Table of Contents

Climate-related health indicators are potentially useful for tracking and predicting the adverse public health effects of climate change, identifying vulnerable populations, and monitoring interventions. However, there is a need to understand stakeholders’ perspectives on the identification, development, and utility of such indicators. A qualitative approach was used, comprising semi-structured interviews with key informants and service providers from government and non-government stakeholder organizations in South Australia. Stakeholders saw a need for indicators that could enable the monitoring of health impacts and time trends, vulnerability to climate change, and those which could also be used as communication tools. Four key criteria for utility were identified, namely robust and credible indicators, specificity, data availability, and being able to be spatially represented. The variability of risk factors in different regions, lack of resources, and data and methodological issues were identified as the main barriers to indicator development. This study demonstrates a high level of stakeholder awareness of the health impacts of climate change, and the need for indicators that can inform policy makers regarding interventions. Full article

Causal evidence for the built environment’s role in supporting physical activity is needed to inform land use and transportation policies. This quasi-longitudinal residential relocation study compared within-person changes in self-reported transportation walking, transportation cycling, and overall physical activity during the past 12 months among adults who did and did not move to a different neighbourhood. In 2014, a random sample of adults from 12 neighbourhoods (Calgary, AB, Canada) with varying urban form and socioeconomic status provided complete self-administered questionnaire data (n = 915). Participants, some of whom moved neighbourhood during the past 12 months (n = 95), reported their perceived change in transportation walking and cycling, and overall physical activity during that period. The questionnaire also captured residential self-selection, and sociodemographic and health characteristics. Walk Scores^® were linked to each participant’s current and previous neighbourhood and three groups identified: walkability “improvers” (n = 48); “decliners” (n = 47), and; “maintainers” (n = 820). Perceived change in physical activity was compared between the three groups using propensity score covariate-adjusted Firth logistic regression (odds ratios: OR). Compared with walkability maintainers, walkability decliners (OR 4.37) and improvers (OR 4.14) were more likely (p < 0.05) to report an increase in their transportation walking since moving neighbourhood, while walkability decliners were also more likely (OR 3.17) to report decreasing their transportation walking since moving. Walkability improvers were more likely than maintainers to increase their transportation cycling since moving neighbourhood (OR 4.22). Temporal changes in neighbourhood walkability resulting from residential relocation appear to be associated with reported temporal changes in transportation walking and cycling in adults. Full article

Malnutrition and dental caries in early childhood remain persistent and intertwined global health challenges, particularly for indigenous and geographically-remote populations. To examine the prevalence and associations between early childhood dental caries, parent-reported mouth pain and malnutrition in the Amazonian region of Ecuador, we conducted a cross-sectional study of the oral health and nutrition status of 1407 children from birth through age 6 in the “Alli Kiru” program (2011–2013). We used multivariate regression analysis to examine relationships between severe caries, parent-reported mouth pain measures, and nutritional status. The prevalence of dental caries was 65.4%, with 44.7% of children having deep or severe caries, and 33.8% reporting mouth pain. The number of decayed, missing and filled teeth (dmft) increased dramatically with age. Malnutrition was prevalent, with 35.9% of children stunted, 1.1% wasted, 7.4% underweight, and 6.8% overweight. As mouth pain increased in frequency, odds for severe caries increased. For each unit increase in mouth pain frequency interfering with sleeping, children had increased odds for being underweight (Adjusted Odds Ratio (AOR): 1.27; 95% CI: 1.02–1.54) and decreased odds for being overweight (AOR: 0.76; 95% CI: 0.58–0.97). This relationship was most pronounced among 3–6 year-olds. Early childhood caries, mouth pain and malnutrition were prevalent in this sample of young children. Parent-reported mouth pain was associated with severe caries, and mouth pain interfering with sleeping was predictive of poor nutritional status. We demonstrate the utility of a parsimonious parent-reported measure of mouth pain to predict young children’s risk for severe early childhood caries and malnutrition, which has implications for community health interventions. Full article

