http://www.mdpi.com/journal/ijerph Latest open access articles published in Int. J. Environ. Res. Public Health at http://www.mdpi.com/journal/ijerph http://www.mdpi.com/1660-4601/10/5/2084 Selecting indicators based on the characteristics and development trends of a given study area is essential for building a framework for assessing urban ecological security. However, few studies have focused on how to select the representative indicators systematically, and quantitative research is lacking. We developed an innovative quantitative modeling approach called the grey dynamic hierarchy analytic system (GDHAS) for both the procedures of indicator selection and quantitative assessment of urban ecological security. Next, a systematic methodology based on the GDHAS is developed to assess urban ecological security comprehensively and dynamically. This assessment includes indicator selection, driving force-pressure-state-impact-response (DPSIR) framework building, and quantitative evaluation. We applied this systematic methodology to assess the urban ecological security of Tianjin, which is a typical coastal super megalopolis and the industry base in China. This case study highlights the key features of our approach. First, 39 representative indicators are selected for the evaluation index system from 62 alternative ones available through the GDHAS. Second, the DPSIR framework is established based on the indicators selected, and the quantitative assessment of the eco-security of Tianjin is conducted. The results illustrate the following: urban ecological security of Tianjin in 2008 was in alert level but not very stable; the driving force and pressure subsystems were in good condition, but the eco-security levels of the remainder of the subsystems were relatively low; the pressure subsystem was the key to urban ecological security; and 10 indicators are defined as the key indicators for five subsystems. These results can be used as the basis for urban eco-environmental management. International Journal of Environmental Research and Public Health 2013-05-21 10 5 Article 10.3390/ijerph10052084 2084 2108 1660-4601 2013-05-21 doi: 10.3390/ijerph10052084 Chaofeng Shao Xiaogang Tian Yang Guan Meiting Ju Qiang Xie http://www.mdpi.com/1660-4601/10/5/2069 This environmental telephone interview scan was designed to identify: (1) how hospitals in one Canadian province incorporated tobacco use identification/documentation systems into practice; and, (2) challenges/issues with tobacco identification/documentation. Participants included 36/139 hospitals previously identified to offer cessation services. Results showed hospitals aided by researchers monitored and tracked tobacco use; those not aligned with researchers did not. The wording of tobacco items most commonly included use within the last 6-months (42%), 30-days (39%), or 7-days (33%), or use without reference to time (e.g., “Do you smoke?”; 39%); wording sometimes depended on admitting form space limitations. The admission process determined where the tobacco item appeared, which differed by hospital—75% included it on an admitting form (75%) and/or nursing assessment (56%); the item sometimes varied by unit. There were also different processes by which the item triggered delivery of cessation interventions; most frequently (69%), staff nurses were triggered to provide an intervention. The findings suggest that adding a tobacco use question to a hospital’s admitting process is potentially not that simple. Deciding on the purpose of the question, when it will be asked and by whom, space allotted on the form, and how it will trigger an intervention are important considerations that can affect the question wording, form/location, systems required, data extraction, and resources. International Journal of Environmental Research and Public Health 2013-05-21 10 5 Article 10.3390/ijerph10052069 2069 2083 1660-4601 2013-05-21 doi: 10.3390/ijerph10052069 Patricia Smith Nancy Cobb Linda Corso http://www.mdpi.com/1660-4601/10/5/2058 The objectives of this study were to determine the prevalence of Campylobacter jejuni and Campylobacter coli in retail beef, beef livers, and pork meats purchased from the Tulsa (OK, USA) area and to further characterize the isolates obtained through antimicrobial susceptibility testing. A total of 97 chilled retail beef (50 beef livers and 47 other cuts), and 100 pork samples were collected. The prevalence of Campylobacter in beef livers was 39/50 (78%), while no Campylobacter was isolated from the other beef cuts. The prevalence in pork samples was 2/100 (2%). A total of 108 Campylobacter isolates (102 beef livers isolates and six pork isolates) were subjected to antimicrobial resistance profiling against sixteen different antimicrobials that belong to eight different antibiotic classes. Of the six pork Campylobacter coli isolates, four showed resistance to all antimicrobials tested. Among the beef liver isolates, the highest antibiotic resistances were to tetracyclines and β-lactams, while the lowest resistances were to macrolides, aminoglycosides, lincosamides, and phenicols. Resistances to the fluoroquinolone, macrolide, aminoglycoside, tetracycline, b-lactam, lincosamide, and phenicol antibiotic classes were significantly higher in Campylobacter coli than Campylobacter jejuni isolates. Multidrug Resistance (MDR) among the 102 Campylobacter (33 Campylobacter jejuni and 69 Campylobacter coli) beef liver isolates was significantly higher in Campylobacter coli (62%) than Campylobacter jejuni (39%). The high prevalence of Campylobacter in retail beef livers and their antimicrobial resistance raise concern about the safety of these retail products. International Journal of Environmental Research and Public Health 2013-05-21 10 5 Article 10.3390/ijerph10052058 2058 2068 1660-4601 2013-05-21 doi: 10.3390/ijerph10052058 Aneesa Noormohamed Mohamed Fakhr http://www.mdpi.com/1660-4601/10/5/2043 The aim of this study was to assess the effectiveness of Screening and Brief Intervention (SBI) for alcohol problems among university students in South Africa. The study design for this efficacy study is a randomized controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by hazardous and harmful drinkers in a university setting. The unit of randomization is the individual university student identified as a hazardous or harmful drinker attending public recruitment venues in a university campus. University students were screened for alcohol problems, and those identified as hazardous or harmful drinkers were randomized into an experimental or control group. The experimental group received one brief counseling session on alcohol risk reduction, while the control group received a health education leaflet. Results indicate that of the 722 screened for alcohol and who agreed to participate in the trial 152 (21.1%) tested positive for the Alcohol Use Disorder Identification Test (AUDIT) (score 8 or more). Among the 147 (96.7%) university students who also attended the 12-month follow-up session, the intervention effect on the AUDIT score was −1.5, which was statistically significant (P = 0.009). Further, the depression scores marginally significantly decreased over time across treatment groups, while other substance use (tobacco and cannabis use), self-rated health status and Posttraumatic Stress Disorder (PTSD) scores did not change over time across treatment groups. The study provides evidence of effective brief intervention by assistant nurses with hazardous and harmful drinkers in a university setting in South Africa. The short duration of the brief intervention makes it a realistic candidate for use in a university setting. International Journal of Environmental Research and Public Health 2013-05-21 10 5 Article 10.3390/ijerph10052043 2043 2057 1660-4601 2013-05-21 doi: 10.3390/ijerph10052043 Supa Pengpid Karl Peltzer Hendry van der Heever Linda Skaal http://www.mdpi.com/1660-4601/10/5/2028 Recent studies have suggested the importance of the neighborhood environment in determining the specific type of physical activity. However, few studies on this topic have been undertaken in Japan. This study examined the association of three types of physical activity and their associations with individual and neighborhood environmental factors among middle-aged and elderly Japanese. Participants were 2,449 adults aged 40–69 living in Fujisawa city who had undergone health checkups and responded to our survey by mail. Individual factors, the International Physical Activity Questionnaire (long form), and its environmental module acted as inputs to the study. The adjusted odds ratios (ORs) of high levels of moderate-to-vigorous intensity leisure-time physical activity (LTPA), walking for active recreation, and transportation were calculated in relation to individual and neighborhood environmental factors through multiple logistic regression models. Not working and good self-rated health were significantly associated with a higher level of each physical activity outcome. According to the adjusted ORs, higher educational attainment, higher economic status, good access to exercise facilities, and owning motor vehicles were associated with longer LTPA time. However, different sets of factors were associated with longer walking times for recreation and transportation. The results suggest that diverse individual and neighborhood environmental characteristics are associated with different physical activity outcomes. Therefore, customizing environments to become activity-friendly is necessary to increase physical activity effectively among middle-aged and elderly Japanese. International Journal of Environmental Research and Public Health 2013-05-17 10 5 Article 10.3390/ijerph10052028 2028 2042 1660-4601 2013-05-17 doi: 10.3390/ijerph10052028 Yoshinobu Saito Yuko Oguma Shigeru Inoue Ayumi Tanaka Yoshitaka Kobori http://www.mdpi.com/1660-4601/10/5/2017 Unmet health care needs are determined as the difference between the services judged necessary and the services actually received, and stem from barriers related to accessibility, availability and acceptability. This study aims to examine the prevalence of unmet needs and to identify the socioeconomic and health status factors that are associated with unmet needs. A cross-sectional study was conducted in Greece in 2010 and involved data from 1,000 consenting subjects (>18 years old). Multiple binary logistic regression analysis was applied to investigate the predictors of unmet needs and to determine the relation between the socio-demographic characteristics and the accessibility, availability and acceptability barriers. Ninety nine participants (9.9%) reported unmet health needs during the 12 months prior to the research. The most frequently self-reported reasons were cost and lack of time. Youth, parenthood, physician consultations, and poor mental health increased the likelihood of unmet needs. Women were less likely to report accessibility and availability than acceptability barriers. Educational differences were evident and individuals with primary and secondary education were associated with significantly more accessibility and availability barriers compared with those with tertiary education. Unmet health needs pose a significant challenge to the health care system, especially given the difficult current financial situation in Greece. It is believed that unmet health needs will continue to increase, which will widen inequalities in health and health care access. International Journal of Environmental Research and Public Health 2013-05-17 10 5 Article 10.3390/ijerph10052017 2017 2027 1660-4601 2013-05-17 doi: 10.3390/ijerph10052017 Evelina Pappa Nick Kontodimopoulos Angelos Papadopoulos Yannis Tountas Dimitris Niakas http://www.mdpi.com/1660-4601/10/5/1977 Water-related parasitic diseases are directly dependent on water bodies for their spread or as a habitat for indispensable intermediate or final hosts. Along with socioeconomic development and improvement of sanitation, overall prevalence is declining in the China. However, the heterogeneity in economic development and the inequity of access to public services result in considerable burden due to parasitic diseases in certain areas and populations across the country. In this review, we demonstrated three aspects of ten major water-related parasitic diseases, i.e., the biology and pathogenicity, epidemiology and recent advances in research in China. General measures for diseases control and special control strategies are summarized. International Journal of Environmental Research and Public Health 2013-05-17 10 5 Review 10.3390/ijerph10051977 1977 2016 1660-4601 2013-05-17 doi: 10.3390/ijerph10051977 Shan Lv Li-Guang Tian Qin Liu Men-Bao Qian Qing Fu Peter Steinmann Jia-Xu Chen Guo-Jing Yang Kun Yang Xiao-Nong Zhou http://www.mdpi.com/1660-4601/10/5/1963 Background: Health-related Habits (HrH) are a major priority in healthcare. However there is little agreement on whether exercise, diet, smoking or dental hygiene are better described as lifestyles, habits or behaviors, and on what is their hierarchical relationship. This research is aimed at representing the basic concepts which are assumed to constitute the conceptual framework enabling us to interpret and organize the field of HrH. Methods: A group of 29 experts with different backgrounds agreed on the definition and hierarchy of HrH following an iterative process which involved framing analysis and nominal group techniques. Results: Formal definitions of health-related behavior, habit, life-style and life-style profile were produced. In addition a series of basic descriptors were identified: health reserve, capital, risk and load. Six main categories of HrH were chosen based on relevance to longevity: diet/exercise, vitality/stress, sleep, cognition, substance use and other risk. Attributes of HrH are clinical meaningfulness, quantifiability, temporal stability, associated morbidity, and unitarity (non-redundancy). Two qualifiers (polarity and stages of change) have also been described. Conclusions: The concepts represented here lay the groundwork for the development of clinical and policy tools related to HrH and lifestyle. An adaptation of this system to define targets of health interventions and to develop the classification of person factors in ICF may be needed in the future. International Journal of Environmental Research and Public Health 2013-05-13 10 5 Article 10.3390/ijerph10051963 1963 1976 1660-4601 2013-05-13 doi: 10.3390/ijerph10051963 Luis Salvador-Carulla Federico Alonso Rafael Gomez Carolyn Walsh José Almenara Mencía Ruiz María Abellán eVITAL group http://www.mdpi.com/1660-4601/10/5/1948 Developed countries are experiencing high levels of mental and physical illness associated with long term health conditions, unhealthy lifestyles and an ageing population. Given the limited capacity of the formal health care sector to address these public health issues, attention is turning to the role of agencies active in civil society. This paper sought to evaluate the associations between participation in community centre activities, the psycho-social wellbeing and health related behaviours. This was based on an evaluation of the South West Well-being programme involving ten organisations delivering leisure, exercise, cooking, befriending, arts and crafts activities. The evaluation consisted of a before-and-after study with 687 adults. The results showed positive changes in self-reported general health, mental health, personal and social well-being. Positive changes were associated with diet and physical activity. Some activities were different in their outcomes—especially in cases where group activities were combined with one-to-one support. The results suggest that community centre activities of this nature offer benefits that are generically supportive of health behaviour changes. Such initiatives can perform an important role in supporting the health improvement objectives of formal health care services. For commissioners and partner agencies, accessibility and participation are attractive features that are particularly pertinent to the current public health context. International Journal of Environmental Research and Public Health 2013-05-10 10 5 Article 10.3390/ijerph10051948 1948 1962 1660-4601 2013-05-10 doi: 10.3390/ijerph10051948 Mat Jones Richard Kimberlee Toity Deave Simon Evans http://www.mdpi.com/1660-4601/10/5/1927 Swine Dysentery (SD) is a severe mucohaemorhagic enteric disease of pigs caused by Brachyspira hyodysenteriae, which has a large impact on pig production and causes important losses due to mortality and sub-optimal performance. Although B. hyodysenteriae has been traditionally considered a pathogen mainly transmitted by direct contact, through the introduction of subclinically infected animals into a previously uninfected herd, recent findings position B. hyodysenteriae as a potential threat for indirect transmission between farms. This article summarizes the knowledge available on the etiological agent of SD and its virulence traits, and reviews the determinants of SD transmission. The between-herds and within-herd transmission routes are addressed. The factors affecting disease transmission are thoroughly discussed, i.e., environmental survival of the pathogen, husbandry factors (production system, production stage, farm management), role of vectors, diet influence and interaction of the microorganism with gut microbiota. Finally, prophylactic and therapeutic approaches to fight against the disease are briefly described. International Journal of Environmental Research and Public Health 2013-05-10 10 5 Review 10.3390/ijerph10051927 1927 1947 1660-4601 2013-05-10 doi: 10.3390/ijerph10051927 Avelino Alvarez-Ordóez Francisco Martínez-Lobo Héctor Arguello Ana Carvajal Pedro Rubio http://www.mdpi.com/1660-4601/10/5/1916 Long-term exposure to elevated indoor radon concentrations has been determined to be the second leading cause of lung cancer in adults after tobacco smoking. With the establishment of a National Radon Program in Canada in 2007 thousands of homes across the country have been tested for radon. Although the vast majority of people are exposed to low or moderate radon concentrations; from time to time; there are homes found with very high concentrations of radon. Among those living in homes with very high radon concentrations, it is typically parents of young children that demonstrate a great deal of concern. They want to know the equivalent risk in terms of the lifetime relative risk of developing lung cancer when a child has lived in a home with high radon for a few years. An answer to this question of risk equivalency is proposed in this paper. The results demonstrate clearly that the higher the radon concentration; the sooner remedial measures should be undertaken; as recommended by Health Canada in the Canadian radon guideline. International Journal of Environmental Research and Public Health 2013-05-08 10 5 Technical Note 10.3390/ijerph10051916 1916 1926 1660-4601 2013-05-08 doi: 10.3390/ijerph10051916 Jing Chen http://www.mdpi.com/1660-4601/10/5/1895 The primary purpose of this study was to explore the link between rail and road traffic noise and overall life satisfaction. While the negative relationship between residential satisfaction and traffic noise is relatively well-established, much less is known about the effect of traffic noise on overall life satisfaction. Based on results of previous studies, we propose a model that links objective noise levels, noise sensitivity, noise annoyance, residential satisfaction and life satisfaction. Since it is not clear whether a bottom-up or top-down relationship between residential satisfaction and life satisfaction holds, we specify models that incorporate both of these theoretical propositions. Empirical models are tested using structural equation modeling and data from a survey among residents of areas with high levels of road traffic noise (n1 = 354) and rail traffic noise (n2 = 228). We find that traffic noise has a negative effect on residential satisfaction, but no significant direct or indirect effects on overall life satisfaction. Noise annoyance due to road and rail traffic noise has strong negative effect on residential satisfaction rather than on overall life satisfaction. These results are very similar for the road and railway traffic contexts and regardless of whether the model assumes the top-down or bottom-up direction of the causation between life satisfaction and residential satisfaction. International Journal of Environmental Research and Public Health 2013-05-07 10 5 Article 10.3390/ijerph10051895 1895 1915 1660-4601 2013-05-07 doi: 10.3390/ijerph10051895 Jan Urban Vojtěch Máca http://www.mdpi.com/1660-4601/10/5/1882 During past decades, the number of dentists has continuously increased in Iran. Beside the quantity, the distribution of dentists affects the oral health status of population. The current study aimed to assess the pure and social disparities in distribution of dentists across the provinces in Iran in 2009. Data on provinces’ characteristics, including population and social