International Journal of Environmental Research and Public Health

IJERPH, Vol. 7, Pages 1105-1120: Human Amebiasis: Breaking the Paradigm?

Ximénez — Tue, 16 Mar 2010 00:00:00 CET

For over 30 years it has been established that the Entamoeba histolytica protozoan included two biologically and genetically different species, one with a pathogenic phenotype called E. histolytica and the other with a non-pathogenic phenotype called Entamoeba dispar. Both of these amoebae species can infect humans. E. histolytica has been considered as a potential pathogen that can cause serious damage to the large intestine (colitis, dysentery) and other extraintestinal organs, mainly the liver (amebic liver abscess), whereas E. dispar is a species that interacts with humans in a commensal relationship, causing no symptoms or any tissue damage. This paradigm, however, should be reconsidered or re-evaluated. In the present work, we report the detection and genotyping of E. dispar sequences of DNA obtained from patients with amebic liver abscesses, including the genotyping of an isolate obtained from a Brazilian patient with a clinical diagnosis of intestinal amebiasis that was previously characterized as an E. dispar species. The genetic diversity and phylogenetic analysis performed by our group has shown the existence of several different genotypes of E. dispar that can be associated to, or be potentiality responsible for intestinal or liver tissue damage, similar to that observed with E. histolytica.

IJERPH, Vol. 7, Pages 1093-1104: Beer and its Non-Alcoholic Compounds: Role in Pancreatic Exocrine Secretion, Alcoholic Pancreatitis and Pancreatic Carcinoma

Gerloff — Mon, 15 Mar 2010 00:00:00 CET

: In this article we provide an overview of the newest data concerning the effect of non-alcoholic constituents of alcoholic beverages, especially of beer, on pancreatic secretion, and their possible role in alcoholic pancreatitis and pancreatic carcinoma. The data indicate that non-alcoholic constituents of beer stimulate pancreatic enzyme secretion in humans and rats, at least in part, by direct action on pancreatic acinar cells. Some non-alcoholic compounds of beer, such as quercetin, resveratrol, ellagic acid or catechins, have been shown to be protective against experimentally induced pancreatitis by inhibiting pancreatic secretion, stellate cell activation or by reducing oxidative stress. Quercetin, ellagic acid and resveratrol also show anti-carcinogenic potential in vitro and in vivo. However, beer contains many more non-alcoholic ingredients. Their relevance in beer-induced functional alterations of pancreatic cells leading to pancreatitis and pancreatic cancer in humans needs to be further evaluated.

IJERPH, Vol. 7, Pages 1076-1092: A New View of Alcohol Metabolism and Alcoholism—Role of the High-Km Class Ⅲ Alcohol Dehydrogenase (ADH3)

Haseba — Mon, 15 Mar 2010 00:00:00 CET

The conventional view is that alcohol metabolism is carried out by ADH1 (Class I) in the liver. However, it has been suggested that another pathway plays an important role in alcohol metabolism, especially when the level of blood ethanol is high or when drinking is chronic. Over the past three decades, vigorous attempts to identify the enzyme responsible for the non-ADH1 pathway have focused on the microsomal ethanol oxidizing system (MEOS) and catalase, but have failed to clarify their roles in systemic alcohol metabolism. Recently, using ADH3-null mutant mice, we demonstrated that ADH3 (Class III), which has a high Km and is a ubiquitous enzyme of ancient origin, contributes to systemic alcohol metabolism in a dose-dependent manner, thereby diminishing acute alcohol intoxication. Although the activity of ADH3 toward ethanol is usually low in vitro due to its very high Km, the catalytic efficiency (kcat/Km) is markedly enhanced when the solution hydrophobicity of the reaction medium increases. Activation of ADH3 by increasing hydrophobicity should also occur in liver cells; a cytoplasmic solution of mouse liver cells was shown to be much more hydrophobic than a buffer solution when using Nile red as a hydrophobicity probe. When various doses of ethanol are administered to mice, liver ADH3 activity is dynamically regulated through induction or kinetic activation, while ADH1 activity is markedly lower at high doses (3–5 g/kg). These data suggest that ADH3 plays a dynamic role in alcohol metabolism, either collaborating with ADH1 or compensating for the reduced role of ADH1. A complex two-ADH model that ascribes total liver ADH activity to both ADH1 and ADH3 explains the dose-dependent changes in the pharmacokinetic parameters (b, CLT, AUC) of blood ethanol very well, suggesting that alcohol metabolism in mice is primarily governed by these two ADHs. In patients with alcoholic liver disease, liver ADH3 activity increases, while ADH1 activity decreases, as alcohol intake increases. Furthermore, ADH3 is induced in damaged cells that have greater hydrophobicity, whereas ADH1 activity is lower when there is severe liver disease. These data suggest that chronic binge drinking and the resulting liver disease shifts the key enzyme in alcohol metabolism from low-Km ADH1 to high-Km ADH3, thereby reducing the rate of alcohol metabolism. The interdependent increase in the ADH3/ADH1 activity ratio and AUC may be a factor in the development of alcoholic liver disease. However, the adaptive increase in ADH3 sustains alcohol metabolism, even in patients with alcoholic liver cirrhosis, which makes it possible for them to drink themselves to death. Thus, the regulation of ADH3 activity may be important in preventing alcoholism development.

IJERPH, Vol. 7, Pages 1047-1075: Leg Length, Body Proportion, and Health: A Review with a Note on Beauty

Barry Bogin — Thu, 11 Mar 2010 00:00:00 CET

Decomposing stature into its major components is proving to be a useful strategy to assess the antecedents of disease, morbidity and death in adulthood. Human leg length (femur + tibia), sitting height (trunk length + head length) and their proportions, for example, (leg length/stature), or the sitting height ratio (sitting height/stature × 100), among others) are associated with epidemiological risk for overweight (fatness), coronary heart disease, diabetes, liver dysfunction and certain cancers. There is also wide support for the use of relative leg length as an indicator of the quality of the environment for growth during infancy, childhood and the juvenile years of development. Human beings follow a cephalo-caudal gradient of growth, the pattern of growth common to all mammals. A special feature of the human pattern is that between birth and puberty the legs grow relatively faster than other post-cranial body segments. For groups of children and youth, short stature due to relatively short legs (i.e., a high sitting height ratio) is generally a marker of an adverse environment. The development of human body proportions is the product of environmental x genomic interactions, although few if any specific genes are known. The HOXd and the short stature homeobox-containing gene (SHOX) are genomic regions that may be relevant to human body proportions. For example, one of the SHOX related disorders is Turner syndrome. However, research with non-pathological populations indicates that the environment is a more powerful force influencing leg length and body proportions than genes. Leg length and proportion are important in the perception of human beauty, which is often considered a sign of health and fertility.

IJERPH, Vol. 7, Pages 1036-1046: Stress Recovery during Exposure to Nature Sound and Environmental Noise

Jesper J. Alvarsson — Thu, 11 Mar 2010 00:00:00 CET

Research suggests that visual impressions of natural compared with urban environments facilitate recovery after psychological stress. To test whether auditory stimulation has similar effects, 40 subjects were exposed to sounds from nature or noisy environments after a stressful mental arithmetic task. Skin conductance level (SCL) was used to index sympathetic activation, and high frequency heart rate variability (HF HRV) was used to index parasympathetic activation. Although HF HRV showed no effects, SCL recovery tended to be faster during natural sound than noisy environments. These results suggest that nature sounds facilitate recovery from sympathetic activation after a psychological stressor.

IJERPH, Vol. 7, Pages 1018-1035: Climate Change and Health in British Columbia: Projected Impacts and a Proposed Agenda for Adaptation Research and Policy

Aleck Ostry — Thu, 11 Mar 2010 00:00:00 CET

This is a case study describing how climate change may affect the health of British Columbians and to suggest a way forward to promote health and policy research, and adaptation to these changes. After reviewing the limited evidence of the impacts of climate change on human health we have developed five principles to guide the development of research and policy to better predict future impacts of climate change on health and to enhance adaptation to these change in BC. We suggest that, with some modification, these principles will be useful to policy makers in other jurisdictions.

IJERPH, Vol. 7, Pages 1002-1017: GIS and Injury Prevention and Control: History, Challenges, and Opportunities

Nathaniel Bell — Thu, 11 Mar 2010 00:00:00 CET

Intentional and unintentional injury is the leading cause of death and potential years of life lost in the first four decades of life in industrialized countries around the world. Despite surgical innovations and improved access to emergency care, research has shown that certain populations remain particularly vulnerable to the risks and consequences of injury. Recent evidence has shown that the analytical, data linkage, and mapping tools of geographic information systems (GIS) technology provide can further address these determinants and identify populations in need. This paper traces the history of injury prevention and discusses current and future challenges in furthering our understanding of the determinants of injury through the use of GIS.

IJERPH, Vol. 7, Pages 991-1001: Effectiveness of Public Health Interventions in Reducing Morbidity and Mortality during Heat Episodes: a Structured Review

Kate L. Bassil — Wed, 10 Mar 2010 00:00:00 CET

Increasing concern over the impact of hot weather on health has fostered the development of public health interventions to reduce heat-related health impacts. However, evidence of the effectiveness of such interventions is rarely cited for justification. Our objective was to review peer-reviewed and grey literature evaluating interventions aimed at reducing morbidity and/or mortality in populations during hot weather episodes. Among studies considering public risk perceptions, most respondents were aware when an extreme heat episode was occurring but did not necessarily change their practices, primarily due to a lack of self-perception as vulnerable and confusion about the appropriate actions to be taken. Among studies of health outcomes during and following heat episodes, studies were suggestive of positive impacts in reducing morbidity and mortality. While the limited evaluative work to date suggests a positive impact of public health interventions, concern persists about whether the most vulnerable groups, like the elderly and homeless, are being adequately reached.

IJERPH, Vol. 7, Pages 975-990: Specialty Care Use in US Patients with Chronic Diseases

Jessica D. Bellinger — Wed, 10 Mar 2010 00:00:00 CET

Despite efforts to eliminate health disparities, racial, ethnic, and geographic groups continue lag behind their counterparts in health outcomes in the United States. The purpose of this study is to determine variation in specialty care utilization by chronic disease status. Data were extracted from the Commonwealth Fund 2006 Health Care Quality Survey (n = 2475). A stratified minority sample design was employed to ensure a representative sample. Logistic regression was used in analyses to predict specialty care utilization in the sample. Poor perceived health, minority status, and lack of insurance was associated with reduced specialty care use and chronic disease diagnosis.

IJERPH, Vol. 7, Pages 966-974: Excessive Exposure to Secondhand Tobacco Smoke among Hospitality Workers in Kyrgyzstan

Denis Vinnikov — Wed, 10 Mar 2010 00:00:00 CET

The aim of this study was to assess the levels of secondhand smoke (SHS) exposure of men and women in public places in Kyrgyzstan. This cross-sectional study involved 10 bars and restaurants in Bishkek the capital city of Kyrgyzstan. Smoking was allowed in all establishments. Median (interquartile range) air nicotine concentrations were 6.82 (2.89, 8.86) μg/m3. Employees were asked about their smoking history and exposure to SHS at work. Employees were exposed to SHS for mean (SD) 13.5 (3.6) hours a day and 5.8 (1.4) days a week. Women were exposed to more hours of SHS at work compared to men. Hospitality workers are exposed to excessive amounts of SHS from customers. Legislation to ban smoking in public places including bars and restaurants is urgently needed to protect workers and patrons from the harmful effects of SHS.

IJERPH, Vol. 7, Pages 938-965: Mechanisms of Geomagnetic Field Influence on Gene Expression Using Influenza as a Model System: Basics of Physical Epidemiology

Valeriy Zaporozhan — Wed, 10 Mar 2010 00:00:00 CET

Recent studies demonstrate distinct changes in gene expression in cells exposed to a weak magnetic field (MF). Mechanisms of this phenomenon are not understood yet. We propose that proteins of the Cryptochrome family (CRY) are "epigenetic sensors" of the MF fluctuations, i.e., magnetic field-sensitive part of the epigenetic controlling mechanism. It was shown that CRY represses activity of the major circadian transcriptional complex CLOCK/BMAL1. At the same time, function of CRY, is apparently highly responsive to weak MF because of radical pairs that periodically arise in the functionally active site of CRY and mediate the radical pair mechanism of magnetoreception. It is known that the circadian complex influences function of every organ and tissue, including modulation of both NF-κB- and glucocorticoids- dependent signaling pathways. Thus, MFs and solar cycles-dependent geomagnetic field fluctuations are capable of altering expression of genes related to function of NF-κB, hormones and other biological regulators. Notably, NF-κB, along with its significant role in immune response, also participates in differential regulation of influenza virus RNA synthesis. Presented data suggests that in the case of global application (example—geomagnetic field), MF-mediated regulation may have epidemiological and other consequences.