Although fine particulate matter with a diameter of <2.5 μm (PM_2.5) has a greater negative impact on human health than particulate matter with a diameter of <10 μm (PM₁₀), measurements of PM_2.5 have only recently been performed, and the spatial coverage of these measurements is limited. Comprehensively assessing PM_2.5 pollution levels and the cumulative health effects is difficult because PM_2.5 monitoring data for prior time periods and certain regions are not available. In this paper, we propose a promising approach for robustly predicting PM_2.5 concentrations. In our approach, a generalized additive model is first used to quantify the non-linear associations between predictors and PM_2.5, the bagging method is used to sample the dataset and train different models to reduce the bias in prediction, and the variogram for the daily residuals of the ensemble predictions is then simulated to improve our predictions. Shandong Province, China, is the study region, and data from 96 monitoring stations were included. To train and validate the models, we used PM_2.5 measurement data from 2014 with other predictors, including PM₁₀ data, meteorological parameters, remote sensing data, and land-use data. The validation results revealed that the R² value was improved and reached 0.89 when PM₁₀ was used as a predictor and a kriging interpolation was performed for the residuals. However, when PM₁₀ was not used as a predictor, our method still achieved a CV R² value of up to 0.86. The ensemble of spatial characteristics of relevant factors explained approximately 32% of the variance and improved the PM_2.5 predictions. The spatiotemporal modeling approach to estimating PM_2.5 concentrations presented in this paper has important implications for assessing PM_2.5 exposure and its cumulative health effects. Full article

In the absence of shorter term disinfectant byproducts (DBPs) data on regulated Trihalomethanes (THMs) and Haloacetic acids (HAAs), epidemiologists and risk assessors have used long-term annual compliance (LRAA) or quarterly (QA) data to evaluate the association between DBP exposure and adverse birth outcomes, which resulted in inconclusive findings. Therefore, we evaluated the reliability of using long-term LRAA and QA data as an indirect measure for short-term exposure. Short-term residential tap water samples were collected in peak DBP months (May–August) in a community water system with five separate treatment stations and were sourced from surface or groundwater. Samples were analyzed for THMs and HAAs per the EPA (U.S. Environmental Protection Agency) standard methods (524.2 and 552.2). The measured levels of total THMs and HAAs were compared temporally and spatially with LRAA and QA data, which showed significant differences (p < 0.05). Most samples from surface water stations showed higher levels than LRAA or QA. Significant numbers of samples in surface water stations exceeded regulatory permissible limits: 27% had excessive THMs and 35% had excessive HAAs. Trichloromethane, trichloroacetic acid, and dichloroacetic acid were the major drivers of variability. This study suggests that LRAA and QA data are not good proxies of short-term exposure. Further investigation is needed to determine if other drinking water systems show consistent findings for improved regulation. Full article

Harmful cyanobacteria have been an important concern for drinking water quality for quite some time, as they may produce cyanotoxins and odorants. Microcystis and Cylindrospermopsis are two common harmful cyanobacterial genera detected in freshwater lakes and reservoirs, with microcystins (MCs) and cylindrospermopsin (CYN) as their important metabolites, respectively. In this study, two sets of duplex qPCR systems were developed, one for quantifying potentially-toxigenic Microcystis and Microcystis, and the other one for cylindrospermopsin-producing cyanobacteria and Cylindrospermopsis. The duplex qPCR systems were developed and validated in the laboratory by using 338 samples collected from 29 reservoirs in Taiwan and her offshore islands. Results show that cell numbers of Microcystis and Cylindorspermopsis enumerated with microscopy, and MCs and CYN concentrations measured with the enzyme-linked immuno-sorbent assay method, correlated well with their corresponding gene copies determined with the qPCR systems (range of coefficients of determination R² = 0.392−0.740). The developed qPCR approach may serve as a useful tool for the water industry to diagnose the presence of harmful cyanobacteria and the potential presence of cyanotoxins in source waters. Full article

Currently, there is a worldwide growing interest in the occurrence and diversity of fungi and their secondary metabolites in aquatic systems, especially concerning their role in water quality and human health. However, this concern is hampered by the scant information that is available in the literature about aquatic fungi and how they affect water quality. There are only few published reports that link certain species of aquatic fungi to human health. The common aquatic fungal species that have been reported so far in African aquatic systems belong to the hyphomycetes kingdom. This paper thus aims to survey the information about the occurrence and factors that control the distribution of different species of fungi in African aquatic systems, as well as their effect on water quality and the possible metabolic pathways that lead to the formation of toxic secondary metabolites that are responsible for the deterioration of water quality. This review will also investigate the analytical and bioanalytical procedures that have been reported for the identification of different species of waterborne fungi and their secondary metabolites. Full article

