International Journal of Environmental Research and Public Health

20 pages, 709 KiB

Open AccessArticle

Symptoms and Health Complaints and Their Association with Perceived Stressors among Students at Nine Libyan Universities

by Walid El Ansari^1,*, Khalid Khalil² and Christiane Stock³

¹ Faculty of Applied Sciences, University of Gloucestershire, Gloucester GL2 9HW, UK

² Faculty of Medical Technology, Misrata, Libya

³ Unit for Health Promotion Research, Institute of Public Health, University of Southern Denmark, Esbjerg 6700, Denmark

Int. J. Environ. Res. Public Health 2014, 11(12), 12088-12107; https://doi.org/10.3390/ijerph111212088 - 25 Nov 2014

Cited by 19 | Viewed by 7027

Abstract

University students are exposed to many stressors. We assessed the associations between two stressors (educational related and general overall), socio-demographic characteristics (five variables), health behaviours/lifestyle factors (six variables), as well as religiosity and quality of life as independent variables, with self-reported symptoms/health complaints [...] Read more.

University students are exposed to many stressors. We assessed the associations between two stressors (educational related and general overall), socio-demographic characteristics (five variables), health behaviours/lifestyle factors (six variables), as well as religiosity and quality of life as independent variables, with self-reported symptoms/health complaints as dependent variables (eight health complaints). A sample of 2100 undergraduate students from nine institutions (six universities, three colleges) located in seven cities in Libya completed a general health questionnaire. The most prevalent symptoms were headaches, depressive mood, difficulties to concentrate and sleep disorder/insomnia that have been reported by 50%–60% of the students. The majority of students (62%) reported having had three or more symptoms sometimes or very often in the last 12 months. There was a positive association between perceived stressors and health symptoms, which remained significant after adjustment for gender and many other relevant factors for headache (OR 1.52; 95% CI 1.15–2.02), depressive mood (OR 2.20; 95% CI 1.64–2.94) and sleep disorder/ insomnia (OR 1.55, 95% CI 1.19–2.03). Other factors independently associated with most health symptoms were female gender and poor self-perceived health. Stress management programmes and a reduction of educational related stressors might help to prevent stress-related symptoms and health complaints in this student population. Full article

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10 pages, 674 KiB

Open AccessArticle

Vitamin D and Psoriasis Pathology in the Mediterranean Region, Valencia (Spain)

by Maria Morales Suárez-Varela^1,2,3,*

, Paloma Reguera-Leal^1,†, William B. Grant^4,†

, Nuria Rubio-López^1,2,3,† and Agustín Llopis-González^1,2,3,†

¹ Unit of Public Health, Hygiene and Environmental Health, Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, 46100 Valencia, Spain

² CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain

³ Center for Advanced Research in Public Health (CSISP-FISABIO), 46010 Valencia, Spain

⁴ Sunlight, Nutrition and Health Research Center, P.O. Box 641603, San Francisco, CA 94164, USA

^† These authors contributed equally to this work.

Int. J. Environ. Res. Public Health 2014, 11(12), 12108-12117; https://doi.org/10.3390/ijerph111212108 - 25 Nov 2014

Cited by 8 | Viewed by 7864

Abstract

Vitamin D has important immunomodulatory effects on psoriasis in the Mediterranean region. To measure vitamin D intake in subjects with and without psoriasis, and to find an association with relevant clinical features, a case-control study was performed using cases (n = 50, 50% [...] Read more.

Vitamin D has important immunomodulatory effects on psoriasis in the Mediterranean region. To measure vitamin D intake in subjects with and without psoriasis, and to find an association with relevant clinical features, a case-control study was performed using cases (n = 50, 50% participation rate) clinically diagnosed with psoriasis and 200 healthy subjects (39.5% participation rate), leaving a final sample of 104 people. A survey was conducted using a food frequency questionnaire and clinical histories. Cases and controls were compared using univariate and multivariate analyses. We observed insufficient intake of cholecalciferol (vitamin D3) or ergocalciferol (vitamin D2) for both cases and controls. Patients with psoriasis were at greater risk of associated pathologies: dyslipidaemia (OR: 3.6, 95% CI: 0.8–15.2); metabolic syndrome (OR: 3.3, 95% CI: 0.2–53.9); hypertension (OR: 1.7, 95% CI: 0.4–7.2). Insufficient vitamin D intake in both psoriasis patients and controls in the Mediterranean population, and cardiovascular comorbility is more frequent in patients with psoriasis. Full article

(This article belongs to the Special Issue Preventive Medicine)

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11 pages, 667 KiB

Open AccessArticle

Dental Caries Experience and Use of Dental Services among Brazilian Prisoners

by Alessandro Leite Cavalcanti^1,*, Iris Sant´Anna Araujo Rodrigues¹, Ingrid Thays De Melo Silveira², Thaliny Batista Sarmento De Oliveira¹, Magaly Suenya De Almeida Pinto¹, Alidianne Fabia Cabral Xavier², Ricardo Dias De Castro² and Wilton Wilney Nascimento Padilha¹

¹ Post Graduate Program in Public Health, State University of Paraiba, Campina Grande, PB 58429-500, Brazil

² Department of Dentistry, State University of Paraiba, Campina Grande, PB 58429-500, Brazil

Int. J. Environ. Res. Public Health 2014, 11(12), 12118-12128; https://doi.org/10.3390/ijerph111212118 - 25 Nov 2014

Cited by 11 | Viewed by 5909

Abstract

This ross-sectional study involving 127 male prisoners evaluates the use of dental services and dental caries among Brazilian inmates. Data were collected by interview and clinical examination. Sociodemographic and sentencing information as well as use of dental services, self-reported dental morbidity, self-perception, and [...] Read more.

This ross-sectional study involving 127 male prisoners evaluates the use of dental services and dental caries among Brazilian inmates. Data were collected by interview and clinical examination. Sociodemographic and sentencing information as well as use of dental services, self-reported dental morbidity, self-perception, and oral health impacts were investigated. The mean DMFT index value was 19.72. Of the components, the decayed component showed the highest mean value (11.06 ± 5.37). Statistically significant association was found between DMFTs with values from 22 to 32 and oral health satisfaction (p = 0.002), difficulty speaking (p = 0.024), shame of talking (p = 0.004) and smiling (p < 0.001). Regarding the use of dental services, 80% had their last dental appointment less than one year ago, with most visits occurring in prison (80%), with restorative treatment (32%), followed by dental pain (26.4%), being the main reasons for such appointments. Most prisoners used dental services provided by the prison. Although restorative treatment has been the main reason for the use of dental services, “decayed” and “missing” components contributed to the high mean DMFT index. Full article

(This article belongs to the Special Issue Social and Environmental Determinants of Oral Health)

19 pages, 2594 KiB

Open AccessArticle

Spatiotemporal Heterogeneity Analysis of Hemorrhagic Fever with Renal Syndrome in China Using Geographically Weighted Regression Models

by Shujuan Li^1,2, Hongyan Ren^1,*, Wensheng Hu³, Liang Lu^4,*, Xinliang Xu¹, Dafang Zhuang¹ and Qiyong Liu⁴

¹ State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, 11A Datun Road, Chaoyang District, Beijing 100101, China

² College of Resources and Environment, University of Chinese Academy of Sciences, No. 19 Yuquan Road, Beijing 100049, China

³ Center for Health Statistics and Information, National Health and Family Planning Commission, No.38 Beilishi Road, Xicheng District, Beijing 100044, China

⁴ State Key Laboratory for Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, China CDC, 5 Changbai Road, Changping, Beijing 102206, China

Int. J. Environ. Res. Public Health 2014, 11(12), 12129-12147; https://doi.org/10.3390/ijerph111212129 - 25 Nov 2014

Cited by 36 | Viewed by 7723

Abstract

Hemorrhagic fever with renal syndrome (HFRS) is an important public health problem in China. The identification of the spatiotemporal pattern of HFRS will provide a foundation for the effective control of the disease. Based on the incidence of HFRS, as well as environmental [...] Read more.

Hemorrhagic fever with renal syndrome (HFRS) is an important public health problem in China. The identification of the spatiotemporal pattern of HFRS will provide a foundation for the effective control of the disease. Based on the incidence of HFRS, as well as environmental factors, and social-economic factors of China from 2005–2012, this paper identified the spatiotemporal characteristics of HFRS distribution and the factors that impact this distribution. The results indicate that the spatial distribution of HFRS had a significant, positive spatial correlation. The spatiotemporal heterogeneity was affected by the temperature, precipitation, humidity, NDVI of January, NDVI of August for the previous year, land use, and elevation in 2005–2009. However, these factors did not explain the spatiotemporal heterogeneity of HFRS incidences in 2010–2012. Spatiotemporal heterogeneity of provincial HFRS incidences and its relation to environmental factors would provide valuable information for hygiene authorities to design and implement effective measures for the prevention and control of HFRS in China. Full article

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14 pages, 820 KiB

Open AccessArticle

Measuring Disability and Its Predicting Factors in a Large Database in Taiwan Using the World Health Organization Disability Assessment Schedule 2.0

by Wen-Chou Chi¹, Kwang-Hwa Chang^2,3, Reuben Escorpizo^4,5, Chia-Feng Yen⁶, Hua-Fang Liao^7,8, Feng-Hang Chang³, Hung-Yi Chiou⁹, Sue-Wen Teng¹⁰, Wen-Ta Chiu^3,10 and Tsan-Hon Liou^1,3,11,*

¹ Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan

² Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan

³ Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei 110, Taiwan

⁴ Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT 05401, USA

⁵ Swiss Paraplegic Research, Nottwil 6207, Switzerland

⁶ Department of Public Health, Tzu Chi University, Hualien 970, Taiwan

⁷ Chinese Association of Early Intervention Profession for Children with Developmental Delays, Hualien City 970, Taiwan

⁸ School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 106, Taiwan

⁹ School of Public Health, Taipei Medical University, Taipei 116, Taiwan

¹⁰ Ministry of Health and Welfare, Taipei 115, Taiwan

¹¹ Department of Physical Medicine and Rehabilitation, College of Medicine, Taipei Medical University, Taipei 116, Taiwan

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Int. J. Environ. Res. Public Health 2014, 11(12), 12148-12161; https://doi.org/10.3390/ijerph111212148 - 25 Nov 2014

Cited by 28 | Viewed by 7858

Abstract

The definition of disability had been unclear until the International Classification of Functioning, Disability, and Health was promulgated in 2001 by the World Health Organization (WHO). Disability is a critical but relatively neglected public-health concern. We conducted this study to measure disabilities by [...] Read more.

The definition of disability had been unclear until the International Classification of Functioning, Disability, and Health was promulgated in 2001 by the World Health Organization (WHO). Disability is a critical but relatively neglected public-health concern. We conducted this study to measure disabilities by using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and identify the factors that contribute to disabilities. We obtained and analyzed the data on people who applied to Taiwan’s disability registration system between September 2012 and August 2013. A total of 158,174 cases were selected for this study. Among the people included in this study, 53% were male, and the females were on average 3 years older than the males. More males than females were of a low socioeconomic status, but the rate of employment was higher among the males than among the females. Age, sex, place of residence, and types and severity of impairment were all determined to be factors that independently contributed to disability. This study has demonstrated that disability can be measured and compared using WHODAS 2.0. Increasing the public-health attention devoted to disability and identifying the factors associated with disability can promote independence and social participation in people with disabilities. Full article

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12 pages, 673 KiB

Open AccessArticle

Influenza Vaccination Coverage among Adults in Korea: 2008–2009 to 2011–2012 Seasons

by Hye Jung Yang¹ and Sung-il Cho^2,*

¹ Graduate School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul 151-742, Korea

² Graduate School of Public Health and Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea

Int. J. Environ. Res. Public Health 2014, 11(12), 12162-12173; https://doi.org/10.3390/ijerph111212162 - 25 Nov 2014

Cited by 27 | Viewed by 6830

Abstract

The aim of this study was to examine seasonal and pandemic influenza vaccination coverage in adults from the 2008–2009 season to the 2011–2012 season, including pandemic and post-pandemic seasons in Korea. We collected data of self-reported vaccine use from the Korean Community Health [...] Read more.

The aim of this study was to examine seasonal and pandemic influenza vaccination coverage in adults from the 2008–2009 season to the 2011–2012 season, including pandemic and post-pandemic seasons in Korea. We collected data of self-reported vaccine use from the Korean Community Health Survey. We also collected information on socioeconomic status and health behaviors in subpopulations. We tested for linear trends among the data to investigate vaccine coverage before and after the pandemic; and multiple logistic regression analyses were performed to identify predictors of obtaining the influenza vaccination. The results revealed a steady increase in vaccination coverage in every subgroup during four consecutive seasons. The highest rate of vaccine coverage (43.6%) occurred two years after the pandemic. Factors associated with vaccine receipt were: older age; lower education level; lower income; and health behaviors such as regular walking and receiving a health check-up. Smoking and drinking alcohol were inversely associated with vaccination. Having a chronic health condition was also a strong predictor of vaccine receipt. Though vaccination coverage rates were high in high-risk groups; disparities in coverage rates were substantial; particularly in young adults. Interventions are needed to minimize the coverage gaps among subgroups and to improve overall vaccination rates. Full article

(This article belongs to the Special Issue Preventive Medicine)

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16 pages, 666 KiB

Open AccessArticle

Support for Indoor Bans on Electronic Cigarettes among Current and Former Smokers

by Stephanie K. Kolar¹, Brooke G. Rogers¹ and Monica Webb Hooper^1,2,*

¹ Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL 33146, USA

² Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 12174-12189; https://doi.org/10.3390/ijerph111212174 - 25 Nov 2014

Cited by 15 | Viewed by 6532

Abstract

Objectives: Electronic cigarette (e-cigarette) use is increasing in the U.S. Although marketed as a safer alternative for cigarettes, initial evidence suggests that e-cigarettes may pose a secondhand exposure risk. The current study explored the prevalence and correlates of support for e-cigarette bans. Methods: [...] Read more.

Objectives: Electronic cigarette (e-cigarette) use is increasing in the U.S. Although marketed as a safer alternative for cigarettes, initial evidence suggests that e-cigarettes may pose a secondhand exposure risk. The current study explored the prevalence and correlates of support for e-cigarette bans. Methods: A sample of 265 current/former smokers completed a cross-sectional telephone survey from June–September 2014; 45% Black, 31% White, 21% Hispanic. Items assessed support for home and workplace bans for cigarettes and e-cigarettes and associated risk perceptions. Results: Most participants were aware of e-cigarettes (99%). Results demonstrated less support for complete e-cigarette bans in homes and workplaces compared to cigarettes. Support for complete e-cigarette bans was strongest among older, higher income, married respondents, and former smokers. Complete e-cigarette bans were most strongly endorsed when perceptions of addictiveness and health risks were high. While both e-cigarette lifetime and never-users strongly supported cigarette smoking bans, endorsement for e-cigarette bans varied by lifetime use and intentions to use e-cigarettes. Conclusions: Support for indoor e-cigarette bans is relatively low among individuals with a smoking history. Support for e-cigarette bans may change as evidence regarding their use emerges. These findings have implications for public health policy. Full article

14 pages, 716 KiB

Open AccessArticle

Childhood Acute Respiratory Infections and Household Environment in an Eastern Indonesian Urban Setting

by Tomoyuki Shibata^1,2,3,*, James L. Wilson^2,4, Lindsey M. Watson¹, Alyse LeDuc¹, Can Meng^1,5, Ansariadi³, Ruslan La Ane³, Syamsuar Manyullei³ and Alimin Maidin³

¹ Public Health Program, Northern Illinois University, DeKalb, IL 60115, USA

² Institute of the Study for Environment, Sustainability, and Energy, Northern Illinois University, DeKalb, IL 60115, USA

³ Faculty of Public Health, Universitas Hasanuddin, Makassar, South Sulawesi 90245, Indonesia

⁴ Department of Geography, Northern Illinois University, DeKalb, IL 60115, USA

⁵ Division of Statistics, Northern Illinois University, DeKalb, IL 60115, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 12190-12203; https://doi.org/10.3390/ijerph111212190 - 25 Nov 2014

Cited by 39 | Viewed by 8773

Abstract

This pilot study evaluated the potential effect of household environmental factors such as income, maternal characteristics, and indoor air pollution on children’s respiratory status in an Eastern Indonesian community. Household data were collected from cross-sectional (n = 461 participants) and preliminary childhood [...] Read more.

This pilot study evaluated the potential effect of household environmental factors such as income, maternal characteristics, and indoor air pollution on children’s respiratory status in an Eastern Indonesian community. Household data were collected from cross-sectional (n = 461 participants) and preliminary childhood case-control surveys (pneumonia cases = 31 diagnosed within three months at a local health clinic; controls = 30). Particulate matter (PM_2.5 and PM₁₀) was measured in living rooms, kitchens, children’s bedrooms, and outside areas in close proximity once during the case-control household interviews (55 homes) and once per hour from 6 a.m. to midnight in 11 homes. The household survey showed that children were 1.98 times (p = 0.02) more likely to have coughing symptoms indicating respiratory infection, if mothers were not the primary caregivers. More children exhibited coughing if they were not exclusively breastfed (OR = 2.18; p = 0.06) or there was a possibility that their mothers were exposed to environmental tobacco smoke during pregnancy (OR = 2.05; p = 0.08). This study suggests that household incomes and mother’s education have an indirect effect on childhood pneumonia and respiratory illness. The concentrations of PM_2.5 and PM₁₀ ranged from 0.5 to 35.7 µg/m³ and 7.7 to 575.7 µg/m³, respectively, based on grab samples. PM was significantly different between the case and control groups (p < 0.01). The study also suggests that ambient air may dilute indoor pollution, but also introduces pollution into the home from the community environment. Effective intervention programs need to be developed that consider multiple direct and indirect risk factors to protect children. Full article

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19 pages, 6654 KiB

Open AccessArticle

Are Biophilic-Designed Site Office Buildings Linked to Health Benefits and High Performing Occupants?

by Tonia Gray^1,*,† and Carol Birrell^2,†

¹ Centre for Educational Research, School of Education University of Western Sydney, Penrith 2751, Australia

² School of Education, University of Western Sydney, Penrith 2751, Australia

^† These authors contributed equally to this work.