situation, were obtained from multiple sources. The disparity measures (including Gini coefficient, index of dissimilarity, Gaswirth index of disparity and relative index of inequality (RII)) and pairwise correlations were used to evaluate the pure and social disparities in the number of dentists in Iran. On average, there were 28 dentists per 100,000 population in the country. There were substantial pure disparities in the distribution of dentists across the provinces in Iran. The unadjusted and adjusted RII values were 3.82 and 2.13, respectively; indicating area social disparity in favor of people in better-off provinces. There were strong positive correlations between density of dentists and better social rank. It is suggested that the results of this study should be considered in conducting plans for redistribution of dentists in the country. In addition, further analyses are needed to explain these disparities. International Journal of Environmental Research and Public Health 2013-05-06 10 5 Article 10.3390/ijerph10051882 1882 1894 1660-4601 2013-05-06 doi: 10.3390/ijerph10051882 Aliasghar Kiadaliri Reza Hosseinpour Hassan Haghparast-Bidgoli Ulf-G Gerdtham http://www.mdpi.com/1660-4601/10/5/1861 Groundwater chemistry of small tropical islands is influenced by many factors, such as recharge, weathering and seawater intrusion, among others, which interact with each other in a very complex way. In this work, multivariate statistical analysis was used to evaluate the factors controlling the groundwater chemistry of Kapas Island (Malaysia). Principal component analysis (PCA) was applied to 17 hydrochemical parameters from 108 groundwater samples obtained from 18 sampling sites. PCA extracted four PCs, namely seawater intrusion, redox reaction, anthropogenic pollution and weather factors, which collectively were responsible for more than 87% of the total variance of the island’s hydrochemistry. The cluster analysis indicated that three factors (weather, redox reaction and seawater intrusion) controlled the hydrochemistry of the area, and the variables were allocated to three groups based on similarity. A Piper diagram classified the island’s water types into Ca-HCO3 water type, Na-HCO3 water type, Na-SO4-Cl water type and Na-Cl water type, indicating recharge, mixed, weathering and leached from sewage and seawater intrusion, respectively. This work will provide policy makers and land managers with knowledge of the precise water quality problems affecting the island and can also serve as a guide for hydrochemistry assessments of other islands that share similar characteristics with the island in question. International Journal of Environmental Research and Public Health 2013-05-06 10 5 Article 10.3390/ijerph10051861 1861 1881 1660-4601 2013-05-06 doi: 10.3390/ijerph10051861 Nura Kura Mohammad Ramli Wan Sulaiman Shaharin Ibrahim Ahmad Aris Adamu Mustapha http://www.mdpi.com/1660-4601/10/5/1845 Leptospirosis is a serious public health concern in the Philippines, not only because of its increasing incidence rate, but also because of its significant health and economic impacts. Despite its relatively high seroprevalence, knowledge on the economic burden of disease, particularly on the value that the society places on disease prevention remains limited. Obtaining such information is important within the context of public health policy. This study was conducted in Metro Manila to determine the economic burden of leptospirosis, by asking respondents about their willingness to contribute to labor (WTCL) for the prevention of leptospirosis. The respondents pledged an average labor contribution of 10.66 h/month. The average WTCL corresponded to a monetary value of US$4.01 per month when valued using the opportunity cost of labor (leisure rate of time). From the monetized labor contribution, the total economic value of preventing leptospirosis was estimated at US$124.97 million per annum, which represents 1.13% of Metro Manila’s gross domestic product (GDP). Estimates from a Tobit regression model identified the respondents’ knowledge regarding leptospirosis, the susceptibility of their homes to flooding, and the proximity of their homes to sewers as significant factors to consider when developing resource contribution programs for leptospirosis prevention. More efforts need to be made in developing community level preventive programs, and in improving public’s knowledge and awareness about leptospirosis. International Journal of Environmental Research and Public Health 2013-05-03 10 5 Article 10.3390/ijerph10051845 1845 1860 1660-4601 2013-05-03 doi: 10.3390/ijerph10051845 Joseph Arbiol Maridel Borja Mitsuyasu Yabe Hisako Nomura Nina Gloriani Shin-ichi Yoshida http://www.mdpi.com/1660-4601/10/5/1831 Japanese encephalitis (JE) is one of the most important mosquito-borne viral diseases in Asia. Pigs are a natural host and the amplifier of JE virus. The sero-conversion rate to JE virus in sentinel pigs reflects the activity of JE virus in the region. We analyzed whether precipitation has any effect on the sero-conversion rate to JE virus in sentinel pigs. Linear regression analysis was performed to determine the correlations between the levels of precipitation and sero-conversion rates to JE virus, in the entire year and during summertime over the period of 32 years from 1969 to 2000. The levels of the annual and summertime precipitation demonstrated statistically significant positive correlations with sero-conversion rates for the whole of the country and for some regions in Japan. The levels of the summertime precipitation, on the other hand, demonstrated statistically significant inverse correlations with the sero-conversion rates in other regions. Further, the levels of precipitation during preceding 10-day periods from days 1–40 before blood collection showed inverse correlation with antibody-positive rates in some regions. The results indicate that the relationship between the annual and summertime precipitation, and the sero-conversion rate to JE virus is complex; both positive and inverse effects are demonstrated depending on the regions. International Journal of Environmental Research and Public Health 2013-05-03 10 5 Article 10.3390/ijerph10051831 1831 1844 1660-4601 2013-05-03 doi: 10.3390/ijerph10051831 Ichiro Kurane Ken-ichi Shibasaki Akira Kotaki Yasuaki Hijioka Tomohiko Takasaki http://www.mdpi.com/1660-4601/10/5/1815 Research shows that one in four migrant farmworkers experienced an episode of one or more mental health disorders such as stress, depression, or anxiety in their lifetime. The purpose of this mixed methods study was to explore experiences and perceptions related to stress and depression among Latino migrant and seasonal farmworkers (MSFWs), and to identify their coping behaviors for dealing with these mental health conditions. Using a mixed methods research approach, three focus group interviews of a sample of Latino MSFWs (N = 29) were conducted and a quantitative survey was implemented (N = 57) at community sites in eastern North Carolina. Four major themes emerged from the focus group data: (1) physical stress related to working conditions; (2) mental stress related to family situations, work environment, documentation status, and lack of resources; (3) depression related to separation from family and the lack of resources; and (4) use of positive and negative mechanisms for coping with stress and depression. A discussion of these themes, results from the survey findings, implications for intervention and outreach programs, along with recommendations for further research, are provided. International Journal of Environmental Research and Public Health 2013-05-03 10 5 Article 10.3390/ijerph10051815 1815 1830 1660-4601 2013-05-03 doi: 10.3390/ijerph10051815 Sloane Winkelman Elizabeth Chaney Jeffrey Bethel http://www.mdpi.com/1660-4601/10/5/1786 The “Hispanic Paradox” suggests that despite rates of poverty similar to African Americans, Hispanics have far better health and mortality outcomes, more comparable to non-Hispanic White Americans. Three prominent possible explanations for the Hispanic Paradox have emerged. The “Healthy Migrant Effect” suggests a health selection effect due to the demands of migration. The Hispanic lifestyle hypothesis focuses on Hispanics’ strong social ties and better health behaviors. The reverse migration argument suggests that the morbidity profile in the USA is affected when many Hispanic immigrants return to their native countries after developing a serious illness. We analyzed data from respondents aged 55 and over from the nationally representative 2006 American Community Survey including Mexican Americans (13,167 U.S. born; 11,378 immigrants), Cuban Americans (314 U.S. born; 3,730 immigrants), and non-Hispanic White Americans (629,341 U.S. born; 31,164 immigrants). The healthy migrant effect was supported with SES-adjusted disability comparable between Mexican, Cuban and non-Hispanic Whites born in the USA and all immigrants having lower adjusted odds of functional limitations than U.S. born non-Hispanic Whites. The reverse migration hypothesis was partially supported, with citizenship and longer duration in the USA associated with higher rates of SES-adjusted disability for Mexican Americans. The Hispanic healthy life-style explanation had little support in this study. Our findings underline the importance of considering nativity when planning for health interventions to address the needs of the growing Hispanic American older adult population. International Journal of Environmental Research and Public Health 2013-05-03 10 5 Article 10.3390/ijerph10051786 1786 1814 1660-4601 2013-05-03 doi: 10.3390/ijerph10051786 Esme Thomson Amani Nuru-Jeter Dawn Richardson Ferrah Raza Meredith Minkler http://www.mdpi.com/1660-4601/10/5/1775 Fluoride is an environmental and industrial pollutant that affects various organs in humans and animals. The cecal tonsil is an important component of the mucosal immune system and performs important and unique immune functions. In the present study, we investigated the effects of dietary high fluorine on the quantities of IgA+ B cells in the cecal tonsil by immunohistochemistry, and the immunoglobulin A (IgA), immunoglobulin G (IgG) and immunoglobulin M (IgM) contents in the cecal tonsil by ELISA. A total of 280 one-day-old avian broilers were divided into four groups and fed on a corn-soybean basal diet as control diet (fluorine 22.6 mg/kg) or the same diet supplemented with 400, 800 and 1,200 mg/kg fluorine (high fluorine groups I, II and III) in the form of sodium fluoride, respectively, throughout a 42-day experimental period. The results showed that the quantities of IgA+ B cells were lower (p < 0.05 or p < 0.01) and the IgA, IgG, and IgM contents were decreased (p < 0.05 or p < 0.01) in high fluorine groups II and III in comparison with those of control group. It was concluded that dietary fluorine, in the 800–1,200 mg/kg range, could reduce the numbers of the IgA+ B cells and immunoglobulin contents in the cecal tonsil, implying the local mucosal immune function was ultimately impacted in broilers. International Journal of Environmental Research and Public Health 2013-05-02 10 5 Article 10.3390/ijerph10051775 1775 1785 1660-4601 2013-05-02 doi: 10.3390/ijerph10051775 Juan Liu Hengmin Cui Xi Peng Jing Fang Zhicai Zuo Junliang Deng Hesong Wang Bangyuan Wu Yuanxin Deng Kangping Wang http://www.mdpi.com/1660-4601/10/5/1763 We investigated the relationship between being bullied and measured body weight and perceived body weight among adolescents of a middle-income sub Saharan African country. Our data originated from the Global School-based Health Survey, which targets adolescents aged 13–15 years. Student weights and heights were measured before administrating the questionnaire which included questions about personal data, health behaviors and being bullied. Standard criteria were used to assess thinness, overweight and obesity. Among 1,006 participants who had complete data, 16.5% (95%CI 13.3–20.2) reported being bullied ≥3 days during the past 30 days; 13.4% were thin, 16.8% were overweight and 7.6% were obese. Categories of actual weight and of perceived weight correlated only moderately (Spearman correlation coefficient 0.37 for boys and 0.57 for girls; p < 0.001). In univariate analysis, both actual obesity (OR 1.76; p = 0.051) and perception of high weight (OR 1.63 for “slightly overweight”; OR 2.74 for “very overweight”, both p < 0.05) were associated with being bullied. In multivariate analysis, ORs for categories of perceived overweight were virtually unchanged while ORs for actual overweight and obesity were substantially attenuated, suggesting a substantial role of perceived weight in the association with being bullied. Actual underweight and perceived thinness also tended to be associated with being bullied, although not significantly. Our findings suggest that more research attention be given to disentangling the significant association between body image, overweight and bullying among adolescents. Further studies in diverse populations are warranted. International Journal of Environmental Research and Public Health 2013-05-02 10 5 Article 10.3390/ijerph10051763 1763 1774 1660-4601 2013-05-02 doi: 10.3390/ijerph10051763 Michael Wilson Bharathi Viswanathan Valentin Rousson Pascal Bovet http://www.mdpi.com/1660-4601/10/5/1747 The consequences of starting smoking by age 18 are significant. Early smoking initiation is associated with higher tobacco dependence, increased difficulty in smoking cessation and more negative health outcomes. The purpose of this study is to examine how closely smoking initiation in a well-defined population of American Indians (AI) resembles a group of Non-Hispanic white (NHW) populations born over an 80 year period. We obtained data on age of smoking initiation among 7,073 AIs who were members of 13 tribes in Arizona, Oklahoma and North and South Dakota from the 1988 Strong Heart Study (SHS) and the 2001 Strong Heart Family Study (SHFS) and 19,747 NHW participants in the 2003 National Health Interview Survey. The participants were born as early as 1904 and as late as 1985. We classified participants according to birth cohort by decade, sex, and for AIs, according to location. We estimated the cumulative incidence of smoking initiation by age 18 in each sex and birth cohort group in both AIs and NHWs and used Cox regression to estimate hazard ratios for the association of birth cohort, sex and region with the age at smoking initiation. We found that the cumulative incidence of smoking initiation by age 18 was higher in males than females in all SHS regions and in NHWs (p < 0.001). Our results show regional variation of age of initiation significant in the SHS (p < 0.001). Our data showed that not all AIs (in this sample) showed similar trends toward increased earlier smoking. For instance, Oklahoma SHS male participants born in the 1980s initiated smoking before age 18 less often than those born before 1920 by a ratio of 0.7. The results showed significant variation in age of initiation across sex, birth cohort, and location. Our preliminary analyses suggest that AI smoking trends are not uniform across region or gender but are likely shaped by local context. If tobacco prevention and control programs depend in part on addressing the origin of AI smoking it may be helpful to increase the awareness in regional differences. International Journal of Environmental Research and Public Health 2013-05-02 10 5 Article 10.3390/ijerph10051747 1747 1762 1660-4601 2013-05-02 doi: 10.3390/ijerph10051747 Raymond Orr Darren Calhoun Carolyn Noonan Ron Whitener Jeff Henderson Jack Goldberg Patrica Henderson http://www.mdpi.com/1660-4601/10/5/1735 Drawing upon a sample of 296 new immigrant women in Hong Kong, this study investigated how social service utilization, family functioning, and sense of community influenced the depressive symptoms of new immigrant women. Results of the structural equation modeling suggested that family functioning and sense of community were both significantly and negatively associated with the depression of new immigrant women. Utilization of community services also influenced the depression of immigrant women indirectly through the mediating effect of sense of community. Implications of the research findings for mental health intervention were discussed. International Journal of Environmental Research and Public Health 2013-04-29 10 5 Article 10.3390/ijerph10051735 1735 1746 1660-4601 2013-04-29 doi: 10.3390/ijerph10051735 Qiaobing Wu Julian Chow http://www.mdpi.com/1660-4601/10/5/1720 Fish consumption has established benefits, including the promotion of cardiovascular health and pre- and neonatal brain and eye development, but local freshwater fish may be a source of contaminants that are especially harmful to fetuses and young children, such as the neurotoxic and developmentally toxic methylmercury and polychlorinated biphenyls. Fish consumption advisories may be issued by state health departments to limit human exposure to these and other toxicants. This study examined the efficacy of a sign designed by the North Carolina Division of Public Health that was posted along a reservoir (Badin Lake) in central North Carolina, USA, for increasing anglers’ awareness of a fish consumption advisory, with a special focus on anglers who share their catch with women and children. In this study, 109 anglers were interviewed about their awareness of fish consumption advisories in general and their knowledge of the Badin Lake fish advisory in particular. Shore anglers were significantly less likely to be aware of the term “fish consumption advisory” and of the specific advisory for Badin Lake than boat anglers. Although a significant increase in knowledge of the specific fish consumption advisory was found for the entire sample of study participants after the sign intervention, a commensurate increase in knowledge was not found for a subsample of anglers who reported sharing their catch with women and children. Study findings underscore differences in fish consumption advisory awareness among subpopulations. Specifically, the study revealed the importance of characterizing the communication needs of shore anglers and anglers who share their catch with sensitive subpopulations (e.g., women and children) for the creation of more targeted communications of fish consumption advisories. International Journal of Environmental Research and Public Health 2013-04-29 10 5 Article 10.3390/ijerph10051720 1720 1734 1660-4601 2013-04-29 doi: 10.3390/ijerph10051720 Catherine LePrevost Kathleen Gray Mercedes Hernández-Pelletier Brennan Bouma Consuelo Arellano W. Cope http://www.mdpi.com/1660-4601/10/5/1698 The mosquito Aedes (Stegomyia) albopictus (Skuse) (Diptera: Culicidae) is an invasive species which has colonized Southern Europe in the last two decades. As it is a competent vector for several arboviruses, its spread is of increasing public health concern, and there is a need for appropriate monitoring tools. In this paper, we have developed a modelling approach to predict mosquito abundance over time, and identify the main determinants of mosquito population dynamics. The model is temperature- and rainfall-driven, takes into account egg diapause during unfavourable periods, and was used to model the population dynamics of Ae. albopictus in the French Riviera since 2008. Entomological collections of egg stage from six locations in Nice conurbation were used for model validation. We performed a sensitivity analysis to identify the key parameters of the mosquito population dynamics. Results showed that the model correctly predicted entomological field data (Pearson r correlation coefficient values range from 0.73 to 0.93). The model’s main control points were related to adult’s mortality rates, the carrying capacity in pupae of the environment, and the beginning of the unfavourable period. The proposed model can be efficiently used as a tool to predict Ae. albopictus population dynamics, and to assess the efficiency of different control strategies. International Journal of Environmental Research and Public Health 2013-04-26 10 5 Article 10.3390/ijerph10051698 1698 1719 1660-4601 2013-04-26 doi: 10.3390/ijerph10051698 Annelise Tran Grégory L'Ambert Guillaume Lacour Romain Benoît Marie Demarchi Myriam Cros Priscilla Cailly Mélaine Aubry-Kientz Thomas Balenghien Pauline Ezanno http://www.mdpi.com/1660-4601/10/5/1681 Preserving the soundscape and geographic extension of quiet areas is a great challenge against the wide-spreading of environmental noise. The E.U. Environmental Noise Directive underlines the need to preserve quiet areas as a new aim for the management of noise in European countries. At the same time, due to their low population density, rural areas characterized by suitable wind are considered appropriate locations for installing wind farms. However, despite the fact that wind farms are represented as environmentally friendly projects, these plants are often viewed as visual and audible intruders, that spoil the landscape and generate noise. Even though the correlations are still unclear, it is obvious that visual impacts of wind farms could increase due to their size and coherence with respect to the rural/quiet environment. In this paper, by using the Immersive Virtual Reality technique, some visual and acoustical aspects of the impact of a wind farm on a sample of subjects were assessed and analyzed. The subjects were immersed in a virtual scenario that represented a situation of a typical rural outdoor scenario that they experienced at different distances from the wind turbines. The influence of the number and the colour of wind turbines on global, visual and auditory judgment were investigated. The main results showed that, regarding the number of wind turbines, the visual component has a weak effect on individual reactions, while the colour influences both visual and auditory individual reactions, although in a different way. International Journal of Environmental Research and Public Health 2013-04-26 10 5 Article 10.3390/ijerph10051681 1681 1697 1660-4601 2013-04-26 doi: 10.3390/ijerph10051681 Luigi Maffei Tina Iachini Massimiliano Masullo Francesco Aletta Francesco Sorrentino Vincenzo Senese Francesco Ruotolo http://www.mdpi.com/1660-4601/10/5/1665 The Nasorosso project of the Italian Youth Department and the National Institute of Health, aimed to raise awareness about drinking and driving under the influence of alcohol among club goers with a series of initiatives. Within the framework of the project, blood alcohol concentration (BAC) was measured on 106,406 individuals before and after clubbing in 66 different recreational sites from 11 Italian provinces, over 16 months. Participating individuals were interviewed regarding sociodemographic and environmental characteristics and alcohol intoxicated people were offered to be taken home. The BAC median at the club entry was 0.26 g/L with 65.3% subjects showing a BAC value under the driving legal limit of 0.5g/L. At the exit from clubs, BAC median value rose to 0.44 g/L and subjects with BAC value under the legal limit decreased to 54.9%. Being male, aged between 18 and 34 years with a diploma, being a drinker and entering the disco with a BAC already beyond the legal limit predicted a BAC value beyond 0.5 g/L at exit from the recreational place. Conversely, being a driver, being a student and exiting from the disco before 4 a.m. reduced the probability of having a BAC higher than 0.5 g/L at the end of the night.  