The wide-spread dissemination of evidence-based programs that can improve health outcomes among older populations often requires an understanding of factors influencing community adoption of such programs. One such program is Texercise Select, a community-based health promotion program previously shown to improve functional health, physical activity, nutritional habits and quality of the life among older adults. This paper assesses the cost-effectiveness of Texercise Select in the context of supportive environments to facilitate its delivery and statewide sustainability. Participants were surveyed using self-reported instruments distributed at program baseline and conclusion. Program costs were based on actual direct costs of program implementation and included costs of recruitment and outreach, personnel costs and participant incentives. Program effectiveness was measured using quality-adjusted life year (QALY) gained, as well as health outcomes, such as healthy days, weekly physical activity and Timed Up-and-Go (TUG) test scores. Preference-based EuroQol (EQ-5D) scores were estimated from the number of healthy days reported by participants and converted into QALYs. There was a significant increase in the number of healthy days (p < 0.05) over the 12-week program. Cost-effectiveness ratios ranged from $1374 to $1452 per QALY gained. The reported cost-effective ratios are well within the common cost-effectiveness threshold of $50,000 for a gained QALY. Some sociodemographic differences were also observed in program impact and cost. Non-Hispanic whites experienced significant improvements in healthy days from baseline to the follow-up period and had higher cost-effectiveness ratios. Results indicate that the Texercise Select program is a cost-effective strategy for increasing physical activity and improving healthy dietary practices among older adults as compared to similar health promotion interventions. In line with the significant improvement in healthy days, physical activity and nutrition-related outcomes among participants, this study supports the use of Texercise Select as an intervention with substantial health and cost benefits. Full article

Nursing assistants (NAs) make up a large share of the healthcare provider workforce and their numbers are expected to grow. NAs are predominantly women who earn a low wage and report financial, work, and family demands. Working as a NA is hazardous; this manuscript specifically examines the biological/infectious, chemical, enviromechanical, physical and psychosocial hazards that appear in the literature to date. A focused search strategy was used to review literature about hazards that fell into each of the five aforementioned domains. While some hazards that were documented were clear, such as exposure to influenza because of close contact with patients (biological/infectious), or exposure to hazardous drugs (chemical), literature was limited. The majority of the literature we reviewed fell into the domain of psychosocial hazards and centered on stress from workplace organization issues (such as mandatory overtime, lack of managerial support, and feeling rushed). More research is needed to understand which hazards NAs identify as most concerning and tailored interventions are needed for risk mitigation. Full article

Heavy traffic is a source of air pollution and a safety concern with important public health implications. We investigated whether green space lowers child asthma risk by buffering the effects of heavy traffic and a lack of neighborhood safety. Multilevel models were used to analyze affirmative asthma cases in nationally representative cross-sectional data from 4447 children aged 6–7 years old in Australia. Case-finding was based upon a triangulation of affirmative responses to three questions on doctor-diagnosed asthma, asthma-related medications and illness with wheezing lasting for at least 1 week within the 12 months prior. Among children considered to be exposed to high traffic volumes and areas with 0 to 20% green space quantity, the odds ratio of affirmative asthma was 1.87 (95% CI 1.37 to 2.55). However, the association between heavy traffic and asthma was significantly lower for participants living in areas with over 40% green space coverage (odds ratio for interaction 0.32, 95% CI 0.12 to 0.84). No association between affirmative asthma and green space coverage was observed for participants not exposed to heavy traffic, nor for the area safety variable. Protecting existing and investing in new green space may help to promote child respiratory health through the buffering of traffic-related air pollution. Full article