Int. J. Environ. Res. Public Health 2014, 11(12), 12204-12222; https://doi.org/10.3390/ijerph111212204 - 26 Nov 2014

Cited by 111 | Viewed by 23786

Abstract

This paper discusses the first phase of a longitudinal study underway in Australia to ascertain the broad health benefits of specific types of biophilic design for workers in a building site office. A bespoke site design was formulated to include open plan workspace, [...] Read more.

This paper discusses the first phase of a longitudinal study underway in Australia to ascertain the broad health benefits of specific types of biophilic design for workers in a building site office. A bespoke site design was formulated to include open plan workspace, natural lighting, ventilation, significant plants, prospect and views, recycled materials and use of non-synthetic materials. Initial data in the first three months was gathered from a series of demographic questions and from interviews and observations of site workers. Preliminary data indicates a strong positive effect from incorporating aspects of biophilic design to boost productivity, ameliorate stress, enhance well-being, foster a collaborative work environment and promote workplace satisfaction, thus contributing towards a high performance workspace. The longitudinal study spanning over two years will track human-plant interactions in a biophilic influenced space, whilst also assessing the concomitant cognitive, social, psychological and physical health benefits for workers. Full article

(This article belongs to the Special Issue Health Benefits of Nature)

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24 pages, 794 KiB

Open AccessArticle

Patient-Reported Outcome Measures and Risk Factors in a Quality Registry: A Basis for More Patient-Centered Diabetes Care in Sweden

by Sixten Borg^1,2,*, Bo Palaszewski^3,4, Ulf-G Gerdtham^1,2,5, Ödegaard Fredrik⁶, Pontus Roos^1,† and Soffia Gudbjörnsdottir^3,4,7

¹ Health Economics Unit, Department of Clinical Sciences in Malmö, Lund University, SE-223 81 Lund, Sweden

² The Swedish Institute for Health Economics (IHE), Box 2127, SE-220 02 Lund, Sweden

³ The National Diabetes Register, SE-413 45 Gothenburg, Sweden

⁴ Centre of Registers in Region Vastra Gotaland, SE-413 45 Gothenburg, Sweden

⁵ Department of Economics, School of Economics and Management, Box 7082, SE-220 07 Lund, Sweden

⁶ Ivey Business School, Western University, 1255 Western Road, London ON N6G ON1, Canada

⁷ Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, SE-413 45 Gothenburg, Sweden

^† Deceased and Previously at Institute of Applied Economics, Malmo, Sweden

Int. J. Environ. Res. Public Health 2014, 11(12), 12223-12246; https://doi.org/10.3390/ijerph111212223 - 26 Nov 2014

Cited by 15 | Viewed by 8092

Abstract

Diabetes is one of the chronic diseases that constitute the greatest disease burden in the world. The Swedish National Diabetes Register is an essential part of the diabetes care system. Currently it mainly records clinical outcomes, but here we describe how it has [...] Read more.

Diabetes is one of the chronic diseases that constitute the greatest disease burden in the world. The Swedish National Diabetes Register is an essential part of the diabetes care system. Currently it mainly records clinical outcomes, but here we describe how it has started to collect patient-reported outcome measures, complementing the standard registry data on clinical outcomes as a basis for evaluating diabetes care. Our aims were to develop a questionnaire to measure patient abilities and judgments of their experience of diabetes care, to describe a Swedish diabetes patient sample in terms of their abilities, judgments, and risk factors, and to characterize groups of patients with a need for improvement. Patient abilities and judgments were estimated using item response theory. Analyzing them together with standard risk factors for diabetes comorbidities showed that the different types of data describe different aspects of a patient’s situation. These aspects occasionally overlap, but not in any particularly useful way. They both provide important information to decision makers, and neither is necessarily more relevant than the other. Both should therefore be considered, to achieve a more complete evaluation of diabetes care and to promote person-centered care. Full article

(This article belongs to the Section Health Economics)

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14 pages, 686 KiB

Open AccessArticle

Oral Health Behaviour and Social and Health Factors in University Students from 26 Low, Middle and High Income Countries

by Karl Peltzer^1,2,3,*

and Supa Pengpid^1,4

¹ ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand

² Department of Psychology, University of Limpopo, Turfloop Campus, Sovenga 0727, South Africa

³ HIV/AIDS/STIs/and TB (HAST), Human Sciences Research Council, Private Bag X41, Pretoria 0001, South Africa

⁴ Department of Research & Innovation, University of Limpopo, Turfloop Campus, Sovenga 0727, South Africa

Int. J. Environ. Res. Public Health 2014, 11(12), 12247-12260; https://doi.org/10.3390/ijerph111212247 - 26 Nov 2014

Cited by 64 | Viewed by 9815

Abstract

Poor oral health is still a major burden for populations throughout the world, particularly in developing countries. The aim of this study was investigate oral health behaviour (tooth brushing and dental attendance) and associated factors in low, middle and high income countries. Using [...] Read more.

Poor oral health is still a major burden for populations throughout the world, particularly in developing countries. The aim of this study was investigate oral health behaviour (tooth brushing and dental attendance) and associated factors in low, middle and high income countries. Using anonymous questionnaires, data were collected from 19,560 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Results indicate that 67.2% of students reported to brush their teeth twice or more times a day, 28.8% about once a day and 4.0% never. Regarding dental check-up visit, 16.3% reported twice a year, 25.6% once a year, 33.9% rarely and 24.3% never. In a multivariate logistic regression analysis, being a male, coming from a wealthy or quite well off family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, depression and PTSD symptoms, tobacco use and frequent gambling, low physical activity, and low daily meal and snacks frequency were associated with inadequate tooth brushing (<twice daily). Further, being a male, older age, coming from a not well off or poor family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, PTSD symptoms, illicit drug use, low physical activity, and low daily snacks frequency, skipping breakfast and inadequate fruit and vegetables consumption were associated with less than one annual dental care visit. Oral health behaviour among the students was found to be low. Various risk factors identified can be used to guide interventions to improve oral health behaviour among university students. Full article

(This article belongs to the Special Issue Social and Environmental Determinants of Oral Health)

22 pages, 712 KiB

Open AccessArticle

Developing a Service Platform Definition to Promote Evidence-Based Planning and Funding of the Mental Health Service System

by Yong Yi Lee^1,2,*

, Carla S. Meurk^1,2,†, Meredith G. Harris^1,2,†, Sandra Diminic^1,2,†, Roman W. Scheurer^2,† and Harvey A. Whiteford^1,2,†

¹ School of Population Health, University of Queensland, via Level 2, Public Health Building, Herston Road, Herston, QLD 4006, Australia

² Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Queensland Health, via Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Locked Bag 500, Sumner Park BC, QLD 4074, Australia

^† These authors contributed equally to this work.

Int. J. Environ. Res. Public Health 2014, 11(12), 12261-12282; https://doi.org/10.3390/ijerph111212261 - 26 Nov 2014

Cited by 3 | Viewed by 6732

Abstract

Ensuring that a mental health system provides ‘value for money’ requires policy makers to allocate resources to the most cost-effective interventions. Organizing cost-effective interventions into a service delivery framework will require a concept that can guide the mapping of evidence regarding disorder-level interventions [...] Read more.

Ensuring that a mental health system provides ‘value for money’ requires policy makers to allocate resources to the most cost-effective interventions. Organizing cost-effective interventions into a service delivery framework will require a concept that can guide the mapping of evidence regarding disorder-level interventions to aggregations of services that are meaningful for policy makers. The ‘service platform’ is an emerging concept that could be used to this end, however no explicit definition currently exists in the literature. The aim of this study was to develop a service platform definition that is consistent with how policy makers conceptualize the major elements of the mental health service system and to test the validity and utility of this definition through consultation with mental health policy makers. We derived a provisional definition informed by existing literature and consultation with experienced mental health researchers. Using a modified Delphi method, we obtained feedback from nine Australian policy makers. Respondents provided written answers to a questionnaire eliciting their views on the acceptability, comprehensibility and usefulness of a service platform definition which was subject to qualitative analysis. Overall, respondents understood the definition and found it both acceptable and useful, subject to certain conditions. They also provided suggestions for its improvement. Our findings suggest that the service platform concept could be a useful way of aggregating mental health services as a means for presenting priority setting evidence to policy makers in mental health. However, further development and testing of the concept is required. Full article

(This article belongs to the Special Issue Mental Health Care)

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21 pages, 1081 KiB

Open AccessArticle

On the Analysis of a Repeated Measure Design in Genome-Wide Association Analysis

by Young Lee^1,2, Suyeon Park^1,2, Sanghoon Moon¹, Juyoung Lee¹, Robert C. Elston³, Woojoo Lee⁴ and Sungho Won^5,*

¹ The Center for Genome Science, Korea National Institute of Health, KCDC, Osong 361-951, Korea

² Department of Applied Statistics, Chung-Ang University, Seoul 156-756, Korea

³ Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH 44106, USA

⁴ Department of Statistics, Inha University, Incheon 402-751, Korea

⁵ Department of Public Health Science, Seoul National University, Seoul 151-742, Korea

Int. J. Environ. Res. Public Health 2014, 11(12), 12283-12303; https://doi.org/10.3390/ijerph111212283 - 28 Nov 2014

Cited by 9 | Viewed by 6182

Abstract

Longitudinal data enables detecting the effect of aging/time, and as a repeated measures design is statistically more efficient compared to cross-sectional data if the correlations between repeated measurements are not large. In particular, when genotyping cost is more expensive than phenotyping cost, the [...] Read more.

Longitudinal data enables detecting the effect of aging/time, and as a repeated measures design is statistically more efficient compared to cross-sectional data if the correlations between repeated measurements are not large. In particular, when genotyping cost is more expensive than phenotyping cost, the collection of longitudinal data can be an efficient strategy for genetic association analysis. However, in spite of these advantages, genome-wide association studies (GWAS) with longitudinal data have rarely been analyzed taking this into account. In this report, we calculate the required sample size to achieve 80% power at the genome-wide significance level for both longitudinal and cross-sectional data, and compare their statistical efficiency. Furthermore, we analyzed the GWAS of eight phenotypes with three observations on each individual in the Korean Association Resource (KARE). A linear mixed model allowing for the correlations between observations for each individual was applied to analyze the longitudinal data, and linear regression was used to analyze the first observation on each individual as cross-sectional data. We found 12 novel genome-wide significant disease susceptibility loci that were then confirmed in the Health Examination cohort, as well as some significant interactions between age/sex and SNPs. Full article

(This article belongs to the Special Issue Genetic Epidemiology)

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8 pages, 624 KiB

Open AccessCase Report

Diagnosing Cervical Dysplasia Using Visual Inspection of the Cervix with Acetic Acid in a Woman in Rural Haiti

by Elizabeth Roger and Oguchi Nwosu^*

Emory University School of Medicine, Atlanta, GA 30322, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 12304-12311; https://doi.org/10.3390/ijerph111212304 - 28 Nov 2014

Cited by 5 | Viewed by 16100

Abstract

Cervical cancer remains a significant cause of morbidity and mortality for women in developing countries, despite the fact that inexpensive, simple and effective screening methods are available. Visual inspection of the cervix with acetic acid (VIA) can be used as part of a [...] Read more.

Cervical cancer remains a significant cause of morbidity and mortality for women in developing countries, despite the fact that inexpensive, simple and effective screening methods are available. Visual inspection of the cervix with acetic acid (VIA) can be used as part of a “screen and treat” program to identify precancerous lesions for cryotherapy treatment. This case report details how the VIA screening test was incorporated into the care of a patient presenting to a maternal health clinic in Thomonde, Haiti which was staffed by doctors and medical students from Emory University School of Medicine in collaboration with Haiti Medishare. As demonstrated here, the VIA test requires minimal materials, can be efficiently incorporated into a physical exams, provides immediate results, and is easily demonstrated to and performed by local healthcare providers. The straightforward and sensitive VIA technique is an ideal cervical cancer screening method for resource poor areas. Full article

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34 pages, 1016 KiB

Open AccessReview

Wellbeing Impacts of City Policies for Reducing Greenhouse Gas Emissions

by Rosemary Hiscock^1,*

, Pierpaolo Mudu², Matthias Braubach², Marco Martuzzi², Laura Perez³ and Clive Sabel¹

¹ School of Geographical Sciences, University of Bristol, University Road, Clifton, Bristol BS8 1SS, UK

² WHO Regional Office for Europe, European Centre for Environment and Health, Bonn office, Platz der Vereinten Nationen 1, 53113 Bonn, Germany

³ Swiss Tropical and Public Health Institute, Socinstr. 57, Basel 4051, Switzerland

Int. J. Environ. Res. Public Health 2014, 11(12), 12312-12345; https://doi.org/10.3390/ijerph111212312 - 28 Nov 2014

Cited by 17 | Viewed by 12336

Abstract

To mitigate climate change, city authorities are developing policies in areas such as transportation, housing and energy use, to reduce greenhouse gas emissions. In addition to their effects on greenhouse gas emissions, these policies are likely to have consequences for the wellbeing of [...] Read more.

To mitigate climate change, city authorities are developing policies in areas such as transportation, housing and energy use, to reduce greenhouse gas emissions. In addition to their effects on greenhouse gas emissions, these policies are likely to have consequences for the wellbeing of their populations for example through changes in opportunities to take physical exercise. In order to explore the potential consequences for wellbeing, we first explore what ‘wellbeing’ is and how it can be operationalised for urban planners. In this paper, we illustrate how wellbeing can be divided into objective and subjective aspects which can be measured quantitatively; our review of measures informs the development of a theoretical model linking wellbeing to policies which cities use to reduce greenhouse gas emissions. Finally, we discuss the extent to which the links proposed in the conceptual model are supported by the literature and how cities can assess wellbeing implications of policies. Full article

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21 pages, 866 KiB

Open AccessArticle

Exploration of Preterm Birth Rates Using the Public Health Exposome Database and Computational Analysis Methods

by Anne D. Kershenbaum^1,*, Michael A. Langston², Robert S. Levine³, Arnold M. Saxton⁴, Tonny J. Oyana⁵

, Barbara J. Kilbourne³, Gary L. Rogers⁶, Lisaann S. Gittner⁷, Suzanne H. Baktash², Patricia Matthews-Juarez⁵ and Paul D. Juarez⁵

¹ Department of Public Health, University of Tennessee, Knoxville, TN 37996, USA

² Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA

³ Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA

⁴ Department of Animal Science, Institute of Agriculture, University of Tennessee, Knoxville, TN 37996, USA

⁵ Research Center on Health Disparities, Equity, and the Exposome, University of Tennessee Health Science Center, Memphis, TN 38163, USA

⁶ National Institute for Computational Sciences, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA

⁷ Department of Political Sciences, Texas Tech University, Lubbock, TX 79409, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 12346-12366; https://doi.org/10.3390/ijerph111212346 - 28 Nov 2014

Cited by 22 | Viewed by 8185

Abstract

Recent advances in informatics technology has made it possible to integrate, manipulate, and analyze variables from a wide range of scientific disciplines allowing for the examination of complex social problems such as health disparities. This study used 589 county-level variables to identify and [...] Read more.

Recent advances in informatics technology has made it possible to integrate, manipulate, and analyze variables from a wide range of scientific disciplines allowing for the examination of complex social problems such as health disparities. This study used 589 county-level variables to identify and compare geographical variation of high and low preterm birth rates. Data were collected from a number of publically available sources, bringing together natality outcomes with attributes of the natural, built, social, and policy environments. Singleton early premature county birth rate, in counties with population size over 100,000 persons provided the dependent variable. Graph theoretical techniques were used to identify a wide range of predictor variables from various domains, including black proportion, obesity and diabetes, sexually transmitted infection rates, mother’s age, income, marriage rates, pollution and temperature among others. Dense subgraphs (paracliques) representing groups of highly correlated variables were resolved into latent factors, which were then used to build a regression model explaining prematurity (R-squared = 76.7%). Two lists of counties with large positive and large negative residuals, indicating unusual prematurity rates given their circumstances, may serve as a starting point for ways to intervene and reduce health disparities for preterm births. Full article

(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)

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1 pages, 593 KiB

Open AccessCorrection

Correction: Giordano, P.C.; et al. Genetic Epidemiology and Preventive Healthcare in Multiethnic Societies: The Hemoglobinopathies. Int. J. Environ. Res. Public Health 2014, 11, 6136–6146

by Piero C. Giordano^*, Cornelis L. Harteveld and Egbert Bakker

Human and Clinical Genetics Department, Leiden University Medical Center, P.O. Box 9600, Leiden 2333 ZC, The Netherlands

Int. J. Environ. Res. Public Health 2014, 11(12), 12367; https://doi.org/10.3390/ijerph111212367 - 28 Nov 2014

Viewed by 4074

Abstract

The authors wish to add the following amendment and correction on their paper published in IJERPH [1]: Page 6139, Line 3 in Paragraph 3: “…Israel, [17,18],…” should read “…Israel and Palestine [17,18]…”. [...] Full article

21 pages, 979 KiB

Open AccessArticle

Health Risk Assessment of Inhalable Particulate Matter in Beijing Based on the Thermal Environment

by Lin-Yu Xu^*, Hao Yin and Xiao-Dong Xie

State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Beijing Normal University, No. 19, Xinjiekouwai Street, Haidian District, Beijing 100875, China

Int. J. Environ. Res. Public Health 2014, 11(12), 12368-12388; https://doi.org/10.3390/ijerph111212368 - 28 Nov 2014

Cited by 30 | Viewed by 7535

Abstract

Inhalable particulate matter (PM₁₀) is a primary air pollutant closely related to public health, and an especially serious problem in urban areas. The urban heat island (UHI) effect has made the urban PM₁₀ pollution situation more complex and severe. In [...] Read more.

