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Open AccessHypothesis Glyphosate, Hard Water and Nephrotoxic Metals: Are They the Culprits Behind the Epidemic of Chronic Kidney Disease of Unknown Etiology in Sri Lanka?

by Channa Jayasumana, Sarath Gunatilake and Priyantha Senanayake

Int. J. Environ. Res. Public Health 2014, 11(2), 2125-2147; doi:10.3390/ijerph110202125

Received: 17 December 2013 / Revised: 22 January 2014 / Accepted: 27 January 2014 / Published: 20 February 2014

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Abstract

The current chronic kidney disease epidemic, the major health issue in the rice paddy farming areas in Sri Lanka has been the subject of many scientific and political debates over the last decade. Although there is no agreement among scientists about the etiology

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The current chronic kidney disease epidemic, the major health issue in the rice paddy farming areas in Sri Lanka has been the subject of many scientific and political debates over the last decade. Although there is no agreement among scientists about the etiology of the disease, a majority of them has concluded that this is a toxic nephropathy. None of the hypotheses put forward so far could explain coherently the totality of clinical, biochemical, histopathological findings, and the unique geographical distribution of the disease and its appearance in the mid-1990s. A strong association between the consumption of hard water and the occurrence of this special kidney disease has been observed, but the relationship has not been explained consistently. Here, we have hypothesized the association of using glyphosate, the most widely used herbicide in the disease endemic area and its unique metal chelating properties. The possible role played by glyphosate-metal complexes in this epidemic has not been given any serious consideration by investigators for the last two decades. Furthermore, it may explain similar kidney disease epidemics observed in Andra Pradesh (India) and Central America. Although glyphosate alone does not cause an epidemic of chronic kidney disease, it seems to have acquired the ability to destroy the renal tissues of thousands of farmers when it forms complexes with a localized geo environmental factor (hardness) and nephrotoxic metals. Full article

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Open AccessArticle Characteristics, Perceived Side Effects and Benefits of Electronic Cigarette Use: A Worldwide Survey of More than 19,000 Consumers

by Konstantinos E. Farsalinos, Giorgio Romagna, Dimitris Tsiapras, Stamatis Kyrzopoulos and Vassilis Voudris

Int. J. Environ. Res. Public Health 2014, 11(4), 4356-4373; doi:10.3390/ijerph110404356

Received: 10 February 2014 / Revised: 14 April 2014 / Accepted: 15 April 2014 / Published: 22 April 2014

Cited by 110 | Viewed by 32873 | PDF Full-text (232 KB) | HTML Full-text | XML Full-text

Abstract

Background: Electronic cigarette (EC) use has grown exponentially over the past few years. The purpose of this survey was to assess the characteristics and experiences of a large sample of EC users and examine the differences between those who partially and completely

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Background: Electronic cigarette (EC) use has grown exponentially over the past few years. The purpose of this survey was to assess the characteristics and experiences of a large sample of EC users and examine the differences between those who partially and completely substituted smoking with EC use. Methods: A questionnaire was prepared, translated into 10 different languages and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers. Results: In total, 19,414 participants were included in the analysis, with 88 of them (0.5%) reported not being smokers at the time of EC use initiation. Complete substitution of smoking was reported by 81.0% of participants (former smokers) while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. They were using ECs for a median of 10 months. They initiated EC use with a median of 18 mg/mL nicotine-concentration liquids; 21.5% used higher than 20 mg/mL. Only 3.5% of participants were using 0-nicotine liquids at the time of the survey. Former smokers were highly dependent (Fagerström Test for Cigarette Dependence = 7) and were heavier smokers (21 cigarettes per day when smoking) compared to current smokers. The most important reasons for initiating EC use for both subgroups was to reduce the harm associated with smoking and to reduce exposure of family members to second-hand smoking. Most considered ECs as less harmful than tobacco cigarettes, while 11.0% considered them absolutely harmless. Side effects were reported by more than half of the participants (59.8%), with the most common being sore/dry mouth and throat; side effects were mild and in most cases were subsequently resolved (partially or completely). Participants experienced significant benefits in physical status and improvements in pre-existing disease conditions (including respiratory disease such as asthma and chronic obstructive lung disease). Being former smoker was independently associated with positive effects in health and improvements in disease conditions. Conclusions: The results of this worldwide survey of dedicated users indicate that ECs are mostly used to avoid the harm associated with smoking. They can be effective even in highly-dependent smokers and are used as long-term substitutes for smoking. High levels of nicotine are used at initiation; subsequently, users try to reduce nicotine consumption, with only a small minority using non-nicotine liquids. Side effects are minor and health benefits are substantial, especially for those who completely substitute smoking with EC use. Further population and interventional studies are warranted. Full article

(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)

Open AccessArticle Cancer, Infant Mortality and Birth Sex-Ratio in Fallujah, Iraq 2005–2009

by Chris Busby, Malak Hamdan and Entesar Ariabi

Int. J. Environ. Res. Public Health 2010, 7(7), 2828-2837; doi:10.3390/ijerph7072828

Received: 7 June 2010 / Revised: 23 June 2010 / Accepted: 30 June 2010 / Published: 6 July 2010

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Abstract

There have been anecdotal reports of increases in birth defects and cancer in Fallujah, Iraq blamed on the use of novel weapons (possibly including depleted uranium) in heavy fighting which occurred in that town between US led forces and local elements in 2004.

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There have been anecdotal reports of increases in birth defects and cancer in Fallujah, Iraq blamed on the use of novel weapons (possibly including depleted uranium) in heavy fighting which occurred in that town between US led forces and local elements in 2004. In Jan/Feb 2010 the authors organised a team of researchers who visited 711 houses in Fallujah, Iraq and obtained responses to a questionnaire in Arabic on cancer, birth defects and infant mortality. The total population in the resulting sample was 4,843 persons with and overall response rate was better than 60%. Relative Risks for cancer were age-standardised and compared to rates in the Middle East Cancer Registry (MECC, Garbiah Egypt) for 1999 and rates in Jordan 1996–2001. Between Jan 2005 and the survey end date there were 62 cases of cancer malignancy reported (RR = 4.22; CI: 2.8, 6.6; p < 0.00000001) including 16 cases of childhood cancer 0-14 (RR = 12.6; CI: 4.9, 32; p < 0.00000001). Highest risks were found in all-leukaemia in the age groups 0-34 (20 cases RR = 38.5; CI: 19.2, 77; p < 0.00000001), all lymphoma 0–34 (8 cases, RR = 9.24;CI: 4.12, 20.8; p < 0.00000001), female breast cancer 0–44 (12 cases RR = 9.7;CI: 3.6, 25.6; p < 0.00000001) and brain tumours all ages (4 cases, RR = 7.4;CI: 2.4, 23.1; P < 0.004). Infant mortality was based on the mean birth rate over the 4 year period 2006–2009 with 1/6th added for cases reported in January and February 2010. There were 34 deaths in the age group 0–1 in this period giving a rate of 80 deaths per 1,000 births. This may be compared with a rate of 19.8 in Egypt (RR = 4.2 p < 0.00001) 17 in Jordan in 2008 and 9.7 in Kuwait in 2008. The mean birth sex-ratio in the recent 5-year cohort was anomalous. Normally the sex ratio in human populations is a constant with 1,050 boys born to 1,000 girls. This is disturbed if there is a genetic damage stress. The ratio of boys to 1,000 girls in the 0–4, 5–9, 10–14 and 15–19 age cohorts in the Fallujah sample were 860, 1,182, 1,108 and 1,010 respectively suggesting genetic damage to the 0–4 group (p < 0.01). Whilst the results seem to qualitatively support the existence of serious mutation-related health effects in Fallujah, owing to the structural problems associated with surveys of this kind, care should be exercised in interpreting the findings quantitatively. Full article

Open AccessArticle Effect of Smoking Abstinence and Reduction in Asthmatic Smokers Switching to Electronic Cigarettes: Evidence for Harm Reversal

by Riccardo Polosa, Jaymin Morjaria, Pasquale Caponnetto, Massimo Caruso, Simona Strano, Eliana Battaglia and Cristina Russo

Int. J. Environ. Res. Public Health 2014, 11(5), 4965-4977; doi:10.3390/ijerph110504965

Received: 3 April 2014 / Revised: 24 April 2014 / Accepted: 30 April 2014 / Published: 8 May 2014

Cited by 37 | Viewed by 21757 | PDF Full-text (393 KB) | HTML Full-text | XML Full-text

Abstract

Electronic cigarettes (e-cigs) are marketed as safer alternatives to tobacco cigarettes and have shown to reduce their consumption. Here we report for the first time the effects of e-cigs on subjective and objective asthma parameters as well as tolerability in asthmatic smokers who

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Electronic cigarettes (e-cigs) are marketed as safer alternatives to tobacco cigarettes and have shown to reduce their consumption. Here we report for the first time the effects of e-cigs on subjective and objective asthma parameters as well as tolerability in asthmatic smokers who quit or reduced their tobacco consumption by switching to these products. We retrospectively reviewed changes in spirometry data, airway hyper-responsiveness (AHR), asthma exacerbations and subjective asthma control in smoking asthmatics who switched to regular e-cig use. Measurements were taken prior to switching (baseline) and at two consecutive visits (Follow-up/1 at 6 (±1) and Follow-up/2 at 12 (±2) months). Eighteen smoking asthmatics (10 single users, eight dual users) were identified. Overall there were significant improvements in spirometry data, asthma control and AHR. These positive outcomes were noted in single and dual users. Reduction in exacerbation rates was reported, but was not significant. No severe adverse events were noted. This small retrospective study indicates that regular use of e-cigs to substitute smoking is associated with objective and subjective improvements in asthma outcomes. Considering that e-cig use is reportedly less harmful than conventional smoking and can lead to reduced cigarette consumption with subsequent improvements in asthma outcomes, this study shows that e-cigs can be a valid option for asthmatic patients who cannot quit smoking by other methods. Full article

(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)

Open AccessArticle Evaluation of Electronic Cigarette Use (Vaping) Topography and Estimation of Liquid Consumption: Implications for Research Protocol Standards Definition and for Public Health Authorities’ Regulation

by Konstantinos E. Farsalinos, Giorgio Romagna, Dimitris Tsiapras, Stamatis Kyrzopoulos and Vassilis Voudris

Int. J. Environ. Res. Public Health 2013, 10(6), 2500-2514; doi:10.3390/ijerph10062500

Received: 18 May 2013 / Revised: 6 June 2013 / Accepted: 7 June 2013 / Published: 18 June 2013

Cited by 85 | Viewed by 21413 | PDF Full-text (572 KB) | HTML Full-text | XML Full-text

Abstract

Background: Although millions of people are using electronic cigarettes (ECs) and research on this topic has intensified in recent years, the pattern of EC use has not been systematically studied. Additionally, no comparative measure of exposure and nicotine delivery between EC and

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Background: Although millions of people are using electronic cigarettes (ECs) and research on this topic has intensified in recent years, the pattern of EC use has not been systematically studied. Additionally, no comparative measure of exposure and nicotine delivery between EC and tobacco cigarette or nicotine replacement therapy (NRTs) has been established. This is important, especially in the context of the proposal for a new Tobacco Product Directive issued by the European Commission. Methods: A second generation EC device, consisting of a higher capacity battery and tank atomiser design compared to smaller cigarette-like batteries and cartomizers, and a 9 mg/mL nicotine-concentration liquid were used in this study. Eighty subjects were recruited; 45 experienced EC users and 35 smokers. EC users were video-recorded when using the device (ECIG group), while smokers were recorded when smoking (SM-S group) and when using the EC (SM-E group) in a randomized cross-over design. Puff, inhalation and exhalation duration were measured. Additionally, the amount of EC liquid consumed by experienced EC users was measured at 5 min (similar to the time needed to smoke one tobacco cigarette) and at 20 min (similar to the time needed for a nicotine inhaler to deliver 4 mg nicotine). Results: Puff duration was significantly higher in ECIG (4.2 ± 0.7 s) compared to SM-S (2.1 ± 0.4 s) and SM-E (2.3 ± 0.5 s), while inhalation time was lower (1.3 ± 0.4, 2.1 ± 0.4 and 2.1 ± 0.4 respectively). No difference was observed in exhalation duration. EC users took 13 puffs and consumed 62 ± 16 mg liquid in 5 min; they took 43 puffs and consumed 219 ± 56 mg liquid in 20 min. Nicotine delivery was estimated at 0.46 ± 0.12 mg after 5 min and 1.63 ± 0.41 mg after 20 min of use. Therefore, 20.8 mg/mL and 23.8 mg/mL nicotine-containing liquids would deliver 1 mg of nicotine in 5 min and 4 mg nicotine in 20 min, respectively. Since the ISO method significantly underestimates nicotine delivery by tobacco cigarettes, it seems that liquids with even higher than 24 mg/mL nicotine concentration would be comparable to one tobacco cigarette. Conclusions: EC use topography is significantly different compared to smoking. Four-second puffs with 20–30 s interpuff interval should be used when assessing EC effects in laboratory experiments, provided that the equipment used does not get overheated. Based on the characteristics of the device used in this study, a 20 mg/mL nicotine concentration liquid would be needed in order to deliver nicotine at amounts similar to the maximum allowable content of one tobacco cigarette (as measured by the ISO 3308 method). The results of this study do not support the statement of the European Commission Tobacco Product Directive that liquids with nicotine concentration of 4 mg/mL are comparable to NRTs in the amount of nicotine delivered to the user. Full article

