International Journal of Environmental Research and Public Health — Open Access Journal

This study aimed to evaluate the data quality of the Brazilian Epidemiological Surveillance System on Foodborne Diseases (VE-DTA) through the evaluation of the completeness of the record after 10-years of its implementation. The study evaluated the measurement of completeness by quantifying ignored, incomplete or blank responses of the data items filled. The evaluation used the percentage of completion of these items regarding the total number of notifications registered in the system. We organized the results according to the general Category of completeness of the database, by year of notification and region of occurrence. We also evaluated the overall completeness percentages of the database and the completeness levels according to the degree of recommendation of completion of each variable (mandatory, essential, and complementary) by the VE-DTA manual. The system presented 7037 outbreaks of foodborne diseases. According to the completeness classification, the database presented general classification as Category 1 since it has 82.1% (n = 5.777) of variables with the level of completion up to 75.1%. We observed that 8.6% of the database was classified as category 2; 9.2% as category 3 and 0.1% as category 4. The improvement on database quality regarding completeness can positively impact on public health and public policies, reducing the number of FBDs deaths. Full article

This study aimed to determine whether hospital competition is associated with improved in-hospital mortality in Shanxi, China. We included a total of 46,959 hospitalizations for acute myocardial infarction (AMI) and 44,063 hospitalizations for pneumonia from 2015 to 2017. Hospital competition was measured as Herfindahl–Hirschman Index based on the patient predicted flow approach. Two-level random-intercept logistic models were applied to explore the effects of hospital competition on quality for both AMI and pneumonia diagnoses. Hospital competition exerts negative or negligible effects on inpatient quality of care, and the pattern of competition effects on quality varies by specific diseases. While hospital competition is insignificantly correlated with lower AMI in-hospital mortality (odds ratio (OR): 0.94, 95% confidence interval (CI): 0.77–1.11), high hospital competition was, in fact, associated with higher in-hospital mortality for pneumonia patients (OR: 1.99, 95% CI: 1.51–2.64). Our study suggests that simply encouraging hospital competition may not provide effective channels to improve inpatient quality of health care in China’s current health care system. Full article

Price of tobacco products has traditionally been relevant both for the industry, to respond to policy changes, and for governments, as an effective tobacco control measure. However, monitoring prices across a wide range of brands and brand variants requires access to expensive commercial sales databases. This study aims to investigate the comparability of average tobacco prices from two commercial sources and an in-house monitoring database which provides daily data in real time at minimal cost. We used descriptive and regression analysis to compare the monthly average numbers of brands, brand variants, products and prices of cigarettes and hand-rolling tobacco using commercial data from Nielsen Scantrack and Kantar Worldpanel, and an online price database (OPD) created in Nottingham, for the period from May 2013 to February 2017. There were marked differences in the number of products tracked in the three data sources. Nielsen was the most comprehensive and Kantar Worldpanel the least. Though average prices were very similar between the three datasets, Nottingham OPD prices were the highest and Kantar Worldpanel the lowest. However, regression analysis demonstrated that after adjustment for differences in product range, price differences between the datasets were very small. After allowing for differences in product range these data sources offer representative prices for application in price research. Online price tracking offers an inexpensive and near real-time alternative to the commercial datasets. Full article

Long-term exposure to high levels of heavy metals can lead to a variety of diseases. In recent years, researchers have paid more attention to mining and smelting areas, industrial areas, and so forth, but they have neglected to report on high geological background areas where heavy metal levels are higher than China’s soil environmental quality standard (GB 15618-2018). In our study, an investigation of heavy metals in paddy soil and rice in the high background area of Guizhou Province was carried out, and the factors affecting the absorption and utilization of heavy metals in rice were discussed. A total of 52 paddy soil and rice samples throughout the high geological background of Guizhou, China, were collected, and concentration(s) of arsenic, cadmium, copper, lead, and zinc were analyzed. The arithmetic mean values of paddy soil heavy metals were 19.7 ± 17.1, 0.577 ± 0.690, 40.5 ± 32.8, 35.5 ± 32.0, and 135 ± 128 mg kg⁻¹ for arsenic, cadmium, copper, lead, and zinc, respectively. Most of the heavy metals’ contents in the soil were above the soil standard value. The highest content of cadmium was 15.5 times that of the soil standard value. The concentration(s) of arsenic, cadmium, copper, lead, and zinc in rice were 0.09 ± 0.03, 0.01 ± 0.01, 1.57 ± 0.69, 0.002 ± 0.003, and 11.56 ± 2.61 mg kg⁻¹, respectively, which are all lower than those specified by Chinese food safety standards (GB 2762-2017). The results and discussion show that the bioavailability, pH, and soil organic matter are important factors that affect the absorption of heavy metals by rice. According to the consumption of rice in Guizhou Province, the risk of eating rice was considered. The results revealed that the hazard quotient is ranked in the order of copper > zinc > cadmium > arsenic > lead, and there is little risk of eating rice in the high geological background area of Guizhou Province. These findings provide impetus for the revision and improvement of this Chinese soil environmental quality standard. Full article