Health policies to prevent harmful use of alcohol in young people should continue to offer targeted information/ prevention; in order to steadily increase the awareness of the dangers and the damages of excessive use of alcohol. International Journal of Environmental Research and Public Health 2013-04-24 10 5 Article 10.3390/ijerph10051665 1665 1680 1660-4601 2013-04-24 doi: 10.3390/ijerph10051665 Roberta Pacifici Andrea Pierantozzi Rita Giovannandrea Ilaria Palmi Luisa Mastrobattista Claudia Mortali Simona Pichini http://www.mdpi.com/1660-4601/10/5/1647 Young children being injured at home is a perennial problem. When parents of young children and family workers discussed what influenced parents’ perceptions and responses to child injury risk at home, both “upstream” and “downstream” causal factors were identified. Among the former, complex and interactive facets of society and contemporary living emerged as potentially critical features. The “wicked problems” model arose from the need to find resolutions for complex problems in multidimensional environments and it proved a useful analogy for child injury. Designing dynamic strategies to provide resolutions to childhood injury, may address our over-dependence on ‘tame solutions’ that only deal with physical cause-and-effect relationships and which cannot address the complex interactive contexts in which young children are often injured. International Journal of Environmental Research and Public Health 2013-04-24 10 5 Article 10.3390/ijerph10051647 1647 1664 1660-4601 2013-04-24 doi: 10.3390/ijerph10051647 Jean Simpson Geoff Fougere Rob McGee http://www.mdpi.com/1660-4601/10/4/1631 This work assesses the environmental impact from chemical emissions due to military tests and routine activities in the area occupied by the Italian Inter-force Test Range (PISQ), located at Salto di Quirra, Sardinia, Italy. After reviewing the military activities carried out at PISQ, such as rocket launching, blasting and armament destruction, projectile and mortar fire impact, the associated pollution is evaluated. Chemical analyses were performed by means of Scanning Electronic Microscopy and Energy Dispersion Spectrometry on biotic and abiotic matrices. Residues of Rb, Tl, W, Ti and Al were found in matrices collected in the PISQ areas and environs. A review of experimental data on air, water, soil, milk, forage and animal tissues obtained by various Public Agencies of Sardinia proved that toxic element residues often exceeded the legal limits. PM10 and PM2.5 air concentrations also exceeded the legal limits after military blasting. Cd and Pb contents in the liver and kidneys of sheep living in farms at PISQ and in control farms that were located more than 20 km away from PISQ were higher than the legal limits. This work was performed to investigate concentration of xenobiotics in ecosystems emitted from PISQ activities. This assessment could be useful to focus future epidemiological studies carried out in PISQ and its neighbouring areas. International Journal of Environmental Research and Public Health 2013-04-19 10 4 Article 10.3390/ijerph10041631 1631 1646 1660-4601 2013-04-19 doi: 10.3390/ijerph10041631 Mauro Cristaldi Cristiano Foschi Germana Szpunar Carlo Brini Fiorenzo Marinelli Lucio Triolo http://www.mdpi.com/1660-4601/10/4/1609 Chemical industry parks in China are considered high-risk areas because they present numerous risks that can damage the environment, such as pollution incidents. In order to identify the environmental risks and the principal risk factors in these areas, we have developed a simple physical model of a regional environmental risk field (ERF) using existing dispersal patterns and migration models. The regional ERF zoning was also conducted and a reference value for diagnostic methods was developed to determine risk-acceptable, risk-warning, and risk-mitigation zones, which can provide a risk source layout for chemical industry parks. In accordance with the environmental risk control requirements, this study focused on the three stages of control and management of environmental risk and established an environmental risk management system including risk source identification and assessment, environmental safety planning, early risk warning, emergency management, assessment of environmental effects, and environmental remediation of pollution accidents. By using this model, the environmental risks in Tianjin Binhai New Area, the largest chemical industry park in China, were assessed and the environmental risk zoning map was drawn, which suggested the existence of many unacceptable environmental risks in this area. Thus, relevant suggestions have been proposed from the perspective of the adjustment of risk source layout, intensified management of environmental risk control and so on. International Journal of Environmental Research and Public Health 2013-04-19 10 4 Article 10.3390/ijerph10041609 1609 1630 1660-4601 2013-04-19 doi: 10.3390/ijerph10041609 Chaofeng Shao Juan Yang Xiaogang Tian Meiting Ju Lei Huang http://www.mdpi.com/1660-4601/10/4/1598 A sensitive and specific monoclonal antibody-based sandwich enzyme-linked immunosorbent assay (ELISA) was established and validated for the detection of staphylococcal enterotoxin A (SEA). After routine fusion and selection, 10 monoclonal antibodies showed high affinity for SEA. An optimal pair for sandwich ELISA was selected by pairwise interaction analysis. After optimization, the limit of detection (LOD) and linear dynamic range of the method were established, and were found to be 0.0282 ng/mL and 0.06–2 ng/mL, respectively. The recovery in pure milk ranged from 82.67% to 111.95% and the intra- and inter-assay coefficients of variation ranged from 3.16% to 6.05% and from 5.16% to 10.79%, respectively. Cross-reactivity with staphylococcal enterotoxin B (SEB), staphylococcal enterotoxin C (SEC), staphylococcal enterotoxin D (SED), and staphylococcal enterotoxin E (SEE) in this method were insignificant. These results indicate that the sandwich ELISA method developed in our study is effective for routine identification of SEA in food samples. International Journal of Environmental Research and Public Health 2013-04-19 10 4 Article 10.3390/ijerph10041598 1598 1608 1660-4601 2013-04-19 doi: 10.3390/ijerph10041598 Hua Kuang Wenbing Wang Liguang Xu Wei Ma Liqiang Liu Libing Wang Chuanlai Xu http://www.mdpi.com/1660-4601/10/4/1586 There is growing evidence that household water treatment interventions improve microbiological water quality and reduce diarrheal disease risk. Few studies have examined, however, the impact of water treatment interventions on household-level hygiene and sanitation. This study examined the association of four water and sanitation conditions (access to latrines, improved sanitation, improved water and the plastic biosand filter) on the levels of total coliforms and E. coli on existing and introduced toys during an on-going randomized controlled trial of the plastic biosand filter (plastic BSF). The following conditions were associated with decreased bacterial contamination on children’s toys: access to a latrine, access to improved sanitation and access to the plastic BSF. Overall, compared to existing toys, introduced toys had significantly lower levels of both E. coli and total coliforms. Results suggest that levels of fecal indicator bacteria contamination on children’s toys may be associated with access to improved water and sanitation conditions in the home. In addition, the fecal indicator bacteria levels on toys probably vary with duration in the household. Additional information on how these toys become contaminated is needed to determine the usefulness of toys as indicators or sentinels of water, sanitation and hygiene conditions, behaviors and risks. International Journal of Environmental Research and Public Health 2013-04-18 10 4 Article 10.3390/ijerph10041586 1586 1597 1660-4601 2013-04-18 doi: 10.3390/ijerph10041586 Christine Stauber Adam Walters Anna de Aceituno Mark Sobsey http://www.mdpi.com/1660-4601/10/4/1572 Food safety is essential in mass catering. In Europe, Regulation (EC) No. 852/2004 requires food business operators to put in place, implement and maintain permanent procedures based on Hazard Analysis and Critical Control Point (HACCP) principles. Each HACCP plan is specifically implemented for the processing plant and processing methods and requires a systematic collection of data on the incidence, elimination, prevention, and reduction of risks. In this five-year-study, the effectiveness of the HACCP plan of a University canteen was verified through periodic internal auditing and microbiological monitoring of meals, small equipment, cooking tools, working surfaces, as well as hands and white coats of the canteen staff. The data obtained revealed no safety risks for the consumers, since Escherichia coli, Salmonella spp. and Listeria monocytogenes were never detected; however, a quite discontinuous microbiological quality of meals was revealed. The fluctuations in the microbial loads of mesophilic aerobes, coliforms, Staphylococcus aureus, Bacillus cereus, and sulphite-reducing clostridia were mainly ascribed to inadequate handling or processing procedures, thus suggesting the need for an enhancement of staff training activities and for a reorganization of tasks. Due to the wide variety of the fields covered by internal auditing, the full conformance to all the requirements was never achieved, though high scores, determined by assigning one point to each answer which matched with the requirements, were achieved in all the years. International Journal of Environmental Research and Public Health 2013-04-17 10 4 Communication 10.3390/ijerph10041572 1572 1585 1660-4601 2013-04-17 doi: 10.3390/ijerph10041572 Andrea Osimani Lucia Aquilanti Stefano Tavoletti Francesca Clementi http://www.mdpi.com/1660-4601/10/4/1562 Tobacco smoking is a major health issue for Indigenous Australians, however there are few interventions with demonstrated efficacy in this population. The Transtheoretical Model may provide a useful framework for describing smoking behaviour and assessing readiness to quit, with the aim of developing better interventions. Interviews were conducted with 593 Indigenous Australians in eight rural and remote communities in north Queensland, to examine stages of change and smoking behaviour. Among current smokers, 39.6% and 43.4% were in Precontemplation and Contemplation stages respectively. A further 13.9% were making preparations to quit (Preparation) whilst only 3.2% said they were actively trying to quit (Action). When analysed by stage of change, the pattern of smoking-related behaviours conformed to the results of past research using the model. Importantly however, distribution of individuals across the stages opposes those observed in investigations of smoking behaviour in non-Indigenous Australian populations. The Transtheoretical Model can be used to meaningfully classify Indigenous smokers in remote north Queensland according to stages along the behaviour change continuum. Importantly, in this large sample across eight communities, most Indigenous smokers were not making preparations to change their smoking behaviour. This suggests that interventions should focus on promoting movement toward the Preparation and Action stages of change. International Journal of Environmental Research and Public Health 2013-04-16 10 4 Article 10.3390/ijerph10041562 1562 1571 1660-4601 2013-04-16 doi: 10.3390/ijerph10041562 Sandra Campbell India Bohanna Anne Swinbourne Yvonne Cadet-James Dallas McKeown Robyn McDermott http://www.mdpi.com/1660-4601/10/4/1547 Fetal alcohol syndrome (FAS) is a congenital syndrome caused by maternal alcohol consumption during pregnancy and is entirely preventable by abstinence from alcohol drinking during this time. Little is known about the prevalence of FAS and maternal alcohol consumption during pregnancy in Western countries. We present the results of FAS/partial fetal alcohol syndrome (PFAS) prevalence study and maternal characteristics in a sample of schoolchildren from a rural province of Croatia. This study involved seven elementary schools with 1,110 enrolled children attending 1st to 4th grade and their mothers. We used an active case ascertainment method with passive parental consent and Clarified IOM criteria. The investigation protocol involved maternal data collection and clinical examination of children. Out of 1,110 mothers, 917 (82.6%) answered the questionnaire. Alcohol exposure during pregnancy was admitted by 11.5%, regular drinking by 4.0% and binge drinking by 1.4% of questioned mothers. Clinical examination involved 824 (74.2%) schoolchildren and disclosed 14 (1.7%) with clinical signs of FAS and 41 (5.0%) of PFAS. The observed FAS prevalence, based on 74.2% participation rate, was 16.9, PFAS 49.7 and combined prevalence was 66.7/1,000 examined schoolchildren. This is the first FAS prevalence study based on active ascertainment among schoolchildren and pregnancy alcohol drinking analysis performed in a rural community of Croatia and Europe. High prevalence of FAS/PFAS and pregnancy alcohol consumption observed in this study revealed that FAS is serious health problem in rural regions as well as a need to develop future studies and preventive measures for pregnancy alcohol drinking and FASD. International Journal of Environmental Research and Public Health 2013-04-16 10 4 Article 10.3390/ijerph10041547 1547 1561 1660-4601 2013-04-16 doi: 10.3390/ijerph10041547 Giorgie Petković Ingeborg Barišić http://www.mdpi.com/1660-4601/10/4/1527 The arsenic (As) exposure represents an important problem in many parts of the World. Indeed, it is estimated that over 100 million individuals are exposed to arsenic, mainly through a contamination of groundwaters. Chronic exposure to As is associated with adverse effects on human health such as cancers, cardiovascular diseases, neurological diseases and the rate of morbidity and mortality in populations exposed is alarming. The purpose of this review is to summarize the genotoxic effects of As in the cells as well as to discuss the importance of signaling and repair of arsenic-induced DNA damage. The current knowledge of specific polymorphisms in candidate genes that confer susceptibility to arsenic exposure is also reviewed. We also discuss the perspectives offered by the determination of biological markers of early effect on health, incorporating genetic polymorphisms, with biomarkers for exposure to better evaluate exposure-response clinical relationships as well as to develop novel preventative strategies for arsenic- health effects. International Journal of Environmental Research and Public Health 2013-04-12 10 4 Review 10.3390/ijerph10041527 1527 1546 1660-4601 2013-04-12 doi: 10.3390/ijerph10041527 Francesca Faita Liliana Cori Fabrizio Bianchi Maria Andreassi http://www.mdpi.com/1660-4601/10/4/1505 Mosquito-vectored pathogens are responsible for devastating human diseases and are (re)emerging in many urban environments. Effective mosquito control in urban landscapes relies on improved understanding of the complex interactions between the ecological and social factors that define where mosquito populations can grow. We compared the density of mosquito habitat and pupae production across economically varying neighborhoods in two temperate U.S. cities (Baltimore, MD and Washington, DC). Seven species of mosquito larvae were recorded. The invasive Aedes albopictus was the only species found in all neighborhoods. Culex pipiens, a primary vector of West Nile virus (WNV), was most abundant in Baltimore, which also had more tire habitats. Both Culex and Aedes pupae were more likely to be sampled in neighborhoods categorized as being below median income level in each city and Aedes pupae density was also greater in container habitats found in these lower income neighborhoods. We infer that lower income residents may experience greater exposure to potential disease vectors and Baltimore residents specifically, were at greater risk of exposure to the predominant WNV vector. However, we also found that resident-reported mosquito nuisance was not correlated with our measured risk index, indicating a potentially important mismatch between motivation needed to engage participation in control efforts and the relative importance of control among neighborhoods. International Journal of Environmental Research and Public Health 2013-04-12 10 4 Article 10.3390/ijerph10041505 1505 1526 1660-4601 2013-04-12 doi: 10.3390/ijerph10041505 Shannon LaDeau Paul Leisnham Dawn Biehler Danielle Bodner http://www.mdpi.com/1660-4601/10/4/1489 This study assessed subjective symptoms related to indoor concentrations of chemicals among residents in a housing estate in Dalian, China, where indoor air pollution by interior decoration materials has recently become a major health problem. Fifty-nine males and 50 females were surveyed for their symptoms related to sick building syndrome. Formaldehyde (HCHO), NO2, and volatile organic compounds (VOCs) in their dwellings were collected using a diffusion sampler and measured by GC/MS. For residents with one or more symptoms in the past, HCHO, butanol or 1,2-dichloroethane concentrations were significantly greater in their bedrooms or kitchens compared with those of subjects without previous symptoms. For residents with one or more symptoms at the time of the study, 1,1,1-trichloroethane, xylene, butanol, methyl isobutyl ketone, and styrene concentrations in their bedrooms or kitchens were significantly greater compared with those of residents without symptoms. HCHO, NO2, and VOCs were detected in all rooms, but their levels were lower than the guideline values except for HCHO in two rooms. Chemical substances from interior decoration materials at indoor air levels lower than their guideline values might have affected the health status of residents. International Journal of Environmental Research and Public Health 2013-04-11 10 4 Article 10.3390/ijerph10041489 1489 1504 1660-4601 2013-04-11 doi: 10.3390/ijerph10041489 Peng Guo Kazuhito Yokoyama Fengyuan Piao Kiyoshi Sakai Md Khalequzzaman Michihiro Kamijima Tamie Nakajima Fumihiko Kitamura http://www.mdpi.com/1660-4601/10/4/1474 Objective: To compare immigrants’ and natives’ perceptions of relational, managerial and informational continuity of care and to explore the influence of the length of stay on immigrants’ perceptions of continuity. Methods: Cross-sectional study based on a survey of a random sample of 1,500 patients, of which 22% (331) were immigrants. The study area was made up by three healthcare areas of the Catalan healthcare system. To collect data, the CCAENA questionnaire was applied. Multivariate