Changes in population birth outcomes, including increases in low birthweight or preterm births, have been documented after natural and manmade disasters. However, information is limited following the 2011 Fukushima Daiichi Nuclear Power Plant Disaster. In this study, we assessed whether there were long-term changes in birth outcomes post-disaster, compared to pre-disaster data, and whether residential area and food purchasing patterns, as proxy measurements of evacuation and radiation-related anxiety, were associated with post-disaster birth outcomes. Maternal and perinatal data were retrospectively collected for all live singleton births at a public hospital, located 23 km from the power plant, from 2008 to 2015. Proportions of low birthweight (<2500 g at birth) and preterm births (<37 weeks gestation at birth) were compared pre- and post-disaster, and regression models were conducted to assess for associations between these outcomes and evacuation and food avoidance. A total of 1101 live singleton births were included. There were no increased proportions of low birthweight or preterm births in any year after the disaster (merged post-disaster risk ratio of low birthweight birth: 0.98, 95% confidence interval (CI): 0.64–1.51; and preterm birth: 0.68, 95% CI: 0.38–1.21). No significant associations between birth outcomes and residential area or food purchasing patterns were identified, after adjustment for covariates. In conclusion, no changes in birth outcomes were found in this institution-based investigation after the Fukushima disaster. Further research is needed on the pathways that may exacerbate or reduce disaster effects on maternal and perinatal health. Full article

We examined the risk factors for and psychological problems associated with violence victimization in a nationwide representative sample of Korean adolescents. Data from the 2016 Korean Youth Risk Behavior Web-based Survey was used. Participants were asked about their experience of being a victim of violence that required medical treatment during the past 12 months, as well as their perceived health, happiness, sleep satisfaction, stress, depressed mood, and suicidality. The 12-month prevalence of violence victimization requiring medical treatment was 2.4%. The results indicated that adolescents were at an increased risk for violence victimization if they were male, older, had parents of a foreign nationality, did not reside with their family, worked part time, resided in small cities or rural areas, were high or low in socioeconomic status (SES), exhibited high or low levels of academic performance, used alcohol or tobacco, and were sexually active. In addition, while violence victimization was negatively associated with perceived health and happiness, it was positively associated with perceived stress, depressed mood, and suicidality. The results indicate that a social disadvantage, involvement in risky behavior, and psychological problems are associated with violence victimization. Effective violence prevention efforts should thus target high-risk groups, and clinical attention is needed to address the psychological costs associated with violence victimization. Full article

The majority of Australia’s coal seam gas (CSG) reserves are in Queensland, where the industry has expanded rapidly in recent years. Despite concerns, health data have not been examined alongside CSG development. This study examined hospitalisation rates as a function of CSG development activity in Queensland, during the period 1995–2011. Admissions data were examined with CSG well numbers, which served as a proxy for CSG development activity. Time series models were used to assess changes in hospitalisation rates for periods of “low”, “medium”, “high”, and “intense” activity compared to a period of “very low” activity, adjusting for covariates. “All-cause” hospitalisation rates increased monotonically with increasing gas well development activity in females (324.0 to 390.3 per 1000 persons) and males (294.2 to 335.4 per 1000 persons). Hospitalisation rates for “Blood/immune” conditions generally increased for both sexes. Female and male hospitalisation rates for “Circulatory” conditions decreased with increasing CSG activity. Hospitalisation rates were generally low for reproductive and birth outcomes; no clear associations were observed. This study showed some outcomes were associated with increasing CSG development activity. However, as a condition of data access, the population and outcomes were aggregated to a broad geographic study area rather than using higher geographic resolution data. Higher resolution data, as well as other data sources, should be explored. Further research should be conducted with an expanded time period to determine if these trends continue as the industry grows. Full article

Black chokeberries (Aronia melanocarpa) are considered to be functional food containing high amounts of anthocyanins, phenols, antioxidants, vitamins and minerals. Whereas organic compounds are well studied, there is little research on the mineral composition of the chokeberries. Thus, the presented study is focused on the determination of Al, As, Ba, Ca, Cd, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Ni, Pb, Se, Sr and Zn in black chokeberry fruits and infusions to study the metals’ extractability. The nutrients Ca, K and Mg are present in the fruits (dried matter) at g/kg level, whereas the other elements are present from µg/kg up to mg/kg level. The extraction yields of the metals from the infusion range from 4 (Al, Mn) up to 44% (Na). The toxic elements present do not pose any health risk when berries or infusions are consumed. Concluding, Aronia berries, as well as infusions derived from them, are a good dietary source of essential metals in addition to the organic compounds also contained. Full article

