereby exacerbating environmental concerns such as biodiversity loss, increased pollution, deforestation and global warming. Such concerns will negatively impact human health although it is widely believed that improving socio-economic circumstances will help to ameliorate environmental impacts and improve health outcomes. However, this belief does not explicitly acknowledge the fact that improvements in socio-economic position are reliant on increased inputs from nature. Gains in population health, particularly through economic means, are disconnected from the appropriation of nature to create wealth so that health gains become unsustainable. The current study investigated the sustainability of human population health in Canada with regard to resource consumption or “ecological footprints” (i.e., the resources required to sustain a given population). Ecological footprints of the 20 largest Canadian cities, along with several important determinants of health such as income and education, were statistically compared with corresponding indicators of human population health outcomes. A significant positive relationship was found between ecological footprints and life expectancy, as well as a significant negative relationship between ecological footprints and the prevalence of high blood pressure. Results suggest that increased appropriation of nature is linked to improved health outcomes. To prevent environmental degradation from excessive appropriation of natural resources will require the development of health promotion strategies that are de-coupled from ever-increasing and unsustainable resource use. Efforts to promote population health should focus on health benefits achieved from a lifestyle based on significantly reduced consumption of natural resources. International Journal of Environmental Research and Public Health 2013-03-26 10 4 Article 10.3390/ijerph10041268 1268 1283 1660-4601 2013-03-26 doi: 10.3390/ijerph10041268 Daniel Rainham Rory Cantwell Timothy Jason http://www.mdpi.com/1660-4601/10/4/1250 Environments shape health and well-being, yet little research has investigated how different real-world environmental settings influence the well-known determinant of health known as stress. Using a cross-over experimental design; this pilot study investigated the effect of four urban environments on physiological and psychological stress measures. Participants (N = 15) were exposed on separate days to one of the four settings for 20 min. These settings were designated as Very Natural; Mostly Natural; Mostly Built and Very Built. Visitation order to the four settings was individually randomized. Salivary cortisol and alpha-amylase; as well as self-report measures of stress; were collected before and after exposure to each setting. Gender was included as a variable in analysis; and additional data about environmental self-identity, pre-existing stress, and perceived restorativeness of settings were collected as measures of covariance. Differences between environmental settings showed greater benefit from exposure to natural settings relative to built settings; as measured by pre-to-post changes in salivary amylase and self-reported stress; differences were more significant for females than for males. Inclusion of covariates in a regression analysis demonstrated significant predictive value of perceived restorativeness on these stress measures, suggesting some potential level of mediation. These data suggest that exposure to natural environments may warrant further investigation as a health promotion method for reducing stress. International Journal of Environmental Research and Public Health 2013-03-26 10 4 Article 10.3390/ijerph10041250 1250 1267 1660-4601 2013-03-26 doi: 10.3390/ijerph10041250 Kurt Beil Douglas Hanes http://www.mdpi.com/1660-4601/10/4/1231 Critical environmental and human health concerns are associated with the rapidly growing fields of nanotechnology and manufactured nanomaterials (MNMs). The main risk arises from occupational exposure via chronic inhalation of nanoparticles. This research presents a chance-constrained nonlinear programming (CCNLP) optimization approach, which is developed to maximize the nanaomaterial production and minimize the risks of workplace exposure to MNMs. The CCNLP method integrates nonlinear programming (NLP) and chance-constrained programming (CCP), and handles uncertainties associated with both the nanomaterial production and workplace exposure control. The CCNLP method was examined through a single-walled carbon nanotube (SWNT) manufacturing process. The