logistic regression models were conducted. Results: Like natives, immigrants perceive high levels of managerial continuity (88.5%) and relational continuity with primary and secondary care physicians (86.7 and 81.8%), and lower levels of informational continuity (59.1%). There were no statistically significant differences in managerial and informational continuity between immigrants and natives. However, immigrants perceive a worse relational continuity with primary care physicians in terms of trust, communication and clinical responsibility. Conversely, immigrants perceive higher relational continuity with secondary care physicians in terms of effective communication and clinical responsibility. Discussion: Similar managerial and informational continuity perceptions seem to point towards a similar treatment of patients, regardless of their immigrant status. However, differences in relational continuity highlight the need for improvements in professionals’ skills in treating immigrants’ patients. International Journal of Environmental Research and Public Health 2013-04-09 10 4 Article 10.3390/ijerph10041474 1474 1488 1660-4601 2013-04-09 doi: 10.3390/ijerph10041474 Marta-Beatriz Aller Josep Colomé Sina Waibel Ingrid Vargas María Vázquez http://www.mdpi.com/1660-4601/10/4/1462 This study investigated the changes in resistance of Acinetobacter baumannii complex and the association of carbapenem-resistant A. baumannii complex (CRAB) infection and hospital antimicrobial usage from 2003 to 2011 in a tertiary care hospital in northeast China. In vitro susceptibilities were determined by disk diffusion test and susceptibility profiles were determined using zone diameter interpretive criteria, as recommended by the Clinical and Laboratory Standards Institute (CLSI). Data on consumption of various antimicrobial agents, expressed as defined daily dose/1,000 patients/day, were collected retrospectively from hospital pharmacy computer database. Most of 2,485 strains of A. baumannii complex were collected from respiratory samples (1,618 isolates, 65.1%), secretions and pus (465, 18.7%) over the years. The rates of antimicrobial resistance in A. baumannii complex increased significantly over the years. The rates of CRAB were between 11.3% and 59.1% over the years. The quarterly use of anti-pseudomonal carbapenems, but not other classes of antibiotics, was strongly correlated with the increase of quarterly CRAB (β  = 1.661; p < 0.001). Dedicated use of anti-pseudomonal carbapenems would be an important intervention to control the increase of CRAB. International Journal of Environmental Research and Public Health 2013-04-09 10 4 Article 10.3390/ijerph10041462 1462 1473 1660-4601 2013-04-09 doi: 10.3390/ijerph10041462 Jiancheng Xu Zhihui Sun Yanyan Li Qi Zhou http://www.mdpi.com/1660-4601/10/4/1439 This theoretical paper addresses the cognitive functions via which quiet and in general pleasurable sounds promote and annoying sounds impede health. The article comprises a literature analysis and an interpretation of how the bidirectional influence of appraising the environment and the feelings of the perceiver can be understood in terms of core affect and motivation. This conceptual basis allows the formulation of a detailed cognitive model describing how sonic content, related to indicators of safety and danger, either allows full freedom over mind-states or forces the activation of a vigilance function with associated arousal. The model leads to a number of detailed predictions that can be used to provide existing soundscape approaches with a solid cognitive science foundation that may lead to novel approaches to soundscape design. These will take into account that louder sounds typically contribute to distal situational awareness while subtle environmental sounds provide proximal situational awareness. The role of safety indicators, mediated by proximal situational awareness and subtle sounds, should become more important in future soundscape research. International Journal of Environmental Research and Public Health 2013-04-08 10 4 Article 10.3390/ijerph10041439 1439 1461 1660-4601 2013-04-08 doi: 10.3390/ijerph10041439 Tjeerd Andringa J. Lanser http://www.mdpi.com/1660-4601/10/4/1418 In 1992, 1998, and 2006, questionnaires were sent to stratified samples of residents aged 18–75 years living near petrochemical industries (n = 600–800 people on each occasion) and in a control area (n = 200–1,000). The aims were to estimate the long-term prevalence and change over time of annoyance caused by industrial odour, industrial noise, and worries about possible health effects, and to identify risk indicators. In 2006, 20% were annoyed by industrial odour, 27% by industrial noise (1–4% in the control area), and 40–50% were worried about health effects or industrial accidents (10–20% in the control area). Multiple logistic regression analyses revealed significantly lower prevalence of odour annoyance in 1998 and 2006 than in 1992, while industrial noise annoyance increased significantly over time. The prevalence of worry remained constant. Risk of odour annoyance increased with female sex, worry of health effects, annoyance by motor vehicle exhausts and industrial noise. Industrial noise annoyance was associated with traffic noise annoyance and worry of health effects of traffic. Health-risk worry due to industrial air pollution was associated with female sex, having children, annoyance due to dust/soot in the air, and worry of traffic air pollution. International Journal of Environmental Research and Public Health 2013-04-03 10 4 Article 10.3390/ijerph10041418 1418 1438 1660-4601 2013-04-03 doi: 10.3390/ijerph10041418 Gösta Axelsson Leo Stockfelt Eva Andersson Anita Gidlof-Gunnarsson Gerd Sallsten Lars Barregard http://www.mdpi.com/1660-4601/10/4/1406 Background: Liquid crystal display (LCD) manufacturing involves three fabrication processes: array, panel and module processes, which result in different levels of volatile organic compound (VOC) exposure. The aim of this study was to assess the potential reproductive endocrine effects of occupational exposures during LCD manufacturing predictive of menstrual cycles as subclinical markers of female reproductive dysfunction effects of low-dose exposures. Methods: A total of 94 fabrication workers were followed for one complete menstrual cycle using daily urine samples: 23 were from the array, 53 from the panel, and 18 from the module work areas. The menstrual cycle characteristics of the study population were measured using a self-administered questionnaire. Urine samples were collected during the first urination in the morning for at least one complete menstrual cycle. The urine was then analyzed to determine the urinary concentrations of follicular stimulating hormone (FSH), estrone conjugates (E1C), and pregnanediol-3-glucuronide (PdG). The results of this analysis were used to assess the potential effects of chemical exposure as determined by handheld volatile organic compound (VOC) monitors and 24 h canisters. Results: The concentration of total VOCs was much higher in the module making area (ND–21,000 ppb) than in panel (ND–766 ppb) and array (58–1,472 ppb) making areas. The concentrations of ethanol and acetone were much higher in the module (1,974.9 and 2,283.2 ppb, respectively) and panel (2256.9 and 592.2 ppb, respectively) making areas. Compared to those in the array making area, we found that E1C (12.55, 95% confidence interval (CI): 8.49, 16.61 μg/mg Cr) and PdG (0.53, 95% CI: 0.29, 0.77 μg/mg Cr) levels in the module group were significantly higher in the early follicular phase; E1C (11.93, 95% CI: 6.21, 17.65 μg/mg Cr) and PdG (0.53, 95% CI: 0.29, 0.77 μg/mg Cr) levels were significantly higher in the periovulatory phase; and all the hormone levels, FSH (1.48, 95% CI: 0.81, 2.15 μg/mg Cr), E1C (9.29, 95% CI: 4.92, 13.66 μg/mg Cr), and PdG (1.01, 95% CI: 0.42, 1.60 μg/mg Cr) were also significantly higher in the luteal phase. In addition, the FSH (0.89, 95% CI: 0.07, 1.71 μg/mg Cr) level in the panel group was significantly higher but E1C (−4.49, 95% CI: −7.90, −1.08 μg/mg Cr) was lower in the early follicular phase; and E1C (−5.16, 95% CI: −9.61, −0.71 μg/mg Cr) level was significantly lower in the periovulatory phase. Conclusions: Our findings add to the evidence that exposure to multiple low-level chemicals is associated with modest changes in reproductive hormone urinary concentrations in healthy premenopausal women. In addition, the FSH (0.89, 95% CI: 0.07, 1.71 μg/mg Cr) level in the panel group was significantly higher but E1C (−4.49, 95% CI: −7.90, −1.08 μg/mg Cr) lower in the early follicular phase; and E1C (−5.16, 95% CI: −9.61, −0.71 μg/mg Cr) level was significantly lower in the periovulatory phase. International Journal of Environmental Research and Public Health 2013-04-03 10 4 Article 10.3390/ijerph10041406 1406 1417 1660-4601 2013-04-03 doi: 10.3390/ijerph10041406 Ching-Chun Lin Chia-Ni Huang Jung-Der Wang Yaw-Huei Hwang Ruei-Hao Shie Yu-Yin Chang Shao-Ping Weng Pau-Chung Chen http://www.mdpi.com/1660-4601/10/4/1392 The Manila clam Ruditapes philippinarum is one of the most important commercial bivalve species consumed in China. Evaluated metal burden in bivalve molluscs can pose potential risks to public health as a result of their frequent consumption. In this study, concentrations of 10 trace elements (Cu, Zn, Mn, Se, Ni, Cd, Cr, Pb, Hg and As) were determined in samples of the bivalve Ruditapes philippinarum, collected from nine mariculture zones along the coast of China between November and December in 2010, in order to evaluate the status of elemental metal pollution in these areas. Also, a public health risk assessment was untaken to assess the potential risks associated with the consumption of clams. The ranges of concentrations found for Cu, Zn, Mn, Se, Ni, Cd, Cr, Pb, Hg and As in R. philippinarum were 12.1–38.0, 49.5–168.3, 42.0–68.0, 4.19–8.71, 4.76–14.32, 0.41–1.11, 0.94–4.74, 0.32–2.59, 0.03–0.23 and 0.46–11.95 mg·kg−1 dry weight, respectively. Clear spatial variations were found for Cu, Zn, Cr, Pb, Hg and As, whereas Mn, Se, Ni, and Cd did not show significant spatial variation. Hotspots of trace element contamination in R. philippinarum can be found along the coast of China, from the north to the south, especially in the Bohai and Yellow Seas. Based on a 58.1 kg individual consuming 29 g of bivalve molluscs per day, the values of the estimated daily intake (EDI) of trace elements analyzed were significantly lower than the values of the accepted daily intake (ADI) established by Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives (JFAO/WHO) and the guidelines of the reference does (RfD) established by the United States Environmental Protection Agency (USEPA). Additionally, the risk of trace elements to humans through R. philippinarum consumption was also assessed. The calculated hazard quotients (HQ) of all trace elements were less than 1. Consequently, there was no obvious public risk from the intake of these trace elements through R. philippinarum consumption. International Journal of Environmental Research and Public Health 2013-04-02 10 4 Article 10.3390/ijerph10041392 1392 1405 1660-4601 2013-04-02 doi: 10.3390/ijerph10041392 Feng Yang Liqiang Zhao Xiwu Yan Yuan Wang http://www.mdpi.com/1660-4601/10/4/1378 Background: We examined the incremental influence on survival of neighbourhood material and social deprivation while accounting for individual level socioeconomic status in a large population-based cohort of Canadians. Methods: More than 500,000 adults were followed for 22 years between 1982 and 2004. Tax records provided information on sex, income, marital status and postal code while a linkage was used to determine vital status. Cox models were used to estimate hazard ratios (HR) for quintiles of neighbourhood material and social deprivation. Results: There were 180,000 deaths over the follow-up period. In unadjusted analyses, those living in the most materially deprived neighbourhoods had elevated risks of mortality (HRmales 1.37, 95% CI: 1.33–1.41; HRfemales 1.20, 95% CI: 1.16–1.24) when compared with those living in the least deprived neighbourhoods. Mortality risk was also elevated for those living in socially deprived neighbourhoods (HRmales 1.15, CI: 1.12–1.18; HRfemales 1.15, CI: 1.12–1.19). Mortality risk associated with material deprivation remained elevated in models that adjusted for individual factors (HRmales 1.20, CI: 1.17–1.24; HRfemales 1.16, CI: 1.13–1.20) and this was also the case for social deprivation (HRmales 1.12, CI: 1.09–1.15; HRfemales 1.09, CI: 1.05–1.12). Immigrant neighbourhoods were protective of mortality risk for both sexes. Being poor and living in the most socially advantageous neighbourhoods translated into a survival gap of 10% over those in the most socially deprived neighbourhoods. The gap for material neighbourhood deprivation was 7%. Conclusions: Living in socially and materially deprived Canadian neighbourhoods was associated with elevated mortality risk while we noted a “healthy immigrant neighbourhood effect”. For those with low family incomes, living in socially and materially deprived areas negatively affected survival beyond their individual circumstances. International Journal of Environmental Research and Public Health 2013-04-02 10 4 Article 10.3390/ijerph10041378 1378 1391 1660-4601 2013-04-02 doi: 10.3390/ijerph10041378 Nancy Ross Lisa Oliver Paul Villeneuve http://www.mdpi.com/1660-4601/10/4/1356 It is clear that high-dose radiation is harmful. However, despite extensive research, assessment of potential health-risks associated with exposure to low-dose radiation (at doses below or equal to 0.1 Gy) is still challenging. Recently, we reported that 0.05 Gy of 137Cs gamma rays (the existing limit for radiation-exposure in the workplace) was incapable of inducing significant in vivo genomic instability (measured by the presence of late-occurring chromosomal damage at 6 months post-irradiation) in bone marrow (BM) cells of two mouse strains, one with constitutively high and one with intermediate levels of the repair enzyme DNA-dependent protein-kinase catalytic-subunit (DNA-PKcs). In this study, we present evidence for a lack of genomic instability in BM cells of the severely combined-immunodeficiency (SCID/J) mouse (which has an extremely low-level of DNA-PKcs activity) exposed whole-body to low-dose radiation (0.05 Gy). Together with our previous report, the data indicate that low-dose radiation (0.05 Gy) is incapable of inducing genomic instability in vivo (regardless of the levels of DNA-PKcs activity of the exposed mice), yet higher doses of radiation (0.1 and 1 Gy) do induce genomic instability in mice with intermediate and extremely low-levels of DNA-PKcs activity (indicating an important role of DNA-PKcs in DNA repair). International Journal of Environmental Research and Public Health 2013-04-02 10 4 Article 10.3390/ijerph10041356 1356 1377 1660-4601 2013-04-02 doi: 10.3390/ijerph10041356 Kanokporn Rithidech Chatchanok Udomtanakunchai Louise Honikel Elbert Whorton http://www.mdpi.com/1660-4601/10/4/1342 Estimating the benefits of preventing child maltreatment (CM) is essential for policy makers to determine whether there are significant returns on investment from interventions to prevent CM. The aim of this study was to estimate the benefits of preventing CM deaths in an Ecuadorian population, and to compare the results to a similar study in a US population. The study used the contingent valuation method to elicit respondents’ willingness to pay (WTP) for a 1 in 100,000 reduction in the risk of CM mortality. After adjusting for differences in purchasing power, the WTP to prevent the CM mortality risk reduction in the Ecuador population was $237 and the WTP for the same risk reduction in the US population was $175. In the pooled analysis, WTP for a reduction in CM mortality was significantly impacted by country (p = 0.03), history of CM (p = 0.007), payment mechanism (p < 0.001), confidence in response (p = 0.014), and appropriateness of the payment mechanism (p < 0.001). These findings suggest that estimating benefits from one culture may not be transferable to another, and that low- and middle-income countries, such as Ecuador, may be better served by developing their own benefits estimates for use in future benefit-cost analyses of interventions designed to prevent CM. International Journal of Environmental Research and Public Health 2013-03-28 10 4 Article 10.3390/ijerph10041342 1342 1355 1660-4601 2013-03-28 doi: 10.3390/ijerph10041342 Phaedra Corso Justin Ingels M. Roldos http://www.mdpi.com/1660-4601/10/4/1324 Using the 2002 World Health Survey, we examine the association between welfare state regimes, gender and mental health among 26 countries classified into seven distinct regimes: Conservative, Southeast Asian, Eastern European, Latin American, Liberal, Southern/Ex-dictatorship, and Social Democratic. A two-level hierarchical model found that the odds of experiencing a brief depressive episode in the last 12 months was significantly higher for Southern/Ex- dictatorship countries than for Southeast Asian (odds ratio (OR) = 0.12, 95% confidence interval (CI) 0.05–0.27) and Eastern European (OR = 0.36, 95% CI 0.22–0.58) regimes after controlling for gender, age, education, marital status, and economic development. In adjusted interaction models, compared to Southern/Ex-dictatorship males (reference category), the odds ratios of depression were significantly lower among Southeast Asian males (OR = 0.16, 95% CI 0.08–0.34) and females (OR = 0.23, 95% CI 0.10–0.53) and Eastern European males (OR = 0.41, 95% CI 0.26–0.63) and significantly higher among females in Liberal (OR = 2.00, 95% CI 1.14–3.49) and Southern (OR = 2.42, 95% CI 1.86–3.15) regimes. Our results highlight the importance of incorporating middle-income countries into comparative welfare regime research and testing for interactions between welfare regimes and gender on mental health. International Journal of Environmental Research and Public Health 2013-03-28 10 4 Article 10.3390/ijerph10041324 1324 1341 1660-4601 2013-03-28 doi: 10.3390/ijerph10041324 Haejoo Chung Edwin Ng Selahadin Ibrahim Björn Karlsson Joan Benach Albert Espelt Carles Muntaner http://www.mdpi.com/1660-4601/10/4/1312 Objective: A significant decline in the prevalence of neural tube defects (NTD) through food fortification has been reported. Questions remain, however, about the effectiveness of this intervention in reducing the gap in prevalence across socioeconomic status (SES). Study Design: Using health number and through record linkage, children born in Ontario hospitals between 1994 and 2009 were followed for the diagnosis of congenital anomalies. SES quintiles were assigned to each child using census information at the time of birth. Adjusted rates and multivariate models were used to compare trends among children born in different SES groups. Results: Children born in low SES areas had significantly higher rates of NTDs (RR = 1.25, CI: 1.14–1.37). Prevalence of NTDs among children born in low and high SES areas declined since food fortification began in 1999 although has started rising again since 2006. While the crude decline was greater in low SES areas, after adjustment for maternal age, the slope of decline and SES gap in prevalence rates remained unchanged overtime. Conclusions: While food fortification is successful in reducing the prevalence of NTDs, it was not associated with removing the gap between high and low SES groups. International Journal of Environmental Research and Public Health 2013-03-28 10 4 Article 10.3390/ijerph10041312 1312 1323 1660-4601 2013-03-28 doi: 10.3390/ijerph10041312 Mohammad Agha Richard Glazier Rahim Moineddin Aideen Moore Astrid Guttmann http://www.mdpi.com/1660-4601/10/4/1304 In this study, in vitro formed Cd-phytochelatin (PC2) complexes were characterized using ion exchange chromatography (IEC) and matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. The ratio of both studied compounds as well as experimental conditions were optimized. The highest yield of the complex was observed under an applied concentration of 100 µg·mL−1 PC2 and 100 µg·mL−1 of CdCl2. The data obtained show that IEC in combination with MALDI-TOF is a reliable and fast method for the determination of these complexes. International Journal of Environmental Research and Public Health 2013-03-28 10 4 Article 10.3390/ijerph10041304 1304 1311 1660-4601 2013-03-28 doi: 10.3390/ijerph10041304 Miguel Rodrigo Natalia Cernei Marketa Kominkova Ondrej Zitka Miroslava Beklova Josef Zehnalek Rene Kizek Vojtech Adam http://www.mdpi.com/1660-4601/10/4/1284 People typically choose to live in quiet areas in order to safeguard their health and wellbeing. However, the benefits of living in quiet areas are relatively understudied compared to the burdens associated with living in noisy areas. Additionally, research is increasingly focusing on the relationship between the human response to noise and measures of health and wellbeing, complementing traditional dose-response approaches, and further