Copper (Cu) is a transition metal and an essential micronutrient for organisms, but also one of the most widespread toxic inorganic contaminants at very high content. The research on Cu isotopes has grown rapidly in the last decade. Hitherto, a large number of studies have been published on the theoretical fractionation mechanisms, experimental data and natural variations of Cu isotopes in variable environments and ecosystems. These studies reported a large variation of δ⁶⁵Cu (−16.49 to +20.04‰) in terrestrial samples and showed that Cu isotopes could be fractionated by various biogeochemical processes to different extent. Several papers have previously reviewed the coupling of Cu and Zn isotope systematics, and we give here a tentative review of the recent publications only on Cu isotopesin variable surface repositories, animals and human beings, with a goal to attract much attention to research on Cu (and other metals) behaviors in the environment and biological systems. Full article

Uranium exposure leads to cerebral dysfunction involving for instance biochemical, neurochemical and neurobehavioral effects. Most studies have focused on mechanisms in uranium-exposed adult animals. However, recent data on developing animals have shown that the developing brain is also sensitive to uranium. Models of uranium exposure during brain development highlight the need to improve our understanding of the effects of uranium. In a model in which uranium exposure began from the first day of gestation, we studied the neurobehavioral consequences as well as the progression of hippocampal neurogenesis in animals from dams exposed to uranium. Our results show that 2-month-old rats exposed to uranium from gestational day 1 displayed deficits in special memory and a prominent depressive-like phenotype. Cell proliferation was not disturbed in these animals, as shown by 5-bromo-2′deoxyuridine (BrdU)/neuronal specific nuclear protein (NeuN) immunostaining in the dentate gyrus. However, in some animals, the pyramidal cell layer was dispersed in the CA3 region. From our previous results with the same model, the hypothesis of alterations of neurogenesis at prior stages of development is worth considering, but is probably not the only one. Therefore, further investigations are needed to correlate cerebral dysfunction and its underlying mechanistic pathways. Full article

Health-enhancing physical activities (PA) performed outdoors could markedly contribute to the adoption of a healthy lifestyle in adolescence. The differences between PA preferences and actual opportunities for these PA are an issue that has received frequent attention. To date, the extent to which these differences are reflected in adolescents meeting PA recommendations and their well-being has not been explored. In total, 10,086 respondents took part in an on-line research project regarding PA preferences. Of them, 2446 also completed the International Physical Activity Questionnaire (Long Form) and the World Health Organization (WHO) W-5 questionnaire to assess well-being. Finally, 1278 of these respondents were involved in objective PA monitoring using pedometers. The study aimed to explore the prevalence and trends regarding outdoor PA. Moreover, we assessed whether the agreement between preferred PA and PA actually undertaken was associated with higher odds for meeting PA recommendations and achieving a higher level of well-being. Of a selection of outdoor activities, Czech and Polish boys preferred cycling, swimming, and downhill skiing, while girls preferred swimming activities, skating, and cycling. The agreement between preferred and PA actually undertaken was associated with higher odds for meeting the weekly PA recommendations and higher levels of well-being both in boys and girls. Evaluation of outdoor PA preferences and taking these preferred activities into account when forming conditions for them was important in the efficient promotion of the physical and mental health of adolescents. Full article

There is increasing evidence that the quality of green space significantly contributes to neighborhood satisfaction and well-being, independent of the mere amount of green space. In this paper, we examined residents’ perceptions of the quality and beneficial affordances of green space in relation to objectively assessed accessibility and usability. We used data from a survey in two neighborhoods (N = 223) of a medium-sized city in the Netherlands, which were similar in the amount of green space and other physical and socio-demographic characteristics, but differed in the availability of accessible and usable green spaces. Results show that residents of the neighborhood with a higher availability of accessible and usable green spaces were more satisfied with their neighborhood. This difference was statistically mediated by the higher level of perceived green space quality. Neighborhood satisfaction was significantly positively related to well-being. However, residents of the two neighborhoods did not differ in self-reported well-being and beneficial affordances of green space. These analyses contribute to a further understanding of how the accessibility and usability of green spaces may increase people’s neighborhood satisfaction. It highlights the importance of perceived quality in addition to the amount of green space when examining the beneficial effects of green space. Full article