study results provide optimal production strategies and alternatives. It reveal that a high control measure guarantees that environmental health and safety (EHS) standards regulations are met, while a lower control level leads to increased risk of violating EHS regulations. The CCNLP optimization approach is a decision support tool for the optimization of the increasing MNMS manufacturing with workplace safety constraints under uncertainties. International Journal of Environmental Research and Public Health 2013-03-26 10 4 Article 10.3390/ijerph10041231 1231 1249 1660-4601 2013-03-26 doi: 10.3390/ijerph10041231 Zhi Chen Yuan Yuan Shu-Shen Zhang Yu Chen Feng-Lin Yang http://www.mdpi.com/1660-4601/10/4/1202 Diarrheal disease is an important health challenge, accounting for the majority of childhood deaths globally. Climate change is expected to increase the global burden of diarrheal disease but little is known regarding climate drivers, particularly in Africa. Using health data from Botswana spanning a 30-year period (1974–2003), we evaluated monthly reports of diarrheal disease among patients presenting to Botswana health facilities and compared this to climatic variables. Diarrheal case incidence presents with a bimodal cyclical pattern with peaks in March (ANOVA p < 0.001) and October (ANOVA p < 0.001) in the wet and dry season, respectively. There is a strong positive autocorrelation (p < 0.001) in the number of reported diarrhea cases at the one-month lag level. Climatic variables (rainfall, minimum temperature, and vapor pressure) predicted seasonal diarrheal with a one-month lag in variables (p < 0.001). Diarrheal case incidence was highest in the dry season after accounting for other variables, exhibiting on average a 20% increase over the yearly mean (p < 0.001). Our analysis suggests that forecasted climate change increases in temperature and decreases in precipitation may increase dry season diarrheal disease incidence with hot, dry conditions starting earlier and lasting longer. Diarrheal disease incidence in the wet season is likely to decline. Our results identify significant health-climate interactions, highlighting the need for an escalated public health focus on controlling diarrheal disease in Botswana. Study findings have application to other arid countries in Africa where diarrheal disease is a persistent public health problem. International Journal of Environmental Research and Public Health 2013-03-26 10 4 Article 10.3390/ijerph10041202 1202 1230 1660-4601 2013-03-26 doi: 10.3390/ijerph10041202 Kathleen Alexander Marcos Carzolio Douglas Goodin Eric Vance http://www.mdpi.com/1660-4601/10/4/1186 The traditional explanatory models used in epidemiology are “disease specific”, identifying risk factors for specific health conditions. Yet social exposures lead to a generalized, cumulative health impact which may not be specific to one illness. Disease-specific models may therefore misestimate social factors’ effects on health. Using data from the Canadian Community Health Survey and Canada 2001 Census we construct and compare “disease-specific” and “generalized health impact” (GHI) models to gauge the negative health effects of one social exposure: socioeconomic position (SEP). We use logistic and multinomial multilevel modeling with neighbourhood-level material deprivation, individual-level education and household income to compare and contrast the two approaches. In disease-specific models, the social determinants under study were each associated with the health conditions of interest. However, larger effect sizes were apparent when outcomes were modeled as compound health problems (0, 1, 2, or 3+ conditions) using the GHI approach. To more accurately estimate social exposures’ impacts on population health, researchers should consider a GHI framework. International Journal of Environmental Research and Public Health 2013-03-25 10 4 Article 10.3390/ijerph10041186 1186 1201 1660-4601 2013-03-25 doi: 10.3390/ijerph10041186 Heather White Patricia O'Campo Rahim Moineddin Flora Matheson http://www.mdpi.com/1660-4601/10/4/1168 Human exposure assessment tools represent a means for understanding human exposure to pesticides in agricultural activities and managing possible health risks. This paper presents a pesticide flow analysis modeling approach developed to assess human exposure to pesticide use in greenhouse flower crops in Colombia, focusing on dermal and inhalation exposure. This approach is based on the material flow analysis methodology. The transfer coefficients were obtained using the