Open AccessArticle Evidence of Coal-Fly-Ash Toxic Chemical Geoengineering in the Troposphere: Consequences for Public Health

by J. Marvin Herndon

Int. J. Environ. Res. Public Health 2015, 12(8), 9375-9390; doi:10.3390/ijerph120809375

Received: 29 June 2015 / Revised: 4 August 2015 / Accepted: 5 August 2015 / Published: 11 August 2015

Abstract

The widespread, intentional and increasingly frequent chemical emplacement in the troposphere has gone unidentified and unremarked in the scientific literature for years. The author presents evidence that toxic coal combustion fly ash is the most likely aerosolized particulate sprayed by tanker-jets for geoengineering,

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The widespread, intentional and increasingly frequent chemical emplacement in the troposphere has gone unidentified and unremarked in the scientific literature for years. The author presents evidence that toxic coal combustion fly ash is the most likely aerosolized particulate sprayed by tanker-jets for geoengineering, weather-modification and climate-modification purposes and describes some of the multifold consequences on public health. Two methods are employed: (1) Comparison of 8 elements analyzed in rainwater, leached from aerosolized particulates, with corresponding elements leached into water from coal fly ash in published laboratory experiments, and (2) Comparison of 14 elements analyzed in dust collected outdoors on a high-efficiency particulate air (HEPA) filter with corresponding elements analyzed in un-leached coal fly ash material. The results show: (1) the assemblage of elements in rainwater and in the corresponding experimental leachate are essentially identical. At a 99% confidence interval, they have identical means (T-test) and identical variances (F-test); and (2) the assemblage of elements in the HEPA dust and in the corresponding average un-leached coal fly ash are likewise essentially identical. The consequences on public health are profound, including exposure to a variety of toxic heavy metals, radioactive elements, and neurologically-implicated chemically mobile aluminum released by body moisture in situ after inhalation or through transdermal induction. Full article

Open AccessArticle Comparison of the Cytotoxic Potential of Cigarette Smoke and Electronic Cigarette Vapour Extract on Cultured Myocardial Cells

by Konstantinos E. Farsalinos, Giorgio Romagna, Elena Allifranchini, Emiliano Ripamonti, Elena Bocchietto, Stefano Todeschi, Dimitris Tsiapras, Stamatis Kyrzopoulos and Vassilis Voudris

Int. J. Environ. Res. Public Health 2013, 10(10), 5146-5162; doi:10.3390/ijerph10105146

Received: 16 August 2013 / Revised: 30 September 2013 / Accepted: 12 October 2013 / Published: 16 October 2013

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Abstract

Background: Electronic cigarettes (ECs) have been marketed as an alternative-to-smoking habit. Besides chemical studies of the content of EC liquids or vapour, little research has been conducted on their in vitro effects. Smoking is an important risk factor for cardiovascular disease and cigarette

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Background: Electronic cigarettes (ECs) have been marketed as an alternative-to-smoking habit. Besides chemical studies of the content of EC liquids or vapour, little research has been conducted on their in vitro effects. Smoking is an important risk factor for cardiovascular disease and cigarette smoke (CS) has well-established cytotoxic effects on myocardial cells. The purpose of this study was to evaluate the cytotoxic potential of the vapour of 20 EC liquid samples and a “base” liquid sample (50% glycerol and 50% propylene glycol, with no nicotine or flavourings) on cultured myocardial cells. Included were 4 samples produced by using cured tobacco leaves in order to extract the tobacco flavour. Methods: Cytotoxicity was tested according to the ISO 10993-5 standard. By activating an EC device at 3.7 volts (6.2 watts—all samples, including the “base” liquid) and at 4.5 volts (9.2 watts—four randomly selected samples), 200 mg of liquid evaporated and was extracted in 20 mL of culture medium. Cigarette smoke (CS) extract from three tobacco cigarettes was produced according to ISO 3308 method (2 s puffs of 35 mL volume, one puff every 60 s). The extracts, undiluted (100%) and in four dilutions (50%, 25%, 12.5%, and 6.25%), were applied to myocardial cells (H9c2); percent-viability was measured after 24 h incubation. According to ISO 10993-5, viability of <70% was considered cytotoxic. Results: CS extract was cytotoxic at extract concentrations >6.25% (viability: 76.9 ± 2.0% at 6.25%, 38.2 ± 0.5% at 12.5%, 3.1 ± 0.2% at 25%, 5.2 ± 0.8% at 50%, and 3.9 ± 0.2% at 100% extract concentration). Three EC extracts (produced by tobacco leaves) were cytotoxic at 100% and 50% extract concentrations (viability range: 2.2%–39.1% and 7.4%–66.9% respectively) and one (“Cinnamon-Cookies” flavour) was cytotoxic at 100% concentration only (viability: 64.8 ± 2.5%). Inhibitory concentration 50 was >3 times lower in CS extract compared to the worst-performing EC vapour extract. For EC extracts produced by high-voltage and energy, viability was reduced but no sample was cytotoxic according to ISO 10993-5 definition. Vapour produced by the “base” liquid was not cytotoxic at any extract concentration. Cell survival was not associated with nicotine concentration of EC liquids. Conclusions: This study indicates that some EC samples have cytotoxic properties on cultured cardiomyoblasts, associated with the production process and materials used in flavourings. However, all EC vapour extracts were significantly less cytotoxic compared to CS extract. Full article

Open AccessArticle Emerging Patient-Driven Health Care Models: An Examination of Health Social Networks, Consumer Personalized Medicine and Quantified Self-Tracking

by Melanie Swan

Int. J. Environ. Res. Public Health 2009, 6(2), 492-525; doi:10.3390/ijerph6020492

Received: 9 January 2009 / Accepted: 2 February 2009 / Published: 5 February 2009

Cited by 251 | Viewed by 18536 | PDF Full-text (3229 KB) | HTML Full-text | XML Full-text

Abstract

A new class of patient-driven health care services is emerging to supplement and extend traditional health care delivery models and empower patient self-care. Patient-driven health care can be characterized as having an increased level of information flow, transparency, customization, collaboration and patient choice

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A new class of patient-driven health care services is emerging to supplement and extend traditional health care delivery models and empower patient self-care. Patient-driven health care can be characterized as having an increased level of information flow, transparency, customization, collaboration and patient choice and responsibility-taking, as well as quantitative, predictive and preventive aspects. The potential exists to both improve traditional health care systems and expand the concept of health care though new services. This paper examines three categories of novel health services: health social networks, consumer personalized medicine and quantified self-tracking. Full article

(This article belongs to the Special Issue Public Health: Feature Papers)

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Open AccessReview Online Social Networking and Addiction—A Review of the Psychological Literature

by Daria J. Kuss and Mark D. Griffiths

Int. J. Environ. Res. Public Health 2011, 8(9), 3528-3552; doi:10.3390/ijerph8093528

Received: 9 March 2011 / Revised: 12 August 2011 / Accepted: 22 August 2011 / Published: 29 August 2011

Cited by 306 | Viewed by 16760 | PDF Full-text (286 KB) | HTML Full-text | XML Full-text

Abstract

Social Networking Sites (SNSs) are virtual communities where users can create individual public profiles, interact with real-life friends, and meet other people based on shared interests. They are seen as a ‘global consumer phenomenon’ with an exponential rise in usage within the last

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Social Networking Sites (SNSs) are virtual communities where users can create individual public profiles, interact with real-life friends, and meet other people based on shared interests. They are seen as a ‘global consumer phenomenon’ with an exponential rise in usage within the last few years. Anecdotal case study evidence suggests that ‘addiction’ to social networks on the Internet may be a potential mental health problem for some users. However, the contemporary scientific literature addressing the addictive qualities of social networks on the Internet is scarce. Therefore, this literature review is intended to provide empirical and conceptual insight into the emerging phenomenon of addiction to SNSs by: (1) outlining SNS usage patterns, (2) examining motivations for SNS usage, (3) examining personalities of SNS users, (4) examining negative consequences of SNS usage, (5) exploring potential SNS addiction, and (6) exploring SNS addiction specificity and comorbidity. The findings indicate that SNSs are predominantly used for social purposes, mostly related to the maintenance of established offline networks. Moreover, extraverts appear to use social networking sites for social enhancement, whereas introverts use it for social compensation, each of which appears to be related to greater usage, as does low conscientiousness and high narcissism. Negative correlates of SNS usage include the decrease in real life social community participation and academic achievement, as well as relationship problems, each of which may be indicative of potential addiction. Full article

(This article belongs to the Special Issue Substance and Behavioral Addictions: Co-Occurrence and Specificity)

Open AccessArticle Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey

by Konstantinos E. Farsalinos, Giorgio Romagna, Dimitris Tsiapras, Stamatis Kyrzopoulos, Alketa Spyrou and Vassilis Voudris

Int. J. Environ. Res. Public Health 2013, 10(12), 7272-7282; doi:10.3390/ijerph10127272

Received: 19 November 2013 / Revised: 11 December 2013 / Accepted: 12 December 2013 / Published: 17 December 2013

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Abstract

Background: A major characteristic of the electronic cigarette (EC) market is the availability of a large number of different flavours. This has been criticised by the public health authorities, some of whom believe that diverse flavours will attract young users and that ECs

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Background: A major characteristic of the electronic cigarette (EC) market is the availability of a large number of different flavours. This has been criticised by the public health authorities, some of whom believe that diverse flavours will attract young users and that ECs are a gateway to smoking. At the same time, several reports in the news media mention that the main purpose of flavour marketing is to attract youngsters. The importance of flavourings and their patterns of use by EC consumers have not been adequately evaluated, therefore, the purpose of this survey was to examine and understand the impact of flavourings in the EC experience of dedicated users. Methods: A questionnaire was prepared and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers. Results: In total, 4,618 participants were included in the analysis, with 4,515 reporting current smoking status. The vast majority (91.1%) were former smokers, while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. Both subgroups had a median smoking history of 22 years and had been using ECs for 12 months. On average they were using three different types of liquid flavours on a regular basis, with former smokers switching between flavours more frequently compared to current smokers; 69.2% of the former subgroup reported doing so on a daily basis or within the day. Fruit flavours were more popular at the time of participation, while tobacco flavours were more popular at initiation of EC use. On a scale from 1 (not at all important) to 5 (extremely important) participants answered that variability of flavours was “very important” (score = 4) in their effort to reduce or quit smoking. The majority reported that restricting variability will make ECs less enjoyable and more boring, while 48.5% mentioned that it would increase craving for cigarettes and 39.7% said that it would have been less likely for them to reduce or quit smoking. The number of flavours used was independently associated with smoking cessation. Conclusions: The results of this survey of dedicated users indicate that flavours are marketed in order to satisfy vapers’ demand. They appear to contribute to both perceived pleasure and the effort to reduce cigarette consumption or quit smoking. Due to the fact that adoption of ECs by youngsters is currently minimal, it seems that implementing regulatory restrictions to flavours could cause harm to current vapers while no public health benefits would be observed in youngsters. Therefore, flavours variability should be maintained; any potential future risk for youngsters being attracted to ECs can be sufficiently minimized by strictly prohibiting EC sales in this population group. Full article