Inhalable particulate matter (PM₁₀) is a primary air pollutant closely related to public health, and an especially serious problem in urban areas. The urban heat island (UHI) effect has made the urban PM₁₀ pollution situation more complex and severe. In this study, we established a health risk assessment system utilizing an epidemiological method taking the thermal environment effects into consideration. We utilized a remote sensing method to retrieve the PM₁₀ concentration, UHI, Normalized Difference Vegetation Index (NDVI), and Normalized Difference Water Index (NDWI). With the correlation between difference vegetation index (DVI) and PM₁₀ concentration, we utilized the established model between PM₁₀ and thermal environmental indicators to evaluate the PM₁₀ health risks based on the epidemiological study. Additionally, with the regulation of UHI, NDVI and NDWI, we aimed at regulating the PM₁₀ health risks and thermal environment simultaneously. This study attempted to accomplish concurrent thermal environment regulation and elimination of PM₁₀ health risks through control of UHI intensity. The results indicate that urban Beijing has a higher PM₁₀ health risk than rural areas; PM₁₀ health risk based on the thermal environment is 1.145, which is similar to the health risk calculated (1.144) from the PM₁₀ concentration inversion; according to the regulation results, regulation of UHI and NDVI is effective and helpful for mitigation of PM₁₀ health risk in functional zones. Full article

(This article belongs to the Special Issue Air Pollution Modeling)

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23 pages, 881 KiB

Open AccessArticle

Using a Social Justice and Health Framework to Assess European Climate Change Adaptation Strategies

by Melanie Boeckmann^1,2,* and Hajo Zeeb¹

¹ Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstr. 30, 28359 Bremen, Germany

² Center for Social Policy Research, University of Bremen, Mary-Somerville-Str. 5, 28359 Bremen, Germany

Int. J. Environ. Res. Public Health 2014, 11(12), 12389-12411; https://doi.org/10.3390/ijerph111212389 - 28 Nov 2014

Cited by 17 | Viewed by 7713

Abstract

Climate change puts pressure on existing health vulnerabilities through higher frequency of extreme weather events, changes in disease vector distribution or exacerbated air pollution. Climate change adaptation policies may hold potential to reduce societal inequities. We assessed the role of public health and [...] Read more.

Climate change puts pressure on existing health vulnerabilities through higher frequency of extreme weather events, changes in disease vector distribution or exacerbated air pollution. Climate change adaptation policies may hold potential to reduce societal inequities. We assessed the role of public health and social justice in European climate change adaptation using a three-fold approach: a document analysis, a critical discourse analysis of a subgroup of strategies, and a ranking of strategies against our social justice framework. The ranking approach favored planning that includes various adaptation types, social issues and infrastructure changes. Themes on values identified in the five subgroup documents showed that risks are perceived as contradictory, technology is viewed as savior, responsibilities need to be negotiated, and social justice is advocated by only a few countries. Of 21 strategy documents assessed overall, those from Austria, England and Sweden received the highest scores in the ranking. Our qualitative assessment showed that in European adaptation planning, progress could still be made through community involvement into adaptation decisions, consistent consideration of social and demographic determinants, and a stronger link between infrastructural adaptation and the health sector. Overall, a social justice framework can serve as an evaluation guideline for adaptation policy documents. Full article

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17 pages, 724 KiB

Open AccessArticle

Autonomous Motivation Is Not Enough: The Role of Compensatory Health Beliefs for the Readiness to Change Stair and Elevator Use

by Theda Radtke^* and Pamela Rackow

Department of Psychology, Applied Social Psychology, University of Zurich, Binzmühlestr.14/Box 14, 8050 Zurich, Switzerland

Int. J. Environ. Res. Public Health 2014, 11(12), 12412-12428; https://doi.org/10.3390/ijerph111212412 - 28 Nov 2014

Cited by 4 | Viewed by 7790

Abstract

Compensatory health beliefs (CHBs) are beliefs that an unhealthy behavior can be compensated with a healthy behavior. In line with the CHBs model, the aim of this study was twofold. First, the study investigated the relationship between autonomous motivation and CHBs that physical [...] Read more.

Compensatory health beliefs (CHBs) are beliefs that an unhealthy behavior can be compensated with a healthy behavior. In line with the CHBs model, the aim of this study was twofold. First, the study investigated the relationship between autonomous motivation and CHBs that physical inactivity can be compensated by taking the stairs instead of the elevator. Second, the study focused on the associations between CHBs and readiness to use the stairs more often and stair and elevator use. Thus, a cross-sectional online questionnaire was designed that was filled out by 135 participants. Path analysis showed that individuals with stronger autonomous motivation to use the stairs strongly agreed that sedentary behavior could be compensated by taking the stairs instead of the elevator. Moreover, CHBs were positively related to readiness to change behavior, but not to self-reported stair and elevator use. Even though future research is necessary to replicate these findings, autonomous motivation seems to have a positive impact on CHBs which, in turn, might boost an intended behavior change. Thus, promoting possible compensation of physical inactivity might foster the readiness to change the unhealthy behavior. Full article

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12 pages, 3376 KiB

Open AccessArticle

Physical, Chemical, and Immunohistochemical Investigation of the Damage to Salivary Glands in a Model of Intoxication with Aluminium Citrate

by Natacha M. M. da Costa^1,†, Russell S. Correa^1,†, Ismael S. M. Júnior¹, Adilson J. R. Figueiredo¹, Kelly F. B. Vilhena¹, Paulo M. A. Farias-Junior¹, Francisco B. Teixeira¹, Nayana M. M. Ferreira¹, João B. Pereira-Júnior², Kelly Das Graças F. Dantas², Marcia C. F. da Silva¹, Ademir F. Silva-Junior¹, Sergio De M. Alves-Junior³, João De Jesus V. Pinheiro³ and Rafael Rodrigues Lima^1,*

¹ Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, 66075-900 Belém-Pará, Brazil

² School of Chemistry, Institute of Exact and Natural Sciences, Federal University of Pará, 66075-900 Belém-Pará, Brazil

³ School of Dentistry, Institute of Health Sciences, Federal University of Pará, 66075-900 Belém-Pará, Brazil

^† These authors contributed equally to this work.

Int. J. Environ. Res. Public Health 2014, 11(12), 12429-12440; https://doi.org/10.3390/ijerph111212429 - 28 Nov 2014

Cited by 14 | Viewed by 6264

Abstract

Aluminum absorption leads to deposits in several tissues. In this study, we have investigated, to our knowledge for the first time, aluminum deposition in the salivary glands in addition to the resultant cellular changes in the parotid and submandibular salivary glands in a [...] Read more.

Aluminum absorption leads to deposits in several tissues. In this study, we have investigated, to our knowledge for the first time, aluminum deposition in the salivary glands in addition to the resultant cellular changes in the parotid and submandibular salivary glands in a model of chronic intoxication with aluminum citrate in rats. Aluminum deposits were observed in the parotid and submandibular glands. Immunohistochemical evaluation of cytokeratin-18 revealed a decreased expression in the parotid gland with no changes in the submandibular gland. A decreased expression of α-smooth muscle actin was observed in the myoepithelial cells of both glands. The expression of metallothionein I and II (MT-I/II), a group of metal-binding proteins, which are useful indicators for detecting physiological responses to metal exposure, was higher in both glands. In conclusion, we have shown that at a certain time and quantity of dosage, aluminum citrate promotes aluminum deposition in the parotid and submandibular glands, leads to an increased expression of MT-I/II in both the glands, damages the cytoskeleton of the myoepithelial cells in both glands, and damages the cytoskeleton of the acinar/ductal cells of the parotid glands, with the submandibular glands showing resistance to the toxicity of the latter. Full article

(This article belongs to the Special Issue Proceedings of 1st Latin American Congress of Clinical and Laboratorial Toxicology (Toxi-Latin 2014))

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13 pages, 927 KiB

Open AccessArticle

Risk Assessment of Heavy Metals in Surface Sediments from the Yanghe River, China

by Jing Li

Key Laboratory of Ecosystem Network Observation and Modeling, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China

Int. J. Environ. Res. Public Health 2014, 11(12), 12441-12453; https://doi.org/10.3390/ijerph111212441 - 28 Nov 2014

Cited by 48 | Viewed by 6684

Abstract

The magnitude and ecological relevance of metal pollution from the upstream of water sources after emergency pollution events was investigated by applying a set of complementary sediment quality assessment methods: (1) geochemical assessment based on background value (the geoaccumulation index); (2) comparisons with [...] Read more.

The magnitude and ecological relevance of metal pollution from the upstream of water sources after emergency pollution events was investigated by applying a set of complementary sediment quality assessment methods: (1) geochemical assessment based on background value (the geoaccumulation index); (2) comparisons with sediment quality guidelines (SQGs); (3) an evaluation of the combined pollution according to the risk index (RI); and (4) investigation of the chemical patterns of target heavy metals (Cd, Zn, Cr, Pb, Ni). The geoaccumulation indices (I_geo) suggested that the magnitude of heavy metal pollution of the sediment of Yanghe River decreased in the order of Cd > Zn > Pb > Cr > Ni. Risk analysis also suggested that Cd and Zn concentrations were sufficiently elevated as to cause adverse biological effects in this study area. According to the RI values, 27% of total sampling sites showed considerable ecological risk for the water body, and 53% of total sampling sites showed very high ecological risk for the waterbody. Sediment-bound Cd was found to be predominantly associated with the exchangeable phase of the sediment (25%–68%), while Cr, Ni, Zn and Pb showed the strongest association with the residual fractions (60%–92%, 53%–67%, 24%–85% and 35%–67%, respectively). Full article

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19 pages, 1870 KiB

Open AccessArticle

Muddying the Waters: A New Area of Concern for Drinking Water Contamination in Cameroon

by Jessica M. Healy Profitós^1,†, Arabi Mouhaman^2,†, Seungjun Lee^3,†, Rebecca Garabed⁴, Mark Moritz⁵, Barbara Piperata⁵, Joe Tien⁶, Michael Bisesi¹ and Jiyoung Lee^1,3,*,†

¹ Division of Environmental Health Sciences, the Ohio State University, Columbus, OH 43210, USA

² Department of Environmental Sciences, University of Maroua, Maroua BP 46, Far North Region, Cameroon

³ Department of Food Science and Technology, the Ohio State University, Columbus, OH 43210, USA

⁴ Department of Veterinary Preventive Medicine, the Ohio State University, Columbus, OH 43210, USA

⁵ Department of Anthropology, the Ohio State University, Columbus, OH 43210, USA

⁶ Department of Mathematics, the Ohio State University, Columbus, OH 43210, USA

^† These authors contributed equally to this work.

Int. J. Environ. Res. Public Health 2014, 11(12), 12454-12472; https://doi.org/10.3390/ijerph111212454 - 28 Nov 2014

Cited by 18 | Viewed by 9107

Abstract

In urban Maroua, Cameroon, improved drinking water sources are available to a large majority of the population, yet this water is frequently distributed through informal distribution systems and stored in home containers (canaries), leaving it vulnerable to contamination. We assessed where [...] Read more.

In urban Maroua, Cameroon, improved drinking water sources are available to a large majority of the population, yet this water is frequently distributed through informal distribution systems and stored in home containers (canaries), leaving it vulnerable to contamination. We assessed where contamination occurs within the distribution system, determined potential sources of environmental contamination, and investigated potential pathogens. Gastrointestinal health status (785 individuals) was collected via health surveys. Drinking water samples were collected from drinking water sources and canaries. Escherichia coli and total coliform levels were evaluated and molecular detection was performed to measure human-associated faecal marker, HF183; tetracycline-resistance gene, tetQ; Campylobacter spp.; and Staphylococcus aureus. Statistical analyses were performed to evaluate the relationship between microbial contamination and gastrointestinal illness. Canari samples had higher levels of contamination than source samples. HF183 and tetQ were detected in home and source samples. An inverse relationship was found between tetQ and E. coli. Presence of tetQ with lower E. coli levels increased the odds of reported diarrhoeal illness than E. coli levels alone. Further work is warranted to better assess the relationship between antimicrobial-resistant bacteria and other pathogens in micro-ecosystems within canaries and this relationship’s impact on drinking water quality. Full article

(This article belongs to the Special Issue Environmental Determinants of Infectious Disease Transmission)

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13 pages, 694 KiB

Open AccessArticle

A Survey of African American Physicians on the Health Effects of Climate Change

by Mona Sarfaty^1,*, Mark Mitchell², Brittany Bloodhart¹ and Edward W Maibach¹

¹ Center for Climate and Health, George Mason University, 4400 University Drive, MS 6A8, Fairfax, VA 22030, USA

² Commission on Environmental Health, National Medical Association, Silver Spring, MD 20910, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 12473-12485; https://doi.org/10.3390/ijerph111212473 - 28 Nov 2014

Cited by 65 | Viewed by 11213

Abstract

The U.S. National Climate Assessment concluded that climate change is harming the health of many Americans and identified people in some communities of color as particularly vulnerable to these effects. In Spring 2014, we surveyed members of the National Medical Association, a society [...] Read more.

The U.S. National Climate Assessment concluded that climate change is harming the health of many Americans and identified people in some communities of color as particularly vulnerable to these effects. In Spring 2014, we surveyed members of the National Medical Association, a society of African American physicians who care for a disproportionate number of African American patients, to determine whether they were seeing the health effects of climate change in their practices; the response rate was 30% (n = 284). Over 86% of respondents indicated that climate change was relevant to direct patient care, and 61% that their own patients were already being harmed by climate change moderately or a great deal. The most commonly reported health effects were injuries from severe storms, floods, and wildfires (88%), increases in severity of chronic disease due to air pollution (88%), and allergic symptoms from prolonged exposure to plants or mold (80%). The majority of survey respondents support medical training, patient and public education regarding the impact of climate change on health, and advocacy by their professional society; nearly all respondents indicated that the US should invest in significant efforts to protect people from the health effects of climate change (88%), and to reduce the potential impacts of climate change (93%). These findings suggest that African American physicians are currently seeing the health impacts of climate change among their patients, and that they support a range of responses by the medical profession, and public policy makers, to prevent further harm. Full article

(This article belongs to the Special Issue Extreme Weather-Related Morbidity and Mortality: Risks and Responses)

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13 pages, 1303 KiB

Open AccessConcept Paper

Effective Removal of Cadmium Ions from a Simulated Gastrointestinal Fluid by Lentinus edodes

by Xin Qiao^1,2, Wen Huang^1,2,* and Yinbing Bian²

¹ College of Food Science and Technology, Huazhong Agricultural University, Wuhan 430070, China

² Institute of Applied Mycology, Huazhong Agricultural University, Wuhan 430070, China

Int. J. Environ. Res. Public Health 2014, 11(12), 12486-12498; https://doi.org/10.3390/ijerph111212486 - 1 Dec 2014

Cited by 9 | Viewed by 5617

Abstract

Lentinus edodes, a functional food, was evaluated as a potential antidote for adsorption/removal of cadmium ion from simulated gastrointestinal fluids. An adsorption/removal capacity of 65.12 mg/g was achieved by L. edodes in solutions with a pH ranging from 2.5 to 6.0, while [...] Read more.

Lentinus edodes, a functional food, was evaluated as a potential antidote for adsorption/removal of cadmium ion from simulated gastrointestinal fluids. An adsorption/removal capacity of 65.12 mg/g was achieved by L. edodes in solutions with a pH ranging from 2.5 to 6.0, while little if any adsorption was observed in solutions with a pH under 2.5. In solutions with pH 6.0, 84% of the cadmium adsorption by L. edodes occurred in the first minute. Scanning electronic microscopic examination showed that the cell wall polysaccharides of L. edodes provided a rough sponge-like surface for effective cadmium adsorption. FTIR indicated that the carboxyl, hydroxyl and –NH groups of the cell wall polysaccharides and proteins were the primary functional groups that chemically bind with cadmium ions. The energy dispersive spectrometry further revealed that cation exchange might be attributed to cadmium biosorption. These results suggested that L. edodes was effective for cadmium detoxication, especially in low concentration. Full article

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15 pages, 710 KiB

Open AccessArticle

Relationship between Caregivers’ Smoking at Home and Urinary Levels of Cotinine in Children

by Yun Wang^1,2, Mei Yang^1,†, Lang Tian^3,†, Zhiqiang Huang^4,†, Faming Chen^5,†, Jingsong Hu^5,†, Fuzhi Wang^1,†, Gui Chen^1,† and Shuiyuan Xiao^1,*

¹ Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan 410078, China

² School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang 830000, China

³ Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha 410013, China

⁴ Academy of Inspection and Quarantine, Changsha 410004, China

⁵ Changsha Central for Disease Control and Prevention, Changsha 410001, China

^† These authors contributed equally to this work.

Int. J. Environ. Res. Public Health 2014, 11(12), 12499-12513; https://doi.org/10.3390/ijerph111212499 - 1 Dec 2014

Cited by 14 | Viewed by 5767

Abstract

Objective: To assess the impact of different smoking behaviors of caregivers on environmental tobacco smoke (ETS) exposure in children aged 5–6 years in Changsha, China. Methods: We conducted a cross-sectional, random digit-dial telephone survey of caregivers (n = 543) between [...] Read more.