IJERPH, Vol. 7, Pages 927-937: Accuracy of the Simplified Thylstrup & Fejerskov Index in Rural Communities with Endemic Fluorosis

Ana Karoline Adelário — Tue, 09 Mar 2010 00:00:00 CET

The aim of the present study was to compare the values of the Thylstrup & Fejerskov Index (TF index) for the determination of the prevalence of dental fluorosis using either all teeth (gold standard) or six upper anterior teeth (simplified TF index). The sample was made up of 396 individuals aged six to 22 years from three Brazilian cities with endemic fluorosis caused by the ingestion of water with high fluoride concentration. The prevalence of dental fluorosis was evaluated by a single trained examiner with excellent intraexaminer agreement (kappa = 0.95). Intraexaminer reproducibilities were calculated at tooth level. Sensitivity, specificity, positive and negative predictive values of the simplified TF compared to gold standard were 90.6 (95%CI: 86.6 to 93.6), 100 (95%CI: 95.3 to 100), 100 (95%CI: 98.3 to 100) and 77.5 (95%CI: 69.8 to 83.5), respectively. The ROC value was 0.953 (95%CI: 0.933 to 0.973). The simplified TF index proved suitable for determining the prevalence of dental fluorosis in regions with endemic fluorosis caused by the ingestion of water with high concentrations of fluoride.

IJERPH, Vol. 7, Pages 870-926: What is Learned from Longitudinal Studies of Advertising and Youth Drinking and Smoking? A Critical Assessment

Jon P. Nelson — Mon, 08 Mar 2010 00:00:00 CET

This paper assesses the methodology employed in longitudinal studies of advertising and youth drinking and smoking behaviors. These studies often are given a causal interpretation in the psychology and public health literatures. Four issues are examined from the perspective of econometrics. First, specification and validation of empirical models. Second, empirical issues associated with measures of advertising receptivity and exposure. Third, potential endogeneity of receptivity and exposure variables. Fourth, sample selection bias in baseline and follow-up surveys. Longitudinal studies reviewed include 20 studies of youth drinking and 26 studies of youth smoking. Substantial shortcomings are found in the studies, which preclude a causal interpretation.

IJERPH, Vol. 7, Pages 853-869: Workplace Vaccination and Other Factors Impacting Influenza Vaccination Decision among Employees in Israel

Shosh Shahrabani — Mon, 08 Mar 2010 00:00:00 CET

The study examined the factors affecting the decision to be vaccinated against influenza among employees in Israel. The research, conducted in 2007/2008, included 616 employees aged 18−65 at various workplaces in Israel, among them companies that offered their employees influenza vaccination. The research questionnaire included socio-demographic characteristics, and the Health Belief Model principles. The results show that the significant factors affecting vaccination compliance include a vaccination program at workplaces, vaccinations in the past, higher levels of vaccine's perceived benefits, and lower levels of barriers to getting the vaccine. We conclude that vaccine compliance is larger at companies with workplace vaccination programs providing easier accessibility to vaccination.

IJERPH, Vol. 7, Pages 842-852: Waist Circumference and BMI in Relation to Serum High Sensitivity C-Reactive Protein (hs-CRP) in Cuban Americans With and Without Type 2 Diabetes

Fatma G. Huffman — Mon, 08 Mar 2010 00:00:00 CET

IJERPH, Vol. 7, Pages 827-841: An Exploratory Approach to Analyzing Alcohol Control Policy Opinions Held by Ontario Adults

Anca R. Ialomiteanu — Mon, 08 Mar 2010 00:00:00 CET

Telephone interview data from a representative sample of 1,216 Ontario adults were analyzed using latent class analysis to determine whether distinct and homogeneous classes of individuals could be identified based on their responding patterns to 11 alcohol policy items. Five latent classes were identified and labeled as: dedicated liberalizers, moderate liberalizers, moderate controllers, dedicated controllers, and an ambivalent class. Multinomial regression analysis indicated that demographic and alcohol factors differentiated the classes. Those most opposed to alcohol controls, dedicated liberalizers, were more likely to be male, younger and heavier drinkers. Given their young age it is possible that further erosion of public support for alcohol controls may be expected.

IJERPH, Vol. 7, Pages 814-826: Molecular Epidemiology for Vector Research on Leishmaniasis

Hirotomo Kato — Fri, 05 Mar 2010 00:00:00 CET

Leishmaniasis is a protozoan disease caused by the genus Leishmania transmitted by female phlebotomine sand flies. Surveillance of the prevalence of Leishmania and responsive vector species in endemic and surrounding areas is important for predicting the risk and expansion of the disease. Molecular biological methods are now widely applied to epidemiological studies of infectious diseases including leishmaniasis. These techniques are used to detect natural infections of sand fly vectors with Leishmania protozoa and are becoming powerful tools due to their sensitivity and specificity. Recently, genetic analyses have been performed on sand fly species and genotyping using PCR-RFLP has been applied to the sand fly taxonomy. In addition, a molecular mass screening method has been established that enables both sand fly species and natural leishmanial infections to be identified simultaneously in hundreds of sand flies with limited effort. This paper reviews recent advances in the study of sand flies, vectors of leishmaniasis, using molecular biological approaches.

IJERPH, Vol. 7, Pages 799-813: Neighborhoods, Alcohol Outlets and Intimate Partner Violence: Addressing Research Gaps in Explanatory Mechanisms

Carol B. Cunradi — Thu, 04 Mar 2010 00:00:00 CET

Indices of heavy drinking have consistently been linked with increased risk for intimate partner violence (IPV) among couples in the general household population. Because IPV is a ‘private’ event, most IPV research has focused on individual-level risk factors, but current social ecological theory suggests that alcohol outlets can act with neighborhood conditions to increase risks for IPV. This paper reviews the theoretical and empirical literatures relevant to identifying specific social mechanisms linking IPV to alcohol use in community settings, and discusses three social mechanisms relevant to these effects: greater numbers of alcohol outlets within a neighborhood may (1) be a sign of loosened normative constraints against violence; (2) promote problem alcohol use among at-risk couples, and; (3) provide environments where groups of persons at risk for IPV may form and mutually reinforce IPV-related attitudes, norms, and problem behaviors. Understanding these mechanisms is of critical public health importance for developing environmental strategies aimed at prevention of IPV, such as changes in zoning, community action and education, and policing.

IJERPH, Vol. 7, Pages 784-798: Perceived Exercise Benefits and Barriers of Non-Exercising Female University Students in the United Kingdom

Geoff P. Lovell — Mon, 01 Mar 2010 00:00:00 CET

Many individuals do not engage in sufficient physical activity due to low perceived benefits and high perceived barriers to exercise. Given the increasing incidence of obesity and obesity related health disorders, this topic requires further exploration. We used the Exercise Benefits/Barriers Scale to assess perceived benefit and barrier intensities to exercise in 200 non-exercising female university students (mean age 19.3 years, SD = 1.06) in the UK. Although our participants were selected because they self reported themselves to be non-exercising, however they reported significantly higher perceived benefits from exercise than perceived barriers to exercise [t(199) = 6.18, p < 0.001], and their perceived benefit/barrier ratio was 1.33. The greatest perceived benefit from exercise was physical performance followed by the benefits of psychological outlook, preventive health, life enhancement, and then social interaction. Physical performance was rated significantly higher than all other benefits. Psychological outlook and preventive health were not rated significantly different, although both were significantly higher than life enhancement and social interaction. Life enhancement was also rated significantly higher than social interaction. The greatest perceived barrier to exercise was physical exertion, which was rated significantly higher than time expenditure, exercise milieu, and family discouragement barriers. Implications from this investigation for the design of physical activity programmes include the importance, for females, of a perception of high benefit/barrier ratio that could be conducive to participation in exercise. Applied interventions need to assist female students to ‘disengage’ from or overcome any perceived ‘unpleasantness’ of physical exertion during physical activity (decrease their perceived barriers), and to further highlight the multiple health and other benefits of regular exercising (increase their perceived benefits).

IJERPH, Vol. 7, Pages 765-783: Prevention of Overweight and Obesity: How Effective is the Current Public Health Approach

Ruth S.M. Chan — Fri, 26 Feb 2010 00:00:00 CET

Obesity is a public health problem that has become epidemic worldwide. Substantial literature has emerged to show that overweight and obesity are major causes of co-morbidities, including type II diabetes, cardiovascular diseases, various cancers and other health problems, which can lead to further morbidity and mortality. The related health care costs are also substantial. Therefore, a public health approach to develop population-based strategies for the prevention of excess weight gain is of great importance. However, public health intervention programs have had limited success in tackling the rising prevalence of obesity. This paper reviews the definition of overweight and obesity and the variations with age and ethnicity; health consequences and factors contributing to the development of obesity; and critically reviews the effectiveness of current public health strategies for risk factor reduction and obesity prevention.

IJERPH, Vol. 7, Pages 751-764: Smoking Behavior among Coronary Heart Disease Patients in Jordan: A Model from a Developing Country

Nesrin N. Abu-Baker — Fri, 26 Feb 2010 00:00:00 CET

The purpose of this study was to compare the frequency of cigarette smoking before and after diagnosis of Coronary Heart Disease (CHD), detect the reasons that discourage quitting smoking and resources of advice about quitting, and investigate the relationship between smoking behaviors and demographic variables. A convenient sample of 300 CHD patients from cardiac outpatient clinics participated. Before disease occurrence, nonsmokers composed 40% of all participants, former smokers 11.7%, and current smokers 48.3%. Surprisingly, after disease occurrence only 29.7% of the patients quit smoking, while 60.7% continued smoking, and 9.6% relapsed. The most frequent reasons given by smokers for not quitting smoking were "do not incline to stop smoking" (25.6%) and “craving for a cigarette” (25%). Doctors were cited most frequently as the reason individuals quit smoking (19.0%). The Jordanian health care system needs to implement systematic intensive smoking cessation programs to maintain and promote CHD patients' motivation to quit smoking.

IJERPH, Vol. 7, Pages 729-750: Recent Developments in Public Health Nursing in the Americas

Gustavo Nigenda — Fri, 26 Feb 2010 00:00:00 CET

This study presents an assessment of the participation and training of nurses in public health areas in the Americas. Information was gathered through a literature review and interviews with key informants from Mexico, Colombia, and Paraguay. Results demonstrate that there is significant variation in definitions of public health nursing across the region and current systematized data about the workforce profile of public health nursing personnel is not available for many countries in the Americas. There are significant regional differences in the levels and types of training of nurses working in public health areas and an increasing number of nurses are pursuing training in public health at the master’s and doctoral levels. Many nurses carry out some or all of the essential functions of public health, but are not considered to be public health nurses. Generally, auxiliary and technical nurses have a broader presence in public health areas than professional nurses. In the future, regional health systems reforms should support increased recruitment and training of public health nurses, as well as stronger roles in public health research and health care at the individual, community, and population levels.

IJERPH, Vol. 7, Pages 711-728: Usefulness of Mendelian Randomization in Observational Epidemiology

Murielle Bochud — Fri, 26 Feb 2010 00:00:00 CET

Mendelian randomization refers to the random allocation of alleles at the time of gamete formation. In observational epidemiology, this refers to the use of genetic variants to estimate a causal effect between a modifiable risk factor and an outcome of interest. In this review, we recall the principles of a “Mendelian randomization” approach in observational epidemiology, which is based on the technique of instrumental variables; we provide simulations and an example based on real data to demonstrate its implications; we present the results of a systematic search on original articles having used this approach; and we discuss some limitations of this approach in view of what has been found so far.

IJERPH, Vol. 7, Pages 698-710: The Impact of School Tobacco Policies on Student Smoking in Washington State, United States and Victoria, Australia

Tracy J. Evans-Whipp — Fri, 26 Feb 2010 00:00:00 CET

This paper measures tobacco polices in statewide representative samples of secondary and mixed schools in Victoria, Australia and Washington, US (N = 3,466 students from 285 schools) and tests their association with student smoking. Results from confounder-adjusted random effects (multi-level) regression models revealed that the odds of student perception of peer smoking on school grounds are decreased in schools that have strict enforcement of policy (odds ratio (OR) = 0.45; 95% CI: 0.25 to 0.82; p = 0.009). There was no clear evidence in this study that a comprehensive smoking ban, harsh penalties, remedial penalties, harm minimization policy or abstinence policy impact on any of the smoking outcomes.