elucidating the impact of noise and health by incorporating human factors as mediators and moderators. To further explore the benefits of living in quiet areas, we compared the results of health-related quality of life (HRQOL) questionnaire datasets collected from households in localities differentiated by their soundscapes and population density: noisy city, quiet city, quiet rural, and noisy rural. The dose-response relationships between noise annoyance and HRQOL measures indicated an inverse relationship between the two. Additionally, quiet areas were found to have higher mean HRQOL domain scores than noisy areas. This research further supports the protection of quiet locales and ongoing noise abatement in noisy areas. International Journal of Environmental Research and Public Health 2013-03-27 10 4 Article 10.3390/ijerph10041284 1284 1303 1660-4601 2013-03-27 doi: 10.3390/ijerph10041284 Daniel Shepherd David Welch Kim Dirks David McBride http://www.mdpi.com/1660-4601/10/4/1268 Earth is a finite system with a limited supply of resources. As the human population grows, so does the appropriation of Earth’s natural capital, thereby exacerbating environmental concerns such as biodiversity loss, increased pollution, deforestation and global warming. Such concerns will negatively impact human health although it is widely believed that improving socio-economic circumstances will help to ameliorate environmental impacts and improve health outcomes. However, this belief does not explicitly acknowledge the fact that improvements in socio-economic position are reliant on increased inputs from nature. Gains in population health, particularly through economic means, are disconnected from the appropriation of nature to create wealth so that health gains become unsustainable. The current study investigated the sustainability of human population health in Canada with regard to resource consumption or “ecological footprints” (i.e., the resources required to sustain a given population). Ecological footprints of the 20 largest Canadian cities, along with several important determinants of health such as income and education, were statistically compared with corresponding indicators of human population health outcomes. A significant positive relationship was found between ecological footprints and life expectancy, as well as a significant negative relationship between ecological footprints and the prevalence of high blood pressure. Results suggest that increased appropriation of nature is linked to improved health outcomes. To prevent environmental degradation from excessive appropriation of natural resources will require the development of health promotion strategies that are de-coupled from ever-increasing and unsustainable resource use. Efforts to promote population health should focus on health benefits achieved from a lifestyle based on significantly reduced consumption of natural resources. International Journal of Environmental Research and Public Health 2013-03-26 10 4 Article 10.3390/ijerph10041268 1268 1283 1660-4601 2013-03-26 doi: 10.3390/ijerph10041268 Daniel Rainham Rory Cantwell Timothy Jason http://www.mdpi.com/1660-4601/10/4/1250 Environments shape health and well-being, yet little research has investigated how different real-world environmental settings influence the well-known determinant of health known as stress. Using a cross-over experimental design; this pilot study investigated the effect of four urban environments on physiological and psychological stress measures. Participants (N = 15) were exposed on separate days to one of the four settings for 20 min. These settings were designated as Very Natural; Mostly Natural; Mostly Built and Very Built. Visitation order to the four settings was individually randomized. Salivary cortisol and alpha-amylase; as well as self-report measures of stress; were collected before and after exposure to each setting. Gender was included as a variable in analysis; and additional data about environmental self-identity, pre-existing stress, and perceived restorativeness of settings were collected as measures of covariance. Differences between environmental settings showed greater benefit from exposure to natural settings relative to built settings; as measured by pre-to-post changes in salivary amylase and self-reported stress; differences were more significant for females than for males. Inclusion of covariates in a regression analysis demonstrated significant predictive value of perceived restorativeness on these stress measures, suggesting some potential level of mediation. These data suggest that exposure to natural environments may warrant further investigation as a health promotion method for reducing stress. International Journal of Environmental Research and Public Health 2013-03-26 10 4 Article 10.3390/ijerph10041250 1250 1267 1660-4601 2013-03-26 doi: 10.3390/ijerph10041250 Kurt Beil Douglas Hanes http://www.mdpi.com/1660-4601/10/4/1231 Critical environmental and human health concerns are associated with the rapidly growing fields of nanotechnology and manufactured nanomaterials (MNMs). The main risk arises from occupational exposure via chronic inhalation of nanoparticles. This research presents a chance-constrained nonlinear programming (CCNLP) optimization approach, which is developed to maximize the nanaomaterial production and minimize the risks of workplace exposure to MNMs. The CCNLP method integrates nonlinear programming (NLP) and chance-constrained programming (CCP), and handles uncertainties associated with both the nanomaterial production and workplace exposure control. The CCNLP method was examined through a single-walled carbon nanotube (SWNT) manufacturing process. The study results provide optimal production strategies and alternatives. It reveal that a high control measure guarantees that environmental health and safety (EHS) standards regulations are met, while a lower control level leads to increased risk of violating EHS regulations. The CCNLP optimization approach is a decision support tool for the optimization of the increasing MNMS manufacturing with workplace safety constraints under uncertainties. International Journal of Environmental Research and Public Health 2013-03-26 10 4 Article 10.3390/ijerph10041231 1231 1249 1660-4601 2013-03-26 doi: 10.3390/ijerph10041231 Zhi Chen Yuan Yuan Shu-Shen Zhang Yu Chen Feng-Lin Yang http://www.mdpi.com/1660-4601/10/4/1202 Diarrheal disease is an important health challenge, accounting for the majority of childhood deaths globally. Climate change is expected to increase the global burden of diarrheal disease but little is known regarding climate drivers, particularly in Africa. Using health data from Botswana spanning a 30-year period (1974–2003), we evaluated monthly reports of diarrheal disease among patients presenting to Botswana health facilities and compared this to climatic variables. Diarrheal case incidence presents with a bimodal cyclical pattern with peaks in March (ANOVA p < 0.001) and October (ANOVA p < 0.001) in the wet and dry season, respectively. There is a strong positive autocorrelation (p < 0.001) in the number of reported diarrhea cases at the one-month lag level. Climatic variables (rainfall, minimum temperature, and vapor pressure) predicted seasonal diarrheal with a one-month lag in variables (p < 0.001). Diarrheal case incidence was highest in the dry season after accounting for other variables, exhibiting on average a 20% increase over the yearly mean (p < 0.001). Our analysis suggests that forecasted climate change increases in temperature and decreases in precipitation may increase dry season diarrheal disease incidence with hot, dry conditions starting earlier and lasting longer. Diarrheal disease incidence in the wet season is likely to decline. Our results identify significant health-climate interactions, highlighting the need for an escalated public health focus on controlling diarrheal disease in Botswana. Study findings have application to other arid countries in Africa where diarrheal disease is a persistent public health problem. International Journal of Environmental Research and Public Health 2013-03-26 10 4 Article 10.3390/ijerph10041202 1202 1230 1660-4601 2013-03-26 doi: 10.3390/ijerph10041202 Kathleen Alexander Marcos Carzolio Douglas Goodin Eric Vance http://www.mdpi.com/1660-4601/10/4/1186 The traditional explanatory models used in epidemiology are “disease specific”, identifying risk factors for specific health conditions. Yet social exposures lead to a generalized, cumulative health impact which may not be specific to one illness. Disease-specific models may therefore misestimate social factors’ effects on health. Using data from the Canadian Community Health Survey and Canada 2001 Census we construct and compare “disease-specific” and “generalized health impact” (GHI) models to gauge the negative health effects of one social exposure: socioeconomic position (SEP). We use logistic and multinomial multilevel modeling with neighbourhood-level material deprivation, individual-level education and household income to compare and contrast the two approaches. In disease-specific models, the social determinants under study were each associated with the health conditions of interest. However, larger effect sizes were apparent when outcomes were modeled as compound health problems (0, 1, 2, or 3+ conditions) using the GHI approach. To more accurately estimate social exposures’ impacts on population health, researchers should consider a GHI framework. International Journal of Environmental Research and Public Health 2013-03-25 10 4 Article 10.3390/ijerph10041186 1186 1201 1660-4601 2013-03-25 doi: 10.3390/ijerph10041186 Heather White Patricia O'Campo Rahim Moineddin Flora Matheson http://www.mdpi.com/1660-4601/10/4/1168 Human exposure assessment tools represent a means for understanding human exposure to pesticides in agricultural activities and managing possible health risks. This paper presents a pesticide flow analysis modeling approach developed to assess human exposure to pesticide use in greenhouse flower crops in Colombia, focusing on dermal and inhalation exposure. This approach is based on the material flow analysis methodology. The transfer coefficients were obtained using the whole body dosimetry method for dermal exposure and the button personal inhalable aerosol sampler for inhalation exposure, using the tracer uranine as a pesticide surrogate. The case study was a greenhouse rose farm in the Bogota Plateau in Colombia. The approach was applied to estimate the exposure to pesticides such as mancozeb, carbendazim, propamocarb hydrochloride, fosetyl, carboxin, thiram, dimethomorph and mandipropamide. We found dermal absorption estimations close to the AOEL reference values for the pesticides carbendazim, mancozeb, thiram and mandipropamide during the study period. In addition, high values of dermal exposure were found on the forearms, hands, chest and legs of study participants, indicating weaknesses in the overlapping areas of the personal protective equipment parts. These results show how the material flow analysis methodology can be applied in the field of human exposure for early recognition of the dispersion of pesticides and support the development of measures to improve operational safety during pesticide management. Furthermore, the model makes it possible to identify the status quo of the health risk faced by workers in the study area. International Journal of Environmental Research and Public Health 2013-03-25 10 4 Article 10.3390/ijerph10041168 1168 1185 1660-4601 2013-03-25 doi: 10.3390/ijerph10041168 Camilo Lesmes-Fabian Claudia Binder http://www.mdpi.com/1660-4601/10/4/1152 This study examines the individual and workplace factors related to depression and stress in a large privately owned enterprise in China. The cross-sectional study design involved 13 privately owned retail enterprises in China. A self-report survey was administered to 4,847 employees aged 18–54 recruited through the management boards of the 13 enterprises. A chi-square test was used to compare differences between the depressed and non-depressed groups on a number of demographic variables and chronic diseases. Logistic regression analysis was performed to assess depression in relation to individual factors (work ability and resilience) and organisational environmental factors (workplace ethos and culture, psychosocial environment and health promotion policies and activities). Significant relationships were found between employee depression all personal factors, and one organisational environmental factor. Personal factors include poor work ability and low resilience, while workplace factors include workplace ethos and culture. The primary organisational environmental factor was a low level of enterprise ethos and culture. International Journal of Environmental Research and Public Health 2013-03-25 10 4 Article 10.3390/ijerph10041152 1152 1167 1660-4601 2013-03-25 doi: 10.3390/ijerph10041152 Jing Sun Nicholas Buys Xinchao Wang http://www.mdpi.com/1660-4601/10/3/1139 Climate change presents risks to health that must be addressed by both decision-makers and public health researchers. Within the application of Environmental Health Impact Assessment (EHIA), there have been few attempts to incorporate climate change-related health risks as an input to the framework. This study used a focus group design to examine the perceptions of government, industry and academic specialists about the suitability of assessing the health consequences of climate change within an EHIA framework. Practitioners expressed concern over a number of factors relating to the current EHIA methodology and the inclusion of climate change-related health risks. These concerns related to the broad scope of issues that would need to be considered, problems with identifying appropriate health indicators, the lack of relevant qualitative information that is currently incorporated in assessment and persistent issues surrounding stakeholder participation. It was suggested that improvements are needed in data collection processes, particularly in terms of adequate communication between environmental and health practitioners. Concerns were raised surrounding data privacy and usage, and how these could impact on the assessment process. These findings may provide guidance for government and industry bodies to improve the assessment of climate change-related health risks. International Journal of Environmental Research and Public Health 2013-03-22 10 3 Article 10.3390/ijerph10031139 1139 1151 1660-4601 2013-03-22 doi: 10.3390/ijerph10031139 Lyle Turner Katarzyna Alderman Des Connell Shilu Tong http://www.mdpi.com/1660-4601/10/3/1125 We conducted this study to determine levels and correlates of hypertension knowledge among rural Chinese adults, and to assess the association between knowledge levels and salty food consumption among hypertensive and non-hypertensive populations. This face-to-face cross sectional survey included 665 hypertensive and 854 non-hypertensive respondents in the rural areas of Heilongjiang province, China. Hypertension knowledge was assessed through a 10-item test; respondents received 10 points for each correct answer. Among respondents, the average hypertension knowledge score was 26 out of a maximum of 100 points for hypertensive and 20 for non-hypertensive respondents. Hypertension knowledge was associated with marital status, education, health status, periodically reading books, newspapers or other materials, history of blood pressure measurement, and attending hypertension educational sessions. Hypertension knowledge is extremely low in rural areas of China. Hypertension education programs should focus on marginal populations, such as individuals who are not married or illiterate to enhance their knowledge levels. Focusing on educational and literacy levels in conjunction with health education is important given illiteracy is still a prominent issue for the Chinese rural population. International Journal of Environmental Research and Public Health 2013-03-18 10 3 Article 10.3390/ijerph10031125 1125 1138 1660-4601 2013-03-18 doi: 10.3390/ijerph10031125 Xia Li Ning Ning Yanhua Hao Hong Sun Lijun Gao Mingli Jiao Qunhong Wu Hude Quan http://www.mdpi.com/1660-4601/10/3/1113 Background: Most childhood unintentional injuries occur in the home; however, very little home injury prevention information is tailored to developing countries. Utilizing our previously developed information dissemination tools and a hazard assessment checklist tailored to a low-income neighborhood in Pakistan, we pilot tested and compared the effectiveness of two dissemination tools. Methods: Two low-income neighborhoods were mapped, identifying families with a child aged between 12 and 59 months. In June and July 2010, all enrolled households underwent a home hazard assessment at the same time hazard reduction education was being given using an in-home tutorial or a pamphlet. A follow up assessment was conducted 4–5 months later. Results: 503 households were enrolled; 256 received a tutorial and 247 a pamphlet. The two groups differed significantly (p < 0.01) in level of maternal education and relationship of the child to the primary caregiver. However, when controlling for these variables, those receiving an in-home tutorial had a higher odds of hazard reduction than the pamphlet group for uncovered vats of water (OR 2.14, 95% CI: 1.28, 3.58), an open fire within reach of the child (OR 3.55, 95% CI: 1.80, 7.00), and inappropriately labeled cooking fuel containers (OR 1.86, 95% CI: 1.07, 3.25). Conclusions: This pilot project demonstrates the potential utility of using home-visit tutorials to decrease home hazards in a low-income neighborhood in Pakistan. A longer-term randomized study is needed to assess actual effectiveness of the use of allied health workers for home-based injury education and whether this results in decreased home injuries. International Journal of Environmental Research and Public Health 2013-03-15 10 3 Article 10.3390/ijerph10031113 1113 1124 1660-4601 2013-03-15 doi: 10.3390/ijerph10031113 Aruna Chandran Uzma Khan Nukhba Zia Asher Feroze Sarah de Ramirez Cheng-Ming Huang Junaid Razzak Adnan Hyder http://www.mdpi.com/1660-4601/10/3/1100 The objective of this study was to explore work-related risk factors of acute occupational pesticide poisoning among male farmers according to the severity of the poisoning. A nationwide sampling survey of male farmers was conducted in South Korea in 2011. A total of 1,958 male farmers were interviewed. Severity of occupational pesticide poisoning in 2010 was evaluated according to symptoms, types of treatment, and number of pesticide poisoning incidents per individual. A multinomial logistic regression model was used to estimate the odds ratio with 95% confidence intervals for risk factors of acute occupational pesticide poisoning. We found that the risk of acute occupational pesticide poisoning increased with lifetime days of pesticide application (OR = 1.74; 95% CI = 1.32–2.29), working a farm of three or more acres in size (OR = 1.49), not wearing personal protective equipment such as gloves (OR = 1.29) or masks (OR = 1.39). Those who engaged in inappropriate work behaviors such as not following pesticide label instructions (OR = 1.61), applying the pesticide in full sun (OR = 1.48), and applying the pesticide upwind (OR = 1.54) had a significantly increased risk of pesticide poisoning. There was no significant risk difference by type of farming. In addition, the magnitude of these risk factors did not differ significantly by severity of acute pesticide poisoning. In fact, our findings suggest that work-related risk factors contributed to the development of acute occupational pesticide poisoning without relation to its severity. Therefore, prevention strategies for reducing occupational pesticide poisoning, regardless of severity, should be recommended to all types of farming and the level of poisoning severity. International Journal of Environmental Research and Public Health 2013-03-14 10 3 Article 10.3390/ijerph10031100 1100 1112 1660-4601 2013-03-14 doi: 10.3390/ijerph10031100 Ji-Hyun Kim Jaeyoung Kim Eun Cha Yousun Ko Doo Kim Won Lee http://www.mdpi.com/1660-4601/10/3/1085 Natural thermal bathing pools contain geothermal water that is very popular to bathe in but the water is not sterilized, irradiated or treated in any way. Increasing tourism in Iceland will lead to increasing numbers of bath guests, which can in turn affect the microbial flora in the pools and therefore user safety. Today, there is no legislation that applies to natural geothermal pools in Iceland, as the water is not used for consumption and the pools are not defined as public swimming pools. In this study, we conducted a microbiological analysis on three popular but different natural pools in Iceland, located at Lýsuhóll, Hveravellir and Landmannalaugar. Total bacterial counts were performed by flow cytometry, and with plate count at 22 °C, 37 °C and 50 °C. The presence of viable coliforms, Enterococcus spp. and pseudomonads were investigated by growth experiments