(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)

Open AccessArticle Stress Recovery during Exposure to Nature Sound and Environmental Noise

by Jesper J. Alvarsson, Stefan Wiens and Mats E. Nilsson

Int. J. Environ. Res. Public Health 2010, 7(3), 1036-1046; doi:10.3390/ijerph7031036

Received: 26 January 2010 / Revised: 20 February 2010 / Accepted: 5 March 2010 / Published: 11 March 2010

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Abstract

Research suggests that visual impressions of natural compared with urban environments facilitate recovery after psychological stress. To test whether auditory stimulation has similar effects, 40 subjects were exposed to sounds from nature or noisy environments after a stressful mental arithmetic task. Skin conductance

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

(This article belongs to the Special Issue Noise and Quality of Life)

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Open AccessReview Leg Length, Body Proportion, and Health: A Review with a Note on Beauty

by Barry Bogin and Maria Inês Varela-Silva

Int. J. Environ. Res. Public Health 2010, 7(3), 1047-1075; doi:10.3390/ijerph7031047

Received: 16 December 2009 / Revised: 28 January 2010 / Accepted: 8 March 2010 / Published: 11 March 2010

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Abstract

Decomposing stature into its major components is proving to be a useful strategy to assess the antecedents of disease, morbidity and death in adulthood. Human leg length (femur + tibia), sitting height (trunk length + head length) and their proportions, for example, (leg

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

(This article belongs to the Special Issue Advances in Epidemiology)

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Open AccessReview The Essential Toxin: Impact of Zinc on Human Health

by Laura M. Plum, Lothar Rink and Hajo Haase

Int. J. Environ. Res. Public Health 2010, 7(4), 1342-1365; doi:10.3390/ijerph7041342

Received: 27 January 2010 / Revised: 8 March 2010 / Accepted: 10 March 2010 / Published: 26 March 2010

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Abstract

Compared to several other metal ions with similar chemical properties, zinc is relatively harmless. Only exposure to high doses has toxic effects, making acute zinc intoxication a rare event. In addition to acute intoxication, long-term, high-dose zinc supplementation interferes with the uptake of

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Compared to several other metal ions with similar chemical properties, zinc is relatively harmless. Only exposure to high doses has toxic effects, making acute zinc intoxication a rare event. In addition to acute intoxication, long-term, high-dose zinc supplementation interferes with the uptake of copper. Hence, many of its toxic effects are in fact due to copper deficiency. While systemic homeostasis and efficient regulatory mechanisms on the cellular level generally prevent the uptake of cytotoxic doses of exogenous zinc, endogenous zinc plays a significant role in cytotoxic events in single cells. Here, zinc influences apoptosis by acting on several molecular regulators of programmed cell death, including caspases and proteins from the Bcl and Bax families. One organ where zinc is prominently involved in cell death is the brain, and cytotoxicity in consequence of ischemia or trauma involves the accumulation of free zinc. Rather than being a toxic metal ion, zinc is an essential trace element. Whereas intoxication by excessive exposure is rare, zinc deficiency is widespread and has a detrimental impact on growth, neuronal development, and immunity, and in severe cases its consequences are lethal. Zinc deficiency caused by malnutrition and foods with low bioavailability, aging, certain diseases, or deregulated homeostasis is a far more common risk to human health than intoxication. Full article

(This article belongs to the Special Issue Heavy Metals and Health)

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Open AccessCommunication Cigarettes Butts and the Case for an Environmental Policy on Hazardous Cigarette Waste

by Thomas E. Novotny, Kristen Lum, Elizabeth Smith, Vivian Wang and Richard Barnes

Int. J. Environ. Res. Public Health 2009, 6(5), 1691-1705; doi:10.3390/ijerph6051691

Received: 2 April 2009 / Accepted: 19 May 2009 / Published: 20 May 2009

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Abstract

Discarded cigarette butts are a form of non-biodegradable litter. Carried as runoff from streets to drains, to rivers, and ultimately to the ocean and its beaches, cigarette filters are the single most collected item in international beach cleanups each year. They are an

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Discarded cigarette butts are a form of non-biodegradable litter. Carried as runoff from streets to drains, to rivers, and ultimately to the ocean and its beaches, cigarette filters are the single most collected item in international beach cleanups each year. They are an environmental blight on streets, sidewalks, and other open areas. Rather than being a protective health device, cigarette filters are primarily a marketing tool to help sell ‘safe’ cigarettes. They are perceived by much of the public (especially current smokers) to reduce the health risks of smoking through technology. Filters have reduced the machine-measured yield of tar and nicotine from burning cigarettes, but there is controversy as to whether this has correspondingly reduced the disease burden of smoking to the population. Filters actually may serve to sustain smoking by making it seem less urgent for smokers to quit and easier for children to initiate smoking because of reduced irritation from early experimentation. Several options are available to reduce the environmental impact of cigarette butt waste, including developing biodegradable filters, increasing fines and penalties for littering butts, monetary deposits on filters, increasing availability of butt receptacles, and expanded public education. It may even be possible to ban the sale of filtered cigarettes altogether on the basis of their adverse environmental impact. This option may be attractive in coastal regions where beaches accumulate butt waste and where smoking indoors is increasingly prohibited. Additional research is needed on the various policy options, including behavioral research on the impact of banning the sale of filtered cigarettes altogether. Full article

(This article belongs to the Special Issue Tobacco Smoking and Public Health)

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Open AccessReview Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences

by Kamal Chaouachi

Int. J. Environ. Res. Public Health 2009, 6(2), 798-843; doi:10.3390/ijerph6020798

Received: 4 January 2009 / Accepted: 8 February 2009 / Published: 23 February 2009

Cited by 64 | Viewed by 14090 | PDF Full-text (807 KB) | HTML Full-text | XML Full-text

Abstract

Hookah (narghile, shisha, “water-pipe”) smoking is now seen by public health officials as a global tobacco epidemic. Cigarette Environmental Tobacco Smoke (ETS) is classically understood as a combination of Side-Stream Smoke (SSS) and Exhaled Main-Stream Smoke (EMSS), both diluted and aged. Some of

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Hookah (narghile, shisha, “water-pipe”) smoking is now seen by public health officials as a global tobacco epidemic. Cigarette Environmental Tobacco Smoke (ETS) is classically understood as a combination of Side-Stream Smoke (SSS) and Exhaled Main-Stream Smoke (EMSS), both diluted and aged. Some of the corresponding cigarette studies have served as the scientific basis for stringent legislation on indoor smoking across the world. Interestingly, one of the distinctive traits of the hookah device is that it generates almost no SSS. Indeed, its ETS is made up almost exclusively by the smoke exhaled by the smoker (EMSS), i.e. which has been filtered by the hookah at the level of the bowl, inside the water, along the hose and then by the smoker’s respiratory tract itself. The present paper reviews the sparse and scattered scientific evidence available about hookah EMSS and the corresponding inferences that can be drawn from the composition of cigarette EMSS. The reviewed literature shows that most of hookah ETS is made up of EMSS and that the latter qualitatively differs from MSS. Keeping in mind that the first victim of passive smoking is the active smoker her/himself, the toxicity of hookah ETS for non-smokers should not be overestimated and hyped in an unscientific way. Full article

(This article belongs to the Special Issue Public Health: Feature Papers)

Open AccessArticle Global Access to Safe Water: Accounting for Water Quality and the Resulting Impact on MDG Progress

by Kyle Onda, Joe LoBuglio and Jamie Bartram

Int. J. Environ. Res. Public Health 2012, 9(3), 880-894; doi:10.3390/ijerph9030880

Received: 14 February 2012 / Revised: 28 February 2012 / Accepted: 1 March 2012 / Published: 14 March 2012

Cited by 138 | Viewed by 13876 | PDF Full-text (554 KB) | HTML Full-text | XML Full-text

Abstract

Monitoring of progress towards the Millennium Development Goal (MDG) drinking water target relies on classification of water sources as “improved” or “unimproved” as an indicator for water safety. We adjust the current Joint Monitoring Programme (JMP) estimate by accounting for microbial water quality

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Monitoring of progress towards the Millennium Development Goal (MDG) drinking water target relies on classification of water sources as “improved” or “unimproved” as an indicator for water safety. We adjust the current Joint Monitoring Programme (JMP) estimate by accounting for microbial water quality and sanitary risk using the only-nationally representative water quality data currently available, that from the WHO and UNICEF “Rapid Assessment of Drinking Water Quality”. A principal components analysis (PCA) of national environmental and development indicators was used to create models that predicted, for most countries, the proportions of piped and of other-improved water supplies that are faecally contaminated; and of these sources, the proportions that lack basic sanitary protection against contamination. We estimate that 1.8 billion people (28% of the global population) used unsafe water in 2010. The 2010 JMP estimate is that 783 million people (11%) use unimproved sources. Our estimates revise the 1990 baseline from 23% to 37%, and the target from 12% to 18%, resulting in a shortfall of 10% of the global population towards the MDG target in 2010. In contrast, using the indicator “use of an improved source” suggests that the MDG target for drinking-water has already been achieved. We estimate that an additional 1.2 billion (18%) use water from sources or systems with significant sanitary risks. While our estimate is imprecise, the magnitude of the estimate and the health and development implications suggest that greater attention is needed to better understand and manage drinking water safety. Full article

(This article belongs to the Special Issue Drinking Water and Health)

Open AccessArticle The Liver-Brain Axis of Alcohol-Mediated Neurodegeneration: Role of Toxic Lipids

by Suzanne M. De la Monte, Lisa Longato, Ming Tong, Sarah DeNucci and Jack R. Wands

Int. J. Environ. Res. Public Health 2009, 6(7), 2055-2075; doi:10.3390/ijerph6072055

Received: 24 June 2009 / Accepted: 16 July 2009 / Published: 23 July 2009

Cited by 48 | Viewed by 13226 | PDF Full-text (762 KB) | HTML Full-text | XML Full-text

Abstract

Alcohol abuse causes progressive toxicity and degeneration in liver and brain due to insulin resistance, which exacerbates oxidative stress and pro-inflammatory cytokine activation. Alcohol-induced steatohepatitis promotes synthesis and accumulation of ceramides and other toxic lipids that cause insulin resistance. Ceramides can readily cross

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Alcohol abuse causes progressive toxicity and degeneration in liver and brain due to insulin resistance, which exacerbates oxidative stress and pro-inflammatory cytokine activation. Alcohol-induced steatohepatitis promotes synthesis and accumulation of ceramides and other toxic lipids that cause insulin resistance. Ceramides can readily cross the blood-brain barrier, and ceramide exposure causes neurodegeneration with insulin resistance and oxidative stress, similar to the effects of alcohol. Therefore, in addition to its direct neurotoxic effects, alcohol misuse establishes a liver-brain axis of neurodegeneration mediated by toxic lipid trafficking across the blood-brain barrier, leading to progressive white matter degeneration and cognitive impairment. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

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Open AccessReview Pesticide Exposure, Safety Issues, and Risk Assessment Indicators

by Christos A. Damalas and Ilias G. Eleftherohorinos

Int. J. Environ. Res. Public Health 2011, 8(5), 1402-1419; doi:10.3390/ijerph8051402

Received: 12 January 2011 / Revised: 18 April 2011 / Accepted: 28 April 2011 / Published: 6 May 2011

Cited by 212 | Viewed by 13180 | PDF Full-text (199 KB) | HTML Full-text | XML Full-text

Abstract

Pesticides are widely used in agricultural production to prevent or control pests, diseases, weeds, and other plant pathogens in an effort to reduce or eliminate yield losses and maintain high product quality. Although pesticides are developed through very strict regulation processes to function