IJERPH, Vol. 7, Pages 675-697: The Changing Disease-Scape in the Third Epidemiological Transition

Kristin Harper — Wed, 24 Feb 2010 00:00:00 CET

The epidemiological transition model describes the changing relationship between humans and their diseases. The first transition occurred with the shift to agriculture about 10,000 YBP, resulting in a pattern of infectious and nutritional diseases still evident today. In the last two centuries, some populations have undergone a second transition, characterized by a decline in infectious disease and rise in degenerative disease. We are now in the throes of a third epidemiological transition, in which a resurgence of familiar infections is accompanied by an array of novel diseases, all of which have the potential to spread rapidly due to globalization.

IJERPH, Vol. 7, Pages 651-674: Knowledge Transfer and Exchange Processes for Environmental Health Issues in Canadian Aboriginal Communities

Susan M. Jack — Tue, 23 Feb 2010 00:00:00 CET

Within Canadian Aboriginal communities, the process for utilizing environmental health research evidence in the development of policies and programs is not well understood. This fundamental qualitative descriptive study explored the perceptions of 28 environmental health researchers, senior external decision-makers and decision-makers working within Aboriginal communities about factors influencing knowledge transfer and exchange, beliefs about research evidence and Traditional Knowledge and the preferred communication channels for disseminating and receiving evidence. The results indicate that collaborative relationships between researchers and decision-makers, initiated early and maintained throughout a research project, promote both the efficient conduct of a study and increase the likelihood of knowledge transfer and exchange. Participants identified that empirical research findings and Traditional Knowledge are different and distinct types of evidence that should be equally valued and used where possible to provide a holistic understanding of environmental issues and support decisions in Aboriginal communities. To facilitate the dissemination of research findings within Aboriginal communities, participants described the elements required for successfully crafting key messages, locating and using credible messengers to deliver the messages, strategies for using cultural brokers and identifying the communication channels commonly used to disseminate and receive this type of information.

IJERPH, Vol. 7, Pages 635-650: When Do Sexual Partnerships Need to Be Accounted for in Transmission Models of Human Papillomavirus?

Heidi Muller — Mon, 22 Feb 2010 00:00:00 CET

Human papillomavirus (HPV) is often transmitted through sexual partnerships. However, many previous HPV transmission models ignore the existence of partnerships by implicitly assuming that each new sexual contact is made with a different person. Here, we develop a simplified pair model—based on the example of HPV—that explicitly includes sexual partnership formation and dissolution. We show that not including partnerships can potentially result in biased projections of HPV prevalence. However, if transmission rates are calibrated to match empirical pre-vaccine HPV prevalence, the projected prevalence under a vaccination program does not vary significantly, regardless of whether partnerships are included.

IJERPH, Vol. 7, Pages 616-634: The Influence of Secondhand Smoke Exposure on Birth Outcomes in Jordan

Nesrin N. Abu-Baker — Mon, 22 Feb 2010 00:00:00 CET

This study investigates how secondhand smoke (SHS) exposure influences neonatal birth weight in Jordan, a country with high smoking prevalence. The findings revealed that as the average number of SHS exposure hours per week increased in the second trimester, the neonatal birth weight decreased while holding all covariates constant. Women who reported a higher average number of SHS exposure hours per week from work in the second trimester, home in the third trimester, and outside in the third trimester were at greater risk for having a low birth weight neonate than women who reported a lower average number of SHS exposure hours.

IJERPH, Vol. 7, Pages 596-615: Text and Structural Data Mining of Influenza Mentions in Web and Social Media

Courtney D. Corley — Mon, 22 Feb 2010 00:00:00 CET

Text and structural data mining of web and social media (WSM) provides a novel disease surveillance resource and can identify online communities for targeted public health communications (PHC) to assure wide dissemination of pertinent information. WSM that mention influenza are harvested over a 24-week period, 5 October 2008 to 21 March 2009. Link analysis reveals communities for targeted PHC. Text mining is shown to identify trends in flu posts that correlate to real-world influenza-like illness patient report data. We also bring to bear a graph-based data mining technique to detect anomalies among flu blogs connected by publisher type, links, and user-tags.

IJERPH, Vol. 7, Pages 583-595: How Do I Look? Body Image Perceptions among University Students from England and Denmark

Walid El Ansari — Sun, 21 Feb 2010 00:00:00 CET

This study examined differences in body image perception between university students in two European countries, United Kingdom and Denmark. A total of 816 British and 548 Danish university students participated in a cross-sectional survey. A self-administered questionnaire assessed socio-demographic information, body image perception (as “too thin”, “just right” or “too fat”), and the association of related factors with body image perception (nutrition behaviour, social support, perceived stressors and quality of life). The proportions of students who perceived themselves as “too thin”, “just right”, or “too fat” were 8.6%, 37.7%, and 53.7% respectively. Multi-factorial logistic regression analysis showed that students who perceived themselves as “too fat” were more likely to be from the British university, to be females, to be older than 30 years, to report stress due to their financial situation and were less likely to have a high quality of life.The findings highlight the need for interventions with focus on healthy food choices whilst acknowledging financial stressors and quality of life.

IJERPH, Vol. 7, Pages 565-582: Evaluation of Pathogen Removal in a Solar Sludge Drying Facility Using Microbial Indicators

Emily F. Shanahan — Fri, 12 Feb 2010 00:00:00 CET

South East Queensland is one of the fastest growing regions in Australia with a correspondingly rapid increase in sewage production. In response, local councils are investing in more effective and sustainable options for the treatment and reuse of domestic and industrial effluents. A novel, evaporative solar dryer system has been installed on the Sunshine Coast to convert sewage sludge into a drier, usable form of biosolids through solar radiation exposure resulting in decreased moisture concentration and pathogen reduction. Solar-dried biosolids were analyzed for selected pathogenic microbial, metal and organic contaminants at the end of different drying cycles in a collaborative study conducted with the Regional Council. Although fecal coliforms were found to be present, enteroviruses, parasites, E. coli, and Salmonella sp. were not detected in the final product. However, elevated levels of zinc and copper were still present which restricted public use of the biosolids. Dilution of the dried biosolids with green waste as well as composting of the biosolids is likely to lead to the production of an environmentally safe, Class A end-product.

IJERPH, Vol. 7, Pages 546-564: Assessing the Vulnerability of Eco-Environmental Health to Climate Change

Shilu Tong — Fri, 12 Feb 2010 00:00:00 CET

There is an urgent need to assess the vulnerability of eco-environmental health to climate change. This paper aims to provide an overview of current research, to identify knowledge gaps, and to propose future research needs in this challenging area. Evidence shows that climate change is affecting and will, in the future, have more (mostly adverse) impacts on ecosystems. Ecosystem degradation, particularly the decline of the life support systems, will undoubtedly affect human health and wellbeing. Therefore, it is important to develop a framework to assess the vulnerability of eco-environmental health to climate change, and to identify appropriate adaptation strategies to minimize the impact of climate change.

IJERPH, Vol. 7, Pages 528-545: Housing and Health in Ghana: The Psychosocial Impacts of Renting a Home

Isaac Luginaah — Thu, 11 Feb 2010 00:00:00 CET

This paper reports the findings of a qualitative study investigating the impacts of renting a home on the psychosocial health of tenants in the Accra Metropolitan Area (AMA) in Ghana. In-depth interviews (n = 33) were conducted with private renters in Adabraka, Accra. The findings show that private renters in the AMA face serious problems in finding appropriate and affordable rental units, as well as a persistent threat of eviction by homeowners. These challenges tend to predispose renters to psychosocial distress and diminishing ontological security. Findings are relevant to a range of pluralistic policy options that emphasize both formal and informal housing provision, together with the reorganization and decentralization of the Rent Control Board to the district level to facilitate easy access by the citizenry.

IJERPH, Vol. 7, Pages 509-527: Is the Health and Wellbeing of University Students Associated with their Academic Performance? Cross Sectional Findings from the United Kingdom

Walid El Ansari — Thu, 11 Feb 2010 00:00:00 CET

This study explored the associations between health awareness, health behaviour, subjective health status, and satisfaction of students with their educational experience as independent variables and three outcomes of educational achievement as dependent variables. We undertook two simultaneous cross-sectional surveys among students from one University in the UK during 2008−2009. The first survey was a general health survey; the second survey measured students’ satisfaction with different aspects of their learning and teaching experience. Students’ registration numbers linked the responses of both questionnaires together, and subsequently linked the questionnaires to the university database to import the grades that students actually achieved in their studies. Generally, students (N = 380) exhibited average medium to high satisfaction with their educational experiences. Students’ satisfaction with their educational experiences was not associated with any of the three indicators of educational achievement (actual module mark; perceived own performance; importance of achieving good grades). The associations of educational satisfaction, health, health behaviours, heath complaints and financial parameters with the three outcomes of educational achievement did not differ between male and female students. Each of the health, health behaviours, health complaints and financial parameters were selectively associated with only some but not all three indicators of student educational achievement. We conclude that the findings support a conceptual framework suggesting reciprocal relationships between health, health behaviour and educational achievement. Comprehensive health promotion programmes may have the potential to influence relevant predictors of educational achievement in university students.

IJERPH, Vol. 7, Pages 494-508: Hydrologic Conditions Describe West Nile Virus Risk in Colorado

Jeffrey Shaman — Thu, 11 Feb 2010 00:00:00 CET

We examine the relationship between hydrologic variability and the incidence of human disease associated with West Nile virus (WNV; family Flaviviridae, genus Flavivirus) infection (hereafter termed “human WN cases”) in Colorado from 2002 to 2007. We find that local hydrologic conditions, as simulated by the Mosaic hydrology model, are associated with differences in human WN cases. In Colorado’s eastern plains, wetter spring conditions and drier summer conditions predict human WN cases. In Colorado’s western mountains, drier spring and summer conditions weakly predict human WN cases. These findings support two working hypotheses: (1) wet spring conditions increase the abundance of Culex tarsalis vectors in the plains, and (2) dry summer conditions, and respondent irrigational practices during such droughts, favor Cx. pipiens and Cx. tarsalis abundance throughout Colorado. Both of these processes potentially increase the local vector-to-host ratio, favoring WNV amplification among competent avian hosts and bridging to humans.

IJERPH, Vol. 7, Pages 473-493: Biological Contribution to Social Influences on Alcohol Drinking: Evidence from Animal Models

Allison M.J. Anacker — Thu, 11 Feb 2010 00:00:00 CET

Social factors have a tremendous influence on instances of heavy drinking and in turn impact public health. However, it is extremely difficult to assess whether this influence is only a cultural phenomenon or has biological underpinnings. Research in non-human primates demonstrates that the way individuals are brought up during early development affects their future predisposition for heavy drinking, and research in rats demonstrates that social isolation, crowding or low social ranking can lead to increased alcohol intake, while social defeat can decrease drinking. Neurotransmitter mechanisms contributing to these effects (i.e., serotonin, GABA, dopamine) have begun to be elucidated. However, these studies do not exclude the possibility that social effects on drinking occur through generalized stress responses to negative social environments. Alcohol intake can also be elevated in positive social situations, for example, in rats following an interaction with an intoxicated peer. Recent studies have also begun to adapt a new rodent species, the prairie vole, to study the role of social environment in alcohol drinking. Prairie voles demonstrate a high degree of social affiliation between individuals, and many of the neurochemical mechanisms involved in regulation of these social behaviors (for example, dopamine, central vasopressin and the corticotropin releasing factor system) are also known to be involved in regulation of alcohol intake. Naltrexone, an opioid receptor antagonist approved as a pharmacotherapy for alcoholic patients, has recently been shown to decrease both partner preference and alcohol preference in voles. These findings strongly suggest that mechanisms by which social factors influence drinking have biological roots, and can be studied using rapidly developing new animal models.