Background: Schools have been identified as important settings for health promotion through physical activity participation, particularly as children are insufficiently active for health. The aim of this study was to investigate the child and school-level influences on children′s physical activity levels and sedentary time during school hours in a sample of children from a low-income community; Methods: One hundred and eighty-six children (110 boys) aged 9–10 years wore accelerometers for 7 days, with 169 meeting the inclusion criteria of 16 h∙day⁻¹ for a minimum of three week days. Multilevel prediction models were constructed to identify significant predictors of sedentary time, light, and moderate to vigorous physical activity during school hour segments. Child-level predictors (sex, weight status, maturity offset, cardiorespiratory fitness, physical activity self-efficacy, physical activity enjoyment) and school-level predictors (number on roll, playground area, provision score) were entered into the models; Results: Maturity offset, fitness, weight status, waist circumference-to-height ratio, sedentary time, moderate to vigorous physical activity, number of children on roll and playground area significantly predicted physical activity and sedentary time; Conclusions: Research should move towards considering context-specific physical activity and its correlates to better inform intervention strategies. Full article

Lead is recognized as one of the most widespread toxic metal contaminants and pervasive environmental health concerns in the environment. In this paper, the effects of nano-hydroxyapatite (NHAP) on remediation in artificially Pb-contaminated soils and ryegrass were studied in a pot experiment. The addition of NHAP decreased the water- and acid-soluble, exchangeable, and reducible fractions of Pb, extracted using the Community Bureau of Reference (BCR) method, whilst greatly increasing the residual fraction of Pb. Oxidizable Pb was increased slightly. No significant increase in soil pH was caused by the application of NHAP. Compared to conditions without NHAP, the addition of NHAP decreased the Pb content in ryegrass shoots and roots by 13.19–20.3% and 2.86–21.1%, respectively. Therefore, the application of NHAP reduced the mobility and bioavailability of Pb in the soil. In addition, the application of NHAP improved the fresh weight of shoots and roots, and promoted the growth of ryegrass. NHAP played a positive role in stimulating ryegrass to secrete tartaric acid. Full article

Preventing frailty and its adverse health outcomes is crucial in countries with a large elderly population, such as Japan. Since the long-term care insurance (LTCI) system was launched, the number of certified older adults with LTCI service requirement has continued to increase. This is a serious problem, because the LTCI service requirement certification is equivalent to disability. The aim of this study was to evaluate the effect of a self-management group intervention on new LTCI service requirement certifications in community-dwelling older adults in Japan. We analyzed the cohort data from a prospective study. In this study, we recruited community-dwelling adults aged 65 years and older who were independent in a city in Kyoto prefecture in 2012. The subjects in the participation group (n = 1620) attended 60-min group training sessions once or twice every two weeks from December 2012 to December 2016. The exercise sessions consisted of mild-intensity aerobic exercise, mild strength training, flexibility and balance exercises, and cool-down activities. These exercise classes were facilitated by well-trained volunteer staff. The outcome measure was the number of new LTCI requirement certifications during a four-year follow-up period. During the four-year follow-up period, 247 subjects (15.2%) in the participation group and 334 (20.6%) in the control group were newly certified for LTCI service requirements. The hazard ratio for new LTCI service requirements in the participation group compared with the control group was 0.73 (95% CI = 0.62–0.86) in the four-year follow-up period. These results indicate the usefulness of self-management group exercise to reduce the incidence of disability in older adults. Thus, increasing self-management group activities in each community should be encouraged. Full article

Although the mental health problems of college students have been the subject of increasing research, there are no studies about its prevalence in Ecuadorian college students. The aim of this study was to determine the mental health problems and their associated factors in Ecuadorian freshmen university students. A sample of 1092 students (53.7% women; mean age = 18.3 years) were recruited from the Technical Particular University of Loja (Ecuador). Socio-demographic, academic, and clinical characteristics were gathered, as well as information on the participants’ mental health through a number of mental health screens. Prevalence of positive screens was 6.2% for prevalence of major depressive episodes, 0.02% for generalized anxiety disorders, 2.2% for panic disorders, 32.0% for eating disorders, 13.1% for suicidal risk. Mental health problems were significantly associated with sex, area of study, self-esteem, social support, personality and histories of mental health problems. The findings offer a starting point for identifying useful factors to target prevention and intervention strategies aimed at university students. Full article