Objective: To assess the impact of different smoking behaviors of caregivers on environmental tobacco smoke (ETS) exposure in children aged 5–6 years in Changsha, China. Methods: We conducted a cross-sectional, random digit-dial telephone survey of caregivers (n = 543) between August and October 2013. Caregivers’ smoking behaviors were collected by a questionnaire. Exposure assessment was based upon determination of urinary cotinine levels in children employing gas chromatography–triple quadrupole mass spectrometry (GC-MS/MS). Results: In children not living with a smoker, children living with one smoker, and children living with more than one smoker at home, median urinary cotinine concentrations (ng/mL) were 0.72, 2.97, and 4.46, respectively. For children living with one smoker, median urinary cotinine levels of children exposed to ETS were associated with caregiver smoking behaviors, i.e., if a caregiver consumed more cigarettes (>20 compared with ≤10; 7.73 versus 2.29 ng/mL, respectively). Conclusions: The magnitude of ETS exposure in children is correlated with the smoking behaviors of the caregiver. Counseling for smoking cessation and educational interventions are needed urgently for smoking caregivers to increase their awareness about ETS exposure and to encourage smoking cessation at home or to take precautions to protect children’s health. Full article

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18 pages, 1171 KiB

Open AccessArticle

The Application of Model Life Table Systems in China: Assessment of System Bias and Error

by Songbo Hu¹ and Chuanhua Yu^1,2,*

¹ School of Public Health, Wuhan University, No. 115 Donghu Road, Wuhan 430071, China

² Global Health Institute, Wuhan University, No. 115 Donghu Road, Wuhan 430071, China

Int. J. Environ. Res. Public Health 2014, 11(12), 12514-12531; https://doi.org/10.3390/ijerph111212514 - 1 Dec 2014

Cited by 1 | Viewed by 6152

Abstract

and projection. Although China is the world's most populous country with approximately a fifth of the world's population, none of the empirical tables from mainland China were used in calibrating the existing models. In this paper, we applied recent three model life table [...] Read more.

and projection. Although China is the world's most populous country with approximately a fifth of the world's population, none of the empirical tables from mainland China were used in calibrating the existing models. In this paper, we applied recent three model life table systems with different inputs to China mortality data to investigate whether or not these systems truly reflect Chinese mortality epidemiological patterns and whether or not system biases exist. The resulting residuals show that, in most cases, the male infant mortality rate (1q0), adult mortality rate (45q15) and old age mortality rate (20q60) have a strong bias towards being overestimated and the life expectancy at birth (e0) bias is underestimated. We also give the detailed results for each case. Furthermore, we found that the average relative errors (AREs) for females are more than those for males for e0, 45q15 and 20q60, but for 1q0, males have larger AREs in the Wilmoth and Murray systems. We also found that the urban population has more errors than the rural population in almost all cases. Finally, by comparing the AREs with 10 other countries, we found the errors for China are more than those for other countries in most cases. It is concluded that these existing model life table systems cannot accurately reflect Chinese mortality epidemiological situations and trajectories. Therefore, model life tables should be used with caution when applied to China on the basis of 5q0. Full article

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12 pages, 683 KiB

Open AccessArticle

Female Media Use Behavior and Agreement with Publicly Promoted Agenda-Specific Health Messages

by Shu-Yu Lyu¹, Ruey-Yu Chen¹, Liang-Ting Tsai², Shih-fan Steve Wang³, Feng-En Lo⁴, Ying-Chen Chi^5,* and Donald E. Morisky⁶

¹ School of Public Health, Taipei Medical University, Taipei 11031, Taiwan

² Graduate Institute of Educational Information and Measurement, National Taichung University of Education, Taichung 40306, Taiwan

³ Department of Journalism, College of Communication, National Chengchi University, Taipei 11605, Taiwan

⁴ Department of Leisure and Recreation Management, Asia University, Taichung 41354, Taiwan

⁵ Department of Education & Research, Taipei City Hospital, Taipei 10341, Taiwan

⁶ Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA 90095, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 12532-12543; https://doi.org/10.3390/ijerph111212532 - 2 Dec 2014

Cited by 1 | Viewed by 5572

Abstract

This study set out to explore the relationship between female media use behavior and agreement with agenda-specific publicly promoted health messages. A random digit dial telephone cross-sectional survey was conducted using a nationally representative sample of female residents aged 25 and over. Respondents’ [...] Read more.

This study set out to explore the relationship between female media use behavior and agreement with agenda-specific publicly promoted health messages. A random digit dial telephone cross-sectional survey was conducted using a nationally representative sample of female residents aged 25 and over. Respondents’ agreement with health messages was measured by a six-item Health Information Scale (HIS). Data were analyzed using chi-square tests and multiple logistic regression. This survey achieved a response rate of 86% (n = 1074). In this study the longest duration of daily television news watching (OR = 2.32), high self-efficacy (OR = 1.56), and greater attention to medical and health news (OR = 5.41) were all correlates of greater agreement with the selected health messages. Surprisingly, Internet use was not significant in the final model. Many women that public health interventions need to be targeting are not receptive to health information that can be accessed through Internet searches. However, they may be more readily targeted by television campaigns. Agenda-specific public health campaigns aiming to empower women to serve as nodes of information transmission and achieve efficient trickle down through the family unit might do better to invest more heavily in television promotion. Full article

18 pages, 1353 KiB

Open AccessArticle

Diversity of Bacterial Communities of Fitness Center Surfaces in a U.S. Metropolitan Area

by Nabanita Mukherjee¹, Scot E. Dowd², Andy Wise³, Sapna Kedia¹, Varun Vohra¹ and Pratik Banerjee^1,*

¹ Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, 338 Robison Hall, 3825 Desoto Avenue, Memphis, TN 38152, USA

² Molecular Research LP (MR DNA), 503 Clovis Road, Shallowater, TX 79363, USA

³ WMC TV Action News 5, NBC Memphis, 1960 Union Ave, Memphis, TN 38104, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 12544-12561; https://doi.org/10.3390/ijerph111212544 - 3 Dec 2014

Cited by 49 | Viewed by 29665

Abstract

Public fitness centers and exercise facilities have been implicated as possible sources for transmitting community-acquired bacterial infections. However, the overall diversity of the bacterial community residing on the surfaces in these indoor environments is still unknown. In this study, we investigated the overall [...] Read more.

Public fitness centers and exercise facilities have been implicated as possible sources for transmitting community-acquired bacterial infections. However, the overall diversity of the bacterial community residing on the surfaces in these indoor environments is still unknown. In this study, we investigated the overall bacterial ecology of selected fitness centers in a metropolitan area (Memphis, TN, USA) utilizing culture-independent pyrosequencing of the 16S rRNA genes. Samples were collected from the skin-contact surfaces (e.g., exercise instruments, floor mats, handrails, etc.) within fitness centers. Taxonomical composition revealed the abundance of Firmicutes phyla, followed by Proteobacter and Actinobacteria, with a total of 17 bacterial families and 25 bacterial genera. Most of these bacterial genera are of human and environmental origin (including, air, dust, soil, and water). Additionally, we found the presence of some pathogenic or potential pathogenic bacterial genera including Salmonella, Staphylococcus, Klebsiella, and Micrococcus. Staphylococcus was found to be the most prevalent genus. Presence of viable forms of these pathogens elevates risk of exposure of any susceptible individuals. Several factors (including personal hygiene, surface cleaning and disinfection schedules of the facilities) may be the reasons for the rich bacterial diversity found in this study. The current finding underscores the need to increase public awareness on the importance of personal hygiene and sanitation for public gym users. Full article

(This article belongs to the Special Issue Environmental Determinants of Infectious Disease Transmission)

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13 pages, 640 KiB

Open AccessArticle

Communicating Program Outcomes to Encourage Policymaker Support for Evidence-Based State Tobacco Control

by Allison M. Schmidt^*, Leah M. Ranney

and Adam O. Goldstein

Tobacco Prevention and Evaluation Program, Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27599, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 12562-12574; https://doi.org/10.3390/ijerph111212562 - 4 Dec 2014

Cited by 10 | Viewed by 6700

Abstract

Tobacco use, the leading cause of preventable death in the U.S., can be reduced through state-level tobacco prevention and cessation programs. In the absence of research about how to communicate the need for these programs to policymakers, this qualitative study aimed to understand [...] Read more.

Tobacco use, the leading cause of preventable death in the U.S., can be reduced through state-level tobacco prevention and cessation programs. In the absence of research about how to communicate the need for these programs to policymakers, this qualitative study aimed to understand the motivations and priorities of policymakers in North Carolina, a state that enacted a strong tobacco control program from 2003–2011, but drastically reduced funding in recent years. Six former legislators (three Democrats, three Republicans) and three lobbyists for health organizations were interviewed about their attitudes towards tobacco use, support of state-funded programs, and reactions to two policy briefs. Five themes emerged: (1) high awareness of tobacco-related health concerns but limited awareness of program impacts and funding, (2) the primacy of economic concerns in making policy decisions, (3) ideological differences in views of the state’s role in tobacco control, (4) the impact of lobbyist and constituent in-person appeals, and (5) the utility of concise, contextualized data. These findings suggest that building relationships with policymakers to communicate ongoing program outcomes, emphasizing economic data, and developing a constituent advocacy group would be valuable to encourage continued support of state tobacco control programs. Full article

7 pages, 640 KiB

Open AccessCommentary

Importance of All Movement Behaviors in a 24 Hour Period for Overall Health

by Jean-Philippe Chaput^1,*, Valerie Carson², Casey E. Gray¹ and Mark S. Tremblay¹

¹ Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada

² Faculty of Physical Education and Recreation, W1-34 Van Vliet Centre, University of Alberta, Edmonton, AL T6G 2H9, Canada

Int. J. Environ. Res. Public Health 2014, 11(12), 12575-12581; https://doi.org/10.3390/ijerph111212575 - 4 Dec 2014

Cited by 325 | Viewed by 20434

Abstract

Physical inactivity and childhood obesity are well-recognized public health concerns that are associated with a range of adverse health outcomes. Historically, the benefits of physical activity (e.g., moderate-to-vigorous physical activity—MVPA) to overall health have dominated discussions and emerging evidence indicates that a broader, [...] Read more.

Physical inactivity and childhood obesity are well-recognized public health concerns that are associated with a range of adverse health outcomes. Historically, the benefits of physical activity (e.g., moderate-to-vigorous physical activity—MVPA) to overall health have dominated discussions and emerging evidence indicates that a broader, more integrated approach is needed to better understand and address current public health crises. Existing guidelines for children and youth around the world only focus on MVPA, and recently sedentary behavior, despite an accumulating body of evidence showing that light-intensity physical activity (LPA) such as walking can provide important health benefits. Furthermore, there is accumulating support for the importance of adequate sleep and that these behaviors moderate the health impact of each other. Ignoring the other components of the movement continuum (i.e., sleep, sedentary time, LPA) while focusing efforts exclusively on MVPA (accounting for <5% of the time in a 24 h period) limits the potential to optimize the health benefits of movement behaviors. In order to address this limitation, experts in Canada are currently developing the world’s first Integrated 24 Hour Movement Behaviour Guidelines for Children and Youth to help advance an integrated healthy active living agenda that has the potential to significantly improve the overall health and well-being of children and youth. Full article

(This article belongs to the Special Issue Physical Activity and Public Health-)

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12 pages, 403 KiB

Open AccessArticle

Multiresistant Bacteria Isolated from Chicken Meat in Austria

by Gernot Zarfel^1,*

, Herbert Galler¹

, Josefa Luxner¹, Christian Petternel¹, Franz F. Reinthaler¹, Doris Haas¹, Clemens Kittinger¹, Andrea J. Grisold¹, Peter Pless² and Gebhard Feierl¹

¹ Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz 8010, Austria

² Animal Health Service of the Department of Veterinary Administration, Styrian Government, Graz 8010, Austria

Int. J. Environ. Res. Public Health 2014, 11(12), 12582-12593; https://doi.org/10.3390/ijerph111212582 - 4 Dec 2014

Cited by 31 | Viewed by 8595

Abstract

Multidrug resistant bacteria (MDR bacteria), such as extended spectrum beta-lactamase (ESBL) Enterobacteriaceae, methicillin resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE), pose a challenge to the human health care system. In recent years, these MDR bacteria have been detected increasingly outside the [...] Read more.

Multidrug resistant bacteria (MDR bacteria), such as extended spectrum beta-lactamase (ESBL) Enterobacteriaceae, methicillin resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE), pose a challenge to the human health care system. In recent years, these MDR bacteria have been detected increasingly outside the hospital environment. Also the contamination of food with MDR bacteria, particularly of meat and meat products, is a concern. The aim of the study was to evaluate the occurrence of MDR bacteria in chicken meat on the Austrian market. For this study, 50 chicken meat samples were analysed. All samples originated from chickens slaughtered in Austrian slaughterhouses and were marked as produced in Austria. Samples were analysed for the presence of ESBL Enterobacteriaceae, methicillin resistant Staphylococci and VRE. Resistance genes of the isolated bacteria were characterised by PCR and sequencing. In the present study 26 ESBL producing E. coli, five mecA gene harbouring Staphylococci (but no MRSA), and four VRE were detected in chicken meat samples of Austrian origin. In 24 (48%) of the samples no ESBL Enterobacteriaceae, MRSA, methicillin resistant coagulase negative Staphylococcus (MRCNS) or VRE could be detected. None of the samples contained all three types of investigated multiresistant bacteria. In concordance to previous studies, CTX-M-1 and SHV-12 were the dominant ESBL genes. Full article

(This article belongs to the Special Issue Antibiotic Resistant and Pathogenic Bacteria in the Food Production Environment: Epidemiological Evolution and Control)

17 pages, 696 KiB

Open AccessArticle

Associations between Moderate-to-Vigorous Physical Activity and Neighbourhood Recreational Facilities: The Features of the Facilities Matter

by Ka Yiu Lee¹, Paul H. Lee²

and Duncan Macfarlane^1,*

¹ Institute of Human Performance, The University of Hong Kong, Pokfulam, Hong Kong, China

² School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong, China

Int. J. Environ. Res. Public Health 2014, 11(12), 12594-12610; https://doi.org/10.3390/ijerph111212594 - 4 Dec 2014

Cited by 20 | Viewed by 6730

Abstract

Objectives: To examine the associations between objectively-assessed moderate-to-vigorous physical activity (MVPA) and perceived/objective measures of neighbourhood recreational facilities categorized into indoor or outdoor, public, residential or commercial facilities. The associations between facility perceptions and objectively-assessed numbers of recreational facilities were also examined. [...] Read more.

Objectives: To examine the associations between objectively-assessed moderate-to-vigorous physical activity (MVPA) and perceived/objective measures of neighbourhood recreational facilities categorized into indoor or outdoor, public, residential or commercial facilities. The associations between facility perceptions and objectively-assessed numbers of recreational facilities were also examined. Method: A questionnaire was used on 480 adults to measure local facility perceptions, with 154 participants wearing ActiGraph accelerometers for ≥4 days. The objectively-assessed number of neighbourhood recreational facilities were examined using direct observations and Geographical Information System data. Results: Both positive and negative associations were found between MVPA and perceived/objective measures of recreational facilities. Some associations depended on whether the recreational facilities were indoor or outdoor, public or residential facilities. The objectively-assessed number of most public recreational facilities was associated with the corresponding facility perceptions, but the size of effect was generally lower than for residential recreational facilities. Conclusions: The objectively-assessed number of residential outdoor table tennis courts and public indoor swimming pools, the objectively-assessed presence of tennis courts and swimming pools, and the perceived presence of bike lanes and swimming pools were positive determinants of MVPA. It is suggested to categorize the recreational facilities into smaller divisions in order to identify unique associations with MVPA. Full article

(This article belongs to the Special Issue Physical Activity and Public Health-)

12 pages, 740 KiB

Open AccessArticle

The Influence of Lifestyle on the Incidence of Dental Caries among 3-Year-Old Japanese Children

by Masako Watanabe^1,2,*, Da-Hong Wang³, Akihiro Ijichi², Chika Shirai², Yu Zou¹, Masayuki Kubo¹, Kei Takemoto¹, Chie Masatomi¹ and Keiki Ogino¹

¹ Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Okayama 700-8558, Japan

² Kobe City Public Health Center, 6-5-1 Kano-cho, Chuo-ku, Kobe 650-8570, Japan

³ Department of Biochemistry, Okayama University of Science, 1-1 Ridai-cho, Okayama 700-0005, Japan

Int. J. Environ. Res. Public Health 2014, 11(12), 12611-12622; https://doi.org/10.3390/ijerph111212611 - 5 Dec 2014

Cited by 48 | Viewed by 10429

Abstract

The present cohort study examined how lifestyle, household environment, and caries activity test score of Japanese children at age 1.5 years affected their dental caries incidence at age 3. Inclusion criteria were 1.5-year-old children with no dental caries. Dental examinations were performed for [...] Read more.