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Pesticides are widely used in agricultural production to prevent or control pests, diseases, weeds, and other plant pathogens in an effort to reduce or eliminate yield losses and maintain high product quality. Although pesticides are developed through very strict regulation processes to function with reasonable certainty and minimal impact on human health and the environment, serious concerns have been raised about health risks resulting from occupational exposure and from residues in food and drinking water. Occupational exposure to pesticides often occurs in the case of agricultural workers in open fields and greenhouses, workers in the pesticide industry, and exterminators of house pests. Exposure of the general population to pesticides occurs primarily through eating food and drinking water contaminated with pesticide residues, whereas substantial exposure can also occur in or around the home. Regarding the adverse effects on the environment (water, soil and air contamination from leaching, runoff, and spray drift, as well as the detrimental effects on wildlife, fish, plants, and other non-target organisms), many of these effects depend on the toxicity of the pesticide, the measures taken during its application, the dosage applied, the adsorption on soil colloids, the weather conditions prevailing after application, and how long the pesticide persists in the environment. Therefore, the risk assessment of the impact of pesticides either on human health or on the environment is not an easy and particularly accurate process because of differences in the periods and levels of exposure, the types of pesticides used (regarding toxicity and persistence), and the environmental characteristics of the areas where pesticides are usually applied. Also, the number of the criteria used and the method of their implementation to assess the adverse effects of pesticides on human health could affect risk assessment and would possibly affect the characterization of the already approved pesticides and the approval of the new compounds in the near future. Thus, new tools or techniques with greater reliability than those already existing are needed to predict the potential hazards of pesticides and thus contribute to reduction of the adverse effects on human health and the environment. On the other hand, the implementation of alternative cropping systems that are less dependent on pesticides, the development of new pesticides with novel modes of action and improved safety profiles, and the improvement of the already used pesticide formulations towards safer formulations (e.g., microcapsule suspensions) could reduce the adverse effects of farming and particularly the toxic effects of pesticides. In addition, the use of appropriate and well-maintained spraying equipment along with taking all precautions that are required in all stages of pesticide handling could minimize human exposure to pesticides and their potential adverse effects on the environment. Full article

(This article belongs to the Special Issue Pesticides and Health)

Open AccessReview Risky Play and Children’s Safety: Balancing Priorities for Optimal Child Development

by Mariana Brussoni, Lise L. Olsen, Ian Pike and David A. Sleet

Int. J. Environ. Res. Public Health 2012, 9(9), 3134-3148; doi:10.3390/ijerph9093134

Received: 18 July 2012 / Revised: 3 August 2012 / Accepted: 22 August 2012 / Published: 30 August 2012

Cited by 33 | Viewed by 12332 | PDF Full-text (85 KB) | HTML Full-text | XML Full-text

Abstract

Injury prevention plays a key role in keeping children safe, but emerging research suggests that imposing too many restrictions on children’s outdoor risky play hinders their development. We explore the relationship between child development, play, and conceptions of risk taking with the aim

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Injury prevention plays a key role in keeping children safe, but emerging research suggests that imposing too many restrictions on children’s outdoor risky play hinders their development. We explore the relationship between child development, play, and conceptions of risk taking with the aim of informing child injury prevention. Generational trends indicate children’s diminishing engagement in outdoor play is influenced by parental and societal concerns. We outline the importance of play as a necessary ingredient for healthy child development and review the evidence for arguments supporting the need for outdoor risky play, including: (1) children have a natural propensity towards risky play; and, (2) keeping children safe involves letting them take and manage risks. Literature from many disciplines supports the notion that safety efforts should be balanced with opportunities for child development through outdoor risky play. New avenues for investigation and action are emerging seeking optimal strategies for keeping children “as safe as necessary,” not “as safe as possible.” This paradigm shift represents a potential for epistemological growth as well as cross-disciplinary collaboration to foster optimal child development while preserving children’s safety. Full article

(This article belongs to the Special Issue Child Injury Prevention) Printed Edition available

Open AccessArticle Ethyl Carbamate in Alcoholic Beverages from Mexico (Tequila, Mezcal, Bacanora, Sotol) and Guatemala (Cuxa): Market Survey and Risk Assessment

by Dirk W. Lachenmeier, Fotis Kanteres, Thomas Kuballa, Mercedes G. López and Jürgen Rehm

Int. J. Environ. Res. Public Health 2009, 6(1), 349-360; doi:10.3390/ijerph6010349

Received: 19 December 2008 / Accepted: 16 January 2009 / Published: 20 January 2009

Cited by 30 | Viewed by 11648 | PDF Full-text (279 KB) | HTML Full-text | XML Full-text

Abstract

Ethyl carbamate (EC) is a recognized genotoxic carcinogen, with widespread occurrence in fermented foods and beverages. No data on its occurrence in alcoholic beverages from Mexico or Central America is available. Samples of agave spirits including tequila, mezcal, bacanora and sotol (n=110), and

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Ethyl carbamate (EC) is a recognized genotoxic carcinogen, with widespread occurrence in fermented foods and beverages. No data on its occurrence in alcoholic beverages from Mexico or Central America is available. Samples of agave spirits including tequila, mezcal, bacanora and sotol (n=110), and of the sugarcane spirit cuxa (n=16) were purchased in Mexico and Guatemala, respectively, and analyzed for EC. The incidence of EC contamination was higher in Mexico than in Guatemala, however, concentrations were below international guideline levels (<0.15 mg/L). Risk assessment found the Margin of Exposure (MOE) in line with that of European spirits. It is therefore unlikely that EC plays a role in high rates of liver cirrhosis reported in Mexico. Full article

(This article belongs to the Special Issue Environmental Research on Alcohol: Public Health Perspectives)

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Open AccessReview Carbonyl Compounds Generated from Electronic Cigarettes

by Kanae Bekki, Shigehisa Uchiyama, Kazushi Ohta, Yohei Inaba, Hideki Nakagome and Naoki Kunugita

Int. J. Environ. Res. Public Health 2014, 11(11), 11192-11200; doi:10.3390/ijerph111111192

Received: 24 June 2014 / Revised: 2 October 2014 / Accepted: 16 October 2014 / Published: 28 October 2014

Cited by 42 | Viewed by 11583 | PDF Full-text (189 KB) | HTML Full-text | XML Full-text

Abstract

Electronic cigarettes (e-cigarettes) are advertised as being safer than tobacco cigarettes products as the chemical compounds inhaled from e-cigarettes are believed to be fewer and less toxic than those from tobacco cigarettes. Therefore, continuous careful monitoring and risk management of e-cigarettes should be

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Electronic cigarettes (e-cigarettes) are advertised as being safer than tobacco cigarettes products as the chemical compounds inhaled from e-cigarettes are believed to be fewer and less toxic than those from tobacco cigarettes. Therefore, continuous careful monitoring and risk management of e-cigarettes should be implemented, with the aim of protecting and promoting public health worldwide. Moreover, basic scientific data are required for the regulation of e-cigarette. To date, there have been reports of many hazardous chemical compounds generated from e-cigarettes, particularly carbonyl compounds such as formaldehyde, acetaldehyde, acrolein, and glyoxal, which are often found in e-cigarette aerosols. These carbonyl compounds are incidentally generated by the oxidation of e-liquid (liquid in e-cigarette; glycerol and glycols) when the liquid comes in contact with the heated nichrome wire. The compositions and concentrations of these compounds vary depending on the type of e-liquid and the battery voltage. In some cases, extremely high concentrations of these carbonyl compounds are generated, and may contribute to various health effects. Suppliers, risk management organizations, and users of e-cigarettes should be aware of this phenomenon. Full article

(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)

Open AccessArticle An Assessment of Indoor Air Quality before, during and after Unrestricted Use of E-Cigarettes in a Small Room

by Grant O'Connell, Stéphane Colard, Xavier Cahours and John D. Pritchard

Int. J. Environ. Res. Public Health 2015, 12(5), 4889-4907; doi:10.3390/ijerph120504889

Received: 18 March 2015 / Revised: 21 April 2015 / Accepted: 28 April 2015 / Published: 6 May 2015

Cited by 6 | Viewed by 11516 | PDF Full-text (453 KB) | HTML Full-text | XML Full-text

Abstract

Airborne chemicals in the indoor environment arise from a wide variety of sources such as burning fuels and cooking, construction materials and furniture, environmental tobacco smoke as well as outdoor sources. To understand the contribution of exhaled e-cigarette aerosol to the pre-existing chemicals

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Airborne chemicals in the indoor environment arise from a wide variety of sources such as burning fuels and cooking, construction materials and furniture, environmental tobacco smoke as well as outdoor sources. To understand the contribution of exhaled e-cigarette aerosol to the pre-existing chemicals in the ambient air, an indoor air quality study was conducted to measure volatile organic compounds (including nicotine and low molecular weight carbonyls), polycyclic aromatic hydrocarbons, tobacco-specific nitrosamines and trace metal levels in the air before, during and after e-cigarette use in a typical small office meeting room. Measurements were compared with human Health Criteria Values, such as indoor air quality guidelines or workplace exposure limits where established, to provide a context for potential bystander exposures. In this study, the data suggest that any additional chemicals present in indoor air from the exhaled e-cigarette aerosol, are unlikely to present an air quality issue to bystanders at the levels measured when compared to the regulatory standards that are used for workplaces or general indoor air quality. Full article

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Open AccessArticle Comparative In Vitro Toxicity Profile of Electronic and Tobacco Cigarettes, Smokeless Tobacco and Nicotine Replacement Therapy Products: E-Liquids, Extracts and Collected Aerosols

by Manoj Misra, Robert D. Leverette, Bethany T. Cooper, Melanee B. Bennett and Steven E. Brown

Int. J. Environ. Res. Public Health 2014, 11(11), 11325-11347; doi:10.3390/ijerph111111325

Received: 1 August 2014 / Revised: 16 October 2014 / Accepted: 24 October 2014 / Published: 30 October 2014

Cited by 26 | Viewed by 11105 | PDF Full-text (683 KB) | HTML Full-text | XML Full-text

Abstract

The use of electronic cigarettes (e-cigs) continues to increase worldwide in parallel with accumulating information on their potential toxicity and safety. In this study, an in vitro battery of established assays was used to examine the cytotoxicity, mutagenicity, genotoxicity and inflammatory responses of

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The use of electronic cigarettes (e-cigs) continues to increase worldwide in parallel with accumulating information on their potential toxicity and safety. In this study, an in vitro battery of established assays was used to examine the cytotoxicity, mutagenicity, genotoxicity and inflammatory responses of certain commercial e-cigs and compared to tobacco burning cigarettes, smokeless tobacco (SLT) products and a nicotine replacement therapy (NRT) product. The toxicity evaluation was performed on e-liquids and pad-collected aerosols of e-cigs, pad-collected smoke condensates of tobacco cigarettes and extracts of SLT and NRT products. In all assays, exposures with e-cig liquids and collected aerosols, at the doses tested, showed no significant activity when compared to tobacco burning cigarettes. Results for the e-cigs, with and without nicotine in two evaluated flavor variants, were very similar in all assays, indicating that the presence of nicotine and flavors, at the levels tested, did not induce any cytotoxic, genotoxic or inflammatory effects. The present findings indicate that neither the e-cig liquids and collected aerosols, nor the extracts of the SLT and NRT products produce any meaningful toxic effects in four widely-applied in vitro test systems, in which the conventional cigarette smoke preparations, at comparable exposures, are markedly cytotoxic and genotoxic. Full article

(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)

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Open AccessArticle Public Perceptions of Climate Change as a Human Health Risk: Surveys of the United States, Canada and Malta

by Karen Akerlof, Roberto DeBono, Peter Berry, Anthony Leiserowitz, Connie Roser-Renouf, Kaila-Lea Clarke, Anastasia Rogaeva, Matthew C. Nisbet, Melinda R. Weathers and Edward W. Maibach

Int. J. Environ. Res. Public Health 2010, 7(6), 2559-2606; doi:10.3390/ijerph7062559

Received: 4 May 2010 / Revised: 3 June 2010 / Accepted: 9 June 2010 / Published: 14 June 2010

Cited by 46 | Viewed by 11087 | PDF Full-text (609 KB) | HTML Full-text | XML Full-text

Abstract

We used data from nationally representative surveys conducted in the United States, Canada and Malta between 2008 and 2009 to answer three questions: Does the public believe that climate change poses human health risks, and if so, are they seen as current or