IJERPH, Vol. 7, Pages 460-472: Trends and Stabilization up to 2022 in Overweight and Obesity in Switzerland, Comparison to France, UK, US and Australia

Heinz Schneider — Thu, 11 Feb 2010 00:00:00 CET

In Switzerland a rapid increase in the total overweight population (BMI ≥ 25) from 30.3% to 37.3% and in the obese segment (BMI ≥ 30) from 5.4% to 8.1% was observed between 1992 and 2007. The objective of this study is to produce a projection until 2022 for the development of adult overweight and obesity in Switzerland based on four National Health Surveys conducted between 1992 and 2007. Based on the projection, these prevalence rates may be expected to stabilize until 2022 at the 2007 level. These results were compared with future projections estimated for France, UK, US and Australia using the same model.

IJERPH, Vol. 7, Pages 443-459: Do Health Beliefs and Behaviors Differ According to Severity of Obesity? A Qualitative Study of Australian Adults

Sophie Lewis — Wed, 03 Feb 2010 00:00:00 CET

Public responses to obesity have focused on providing standardized messages and supports to all obese individuals, but there is limited understanding of the impact of these messages on obese adults. This descriptive qualitative study using in-depth interviews and a thematic method of analysis, compares the health beliefs and behaviors of 141 Australian adults with mild to moderate (BMI 30−39.9) and severe (BMI ≥ 40) obesity. Mildly obese individuals felt little need to change their health behaviors or to lose weight for health reasons. Most believed they could “lose weight” if they needed to, distanced themselves from the word obesity, and stigmatized those “fatter” than themselves. Severely obese individuals felt an urgent need to change their health behaviors, but felt powerless to do so. They blamed themselves for their weight, used stereotypical language to describe their health behaviors, and described being “at war” with their bodies. Further research, particularly about the role of stigma and stereotyping, is needed to fully understand the impact of obesity messaging on the health beliefs, behaviors, and wellbeing of obese and severely obese adults.

IJERPH, Vol. 7, Pages 427-442: Potential Risk Factors for Cutaneous Squamous Cell Carcinoma include Oral Contraceptives: Results of a Nested Case-Control Study

Maryam M. Asgari — Wed, 03 Feb 2010 00:00:00 CET

Recently, a population-based case-control study observed a 60% increased odds ratio (OR) for cutaneous squamous cell carcinoma (SCC) among women who had ever used oral contraceptives (OCs) compared with non users (95% confidence interval (CI) = 1.0–2.5). To further characterize the putative association between OC use and SCC risk, we conducted a nested case-control study using a large retrospective cohort of 111,521 Kaiser Permanente Northern California members. Multivariable conditional logistic regression was used to estimate ORs and CIs adjusting for known and hypothesized SCC risk factors. Pre-diagnostic OC use was associated with a statistically significant increased OR for SCC in univariate analysis (OR = 2.4, CI = 1.2–4.8), with borderline statistical significance in multivariable analysis (CI = 2.0, CI = 0.91–4.5). Given the high incidence of SCC in the general population and the prevalent use of OCs among women in the United States, there is a need for more large, carefully designed epidemiologic studies to determine whether the observed association between OC use and SCC can be replicated and to better understand the etiologic basis of an association if one exists.

IJERPH, Vol. 7, Pages 413-426: Nutritionist’s Variation in Counseling Style and the Effect on Weight Change of Patients Attending a Community Based Lifestyle Modification Program

Kris Y. W. Lok — Tue, 02 Feb 2010 00:00:00 CET

Information concerning the nature of nutritionist-patient relationships is very limited. This qualitative and quantitative study examined nutritionist’s skills, attributes, and beliefs towards nutrition counseling during a lifestyle modification intervention program, and whether this affected the patient’s weight outcome. 24 nutrition consultations were observed during the program and the nutritionists were interviewed for their perception on practice (n = 4). A statistically significant difference was observed between the nutritionists in regard to patient’s weight change after adjustment for age and baseline weight (p < 0.001). Key nutritionist skills identified that influenced weight outcome were meticulous investigation of the underlying obesity cause, identification of the subject’s stage of change, and psychological support.

IJERPH, Vol. 7, Pages 395-412: Heavy Metals in Soil and Crops of an Intensively Farmed Area: A Case Study in Yucheng City, Shandong Province, China

Lin Jia — Mon, 01 Feb 2010 00:00:00 CET

Yucheng City is located in northwestern Shandong Province, China, and is situated on the Huang-Huai-Hai Plain, the largest alluvial plain in China. In this study, 86 surface soil samples were collected in Yucheng City and analyzed for cation exchange capacity (CEC), soil organic matter (SOM), pH, available phosphorus (avail. P), phosphorus (P), aluminum (Al), and iron (Fe). These soils were also analyzed for ‘total’ chromium (Cr), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), mercury (Hg), cadmium (Cd), and lead (Pb), together with 92 wheat samples and 37 corn samples. There was no obvious heavy metal contamination in the soil and irrigation water. But the long-term accumulation of heavy metals in soil has lead to an increase of Ni, As, Hg and Pb concentrations in some of wheat and corn samples and Cd in wheat samples. Because of the numerous sources of soil heavy metals and the lower level of heavy metal in irrigation water, there is no significant relation between soil heavy metal concentrations and irrigation water concentrations. Cr, Ni were mainly from the indigenous clay minerals according to multivariate analysis. Little contribution to soil heavy metal contents from agricultural fertilizer use was found and the local anomalies of As, Cd, Hg, Pb in wheat and corn grain are attributed to the interactive effects of irrigation and fertilizer used. Aerial Hg, however may also be the source of Hg for soil, wheat and corn.

IJERPH, Vol. 7, Pages 380-394: On Application of the Empirical Bayes Shrinkage in Epidemiological Settings

Yuejen Zhao — Thu, 28 Jan 2010 00:00:00 CET

This paper aims to provide direct and indirect evidence on setting up rules for applications of the empirical Bayes shrinkage (EBS), and offers cautionary remarks concerning its applicability. In epidemiology, there is still a lack of relevant criteria in the application of EBS. The bias of the shrinkage estimator is investigated in terms of the sums of errors, squared errors and absolute errors, for both total and individual groups. The study reveals that assessing the underlying exchangeability assumption is important for appropriate use of EBS. The performance of EBS is indicated by a ratio statistic f of the between-group and within-group mean variances. If there are significant differences between the sample means, EBS is likely to produce erratic and even misleading information.

IJERPH, Vol. 7, Pages 333-352: A Multilevel Model for Comorbid Outcomes: Obesity and Diabetes in the US

Peter Congdon — Wed, 27 Jan 2010 00:00:00 CET

Multilevel models are overwhelmingly applied to single health outcomes, but when two or more health conditions are closely related, it is important that contextual variation in their joint prevalence (e.g., variations over different geographic settings) is considered. A multinomial multilevel logit regression approach for analysing joint prevalence is proposed here that includes subject level risk factors (e.g., age, race, education) while also taking account of geographic context. Data from a US population health survey (the 2007 Behavioral Risk Factor Surveillance System or BRFSS) are used to illustrate the method, with a six category multinomial outcome defined by diabetic status and weight category (obese, overweight, normal). The influence of geographic context is partly represented by known geographic variables (e.g., county poverty), and partly by a model for latent area influences. In particular, a shared latent variable (common factor) approach is proposed to measure the impact of unobserved area influences on joint weight and diabetes status, with the latent variable being spatially structured to reflect geographic clustering in risk.

IJERPH, Vol. 7, Pages 364-379: Alcohol Abuse in Pregnant Women: Effects on the Fetus and Newborn, Mode of Action and Maternal Treatment

Asher Ornoy — Wed, 27 Jan 2010 00:00:00 CET

Offspring of mothers using ethanol during pregnancy are known to suffer from developmental delays and/or a variety of behavioral changes. Ethanol, may affect the developing fetus in a dose dependent manner. With very high repetitive doses there is a 6–10% chance of the fetus developing the fetal alcoholic syndrome manifested by prenatal and postnatal growth deficiency, specific craniofacial dysmorphic features, mental retardation, behavioral changes and a variety of major anomalies. With lower repetitive doses there is a risk of "alcoholic effects" mainly manifested by slight intellectual impairment, growth disturbances and behavioral changes. Binge drinking may impose some danger of slight intellectual deficiency. It is advised to offer maternal abstinence programs prior to pregnancy, but they may also be initiated during pregnancy with accompanying close medical care. The long term intellectual outcome of children born to ethanol dependent mothers is influenced to a large extent by the environment in which the exposed child is raised.

IJERPH, Vol. 7, Pages 353-363: Hypertension, Diabetes Mellitus and Task Shifting in Their Management in Sub-Saharan Africa

Alain Lekoubou — Wed, 27 Jan 2010 00:00:00 CET

Chronic diseases are becoming increasingly important in sub-Saharan Africa (SSA). The current density and distribution of health workforce suggest that SSA cannot respond to the growing demand for chronic disease care, together with the frequent infectious diseases. Innovative approaches are therefore needed to rapidly expand the health workforce. In this article, we discuss the evidences in support of nurse-led strategies for chronic disease management in SSA, with a focus on hypertension and diabetes mellitus.

IJERPH, Vol. 7, Pages 325-332: To Match or Not to Match in Epidemiological Studies—Same Outcome but Less Power

Tomas Faresjö — Tue, 26 Jan 2010 00:00:00 CET

This study aimed to analyze the possible resemblance or difference in outcome in a case-control study of quality of life for IBS patients compared to controls free from the disease, when a matching procedure for age and sex was applied for the control group compared to when all participating subjects were included in the control group. The main result was that almost the same and identical results were found irrespective of whether matching or not matching was applied in this epidemiological case-control study. The matching procedure however, slightly diminished the statistical power of the results.

IJERPH, Vol. 7, Pages 314-324: Indoor Air in Beauty Salons and Occupational Health Exposure of Cosmetologists to Chemical Substances

Alexandra Tsigonia — Tue, 26 Jan 2010 00:00:00 CET

The indoor environment in four beauty salons located in Athens (Greece) was examined in order to investigate the occupational health exposure of cosmetologists to various chemical products typically used in their work. Chemical substances chosen for investigation were volatile organic compounds (VOCs), formaldehyde, ozone and carbon dioxide. Total VOCs levels measured showed significant variation (100–1,450 μg m-3) depending on the products used and the number of treatments carried out, as well as ventilation. The main VOCs found in the salons were aromatics (toluene, xylene), esters and ketones (ethyl acetate, acetone, etc.) which are used as solvents in various beauty products; terpenes (pinene, limonene, camphor, menthenol) which have a particular odor and others like camphor which have specific properties. Ozone concentrations measured in all salons were quite low (0.1 and 13.3 μg m-3) and formaldehyde concentrations detected were lower than the detection limit of the method in all salons (<0.05 ppm). Carbon dioxide levels ranged between 402 and 1,268 ppm, depending on the number of people present in the salons during measurements and ventilation. Cosmetologists may be exposed to high concentrations of a mixture of volatile organic compounds although these levels could be decreased significantly by following certain practices such as good ventilation of the areas, closing the packages of the beauty products when not in use and finally selecting safer beauty products without strong odor.

IJERPH, Vol. 7, Pages 303-313: The Toxicity of Depleted Uranium

Wayne Briner — Mon, 25 Jan 2010 00:00:00 CET

Depleted uranium (DU) is an emerging environmental pollutant that is introduced into the environment primarily by military activity. While depleted uranium is less radioactive than natural uranium, it still retains all the chemical toxicity associated with the original element. In large doses the kidney is the target organ for the acute chemical toxicity of this metal, producing potentially lethal tubular necrosis. In contrast, chronic low dose exposure to depleted uranium may not produce a clear and defined set of symptoms. Chronic low-dose, or subacute, exposure to depleted uranium alters the appearance of milestones in developing organisms. Adult animals that were exposed to depleted uranium during development display persistent alterations in behavior, even after cessation of depleted uranium exposure. Adult animals exposed to depleted uranium demonstrate altered behaviors and a variety of alterations to brain chemistry. Despite its reduced level of radioactivity evidence continues to accumulate that depleted uranium, if ingested, may pose a radiologic hazard. The current state of knowledge concerning DU is discussed.

IJERPH, Vol. 7, Pages 291-302: Correcting the Actual Reproduction Number: A Simple Method to Estimate R0 from Early Epidemic Growth Data

Hiroshi Nishiura — Thu, 21 Jan 2010 00:00:00 CET

The basic reproduction number, R0, a summary measure of the transmission potential of an infectious disease, is estimated from early epidemic growth rate, but a likelihood-based method for the estimation has yet to be developed. The present study corrects the concept of the actual reproduction number, offering a simple framework for estimating R0 without assuming exponential growth of cases. The proposed method is applied to the HIV epidemic in European countries, yielding R0 values ranging from 3.60 to 3.74, consistent with those based on the Euler-Lotka equation. The method also permits calculating the expected value of R0 using a spreadsheet.