whole body dosimetry method for dermal exposure and the button personal inhalable aerosol sampler for inhalation exposure, using the tracer uranine as a pesticide surrogate. The case study was a greenhouse rose farm in the Bogota Plateau in Colombia. The approach was applied to estimate the exposure to pesticides such as mancozeb, carbendazim, propamocarb hydrochloride, fosetyl, carboxin, thiram, dimethomorph and mandipropamide. We found dermal absorption estimations close to the AOEL reference values for the pesticides carbendazim, mancozeb, thiram and mandipropamide during the study period. In addition, high values of dermal exposure were found on the forearms, hands, chest and legs of study participants, indicating weaknesses in the overlapping areas of the personal protective equipment parts. These results show how the material flow analysis methodology can be applied in the field of human exposure for early recognition of the dispersion of pesticides and support the development of measures to improve operational safety during pesticide management. Furthermore, the model makes it possible to identify the status quo of the health risk faced by workers in the study area. International Journal of Environmental Research and Public Health 2013-03-25 10 4 Article 10.3390/ijerph10041168 1168 1185 1660-4601 2013-03-25 doi: 10.3390/ijerph10041168 Camilo Lesmes-Fabian Claudia Binder http://www.mdpi.com/1660-4601/10/4/1152 This study examines the individual and workplace factors related to depression and stress in a large privately owned enterprise in China. The cross-sectional study design involved 13 privately owned retail enterprises in China. A self-report survey was administered to 4,847 employees aged 18–54 recruited through the management boards of the 13 enterprises. A chi-square test was used to compare differences between the depressed and non-depressed groups on a number of demographic variables and chronic diseases. Logistic regression analysis was performed to assess depression in relation to individual factors (work ability and resilience) and organisational environmental factors (workplace ethos and culture, psychosocial environment and health promotion policies and activities). Significant relationships were found between employee depression all personal factors, and one organisational environmental factor. Personal factors include poor work ability and low resilience, while workplace factors include workplace ethos and culture. The primary organisational environmental factor was a low level of enterprise ethos and culture. International Journal of Environmental Research and Public Health 2013-03-25 10 4 Article 10.3390/ijerph10041152 1152 1167 1660-4601 2013-03-25 doi: 10.3390/ijerph10041152 Jing Sun Nicholas Buys Xinchao Wang http://www.mdpi.com/1660-4601/10/3/1139 Climate change presents risks to health that must be addressed by both decision-makers and public health researchers. Within the application of Environmental Health Impact Assessment (EHIA), there have been few attempts to incorporate climate change-related health risks as an input to the framework. This study used a focus group design to examine the perceptions of government, industry and academic specialists about the suitability of assessing the health consequences of climate change within an EHIA framework. Practitioners expressed concern over a number of factors relating to the current EHIA methodology and the inclusion of climate change-related health risks. These concerns related to the broad scope of issues that would need to be considered, problems with identifying appropriate health indicators, the lack of relevant qualitative information that is currently incorporated in assessment and persistent issues surrounding stakeholder participation. It was suggested that improvements are needed in data collection processes, particularly in terms of adequate communication between environmental and health practitioners. Concerns were raised surrounding data privacy and usage, and how these could impact on the assessment process. These findings may provide guidance for government and industry bodies to improve the assessment of climate change-related health risks. International Journal of Environmental Research and Public Health 2013-03-22 10 3 Article 10.3390/ijerph10031139 1139 1151 1660-4601 2013-03-22 doi: 10.3390/ijerph10031139 Lyle Turner Katarzyna Alderman Des Connell Shilu Tong http://www.mdpi.com/1660-4601/10/3/1125 We conducted this study to determine levels and correlates of hypertension knowledge among rural Chinese adults, and