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We used data from nationally representative surveys conducted in the United States, Canada and Malta between 2008 and 2009 to answer three questions: Does the public believe that climate change poses human health risks, and if so, are they seen as current or future risks? Whose health does the public think will be harmed? In what specific ways does the public believe climate change will harm human health? When asked directly about the potential impacts of climate change on health and well-being, a majority of people in all three nations said that it poses significant risks; moreover, about one third of Americans, one half of Canadians, and two-thirds of Maltese said that people are already being harmed. About a third or more of people in the United States and Canada saw themselves (United States, 32%; Canada, 67%), their family (United States, 35%; Canada, 46%), and people in their community (United States, 39%; Canada, 76%) as being vulnerable to at least moderate harm from climate change. About one third of Maltese (31%) said they were most concerned about the risk to themselves and their families. Many Canadians said that the elderly (45%) and children (33%) are at heightened risk of harm, while Americans were more likely to see people in developing countries as being at risk than people in their own nation. When prompted, large numbers of Canadians and Maltese said that climate change can cause respiratory problems (78–91%), heat-related problems (75–84%), cancer (61–90%), and infectious diseases (49–62%). Canadians also named sunburn (79%) and injuries from extreme weather events (73%), and Maltese cited allergies (84%). However, climate change appears to lack salience as a health issue in all three countries: relatively few people answered open-ended questions in a manner that indicated clear top-of-mind associations between climate change and human health risks. We recommend mounting public health communication initiatives that increase the salience of the human health consequences associated with climate change. Full article

(This article belongs to the Special Issue Climate Change and Human Health Impacts and Adaptation)

Open AccessArticle Verification of the Addiction Severity Index Japanese Version (ASI-J) as a Treatment-Customization, Prediction, and Comparison Tool for Alcohol-Dependent Individuals

by Ayako Haraguchi, Yasukazu Ogai, Eiichi Senoo, Satoru Saito, Yoshihiro Suzuki, Aihide Yoshino, Aro Ino, Kenji Yanbe, Mitsuru Hasegawa, Masaru Murakami, Masanobu Murayama, Toru Ishikawa, Susumu Higuchi and Kazutaka Ikeda

Int. J. Environ. Res. Public Health 2009, 6(8), 2205-2225; doi:10.3390/ijerph6082205

Received: 7 July 2009 / Accepted: 10 August 2009 / Published: 12 August 2009

Cited by 5 | Viewed by 11027 | PDF Full-text (558 KB) | HTML Full-text | XML Full-text

Abstract

Objective: To demonstrate the usefulness of the Addiction Severity Index Japanese Version (ASI-J) in Japanese alcohol-dependent individuals. The ASI is a frequently used clinical and research instrument that measures severities in seven functional domains in people with substance abuse disorders. Methods: A total

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Objective: To demonstrate the usefulness of the Addiction Severity Index Japanese Version (ASI-J) in Japanese alcohol-dependent individuals. The ASI is a frequently used clinical and research instrument that measures severities in seven functional domains in people with substance abuse disorders. Methods: A total of 370 male inpatients with a history of alcohol dependence participated in the study. Forty-nine participants were excluded in the final analysis due to lack of reliability (i.e., patient misrepresentation or inability to understand). We used the ASI-J and a series of indexes that determined patient states during and post-treatment. Results: The correlations between ASI Composite Scores (CSs), which were calculated through a weighted formula and indicated the severity of each problem area, were significant but low in eight relations and not significant in 13 relations, indicating substantial independence of the problem areas. Significant differences were found in Family/Social CSs between abstinent and relapsed alcohol-dependent individuals. The questions of undesirable attitude were significantly related to the CSs of Employment, Drug use, Family/Social, and Psychiatric sections. Significant differences were observed in patient demographics, CS, and ASI Severity Rating (SR) and interviewer’s subjective scoring between alcohol-dependent individuals and drug abusers. CSs in Japanese alcohol-dependent individuals were generally similar to corresponding CSs in individuals from other countries, with the exception of The Netherlands. Conclusions: This study demonstrated that the ASI-J is useful for understanding individual profiles of problems for each patient and planning customized treatment. The ASI-J served as a predictive tool for relapse and compliance to treatment afterward and was shown to be useful as a comparison tool in clarifying similarities and differences between substance abuser groups. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

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Open AccessReview Bacterial Degradation of Aromatic Compounds

by Jong-Su Seo, Young-Soo Keum and Qing X. Li

Int. J. Environ. Res. Public Health 2009, 6(1), 278-309; doi:10.3390/ijerph6010278

Received: 6 November 2008 / Accepted: 6 January 2009 / Published: 13 January 2009

Cited by 248 | Viewed by 11013 | PDF Full-text (320 KB) | HTML Full-text | XML Full-text

Abstract

Aromatic compounds are among the most prevalent and persistent pollutants in the environment. Petroleum-contaminated soil and sediment commonly contain a mixture of polycyclic aromatic hydrocarbons (PAHs) and heterocyclic aromatics. Aromatics derived from industrial activities often have functional groups such as alkyls, halogens and

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Aromatic compounds are among the most prevalent and persistent pollutants in the environment. Petroleum-contaminated soil and sediment commonly contain a mixture of polycyclic aromatic hydrocarbons (PAHs) and heterocyclic aromatics. Aromatics derived from industrial activities often have functional groups such as alkyls, halogens and nitro groups. Biodegradation is a major mechanism of removal of organic pollutants from a contaminated site. This review focuses on bacterial degradation pathways of selected aromatic compounds. Catabolic pathways of naphthalene, fluorene, phenanthrene, fluoranthene, pyrene, and benzo[a]pyrene are described in detail. Bacterial catabolism of the heterocycles dibenzofuran, carbazole, dibenzothiophene, and dibenzodioxin is discussed. Bacterial catabolism of alkylated PAHs is summarized, followed by a brief discussion of proteomics and metabolomics as powerful tools for elucidation of biodegradation mechanisms. Full article

(This article belongs to the Special Issue Biodegradability and Environmental Sciences)

Open AccessArticle Food Intakes by Preschool Children in Flanders Compared with Dietary Guidelines

by Inge Huybrechts, Christophe Matthys, Carine Vereecken, Lea Maes, Elisabeth HM Temme, Herman Van Oyen, Guy De Backer and Stefaan De Henauw

Int. J. Environ. Res. Public Health 2008, 5(4), 243-257; doi:10.3390/ijerph5040243

Received: 27 October 2008 / Accepted: 5 December 2008 / Published: 8 December 2008

Cited by 44 | Viewed by 10850 | PDF Full-text (344 KB) | HTML Full-text | XML Full-text

Abstract

The objective of this study was to compare food group intakes among preschool children with food-based dietary guidelines (FBDG) and to determine the proportion of children meeting these guidelines. Food consumption of preschool children (2.5-6.5 years) living in Flanders (Belgium) were assessed in

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The objective of this study was to compare food group intakes among preschool children with food-based dietary guidelines (FBDG) and to determine the proportion of children meeting these guidelines. Food consumption of preschool children (2.5-6.5 years) living in Flanders (Belgium) were assessed in a cross-sectional study, using proxy reported 3d estimated dietary records (EDR) (n 696). Statistical modelling was used to account for within-individual variation in the 3d EDR. Mean daily intakes of most food groups (beverages, vegetables, fruit and milk) were below the minimum recommendations. Only ‘grains and potatoes’ and ‘meat products’ were in line with the recommendations and ‘bread and cereals’ showed borderline intakes. Mean intakes of energy-dense and low-nutritious foods, which are discouraged within a healthy diet (like snacks and sugared drinks), were high. Furthermore, the percentage of children complying with the different food-based dietary guidelines was for most food groups extremely low (ranging from approximately 4% for fluid and vegetable intakes up to 99% for potato intakes). Boys had in general higher mean intakes of the recommended food groups. In conclusion, preschool children in Flanders follow eating patterns that do not meet Flemish FBDG. Although the impact of these eating habits on preschooler’s current and future health should be further investigated, it is clear that nutrition education and intervention are needed among preschool children and their parents in Flanders. Full article

(This article belongs to the Special Issue Public Health: Feature Papers)

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Open AccessArticle The Effect of Handwashing with Water or Soap on Bacterial Contamination of Hands

by Maxine Burton, Emma Cobb, Peter Donachie, Gaby Judah, Val Curtis and Wolf-Peter Schmidt

Int. J. Environ. Res. Public Health 2011, 8(1), 97-104; doi:10.3390/ijerph8010097

Received: 24 November 2010 / Revised: 30 December 2010 / Accepted: 31 December 2010 / Published: 6 January 2011

Cited by 32 | Viewed by 10564 | PDF Full-text (195 KB) | HTML Full-text | XML Full-text

Abstract

Handwashing is thought to be effective for the prevention of transmission of diarrhoea pathogens. However it is not conclusive that handwashing with soap is more effective at reducing contamination with bacteria associated with diarrhoea than using water only. In this study 20 volunteers

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Handwashing is thought to be effective for the prevention of transmission of diarrhoea pathogens. However it is not conclusive that handwashing with soap is more effective at reducing contamination with bacteria associated with diarrhoea than using water only. In this study 20 volunteers contaminated their hands deliberately by touching door handles and railings in public spaces. They were then allocated at random to (1) handwashing with water, (2) handwashing with non-antibacterial soap and (3) no handwashing. Each volunteer underwent this procedure 24 times, yielding 480 samples overall. Bacteria of potential faecal origin (mostly Enterococcus and Enterobacter spp.) were found after no handwashing in 44% of samples. Handwashing with water alone reduced the presence of bacteria to 23% (p < 0.001). Handwashing with plain soap and water reduced the presence of bacteria to 8% (comparison of both handwashing arms: p < 0.001). The effect did not appear to depend on the bacteria species. Handwashing with non-antibacterial soap and water is more effective for the removal of bacteria of potential faecal origin from hands than handwashing with water alone and should therefore be more useful for the prevention of transmission of diarrhoeal diseases. Full article

(This article belongs to the Special Issue Drinking Water and Health)

Open AccessArticle The Influence of Individual, Social and Physical Environment Factors on Physical Activity in the Adult Population in Andalusia, Spain

by Julia Bolívar, Antonio Daponte, Miguel Rodríguez and José Juan Sánchez

Int. J. Environ. Res. Public Health 2010, 7(1), 60-77; doi:10.3390/ijerph7010060

Received: 24 October 2009 / Accepted: 16 December 2009 / Published: 5 January 2010

Cited by 11 | Viewed by 10550 | PDF Full-text (776 KB) | HTML Full-text | XML Full-text

Abstract

A person’s physical and social environment is considered as an influencing factor in terms of rates of engagement in physical activity. This study analyses the influence of socio-demographic, physical and social environmental factors on physical activity reported in the adult population in Andalusia.

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

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Open AccessReview Alcohol Abuse in Pregnant Women: Effects on the Fetus and Newborn, Mode of Action and Maternal Treatment

by Asher Ornoy and Zivanit Ergaz

Int. J. Environ. Res. Public Health 2010, 7(2), 364-379; doi:10.3390/ijerph7020364

Received: 16 December 2009 / Accepted: 22 January 2010 / Published: 27 January 2010

Cited by 53 | Viewed by 10185 | PDF Full-text (135 KB) | HTML Full-text | XML Full-text

Abstract

Offspring of mothers using ethanol during pregnancy are known to suffer from developmental delays and/or a variety of behavioral changes. Ethanol, may affect the developing fetus in a dose dependent manner. With very high repetitive doses there is a 6–10% chance of the

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

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessArticle Examining Factors in the Research Institute on Addictions Self-Inventory (RIASI): Associations with Alcohol Use and Problems at Assessment and Follow-Up

by Robert E. Mann, Gina Stoduto, Rosely Flam Zalcman, Thomas H. Nochajski, Louise Hall, Patricia Dill and Elisabeth Wells-Parker

Int. J. Environ. Res. Public Health 2009, 6(11), 2898-2918; doi:10.3390/ijerph6112898

Received: 7 October 2009 / Accepted: 18 November 2009 / Published: 24 November 2009

Cited by 7 | Viewed by 10167 | PDF Full-text (269 KB) | HTML Full-text | XML Full-text

Abstract

Impaired driving is a leading cause of alcohol-related deaths and injuries. Rehabilitation or remedial programs, involving assessment and screening of convicted impaired drivers to determine problem severity and appropriate programs, are an important component of society’s response to this problem. Ontario’s remedial program,

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

(This article belongs to the Special Issue Alcohol and Public Health)

Open AccessReview Water Microbiology. Bacterial Pathogens and Water

by João P. S. Cabral

Int. J. Environ. Res. Public Health 2010, 7(10), 3657-3703; doi:10.3390/ijerph7103657