Whilst a growing body of evidence demonstrates people derive a range of health and wellbeing benefits from visiting parks, only a limited number of attempts have been made to provide a complementary economic assessment of parks. The aim of this exploratory study was to directly estimate the perceived health and wellbeing benefits attained from parks and the economic value assigned to parks by park users in Victoria, Australia. The research employed a mixed methods approach (survey and interviews) to collect primary data from a selection of 140 park users: 100 from two metropolitan parks in Melbourne and 40 from a park on the urban fringe of Melbourne, Victoria. Our findings suggest that park users derive a range of perceived physical, mental/spiritual, and social health benefits, but park use was predominantly associated with physical health benefits. Overall, our exploratory study findings suggest that park users are willing to pay for parks, as they highly value them as places for exercising, socialising, and relaxing. Importantly, most people would miss parks if they did not exist. The findings aim to provide park managers, public health advocates, and urban policy makers with evidence about the perceived health and wellbeing benefits of park usage and the economic value park visitors place on parks. Full article

Chemical disinfection of water supplies brings significant public health benefits by reducing microbial contamination. The process can however, result in the formation of toxic compounds through interactions between disinfectants and organic material in the source water. These new compounds are termed disinfection by-products (DBPs). The most common are the trihalomethanes (THMs) such as trichloromethane (chloroform), dichlorobromomethane, chlorodibromomethane and tribromomethane (bromoform); these are commonly reported as a single value for total trihalomethanes (TTHMs). Analysis of DBPs is commonly performed via time- and solvent-intensive sample preparation techniques such as liquid–liquid and solid phase extraction. In this study, a method using headspace gas chromatography with micro-electron capture detection was developed and applied for the analysis of THMs in drinking and recycled waters from across Melbourne (Victoria, Australia). The method allowed almost complete removal of the sample preparation step whilst maintaining trace level detection limits (>1 ppb). All drinking water samples had TTHM concentrations below the Australian regulatory limit of 250 µg/L but some were above the U.S. EPA limit of 60 µg/L. The highest TTHM concentration was 67.2 µg/L and lowest 22.9 µg/L. For recycled water, samples taken directly from treatment plants held significantly higher concentrations (153.2 µg/L TTHM) compared to samples from final use locations (4.9–9.3 µg/L). Full article

Population Health and Environment (PHE) strategies are argued to improve ecosystem and human health by addressing family size and its effects on natural resource use, food security, and reproductive health. This study investigates men’s views on a PHE family planning (FP) programme delivered among the pastoral Samburu tribe in rural northern Kenya. Three focus group discussions and nine semi-structured interviews were conducted with 27 Samburu men. These discussions revealed support for environmentally-sensitised family planning promotion. Men highlighted their dependency on natural resources and challenges faced in providing for large families and maintaining livestock during drought. These practices were said to lead to natural resource exhaustion, environmental degradation, and wildlife dispersal, undermining key economic benefits of environmental and wildlife conservation. Relating family size to the environment is a compelling strategy to improve support for FP among Samburu men. Kenyan policy-makers should consider integrating community-based PHE strategies among underserved pastoral groups living in fragile ecosystems. Full article