to assess the association between knowledge levels and salty food consumption among hypertensive and non-hypertensive populations. This face-to-face cross sectional survey included 665 hypertensive and 854 non-hypertensive respondents in the rural areas of Heilongjiang province, China. Hypertension knowledge was assessed through a 10-item test; respondents received 10 points for each correct answer. Among respondents, the average hypertension knowledge score was 26 out of a maximum of 100 points for hypertensive and 20 for non-hypertensive respondents. Hypertension knowledge was associated with marital status, education, health status, periodically reading books, newspapers or other materials, history of blood pressure measurement, and attending hypertension educational sessions. Hypertension knowledge is extremely low in rural areas of China. Hypertension education programs should focus on marginal populations, such as individuals who are not married or illiterate to enhance their knowledge levels. Focusing on educational and literacy levels in conjunction with health education is important given illiteracy is still a prominent issue for the Chinese rural population. International Journal of Environmental Research and Public Health 2013-03-18 10 3 Article 10.3390/ijerph10031125 1125 1138 1660-4601 2013-03-18 doi: 10.3390/ijerph10031125 Xia Li Ning Ning Yanhua Hao Hong Sun Lijun Gao Mingli Jiao Qunhong Wu Hude Quan http://www.mdpi.com/1660-4601/10/3/1113 Background: Most childhood unintentional injuries occur in the home; however, very little home injury prevention information is tailored to developing countries. Utilizing our previously developed information dissemination tools and a hazard assessment checklist tailored to a low-income neighborhood in Pakistan, we pilot tested and compared the effectiveness of two dissemination tools. Methods: Two low-income neighborhoods were mapped, identifying families with a child aged between 12 and 59 months. In June and July 2010, all enrolled households underwent a home hazard assessment at the same time hazard reduction education was being given using an in-home tutorial or a pamphlet. A follow up assessment was conducted 4–5 months later. Results: 503 households were enrolled; 256 received a tutorial and 247 a pamphlet. The two groups differed significantly (p < 0.01) in level of maternal education and relationship of the child to the primary caregiver. However, when controlling for these variables, those receiving an in-home tutorial had a higher odds of hazard reduction than the pamphlet group for uncovered vats of water (OR 2.14, 95% CI: 1.28, 3.58), an open fire within reach of the child (OR 3.55, 95% CI: 1.80, 7.00), and inappropriately labeled cooking fuel containers (OR 1.86, 95% CI: 1.07, 3.25). Conclusions: This pilot project demonstrates the potential utility of using home-visit tutorials to decrease home hazards in a low-income neighborhood in Pakistan. A longer-term randomized study is needed to assess actual effectiveness of the use of allied health workers for home-based injury education and whether this results in decreased home injuries. International Journal of Environmental Research and Public Health 2013-03-15 10 3 Article 10.3390/ijerph10031113 1113 1124 1660-4601 2013-03-15 doi: 10.3390/ijerph10031113 Aruna Chandran Uzma Khan Nukhba Zia Asher Feroze Sarah de Ramirez Cheng-Ming Huang Junaid Razzak Adnan Hyder http://www.mdpi.com/1660-4601/10/3/1100 The objective of this study was to explore work-related risk factors of acute occupational pesticide poisoning among male farmers according to the severity of the poisoning. A nationwide sampling survey of male farmers was conducted in South Korea in 2011. A total of 1,958 male farmers were interviewed. Severity of occupational pesticide poisoning in 2010 was evaluated according to symptoms, types of treatment, and number of pesticide poisoning incidents per individual. A multinomial logistic regression model was used to estimate the odds ratio with 95% confidence intervals for risk factors of acute occupational pesticide poisoning. We found that the risk of acute occupational pesticide poisoning increased with lifetime days of pesticide application (OR = 1.74; 95% CI = 1.32–2.29), working a farm of three or more acres in size (OR = 1.49), not wearing personal protective equipment such as gloves (OR = 1.29) or masks (OR = 1.39). Those who engaged in inappropriate work behaviors such as not following pesticide label instructions (OR = 1.61), applying the pesticide in full sun (OR = 1.48), and