Received: 19 August 2010 / Revised: 7 September 2010 / Accepted: 28 September 2010 / Published: 15 October 2010

Cited by 127 | Viewed by 10150 | PDF Full-text (388 KB) | HTML Full-text | XML Full-text

Abstract

Water is essential to life, but many people do not have access to clean and safe drinking water and many die of waterborne bacterial infections. In this review a general characterization of the most important bacterial diseases transmitted through water—cholera, typhoid fever and

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Water is essential to life, but many people do not have access to clean and safe drinking water and many die of waterborne bacterial infections. In this review a general characterization of the most important bacterial diseases transmitted through water—cholera, typhoid fever and bacillary dysentery—is presented, focusing on the biology and ecology of the causal agents and on the diseases’ characteristics and their life cycles in the environment. The importance of pathogenic Escherichia coli strains and emerging pathogens in drinking water-transmitted diseases is also briefly discussed. Microbiological water analysis is mainly based on the concept of fecal indicator bacteria. The main bacteria present in human and animal feces (focusing on their behavior in their hosts and in the environment) and the most important fecal indicator bacteria are presented and discussed (focusing on the advantages and limitations of their use as markers). Important sources of bacterial fecal pollution of environmental waters are also briefly indicated. In the last topic it is discussed which indicators of fecal pollution should be used in current drinking water microbiological analysis. It was concluded that safe drinking water for all is one of the major challenges of the 21st century and that microbiological control of drinking water should be the norm everywhere. Routine basic microbiological analysis of drinking water should be carried out by assaying the presence of Escherichia coli by culture methods. Whenever financial resources are available, fecal coliform determinations should be complemented with the quantification of enterococci. More studies are needed in order to check if ammonia is reliable for a preliminary screening for emergency fecal pollution outbreaks. Financial resources should be devoted to a better understanding of the ecology and behavior of human and animal fecal bacteria in environmental waters. Full article

(This article belongs to the Special Issue Drinking Water and Health)

Open AccessArticle Use of Multi-Objective Air Pollution Monitoring Sites and Online Air Pollution Monitoring System for Total Health Risk Assessment in Hyderabad, India

by Y. Anjaneyulu, I. Jayakumar, V. Hima Bindu, G. Sagareswar, P. V. Mukunda Rao, N. Rambabu and K. V. Ramani

Int. J. Environ. Res. Public Health 2005, 2(2), 343-354; doi:10.3390/ijerph2005020021

Received: 10 January 2005 / Accepted: 10 April 2005 / Published: 14 August 2005

Cited by 5 | Viewed by 10086 | PDF Full-text (3180 KB) | HTML Full-text | XML Full-text

Abstract

A consensus has been emerging among public health experts in developing countries that air pollution, even at current ambient levels, aggravates respiratory and cardiovascular diseases and leads to premature mortality. Recent studies have also presented well-founded theories concerning the biological mechanisms involved and

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A consensus has been emerging among public health experts in developing countries that air pollution, even at current ambient levels, aggravates respiratory and cardiovascular diseases and leads to premature mortality. Recent studies have also presented well-founded theories concerning the biological mechanisms involved and the groups of people that are probably more susceptible to health effects caused or exacerbated by inhalation of ambient particulate matter (PM.). On the basis of prognostic studies carried out in Center for Environment, JNT University, Hyderabad “it has been estimated that in Hyderabad some 1,700 to 3,000 people per year die prematurely as a result of inhaling PM”. These figures reflect only the effects of acute exposure to air pollution. If the long-term effects of chronic exposure are taken into account, 10,000–15,000 people a year could die prematurely in Hyderabad. This estimate of the chronic effects is based on other studies, which are not completely comparable with the Hyderabad situation. While the study designs and analyses in these other studies may indeed be different or irrelevant to Hyderabad, the fact they were carried out in other countries is irrelevant. Taking into account these considerations, a model for total health risk assessment for the city of Hyderabad, and its state of Andhra Pradesh in India has been developed using a multi-objective air pollution monitoring network and online and real time air pollution monitoring stations. For the model studies a number of potential monitoring sites were screened for general and site-specific criteria in a geographic information system (GIS) environment that may, on a local basis, affect the representativeness of the data collected. Local features that may affect either the chemical or meteorological parameters are evaluated to assure a minimum of interference. Finally, for monitoring air pollution, an online and real-time monitoring system was designed using advanced electrochemical sensor systems (sulphur dioxide, oxides of nitrogen, carbon monoxide, hydrocarbons, ozone, mercaptans and hydrogen sulphide) and a particulate matter analyzer (total suspended particulate matter TSPM), PM_2.5 and PM₁₀). The sensor and data acquisition systems are programmed to monitor pollution levels at ½ hour durations during peak hours and at 1-hour intervals at other times. Presently, extensive statistical and numerical simulations are being carried out at our center to correlate the individuals living in the monitored areas with respiratory infections with air pollution. Full article

Open AccessArticle The Evaluation of the Impact of a Stand-Biased Desk on Energy Expenditure and Physical Activity for Elementary School Students

by Mark E. Benden, Hongwei Zhao, Christina E. Jeffrey, Monica L. Wendel and Jamilia J. Blake

Int. J. Environ. Res. Public Health 2014, 11(9), 9361-9375; doi:10.3390/ijerph110909361

Received: 6 June 2014 / Revised: 1 September 2014 / Accepted: 2 September 2014 / Published: 10 September 2014

Cited by 18 | Viewed by 10072 | PDF Full-text (173 KB) | HTML Full-text | XML Full-text

Abstract

Due to the increasing prevalence of childhood obesity, the association between classroom furniture and energy expenditure as well as physical activity was examined using a standing-desk intervention in three central-Texas elementary schools. Of the 480 students in the 24 classrooms randomly assigned to

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Due to the increasing prevalence of childhood obesity, the association between classroom furniture and energy expenditure as well as physical activity was examined using a standing-desk intervention in three central-Texas elementary schools. Of the 480 students in the 24 classrooms randomly assigned to either a seated or stand-biased desk equipped classroom, 374 agreed to participate in a week-long data collection during the fall and spring semesters. Each participant’s data was collected using Sensewear^® armbands and was comprised of measures of energy expenditure (EE) and step count. A hierarchical linear mixed effects model showed that children in seated desk classrooms had significantly lower (EE) and fewer steps during the standardized lecture time than children in stand-biased classrooms after adjusting for grade, race, and gender. The use of a standing desk showed a significant higher mean energy expenditure by 0.16 kcal/min (p < 0.0001) in the fall semester, and a higher EE by 0.08 kcal/min (p = 0.0092) in the spring semester. Full article

Open AccessReview What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review

by Mariana Brussoni, Rebecca Gibbons, Casey Gray, Takuro Ishikawa, Ellen Beate Hansen Sandseter, Adam Bienenstock, Guylaine Chabot, Pamela Fuselli, Susan Herrington, Ian Janssen, William Pickett, Marlene Power, Nick Stanger, Margaret Sampson and Mark S. Tremblay

Int. J. Environ. Res. Public Health 2015, 12(6), 6423-6454; doi:10.3390/ijerph120606423

Received: 26 January 2015 / Revised: 29 March 2015 / Accepted: 8 April 2015 / Published: 8 June 2015

Abstract

Risky outdoor play has been associated with promoting children’s health and development, but also with injury and death. Risky outdoor play has diminished over time, concurrent with increasing concerns regarding child safety and emphasis on injury prevention. We sought to conduct a systematic

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Risky outdoor play has been associated with promoting children’s health and development, but also with injury and death. Risky outdoor play has diminished over time, concurrent with increasing concerns regarding child safety and emphasis on injury prevention. We sought to conduct a systematic review to examine the relationship between risky outdoor play and health in children, in order to inform the debate regarding its benefits and harms. We identified and evaluated 21 relevant papers for quality using the GRADE framework. Included articles addressed the effect on health indicators and behaviours from three types of risky play, as well as risky play supportive environments. The systematic review revealed overall positive effects of risky outdoor play on a variety of health indicators and behaviours, most commonly physical activity, but also social health and behaviours, injuries, and aggression. The review indicated the need for additional “good quality” studies; however, we note that even in the face of the generally exclusionary systematic review process, our findings support the promotion of risky outdoor play for healthy child development. These positive results with the marked reduction in risky outdoor play opportunities in recent generations indicate the need to encourage action to support children’s risky outdoor play opportunities. Policy and practice precedents and recommendations for action are discussed. Full article

Open AccessReview Thimerosal Exposure and the Role of Sulfation Chemistry and Thiol Availability in Autism

by Janet K. Kern, Boyd E. Haley, David A. Geier, Lisa K. Sykes, Paul G. King and Mark R. Geier

Int. J. Environ. Res. Public Health 2013, 10(8), 3771-3800; doi:10.3390/ijerph10083771

Received: 14 May 2013 / Revised: 10 July 2013 / Accepted: 11 July 2013 / Published: 20 August 2013

Cited by 18 | Viewed by 9995 | PDF Full-text (285 KB) | HTML Full-text | XML Full-text

Abstract

Autism spectrum disorder (ASD) is a neurological disorder in which a significant number of the children experience a developmental regression characterized by a loss of previously acquired skills and abilities. Typically reported are losses of verbal, nonverbal, and social abilities. Several recent studies

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Autism spectrum disorder (ASD) is a neurological disorder in which a significant number of the children experience a developmental regression characterized by a loss of previously acquired skills and abilities. Typically reported are losses of verbal, nonverbal, and social abilities. Several recent studies suggest that children diagnosed with an ASD have abnormal sulfation chemistry, limited thiol availability, and decreased glutathione (GSH) reserve capacity, resulting in a compromised oxidation/reduction (redox) and detoxification capacity. Research indicates that the availability of thiols, particularly GSH, can influence the effects of thimerosal (TM) and other mercury (Hg) compounds. TM is an organomercurial compound (49.55% Hg by weight) that has been, and continues to be, used as a preservative in many childhood vaccines, particularly in developing countries. Thiol-modulating mechanisms affecting the cytotoxicity of TM have been identified. Importantly, the emergence of ASD symptoms post-6 months of age temporally follows the administration of many childhood vaccines. The purpose of the present critical review is provide mechanistic insight regarding how limited thiol availability, abnormal sulfation chemistry, and decreased GSH reserve capacity in children with an ASD could make them more susceptible to the toxic effects of TM routinely administered as part of mandated childhood immunization schedules. Full article

(This article belongs to the Special Issue Environmental Health Risk Assessment)

Open AccessArticle Comparison of Select Analytes in Exhaled Aerosol from E-Cigarettes with Exhaled Smoke from a Conventional Cigarette and Exhaled Breaths

by Gerald A. Long

Int. J. Environ. Res. Public Health 2014, 11(11), 11177-11191; doi:10.3390/ijerph111111177

Received: 21 August 2014 / Revised: 14 October 2014 / Accepted: 16 October 2014 / Published: 27 October 2014

Abstract

Exhaled aerosols were collected following the use of two leading U.S. commercial electronic cigarettes (e-cigarettes) and a conventional cigarette by human subjects and analyzed for phenolics, carbonyls, water, glycerin and nicotine using a vacuum-assisted filter pad capture system. Exhaled breath blanks were determined

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Exhaled aerosols were collected following the use of two leading U.S. commercial electronic cigarettes (e-cigarettes) and a conventional cigarette by human subjects and analyzed for phenolics, carbonyls, water, glycerin and nicotine using a vacuum-assisted filter pad capture system. Exhaled breath blanks were determined for each subject prior to each product use and aerosol collection session. Distribution and mass balance of exhaled e-cigarette aerosol composition was greater than 99.9% water and glycerin, and a small amount (<0.06%) of nicotine. Total phenolic content in exhaled e-cigarette aerosol was not distinguishable from exhaled breath blanks, while total phenolics in exhaled cigarette smoke were significantly greater than in exhaled e-cigarette aerosol and exhaled breaths, averaging 66 µg/session (range 36 to 117 µg/session). The total carbonyls in exhaled e-cigarette aerosols were also not distinguishable from exhaled breaths or room air blanks. Total carbonyls in exhaled cigarette smoke was significantly greater than in exhaled e-cigarette aerosols, exhaled breath and room air blanks, averaging 242 µg/session (range 136 to 352 µg/session). These results indicate that exhaled e-cigarette aerosol does not increase bystander exposure for phenolics and carbonyls above the levels observed in exhaled breaths of air. Full article