on selective media. All samples were screened for noroviruses by real time PCR. The results indicate higher fecal contamination in the geothermal pools where the geothermal water flow was low and bathing guest count was high during the day. The number of cultivated Pseudomonas spp. was high (13,000–40,000 cfu/100 mL) in the natural pools, and several strains were isolated and classified as opportunistic pathogens. Norovirus was not detected in the three pools. DNA was extracted from one-liter samples in each pool and analyzed by partial 16S rRNA gene sequencing. Microbial diversity analysis revealed different microbial communities between the pools and they were primarily composed of alpha-, beta- and gammaproteobacteria. International Journal of Environmental Research and Public Health 2013-03-14 10 3 Article 10.3390/ijerph10031085 1085 1099 1660-4601 2013-03-14 doi: 10.3390/ijerph10031085 Berglind Thorolfsdottir Viggo Marteinsson http://www.mdpi.com/1660-4601/10/3/1062 Nitro-polycyclic aromatic hydrocarbons (nitro-PAHs) are a class of genotoxic environmental contaminants. We have long been interested in determining the mechanisms by which nitro-PAHs induce genotoxicity. Although the metabolic activation of nitro-PAHs leading to toxicological activities has been well studied, the photo-induced activation of nitro-PAHs has seldom been reported. In this paper, we report photo-induced lipid peroxidation by 19 nitro-PAHs. The results indicated that all but two of the nitro-PAHs can induce lipid peroxidation. Mechanistic studies suggest that lipid peroxidation by nitro-PAHs is mediated by free radicals generated in the reaction. There was no structural correlation between the nitro-PAHs and their ability to induce lipid peroxidation upon UVA irradiation, or between the HOMO-LUMO gap and the ability to cause lipid peroxidation. Most of the nitro-PAHs are less potent in terms of causing lipid peroxidation than their parent PAHs. The lack of correlation is attributed to the complex photophysics and photochemistry of the nitro-PAHs and the yield of reactive oxygen species (ROS) and other factors. International Journal of Environmental Research and Public Health 2013-03-14 10 3 Article 10.3390/ijerph10031062 1062 1084 1660-4601 2013-03-14 doi: 10.3390/ijerph10031062 Qingsu Xia Jun-Jie Yin Yuewei Zhao Yuh-Sen Wu Yu-Qui Wang Liang Ma Shoujun Chen Xin Sun Peter Fu Hongtao Yu http://www.mdpi.com/1660-4601/10/3/1048 Continuous measurements of surface ozone (O3) and nitrogen oxides (NOX) at an urban site (39°37′N, 118°09′E) in Tangshan, the largest heavy industry city of North China during summertime from 2008 to 2011 are presented. The pollution of O3 was serious in the city. The daily maximum 1 h means (O3_1-hr max) reached 157 ± 55, 161 ± 54, 120 ± 50, and 178 ± 75 μg/m3 corresponding to an excess over the standard rates of 21%, 27%, 10%, and 40% in 2008–2011, respectively. The total oxidant level (OX = O3 + NO2) was high, with seasonal average concentrations up to 100 μg/m3 in summer. The level of OX at a given location was made up of NOX-independent and NOX-dependent contributions. The independent part can be considered as a regional contribution and was about 100 μg/m3 in Tangshan. Statistical early warning analysis revealed that the O3 levels would exceed the standard rate by 50% on the day following a day when the daily average ozone concentration (O3_mean) exceeded 87 μg/m3 and the daily maximum temperature (T_max) exceeded 29 °C. The exceed-standard rate would reach 80% when O3_mean and T_max exceeded 113 μg/m3 and 31 °C. Similarly, the exceed-standard rate would reach 100% when O3_mean and T_max exceeded 127 μg/m3 and 33 °C, respectively. International Journal of Environmental Research and Public Health 2013-03-13 10 3 Article 10.3390/ijerph10031048 1048 1061 1660-4601 2013-03-13 doi: 10.3390/ijerph10031048 Pei Li Jinyuan Xin Xiaoping Bai Yuesi Wang Shigong Wang Shixi Liu Xiaoxin Feng http://www.mdpi.com/1660-4601/10/3/1037 Tobacco use and cigarette smoking have long been causally linked to a wide variety of poor health outcomes, resulting in a number of public health policy initiatives to reduce prevalence and consumption. Benefits of these initiatives, however, have not been well-established quantitatively. Using 2005–2008 New York Adult Tobacco Survey data, we developed a simulation model to estimate the effectiveness and net benefits of the New York Tobacco Control Program’s (NY TCP’s) adult smoking cessation assistance initiatives, specifically media campaigns, telephone quitline counseling, and nicotine replacement therapy. In 2008, we estimate that NY TCP generated an estimated 49,195 additional, non-relapsing adult quits (95% CI: 19,878; 87,561) for a net benefit of over $800 million (95% CI: $211 million; $1,575 million). Although the simulation results varied considerably, reflecting uncertainty in the estimates and data, and data sufficient to establish definite causality are lacking, the cessation initiatives examined appear to yield substantial societal benefits. These benefits are of sufficient magnitude to fully offset expenditures not only on these initiatives, but on NY TCP as a whole. International Journal of Environmental Research and Public Health 2013-03-13 10 3 Article 10.3390/ijerph10031037 1037 1047 1660-4601 2013-03-13 doi: 10.3390/ijerph10031037 Sean Simpson James Nonnemaker http://www.mdpi.com/1660-4601/10/3/1020 Enterococcus spp. from two poultry farms and proximate surface and ground water sites in an area of intensive poultry production were tested for resistance to 16 clinical antibiotics. Resistance patterns were compared to assess trends and possible correlations for specific antimicrobials and levels of resistance. Enterococci were detected at all 12 surface water sites and three of 28 ground water sites. Resistance to lincomycin, tetracycline, penicillin and ciprofloxacin in poultry litter isolates was high (80.3%, 65.3%, 61.1% and 49.6%, respectively). Resistance in the surface water to the same antibiotics was 87.1%, 24.1%, 7.6% and 12.9%, respectively. Overall, 86% of litter isolates, 58% of surface water isolates and 100% of ground water isolates were resistant to more than one antibiotic. Fifty-four different resistance patterns were recognised in isolates obtained from litter and environmental samples and several E. faecium and E. faecalis isolates from litter and environment samples shared the same resistance pattern. Multiple antibiotic resistant (MAR) indices calculated to assess health risks due to the presence of resistant enterococci suggested an increased presence of antibiotics in surface water, likely from poultry sources as no other wastewater contributions in the area were documented. International Journal of Environmental Research and Public Health 2013-03-12 10 3 Article 10.3390/ijerph10031020 1020 1036 1660-4601 2013-03-12 doi: 10.3390/ijerph10031020 Vesna Furtula Charlene Jackson Erin Farrell John Barrett Lari Hiott Patricia Chambers http://www.mdpi.com/1660-4601/10/3/1006 Ingestion of inorganic arsenic (iAs) is considered to be related to the development of diabetes mellitus. In order to clarify the possible differences in the metabolism in diabetics, we measured urinary iAs metabolites in diabetic cases and non-diabetic control subjects in Faridpur, an arsenic-contaminated area in Bangladesh. Physician-diagnosed type 2 diabetic cases (140 persons) and non-diabetic controls (180 persons) were recruited. Drinking water and spot urine samples were collected. Mean concentrations of total arsenic in drinking water did not differ between cases (85.1 μg/L) and controls (85.8 μg/L). The percentage of urinary iAs (iAs%) was significantly lower in cases (8.6%) than in controls (10.4%), while that of dimethylarsinic acid (DMA%) was higher in cases (82.6%) than in controls (79.9%). This may have been due to the higher secondary methylation index (SMI) in the former (11.6) rather than the latter (10.0). Adjusting for matching factors (sex and unions), and the additional other covariates (age and water arsenic) significantly attenuated the differences in iAs%, SMI, and DMA%, respectively, though the difference in monomethylarsonic acid% was newly significant in the latter adjustment. Our study did not suggest any significant differences in urinary arsenic metabolites between diabetic and non-diabetic subjects. International Journal of Environmental Research and Public Health 2013-03-12 10 3 Article 10.3390/ijerph10031006 1006 1019 1660-4601 2013-03-12 doi: 10.3390/ijerph10031006 Saika Nizam Masashi Kato Hiroshi Yatsuya Md. Khalequzzaman Shoko Ohnuma Hisao Naito Tamie Nakajima http://www.mdpi.com/1660-4601/10/3/994 Toxoplasma gondii is a zoonotic protozoan that causes serious illness in humans and infects animals worldwide, including the Canadian Arctic. Indeed, high prevalence of infection amongst Inuit has been recorded, possibly due to consumption of raw infected seal meat. Here we explore the hypothesis that T. gondii oocysts contaminate the coastal marine environment via surface runoff from across the boreal watershed, particularly during the snowmelt period. We propose a conceptual framework of the different processes governing the fate and transport of T. gondii oocysts from the melting snowpack to the Canadian arctic coast via the freshwater runoff. This framework identifies the feasibility of a transmission pathway of oocysts from contaminated soil to the marine environment, but also the complexity and multiplicity of mechanisms involved. In addition, the framework identifies knowledge gaps for guiding future studies on T. gondii oocysts. Furthermore, this work could be used as a tool to investigate the possible estuarine contamination by other faeces-borne pathogens transported via the spring freshet in seasonally snow covered watersheds. International Journal of Environmental Research and Public Health 2013-03-11 10 3 Article 10.3390/ijerph10030994 994 1005 1660-4601 2013-03-11 doi: 10.3390/ijerph10030994 Audrey Simon Michel Poulin Alain Rousseau Nicholas Ogden http://www.mdpi.com/1660-4601/10/3/980 The association of socioeconomic status (SES) with nutrients intakes attracts public attention worldwide. In the current study, we examined the associations of SES with dietary salt intake and health outcomes in general Japanese workers (2,266) who participated in this Japanese occupational cohort. SES was assessed by a self-administered questionnaire. Dietary intakes were assessed with a validated, brief, self-administered diet history questionnaire (BDHQ). Multiple linear regression and stratified analysis were used to evaluate the associations of salt intake with the confounding factors. Education levels and household incomes were significantly associated with salt intake, as well as blood pressures (P < 0.05). After adjusting for age, sex and total energy intake, both years of education and household income significantly affect the salt intake (for education, β = −0.031, P = 0.040; for household income, β = −0.046, P = 0.003). SES factors also affect the risk of hypertension, those subjects with higher levels of education or income had lower risk to become hypertensive (ORs for education was 0.904, P < 0.001; ORs for income was 0.956, P = 0.032). Our results show that SES is an independent determinant of salt intake and blood pressure, in order to lower the risk of hypertension, the efforts to narrow the social status gaps should be considered by the health policy-makers. International Journal of Environmental Research and Public Health 2013-03-11 10 3 Article 10.3390/ijerph10030980 980 993 1660-4601 2013-03-11 doi: 10.3390/ijerph10030980 Koichi Miyaki Yixuan Song Setsuko Taneichi Akizumi Tsutsumi Hideki Hashimoto Norito Kawakami Masaya Takahashi Akihito Shimazu Akiomi Inoue Sumiko Kurioka Takuro Shimbo http://www.mdpi.com/1660-4601/10/3/963 The aim of the present study was to evaluate the risk of lung cancer from combined exposure to radon and smoking. Methodologically, it is based on case-control studies nested within two Czech cohort studies of nearly 11,000 miners followed-up for mortality in 1952–2010 and nearly 12,000 inhabitants exposed to high levels of radon in homes, with mortality follow-up in 1960–2010. In addition to recorded radon exposure, these studies use information on smoking collected from the subjects or their relatives. A total of 1,029 and 370 cases with smoking information have been observed in the occupational and environmental (residential) studies, respectively. Three or four control subjects have been individually matched to cases according to sex, year of birth, and age. The combined effect from radon and smoking is analyzed in terms of geometric mixture models of which the additive and multiplicative models are special cases. The resulting models are relatively close to the additive interaction (mixing parameter 0.2 and 0.3 in the occupational and residential studies, respectively). The impact of the resulting model in the residential radon study is illustrated by estimates of lifetime risk in hypothetical populations of smokers and non-smokers. In comparison to the multiplicative risk model, the lifetime risk from the best geometric mixture model is considerably higher, particularly in the non-smoking population. International Journal of Environmental Research and Public Health 2013-03-07 10 3 Article 10.3390/ijerph10030963 963 979 1660-4601 2013-03-07 doi: 10.3390/ijerph10030963 Ladislav Tomasek http://www.mdpi.com/1660-4601/10/3/950 This study examines demographic, cognitive and behavioral factors that predict pediatric dog-bite injury risk in rural China. A total of 1,537 children (grades 4–6) in rural regions of Anhui, Hebei and Zhejiang Provinces, China completed self-report questionnaires assessing beliefs about and behaviors with dogs. The results showed that almost 30% of children reported a history of dog bites. Children answered 56% of dog-safety knowledge items correctly. Regressions revealed both demographic and cognitive/behavioral factors predicted children’s risky interactions with dogs and dog-bite history. Boys behaved more riskily with dogs and were more frequently bitten. Older children reported greater risks with dogs and more bites. With demographics controlled, attitudes/beliefs of invulnerability, exposure frequency, and dog ownership predicted children’s self-reported risky practice with dogs. Attitudes/beliefs of invulnerability, dog exposure, and dog ownership predicted dog bites. In conclusion, both demographic and cognitive/behavioral factors influenced rural Chinese children’s dog-bite injury risk. Theory-based, empirically-supported intervention programs might reduce dog-bite injuries in rural China. International Journal of Environmental Research and Public Health 2013-03-07 10 3 Article 10.3390/ijerph10030950 950 962 1660-4601 2013-03-07 doi: 10.3390/ijerph10030950 Jiabin Shen Shaohua Li Huiyun Xiang Shulan Pang Guozhang Xu David Schwebel http://www.mdpi.com/1660-4601/10/3/936 The main objective of the present study was to assess culturable airborne fungal concentrations, and types in different seasons. Two-stage viable impactor samplers were used with malt extract agar medium as the collection media. Culturable airborne fungal concentrations were collected indoors and outdoors of 43 homes in urban and rural environments from November 2008 to October 2009 in Egypt. Fungal concentrations were significantly higher in the rural environment than the urban environment. The median indoor and outdoor total fungal concentrations were 608 and 675 CFU/m3 in the urban environment and 1,932 and 1,872 CFU/m3 in the rural environment, respectively. The greatest concentrations were found in the autumn and spring season. Indoor and outdoor concentrations were significantly correlated (P < 0.001). The highest concentrations were observed in the fungal size range of <8 µm (fine fraction). The indoor/outdoor (I/O) ratios were not statistically different between seasons. Alternaria, Aspergillus, Cladosporium, Penicillium and yeasts were the predominant genera indoors and outdoors, and the abundance of genera varied by season and region. This study is of a potential interest as little reported research on the indoor fungal air quality from Egypt. International Journal of Environmental Research and Public Health 2013-03-06 10 3 Article 10.3390/ijerph10030936 936 949 1660-4601 2013-03-06 doi: 10.3390/ijerph10030936 Abdel Awad Shawn Gibbs Patrick Tarwater Christopher Green http://www.mdpi.com/1660-4601/10/3/913 There is mounting empirical evidence that interacting with nature delivers measurable benefits to people. Reviews of this topic have generally focused on a specific type of benefit, been limited to a single discipline, or covered the benefits delivered from a particular type of interaction. Here we construct novel typologies of the settings, interactions and potential benefits of people-nature experiences, and use these to organise an assessment of the benefits of interacting with nature. We discover that evidence for the benefits of interacting with nature is geographically biased towards high latitudes and Western societies, potentially contributing to a focus on certain types of settings and benefits. Social scientists have been the most active researchers in this field. Contributions from ecologists are few in number, perhaps hindering the identification of key ecological features of the natural environment that deliver human benefits. Although many types of benefits have been studied, benefits to physical health, cognitive performance and psychological well-being have received much more attention than the social or spiritual benefits of interacting with nature, despite the potential for important consequences arising from the latter. The evidence for most benefits is correlational, and although there are several experimental studies, little as yet is known about the mechanisms that are important for delivering these benefits. For example, we do not know which characteristics of natural settings (e.g., biodiversity, level of disturbance, proximity, accessibility) are most important for triggering a beneficial interaction, and how these characteristics vary in importance among cultures, geographic regions and socio-economic groups. These are key directions for future research if we are to design landscapes that promote high quality interactions between people and nature in a rapidly urbanising world. International Journal of Environmental Research and Public Health 2013-03-06 10 3 Review 10.3390/ijerph10030913 913 935 1660-4601 2013-03-06 doi: 10.3390/ijerph10030913 Lucy Keniger Kevin Gaston Katherine Irvine Richard Fuller http://www.mdpi.com/1660-4601/10/3/892 This study brings together the literature on social network approaches to social capital and health and on migration and HIV risks to examine how non-migrating wives of labor migrants use their personal networks to cope with perceived risks of HIV infection in rural southern Mozambique. Using data from a 2006 survey of 1,680 women and their dyadic interactions, we compare the composition of personal networks, HIV/AIDS communication, and preventive behavior of women married to migrants and those married to non-migrants. Results show that migrants’ wives were more likely than non-migrants’ wives to have other migrants’ wives as personal network members, to engage in HIV/AIDS communication, and to discuss HIV prevention. However, they were no more likely to talk about HIV/AIDS with migrants’ wives than with non-migrants’ wives. They were also no more likely to talk about AIDS and its prevention than non-migrants’ wives who express worry about HIV infection from their spouses. Finally, we detect that network members’ prevention behavior was similar to respondents’, although this did not depend on migration. We contextualize these findings within the literature and discuss their policy implications. International Journal of Environmental Research and Public Health 2013-03-06 10 3 Article 10.3390/ijerph10030892 892 912 1660-4601 2013-03-06 doi: 10.3390/ijerph10030892 Winfred Avogo Victor Agadjanian http://www.mdpi.com/1660-4601/10/3/879 Bacterial contamination of drinking water is a major public health problem in rural China. To explore bacterial contamination in rural areas of Beijing and identify possible causes of bacteria in drinking water samples, water samples were collected from wells in ten rural districts of Beijing, China. Total bacterial count, total coliforms and Escherichia coli in drinking water were then determined and water source and wellhead protection were investigated. The bacterial contamination in drinking water was serious in areas north of Beijing, with the total bacterial count, total coliforms and Escherichia coli in some water samples reaching 88,000 CFU/mL, 1,600 MPN/100 mL and 1,600 MPN/100 mL, respectively. Water source types, well depth, whether the well was adequately sealed and housed, and whether wellhead is above or below ground were the main factors influencing bacterial contamination levels in drinking water. The bacterial contamination was serious in the water of shallow wells and