IJERPH, Vol. 7, Pages 284-290: Determinants of Exposure to Environmental Tobacco Smoke (ETS) among Non Smoking Adolescents (Aged 11-17 Years Old) in Greece: Results from the 2004-2005 GYTS Study

George Rachiotis — Thu, 21 Jan 2010 00:00:00 CET

The aim of the study is to investigate the determinants of exposure to ETS among Greek adolescents aged 11-17 years old. The GYTS questionnaire was completed by 5,179 adolescents. About 3 in 4 responders (76.8%) were exposed to ETS at home, and 38.5% were exposed to ETS outside of the home. Gender, age group, parental and close friends smoking status were significant determinants of adolescent’s exposure to ETS. The results of the study could be valuable for the implementation of public health initiatives in Greece aiming to reduce the burden of adolescent’s exposure to passive smoking.

IJERPH, Vol. 7, Pages 269-283: Categorizing US State Drinking Practices and Consumption Trends

William C. Kerr — Wed, 20 Jan 2010 00:00:00 CET

US state alcohol consumption patterns and trends are examined in order to identify groups of states with similar drinking habits or cultures. Rates of heavy drinking and current abstention and per capita apparent consumption levels are used to categorize states. Six state groupings were identified: North Central and New England with the highest consumption and heavy drinking levels; Middle Atlantic, Pacific and South Coast with moderate drinking levels; and Dry South with the lowest drinking levels. Analyses of relationships between beer and spirits series for states within groups as compared to those in different groups failed to clearly indicate group cohesiveness.

IJERPH, Vol. 7, Pages 229-268: Advancing the Selection of Neurodevelopmental Measures in Epidemiological Studies of Environmental Chemical Exposure and Health Effects

Eric Youngstrom — Tue, 19 Jan 2010 00:00:00 CET

With research suggesting increasing incidence of pediatric neurodevelopmental disorders, questions regarding etiology continue to be raised. Neurodevelopmental function tests have been used in epidemiology studies to evaluate relationships between environmental chemical exposures and neurodevelopmental deficits. Limitations of currently used tests and difficulties with their interpretation have been described, but a comprehensive critical examination of tests commonly used in studies of environmental chemicals and pediatric neurodevelopmental disorders has not been conducted. We provide here a listing and critical evaluation of commonly used neurodevelopmental tests in studies exploring effects from chemical exposures and recommend measures that are not often used, but should be considered. We also discuss important considerations in selecting appropriate tests and provide a case study by reviewing the literature on polychlorinated biphenyls.

IJERPH, Vol. 7, Pages 203-228: Environmental Remediation and Conversion of Carbon Dioxide (CO2) into Useful Green Products by Accelerated Carbonation Technology

Mihee Lim — Mon, 18 Jan 2010 00:00:00 CET

This paper reviews the application of carbonation technology to the environmental industry as a way of reducing carbon dioxide (CO2), a green house gas, including the presentation of related projects of our research group. An alternative technology to very slow natural carbonation is the co-called ‘accelerated carbonation’, which completes its fast reaction within few hours by using pure CO2. Carbonation technology is widely applied to solidify or stabilize solid combustion residues from municipal solid wastes, paper mill wastes, etc. and contaminated soils, and to manufacture precipitated calcium carbonate (PCC). Carbonated products can be utilized as aggregates in the concrete industry and as alkaline fillers in the paper (or recycled paper) making industry. The quantity of captured CO2 in carbonated products can be evaluated by measuring mass loss of heated samples by thermo-gravimetric (TG) analysis. The industrial carbonation technology could contribute to both reduction of CO2 emissions and environmental remediation.

IJERPH, Vol. 7, Pages 189-202: Theoretical Models and Operational Frameworks in Public Health Ethics

Carlo Petrini — Mon, 18 Jan 2010 00:00:00 CET

The article is divided into three sections: (i) an overview of the main ethical models in public health (theoretical foundations); (ii) a summary of several published frameworks for public health ethics (practical frameworks); and (iii) a few general remarks. Rather than maintaining the superiority of one position over the others, the main aim of the article is to summarize the basic approaches proposed thus far concerning the development of public health ethics by describing and comparing the various ideas in the literature. With this in mind, an extensive list of references is provided.

IJERPH, Vol. 7, Pages 178-188: Aflatoxin Contamination in Food and Body Fluids in Relation to Malnutrition and Cancer Status in Cameroon

Angele N. Tchana — Mon, 18 Jan 2010 00:00:00 CET

Aflatoxins are food contaminants usually associated with hepatitis, immunodepression, impairment of fertility and cancer. The present work was to determine the presence of aflatoxins in eggs, milk, urine, and blood samples that were collected from various sources and periods; and hepatitis B virus antigen in blood samples. Aflatoxin was found in eggs (45.2%), cow raw milk (15.9%), breast milk (4.8%), urine from kwashiorkor and marasmic kwashiorkor children (45.5%), and sera from primary liver cancer patients (63.9%); HbsAg was also detected in 69.4% of the serum samples, but there was no association between both factors. Both AF and hepatitis B virus seem to be risk factors that could increase the incidence and prevalence rates of malnutrition and cancer in Cameroon.

IJERPH, Vol. 7, Pages 164-177: Estimating Prevalence of Coronary Heart Disease for Small Areas Using Collateral Indicators of Morbidity

Peter Congdon — Mon, 18 Jan 2010 00:00:00 CET

Different indicators of morbidity for chronic disease may not necessarily be available at a disaggregated spatial scale (e.g., for small areas with populations under 10 thousand). Instead certain indicators may only be available at a more highly aggregated spatial scale; for example, deaths may be recorded for small areas, but disease prevalence only at a considerably higher spatial scale. Nevertheless prevalence estimates at small area level are important for assessing health need. An instance is provided by England where deaths and hospital admissions for coronary heart disease are available for small areas known as wards, but prevalence is only available for relatively large health authority areas. To estimate CHD prevalence at small area level in such a situation, a shared random effect method is proposed that pools information regarding spatial morbidity contrasts over different indicators (deaths, hospitalizations, prevalence). The shared random effect approach also incorporates differences between small areas in known risk factors (e.g., income, ethnic structure). A Poisson-multinomial equivalence may be used to ensure small area prevalence estimates sum to the known higher area total. An illustration is provided by data for London using hospital admissions and CHD deaths at ward level, together with CHD prevalence totals for considerably larger local health authority areas. The shared random effect involved a spatially correlated common factor, that accounts for clustering in latent risk factors, and also provides a summary measure of small area CHD morbidity.

IJERPH, Vol. 7, Pages 146-163: Maternal Cigarette Smoking during Pregnancy and Offspring Externalizing Behavioral Problems: A Propensity Score Matching Analysis

Brian B. Boutwell — Thu, 14 Jan 2010 00:00:00 CET

A body of empirical research has revealed that prenatal exposure to tobacco smoke is related to a host of negative outcomes, including reduced cognitive abilities, later-life health problems, and childhood behavioral problems. While these findings are often interpreted as evidence of the causal role that prenatal exposure to tobacco smoke has on human phenotypes, emerging evidence has suggested that the association between prenatal exposure to tobacco smoke and behavioral phenotypes may be spurious. The current analysis of data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) revealed that the association between prenatal exposure to cigarette smoke and externalizing behavioral problems was fully accounted for by confounding factors. The implications that these findings have for policy and research are discussed.

IJERPH, Vol. 7, Pages 125-145: Assessing the Relationship between Socioeconomic Conditions and Urban Environmental Quality in Accra, Ghana

Julius Fobil — Wed, 13 Jan 2010 00:00:00 CET

The influence of socioeconomic status (SES) on health inequalities is widely known, but there is still poor understanding of the precise relationship between area-based socioeconomic conditions and neighborhood environmental quality. This study aimed to investigate the socioeconomic conditions which predict urban neighbourhood environmental quality. The results showed wide variation in levels of association between the socioeconomic variables and environmental conditions, with strong evidence of a real difference in environmental quality across the five socioeconomic classes with respect to total waste generation (p < 0.001), waste collection rate (p < 0.001), sewer disposal rate (p < 0.001), non-sewer disposal (p < 0.003), the proportion of households using public toilets (p = 0.005). Socioeconomic conditions are therefore important drivers of change in environmental quality and urban environmental interventions aimed at infectious disease prevention and control if they should be effective could benefit from simultaneous implementation with other social interventions.

IJERPH, Vol. 7, Pages 115-124: Advances in Identifying Beryllium Sensitization and Disease

Dan Middleton — Wed, 13 Jan 2010 00:00:00 CET

Beryllium is a lightweight metal with unique qualities related to stiffness, corrosion resistance, and conductivity. While there are many useful applications, researchers in the 1930s and l940s linked beryllium exposure to a progressive occupational lung disease. Acute beryllium disease is a pulmonary irritant response to high exposure levels, whereas chronic beryllium disease (CBD) typically results from a hypersensitivity response to lower exposure levels. A blood test, the beryllium lymphocyte proliferation test (BeLPT), was an important advance in identifying individuals who are sensitized to beryllium (BeS) and thus at risk for developing CBD. While there is no true "gold standard" for BeS, basic epidemiologic concepts have been used to advance our understanding of the different screening algorithms.

IJERPH, Vol. 7, Pages 89-114: Avian Colibacillosis and Salmonellosis: A Closer Look at Epidemiology, Pathogenesis, Diagnosis, Control and Public Health Concerns

S. M. Lutful Kabir — Tue, 12 Jan 2010 00:00:00 CET

Avian colibacillosis and salmonellosis are considered to be the major bacterial diseases in the poultry industry world-wide. Colibacillosis and salmonellosis are the most common avian diseases that are communicable to humans. This article provides the vital information on the epidemiology, pathogenesis, diagnosis, control and public health concerns of avian colibacillosis and salmonellosis. A better understanding of the information addressed in this review article will assist the poultry researchers and the poultry industry in continuing to make progress in reducing and eliminating avian colibacillosis and salmonellosis from the poultry flocks, thereby reducing potential hazards to the public health posed by these bacterial diseases.

IJERPH, Vol. 7, Pages 78-88: What Defines an Effective Anti-Tobacco TV Advertisement? A Pilot Study among Greek Adolescents

Constantine I. Vardavas — Fri, 08 Jan 2010 00:00:00 CET

As the Framework Convention on Tobacco Control (FCTC) calls for public health awareness on tobacco use, mass media campaigns should be appropriately designed so as to maximize their effectiveness. In this methodological pilot study, 95 Greek adolescents (mean age 15 ± 1.8 years), were shown seven different anti tobacco ads, and asked to rate the ad theme, message and emotional context on a 1−7 Likert scale. Health related ads were rated the highest, and as identified through the logistic regression analysis, adolescents who perceived an ad to be emotional or to have a clear message that was relevant to them, were more likely to rate the ad as more effective. The strong agreement between the above findings and the existing literature indicates the applicability of this pilot study’s methodological approach.

IJERPH, Vol. 7, Pages 60-77: The Influence of Individual, Social and Physical Environment Factors on Physical Activity in the Adult Population in Andalusia, Spain

Julia Bolívar — Tue, 05 Jan 2010 00:00:00 CET

A person’s physical and social environment is considered as an influencing factor in terms of rates of engagement in physical activity. This study analyses the influence of socio-demographic, physical and social environmental factors on physical activity reported in the adult population in Andalusia. This is a cross-sectional study using data collected in the Andalusia Health Survey in 1999 and 2003. In addition to the influence of the individual’s characteristics, if there are no green spaces in the neighbourhood it is less likely that men and women will take exercise (OR = 1.26; 95% CI = 1.13, 1.41). Likewise, a higher local illiteracy rate also has a negative influence on exercise habits in men (OR = 1.39; 95% CI = 1.21, 1.59) and in women (OR = 1.22; 95% CI = 1.07, 1.40). Physical activity is influenced by individuals’ characteristics as well as by their social and physical environment, the most disadvantaged groups are less likely to engage in physical activity.