The present cohort study examined how lifestyle, household environment, and caries activity test score of Japanese children at age 1.5 years affected their dental caries incidence at age 3. Inclusion criteria were 1.5-year-old children with no dental caries. Dental examinations were performed for 33,655 children who participated in routine dental examinations at 1.5 years of age, and the exam was repeated approximately 21 months later (at age 3) at the Kobe City Public Health Center in Japan. After excluding 622 children who had caries at age 1.5 and 1831 children with missing lifestyle and household environment data in the questionnaires, the final data analysis was performed on a total of 31,202 children (16,052 boys, 15,150 girls).The multivariate logistic regression analysis indicated a strong association of the consumption of sugar-sweetened beverages/snacks, less frequent tooth brushing by the parents, lack of fluoride varnish, family history of smoking, with the risk of developing dental caries. A child’s late bedtime is also one of the major risk factors for dental caries development. Further investigation is needed to examine whether the short duration or the irregularity of the sleep-wake cycle would affect early childhood oral health and whether there is a relationship between late bedtime and late night snack intake. Full article

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9 pages, 656 KiB

Open AccessArticle

Effect of a Brief Heat Exposure on Blood Pressure and Physical Performance of Older Women Living in the Community—A Pilot-Study

by Anja Stotz¹, Kilian Rapp¹, Juha Oksa², Dawn A. Skelton³

, Nina Beyer⁴, Jochen Klenk^1,5

, Clemens Becker¹ and Ulrich Lindemann^1,*

¹ Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, 70376 Stuttgart, Germany

² Physical Work Capacity Team, Finnish Institute of Occupational Health, 90220 Oulu, Finland

³ Institute of Applied Health Research, Glasgow Caledonian University, Scotland, G4 0BA, UK

⁴ Musculoskeletal Rehabilitation Research Unit, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, 2400 NV Copenhagen, Denmark

⁵ Institute of Epidemiology, Ulm University, 89081 Ulm, Germany

Int. J. Environ. Res. Public Health 2014, 11(12), 12623-12631; https://doi.org/10.3390/ijerph111212623 - 5 Dec 2014

Cited by 26 | Viewed by 7502

Abstract

Global climate change is affecting health and mortality, particularly in vulnerable populations. High ambient temperatures decrease blood pressure (BP) in young and middle aged adults and may lead to orthostatic hypotension, increasing the risk of falls in older adults. The aim of this [...] Read more.

Global climate change is affecting health and mortality, particularly in vulnerable populations. High ambient temperatures decrease blood pressure (BP) in young and middle aged adults and may lead to orthostatic hypotension, increasing the risk of falls in older adults. The aim of this study was to evaluate the feasibility of a test protocol to investigate BP response and aerobic capacity of older adults in a hot indoor environment. BP response and aerobic capacity were assessed in 26 community-dwelling older women (median age 75.5 years) at a room temperature of either 20 °C or 30 °C. The protocol was well tolerated by all participants. In the 30 °C condition systolic and diastolic BP (median difference 10 and 8 mmHg, respectively) and distance walked in 6 min (median difference 29.3 m) were lower than in the 20 °C condition (all p < 0.01). Systolic BP decreased after standing up from a lying position in the 30 °C (17.4 mmHg) and 20 °C (14.2 mmHg) condition (both p < 0.001). In conclusion, the protocol is feasible in this cohort and should be repeated in older adults with poor physical performance and impaired cardio-vascular response mechanisms. Furthermore, aerobic capacity was reduced after exposure to hot environmental temperatures, which should be considered when recommending exercise to older people during the summer months. Full article

20 pages, 718 KiB

Open AccessArticle

The Association between Access to Public Transportation and Self-Reported Active Commuting

by Sune Djurhuus^1,2,†, Henning S. Hansen^2,†, Mette Aadahl^1,† and Charlotte Glümer^1,3,*

¹ Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup University Hospital, Nordre Ringvej 57, Section 84–85, DK-2600 Glostrup, Denmark

² Department of Planning, Alborg University Copenhagen, A.C. Meyers Vænge 15, DK-2450 Copenhagen, Denmark

³ Department of Health Sciences and Technology, Aalborg University, Frederik Bayers Vej 7D2, DK-9220 Aalborg, Denmark

^† These authors contributed equally to this work.

Int. J. Environ. Res. Public Health 2014, 11(12), 12632-12651; https://doi.org/10.3390/ijerph111212632 - 5 Dec 2014

Cited by 45 | Viewed by 8959

Abstract

Active commuting provides routine-based regular physical activity which can reduce the risk of chronic diseases. Using public transportation involves some walking or cycling to a transit stop, transfers and a walk to the end location and users of public transportation have been found [...] Read more.

Active commuting provides routine-based regular physical activity which can reduce the risk of chronic diseases. Using public transportation involves some walking or cycling to a transit stop, transfers and a walk to the end location and users of public transportation have been found to accumulate more moderate physical activity than non-users. Understanding how public transportation characteristics are associated with active transportation is thus important from a public health perspective. This study examines the associations between objective measures of access to public transportation and self-reported active commuting. Self-reported time spent either walking or cycling commuting each day and the distance to workplace were obtained for adults aged 16 to 65 in the Danish National Health Survey 2010 (n = 28,928). Access to public transportation measures were computed by combining GIS-based road network distances from home address to public transit stops an integrating their service level. Multilevel logistic regression was used to examine the association between access to public transportation measures and active commuting. Distance to bus stop, density of bus stops, and number of transport modes were all positively associated with being an active commuter and with meeting recommendations of physical activity. No significant association was found between bus services at the nearest stop and active commuting. The results highlight the importance of including detailed measurements of access to public transit in order to identify the characteristics that facilitate the use of public transportation and active commuting. Full article

(This article belongs to the Special Issue Physical Activity and Public Health-)

16 pages, 927 KiB

Open AccessArticle

The Association between Road Traffic Noise Exposure, Annoyance and Health-Related Quality of Life (HRQOL)

by Harris Héritier^1,2, Danielle Vienneau^1,2

, Patrizia Frei³, Ikenna C. Eze^1,2, Mark Brink⁴

, Nicole Probst-Hensch^1,2 and Martin Röösli^1,2,*

¹ Swiss Tropical and Public Health Institute, Socinstr. 57, P.O. Box, CH-4002 Basel, Switzerland

² University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland

³ Krebsliga Schweiz, 3001 Bern, Switzerland

⁴ Federal Office for the Environment, 3003 Bern, Switzerland

Int. J. Environ. Res. Public Health 2014, 11(12), 12652-12667; https://doi.org/10.3390/ijerph111212652 - 5 Dec 2014

Cited by 67 | Viewed by 9687

Abstract

The aim of this study is to investigate the relationships between road traffic noise exposure, annoyance caused by different noise sources and validated health indicators in a cohort of 1375 adults from the region of Basel, Switzerland. Road traffic noise exposure for each [...] Read more.

The aim of this study is to investigate the relationships between road traffic noise exposure, annoyance caused by different noise sources and validated health indicators in a cohort of 1375 adults from the region of Basel, Switzerland. Road traffic noise exposure for each study participant was determined using modelling, and annoyance from various noise sources was inquired by means of a four-point Likert scale. Regression parameters from multivariable regression models for the von Zerssen score of somatic symptoms (point symptom score increase per annoyance category) showed strongest associations with annoyance from industry noise (2.36, 95% CI: 1.54, 3.17), neighbour noise (1.62, 95% CI: 1.17, 2.06) and road traffic noise (1.53, 95% CI: 1.09, 1.96). Increase in modelled noise exposure by 10 dB(A) resulted in a von Zerssen symptom score increase of 0.47 (95% CI: −0.01, 0.95) units. Subsequent structural equation modelling revealed that the association between physical noise exposure and health-related quality of life (HRQOL) is strongly mediated by annoyance and sleep disturbance. This study elucidates the complex interplay of different factors for the association between physical noise exposure and HRQOL. Full article

(This article belongs to the Special Issue Sound and Health related Quality of Life)

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15 pages, 1269 KiB

Open AccessArticle

Lead in School Children from Morelos, Mexico: Levels, Sources and Feasible Interventions

by Paulina Farías¹

, Urinda Álamo-Hernández^1,*, Leonardo Mancilla-Sánchez¹, José Luis Texcalac-Sangrador¹, Leticia Carrizales-Yáez² and Horacio Riojas-Rodríguez¹

¹ Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P., Cuernavaca, Morelos 62100, Mexico

² Departamento de Toxicología Ambiental, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí 78000, Mexico

Int. J. Environ. Res. Public Health 2014, 11(12), 12668-12682; https://doi.org/10.3390/ijerph111212668 - 8 Dec 2014

Cited by 25 | Viewed by 7115

Abstract

Background: Lead is a pervasive pollutant, associated at low levels to many adverse health effects. Objective: To investigate lead levels, exposure pathways and intervention possibilities in school children from Alpuyeca, in Morelos, Mexico. Methods: Blood lead concentrations (BPb) were measured [...] Read more.

Background: Lead is a pervasive pollutant, associated at low levels to many adverse health effects. Objective: To investigate lead levels, exposure pathways and intervention possibilities in school children from Alpuyeca, in Morelos, Mexico. Methods: Blood lead concentrations (BPb) were measured in 226 children in 2011. Exposure pathways were assessed through a questionnaire, lead measurements in different environmental matrices and spatial aggregation analysis of lead concentrations. Results: BPb ranged from 1.5 to 36.5 µg/dL, with a mean (SD) of 7.23 (4.9) µg/dL. Sixty-four and 18% of the children had BPb > 5 µg/dL and > 10 µg/dL, respectively. The use of lead glazed ceramics was reported in almost half of the households; it was the main BPb determinant and it was associated with an increased risk of having BPb > 5 g/dL by 2.7 times (p = 0.001). Environmental samples were within US EPA’s lead recommended limits, and blood lead levels were randomly distributed in the community. Conclusions: Lead remains a public health problem in Alpuyeca, Mexico. Unlike other local pollutants, lead exposure prevention can be achieved inexpensively and in a short term. Interventions should make mothers aware of lead’s health effects and empower them to safeguard their children’s health by avoiding the culturally ingrained use of lead glazed pottery. Full article

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17 pages, 700 KiB

Open AccessArticle

Health Impact Assessment Practice and Potential for Integration within Environmental Impact and Strategic Environmental Assessments in Italy

by Nunzia Linzalone^1,*, Giorgio Assennato², Adele Ballarini³, Ennio Cadum⁴, Mario Cirillo⁵, Liliana Cori¹, Francesca De Maio⁵, Loredana Musmeci⁶, Marinella Natali³, Sabrina Rieti⁵, Maria Eleonora Soggiu⁶ and Fabrizio Bianchi¹

¹ Institute of Clinical Physiology, National Council of Research, via Moruzzi 1, 56127 Pisa, Italy

² Regional Agency for the Protection of the Environment, Apulia Corso Trieste 27, 70126 Bari, Italy

³ Regional Public Health Service, Emilia-Romagna Viale Moro 21, 40127 Bologna, Italy

⁴ Regional Agency for the Protection of the Environment, Piedmont via Sabaudia 164, 10095 Grugliasco, Italy

⁵ Institute for Environmental Protection and Research, via Vitaliano Brancati 48, 00144 Roma, Italy

⁶ Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy

Int. J. Environ. Res. Public Health 2014, 11(12), 12683-12699; https://doi.org/10.3390/ijerph111212683 - 8 Dec 2014

Cited by 20 | Viewed by 8837

Abstract

Avoiding or minimizing potential environmental impact is the driving idea behind protecting a population’s health via Environmental Impact Assessments (EIAs) and Strategic Environmental Assessments (SEAs). However, both are often carried out without any systematic approach. This paper describes the findings of a review [...] Read more.

Avoiding or minimizing potential environmental impact is the driving idea behind protecting a population’s health via Environmental Impact Assessments (EIAs) and Strategic Environmental Assessments (SEAs). However, both are often carried out without any systematic approach. This paper describes the findings of a review of HIA, EIA and SEA experiences carried out by the authors, who act as institutional competent subjects at the national and regional levels in Italy. The analysis of how health is tackled in EIA and SEA procedures could support the definition of a protocol for the integration of HIA with EIA and SEA. Although EIA and SEA approaches include the aim of protecting health, significant technical and methodological gaps are present when assessing health systematically, and their basic principles regarding assessment are unsatisfactory for promoting and addressing healthcare concepts stated by the WHO. HIA is still poorly integrated into the decision-making process, screening and monitoring phases are only occasionally implemented, and operational details are not well-defined. The collaborative approach of institutions involved in environment and health is a core element in a systematic advancement toward supporting effective decisions and effective protection of the environment and health. At the Italian national level, the definition of guidelines and tools for HIA, also in relation with EIA and SEA, is of great interest. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

16 pages, 724 KiB

Open AccessArticle

Alcohol Consumption Patterns among Adolescents are Related to Family Structure and Exposure to Drunkenness within the Family: Results from the SEYLE Project

by Erik Rüütel^1,2,*, Merike Sisask¹, Airi Värnik¹, Peeter Värnik¹

, Vladimir Carli³, Camilla Wasserman⁴, Christina W. Hoven⁴, Marco Sarchiapone⁵, Alan Apter⁶, Judit Balazs^7,8

, Julio Bobes⁹, Romuald Brunner¹⁰, Paul Corcoran¹¹, Doina Cosman¹², Christian Haring¹³, Miriam Iosue⁵, Michael Kaess¹⁰, Jean-Pierre Kahn¹⁴, Vita Poštuvan¹⁵, Pilar A. Sáiz⁹ and Danuta Wasserman³ Show full author list Hide full author list

¹ Estonian-Swedish Mental Health and Suicidology Institute, Tallinn University Social Work Institute, Tallinn 11615, Estonia

² Justice College, Estonian Academy of Security Sciences, Tallinn 12012, Estonia

³ National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) at Karolinska Institutet, Stockholm SE-171 77, Sweden

⁴ Department of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY 10032, USA

⁵ Medicine and Health Science Department, University of Molise, Via De Sanctis, 86100 Campobasso, Italy

⁶ Feinberg Child Study Center, Schneider Children's Medical Center, Tel Aviv University, Tel Aviv 69978, Israel

⁷ Vadaskert Child and Adolescent Psychiatric Hospital, Budapest 1021, Hungary

⁸ Institute of Psychology, Eötvös Loránd University, Budapest 1064, Hungary

⁹ Department of Psychiatry, School of Medicine, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo 33003, Spain

¹⁰ Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg 69047, Germany

¹¹ National Suicide Research Foundation, Cork, Ireland

¹² Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania

¹³ Research Division for Mental Health, University for Health Science, Medical Informatics Technology (UMIT), Hall in Tyrol 6060, Austria

¹⁴ Department of Psychiatry and Clinical Psychology, Centre Hospitalo-Universitaire CHU de NANCY, Université de Lorraine, Nancy 54500, France

¹⁵ Slovene Center for Suicide Research, UP IAM, University of Primorska, Koper SI-6000, Slovenia

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Int. J. Environ. Res. Public Health 2014, 11(12), 12700-12715; https://doi.org/10.3390/ijerph111212700 - 8 Dec 2014

Cited by 31 | Viewed by 15400

Abstract

There is expedient evidence showing that differences in adolescent alcohol consumption and other risk-behaviour depend on both family structure and family member drunkenness exposure. Data were obtained among adolescents (N = 12,115, mean age 14.9 ± 0.89) in Austria, Estonia, France, Germany, Hungary, [...] Read more.

There is expedient evidence showing that differences in adolescent alcohol consumption and other risk-behaviour depend on both family structure and family member drunkenness exposure. Data were obtained among adolescents (N = 12,115, mean age 14.9 ± 0.89) in Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain within the European Union’s 7th Framework Programme funded project, ‘Saving and Empowering Young Lives in Europe (SEYLE)’. The current study reveals how adolescents’ alcohol consumption patterns are related to their family structure and having seen their family member drunk. The results revealed statistically significant differences in adolescent alcohol consumption depending on whether the adolescent lives in a family with both birth parents, in a single-parent family or in a family with one birth parent and one step-parent. The study also revealed that the abstaining from alcohol percentage among adolescents was greater in families with both birth parents compared to other family types. The study also showed that the more often adolescents see their family member drunk the more they drink themselves. There is no difference in adolescent drinking patterns whether they see their family member drunk once a month or once a week. This study gives an insight on which subgroups of adolescents are at heightened risk of alcohol abuse and that decrease of family member drunkenness may have positive effects on the drinking habits of their children. Full article

(This article belongs to the Special Issue Suicide Prevention among Youth)

10 pages, 652 KiB

Open AccessArticle

Counseling Role of Primary Care Physicians in Preventing Early Childhood Caries in Children with Congenital Heart Disease

by Zifeng Liu^1,2,†, Dongsheng Yu^2,†, Lijie Zhou², Jing Yang², Jiaxuan Lu², Hui Lu² and Wei Zhao^2,*

¹ Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510275, China

² Department of Pediatric Dentistry, Guanghua School of Stomotology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510275, China

^† These authors contributed equally to this work.

Int. J. Environ. Res. Public Health 2014, 11(12), 12716-12725; https://doi.org/10.3390/ijerph111212716 - 9 Dec 2014

Cited by 6 | Viewed by 6962

Abstract

The dental health of preschool children with congenital heart disease (CHD) is usually poor, which may contribute to the development of infective endocarditis (IE). Primary care physicians play an important role in providing access to preventive dental services, particularly for preschool children. The [...] Read more.