applying the pesticide upwind (OR = 1.54) had a significantly increased risk of pesticide poisoning. There was no significant risk difference by type of farming. In addition, the magnitude of these risk factors did not differ significantly by severity of acute pesticide poisoning. In fact, our findings suggest that work-related risk factors contributed to the development of acute occupational pesticide poisoning without relation to its severity. Therefore, prevention strategies for reducing occupational pesticide poisoning, regardless of severity, should be recommended to all types of farming and the level of poisoning severity. International Journal of Environmental Research and Public Health 2013-03-14 10 3 Article 10.3390/ijerph10031100 1100 1112 1660-4601 2013-03-14 doi: 10.3390/ijerph10031100 Ji-Hyun Kim Jaeyoung Kim Eun Cha Yousun Ko Doo Kim Won Lee http://www.mdpi.com/1660-4601/10/3/1085 Natural thermal bathing pools contain geothermal water that is very popular to bathe in but the water is not sterilized, irradiated or treated in any way. Increasing tourism in Iceland will lead to increasing numbers of bath guests, which can in turn affect the microbial flora in the pools and therefore user safety. Today, there is no legislation that applies to natural geothermal pools in Iceland, as the water is not used for consumption and the pools are not defined as public swimming pools. In this study, we conducted a microbiological analysis on three popular but different natural pools in Iceland, located at Lýsuhóll, Hveravellir and Landmannalaugar. Total bacterial counts were performed by flow cytometry, and with plate count at 22 °C, 37 °C and 50 °C. The presence of viable coliforms, Enterococcus spp. and pseudomonads were investigated by growth experiments on selective media. All samples were screened for noroviruses by real time PCR. The results indicate higher fecal contamination in the geothermal pools where the geothermal water flow was low and bathing guest count was high during the day. The number of cultivated Pseudomonas spp. was high (13,000–40,000 cfu/100 mL) in the natural pools, and several strains were isolated and classified as opportunistic pathogens. Norovirus was not detected in the three pools. DNA was extracted from one-liter samples in each pool and analyzed by partial 16S rRNA gene sequencing. Microbial diversity analysis revealed different microbial communities between the pools and they were primarily composed of alpha-, beta- and gammaproteobacteria. International Journal of Environmental Research and Public Health 2013-03-14 10 3 Article 10.3390/ijerph10031085 1085 1099 1660-4601 2013-03-14 doi: 10.3390/ijerph10031085 Berglind Thorolfsdottir Viggo Marteinsson http://www.mdpi.com/1660-4601/10/3/1062 Nitro-polycyclic aromatic hydrocarbons (nitro-PAHs) are a class of genotoxic environmental contaminants. We have long been interested in determining the mechanisms by which nitro-PAHs induce genotoxicity. Although the metabolic activation of nitro-PAHs leading to toxicological activities has been well studied, the photo-induced activation of nitro-PAHs has seldom been reported. In this paper, we report photo-induced lipid peroxidation by 19 nitro-PAHs. The results indicated that all but two of the nitro-PAHs can induce lipid peroxidation. Mechanistic studies suggest that lipid peroxidation by nitro-PAHs is mediated by free radicals generated in the reaction. There was no structural correlation between the nitro-PAHs and their ability to induce lipid peroxidation upon UVA irradiation, or between the HOMO-LUMO gap and the ability to cause lipid peroxidation. Most of the nitro-PAHs are less potent in terms of causing lipid peroxidation than their parent PAHs. The lack of correlation is attributed to the complex photophysics and photochemistry of the nitro-PAHs and the yield of reactive oxygen species (ROS) and other factors. International Journal of Environmental Research and Public Health 2013-03-14 10 3 Article 10.3390/ijerph10031062 1062 1084 1660-4601 2013-03-14 doi: 10.3390/ijerph10031062 Qingsu Xia Jun-Jie Yin Yuewei Zhao Yuh-Sen Wu Yu-Qui Wang Liang Ma Shoujun Chen Xin Sun Peter Fu Hongtao Yu http://www.mdpi.com/1660-4601/10/3/1048 Continuous measurements of surface ozone (O3) and nitrogen oxides (NOX) at an urban site (39°37′N, 118°09′E) in Tangshan, the largest heavy industry city of North China during summertime from 2008 to 2011 are presented. The pollution of O3 was serious in the city. The daily maximum 1 h means (O3_1-hr max) reached 157 ± 55, 161 ± 54, 120 ± 50, and 178 ± 75 