IJERPH, Vol. 7, Pages 46-59: Challenging the “Inoffensiveness” of Regular Cannabis Use by Its Associations with Other Current Risky Substance Use—A Census of 20-Year-Old Swiss Men

Gerhard Gmel — Mon, 04 Jan 2010 00:00:00 CET

3,537 men enrolling in 2007 for mandatory army recruitment procedures were assessed for the co-occurrence of risky licit substance use among risky cannabis users. Risky cannabis use was defined as at least twice weekly; risky alcohol use as 6+ drinks more than once/monthly, or more than 20 drinks per week; and risky tobacco use as daily smoking. Ninety-five percent of all risky cannabis users reported other risky use. They began using cannabis earlier than did non-risky users, but age of onset was unrelated to other risky substance use. A pressing public health issue among cannabis users stems from risky licit substance use warranting preventive efforts within this age group.

IJERPH, Vol. 7, Pages 29-45: Epidemiological Methods: About Time

Helena Chmura Kraemer — Thu, 31 Dec 2009 00:00:00 CET

Epidemiological studies often produce false positive results due to use of statistical approaches that either ignore or distort time. The three time-related issues of focus in this discussion are: (1) cross-sectional vs. cohort studies, (2) statistical significance vs. public health significance, and (3), how risk factors "work together" to impact public health significance. The issue of time should be central to all thinking in epidemiology research, affecting sampling, measurement, design, analysis and, perhaps most important, the interpretation of results that might influence clinical and public-health decision-making and subsequent clinical research.

IJERPH, Vol. 7, Pages 28: Publisher’s Note – Received Date Error, Int. J. Environ. Res. Public Health 2009, 6, 3105-3114

Shu-Kun Lin — Tue, 29 Dec 2009 00:00:00 CET

Publisher’s Note added on 29 December 2009: The received date of Int. J. Environ. Res. Public Health 2009, 6, 3105-3114 was wrongly published. [...]

IJERPH, Vol. 7, Pages 9-27: The Selection of an Appropriate Count Data Model for Modelling Health Insurance and Health Care Demand: Case of Indonesia

Budi Hidayat — Tue, 29 Dec 2009 00:00:00 CET

We apply several estimators to Indonesian household data to estimate the relationship between health insurance and the number of outpatient visits to public and private providers. Once endogeneity of insurance is taken into account, there is a 63 percent increase in the average number of public visits by the beneficiaries of mandatory insurance for civil servants. Individuals' decisions to make first contact with private providers is affected by private insurance membership. However, insurance status does not make any difference for the number of future outpatient visits.

IJERPH, Vol. 7, Pages 1-8: Quality Health Care in the European Union Thanks to Competition Law

Diego Fornaciari — Thu, 24 Dec 2009 00:00:00 CET

There are many biases concerning the application of competition law in health care. Quality concerns can however be integrated into competition law analysis. The aim of this paper is to identify the links between the application of competition law in the European Union and the right to quality health care and to point out the problems that arise when integrating quality concerns in competition law analysis. Guidelines must be issued and competition authorities must work together with institutions that have expertise in the field of health care quality measurement in order to integrate these dimensions in competition practice.

IJERPH, Vol. 6, Pages 3225-3234: Access to Health Care and Religion among Young American Men

R. Frank Gillum — Fri, 18 Dec 2009 00:00:00 CET

In order to elucidate cultural correlates of utilization of primary health services by young adult men, we investigated religion in which one was raised and service utilization. Using data from a national survey we tested the hypothesis that religion raised predicts access to and utilization of a regular medical care provider, examinations, HIV and other STD testing and counseling at ages 18–44 years in men born between 1958 and 1984. We also hypothesized that religion raised would be more predictive of utilization for Hispanic Americans and non-Hispanic Black Americans than for non-Hispanic White Americans. The study included a national sample of 4276 men aged 18–44 years. Descriptive and multivariate statistics were used to assess the hypotheses using data on religion raised and responses to 14 items assessing health care access and utilization. Compared to those raised in no religion, those raised mainline Protestant were more likely (p < 0.01) to report a usual source of care (67% vs. 79%), health insurance coverage (66% vs. 80%) and physical examination (43% vs. 48%). Religion raised was not associated with testicular exams, STD counseling or HIV testing. In multivariate analyses controlling for confounders, significant associations of religion raised with insurance coverage, a physician as usual source of care and physical examination remained which varied by race/ethnicity. In conclusion, although religion is a core aspect of culture that deserves further study as a possible determinant of health care utilization, we were not able to document any consistent pattern of significant association even in a population with high rates of religious participation.

IJERPH, Vol. 6, Pages 3205-3224: Externalities from Alcohol Consumption in the 2005 US National Alcohol Survey: Implications for Policy

Thomas K. Greenfield — Fri, 11 Dec 2009 00:00:00 CET

A subsample (n = 2,550) of the 2005 US National Alcohol Survey of adults was used to estimate prevalence and correlates of six externalities from alcohol abuse—family problems, assaults, accompanying intoxicated driver, vehicular accident, financial problems and vandalized property—all from another‘s drinking. On a lifetime basis, 60% reported externalities, with a lower 12-month rate (9%). Women reported more family/marital and financial impacts and men more assaults, accompanying drunk drivers, and accidents. Being unmarried, older, white and ever having monthly heavy drinking or alcohol problems was associated with more alcohol externalities. Publicizing external costs of drinking could elevate political will for effective alcohol controls.

IJERPH, Vol. 6, Pages 3190-3204: Geo-Relationship between Cancer Cases and the Environment by GIS: A Case Study of Trabzon in Turkey

Tahsin Yomralioglu — Fri, 11 Dec 2009 00:00:00 CET

Cancer is an important health issue in Turkey because it ranks as the second cause of death in the country. Examination of the relationships between the distribution of cancer cases and geo-environmental factors is significant in determining the causes of cancer. In this study, GIS were used to provide data about the distribution of cancer types in Trabzon province, Turkey. To determine the cancer occurrence density, the cancer incidence rates were calculated according to local census data, then a cancer density map was produced, and correlations between cancer types and geographical factors were examined.

IJERPH, Vol. 6, Pages 3179-3189: An Exploratory Study of Diabetes in a First Nation Community with Respect to Serum Concentrations of p,p’-DDE and PCBs and Fish Consumption

Aline Philibert — Fri, 11 Dec 2009 00:00:00 CET

This study examined the association between self-reported diabetes, fish consumption and serum levels of organochlorines in a First Nation community. One quarter of the 101 participants reported diabetes. Serum PCBs, but not p,p’-DDE, were positively correlated to consumption frequency of total fish, walleye and pike, but not trout. Reported diabetes was positively associated to p,p’-DDE and some PCB congeners. Odds Ratios (OR) for reported diabetes for those in the upper 75th percentile for serum p,p’-DDE compared to the others were 3.5 (95% CI 1–13.8) and 6.1 (95% CI 1.4–27.3) (weight wet and lipid-standardized values, respectively) and for total sum of PCBs: 4.91 (95% CI 1.4–19.0) and 5.51 (95% CI 1.3–24.1). For participants who were in the upper 50th percentile for trout and white fish intake, reported diabetes was respectively 6 and 4 times lower compared to the others. These findings support the hypothesis that environmental exposure to elevated p,p’-DDE and PCBs is associated with increased risk of diabetes. Consumption of trout and white fish may be beneficial to reduce risk.

IJERPH, Vol. 6, Pages 3169-3178: Seasonal and Spatial Variations of Indoor Pollen in a Hospital

Rafael Tormo-Molina — Thu, 10 Dec 2009 00:00:00 CET

The airborne indoor pollen in a hospital of Badajoz (Spain) was monitored over two years using a personal Burkard sampler. The air was sampled in four places indoors—one closed room and one open ward on each of the ground and the third floors—and one place outdoors at the entrance to the hospital. The results were compared with data from a continuous volumetric sampler. While 32 pollen types were identified, nearly 75% of the total counts were represented by just five of them. These were: Quercus, Cupressaceae, Poaceae, Olea, and Plantago. The average indoor concentration was 25.2 grains/m3, and the average indoor/outdoor ratio was 0.27. A strong seasonal pattern was found, with the highest levels in spring and winter, and the indoor concentrations were correlated with the outdoor one. Indoor air movement led to great homogeneity in the airborne pollen presence: the indoor results were not influenced by whether or not the room was isolated, the floor level, or the number of people in or transiting the site during sampling. The presence of ornamental vegetation in the area surrounding the building affected the indoor counts directly as sources of the pollen.

IJERPH, Vol. 6, Pages 3156-3168: Alcoholism and Intimate Partner Violence: Effects on Children’s Psychosocial Adjustment

Keith Klostermann — Thu, 10 Dec 2009 00:00:00 CET

It is widely recognized that alcoholism and relationship violence often have serious consequences for adults; however, children living with alcoholic parents are susceptible to the deleterious familial environments these caregivers frequently create. Given the prevalence of IPV among patients entering substance abuse treatment, coupled with the negative familial consequences associated with these types of behavior, this review explores what have been, to this point, two divergent lines of research: (a) the effects of parental alcoholism on children, and (b) the effects of children’s exposure to intimate partner violence. In this article, the interrelationship between alcoholism and IPV is examined, with an emphasis on the developmental impact of these behaviors (individually and together) on children living in the home and offers recommendations for future research directions.

IJERPH, Vol. 6, Pages 3143-3155: Effect of Medicaid Coverage of Tobacco-Dependence Treatments on Smoking Cessation

Feng Liu — Wed, 09 Dec 2009 00:00:00 CET

Smoking cessation aids (nicotine replacement products and anti-depressant medication) have been proven to double quitting rates compared to placebo in several randomized controlled trials. But the high initial cost of cessation aids might create a financial barrier to cessation for low-income smokers. In the U.S., Medicaid provides health insurance coverage to low-income people, and in some states covers smoking cessation products. This paper uses nationally representative data of the U.S. to examine how the Medicaid coverage of cessation aids affect smoking behavior. The results indicate the Medicaid coverage of cessation products is positively associated with successful quitting among women aged 18–44.

IJERPH, Vol. 6, Pages 3127-3142: Toxicological Assessment of Toxic Element Residues in Swine Kidney and Its Role in Public Health Risk Assessment

Dragan R. Milićević — Tue, 08 Dec 2009 00:00:00 CET

In order to ensure the safety of consumers in Serbia the prevalence of toxic elements (As, Cd, Hg, Pb) in swine kidney collected from three different areas in Serbia (n = 90) was determined by atomic absorption spectrometry. Also, in order to find information on the effects of accumulation of toxic elements on swine kidney, pathohistological examination of the kidneys was performed. The presence of mercury was found in 33.3% of kidney samples in the range of 0.005–0.055 mg/kg, while the presence of cadmium was detected less often (27.7%) but in larger amounts (0.05–1.23 mg/kg). The presence of arsenic was found only in one sample, while no lead was found. The results of the metal-to-metal correlation analysis supported there were the result of different sources of contamination. Pathohistological examination of kidneys confirms tubulopathies with oedema and cell vacuolization. In addition, haemorrhages and necrosis of proximal kidney tubule cells were found. This study demonstrates that toxic elements in Serbian slaughtered pigs are found at levels comparable to those reported in other countries, and consequently the levels reported in this study do not represent a concern from a consumer safety point of view. The lack of a strong correlation between histopathological changes and the incidence of toxic elements found in this study might be explained as the result of synergism among toxic elements and other nephrotoxic compounds which enhance the toxicity of the individual toxins even at the relatively low mean concentrations observed in this study.

IJERPH, Vol. 6, Pages 3115-3126: Examining the Dynamic Association of BMI and Mortality in the Framingham Heart Study

Jianghua He — Mon, 07 Dec 2009 00:00:00 CET

Based on the 40-year follow-up of the Framingham Heart Study (FHS), we used logistic regression models to demonstrate that different designs of an observational study may lead to different results about the association between BMI and all-cause mortality. We also used dynamic survival models to capture the time-varying relationships between BMI and mortality in FHS. The results consistently show that the association between BMI and mortality is dynamic, especially for men. Our analysis suggests that the dynamic property may explain part of the heterogeneity observed in the literature about the association of BMI and mortality.