The dental health of preschool children with congenital heart disease (CHD) is usually poor, which may contribute to the development of infective endocarditis (IE). Primary care physicians play an important role in providing access to preventive dental services, particularly for preschool children. The object of this study was to provide epidemiologic evidence for the impact of primary care physicians’ (PCP’s) counseling role on early childhood caries in children with CHD in Guangzhou, China, which might guide future caries prevention to decrease the risk of IE in children with CHD. A hospital-based, case-control study was performed, which contained 100 children with newly diagnosed early childhood caries and 100 matched (sex and age) children without dental caries. All of the subjects were diagnosed with CHD at birth and recruited from Guangdong Cardiovascular Institute from 2012 through 2013. A conditional multivariate logistic-regression model was used to assess the associations between PCPs’ role and early childhood caries with a significance level of 5%. Our findings revealed that mother’s education level (OR = 0.36, CL = 0.14–0.92) and knowledge, being educated on the relationship between CHD and infective endocarditis (OR = 0.48, CL = 0.25–0.94) and the impact of oral health on infective endocarditis (OR = 0.37, CL = 0.18–0.79) by the PCP were associated with early childhood caries. PCPs played an important role in preventing early childhood caries among preschool children with CHD in Guangzhou, China. Full article

(This article belongs to the Special Issue Social and Environmental Determinants of Oral Health)

13 pages, 722 KiB

Open AccessArticle

Assessment of Sex-Related Behaviours, Human Immunodeficiency Virus (HIV) Knowledge and Sexually Transmitted Infections (STIs) among Men of Reproductive Age in Cameroon

by Abayomi Samuel Oyekale

Department of Agricultural Economics and Extension, North-West University Mafikeng Campus, Mmabatho 2735, South Africa

Int. J. Environ. Res. Public Health 2014, 11(12), 12726-12738; https://doi.org/10.3390/ijerph111212726 - 9 Dec 2014

Cited by 2 | Viewed by 6013

Abstract

Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), are among the major public health challenges in Cameroon. This paper determined the effect of men’s sex-related behaviors and HIV knowledge on reported STIs. The data came from the 2012 Cameroon’s Demographic and Health [...] Read more.

Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), are among the major public health challenges in Cameroon. This paper determined the effect of men’s sex-related behaviors and HIV knowledge on reported STIs. The data came from the 2012 Cameroon’s Demographic and Health Survey (DHS) that were collected from 7191 respondents in 2012. Descriptive and logistic regression methods were used for data analysis. Results showed that majority of the respondents were aware of STIs and Acquired Immune Deficiency Syndrome (AIDS), while 3.96% reported STIs. Also, 49.45% of the men had no wife, while 75.58% and 84.58% noted that condoms and keeping of one partner could be used to prevent HIV transmission, respectively. Wrong impressions that mosquito bites and sharing of food could lead to HIV infection were held by 31.94% and 12.44% of the men, respectively. Among those that reported STIs, 33.33%, 30.18% and 13.33% respectively used condom during sex with most recent partner, second to most recent partner and third to most recent partner, compared to 24.69%, 15.04% and 4.17% among those that did not report STIs. Logistic regression results showed that probability of STI increased significantly (p < 0.05) with condom use with third most recent partners, being married, wrong knowledge that mosquito bites cause HIV and being away for more than one month, while it significantly reduced (p < 0.05) with number of children, knowledge that having one partner prevents STIs. It was concluded that policy initiatives and programmes to enhance right sexual knowledge and behavior among men would go a long way in reducing STI incidence in Cameroon. Full article

28 pages, 6313 KiB

Open AccessArticle

Creating Locally-Resolved Mobile-Source Emissions Inputs for Air Quality Modeling in Support of an Exposure Study in Detroit, Michigan, USA

by Michelle Snyder^1,*, Saravanan Arunachalam^1,†, Vlad Isakov^2,†, Kevin Talgo^1,†, Brian Naess^1,†, Alejandro Valencia^1,†, Mohammad Omary^1,†, Neil Davis^1,†, Rich Cook^3,† and Adel Hanna^1,†

¹ Institute for the Environment, University of North Carolina at Chapel Hill, 100 Europa Drive, Suite 490, Chapel Hill, NC 27517, USA

² National Exposure Research Laboratory, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711, USA

³ Office of Transportation and Air Quality, U.S. Environmental Protection Agency, 2000 Traverwood Drive, Ann Arbor, MI 48105, USA

^† These authors contributed equally to this work.

Int. J. Environ. Res. Public Health 2014, 11(12), 12739-12766; https://doi.org/10.3390/ijerph111212739 - 9 Dec 2014

Cited by 18 | Viewed by 7836

Abstract

This work describes a methodology for modeling the impact of traffic-generated air pollutants in an urban area. This methodology presented here utilizes road network geometry, traffic volume, temporal allocation factors, fleet mixes, and emission factors to provide critical modeling inputs. These inputs, assembled [...] Read more.

This work describes a methodology for modeling the impact of traffic-generated air pollutants in an urban area. This methodology presented here utilizes road network geometry, traffic volume, temporal allocation factors, fleet mixes, and emission factors to provide critical modeling inputs. These inputs, assembled from a variety of sources, are combined with meteorological inputs to generate link-based emissions for use in dispersion modeling to estimate pollutant concentration levels due to traffic. A case study implementing this methodology for a large health study is presented, including a sensitivity analysis of the modeling results reinforcing the importance of model inputs and identify those having greater relative impact, such as fleet mix. In addition, an example use of local measurements of fleet activity to supplement model inputs is described, and its impacts to the model outputs are discussed. We conclude that with detailed model inputs supported by local traffic measurements and meteorology, it is possible to capture the spatial and temporal patterns needed to accurately estimate exposure from traffic-related pollutants. Full article

(This article belongs to the Special Issue Air Pollution Modeling)

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10 pages, 712 KiB

Open AccessArticle

Alanine Aminotransferase within Reference Range Is Associated with Metabolic Syndrome in Middle-Aged and Elderly Chinese Men and Women

by Xuebing Zhang^1,2, Yiming Mu^1,*, Wenhua Yan¹, Jianming Ba¹ and Hongmei Li²

¹ Department of Endocrinology, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China

² Department of Endocrinology, MeiTan General Hospital, Beijing 100028, China

Int. J. Environ. Res. Public Health 2014, 11(12), 12767-12776; https://doi.org/10.3390/ijerph111212767 - 10 Dec 2014

Cited by 8 | Viewed by 6402

Abstract

Objective: To investigate the association between serum ALT level within reference range (≤40 U/L) and morbidity of MetS in a large middle-aged and elderly Chinese community population. Methods: Our study was a community-based cross-sectional survey which used cluster sampling method. From [...] Read more.

Objective: To investigate the association between serum ALT level within reference range (≤40 U/L) and morbidity of MetS in a large middle-aged and elderly Chinese community population. Methods: Our study was a community-based cross-sectional survey which used cluster sampling method. From November 2011 to August 2012 a total of 16,539 subjects (males 5184; females 11,355) with serum ALT levels in the normal range aged ≥40 years from Shijingshan District (Beijing, China) were included in the study. Data on demographic information, lifestyle, history of diabetes mellitus, hypertension, dyslipidemia and liver disease were collected. Body height, body weight, waist circumference, hip circumference, and blood pressure were recorded. The oral glucose tolerance test or a standard meal test and blood lipid test was performed. The determination of metabolic syndrome was according to the unified criteria published in 2009. The association between serum ALT level and metabolic syndrome was evaluated by logistic regression. The association between serum ALT level and all components of metabolic syndrome was evaluated by multiple linear regression. p < 0.05 was regarded as statistically significant. Results: The prevalence of metabolic syndrome was 41.4% in males and 40.6% in females. We found ALT level was positively associated with odds of metabolic syndrome after adjustment for age, smoking, and alcohol intake. The odds ratio values of MetS in the ALT quartiles 2–4 groups were 1.920 (95%CI: 1.619–2.277), 2.853 (95%CI: 2.407–3.381), and 4.171 (95%CI: 3.510–4.956) in males; 1.889 (95%CI: 1.671–2.136), 3.490 (95%CI: 3.095–3.935), and 5.593 (95%CI: 4.957–6.311) in females, respectively, compared with the ALT quartile 1 group. Conclusions: Higher serum ALT level within the reference range was associated with increased odds of MetS in middle-aged and elderly Chinese men and women. Full article

18 pages, 708 KiB

Open AccessArticle

Mobile Applications for Participation at the Shopping Mall: Content Analysis and Usability for Persons with Physical Disabilities and Communication or Cognitive Limitations

by Claudine Auger^1,2,*, Emilie Leduc^1,2, Delphine Labbé^1,3, Cassioppée Guay^1,2, Brigitte Fillion¹, Carolina Bottari^1,2 and Bonnie Swaine^1,2

¹ Center for Interdisciplinary Research in Rehabilitation of Greater Montreal—Lucie-Bruneau Rehabilitation Center (CRIR-CRLB), 2275 Avenue Laurier East, Montreal, QC H2H 2N8, Canada

² School of Rehabilitation, Université de Montréal, C.P. 6128 Succursale Centre-Ville, Montreal, QC H3C 3J7, Canada

³ Department of Psychology, University of Quebec at Montreal, C.P. 888 Succursale Centre-Ville, Montreal, QC H3C 3P8, Canada

Int. J. Environ. Res. Public Health 2014, 11(12), 12777-12794; https://doi.org/10.3390/ijerph111212777 - 10 Dec 2014

Cited by 18 | Viewed by 7995

Abstract

The aim of this exploratory study was to determine the important features in content and usability of existing mobile applications evaluating environmental barriers and facilitators (EBF) to participation for persons with physical disabilities presenting mild communication or cognitive limitations. A rigorous process based [...] Read more.

The aim of this exploratory study was to determine the important features in content and usability of existing mobile applications evaluating environmental barriers and facilitators (EBF) to participation for persons with physical disabilities presenting mild communication or cognitive limitations. A rigorous process based on a user-centered design approach led to the identification of two relevant mobile applications to evaluate the EBF. An accessibility expert, the research team as well as five users then tested the mobile applications in a shopping mall. A thematic content analysis of the research team’s and users’ comments established 10 categories of key features that adequately respond to the needs of the clientele targeted in this study. In terms of content, granularity and contextualization of the information provided were considered important. With respect to usability, relevant features were place finding, rating system, presentation of results, compatibility, user-friendliness, aesthetics, credibility of the information as well as connectivity/interactiveness. The research team and the users agreed on some aspects such as aesthetics, but had different perspectives on features such as the rating system or the connectivity/interactiveness of the application. The users proposed new features suggesting that the existing mobile applications did not correspond to all their needs. Full article

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

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22 pages, 1385 KiB

Open AccessArticle

Preliminary Evaluation of a Regional Atmospheric Chemical Data Assimilation System for Environmental Surveillance

by Pius Lee^1,* and Yang Liu²

¹ Air Resources Laboratory, Office of Oceanic and Atmospheric Research, National Oceanic and Atmospheric Administration, College Park, MD 20740, USA

² Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 12795-12816; https://doi.org/10.3390/ijerph111212795 - 11 Dec 2014

Cited by 1 | Viewed by 6595

Abstract

We report the progress of an ongoing effort by the Air Resources Laboratory, NOAA to build a prototype regional Chemical Analysis System (ARLCAS). The ARLCAS focuses on providing long-term analysis of the three dimensional (3D) air-pollutant concentration fields over the continental U.S. It [...] Read more.

We report the progress of an ongoing effort by the Air Resources Laboratory, NOAA to build a prototype regional Chemical Analysis System (ARLCAS). The ARLCAS focuses on providing long-term analysis of the three dimensional (3D) air-pollutant concentration fields over the continental U.S. It leverages expertise from the NASA Earth Science Division-sponsored Air Quality Applied Science Team (AQAST) for the state-of-science knowledge in atmospheric and data assimilation sciences. The ARLCAS complies with national operational center requirement protocols and aims to have the modeling system to be maintained by a national center. Meteorology and chemistry observations consist of land-, air- and space-based observed and quality-assured data. We develop modularized testing to investigate the efficacies of the various components of the ARLCAS. The sensitivity testing of data assimilation schemes showed that with the increment of additional observational data sets, the accuracy of the analysis chemical fields also increased incrementally in varying margins. The benefit is especially noted for additional data sets based on a different platform and/or a different retrieval algorithm. We also described a plan to apply the analysis chemical fields in environmental surveillance at the Centers for Disease Control and Prevention. Full article

(This article belongs to the Special Issue Air Pollution Modeling)

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18 pages, 694 KiB

Open AccessReview

A Critical Review of an Authentic and Transformative Environmental Justice and Health Community — University Partnership

by Sacoby Wilson^1,†, Dayna Campbell^2,†, Laura Dalemarre^1,*,†, Herb Fraser-Rahim³ and Edith Williams⁴

¹ Maryland Institute of Applied Environmental Health, University of Maryland, College Park, MD 20742, USA

² Department of Health Promotion, Education, and Behavior, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA

³ Charleston Community Research to Action Board, 2125 Dorchester Rd., North Charleston, SC 29405, USA

⁴ Department of Epidemiology and Biostatistics, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA

^† These authors contributed equally to this work.

Int. J. Environ. Res. Public Health 2014, 11(12), 12817-12834; https://doi.org/10.3390/ijerph111212817 - 11 Dec 2014

Cited by 27 | Viewed by 9137

Abstract

Distressed neighborhoods in North Charleston (SC, USA) are impacted by the cumulative effects of multiple environmental hazards and expansion of the Port of Charleston. The Low Country Alliance for Model Communities (LAMC) built an environmental justice partnership to address local concerns. This case [...] Read more.

Distressed neighborhoods in North Charleston (SC, USA) are impacted by the cumulative effects of multiple environmental hazards and expansion of the Port of Charleston. The Low Country Alliance for Model Communities (LAMC) built an environmental justice partnership to address local concerns. This case study examines the process of building and sustaining a successful transformative and authentic community-university partnership. We apply the framework established by Community-Campus Partnerships for Health (CCPH), focusing on four of the nine principles of Good Practice of Community Campus Partnerships. Full article

(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)

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13 pages, 688 KiB

Open AccessArticle

Secondhand Smoke Exposure, Indoor Smoking Bans and Smoking-Related Knowledge in China

by Yue Jin¹, Ling Wang¹, Bo Lu² and Amy K. Ferketich^1,*

¹ Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Ave., Columbus, OH 43210, USA

² Division of Biostatistics, College of Public Health, The Ohio State University, 1841 Neil Ave., Columbus, OH 43210, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 12835-12847; https://doi.org/10.3390/ijerph111212835 - 11 Dec 2014

Cited by 17 | Viewed by 6660

Abstract

Although previous studies have provided strong evidence that Chinese individuals are exposed to secondhand smoke (SHS) and lack knowledge of its harmful effects, there has not been an in-depth exploration of the variability in exposure and knowledge by geographic region, occupation, and socioeconomic [...] Read more.

Although previous studies have provided strong evidence that Chinese individuals are exposed to secondhand smoke (SHS) and lack knowledge of its harmful effects, there has not been an in-depth exploration of the variability in exposure and knowledge by geographic region, occupation, and socioeconomic status. The objectives of this study were to examine: (1) the demographic factors associated with the level of knowledge of the harmful effects of smoking; (2) the factors related to implementation of in-home and workplace smoking bans; and (3) geographic differences in being exposed to SHS in government buildings, healthcare facilities, restaurants, public transportations, and schools. We used data from the 2010 Global Adult Tobacco Survey-China. Chi-square tests were used for statistical analysis. The results suggested that among Chinese citizens age 15 years and older, there is poor knowledge of the harmful effects of tobacco, and knowledge varies with region and socioeconomic status. Over three-quarters of the households had no smoking restrictions, and a large percentage of workers reported working in places with no smoking ban. In public places, exposure to SHS was high, particularly in rural areas and in the Southwest. These results suggest Chinese individuals are not well informed of smoking and SHS associated risks and are regularly exposed to SHS at home, work and public places. Full article

(This article belongs to the Special Issue Tobacco Control)

18 pages, 2730 KiB

Open AccessArticle

Addressing Health Disparities in Chronic Kidney Disease

by Ta-Chien Chan¹

, I.-Chun Fan^1,2, Michael Shi-Yung Liu^1,3, Ming-Daw Su⁴ and Po-Huang Chiang^5,*

¹ Research Center for Humanities and Social Sciences, Academia Sinica, Taipei City 115, Taiwan

² The Institute of History and Philology, Academia Sinica, Taipei City 115, Taiwan

³ Institute of Taiwan History, Academia Sinica, Taipei City 115, Taiwan

⁴ Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei City 106, Taiwan

⁵ Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan

Int. J. Environ. Res. Public Health 2014, 11(12), 12848-12865; https://doi.org/10.3390/ijerph111212848 - 11 Dec 2014

Cited by 17 | Viewed by 9394

Abstract

According to the official health statistics, Taiwan has the highest prevalence of end stage renal disease (ESRD) in the world. Each year, around 60,000 ESRD patients in Taiwan consume 6% of the national insurance budget for dialysis treatment. The prevalence of chronic kidney [...] Read more.