μg/m3 corresponding to an excess over the standard rates of 21%, 27%, 10%, and 40% in 2008–2011, respectively. The total oxidant level (OX = O3 + NO2) was high, with seasonal average concentrations up to 100 μg/m3 in summer. The level of OX at a given location was made up of NOX-independent and NOX-dependent contributions. The independent part can be considered as a regional contribution and was about 100 μg/m3 in Tangshan. Statistical early warning analysis revealed that the O3 levels would exceed the standard rate by 50% on the day following a day when the daily average ozone concentration (O3_mean) exceeded 87 μg/m3 and the daily maximum temperature (T_max) exceeded 29 °C. The exceed-standard rate would reach 80% when O3_mean and T_max exceeded 113 μg/m3 and 31 °C. Similarly, the exceed-standard rate would reach 100% when O3_mean and T_max exceeded 127 μg/m3 and 33 °C, respectively. International Journal of Environmental Research and Public Health 2013-03-13 10 3 Article 10.3390/ijerph10031048 1048 1061 1660-4601 2013-03-13 doi: 10.3390/ijerph10031048 Pei Li Jinyuan Xin Xiaoping Bai Yuesi Wang Shigong Wang Shixi Liu Xiaoxin Feng http://www.mdpi.com/1660-4601/10/3/1037 Tobacco use and cigarette smoking have long been causally linked to a wide variety of poor health outcomes, resulting in a number of public health policy initiatives to reduce prevalence and consumption. Benefits of these initiatives, however, have not been well-established quantitatively. Using 2005–2008 New York Adult Tobacco Survey data, we developed a simulation model to estimate the effectiveness and net benefits of the New York Tobacco Control Program’s (NY TCP’s) adult smoking cessation assistance initiatives, specifically media campaigns, telephone quitline counseling, and nicotine replacement therapy. In 2008, we estimate that NY TCP generated an estimated 49,195 additional, non-relapsing adult quits (95% CI: 19,878; 87,561) for a net benefit of over $800 million (95% CI: $211 million; $1,575 million). Although the simulation results varied considerably, reflecting uncertainty in the estimates and data, and data sufficient to establish definite causality are lacking, the cessation initiatives examined appear to yield substantial societal benefits. These benefits are of sufficient magnitude to fully offset expenditures not only on these initiatives, but on NY TCP as a whole. International Journal of Environmental Research and Public Health 2013-03-13 10 3 Article 10.3390/ijerph10031037 1037 1047 1660-4601 2013-03-13 doi: 10.3390/ijerph10031037 Sean Simpson James Nonnemaker http://www.mdpi.com/1660-4601/10/3/1020 Enterococcus spp. from two poultry farms and proximate surface and ground water sites in an area of intensive poultry production were tested for resistance to 16 clinical antibiotics. Resistance patterns were compared to assess trends and possible correlations for specific antimicrobials and levels of resistance. Enterococci were detected at all 12 surface water sites and three of 28 ground water sites. Resistance to lincomycin, tetracycline, penicillin and ciprofloxacin in poultry litter isolates was high (80.3%, 65.3%, 61.1% and 49.6%, respectively). Resistance in the surface water to the same antibiotics was 87.1%, 24.1%, 7.6% and 12.9%, respectively. Overall, 86% of litter isolates, 58% of surface water isolates and 100% of ground water isolates were resistant to more than one antibiotic. Fifty-four different resistance patterns were recognised in isolates obtained from litter and environmental samples and several E. faecium and E. faecalis isolates from litter and environment samples shared the same resistance pattern. Multiple antibiotic resistant (MAR) indices calculated to assess health risks due to the presence of resistant enterococci suggested an increased presence of antibiotics in surface water, likely from poultry sources as no other wastewater contributions in the area were documented. International Journal of Environmental Research and Public Health 2013-03-12 10 3 Article 10.3390/ijerph10031020 1020 1036 1660-4601 2013-03-12 doi: 10.3390/ijerph10031020 Vesna Furtula Charlene Jackson Erin Farrell John Barrett Lari Hiott Patricia Chambers http://www.mdpi.com/1660-4601/10/3/1006 Ingestion of inorganic arsenic (iAs) is considered to be related to the development of diabetes mellitus. In order to clarify the possible differences in the metabolism in diabetics, we measured urinary iAs metabolites in diabetic cases and non-diabetic control subjects in Faridpur, an arsenic-contaminated area in Bangladesh. Physician-diagnosed