IJERPH, Vol. 6, Pages 3105-3114: Very Low Dose Fetal Exposure to Chernobyl Contamination Resulted in Increases in Infant Leukemia in Europe and Raises Questions about Current Radiation Risk Models

Christopher C. Busby — Mon, 07 Dec 2009 00:00:00 CET

Following contamination from the Chernobyl accident in April 1986 excess infant leukemia (0–1 y) was reported from five different countries, Scotland, Greece, Germany, Belarus and Wales and Scotland combined. The cumulative absorbed doses to the fetus, as conventionally assessed, varied from 0.02 mSv in the UK through 0.06 mSv in Germany, 0.2 mSv in Greece and 2 mSv in Belarus, where it was highest. Nevertheless, the effect was real and given the specificity of the cohort raised questions about the safety of applying the current radiation risk model of the International Commission on Radiological Protection (ICRP) to these internal exposures, a matter which was discussed in 2000 by Busby and Cato [7,8] and also in the reports of the UK Committee examining Radiation Risk from Internal Emitters. Data on infant leukemia in the United Kingdom, chosen on the basis of the cohorts defined by the study of Greece were supplied by the UK Childhood Cancer Research Group. This has enabled a study of leukemia in the combined infant population of 15,466,845 born in the UK, Greece, and Germany between 1980 and 1990. Results show a statistically significant excess risk RR = 1.43 (95% CI 1.13 < RR < 1.80 (2-tailed); p = 0.0025) in those born during the defined peak exposure period of 01/07/86 to 31/12/87 compared with those born between 01/01/80 and 31/12/85 and 01/01/88 and 31/12/90. The excess risks in individual countries do not increase monotonically with the conventionally calculated doses, the relation being biphasic, increasing sharply at low doses and falling at high doses. This result is discussed in relation to fetal/cell death at higher doses and also to induction of DNA repair. Since the cohort is chosen specifically on the basis of exposure to internal radionuclides, the result can be expressed as evidence for a significant error in the conventional modeling for such internal fetal exposures.

IJERPH, Vol. 6, Pages 3097-3104: Deadly Partners: Interdependence of Alcohol and Trauma in the Clinical Setting

Amanda V. Hayman — Fri, 04 Dec 2009 00:00:00 CET

Trauma is the leading cause of death for Americans aged 1 to 45. Over a third of all fatal motor vehicle collisions and nearly eighty percent of completed suicides involve alcohol. Alcohol can be both a cause of traumatic injury as well as a confounding factor in the diagnosis and treatment of the injured patient. Fortunately, brief interventions after alcohol-related traumatic events have been shown to decrease both trauma recidivism and long-term alcohol use. This review will address the epidemiology of alcohol-related trauma, the influence of alcohol on mortality and other outcomes, and the role of prevention in alcohol-related trauma, within the confines of the clinical setting.

IJERPH, Vol. 6, Pages 3082-3096: Associations between Area-Level Unemployment, Body Mass Index, and Risk Factors for Cardiovascular Disease in an Urban Area

Ashley Isaac Naimi — Fri, 04 Dec 2009 00:00:00 CET

Introduction: Cardiovascular Disease (CVD) has been linked to "neighbourhood" socioeconomic status (nSES), often operationalized as a composite index of aggregate income, occupation and education within predefined administrative boundaries. The role of specific, non-composite socioeconomic markers has not been clearly explained. It is also unclear whether the relationship between nSES and CVD varies according to sex. We sought to determine whether area-level unemployment (ALU) was associated with CVD risk, and whether this association differed by sex. Methods: 342 individuals from the Montreal Neighbourhood Survey of Lifestyle and Health provided self-reported behavioural and socioeconomic information. A nurse collected biochemical and anthropometric data. ALU, a weighted average of the proportion of persons 15-years and older available for but without work, was measured using a Geographic Information System for a 250 m buffer centred on individual residence. Generalized Estimating Equations were used to estimate the associations between ALU, body mass index (BMI) and a cumulative score for total cardiometabolic risk (TCR). Results: After confounder adjustments, the mean 4th minus 1st quartile difference in BMI was 3.19 kg/m2 (95% CI: 2.39, 3.99), while the prevalence ratio for the 4th relative to 1st quartile for TCR was 2.20 (95 % CI: 1.53, 3.17). Sex interacted with ALU; women relative to men had greater mean 3.97 kg/m2 (95% CI: 2.08, 5.85) BMI and greater mean TCR 1.51 (95% CI: 0.78, 2.90), contrasted at mean ALU. Conclusions: Area-level unemployment is associated with greater CVD risk, and this association is stronger for women.

IJERPH, Vol. 6, Pages 3070-3081: Sudden Unexpected Death in Alcohol Misuse—An Unrecognized Public Health Issue?

Alexa H. Templeton — Fri, 04 Dec 2009 00:00:00 CET

Sudden arrhythmic cardiac death can occur in chronic misusers of alcohol. The only findings at post mortem are fatty liver and a negative or low blood alcohol. This is an under-recognized entity. Coroner‘s post mortems in a typical UK city were studied. Seven out of 1,292 (0.5%) post mortems were deemed to have died of alcohol associated arrhythmic death. Applying this study to the UK as a whole, alcohol related arrhythmic death or as we have termed it SUDAM (Sudden Unexpected Death in Alcohol Misuse) probably accounts for around 1,000 deaths, many of which are misattributed to other causes

IJERPH, Vol. 6, Pages 3056-3069: Assessment of Japanese Stimulant Control Law Offenders Using the Addiction Severity Index—Japanese Version: Comparison with Patients in Treatment Settings

Takashi Watanabe — Thu, 03 Dec 2009 00:00:00 CET

The present study assessed problems in Japanese prisoners (inmates) who abused methamphetamine. Fifty-two male inmates were assessed in 2005–2007 using the Addiction Severity Index-Japanese version and compared with 55 male methamphetamine abusers in hospitals and recovery centers. The χ2 and Mann-Whitney-Wilcoxon tests showed that the inmates had a significantly lower education level, more frequently had full-time jobs, had more experience living with a sexual partner, and more frequently had a history of juvenile delinquency and criminal records than patients. Although psychiatric symptoms, such as depression, anxiety, and hallucinations, were not common among inmates, suicidal behavior and trouble controlling violence were common in both groups.

IJERPH, Vol. 6, Pages 3040-3055: Mapping Environmental Dimensions of Dengue Fever Transmission Risk in the Aburrá Valley, Colombia

Sair Arboleda — Wed, 02 Dec 2009 00:00:00 CET

Dengue fever (DF) is endemic in Medellín, the second largest Colombian city, and surrounding municipalities. We used DF case and satellite environmental data to investigate conditions associated with suitable areas for DF occurrence in 2008 in three municipalities (Bello, Medellín and Itagüí). We develop spatially stratified tests of ecological niche models, and found generally good predictive ability, with all model tests yielding results significantly better than random expectations. We concluded that Bello and Medellín present ecological conditions somewhat different from, and more suitable for DF than, those of Itagüí. We suggest that areas predicted by our models as suitable for DF could be considered as at-risk, and could be used to guide campaigns for DF prevention in these municipalities.

IJERPH, Vol. 6, Pages 3025-3039: Natural Environment Suitability of China and Its Relationship with Population Distributions

Xiaohuan Yang — Tue, 01 Dec 2009 00:00:00 CET

The natural environment factor is one of the main indexes for evaluating human habitats, sustained economic growth and ecological health status. Based on Geographic Information System (GIS) technology and an analytic hierarchy process method, this article presents the construction of the Natural Environment Suitability Index (NESI) model of China by using natural environment data including climate, hydrology, surface configuration and ecological conditions. The NESI value is calculated in grids of 1 km by 1 km through ArcGIS. The spatial regularity of NESI is analyzed according to its spatial distribution and proportional structure. The relationship of NESI with population distribution and economic growth is also discussed by analyzing NESI results with population distribution data and GDP data in 1 km by 1 km grids. The study shows that: (1) the value of NESI is higher in the East and lower in the West in China; The best natural environment area is the Yangtze River Delta region and the worst are the northwest of Tibet and southwest of Xinjiang. (2) There is a close correlation among natural environment, population distribution and economic growth; the best natural environment area, the Yangtze River Delta region, is also the region with higher population density and richer economy. The worst natural environment areas, Northwest and Tibetan Plateau, are also regions with lower population density and poorer economies.

IJERPH, Vol. 6, Pages 3023-3024: Occupational Noise Exposure and Age Correction: The Problem of Selection Bias

Robert A. Dobie — Tue, 01 Dec 2009 00:00:00 CET

Selection bias often invalidates conclusions about populations based on clinical convenience samples. A recent paper in this journal [1] makes two surprising assertions about noise-induced permanent threshold shift (NIPTS): first, that there is more NIPTS at 2 kHz than at higher frequencies; second, that NIPTS declines with advancing age. Neither assertion can be supported with the data presented, which were obtained from a clinical sample; both are consistent with the hypothesis that people who choose to attend an audiology clinic have worse hearing, especially at 2 kHz, than people of the same age and gender who choose not to attend.

IJERPH, Vol. 6, Pages 3010-3022: Gender Differences in Interpersonal Problems of Alcohol-Dependent Patients and Healthy Controls

Sandra E. Mueller — Tue, 01 Dec 2009 00:00:00 CET

Alcohol dependence is a heavy burden on patients, their families, and society. Epidemiological studies indicate that alcohol dependence will affect many individuals at some time in their lives, with men affected more frequently than women. Since alcohol-dependent patients often exhibit a lack of social skills and suffer from interpersonal problems, the aim of this study is to elucidate whether men and women experience the same interpersonal problems. Eighty-five alcohol-dependent patients (48 men; 37 women) after detoxification and 62 healthy controls (35 men; 27 women) were recruited. Interpersonal problems were measured with the Inventory of Interpersonal Problems (IIP-64). Additionally, alcohol-dependent patients were interviewed with the Alcohol Use Disorders Identification Test (AUDIT) and were subtyped according to Lesch’s Alcohol Typology (LAT). There were no significant gender differences in the AUDIT and LAT between alcohol-dependent men and women. Interpersonal problems of alcohol-dependent men differed significantly in one out of eight dimensions from controls; alcohol-dependent men perceive themselves as colder than male controls. Alcohol-dependent women differed in four out of eight interpersonal dimensions from female controls. Alcohol-dependent women rated themselves as significantly more vindictive, more introverted, more overly accommodating and more intrusive than female controls. Results suggest that alcohol-dependent men and women suffer from different interpersonal problems and furthermore alcohol-dependent women perceive more interpersonal problems, whereas the severity of alcohol dependence did not differ between the groups. Our findings indicate that alcohol-dependent women may profit more from a gender-specific treatment approach aimed at improving treatment outcome than alcohol-dependent men.

IJERPH, Vol. 6, Pages 2992-3009: Dental Caries Risk Studies Revisited: Causal Approaches Needed for Future Inquiries

Jolanta Aleksejūnienė — Mon, 30 Nov 2009 00:00:00 CET

Prediction of high-risk individuals and the multi-risk approach are common inquiries in caries risk epidemiology. These studies prepared the ground for future studies; specific hypotheses about causal patterns can now be formulated and tested applying advanced statistical methods designed for causal studies, such as structural equation modeling, path analysis and multilevel modeling. Causal studies should employ measurements, analyses and interpretation of findings, which are in accordance to causal aims. Examples of causal empirical studies from medical and oral research are presented.

IJERPH, Vol. 6, Pages 2980-2991: “This Is Public Health: Recycling Counts!” Description of a Pilot Health Communications Campaign

Nancy L. Chase — Mon, 30 Nov 2009 00:00:00 CET

This paper describes the development, implementation, and evaluation of a pilot recycling campaign. The goal of the campaign was to increase people’s awareness and knowledge about recycling and the link between a healthy environment and the public’s health. A total of 258 individuals attended campaign week events and completed an initial survey. Results identified inconvenience of recycling facility locations as a key barrier to recycling. Post-campaign survey results revealed increased recycling of paper, plastic, glass, and cans (p < 0.05). The majority of participants “agreed” or “strongly agreed” that as a result of campaign messages they had greater awareness about recycling (88.4%) and their recycling efforts increased (61.6%).

IJERPH, Vol. 6, Pages 2967-2979: Musculoskeletal Disorders Among Cosmetologists

Alexandra Tsigonia — Fri, 27 Nov 2009 00:00:00 CET

A cross-sectional study was performed to investigate the relationships between physical, psychosocial, and individual characteristics and different endpoints of low back, neck, shoulder, hand/wrist and knee musculoskeletal complaints among cosmetologists in Athens, Greece. The study population consisted of 95 female and seven male beauty therapists (response rate 90%) with a mean age and duration of employment of 38 and 16 years, respectively. Neck pain was the most prevalent musculoskeletal complaint, reported by 58% of the subjects, while hand/wrist and low back complaints resulted more frequently in self-reported consequences (chronicity, care seeking and absenteeism). Significant relationships were found between self-reported physical risk factors like prolonged sitting, use of vibrating tools, reaching far and awkward body postures and the occurrence of musculoskeletal disorders at various body sites. Among psychosocial variables co-worker support and skill discretion seem to be the most important reflecting organizational problems and cognitive-behavioral aspects. The study results also suggest that effective intervention strategies most likely have to take into account both ergonomic improvements and organizational aspects.