According to the official health statistics, Taiwan has the highest prevalence of end stage renal disease (ESRD) in the world. Each year, around 60,000 ESRD patients in Taiwan consume 6% of the national insurance budget for dialysis treatment. The prevalence of chronic kidney disease (CKD) has been climbing during 2008–2012. However, the spatial disparities and clustering of CKD at the public health level have rarely been discussed. The aims of this study are to explore the possible population level risk factors and identify any clusters of CKD, using the national health insurance database. The results show that the ESRD prevalence in females is higher than that in males. ESRD medical expenditure constitutes 87% of total CKD medical expenditure. Pre-CKD and pre-ESRD disease management might slow the progression from CKD to ESRD. After applying ordinary least-squares regression, the percentages of high education status and the elderly in the townships are positively correlated with CKD prevalence. Geographically weighted regression and Local Moran’s I are used for identifying the clusters in southern Taiwan. The findings can be important evidence for earlier and targeted community interventions and reducing the health disparities of CKD. Full article

(This article belongs to the Special Issue Proceedings from 2014 Global Land Project (GLP) Asia Conference)

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30 pages, 1777 KiB

Open AccessConcept Paper

The Public Health Exposome: A Population-Based, Exposure Science Approach to Health Disparities Research

by Paul D. Juarez^1,*,†, Patricia Matthews-Juarez^1,†, Darryl B. Hood^2,†, Wansoo Im^3,†, Robert S. Levine⁴, Barbara J. Kilbourne^5,†, Michael A. Langston⁶, Mohammad Z. Al-Hamdan⁷, William L. Crosson⁷, Maurice G. Estes⁸, Sue M. Estes⁷, Vincent K. Agboto⁴, Paul Robinson⁹, Sacoby Wilson¹⁰ and Maureen Y. Lichtveld^11,†

¹ Research Center on Health Disparities, Equity, and the Exposome, University of Tennessee Health Science Center, 66 N. Pauline, Memphis, TN 38105, USA

² Department of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, OH 43210, USA

³ Vertices, Inc., 317 George Street 411, New Brunswick, NJ 08901, USA

⁴ Department of Family & Community Medicine, Meharry Medical College, Nashville, TN 37208, USA

⁵ Department of Sociology, Tennessee State University, Nashville, TN 37209, USA

⁶ Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA

⁷ National Space Science and Technology Center, Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL 35805, USA

⁸ National Space Science and Technology Center, University of Alabama, Huntsville, AL 35805, USA

⁹ Department of Ophthalmology, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA

¹⁰ Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MA 20742, USA

¹¹ Department of Global Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70112, USA

^† These authors contributed equally to this work.

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Int. J. Environ. Res. Public Health 2014, 11(12), 12866-12895; https://doi.org/10.3390/ijerph111212866 - 11 Dec 2014

Cited by 141 | Viewed by 20976

Abstract

The lack of progress in reducing health disparities suggests that new approaches are needed if we are to achieve meaningful, equitable, and lasting reductions. Current scientific paradigms do not adequately capture the complexity of the relationships between environment, personal health and population level [...] Read more.

The lack of progress in reducing health disparities suggests that new approaches are needed if we are to achieve meaningful, equitable, and lasting reductions. Current scientific paradigms do not adequately capture the complexity of the relationships between environment, personal health and population level disparities. The public health exposome is presented as a universal exposure tracking framework for integrating complex relationships between exogenous and endogenous exposures across the lifespan from conception to death. It uses a social-ecological framework that builds on the exposome paradigm for conceptualizing how exogenous exposures “get under the skin”. The public health exposome approach has led our team to develop a taxonomy and bioinformatics infrastructure to integrate health outcomes data with thousands of sources of exogenous exposure, organized in four broad domains: natural, built, social, and policy environments. With the input of a transdisciplinary team, we have borrowed and applied the methods, tools and terms from various disciplines to measure the effects of environmental exposures on personal and population health outcomes and disparities, many of which may not manifest until many years later. As is customary with a paradigm shift, this approach has far reaching implications for research methods and design, analytics, community engagement strategies, and research training. Full article

(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)

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19 pages, 708 KiB

Open AccessArticle

A Health Impact Assessment Framework for Assessing Vulnerability and Adaptation Planning for Climate Change

by Helen Brown^*, Jeffery Spickett and Dianne Katscherian

School of Public Health, World Health Organization Collaborating Centre for Environmental Health Impact Assessment, GPO Box U1987, Perth, WA 6845, Australia

Int. J. Environ. Res. Public Health 2014, 11(12), 12896-12914; https://doi.org/10.3390/ijerph111212896 - 12 Dec 2014

Cited by 18 | Viewed by 9864

Abstract

This paper presents a detailed description of an approach designed to investigate the application of the Health Impact Assessment (HIA) framework to assess the potential health impacts of climate change. A HIA framework has been combined with key climate change terminology and concepts. [...] Read more.

This paper presents a detailed description of an approach designed to investigate the application of the Health Impact Assessment (HIA) framework to assess the potential health impacts of climate change. A HIA framework has been combined with key climate change terminology and concepts. The fundamental premise of this framework is an understanding of the interactions between people, the environment and climate. The diversity and complexity of these interactions can hinder much needed action on the critical health issue of climate change. The objectives of the framework are to improve the methodology for understanding and assessing the risks associated with potential health impacts of climate change, and to provide decision-makers with information that can facilitate the development of effective adaptation plans. While the process presented here provides guidance with respect to this task it is not intended to be prescriptive. As such, aspects of the process can be amended to suit the scope and available resources of each project. A series of working tables has been developed to assist in the collation of evidence throughout the process. The framework has been tested in a number of locations including Western Australia, Solomon Islands, Vanuatu and Nauru. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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12 pages, 1131 KiB

Open AccessArticle

Rat Lung Response to PM_2.5 Exposure under Different Cold Stresses

by Bin Luo^1,*,†, Hongxia Shi^2,†, Lina Wang¹, Yanrong Shi¹, Cheng Wang¹, Jingli Yang¹, Yaxiong Wan¹ and Jingping Niu¹

¹ Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou 730000, China

² Lanzhou university Second Hospital, Lanzhou 730030, China

^† These authors contributed equally to this work.

Int. J. Environ. Res. Public Health 2014, 11(12), 12915-12926; https://doi.org/10.3390/ijerph111212915 - 12 Dec 2014

Cited by 48 | Viewed by 8175

Abstract

Ambient particulate matters and temperature were reported to have additive effects over the respiratory disease hospital admissions and deaths. The purpose of this study is to discuss the interactive pulmonary toxicities of cold stress and fine particulate matter (PM_2.5) exposure by [...] Read more.

Ambient particulate matters and temperature were reported to have additive effects over the respiratory disease hospital admissions and deaths. The purpose of this study is to discuss the interactive pulmonary toxicities of cold stress and fine particulate matter (PM_2.5) exposure by estimating inflammation and oxidative stress responses. 48 Wistar male rats, matched by weight and age, were randomly assigned to six groups, which were treated with cold stress alone (0 °C, 10 °C, and 20 °C (Normal control)) and cold stresses plus PM_2.5 exposures respectively. Cold stress alone groups were intratracheal instillation of 0.25 mL normal saline, while cold stress plus PM_2.5 exposure groups were intratracheal instillation of 8 mg/0.25 mL PM_2.5. These procedures were carried out for three times with an interval of 48 hours for each treatment. All rats were sacrificed after 48 hours of the third treatment. The bronchoalveolar lavage fluid (BALF) was collected for analyzing inflammatory cells and cytokines, and lung homogenate MDA was determined for oxidative stress estimation. Results showed higher level of total cell and neutrophil in the BALF of PM_2.5 exposed groups (p < 0.05). Negative relationships between cold stress intensity and the level of tumor necrosis factor alpha (TNF-a), C-reactive protein (CRP) interleukin-6 (IL-6) and interleukin-8 (IL-8) in BALF were indicated in PM_2.5 exposure groups. Exposure to cold stress alone caused significant increase of inflammatory cytokines and methane dicarboxylic aldehyde (MDA) and decline of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity only in 0 °C exposure group (p < 0.05). The two-way ANOVA found significant interactive effects between PM_2.5 exposure and cold stress in the level of neutrophil, IL-6 and IL-8 and SOD activity (p < 0.05). These data demonstrated that inflammation and oxidative stress involved in the additive effect of PM_2.5 exposure and cold stress on pulmonary toxicity, providing explanation for epidemiological studies on the health effect of ambient PM_2.5 and cold stress. Full article

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11 pages, 9341 KiB

Open AccessArticle

Histological Changes in Gills of Two Fish Species as Indicators of Water Quality in Jansen Lagoon (São Luís, Maranhão State, Brazil)

by Débora M. S. Santos^1,2,*, Mércia Regina S. Melo¹, Denise Carla S. Mendes¹, Iolanda Karoline B. S. Rocha¹, Jakeline Priscila L. Silva¹, Sildiane M. Cantanhêde¹ and Paulo C. Meletti³

¹ Departamento de Química e Biologia, Universidade Estadual do Maranhão, São Luís—MA, 65055-000, Brazil

² University City Paulo VI, s/no, Cidade Operária, São Luís—MA, 65055-000, Brazil

³ Departamento de Ciências Fisiológicas, Universidade Estadual de Londrina, PR, 86057-970, Brazil

Int. J. Environ. Res. Public Health 2014, 11(12), 12927-12937; https://doi.org/10.3390/ijerph111212927 - 12 Dec 2014

Cited by 55 | Viewed by 14182

Abstract

Water quality of the Jansen Lagoon (São Luís, Maranhão State, Brazil) was assessed through histological biomarkers and microbiological parameters. To this end, 29 fish specimens (11 Centropomus undecimalis and 18 Sardinella sp) and eight water samples were collected during the rainy and dry [...] Read more.

Water quality of the Jansen Lagoon (São Luís, Maranhão State, Brazil) was assessed through histological biomarkers and microbiological parameters. To this end, 29 fish specimens (11 Centropomus undecimalis and 18 Sardinella sp) and eight water samples were collected during the rainy and dry periods of 2013. The lagoon water showed thermotolerant coliform indices above the limit set forth in CONAMA Resolution 357/2005. Histological changes observed in the gills were: lifting of the respiratory epithelium, hyperplasia of the lamellar epithelium, incomplete and complete fusion of several lamellae, disorganization of the lamellae, congestion of blood vessels, aneurysms, hypertrophy of the respiratory epithelium, hemorrhage and rupture of the lamellar epithelium and parasite. The histological alteration index (HAI) average value to Sardinella sp was 31.8 and to C. undecimalis was 22.2. The average HAI value in both species corresponds to category 21–50, with tissue injuries being classified from moderate to severe. The presence of histological injuries and the HAI values indicate that the fish sampled from the Jansen Lagoon are reacting to non-specific xenobiotics present at the site. Full article

(This article belongs to the Special Issue Proceedings of 1st Latin American Congress of Clinical and Laboratorial Toxicology (Toxi-Latin 2014))

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31 pages, 1348 KiB

Open AccessArticle

Overall Accessibility to Traveling by Rail for the Elderly with and without Functional Limitations: The Whole-Trip Perspective

by Catherine Sundling^1,*, Birgitta Berglund^2,3, Mats E. Nilsson⁴, Ragne Emardson⁵ and Leslie R. Pendrill⁵

¹ Ekman Laboratory, Department of Psychology, Stockholm University, SE-106-91 Stockholm, Sweden

² Institute of Environmental Medicine, Karolinska Institutet, P.O. Box 210, SE-171-77 Stockholm, Sweden

³ Department of Psychology, Stockholm University, SE-106-91 Stockholm, Sweden

⁴ Ekman Laboratory, Department of Psychology, Stockholm University, SE-106-91 Stockholm, Sweden

⁵ SP Technical Research Institute of Sweden, P.O. Box 857, SE-501-15 Borås, Sweden

Int. J. Environ. Res. Public Health 2014, 11(12), 12938-12968; https://doi.org/10.3390/ijerph111212938 - 12 Dec 2014

Cited by 25 | Viewed by 6874

Abstract

Elderly persons’ perceived accessibility to railway traveling depends on their functional limitations/diseases, their functional abilities and their travel behaviors in interaction with the barriers encountered during whole trips. A survey was conducted on a random sample of 1000 city residents (65–85 years old; [...] Read more.

Elderly persons’ perceived accessibility to railway traveling depends on their functional limitations/diseases, their functional abilities and their travel behaviors in interaction with the barriers encountered during whole trips. A survey was conducted on a random sample of 1000 city residents (65–85 years old; 57% response rate). The travels were perceived least accessible by respondents with severely reduced functional ability and by those with more than one functional limitation/disease (e.g., restricted mobility and chronic pain). Those who traveled “often”, perceived the accessibility to be better than those who traveled less frequently. For travelers with high functional ability, the main barriers to more frequent traveling were travel costs and low punctuality. For those with low functional ability, one’s own health was reported to be the main barrier. Our results clarify the links among existing functional limitations/functional abilities, the barriers encountered, the travel behavior, and the overall accessibility to traveling. By operationalizing the whole-trip concept as a chain of events, we deliver practical knowledge on vulnerable groups for decision-making to improve the transport environment for all. Full article

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14 pages, 681 KiB

Open AccessArticle

General Practitioners’ Knowledge and Concern about Electromagnetic Fields

by Gabriele Berg-Beckhoff^1,*, Jürgen Breckenkamp², Pia Veldt Larsen³ and Bernd Kowall⁴

¹ Unit of Health Promotion Research, University of Southern Denmark, Esbjerg 6700, Denmark

² Department of Epidemiology and International Public Health, University of Bielefeld, Bielefeld 33615, Germany

³ Center for Clinical Epidemiology, Odense University Hospital, University of Southern Denmark, Odense 5000, Denmark

⁴ Institute for Medical Informatics, Biometry and Epidemiology, Center of Clinical Epidemiology, University of Duisburg-Essen, Essen 45147, Germany

Int. J. Environ. Res. Public Health 2014, 11(12), 12969-12982; https://doi.org/10.3390/ijerph111212969 - 12 Dec 2014

Cited by 5 | Viewed by 5882

Abstract

Our aim is to explore general practitioners’ (GPs’) knowledge about EMF, and to assess whether different knowledge structures are related to the GPs’ concern about EMF. Random samples were drawn from lists of GPs in Germany in 2008. Knowledge about EMF was assessed [...] Read more.

Our aim is to explore general practitioners’ (GPs’) knowledge about EMF, and to assess whether different knowledge structures are related to the GPs’ concern about EMF. Random samples were drawn from lists of GPs in Germany in 2008. Knowledge about EMF was assessed by seven items. A latent class analysis was conducted to identify latent structures in GPs’ knowledge. Further, the GPs’ concern about EMF health risk was measured using a score comprising six items. The association between GPs’ concern about EMF and their knowledge was analysed using multiple linear regression. In total 435 (response rate 23.3%) GPs participated in the study. Four groups were identified by the latent class analysis: 43.1% of the GPs gave mainly correct answers; 23.7% of the GPs answered low frequency EMF questions correctly; 19.2% answered only the questions relating EMF with health risks, and 14.0% answered mostly “don’t know”. There was no association between GPs’ latent knowledge classes or between the number of correct answers given by the GPs and their EMF concern, whereas the number of incorrect answers was associated with EMF concern. Greater EMF concern in subjects with more incorrect answers suggests paying particular attention to misconceptions regarding EMF in risk communication. Full article

14 pages, 683 KiB

Open AccessArticle

Six-Month Outcome in Bipolar Spectrum Alcoholics Treated with Acamprosate after Detoxification: A Retrospective Study

by Angelo Giovanni Icro Maremmani^1,2, Silvia Bacciardi¹, Luca Rovai¹, Fabio Rugani¹, Enrico Massimetti¹, Denise Gazzarrini¹, Liliana Dell'Osso³ and Icro Maremmani^1,2,4,*

¹ Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Pisa 56100, Italy

² Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca 55045, Italy

³ Section of Psychiatry, Department of Experimental and Clinical Medicine, University of Pisa, Pisa 56100, Italy

⁴ De Lisio Institute of Behavioural Sciences, Pisa 56100, Italy

Int. J. Environ. Res. Public Health 2014, 11(12), 12983-12996; https://doi.org/10.3390/ijerph111212983 - 12 Dec 2014

Cited by 10 | Viewed by 5632

Abstract

Background: Glutamate system is modified by ethanol and contributes both to the euphoric and the dysphoric consequences of intoxication, but there is now growing evidence that the glutamatergic system also plays a central role in the neurobiology and treatment of mood disorders, [...] Read more.

Background: Glutamate system is modified by ethanol and contributes both to the euphoric and the dysphoric consequences of intoxication, but there is now growing evidence that the glutamatergic system also plays a central role in the neurobiology and treatment of mood disorders, including major depressive disorders and bipolar disorders. We speculate that, using acamprosate, patients with bipolar depression (BIP-A) can take advantage of the anti-glutamate effect of acamprosate to “survive” in treatment longer than peers suffering from non-bipolar depression (NBIP-A) after detoxification. Method: We retrospectively evaluated the efficacy of a long-term (six-month) acamprosate treatment, after alcohol detoxification, in 41 patients (19 males and 22 females), who could be classified as depressed alcoholics, while taking into account the presence/absence of bipolarity. Results: During the period of observation most NBIP-A patients relapsed, whereas a majority of BIP-A patients were still in treatment at the end of their period of observation. The cumulative proportion of ‘surviving’ patients was significantly higher in BIP-A patients, but this finding was not related to gender or to other demographic or clinically investigated characteristics. The treatment time effect was significant in both subgroups. The treatment time-group effect was significant (and significantly better) for bipolar patients on account of changes in the severity of their illness. Limitations: Retrospective methodology and the lack of DSM criteria in diagnosing bipolarity. Conclusions: Bipolarity seems to be correlated with the efficacy of acamprosate treatment in inducing patients to refrain from alcohol use after detoxification (while avoiding relapses) in depressed alcoholics. Placebo-controlled clinical trials are now warranted to check the validity of this hypothesis. Full article

20 pages, 3258 KiB

Open AccessArticle

Changing Patterns of Health in Communities Impacted by a Bioenergy Project in Northern Sierra Leone

by Astrid M. Knoblauch^1,2

, Mary H. Hodges³, Mohamed S. Bah³, Habib I. Kamara³, Anita Kargbo³, Jusufu Paye³, Hamid Turay³, Emmanuel D. Nyorkor³, Mark J. Divall⁴, Yaobi Zhang⁵, Jürg Utzinger^1,2 and Mirko S. Winkler^1,2,*

¹ Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland

² University of Basel, P.O. Box, CH-4003 Basel, Switzerland

³ Helen Keller International Sierra Leone, P.O. Box, Freetown, Sierra Leone

⁴ SHAPE Consulting Ltd., Pretoria 0062, South Africa

⁵ Helen Keller International, Regional Office for Africa, P.O. Box, Dakar, Senegal

Int. J. Environ. Res. Public Health 2014, 11(12), 12997-13016; https://doi.org/10.3390/ijerph111212997 - 12 Dec 2014

Cited by 21 | Viewed by 8025

Abstract

Large private sector investments in low- and middle-income countries are often critically evaluated with regards to their environmental, social, human rights, and health impacts. A health impact assessment, including a baseline health survey, was commissioned by the Addax Bioenergy Sierra Leone project in [...] Read more.