wells that were not closed, had no well housing or had a wellhead below ground level. The contamination sources around wells, including village dry toilets and livestock farms, were well correlated with bacterial contamination. Total bacterial counts were affected by proximity to sewage ditches and polluting industries, however, proximity to landfills did not influence the microbial indicators. International Journal of Environmental Research and Public Health 2013-03-05 10 3 Article 10.3390/ijerph10030879 879 891 1660-4601 2013-03-05 doi: 10.3390/ijerph10030879 Bixiong Ye Linsheng Yang Yonghua Li Wuyi Wang Hairong Li http://www.mdpi.com/1660-4601/10/3/867 The relationship between early childhood caries (ECC) and obesity is controversial. This cross-sectional survey investigated this association in children from low-income families in Goiania, Goias, Brazil and considered the role of several social determinants. A questionnaire examining the characteristics of the children and their families was administered to the primary caregiver during home visits. In addition, children (approximately 6 years of age) had their height, weight, and tooth condition assessed. The primary ECC outcome was categorized as one of the following: caries experience (decayed, missing, filled tooth: “dmft” index > 0), active ECC (decayed teeth > 0), or active severe ECC (decayed teeth ≥ 6). Descriptive, bivariate and logistic regression analyses were conducted. The participants in the current study consisted of 269 caregiver-child dyads, 88.5% of whom were included in the Family Health Program. Caregivers were mostly mothers (67.7%), were 35.3 ± 10.0 years old on average and had 9.8 ± 3.1 years of formal education. The mean family income was 2.3 ± 1.5 times greater than the Brazilian minimum wage. On average, the children in the current study were 68.7 ± 3.8 months old. Of these, 51.7% were boys, 23.4% were overweight or obese, 45.0% had active ECC, and 17.1% had severe ECC. The average body mass index (BMI) of the children was 15.9 ± 2.2, and their dmft index was 2.5 ± 3.2. BMI was not associated with any of the three categories of dental caries (p > 0.05). In contrast, higher family incomes were significantly associated with the lack of caries experience in children (OR 1.22, 95%CI 1.01–1.50), but the mother’s level of education was not significantly associated with ECC. International Journal of Environmental Research and Public Health 2013-03-05 10 3 Article 10.3390/ijerph10030867 867 878 1660-4601 2013-03-05 doi: 10.3390/ijerph10030867 Luciane Costa Anelise Daher Maria Queiroz http://www.mdpi.com/1660-4601/10/3/856 Drowning represents the third leading cause of fatal unintentional injury in infants (0–1 years). The aim of this study is to investigate correlates of unsupervised bathing. This cross-sectional study included 1,410 parents with an infant. Parents completed a questionnaire regarding supervision during bathing, socio-demographic factors, and Protection Motivation Theory-constructs. To determine correlates of parents who leave their infant unsupervised, logistic regression analyses were performed. Of the parents, 6.2% left their child unsupervised in the bathtub. Parents with older children (OR 1.24; 95%CI 1.00–1.54) were more likely to leave their child unsupervised in the bathtub. First-time parents (OR 0.59; 95%CI 0.36–0.97) and non-Western migrant fathers (OR 0.18; 95%CI 0.05–0.63) were less likely to leave their child unsupervised in the bathtub. Furthermore, parents who perceived higher self-efficacy (OR 0.57; 95%CI 0.47–0.69), higher response efficacy (OR 0.34; 95%CI 0.24–0.48), and higher severity (OR 0.74; 95%CI 0.58–0.93) were less likely to leave their child unsupervised. Since young children are at great risk of drowning if supervision is absent, effective strategies for drowning prevention should be developed and evaluated. In the meantime, health care professionals should inform parents with regard to the importance of supervision during bathing. International Journal of Environmental Research and Public Health 2013-03-04 10 3 Article 10.3390/ijerph10030856 856 866 1660-4601 2013-03-04 doi: 10.3390/ijerph10030856 Mirjam van Beelen Eduard van Beeck Paul den Hertog Tinneke Beirens Hein Raat http://www.mdpi.com/1660-4601/10/3/845 Individuals of the water louse, Asellus aquaticus, enter drinking water distribution systems in temperate parts of the world, where they establish breeding populations. We analysed populations of surface water A. aquaticus from two ponds for associated faecal indicator bacteria and assessed the risk of A. aquaticus transporting bacteria into distribution systems. Concentrations of up to two E. coli and five total coliforms·mL−1 were measured in the water and 200 E. coli and >240 total coliforms·mL−1 in the sediments of the investigated ponds. Concentrations of A. aquaticus associated bacteria never exceeded three E. coli and six total coliforms·A. aquaticus−1. During exposure to high concentrations of coliforms, concentrations reached 350 coliforms·A. aquaticus−1. A. aquaticus associated E. coli were only detected as long as E. coli were present in the water and sediment. The calculated probability of exceeding drinking water guideline values in non-disinfected systems by intrusion of A. aquaticus was low. Only in scenarios with narrow pipes and low flows, did total coliforms exceed guideline values, implying that the probability of detection by routine monitoring is also low. The study expands the knowledge base for evaluating incidents with presence of coliform indicators in drinking water by showing that intruding A. aquaticus were not important carriers of E. coli or other coliform bacteria even when emerging from faecally contaminated waters. International Journal of Environmental Research and Public Health 2013-03-01 10 3 Article 10.3390/ijerph10030845 845 855 1660-4601 2013-03-01 doi: 10.3390/ijerph10030845 Sarah Christensen Erik Arvin Erling Nissen Hans-Jørgen Albrechtsen http://www.mdpi.com/1660-4601/10/3/830 In this study the effect of Boswellia papyrifera (B. papyrifera) and Boswellia carterii (B. carterii) smoke exposure on spermatogenesis and sperm parameters in male albino rats was investigated. Rats (n = 11) were exposed daily in smoking chambers to smoke emanated by burning 4 g each of either B. papyrifera or B. carterii for 48 days. At the end of exposure duration rats were killed, and the testes were excised and analysed for histopathological and ultrastructural changes. Sperm analysis including total sperm count, motility, velocity and relative percentage of abnormal sperms were recorded. Rats exposed to B. papyrifera and B. carterii showed significant disturbances in spermatogenetic patterns and changes in sperm kinetics compared to unexposed rats. Atrophied seminiferous tubules with dynamic changes were also noticed. The boundaries of intercellular and intracellular vacuoles were seen in the Sertoli cells. Furthermore, in spermatids acrosomal vesicles were not fully formed. Degenerating spermatids were devoid of their nuclear membrane with electron dense matrix and vacuolization. Structural changes in Leydig cells were observed. Sperm analysis in exposed rats exhibited significant decrease in the sperm count, motility, speed and an increase in sperm anomalies when compare to controls. These findings demonstrate that the B. papyrifera and B. carterii smoke affects the process of spermatogenesis and sperm parameters and indicate the detrimental effects of these incense materials on human reproductive system. International Journal of Environmental Research and Public Health 2013-02-28 10 3 Article 10.3390/ijerph10030830 830 844 1660-4601 2013-02-28 doi: 10.3390/ijerph10030830 Mukhtar Ahmed Nasser Al-Daghri Majed Alokail Tajamul Hussain http://www.mdpi.com/1660-4601/10/3/816 While contact tracing and case isolation are considered as the first choice of interventions against a smallpox bioterrorist event, their effectiveness under vaccination is questioned, because not only susceptibility of host and infectiousness of case but also the risk of severe clinical manifestations among cases is known to be reduced by vaccine-induced immunity, thereby potentially delaying the diagnosis and increasing mobility among vaccinated cases. We employed a multi-type stochastic epidemic model, aiming to assess the feasibility of contact tracing and case isolation in a partially vaccinated population and identify data gaps. We computed four epidemiological outcome measures, i.e., (i) the threshold of a major epidemic under the interventions; (ii) the expected total number of cases; (iii) the probability of extinction, and (iv) the expected duration of an outbreak, demonstrating that all of these outcomes critically depend on the clinical impact of past vaccination on the diagnosis and movement of vaccinated cases. We discuss that, even in the absence of smallpox in the present day, one should consider the way to empirically quantify the delay in case detection and an increase in the frequency of contacts among previously vaccinated cases compared to unvaccinated during the early stage of an epidemic so that the feasibility of contact tracing and case isolation in a vaccinated population can be explicitly assessed. International Journal of Environmental Research and Public Health 2013-02-27 10 3 Article 10.3390/ijerph10030816 816 829 1660-4601 2013-02-27 doi: 10.3390/ijerph10030816 Kenji Mizumoto Keisuke Ejima Taro Yamamoto Hiroshi Nishiura http://www.mdpi.com/1660-4601/10/3/808 Klebsiella pneumoniae is a frequent cause of infectious outbreaks in Neonatal Intensive Care Units (NICUs). The aim of this paper is to describe an outbreak occurred in a 13-bed NICU and the control measures adopted in order to interrupt the chain of transmission. We described the microbiological investigations, the NICU staff compliance to the infection control measures by means of a specifically designed check-list and the control measures adopted. Six cases of primary bloodstream infections sustained by ampicillin/piperacillin-resistant Klebsiella pneumoniae were observed over a two-month period. One culture obtained from a 12% saccarose multiple-dose solution allowed the growth of Klebsiella pneumoniae. During the inspections performed by the Hospital Infection Control Team, using the check-list for the evaluation of the NICU staff compliance to the infection control measures, several breaches in the infection control policy were identified and control measures were adopted. In our case the definition of a specific check-list led to the adoption of the correct control measures. Further studies would be helpful in order to develop a standard check-list able to identify critical flows in the adhesion to the guidelines. It could be used in different NICUs and allow to obtain reproducible levels of infection control. International Journal of Environmental Research and Public Health 2013-02-26 10 3 Article 10.3390/ijerph10030808 808 815 1660-4601 2013-02-26 doi: 10.3390/ijerph10030808 Giuliana Fabbri Manuela Panico Laura Dallolio Roberta Suzzi Matilde Ciccia Fabrizio Sandri Patrizia Farruggia http://www.mdpi.com/1660-4601/10/3/793 Lakes in the middle and lower reaches of the Yangtze River form a shallow lake group unique in the World that is becoming increasingly polluted by heavy metals. Previous studies have largely focused on individual lakes, with limited exploration of the regional pattern of heavy metal pollution of the lake group in this area. This paper explores the sources, intensity and spatial patterns of heavy metal pollution of lake sediments. A total of 45 sample lakes were selected and the concentrations of key metal elements in the sediments of each lake were measured. The cluster analysis (CA), principal component analysis (PCA) and Geo-accumulation index (Ig) analysis permitted analysis of the source and pollution intensity of the target lakes. Results suggested a notable spatial variation amongst the sample lakes. Lakes in the upper part of the lower reach of the Yangtze River surrounded by typical urban landscapes were strongly or extremely polluted, with high concentrations of Pb, Zn, Cu and Cd in their sediments. This was attributed to large amount of untreated industrial discharges and municipal sewage produced within the lake catchments. In contrast, the heavy-metal pollution of lakes in the Taihu Delta area was notably lower due to industrial restructuring and implementation of effective environmental protection measures. Lakes along the middle reach of Yangtze River surrounded by agricultural areas were unpolluted to moderately polluted by heavy metals overall. Our results suggested that lakes in the central part of China require immediate attention and efforts should be made to implement management plans to prevent further degradation of water quality in these lakes. International Journal of Environmental Research and Public Health 2013-02-26 10 3 Article 10.3390/ijerph10030793 793 807 1660-4601 2013-02-26 doi: 10.3390/ijerph10030793 Haiao Zeng Jinglu Wu http://www.mdpi.com/1660-4601/10/3/776 Investigating the health status of agricultural workers is a challenging goal. Contradictory outcomes concerning farmers’ health are reported in the literature. In this cross-sectional study, certain clinical and neurobehavioral health outcomes were compared between farmers and non-farmers living in the same rural area. Farmers (328) and non-farmers (347), matched per age and sex, were selected randomly in an agricultural area in West Greece. Both groups underwent haematological and biochemical examinations and were administered two neurobehavioral tests, namely the Mini-Mental State Examination (MMSE) and the Montgomery-Åsberg Depression Rating Scale (MADRS). Sociodemographic, personal medical, nutritional and lifestyle data were recorded. According to personal statements, farmers suffered from hypertension, cardiovascular, orthopaedic and ENT problems in higher frequency. Haematocrit, haemoglobin and serum cholinesterase’s activity were found to be lower among farmers. Lower prevalence of hypertension and better performances on MMSE and MADRS tests were recorded in young farmers in relation to young non-farmers, while these findings were reversed in older ages. Odds Ratios were calculated through multivariate logistic regression models. Factors affecting these impairments remain to be clarified. International Journal of Environmental Research and Public Health 2013-02-26 10 3 Article 10.3390/ijerph10030776 776 792 1660-4601 2013-02-26 doi: 10.3390/ijerph10030776 Konstantinos Demos Eleni Sazakli Eleni Jelastopulu Nikolaos Charokopos John Ellul Michalis Leotsinidis http://www.mdpi.com/1660-4601/10/3/762 This study investigated the spatial distribution of copper (Cu), zinc (Zn), cadmium (Cd), lead (Pb), chromium (Cr), cobalt (Co), nickel (Ni) and arsenic (As) in roadside topsoil in the Qinghai-Tibet Plateau and evaluated the potential environmental risks of these roadside heavy metals due to traffic emissions. A total of 120 topsoil samples were collected along five road segments in the Qinghai-Tibet Plateau. The nonlinear regression method was used to formulize the relationship between the metal concentrations in roadside soils and roadside distance. The Hakanson potential ecological risk index method was applied to assess the degrees of heavy metal contaminations. The regression results showed that both of the heavy metals’ concentrations and their ecological risk indices decreased exponentially with the increase of roadside distance. The large R square values of the regression models indicate that the exponential regression method can suitably describe the relationship between heavy metal accumulation and roadside distance. For the entire study region, there was a moderate level of potential ecological risk within a 10 m roadside distance. However, Cd was the only prominent heavy metal which posed potential hazard to the local soil ecosystem. Overall, the rank of risk contribution to the local environments among the eight heavy metals was Cd > As > Ni > Pb > Cu > Co > Zn > Cr. Considering that Cd is a more hazardous heavy metal than other elements for public health, the local government should pay special attention to this traffic-related environmental issue. International Journal of Environmental Research and Public Health 2013-02-25 10 3 Article 10.3390/ijerph10030762 762 775 1660-4601 2013-02-25 doi: 10.3390/ijerph10030762 Xuedong Yan Dan Gao Fan Zhang Chen Zeng Wang Xiang Man Zhang http://www.mdpi.com/1660-4601/10/3/747 Studies show that the association between socio-economic status (SES) and self-rated health (SRH) varies in different countries, however there are not many country-comparisons that examine this relationship over time. The objective of the present study is to determine the effect of three SES measures on SRH in 29 countries according to findings in European Social Surveys (2002–2008), in order to study how socio-economic inequalities can vary our subjective state of health. In line with previous studies, income inequalities seem to be greater not only in Anglo-Saxon and Scandinavian countries, but especially in Eastern European countries. The impact of education is greater in Southern countries, and this effect is similar in Eastern and Scandinavian countries, although occupational status does not produce significant differences in southern countries. This study shows the general relevance of socio-educational factors on SRH. Individual economic conditions are obviously a basic factor contributing to a good state of health, but education could be even more relevant to preserve it. In this sense, policies should not only aim at reducing income inequalities, but should also further the education of people who are in risk of social exclusion. International Journal of Environmental Research and Public Health 2013-02-25 10 3 Article 10.3390/ijerph10030747 747 761 1660-4601 2013-02-25 doi: 10.3390/ijerph10030747 Javier Alvarez-Galvez Maria Rodero-Cosano Emma Motrico Jose Salinas-Perez Carlos Garcia-Alonso Luis Salvador-Carulla http://www.mdpi.com/1660-4601/10/2/742 A recent publication in International Journal of Environmental Research and Public Health by Chari et al. [1] provides no basis for changing the National Ambient Air Quality Standard (NAAQS) for lead in the U.S. to protect children in low socio-economic (SES) populations. The studies selected by Chari et al. for analysis do not provide comparable information on regression coefficients for the blood lead level-IQ relationship. The coefficients differ from one another more on the basis of unequal blood lead metrics, ages of blood lead measurement, and differences in covariate adjustments and standardization, than the difference postulated by Chari et al. to correspond to low vs. high SES populations. International Journal of Environmental Research and Public Health 2013-02-21 10 2 Comment 10.3390/ijerph10020742 742 746 1660-4601 2013-02-21 doi: 10.3390/ijerph10020742 Teresa Bowers http://www.mdpi.com/1660-4601/10/2/729 The purpose of this study was to determine whether there is a growing inequity in tobacco use, susceptibility to future smoking, and quit attempts among Off-Reserve Aboriginal (ORA) youth in Canada relative to Non-Aboriginal youth. Current smoking, susceptibility to future smoking and quit attempts were examined among a nationally representative sample of ORA and Non-Aboriginal Canadian youth. Data are from cross-sectional surveys of 88,661 respondents in Grades 6 to 9 across the 2004, 2006 and 2008 survey waves of the Youth Smoking Survey (YSS). At each wave, ORA youth were more likely to be current smokers (overall OR = 3.91, 95% CI 3.47 to 4.41), to be susceptible to future smoking (overall OR = 1.37, 95% CI 1.27 to 1.48), and less likely to have ever made a quit attempt compared to Non-Aboriginal youth (overall OR = 0.74, 95% CI 0.57 to 0.96). Although susceptibility to future smoking declined for Non-Aboriginal youth, the prevalence of susceptibility remained stable among ORA youth. The percentage of ORA youth reporting making a quit attempt increased, however, current smoking rates among ORA youth did not decline. These findings suggest that the disparity in susceptibility to future tobacco use among ORA and Non-Aboriginal youth has increased over time. Despite increased rates of quit attempts, current smoking rates remain significantly higher among ORA youth. Tobacco control programs for Aboriginal youth should be a public health priority. International Journal of Environmental Research and Public Health 2013-02-21 10 2 Article 10.3390/ijerph10020729 729 741 1660-4601 2013-02-21 doi: 10.3390/ijerph10020729 Tara Elton-Marshall Scott Leatherdale Robin Burkhalter K. Brown http://www.mdpi.com/1660-4601/10/2/717 The increasing worldwide use of paediatric computed tomography (CT) has led to increasing concerns regarding the subsequent effects of exposure to radiation. In response to this concern, the international EPI-CT project was developed to study the risk of cancer in a large multi-country cohort. In radiation epidemiology, accurate estimates of organ-specific doses are