(This article belongs to the Special Issue Electronic Cigarettes as a Tool in Tobacco Harm Reduction)

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Open AccessArticle Inequities in the Global Health Workforce: The Greatest Impediment to Health in Sub-Saharan Africa

by Stella C. E. Anyangwe and Chipayeni Mtonga

Int. J. Environ. Res. Public Health 2007, 4(2), 93-100; doi:10.3390/ijerph2007040002

Received: 29 January 2007 / Accepted: 30 April 2007 / Published: 30 June 2007

Cited by 125 | Viewed by 9937 | PDF Full-text (248 KB) | HTML Full-text | XML Full-text

Abstract

Health systems played a key role in the dramatic rise in global life expectancy that occurred during the 20th century, and have continued to contribute enormously to the improvement of the health of most of the world’s population. The health workforce is the

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Health systems played a key role in the dramatic rise in global life expectancy that occurred during the 20th century, and have continued to contribute enormously to the improvement of the health of most of the world’s population. The health workforce is the backbone of each health system, the lubricant that facilitates the smooth implementation of health action for sustainable socio-economic development. It has been proved beyond reasonable doubt that the density of the health workforce is directly correlated with positive health outcomes. In other words, health workers save lives and improve health. About 59 million people make up the health workforce of paid full-time health workers world-wide. However, enormous gaps remain between the potential of health systems and their actual performance, and there are far too many inequities in the distribution of health workers between countries and within countries. The Americas (mainly USA and Canada) are home to 14% of the world’s population, bear only 10% of the world’s disease burden, have 37% of the global health workforce and spend about 50% of the world’s financial resources for health. Conversely, sub-Saharan Africa, with about 11% of the world’s population bears over 24% of the global disease burden, is home to only 3% of the global health workforce, and spends less than 1% of the world’s financial resources on health. In most developing countries, the health workforce is concentrated in the major towns and cities, while rural areas can only boast of about 23% and 38% of the country’s doctors and nurses respectively. The imbalances exist not only in the total numbers and geographical distribution of health workers, but also in the skills mix of available health workers. WHO estimates that 57 countries world wide have a critical shortage of health workers, equivalent to a global deficit of about 2.4 million doctors, nurses and midwives. Thirty six of these countries are in sub-Saharan Africa. They would need to increase their health workforce by about 140% to achieve enough coverage for essential health interventions to make a positive difference in the health and life expectancy of their populations. The extent causes and consequences of the health workforce crisis in Sub-Saharan Africa, and the various factors that influence and are related to it are well known and described. Although there is no “magic bullet” solution to the problem, there are several documented, tested and tried best practices from various countries. The global health workforce crisis can be tackled if there is global responsibility, political will, financial commitment and public-private partnership for country-led and country-specific interventions that seek solutions beyond the health sector. Only when enough health workers can be trained, sustained and retained in sub-Saharan African countries will there be meaningful socio-economic development and the faintest hope of attaining the Millennium Development Goals in the sub-continent. Full article

Open AccessArticle Health Risk Assessment of Cyanobacterial (Blue-green Algal) Toxins in Drinking Water

by Ian R. Falconer and Andrew R. Humpage

Int. J. Environ. Res. Public Health 2005, 2(1), 43-50; doi:10.3390/ijerph2005010043

Received: 15 November 2004 / Accepted: 6 February 2005 / Published: 30 April 2005

Cited by 122 | Viewed by 9887 | PDF Full-text (112 KB) | HTML Full-text | XML Full-text

Abstract

Cyanobacterial toxins have caused human poisoning in the Americas, Europe and Australia. There is accumulating evidence that they are present in treated drinking water supplies when cyanobacterial blooms occur in source waters. With increased population pressure and depleted groundwater reserves, surface water is

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Cyanobacterial toxins have caused human poisoning in the Americas, Europe and Australia. There is accumulating evidence that they are present in treated drinking water supplies when cyanobacterial blooms occur in source waters. With increased population pressure and depleted groundwater reserves, surface water is becoming more used as a raw water source, both from rivers and lakes/reservoirs. Additional nutrients in water which arise from sewage discharge, agricultural run-off or storm water result in overabundance of cyanobacteria, described as a ‘water bloom’. The majority of cyanobacterial water-blooms are of toxic species, producing a diversity of toxins. The most important toxins presenting a risk to the human population are the neurotoxic alkaloids (anatoxins and paralytic shellfish poisons), the cyclic peptide hepatotoxins (microcystins) and the cytotoxic alkaloids (cylindrospermopsins). At the present time the only cyanobacteral toxin family that have been internationally assessed for health risk by the WHO are the microcystins, which cause acute liver injury and are active tumour promoters. Based on sub-chronic studies in rodents and pigs, a provisional Guideline Level for drinking water of 1μg/L of microcystin-LR has been determined. This has been adopted in legislation in countries in Europe, South America and Australasia. This may be revised in the light of future teratogenicity, reproductive toxicity and carcinogenicity studies. The other cyanobacterial toxin which has been proposed for detailed health risk assessment is cylindrospermopsin, a cytotoxic compound which has marked genotoxicity, probable mutagenicity, and is a potential carcinogen. This toxin has caused human poisoning from drinking water, and occurs in water supplies in the USA, Europe, Asia, Australia and South America. An initial health risk assessment is presented with a proposed drinking water Guideline Level of 1μg/L. There is a need for both increased monitoring data for toxins in drinking water and epidemiological studies on adverse health effects in exposed populations to clarify the extent of the health risk. Full article

Open AccessReview Indirect Potable Reuse: A Sustainable Water Supply Alternative

by Clemencia Rodriguez, Paul Van Buynder, Richard Lugg, Palenque Blair, Brian Devine, Angus Cook and Philip Weinstein

Int. J. Environ. Res. Public Health 2009, 6(3), 1174-1203; doi:10.3390/ijerph6031174

Received: 22 December 2008 / Accepted: 11 March 2009 / Published: 17 March 2009

Cited by 57 | Viewed by 9878 | PDF Full-text (191 KB) | HTML Full-text | XML Full-text

Abstract

The growing scarcity of potable water supplies is among the most important issues facing many cities, in particular those using single sources of water that are climate dependent. Consequently, urban centers are looking to alternative sources of water supply that can supplement variable

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The growing scarcity of potable water supplies is among the most important issues facing many cities, in particular those using single sources of water that are climate dependent. Consequently, urban centers are looking to alternative sources of water supply that can supplement variable rainfall and meet the demands of population growth. A diversified portfolio of water sources is required to ensure public health, as well as social, economical and environmental sustainability. One of the options considered is the augmentation of drinking water supplies with advanced treated recycled water. This paper aims to provide a state of the art review of water recycling for drinking purposes with emphasis on membrane treatment processes. An overview of significant indirect potable reuse projects is presented followed by a description of the epidemiological and toxicological studies evaluating any potential human health impacts. Finally, a summary of key operational measures to protect human health and the areas that require further research are discussed. Full article

(This article belongs to the Special Issue Sustainability: Environmental Studies and Public Health)

Open AccessReview What is Learned from Longitudinal Studies of Advertising and Youth Drinking and Smoking? A Critical Assessment

by Jon P. Nelson

Int. J. Environ. Res. Public Health 2010, 7(3), 870-926; doi:10.3390/ijerph7030870

Received: 29 December 2009 / Revised: 20 February 2010 / Accepted: 28 February 2010 / Published: 8 March 2010

Cited by 17 | Viewed by 9864 | PDF Full-text (673 KB) | HTML Full-text | XML Full-text

Abstract

This paper assesses the methodology employed in longitudinal studies of advertising and youth drinking and smoking behaviors. These studies often are given a causal interpretation in the psychology and public health literatures. Four issues are examined from the perspective of econometrics. First, specification

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

(This article belongs to the Special Issue Health Economics)

Open AccessReview Biophilia: Does Visual Contact with Nature Impact on Health and Well-Being?

by Bjørn Grinde and Grete Grindal Patil

Int. J. Environ. Res. Public Health 2009, 6(9), 2332-2343; doi:10.3390/ijerph6092332

Received: 22 July 2009 / Accepted: 27 August 2009 / Published: 31 August 2009

Cited by 72 | Viewed by 9836 | PDF Full-text (135 KB) | HTML Full-text | XML Full-text

Abstract

It is concluded that an environment devoid of Nature may act as a "discord", i.e., have a negative effect. While the term mismatch is used for any difference between present living conditions and the environment of evolutionary adaptation, discords are mismatches with a

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It is concluded that an environment devoid of Nature may act as a "discord", i.e., have a negative effect. While the term mismatch is used for any difference between present living conditions and the environment of evolutionary adaptation, discords are mismatches with a potentially undesirable impact on health or quality of life. The problem is partly due to the visual absence of plants, and may be ameliorated by adding elements of Nature, e.g., by creating parks, by offering a view through windows, and by potted plants. The conclusion is based on an evaluation of some fifty relevant empirical studies. Full article

Open AccessArticle Human Health Risk Assessment due to Global Warming – A Case Study of the Gulf Countries

by Tahir Husain and Junaid Rafi Chaudhary

Int. J. Environ. Res. Public Health 2008, 5(4), 204-212; doi:10.3390/ijerph5040204

Received: 25 September 2008 / Accepted: 25 November 2008 / Published: 28 November 2008

Cited by 20 | Viewed by 9814 | PDF Full-text (214 KB) | HTML Full-text | XML Full-text

Abstract

Accelerated global warming is predicted by the Intergovernmental Panel on Climatic Change (IPCC) due to increasing anthropogenic greenhouse gas emissions. The climate changes are anticipated to have a long-term impact on human health, marine and terrestrial ecosystems, water resources and vegetation. Due to

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Accelerated global warming is predicted by the Intergovernmental Panel on Climatic Change (IPCC) due to increasing anthropogenic greenhouse gas emissions. The climate changes are anticipated to have a long-term impact on human health, marine and terrestrial ecosystems, water resources and vegetation. Due to rising sea levels, low lying coastal regions will be flooded, farmlands will be threatened and scarcity of fresh water resources will be aggravated. This will in turn cause increased human suffering in different parts of the world. Spread of disease vectors will contribute towards high mortality, along with the heat related deaths. Arid and hot climatic regions will face devastating effects risking survival of the fragile plant species, wild animals, and other desert ecosystems. The paper presents future changes in temperature, precipitation and humidity and their direct and indirect potential impacts on human health in the coastal regions of the Gulf countries including Yemen, Oman, United Arab Emirates, Qatar, and Bahrain. The analysis is based on the long-term changes in the values of temperature, precipitation and humidity as predicted by the global climatic simulation models under different scenarios of GHG emission levels. Monthly data on temperature, precipitation, and humidity were retrieved from IPCC databases for longitude 41.25°E to 61.875°E and latitude 9.278°N to 27.833°N. Using an average of 1970 to 2000 values as baseline, the changes in the humidity, temperature and precipitation were predicted for the period 2020 to 2050 and 2070 to 2099. Based on epidemiological studies on various diseases associated with the change in temperature, humidity and precipitation in arid and hot regions, empirical models were developed to assess human health risk in the Gulf region to predict elevated levels of diseases and mortality rates under different emission scenarios as developed by the IPCC.The preliminary assessment indicates increased mortality rates due to cardiovascular and respiratory illnesses, thermal stress, and increased frequency of infectious vector borne diseases in the region between 2070 and 2099. Full article

(This article belongs to the Special Issue Public Health: Feature Papers)

Open AccessArticle Hazardous Compounds in Tobacco Smoke

by Reinskje Talhout, Thomas Schulz, Ewa Florek, Jan Van Benthem, Piet Wester and Antoon Opperhuizen

Int. J. Environ. Res. Public Health 2011, 8(2), 613-628; doi:10.3390/ijerph8020613

Received: 28 December 2010 / Revised: 2 February 2011 / Accepted: 7 February 2011 / Published: 23 February 2011

Cited by 136 | Viewed by 9808 | PDF Full-text (211 KB) | HTML Full-text | XML Full-text