Flowers are frequently treated with pesticides and, as a result, florists handling daily a large number of flowers can be exposed to pesticide residues. A study was conducted among twenty volunteer florists located in Namur Province and in the Brussels Capital Region of Belgium in order to assess their potential dermal exposure to dislodgeable pesticide residues transferred from flowers to hands. Two pairs of cotton gloves were worn during two consecutive half days while handling flowers and preparing bouquets (from min 2 h to max 3 h/day). The residual pesticide deposits on the glove samples were extracted with a multi-residue Quick Easy Cheap Effective Rugged Safe (QuEChERS) method and analyzed by a combination of gas and liquid chromatography tandem mass spectrometry (GC-MS/MS and LC-MS/MS) by an accredited laboratory. A total of 111 active substances (mainly insecticides and fungicides) were detected, with an average of 37 active substances per sample and a total concentration per glove sample of 22.22 mg/kg. Several predictive levels of contamination were considered to assess the risk. The potential dermal exposures (PDE) of florists were estimated at the average, for different percentiles, and at the maximum concentration of residues in samples. At the PDE P90 and at the PDE_MAX (or worst case) values, three and five active substances respectively exceed the Acceptable Operator Exposure Level (AOEL), indicating risk situations. For the systemic exposure (SE), one active substance (clofentezine) exceeds the AOEL at the P90 predictive level. In the worst case, SE_MAX (at the maximum concentrations), four active substances (clofentezine, famoxadone, methiocarb, and pyridaben) exceed their respective AOEL values. Among the 14 most frequently detected active substances, two have SE_MAX values exceeding the AOEL. Exposure could be particularly critical for clofentezine with an SE_MAX value four times higher than the AOEL (393%). The exposure of florists appeared to be an example of a unique professional situation in which workers are exposed regularly to both a very high number of toxic chemicals and rather high concentration levels. Therefore the priority should be to raise the level of awareness among the florists who must change their habits and practices if they want to minimize their exposure. Full article

Recent studies have revealed that not only fish but also rice consumption may significantly contribute to human exposure to mercury (Hg) in Asian countries. It is therefore essential to assess dietary exposure to Hg in rice and its associated health risk. However, risk assessments of Hg in rice in non-contaminated areas are generally lacking in Asian countries. In the present study, Hg concentrations were measured in rice samples collected from markets and supermarkets in Suzhou, a typical city in Eastern China. In addition, the rice ingestion rates (IR) were assessed via a questionnaire-based survey of Suzhou residents. The data were then used to assess the risk of Hg exposure associated with rice consumption, by calculating the hazard quotient (HQ). Hg contents in rice samples were well below the national standard (20 μg/kg), ranging from 1.46 to 8.48 ng/g. They were also significantly (p > 0.05) independent of the area of production and place of purchase (markets vs. supermarkets in the different districts). Our results indicate a low risk of Hg exposure from rice in Suzhou (HQ: 0.005–0.05), despite the generally high personal IR (0.05–0.4 kg/day). The risk of Hg associated with rice consumption for Suzhou residents was not significantly affected by the age or sex of the consumer (p > 0.05). Overall, our results provide a study of human exposure to Hg in rice in Chinese cities not known to be contaminated with Hg. Future studies should examine Hg exposure in different areas in China and in potentially vulnerable major food types. Full article

Background: This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods: The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 to 31 March 2015. The presence or absence of dental visits and number of days spent on dental care services during the year were calculated using insurance claims submitted. Equivalent household income was calculated using individual income data from 1 January to 31 December 2013, declared for taxation. Results: Of the 216,211 enrolled subjects, 50.3% had dental care during the year. Among those with dental visits, the average number of days (standard deviation) spent on dental care services per year was 7.7 (7.1). Low income was associated with a decreased rate of dental care utilization regardless of age and sex. However, there was a significant inverse linear association between the number of days spent on dental care services and income levels for both sexes. Conclusions: There were income-related inequalities in access to dental care services, regardless of the age group or sex, within the Japanese universal health insurance system. Full article

Background: Prevalence and characteristics of fetal alcohol syndrome (FAS) and total fetal alcohol spectrum disorders (FASD) were studied in a second sample of three South African rural communities to assess change. Methods: Active case ascertainment focused on children with height, weight and/or head circumference ≤25th centile and randomly-selected children. Final diagnoses were based on dysmorphology, neurobehavioral scores, and maternal risk interviews. Results: Cardinal facial features, head circumference, and total dysmorphology scores differentiated specific FASD diagnostic categories in a somewhat linear fashion but all FASD traits were significantly worse than those of randomly-selected controls. Neurodevelopmental delays were significantly worse for children with FASD than controls. Binge alcohol use was clearly documented as the proximal maternal risk factor for FASD, and significant distal risk factors were: low body mass, education, and income; high gravidity, parity, and age at birth of the index child. FAS rates continue to extremely high in these communities at 89–129 per 1000 children. Total FASD affect 196–276 per 1000 or 20–28% of the children in these communities. Conclusions: Very high rates of FASD persist in these general populations where regular, heavy drinking, often in a binge fashion, co-occurs with low socioeconomic conditions. Full article