Large private sector investments in low- and middle-income countries are often critically evaluated with regards to their environmental, social, human rights, and health impacts. A health impact assessment, including a baseline health survey, was commissioned by the Addax Bioenergy Sierra Leone project in 2010. As part of the monitoring, a follow-up survey was conducted three years later. A set of health indicators was assessed at six impacted and two control sites. Most of these indices improved, particularly at the impacted sites. The prevalences of stunting, wasting, and Plasmodium falciparum in children under five years of age decreased significantly at impacted sites (all p < 0.05) and non-significantly at control sites. Anemia in children and in women of reproductive age (15–49 years) decreased significantly at impacted and control sites (p < 0.05 and p < 0.001, respectively). Health facility-based deliveries increased significantly at the impacted sites (p < 0.05). The prevalences of helminth infections in children aged 10–15 years remained approximately at the same levels, although focal increases at the impacted sites were noted. Access to improved sanitation decreased significantly (p < 0.05) at control and non-significantly at impacted sites. Water quality remained poor without significant changes. The epidemiologic monitoring of a bioenergy project provides a useful contribution for evidence-based decision-making. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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18 pages, 718 KiB

Open AccessArticle

Disparities in Rates of Inpatient Mortality and Adverse Events: Race/Ethnicity and Language as Independent Contributors

by Anika L. Hines^1,*, Roxanne M. Andrews², Ernest Moy², Marguerite L. Barrett³ and Rosanna M. Coffey¹

¹ Truven Health Analytics, 7700 Old Georgetown Road Suite 650, Bethesda, MD 20814, USA

² Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA

³ Barrett, Inc., 13943 Boquita Drive, Del Mar, CA 92014, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 13017-13034; https://doi.org/10.3390/ijerph111213017 - 12 Dec 2014

Cited by 37 | Viewed by 9146

Abstract

Patients with limited English proficiency have known limitations accessing health care, but differences in hospital outcomes once access is obtained are unknown. We investigate inpatient mortality rates and obstetric trauma for self-reported speakers of English, Spanish, and languages of Asia and the Pacific [...] Read more.

Patients with limited English proficiency have known limitations accessing health care, but differences in hospital outcomes once access is obtained are unknown. We investigate inpatient mortality rates and obstetric trauma for self-reported speakers of English, Spanish, and languages of Asia and the Pacific Islands (API) and compare quality of care by language with patterns by race/ethnicity. Data were from the United States Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, 2009 State Inpatient Databases for California. There were 3,757,218 records. Speaking a non-English principal language and having a non-White race/ethnicity did not place patients at higher risk for inpatient mortality; the exception was significantly higher stroke mortality for Japanese-speaking patients. Patients who spoke API languages or had API race/ethnicity had higher risk for obstetric trauma than English-speaking White patients. Spanish-speaking Hispanic patients had more obstetric trauma than English-speaking Hispanic patients. The influence of language on obstetric trauma and the potential effects of interpretation services on inpatient care are discussed. The broader context of policy implications for collection and reporting of language data is also presented. Results from other countries with and without English as a primary language are needed for the broadest interpretation and generalization of outcomes. Full article

(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)

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12 pages, 655 KiB

Open AccessArticle

Occupational Hazards Education for Nursing Staff through Web-Based Learning

by Chen-Yin Tung¹, Chia-Chen Chang¹, Jin-Lain Ming² and Keh-Ping Chao^3,*

¹ Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei 10610, Taiwan

² Nursing Department, Taipei Veterans General Hospital, Taipei 11217, Taiwan

³ Department of Occupational Safety and Health, College of Public Health, China Medical University, 91 Hsueh-Shih Rd., Taichung 40402, Taiwan

Int. J. Environ. Res. Public Health 2014, 11(12), 13035-13046; https://doi.org/10.3390/ijerph111213035 - 12 Dec 2014

Cited by 13 | Viewed by 7430

Abstract

This study aims to explore the efficiency of using online education as an intervention measure to prevent occupational hazards in a clinical nursing setting. The subjects were 320 female nursing staff from two hospitals in Taiwan. The questionnaire results indicated that the subjects [...] Read more.

This study aims to explore the efficiency of using online education as an intervention measure to prevent occupational hazards in a clinical nursing setting. The subjects were 320 female nursing staff from two hospitals in Taiwan. The questionnaire results indicated that the subjects primarily experienced human factor occupational hazards, as well as psychological and social hazards. Specifically, 73.1% and 69.8% of the subjects suffered from poor sleep quality and low back pain, respectively. After web-based learning, the experimental group had higher post-test scores than the control group in terms of knowledge, attitudes, and practices (KAP). However, there was only a significant difference (p < 0.05) in their knowledge about the prevention of occupational hazards. It is suggested that an online discussion may enhance nursing staff’s participation in web-based learning, and further facilitate their comments on negative factors. The findings can highly promote nursing staff’s attitudes and practices toward preventing occupational hazards through web-based learning. Full article

18 pages, 921 KiB

Open AccessArticle

Urinary Concentrations of Toxic and Essential Trace Elements among Rural Residents in Hainan Island, China

by Yosuke Inoue^1,*, Masahiro Umezaki¹, Hongwei Jiang², Dandan Li³, Jianwei Du³, Yuming Jin³, Bin Yang³, Bai Li⁴, Yufeng Li⁴

and Chiho Watanabe¹

¹ Department of Human Ecology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan

² Research Institute for Humanity and Nature, 457-4 Motoyama, Kamigamo, Kita-ku, Kyoto 603-8047, Japan

³ Hainan Provincial Center for Disease Control and Prevention, 44 Haifu Road, Haikou, Hainan 57023, China

⁴ Institute of High Energy Physics, Chinese Academy of Science, 19B Yuquan Road, Shijingshan District, Beijing 100049, China

Int. J. Environ. Res. Public Health 2014, 11(12), 13047-13064; https://doi.org/10.3390/ijerph111213047 - 12 Dec 2014

Cited by 22 | Viewed by 6605

Abstract

Background: Toxic element exposure and essential trace element consumption may have changed after the Chinese economy transformed to a market-oriented system. The objectives of this study were to measure urinary concentrations of toxic (arsenic, cadmium, lead) and essential trace (selenium, zinc, copper) [...] Read more.

Background: Toxic element exposure and essential trace element consumption may have changed after the Chinese economy transformed to a market-oriented system. The objectives of this study were to measure urinary concentrations of toxic (arsenic, cadmium, lead) and essential trace (selenium, zinc, copper) elements among rural residents in Hainan, China and to examine if variations in economic development are linked to differences in toxic and trace element exposure. Methods: We conducted a questionnaire-based survey and undertook anthropometric measurements of residents aged ≥20 years (n = 599). Urinary samples were collected and analyzed using inductively coupled plasma mass spectrometry. Results: The median (μg/g creatinine) element concentrations were: arsenic, 73.2; cadmium, 1.8; lead, 3.1; selenium, 36.5; zinc, 371; and copper, 11.0. Intra-community variation in element concentrations was explained by age (arsenic, cadmium, zinc and copper), sex (arsenic, cadmium and selenium: higher in females; zinc: higher in males), body mass index (cadmium) and individual involvement in the market economy as indexed by agrochemical use (lead and selenium). The degree of community-level economic development, which was determined by the proportion of people living in better housing among the study communities, was positively associated with cadmium concentration. Conclusions: The degree of community-level economic development was positively associated with urinary cadmium concentration while individual involvement in the market economy was positively associated with lead and selenium. Full article

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9 pages, 773 KiB

Open AccessArticle

The Development of a Bilingual Interactive Video to Improve Physical Activity and Healthful Eating in a Head Start Population

by Veronica Piziak

Division of Endocrinology, Baylor Scott & White Health, College of Medicine, The Texas A&M Health Science Center, 2401 South 31st Street, Temple, TX 76508, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 13065-13073; https://doi.org/10.3390/ijerph111213065 - 15 Dec 2014

Cited by 5 | Viewed by 5594

Abstract

The prevalence of obesity in the Hispanic preschool population remains elevated, particularly among children in low income families below the poverty level. Obesity leads to the early onset of metabolic syndrome and Type 2 diabetes. The Head Start population of Texas is largely [...] Read more.

The prevalence of obesity in the Hispanic preschool population remains elevated, particularly among children in low income families below the poverty level. Obesity leads to the early onset of metabolic syndrome and Type 2 diabetes. The Head Start population of Texas is largely comprised of this high risk group. Their physical activity level is suboptimal in part due to lack of available outside play areas and time spent watching television and playing sedentary video games. Dietary intake is frequently high in sugar sweetened beverages and low in vegetables. The group is frequently bilingual with limited vocabulary and has not learned to read. Preserving their Mexican American culture is a concern. This article describes the development and assessment of a group of bilingual interactive video interventions to improve age appropriate physical activity while providing basic nutrition education focusing on increasing vegetable and water intake and decreasing sugar sweetened beverages. Suggestions for development and assessment of content were provided by focus groups of Head Start teachers, managers and dietitians in the Texas counties of Bastrop, Hidalgo and McLennon. A demonstration of the videos was conducted in Bastrop County. Teachers, students and managers felt that the videos provided excellent information, improved exercise participation and engaged the children. Full article

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10 pages, 705 KiB

Open AccessArticle

Difference in Health Inequity between Two Population Groups due to a Social Determinant of Health

by Ramal Moonesinghe^*, Karen Bouye and Ana Penman-Aguilar

Office of Minority Health and Health Equity, Center for Disease Control and Prevention, 4770 Buford Highway, Mailstop K77, Atlanta, GA 30341, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 13074-13083; https://doi.org/10.3390/ijerph111213074 - 16 Dec 2014

Cited by 7 | Viewed by 9105

Abstract

The World Health Organization defines social determinants of health as “complex, integrated, and overlapping social structures and economic systems” that are responsible for most health inequities. Similar to the individual-level risk factors such as behavioral and biological risk factors that influence disease, we [...] Read more.

The World Health Organization defines social determinants of health as “complex, integrated, and overlapping social structures and economic systems” that are responsible for most health inequities. Similar to the individual-level risk factors such as behavioral and biological risk factors that influence disease, we consider social determinants of health such as the distribution of income, wealth, influence and power as risk factors for risk of disease. We operationally define health inequity in a disease within a population due to a risk factor that is unfair and avoidable as the difference between the disease outcome with and without the risk factor in the population. We derive expressions for difference in health inequity between two populations due to a risk factor that is unfair and avoidable for a given disease. The difference in heath inequity between two population groups due to a risk factor increases with increasing difference in relative risks and the difference in prevalence of the risk factor in the two populations. The difference in health inequity could be larger than the difference in health outcomes between the two populations in some situations. Compared to health disparities which are typically measured and monitored using absolute or relative disparities of health outcomes, the methods presented in this manuscript provide a different, yet complementary, picture because they parse out the contributions of unfair and avoidable risk factors. Full article

(This article belongs to the Special Issue Eliminating Health Disparities to Achieve Health Equity)

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13 pages, 1960 KiB

Open AccessArticle

Metabolic Influence of Psychrophilic Diatoms on Travertines at the Huanglong Natural Scenic District of China

by Shiyong Sun¹

, Faqin Dong^1,*, Hermann Ehrlich², Xueqing Zhao¹, Mingxue Liu¹, Qunwei Dai¹, Qiongfang Li¹, Dejun An³ and Hailiang Dong⁴

¹ Department of Geological and Mineral Engineering, Key Laboratory of Solid Waste Treatment and Resource Recycle & Fundamental Science on Nuclear Waste and Environmental Security Laboratory, Southwest University of Science and Technology, Mianyang 621010, China

² Institute of Experimental Physics, Technische Universität Bergakademie Freiberg, Freiberg 09599, Germany

³ Huanglong National Scenic Resort Administrative Bureau, Songpan 623300, China

⁴ Department of Geology and Environmental Earth Science, Miami University, Oxford, OH 45056, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 13084-13096; https://doi.org/10.3390/ijerph111213084 - 16 Dec 2014

Cited by 16 | Viewed by 7004

Abstract

Diatoms are a highly diversified group of algae that are widely distributed in aquatic ecosystems, and various species have different nutrient and temperature requirements for optimal growth. Here, we describe unusual psychrophilic diatoms of Cymbella in a travertine deposition environment in southwestern China [...] Read more.

Diatoms are a highly diversified group of algae that are widely distributed in aquatic ecosystems, and various species have different nutrient and temperature requirements for optimal growth. Here, we describe unusual psychrophilic diatoms of Cymbella in a travertine deposition environment in southwestern China in winter season. Travertine surfaces are colonized by these psychrophilic diatoms, which form biofilms of extracellular polysaccharide substances (EPS) with active metabolic activities in extremely cold conditions. The travertine in Huanglong, is a typical single crystalline calcite with anisotropic lattice distortions of unit cell parameters along axes of a and c, and this structure is suggestive of some level of metabolic mediation on mineralization. Near-edge X-ray absorption fine structure spectroscopy (NEXAFS) results further confirmed the occurrence of biogenic distortion of the crystal lattice of travertine calcite. Overall, our results imply that the metabolic influence of psychrophilic diatoms may be particularly important for promoting formation and dissolution of travertine in extremely cold environments of Huanglong. The EPS of psychrophilic diatoms will protect travertine from HCO₃⁻ etching and provide template for forming travertine when water re-flowing, in warm season. Full article

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20 pages, 687 KiB

Open AccessArticle

Health Care Facilities Resilient to Climate Change Impacts

by Jaclyn Paterson^1,*, Peter Berry^1,†, Kristie Ebi^2,† and Linda Varangu³

¹ Climate Change and Health Office, Health Canada, 171 Slater Street, Ottawa, ON K1A 0K9, Canada

² ClimAdapt LLC, 424 Tyndall Street, Los Altos, CA 94022, USA

³ Canadian Coalition for Green Health Care, 1724 Concession 6 West, RR #2, Branchton, ON N0B 1L0, Canada

^† These authors contributed equally to this work.

Int. J. Environ. Res. Public Health 2014, 11(12), 13097-13116; https://doi.org/10.3390/ijerph111213097 - 16 Dec 2014

Cited by 75 | Viewed by 16019

Abstract

Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are [...] Read more.

Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator’s guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change. Full article

(This article belongs to the Special Issue Extreme Weather-Related Morbidity and Mortality: Risks and Responses)

13 pages, 787 KiB

Open AccessArticle

Chlorpyrifos Exposure and Respiratory Health among Adolescent Agricultural Workers

by Catherine L. Callahan¹, Manal Al-Batanony², Ahmed A. Ismail²

, Gaafar Abdel-Rasoul², Olfat Hendy³, James R. Olson^1,4, Diane S. Rohlman^5,6 and Matthew R. Bonner^1,*

¹ Department of Epidemiology and Environmental Health, State University of New York at Buffalo, 270 Farber Hall, Buffalo, NY 14214, USA

² Community Medicine and Public Health Department, Faculty of Medicine, Menoufia University, Shebin El-Kom 32511, Egypt

³ Clinical Pathology and Hematology and Immunology, Menoufia University, Shebin El-Kom 32511, Egypt

⁴ Department of Pharmacology and Toxicology, State University of New York at Buffalo, 102 Farber Hall, Buffalo, NY 14214, USA

⁵ Department of Occupational and Environmental Health, University of Iowa, 145 N. Riverside Drive 100 CPHB Iowa City, IA 52242, USA

⁶ Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L606 Portland, OR 97239, USA

Int. J. Environ. Res. Public Health 2014, 11(12), 13117-13129; https://doi.org/10.3390/ijerph111213117 - 16 Dec 2014

Cited by 26 | Viewed by 8642

Abstract

Chlorpyrifos (CPF) is a commonly used organophosphate insecticide (OP). In adults, exposure to OPs has been inconsistently associated with reduced lung function. OP exposure and lung function has not been assessed in adolescents. The objective of this study was to assess CPF exposure [...] Read more.

Chlorpyrifos (CPF) is a commonly used organophosphate insecticide (OP). In adults, exposure to OPs has been inconsistently associated with reduced lung function. OP exposure and lung function has not been assessed in adolescents. The objective of this study was to assess CPF exposure and lung function among Egyptian adolescents. We conducted a 10-month study of male adolescent pesticide applicators (n = 38) and non-applicators of similar age (n = 24). Urinary 3,5,6-trichloro-2-pyridinol (TPCy), a CPF-specific metabolite, was analyzed in specimens collected throughout the study. Spirometry was performed twice after pesticide application: day 146, when TCPy levels were elevated and day 269, when TCPy levels were near baseline. Applicators had higher levels of TCPy (mean cumulative TCPy day 146 = 33,217.6; standard deviation (SD) = 49,179.3) than non-applicators (mean cumulative TCPy day 146 = 3290.8; SD = 3994.9). Compared with non-applicators, applicators had higher odds of reporting wheeze, odds ratio = 3.41 (95% CI: 0.70; 17.41). Cumulative urinary TCPy was inversely associated with spirometric measurements at day 146, but not at day 269. Although generally non-significant, results were consistent with an inverse association between exposure to CPF and lung function. Full article

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Int. J. Environ. Res. Public Health, Volume 11, Issue 12 (December 2014) – 66 articles , Pages 12088-13143

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