Abstract

Tobacco smoke is a toxic and carcinogenic mixture of more than 5,000 chemicals. The present article provides a list of 98 hazardous smoke components, based on an extensive literature search for known smoke components and their human health inhalation risks. An electronic database

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Tobacco smoke is a toxic and carcinogenic mixture of more than 5,000 chemicals. The present article provides a list of 98 hazardous smoke components, based on an extensive literature search for known smoke components and their human health inhalation risks. An electronic database of smoke components containing more than 2,200 entries was generated. Emission levels in mainstream smoke have been found for 542 of the components and a human inhalation risk value for 98 components. As components with potential carcinogenic, cardiovascular and respiratory effects have been included, the three major smoke-related causes of death are all covered by the list. Given that the currently used Hoffmann list of hazardous smoke components is based on data from the 1990s and only includes carcinogens, it is recommended that the current list of 98 hazardous components is used for regulatory purposes instead. To enable risk assessment of components not covered by this list, thresholds of toxicological concern (TTC) have been established from the inhalation risk values found: 0.0018 µg day⁻¹ for all risks, and 1.2 µg day⁻¹ for all risks excluding carcinogenicity, the latter being similar to previously reported inhalation TTCs. Full article

(This article belongs to the Special Issue Tobacco Smoking: Public Health, Science and Policy)

Open AccessArticle Biodegradation of Bisphenol A, Bisphenol F and Bisphenol S in Seawater

by Erica Danzl, Kazunari Sei, Satoshi Soda, Michihiko Ike and Masanori Fujita

Int. J. Environ. Res. Public Health 2009, 6(4), 1472-1484; doi:10.3390/ijerph6041472

Received: 7 January 2009 / Accepted: 9 April 2009 / Published: 17 April 2009

Cited by 52 | Viewed by 9695 | PDF Full-text (229 KB) | HTML Full-text | XML Full-text

Abstract

A group of compounds structurally similar to bis(4-hydroxyphenyl)propane (bisphenol A, BPA) are called bisphenols (BPs), and some of them can partially replace BPA in industrial applications. The production and consumption of BPs other than BPA, especially those of bis(4-hydroxyphenyl)methane (bisphenol F, BPF) and

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A group of compounds structurally similar to bis(4-hydroxyphenyl)propane (bisphenol A, BPA) are called bisphenols (BPs), and some of them can partially replace BPA in industrial applications. The production and consumption of BPs other than BPA, especially those of bis(4-hydroxyphenyl)methane (bisphenol F, BPF) and bis(4-hydroxy-phenyl)sulfone (bisphenol S, BPS), have increased recently, leading to their detection as contaminants in the aquatic environment. The three compounds tested 100% positive for estrus response in 1936 and concerns about their health risks have been increasing. Abundant data on degradation of bisphenols (BPs) has been published, but results for biodegradation of BPs in seawater are lacking. However, several research groups have focused on this topic recently. In this study, the biodegradation behaviors of three BPs, namely BPA, BPF and BPS, in seawater were investigated using TOC Handai (TOC, potential test) and river (sea) die-away (SDA, simulation test) methods, which are both a kind of river-die-away test. The main difference between the tests is that indigenous microcosms remain in the sampled raw seawater for the SDA experiments, but they are removed through filtration and dispersed into artificial seawater for the TOC experiments. The BPs, except for BPS, were degraded using both methods. The SDA method produced better biodegradation results than the TOC method in terms of degradation time (both lag and degradation periods). Biodegradation efficiencies were measured at 75-100% using the SDA method and 13-63% using the TOC method. BPF showed better degradation efficiency than BPA, BPF was > 92% and BPA 83% depleted according to the SDA tests. BPS degradation was not observed. As a conclusion, the biodegradability of the three BPs in seawater could be ranked as BPF > BPA >> BPS. BPF is more biodegradable than BPA in seawater and BPS is more likely to accumulate in the aquatic environment. BPS poses a lower risk to human health and to the environment than BPA or BPF but it is not amenable to biodegradation and might be persistent and become an ecological burden. Thus other degradation methods need to be found for the removal of BPS in the environment. Full article

(This article belongs to the Special Issue Biodegradability and Environmental Sciences)

Open AccessArticle Connectivity for Healthcare and Well-Being Management: Examples from Six European Projects

by Maged N. Kamel Boulos, Ricardo Castellot Lou, Athanasios Anastasiou, Chris D. Nugent, Jan Alexandersson, Gottfried Zimmermann, Ulises Cortes and Roberto Casas

Int. J. Environ. Res. Public Health 2009, 6(7), 1947-1971; doi:10.3390/ijerph6071947

Received: 26 May 2009 / Accepted: 2 July 2009 / Published: 6 July 2009

Cited by 57 | Viewed by 9689 | PDF Full-text (731 KB) | HTML Full-text | XML Full-text

Abstract

Technological advances and societal changes in recent years have contributed to a shift in traditional care models and in the relationship between patients and their doctors/carers, with (in general) an increase in the patient-carer physical distance and corresponding changes in the modes of

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Technological advances and societal changes in recent years have contributed to a shift in traditional care models and in the relationship between patients and their doctors/carers, with (in general) an increase in the patient-carer physical distance and corresponding changes in the modes of access to relevant care information by all groups. The objective of this paper is to showcase the research efforts of six projects (that the authors are currently, or have recently been, involved in), CAALYX, eCAALYX, COGKNOW, EasyLine+, I2HOME, and SHARE-it, all funded by the European Commission towards a future where citizens can take an active role into managing their own healthcare. Most importantly, sensitive groups of citizens, such as the elderly, chronically ill and those suffering from various physical and cognitive disabilities, will be able to maintain vital and feature-rich connections with their families, friends and healthcare providers, who can then respond to, and prevent, the development of adverse health conditions in those they care for in a timely manner, wherever the carers and the people cared for happen to be. Full article

(This article belongs to the Special Issue Public Health Informatics)

Open AccessArticle Parenthood—A Contributing Factor to Childhood Obesity

by Fatma G. Huffman, Sankarabharan Kanikireddy and Manthan Patel

Int. J. Environ. Res. Public Health 2010, 7(7), 2800-2810; doi:10.3390/ijerph7072800

Received: 14 May 2010 / Revised: 17 June 2010 / Accepted: 28 June 2010 / Published: 30 June 2010

Cited by 32 | Viewed by 9445 | PDF Full-text (227 KB) | HTML Full-text | XML Full-text

Abstract

Prevalence of childhood obesity and its complications have increased world-wide. Parental status may be associated with children’s health outcomes including their eating habits, body weight and blood cholesterol. The National Health and Nutrition Examination Survey (NHANES) for the years 1988–1994, provided a unique

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Prevalence of childhood obesity and its complications have increased world-wide. Parental status may be associated with children’s health outcomes including their eating habits, body weight and blood cholesterol. The National Health and Nutrition Examination Survey (NHANES) for the years 1988–1994, provided a unique opportunity for matching parents to children enabling analyses of joint demographics, racial differences and health indicators. Specifically, the NHANES III data, 1988–1994, of 219 households with single-parents and 780 dual-parent households were analyzed as predictors for primary outcome variables of children’s Body Mass Index (BMI), dietary nutrient intakes and blood cholesterol. Children of single-parent households were significantly (p < 0.01) more overweight than children of dual-parent households. Total calorie and saturated fatty acid intakes were higher among children of single-parent households than dual-parent households (p < 0.05). On average, Black children were more overweight (p < 0.04) than children of other races. The study results implied a strong relationship between single-parent status and excess weight in children. Further studies are needed to explore the dynamics of single-parent households and its influence on childhood diet and obesity. Parental involvement in the development of school- and community-based obesity prevention programs are suggested for effective health initiatives. Economic constraints and cultural preferences may be communicated directly by family involvement in these much needed public health programs. Full article

(This article belongs to the Special Issue Obesity and Public Health)

Open AccessArticle Small Area and Individual Level Predictors of Physical Activity in Urban Communities: A Multi-Level Study in Stoke on Trent, England

by Thomas Cochrane, Rachel C. Davey, Chris Gidlow, Graham R. Smith, Jon Fairburn, Christopher J. Armitage, Hilde Stephansen and Svetlana Speight

Int. J. Environ. Res. Public Health 2009, 6(2), 654-677; doi:10.3390/ijerph60200654

Received: 18 November 2008 / Accepted: 10 February 2009 / Published: 13 February 2009

Cited by 15 | Viewed by 9382 | PDF Full-text (419 KB) | HTML Full-text | XML Full-text

Abstract

Reducing population physical inactivity has been declared a global public health priority. We report a detailed multi-level analysis of small area indices and individual factors as correlates of physical activity in deprived urban areas. Multi-level regression analysis was used to investigate environmental and

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Reducing population physical inactivity has been declared a global public health priority. We report a detailed multi-level analysis of small area indices and individual factors as correlates of physical activity in deprived urban areas. Multi-level regression analysis was used to investigate environmental and individual correlates of physical activity. Nine individual factors were retained in the overall model, two related to individual intentions or beliefs, three to access to shops, work or fast food outlets and two to weather; age and gender being the other two. Four area level indices related to: traffic, road casualties, criminal damage and access to green space were important in explaining variation in physical activity. Full article

(This article belongs to the Special Issue Public Health: Feature Papers)

Open AccessReview Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System

by Lisa A. Barker, Belinda S. Gout and Timothy C. Crowe

Int. J. Environ. Res. Public Health 2011, 8(2), 514-527; doi:10.3390/ijerph8020514

Received: 20 December 2010 / Revised: 10 January 2011 / Accepted: 4 February 2011 / Published: 16 February 2011

Cited by 139 | Viewed by 9316 | PDF Full-text (166 KB) | HTML Full-text | XML Full-text

Abstract

Malnutrition is a debilitating and highly prevalent condition in the acute hospital setting, with Australian and international studies reporting rates of approximately 40%. Malnutrition is associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, longer lengths

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Malnutrition is a debilitating and highly prevalent condition in the acute hospital setting, with Australian and international studies reporting rates of approximately 40%. Malnutrition is associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, longer lengths of hospital stay, higher treatment costs and increased mortality. Referral rates for dietetic assessment and treatment of malnourished patients have proven to be suboptimal, thereby increasing the likelihood of developing such aforementioned complications. Nutrition risk screening using a validated tool is a simple technique to rapidly identify patients at risk of malnutrition, and provides a basis for prompt dietetic referrals. In Australia, nutrition screening upon hospital admission is not mandatory, which is of concern knowing that malnutrition remains under-reported and often poorly documented. Unidentified malnutrition not only heightens the risk of adverse complications for patients, but can potentially result in foregone reimbursements to the hospital through casemix-based funding schemes. It is strongly recommended that mandatory nutrition screening be widely adopted in line with published best-practice guidelines to effectively target and reduce the incidence of hospital malnutrition. Full article

(This article belongs to the Special Issue Malnutrition and Public Health)

Open AccessArticle Prevalence of Alcohol Consumption and Hazardous Drinking, Tobacco and Drug Use in Urban Tanzania, and Their Associated Risk Factors

by Joseph Mbatia, Rachel Jenkins, Nicola Singleton and Bethany White

Int. J. Environ. Res. Public Health 2009, 6(7), 1991-2006; doi:10.3390/ijerph6071991

Received: 4 June 2009 / Accepted: 9 July 2009 / Published: 16 July 2009

Cited by 29 | Viewed by 9312 | PDF Full-text (253 KB) | HTML Full-text | XML Full-text

Abstract

Evidence suggests substance abuse in Tanzania is a growing public health problem. A random sample of 899 adults aged 15-59 in two urban sites of differing levels of poverty surveyed alcohol, tobacco and illicit substance use. Rates of substance use were 17.2%. 8.7%

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Evidence suggests substance abuse in Tanzania is a growing public health problem. A random sample of 899 adults aged 15-59 in two urban sites of differing levels of poverty surveyed alcohol, tobacco and illicit substance use. Rates of substance use were 17.2%. 8.7% and 0.8% for alcohol, tobacco and cannabis, respectively. Living in the less affluent area was associated with higher lifetime rates of tobacco and alcohol use. Substance use is less prevalent in Tanzania than in richer countries, but lifetime consumption is higher in poorer areas. The association of substance use with a range of socio-economic factors warrants further research. Full article

(This article belongs to the Special Issue Alcohol and Public Health)

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