type 2 diabetic cases (140 persons) and non-diabetic controls (180 persons) were recruited. Drinking water and spot urine samples were collected. Mean concentrations of total arsenic in drinking water did not differ between cases (85.1 μg/L) and controls (85.8 μg/L). The percentage of urinary iAs (iAs%) was significantly lower in cases (8.6%) than in controls (10.4%), while that of dimethylarsinic acid (DMA%) was higher in cases (82.6%) than in controls (79.9%). This may have been due to the higher secondary methylation index (SMI) in the former (11.6) rather than the latter (10.0). Adjusting for matching factors (sex and unions), and the additional other covariates (age and water arsenic) significantly attenuated the differences in iAs%, SMI, and DMA%, respectively, though the difference in monomethylarsonic acid% was newly significant in the latter adjustment. Our study did not suggest any significant differences in urinary arsenic metabolites between diabetic and non-diabetic subjects. International Journal of Environmental Research and Public Health 2013-03-12 10 3 Article 10.3390/ijerph10031006 1006 1019 1660-4601 2013-03-12 doi: 10.3390/ijerph10031006 Saika Nizam Masashi Kato Hiroshi Yatsuya Md. Khalequzzaman Shoko Ohnuma Hisao Naito Tamie Nakajima http://www.mdpi.com/1660-4601/10/3/994 Toxoplasma gondii is a zoonotic protozoan that causes serious illness in humans and infects animals worldwide, including the Canadian Arctic. Indeed, high prevalence of infection amongst Inuit has been recorded, possibly due to consumption of raw infected seal meat. Here we explore the hypothesis that T. gondii oocysts contaminate the coastal marine environment via surface runoff from across the boreal watershed, particularly during the snowmelt period. We propose a conceptual framework of the different processes governing the fate and transport of T. gondii oocysts from the melting snowpack to the Canadian arctic coast via the freshwater runoff. This framework identifies the feasibility of a transmission pathway of oocysts from contaminated soil to the marine environment, but also the complexity and multiplicity of mechanisms involved. In addition, the framework identifies knowledge gaps for guiding future studies on T. gondii oocysts. Furthermore, this work could be used as a tool to investigate the possible estuarine contamination by other faeces-borne pathogens transported via the spring freshet in seasonally snow covered watersheds. International Journal of Environmental Research and Public Health 2013-03-11 10 3 Article 10.3390/ijerph10030994 994 1005 1660-4601 2013-03-11 doi: 10.3390/ijerph10030994 Audrey Simon Michel Poulin Alain Rousseau Nicholas Ogden http://www.mdpi.com/1660-4601/10/3/980 The association of socioeconomic status (SES) with nutrients intakes attracts public attention worldwide. In the current study, we examined the associations of SES with dietary salt intake and health outcomes in general Japanese workers (2,266) who participated in this Japanese occupational cohort. SES was assessed by a self-administered questionnaire. Dietary intakes were assessed with a validated, brief, self-administered diet history questionnaire (BDHQ). Multiple linear regression and stratified analysis were used to evaluate the associations of salt intake with the confounding factors. Education levels and household incomes were significantly associated with salt intake, as well as blood pressures (P < 0.05). After adjusting for age, sex and total energy intake, both years of education and household income significantly affect the salt intake (for education, β = −0.031, P = 0.040; for household income, β = −0.046, P = 0.003). SES factors also affect the risk of hypertension, those subjects with higher levels of education or income had lower risk to become hypertensive (ORs for education was 0.904, P < 0.001; ORs for income was 0.956, P = 0.032). Our results show that SES is an independent determinant of salt intake and blood pressure, in order to lower the risk of hypertension, the efforts to narrow the social status gaps should be considered by the health policy-makers. International Journal of Environmental Research and Public Health 2013-03-11 10 3 Article 10.3390/ijerph10030980 980 993 1660-4601 2013-03-11 doi: 10.3390/ijerph10030980 Koichi Miyaki Yixuan Song Setsuko Taneichi Akizumi Tsutsumi Hideki Hashimoto Norito Kawakami Masaya Takahashi Akihito Shimazu Akiomi Inoue Sumiko Kurioka Takuro Shimbo http://www.mdpi.com/1660-4601/10/3/963 The aim of the present study was to evaluate the risk of lung cancer