essential. In EPI-CT, data collection is split into two time periods—before and after introduction of the Picture Archiving Communication System (PACS) introduced in the 1990s. Prior to PACS, only sparse information about scanner settings is available from radiology departments. Hence, a multi-level approach was developed to retrieve information from a questionnaire, surveys, scientific publications, and expert interviews. For the years after PACS was introduced, scanner settings will be extracted from Digital Imaging and Communications in Medicine (DICOM) headers, a protocol for storing medical imaging data. Radiation fields and X-ray interactions within the body will be simulated using phantoms of various ages and Monte-Carlo-based radiation transport calculations. Individual organ doses will be estimated for each child using an accepted calculation strategy, scanner settings, and the radiation transport calculations. Comprehensive analyses of missing and uncertain dosimetry data will be conducted to provide uncertainty distributions of doses. International Journal of Environmental Research and Public Health 2013-02-18 10 2 Article 10.3390/ijerph10020717 717 728 1660-4601 2013-02-18 doi: 10.3390/ijerph10020717 Isabelle Thierry-Chef Jérémie Dabin Eva Friberg Johannes Hermen Tore Istad Andreas Jahnen Lucian Krille Choonsik Lee Carlo Maccia Arvid Nordenskjöld Hilde Olerud Kaddour Rani Jean-Luc Rehel Steven Simon Lara Struelens Ausrele Kesminiene http://www.mdpi.com/1660-4601/10/2/712 In their recent article [1], Chari et al. call attention to the important subject of setting National Ambient Air Quality Standards (NAAQS) to provide requisite protection for public health, including the health of sensitive groups, as specified under the Clean Air Act (73 FR 66965) [2]. The authors focus on consideration of susceptibility to inform policy choices, using lead (Pb)-related neurocognitive effects and children from low socioeconomic status (SES) families in the context of alternative Pb standard levels. Our comments focus on the authors’ analysis of the scientific evidence and not on policy. We agree with the authors that the health effects evidence for Pb indicates a role (or roles) for SES-related factors in influencing childhood Pb exposure and associated health effects. We disagree, however, with the authors’ interpretation of the literature on SES influence on the shape of the concentration-response (C-R) relationship between children’s blood Pb and IQ (e.g., steepness of the slope). We further address aspects of the scientific evidence that are important to the consideration of sensitive populations in the context of the Pb NAAQS, and how the U.S. Environmental Protection Agency (EPA) considered this evidence in setting the Pb NAAQS in 2008. International Journal of Environmental Research and Public Health 2013-02-08 10 2 Comment 10.3390/ijerph10020712 712 716 1660-4601 2013-02-08 doi: 10.3390/ijerph10020712 Deirdre Murphy Molini Patel Ellen Kirrane Lisa Vinikoor-Imler http://www.mdpi.com/1660-4601/10/2/699 The aim of this study was to characterize the placental transfer of some environmental pollutants, and to explore the possibility of quantitatively predicting in utero exposure to these contaminants from concentrations assessed in maternal blood. Levels of toxic substances such as pesticides (p,p’-DDE, β-HCH, and HCB), polychlorinated biphenyls (PCBs), perfluorooctane sulfonate (PFOS), and perfluorooctanoic acid (PFOA) were determined in serum samples of 38 pregnant women living in Rome and in samples of cord blood from their respective newborns. The study was carried out in the years 2008–2009. PCB mean concentrations in maternal serum and cord serum ranged from 0.058 to 0.30, and from 0.018 to 0.064 ng/g·fw respectively. Arithmetic means of PFOS and PFOA concentrations in mothers and newborns were 3.2 and 1.4 ng/g·fw, and 2.9 and 1.6 ng/g·fw. A strong correlation was observed between concentrations in the maternal and the foetal compartment for PFOS (Spearman r = 0.74, p < 0.001), PFOA (Spearman r = 0.70, p < 0.001), PCB 153 (Spearman r = 0.60, p < 0.001), HCB (Spearman r = 0.68, p < 0.001), PCB 180 (Spearman r = 0.55, p = 0.0012), and p,p’-DDE (Spearman r = 0.53, p = 0.0099). A weak correlation (p < 0.1) was observed for PCBs 118 and 138. International Journal of Environmental Research and Public Health 2013-02-07 10 2 Article 10.3390/ijerph10020699 699 711 1660-4601 2013-02-07 doi: 10.3390/ijerph10020699 Maria Porpora Renato Lucchini Annalisa Abballe Anna Ingelido Silvia Valentini Eliana Fuggetta Veronica Cardi Adele Ticino Valentina Marra Anna Fulgenzi Elena Felip http://www.mdpi.com/1660-4601/10/2/678 Aboriginal people across Australia suffer significant health inequalities compared with the non-Indigenous population. Evidence indicates that inroads can be made to reduce these inequalities by better understanding social and cultural determinants of health, applying holistic notions of health and developing less rigid definitions of wellbeing. The following article draws on qualitative research on Victorian Aboriginal peoples’ relationship to their traditional land (known as Country) and its link to wellbeing, in an attempt to tackle this. Concepts of wellbeing, Country and nature have also been reviewed to gain an understanding of this relationship. An exploratory framework has been developed to understand this phenomenon focusing on positive (e.g., ancestry and partnerships) and negative (e.g., destruction of Country and racism) factors contributing to Aboriginal peoples’ health. The outcome is an explanation of how Country is a fundamental component of Aboriginal Victorian peoples’ wellbeing and the framework articulates the forces that impact positively and negatively on this duality. This review is critical to improving not only Aboriginal peoples’ health but also the capacity of all humanity to deal with environmental issues like disconnection from nature and urbanisation. International Journal of Environmental Research and Public Health 2013-02-07 10 2 Article 10.3390/ijerph10020678 678 698 1660-4601 2013-02-07 doi: 10.3390/ijerph10020678 Jonathan Kingsley Mardie Townsend Claire Henderson-Wilson Bruce Bolam http://www.mdpi.com/1660-4601/10/2/660 It is generally believed that there is an inverse relationship between population growth and vegetation cover. However, reports about vegetation protection and reforestation around the World have been continuously increasing in recent decades, which seems to indicate that this relationship may not be true. In this paper, we have taken 21 cities in Guangdong Province, China as the study area to test the long-term relationship between population growth and vegetation cover, using an AVHRR NDVI data set and the panel cointegrated regression method. The results show that there is a long-term inverted N-shaped curve relationship between population growth and vegetation cover in the region where there are frequent human activities and the influence of climate change on vegetation cover changes is relatively small. The two turning points of the inverted N-shaped curve for the case of Guangdong Province correspond to 2,200 persons·km−2 and 3,820 persons·km−2, and they can provide a reference range for similar regions of the World. It also states that the population urbanization may have a negative impact on the vegetation cover at the early stage, but have a positive impact at the later stage. In addition, the Panel Error Correction Model (PECM) is used to investigate the causality direction between population growth and vegetation cover. The results show that not only will the consuming destruction effect and planting construction effect induced by the population growth have a great impact on vegetation cover changes, but vegetation cover changes in turn will also affect the population growth in the long term. International Journal of Environmental Research and Public Health 2013-02-07 10 2 Article 10.3390/ijerph10020660 660 677 1660-4601 2013-02-07 doi: 10.3390/ijerph10020660 Chao Li Yaoqiu Kuang Ningsheng Huang Chao Zhang http://www.mdpi.com/1660-4601/10/2/638 Consumption of fish has well-known human health benefits, though some fish may contain elevated levels of mercury (Hg) that are especially harmful to developing children. Fish length is most often the basis for establishing fishery harvest regulations that determine which fish will ultimately be consumed by humans. It is, therefore, essential to quantify the relationship between fish length and Hg accumulation in regard to harvest regulations for effective fishery and public health policy. We examined this relationship for three sportfish from six lakes across North Carolina, USA. Bluegill (Lepomis macrochirus) had the lowest Hg levels and only the very largest fish in the most contaminated site exceeded the US Environmental Protection Agency (USEPA) Hg screening level. Black crappie (Pomoxis nigromaculatus) had an intermediate level of Hg and larger individuals exceeded the USEPA screening level; however, they tended not to exceed this level before reaching the harvest length limit. Largemouth bass (Micropterus salmoides) exceeded the USEPA screening level at sizes below the fishery length limit in two lakes, leaving only higher risk fish for anglers to harvest and consume. Removing the effects of fish age and trophic position, we found strong positive correlations between Hg and fish length for largemouth bass and black crappie. We suggest public health officials and wildlife managers collaborate to structure fishery regulations and length-based fish consumption advisories that protect consumers from Hg exposure and communicate the relative risk of fish consumption. International Journal of Environmental Research and Public Health 2013-02-06 10 2 Article 10.3390/ijerph10020638 638 659 1660-4601 2013-02-06 doi: 10.3390/ijerph10020638 Dana Sackett W. Cope James Rice D. Aday http://www.mdpi.com/1660-4601/10/2/623 Construction-related occupations have very high smoking prevalence rates and are an identified priority population for efforts to promote cessation. This study sought to identify the smoking cessation supports and services which best suited this workforce group, and to identify gaps in reach of preventive health services. We performed qualitative text analysis on pre-existing conversations about smoking cessation among workers in this sector. The material appeared on a discussion forum about residential construction from 1998 and 2011. Roughly 250 unique user names appeared in these discussions. The qualitative analysis addressed knowledge, motivation, environmental influences, and positive and negative experiences with supports for cessation. Self-identified smokers tended to want to quit and described little social value in smoking. Actual quit attempts were attributed to aging and tangible changes in health and fitness. Peer-to-peer social support for cessation was evident. Advice given was to avoid cigarettes and smokers, to focus on personal skills, personal commitment, and the benefits of cessation (beyond the harms from smoking). Many discussants had received medical support for cessation, but behavioural counselling services appeared underutilized. Our findings support efforts toward more complete bans on workplace smoking and increased promotion of available behavioural support services among dispersed blue-collar workers. International Journal of Environmental Research and Public Health 2013-02-04 10 2 Article 10.3390/ijerph10020623 623 637 1660-4601 2013-02-04 doi: 10.3390/ijerph10020623 Susan Bondy Kim Bercovitz http://www.mdpi.com/1660-4601/10/2/606 Based on the 2009 Thematic Household Survey in Hong Kong, this study compared health status and utilization of health care services in Hong Kong between migrants from Mainland China and natives. Overall, Mainland migrants reported lower socioeconomic conditions, worse health status, and less health care services utilization than the natives. After controlling for socio-demographic factors, we found that the migrants were 1.2 times more likely to report fair or poor health and 0.78 times less likely to report having a usual source of care, compared with the natives. Mainland migrants also had fewer physician visits and relied more on the public sector. Within the migrant group, those who had language advantage had more visits, and the recent arrivals who stayed in Hong Kong for three years or less had fewer visits and were far less likely to have a usual source of care. The findings underscore migration as an important social determinant of health in Hong Kong. A combination of targeted social and health policies is needed to help Mainland migrants better integrate into society and to improve their access to care. Programs should be tailored to address varying needs from different subgroups among migrants. International Journal of Environmental Research and Public Health 2013-02-04 10 2 Article 10.3390/ijerph10020606 606 622 1660-4601 2013-02-04 doi: 10.3390/ijerph10020606 Su Liu Catherine Hu Selene Mak http://www.mdpi.com/1660-4601/10/2/590 Objectives: To evaluate the effects of folic acid supplementation on isolated oral cleft recurrence and fetal growth. Patients and Methods: The study included 2,508 women who were at-risk for oral cleft recurrence and randomized into two folic acid supplementation groups: 0.4 and 4 mg per day before pregnancy and throughout the first trimester. The infant outcome data were based on 234 live births. In addition to oral cleft recurrence, several secondary outcomes were compared between the two folic acid groups. Cleft recurrence rates were also compared to historic recurrence rates. Results: The oral cleft recurrence rates were 2.9% and 2.5% in the 0.4 and 4 mg groups, respectively. The recurrence rates in the two folic acid groups both separately and combined were significantly different from the 6.3% historic recurrence rate post the folic acid fortification program for this population (p = 0.0009 when combining the two folic acid groups). The rate of cleft lip with palate recurrence was 2.9% in the 0.4 mg group and 0.8% in the 4 mg group. There were no elevated fetal growth complications in the 4 mg group compared to the 0.4 mg group. Conclusions: The study is the first double-blinded randomized clinical trial (RCT) to study the effect of high dosage folic acid supplementation on isolated oral cleft recurrence. The recurrence rates were similar between the two folic acid groups. However, the results are suggestive of a decrease in oral cleft recurrence compared to the historic recurrence rate. A RCT is still needed to identify the effect of folic acid on oral cleft recurrence given these suggestive results and the supportive results from previous interventional and observational studies, and the study offers suggestions for such future studies. The results also suggest that high dosage folic acid does not compromise fetal growth. International Journal of Environmental Research and Public Health 2013-02-04 10 2 Article 10.3390/ijerph10020590 590 605 1660-4601 2013-02-04 doi: 10.3390/ijerph10020590 George Wehby Têmis Félix Norman Goco Antonio Richieri-Costa Hrishikesh Chakraborty Josiane Souza Rui Pereira Carla Padovani Danilo Moretti-Ferreira Jeffrey Murray http://www.mdpi.com/1660-4601/10/2/571 Socioeconomic status is a strong predictor of cardiovascular disease. Pulse pressure, the difference between systolic and diastolic blood pressure, has been identified as an important predictor of cardiovascular risk even after accounting for absolute measures of blood pressure. However, little is known about the social determinants of pulse pressure. The aim of this study was to examine individual- and area-level socioeconomic gradients of pulse pressure in a sample of 2,789 Australian adults. Using data from the North West Adelaide Health Study we estimated the association between pulse pressure and three indices of socioeconomic status (education, income and employment status) at the area and individual level for hypertensive and normotensive participants, using Generalized Estimating Equations. In normotensive individuals, area-level education (estimate: −0.106; 95% CI: −0.172, −0.041) and individual-level income (estimate: −1.204; 95% CI: −2.357, −0.050) and employment status (estimate: −1.971; 95% CI: −2.894, −1.048) were significant predictors of pulse pressure, even after accounting for the use of medication and lifestyle behaviors. In hypertensive individuals, only individual-level measures of socioeconomic status were significant predictors of pulse pressure (education estimate: −2.618; 95% CI: −4.878, −0.357; income estimate: −1.683, 95% CI: −3.743, 0.377; employment estimate: −2.023; 95% CI: −3.721, −0.326). Further research is needed to better understand how individual- and area-level socioeconomic status influences pulse pressure in normotensive and hypertensive individuals. International Journal of Environmental Research and Public Health 2013-02-04 10 2 Article 10.3390/ijerph10020571 571 589 1660-4601 2013-02-04 doi: 10.3390/ijerph10020571 Lisa Matricciani Catherine Paquet Natasha Howard Robert Adams Neil Coffee Anne Taylor Mark Daniel http://www.mdpi.com/1660-4601/10/2/568 Those interested in child survival frequently cite and follow the under-five mortality rate. While a useful measure, the under-five mortality rate lumps together neonatal and post-neonatal mortality with deaths in the 1–4 year period. Unfortunately, this hampers public health decision making about the most appropriate child survival strategies as children survive beyond their first year of life. International Journal of Environmental Research and Public Health 2013-02-01 10 2 Editorial 10.3390/ijerph10020568 568 570 1660-4601 2013-02-01 doi: 10.3390/ijerph10020568 David Meddings http://www.mdpi.com/1660-4601/10/2/556 The present study was undertaken to determine the bacterial agents present in various clinical solid wastes, general waste and clinical sharp waste. The waste was collected from different wards/units in a healthcare facility in Penang Island, Malaysia. The presence of bacterial agents in clinical and general waste was determined using the conventional bacteria identification methods. Several pathogenic bacteria including opportunistic bacterial agent such as Pseudomonas aeruginosa, Salmonella spp., Klebsiella pneumoniae, Serratia marcescens, Acinetobacter baumannii, Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus pyogenes were detected in clinical solid wastes. The presence of specific pathogenic bacterial strains in clinical sharp waste was determined using 16s rDNA analysis. In this study, several nosocomial pathogenic bacteria strains of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Lysinibacillus sphaericus, Serratia marcescens, and Staphylococcus aureus were detected in clinical sharp waste. The present study suggests that waste generated from healthcare facilities should be sterilized at the point of generation in order to eliminate nosocomial infections from the general waste or either of the clinical wastes. International Journal of Environmental Research and Public Health 2013-01-31 10 2 Article 10.3390/ijerph10020556 556 567 1660-4601 2013-01-31 doi: 10.3390/ijerph10020556 Md. Hossain Nik Rahman Venugopal Balakrishnan Vignesh Puvanesuaran Md. Sarker Mohd Kadir http://www.mdpi.com/1660-4601/10/2/541 Aims: We assessed the levels of airborne bacteria, Gram-negative bacteria (GNB), and fungi in six hospital lobbies, and investigated the environmental and hospital characteristics that affected the airborne microorganism levels. Methods: An Andersen single-stage sampler equipped with appropriate nutrition plate agar was used to collect the samples. The three types of microorganisms were repeatedly collected at a fixed location in each hospital (assumed to be representative of the entire hospital lobby) from 08:00 through 24:00, with a sampling time of less than 5 min. Temperature and relative humidity were simultaneously monitored. Results: Multiple regression analysis was used to identify the major factors affecting microorganism levels. The average levels of bacteria (7.2 × 102 CFU/m3), GNB (1.7 × 10 CFU/m3), and fungi (7.7 × 10 CFU/m3) indicated that all hospital lobbies were generally contaminated. Season was the only factor that significantly affected the levels of all microorganisms (p < 0.0001), where contamination was the highest during the summer, significantly higher than during the winter. Other significant factors varied by microorganism, as follows: airborne bacteria (number of people in the lobby, sampling time), GNB (scale of hospital), and fungi (humidity and air temperature). Conclusions: Hospital lobby air was generally contaminated with microorganisms, including bacteria, GNB, and fungi. Environmental factors that may significantly influence the airborne concentrations of these agents should be managed to minimize airborne levels. International Journal of Environmental Research and Public Health 2013-01-31 10 2 Article 10.3390/ijerph10020541 541 555 1660-4601 2013-01-31 doi: 10.3390/ijerph10020541 Dong-Uk Park Jeong-Kwan Yeom Won Lee Kyeong-Min Lee