IJERPH, Vol. 6, Pages 2950-2966: Health Economic Assessment: A Methodological Primer

Steven Simoens — Fri, 27 Nov 2009 00:00:00 CET

This review article aims to provide an introduction to the methodology of health economic assessment of a health technology. Attention is paid to defining the fundamental concepts and terms that are relevant to health economic assessments. The article describes the methodology underlying a cost study (identification, measurement and valuation of resource use, calculation of costs), an economic evaluation (type of economic evaluation, the cost-effectiveness plane, trial- and model-based economic evaluation, discounting, sensitivity analysis, incremental analysis), and a budget impact analysis. Key references are provided for those readers who wish a more advanced understanding of health economic assessments.

IJERPH, Vol. 6, Pages 2934-2949: Chronic Stress and the Development of Early Atherosclerosis: Moderating Effect of Endothelial Dysfunction and Impaired Arterial Elasticity

Nadja Chumaeva — Fri, 27 Nov 2009 00:00:00 CET

This study aims to explore the interactive effect of vital exhaustion (VE) and endothelial dysfunction on preclinical atherosclerosis, assessed by carotid intima-media thickness (IMT). Furthermore, interaction between VE and carotid elasticity is examined. Participants were 1,596 young healthy adults from the Cardiovascular Risk in Young Finns study. Endothelial dysfunction was measured by brachial flow-mediated dilatation (FMD), and carotid elasticity by carotid artery compliance (CAC). Significant interactions between FMD and VE, and between CAC and VE, for IMT were found in participants with the very lowest FMD and CAC. Thus, VE may be harmful if the endothelium is not working properly.

IJERPH, Vol. 6, Pages 2919-2933: The Role of Endocarditis, Myocarditis and Pericarditis in Qualitative and Quantitative Data Analysis

Norman Schöffel — Thu, 26 Nov 2009 00:00:00 CET

The current study is the first scientometric analysis of research activity and output in the field of inflammatory disorders of the heart (endo-, myo- and pericarditis). Scientometric methods are used to compare scientific performance on national and on international scale to identify single areas of research interest. Interest and research productivity in inflammatory diseases of the heart have increased since 1990. The majority of publications about inflammatory heart disorders were published in Western Europe and North America. The United States of America had a leading position in terms of research productivity and quality; half of the most productive authors in this study came from American institutions. The analysis of international cooperation revealed research activity in countries that are less established in the field of inflammatory heart disorder research, such as Brazil, Saudi Arabia and Tunisia. These results indicate that future research of heart inflammation may no longer be influenced predominantly by a small number of countries. Furthermore, this study revealed weaknesses in currently established scientometric parameters (i.e., h-index, impact factor) that limit their suitability as measures of research quality. In this respect, self-citations should be generally excluded from calculations of h-index and impact factor.

IJERPH, Vol. 6, Pages 2898-2918: Examining Factors in the Research Institute on Addictions Self-Inventory (RIASI): Associations with Alcohol Use and Problems at Assessment and Follow-Up

Robert E. Mann — Tue, 24 Nov 2009 00:00:00 CET

Impaired driving is a leading cause of alcohol-related deaths and injuries. Rehabilitation or remedial programs, involving assessment and screening of convicted impaired drivers to determine problem severity and appropriate programs, are an important component of society’s response to this problem. Ontario’s remedial program, Back on Track (BOT), involves an assessment process that includes administration of the Research Institute on Addictions Self-Inventory (RIASI) to determine assignment to an education or treatment program. The purpose of this study is to identify factors within the RIASI and examine how factor scores are associated with alcohol use and problem indicators at assessment and six-month follow-up. The sample included 22,298 individuals who completed BOT from 2000 to 2005. Principal component factor analysis with varimax rotation was conducted on RIASI data and an eight factor solution was retained: (1) Negative Affect, (2) Sensation Seeking, (3) Alcohol-Quantity, (4) Social Conformity, (5) High Risk Lifestyle, (6) Alcohol Problems, (7) Interpersonal Competence, and (8) Family History. Regression analyses were conducted to examine associations between factors and alcohol and problem measures obtained at assessment and at follow-up. Most factors, except for Interpersonal Competence, were associated with more alcohol use and problems at assessment. A similar pattern was observed at 6-month follow-up, but interestingly some factors (Negative Affect, Sensation Seeking, Alcohol-Quantity and Family History) predicted fewer days of alcohol use. The Interpersonal Competence factor was associated with significantly lower levels of alcohol use and problems at both assessment and follow-up. This work suggests that the RIASI provides information on several domains that have important relationships with alcohol problem severity and outcomes.

IJERPH, Vol. 6, Pages 2883-2897: Two Distinct Training Methods for a Doctrine of Life with Healthy Heart in a Low Socioeconomic Society Model

Selma Metintas — Thu, 19 Nov 2009 00:00:00 CET

This study was conducted in three stages in a semi-rural region of Eskisehir, Turkey. In the first stage, individuals selected by random sampling were evaluated for cardiovascular disease risk factors. In the second stage, Group I and Group II training materials were randomly distributed. In the third stage, the subjects were screened one year later to assess and determine if there had been any changes in their attitudes towards the dangers of cardiovascular diseases. The number of active smokers significantly decreased after the training in the both groups. The percentage of people with regulated blood pressure exhibited an increase in Group II more than Group I.

IJERPH, Vol. 6, Pages 2880-2882: Indoor Air Pollution: An Old Problem with New Challenges

John Spengler — Thu, 19 Nov 2009 00:00:00 CET

Hazards in our indoor environments have been recognized since biblical times. The advice in Leviticus 14:33–48 for treating mold infested houses has contemporary meaning in the recent World Health Organization (WHO) document on damp and moldy indoor spaces [1]. In the developed world, faulty combustion, carbon monoxide from coal gas, lead paint, poor ventilation of tenement housing and hospitals have been recognized for decades as unhealthy. Indoor air quality, however, was not appreciated as an important component of public health until the proliferation of sealed buildings, energy conservation programs (urea formaldehyde foam insulation), new products, and the recognition of the health effects of radon, asbestos and latex. [...]

IJERPH, Vol. 6, Pages 2865-2879: Leachability of Arsenic and Heavy Metals from Mine Tailings of Abandoned Metal Mines

Mihee Lim — Tue, 17 Nov 2009 00:00:00 CET

Mine tailings from an abandoned metal mine in Korea contained high concentrations of arsenic (As) and heavy metals [e.g., As: 67,336, Fe: 137,180, Cu: 764, Pb: 3,572, and Zn: 12,420 (mg/kg)]. US EPA method 6010 was an effective method for analyzing total arsenic and heavy metals concentrations. Arsenic in the mine tailings showed a high residual fraction of 89% by a sequential extraction. In Toxicity Characteristic Leaching Procedure (TCLP) and Korean Standard Leaching Test (KSLT), leaching concentrations of arsenic and heavy metals were very low [e.g., As (mg/L): 0.4 for TCLP and 0.2 for KSLT; cf. As criteria (mg/L): 5.0 for TCLP and 1.5 for KSLT].

IJERPH, Vol. 6, Pages 2849-2864: Variation of Natural Streamflow since 1470 in the Middle Yellow River, China

Chi-Yuan Miao — Tue, 17 Nov 2009 00:00:00 CET

Nowadays, as the available water resources throughout the World are becoming depleted, in order to manage and plan water resource better, more and more attention is being paid into the fluctuating characteristics of water discharges. However, the preexisting research was mainly focused on the last half century. In this paper, the natural streamflow observed since 1470 at the Sanmenxia station in the middle Yellow River basin was collected, and the methods of variation coefficient, moving average, Mann-Kendall test and wavelet transform were applied to analyze the dynamic characteristics of the streamflow. The results showed that, (1) between 1470 and 2007, the natural streamflow changed 200–919 ×108 m3, and water discharge varied moderately; (2) in the middle Yellow River basin, it appears that the most severe and most persistent droughts during circa 1868–1990, the periods of 1470s–1490s, 1920s–1930s and 1990s–2000s also presented the condition of sustained low flows; (3) the natural streamflow series shows increasing and decreasing trends during the periods of 1470–1880 and 1881–2007, respectively, but both trends are not significant at >95% confidence; in addition, it is still found the streamflow series shows abrupt changes circa 1845, 1935 and 1960, respectively; (4) within a 250-year scale, there are circa 11, 26, 67 and 120-year periods for natural streamflow at the Sanmenxia station, and the periodicity of the 120-year one is the strongest. The dynamic characteristics of natural streamflow is the comprehensive result by many influencing factors, such as precipitation, temperature, El Niño-Southern Oscillation, sunspots, human activity etc.

IJERPH, Vol. 6, Pages 2843-2848: Public Health and Nursing: A Natural Partnership

Christine Savage — Mon, 16 Nov 2009 00:00:00 CET

The health of individuals occurs within the context of their environment and the other individuals they interact with in the communities they live in, work in and visit. Promoting the health of the public requires multiple strategies aimed at improving the environment, the health knowledge of groups and individuals, maintaining adequate food and water, and reducing the spread of disease. Many disciplines are needed to meet these goals, but the largest segment of the professional health work force required to meet these needs is nursing. Historically, nursing leaders in public health such as Florence Nightingale and Lillian Wald made significant inroads related to serious health issues because they were nurses. Today across the globe, nurses provide the key components of public health interventions including well baby care, health education, screening and immunization clinics, disaster management and emergency preparedness. With the growing nursing shortage in acute care settings, the brain drain of nurses from certain areas of the world, the shrinking public dollars for preventive health care, the nursing workforce needed to continue to provide these essential health care services is threatened. It is essential to put the spot light on nursing’s role in public health with the hopes of attracting more public funds and more nurses to provide these essential services.

IJERPH, Vol. 6, Pages 2833-2842: Application of the WHO Keys of Safer Food to Improve Food Handling Practices of Food Vendors in a Poor Resource Community in Ghana

Eric S. Donkor — Fri, 13 Nov 2009 00:00:00 CET

Data was collected from food vendors in a poor resource community in Ghana, which showed that the vendors constituted an important source of oro-faecal transmission. Following this, the WHO five keys of safer food were utilized in an evidence based training programme for the vendors to improve their food handling practices. Impact assessment of the food safety training showed that 67.6% of the vendors had acquired some knowledge from the workshop and were putting it into practice. Lack of food safety equipment was a major hinderance to behavioral change among the vendors as far food handling practices are concerned.

IJERPH, Vol. 6, Pages 2822-2832: Impact of Co-Occurring Psychiatric Disorders on Retention in a Methadone Maintenance Program: An 18-Month Follow-Up Study

Mònica Astals — Thu, 12 Nov 2009 00:00:00 CET

We assess the influence of co-occurring psychiatric disorders on retention in 189 opioid dependent patients in a methadone maintenance treatment (MMT) and determine the incidence of psychiatric co-morbidity during an 18-month follow-up period. About 68.5 % were retained in the MMT. Neither co-occurring mental disorders (chi-square = 0.303, df = 1, p = 0.622) nor methadone doses [85 (88.9) vs. 79.2 (85) mg/day, p = 0.672] were related to retention. In the follow-up period 19 new diagnoses were made, mainly major depression and antisocial and borderline personality disorders. Co-occurring psychiatric disorders should be assessed during MMT follow-up.

IJERPH, Vol. 6, Pages 2812-2821: Incidence and Risk Factors of Workplace Violence on Nursing Staffs Caring for Chronic Psychiatric Patients in Taiwan

Wen-Ching Chen — Thu, 12 Nov 2009 00:00:00 CET

This one-year follow-up study determined the incidence and risk factors of workplace violence against nursing staff in a psychiatric hospital. The cohort members had a website to report events whenever they came across violence. A total of 971 events were reported. The incidence rates of physical violence, verbal abuse, bullying/mobbing, sexual harassment, and racial harassment were 1.7, 3.7, 0.2, 0.3, and 0 per staff-year, respectively. Young age, female sex, lower education, shorter duration of employment, and high level of anxiety of staff seemed to be the determinants of violence. Pre-placement education should focus on these staff to reduce workplace violence.