from combined exposure to radon and smoking. Methodologically, it is based on case-control studies nested within two Czech cohort studies of nearly 11,000 miners followed-up for mortality in 1952–2010 and nearly 12,000 inhabitants exposed to high levels of radon in homes, with mortality follow-up in 1960–2010. In addition to recorded radon exposure, these studies use information on smoking collected from the subjects or their relatives. A total of 1,029 and 370 cases with smoking information have been observed in the occupational and environmental (residential) studies, respectively. Three or four control subjects have been individually matched to cases according to sex, year of birth, and age. The combined effect from radon and smoking is analyzed in terms of geometric mixture models of which the additive and multiplicative models are special cases. The resulting models are relatively close to the additive interaction (mixing parameter 0.2 and 0.3 in the occupational and residential studies, respectively). The impact of the resulting model in the residential radon study is illustrated by estimates of lifetime risk in hypothetical populations of smokers and non-smokers. In comparison to the multiplicative risk model, the lifetime risk from the best geometric mixture model is considerably higher, particularly in the non-smoking population. International Journal of Environmental Research and Public Health 2013-03-07 10 3 Article 10.3390/ijerph10030963 963 979 1660-4601 2013-03-07 doi: 10.3390/ijerph10030963 Ladislav Tomasek http://www.mdpi.com/1660-4601/10/3/950 This study examines demographic, cognitive and behavioral factors that predict pediatric dog-bite injury risk in rural China. A total of 1,537 children (grades 4–6) in rural regions of Anhui, Hebei and Zhejiang Provinces, China completed self-report questionnaires assessing beliefs about and behaviors with dogs. The results showed that almost 30% of children reported a history of dog bites. Children answered 56% of dog-safety knowledge items correctly. Regressions revealed both demographic and cognitive/behavioral factors predicted children’s risky interactions with dogs and dog-bite history. Boys behaved more riskily with dogs and were more frequently bitten. Older children reported greater risks with dogs and more bites. With demographics controlled, attitudes/beliefs of invulnerability, exposure frequency, and dog ownership predicted children’s self-reported risky practice with dogs. Attitudes/beliefs of invulnerability, dog exposure, and dog ownership predicted dog bites. In conclusion, both demographic and cognitive/behavioral factors influenced rural Chinese children’s dog-bite injury risk. Theory-based, empirically-supported intervention programs might reduce dog-bite injuries in rural China. International Journal of Environmental Research and Public Health 2013-03-07 10 3 Article 10.3390/ijerph10030950 950 962 1660-4601 2013-03-07 doi: 10.3390/ijerph10030950 Jiabin Shen Shaohua Li Huiyun Xiang Shulan Pang Guozhang Xu David Schwebel http://www.mdpi.com/1660-4601/10/3/936 The main objective of the present study was to assess culturable airborne fungal concentrations, and types in different seasons. Two-stage viable impactor samplers were used with malt extract agar medium as the collection media. Culturable airborne fungal concentrations were collected indoors and outdoors of 43 homes in urban and rural environments from November 2008 to October 2009 in Egypt. Fungal concentrations were significantly higher in the rural environment than the urban environment. The median indoor and outdoor total fungal concentrations were 608 and 675 CFU/m3 in the urban environment and 1,932 and 1,872 CFU/m3 in the rural environment, respectively. The greatest concentrations were found in the autumn and spring season. Indoor and outdoor concentrations were significantly correlated (P < 0.001). The highest concentrations were observed in the fungal size range of <8 µm (fine fraction). The indoor/outdoor (I/O) ratios were not statistically different between seasons. Alternaria, Aspergillus, Cladosporium, Penicillium and yeasts were the predominant genera indoors and outdoors, and the abundance of genera varied by season and region. This study is of a potential interest as little reported research on the indoor fungal air quality from Egypt. International Journal of Environmental Research and Public Health 2013-03-06 10 3 Article 10.3390/ijerph10030936 936 949 1660-4601 2013-03-06 doi: 10.3390/ijerph10030936 Abdel Awad Shawn Gibbs Patrick Tarwater Christopher Green