Standard statistical modelling has shown that the reallocation of sitting time to either standing or stepping may be beneficial for metabolic health. However, this overlooks the inherent dependency of time spent in all behaviours. The aim is to examine the associations between physical behaviours and markers of metabolic health (fasting glucose, fasting insulin, 2-h glucose, 2-h insulin, Homeostasis Model Assessment of Insulin Sensitivity (HOMA-IS), Matsuda Insulin Sensitivity Index (Matsuda-ISI) while quantifying the associations of reallocating time from one physical behaviour to another using compositional analysis. Objectively measured physical behaviour data were analysed (n = 435) using compositional analysis and compositional isotemporal substitutions to estimate the association of reallocating time from one behaviour to another in a population at high risk of type 2 diabetes mellitus (T2DM). Stepping time was associated with all markers of metabolic health relative to all other behaviours. Reallocating 30 min from sleep, sitting, or standing to stepping was associated with 5–6 fold lower 2-h glucose, 15–17 fold lower 2-h insulin, and higher insulin sensitivity (10–11 fold via HOMA-IS, 12–15 fold via Matsuda-ISI). Associations of reallocating time from any behaviour to stepping were maintained for 2-h glucose, 2-h insulin, and Matsuda-ISI after further adjusting for body mass index (BMI). Relocating time from stepping into sleep, sitting, or standing was associated with lower insulin sensitivity. Stepping time may be the most important behavioural composition when promoting improved metabolic health in adults at risk of T2DM. Full article

Background: Research has shown that suicide is a highly present phenomenon among the drug dependent population. Moreover, individuals with substance use disorder (SUD) present high psychopathological comorbidity. This study aimed to describe which clinical syndromes are linked to the presence of risk of suicide. Methods: The study was based on a consecutive non-probabilistic convenience sample of 196 patients who attended the Public Addiction Center in Girona (Spain). Sociodemographic data, as well as suicide risk and drug related characteristics, were recorded. The risk of suicide was assessed with the Spanish version of “risk of suicide”. Complicated grief was assessed with the Spanish version of the Inventory of Complicated Grief. Clinical syndromes were measured with the Spanish version of MCMI-III. Results: The syndromes most frequently associated with the presence of risk of suicide were complicated grief, major depression and thought disorder. Conclusions: Different psychopathological syndromes were identified in relation to risk of suicide among patients with SUD. The present results highlight the importance of accurately diagnosing those individuals. Full article

Florida geologic units and soils contain a wide range in concentrations of naturally-occurring arsenic. The average range of bulk rock concentrations is 1 to 13.1 mg/kg with concentrations in accessary minerals being over 1000 mg/kg. Florida soils contain natural arsenic concentrations which can exceed 10 mg/kg in some circumstances, with organic-rich soils often having the highest concentrations. Anthropogenic sources of arsenic have added about 610,000 metric tons of arsenic into the Florida environment since 1970, thereby increasing background concentrations in soils. The anthropogenic sources of arsenic in soils include: pesticides (used in Florida beginning in the 1890’s), fertilizers, chromated copper arsenate (CCA)-treated wood, soil amendments, cattle-dipping vats, chicken litter, sludges from water treatment plants, and others. The default Soil Cleanup Target Level (SCTL) in Florida for arsenic in residential soils is 2.1 mg/kg which is below some naturally-occurring background concentrations in soils and anthropogenic concentrations in agricultural soils. A review of risk considerations shows that adverse health impacts associated with exposure to arsenic is dependent on many factors and that the Florida cleanup levels are very conservative. Exposure to arsenic in soils at concentrations that exceed the Florida default cleanup level set specifically for residential environments does not necessarily pose a meaningful a priori public health risk, given important considerations such as the form of arsenic present, the route(s) of exposure, and the actual circumstances of exposure (e.g., frequency, duration, and magnitude). Full article

The objective of this effort is to gather data to tailor interventions appropriately. Greater understanding of the correlates of socioeconomic status and obesogenic dietary behaviors was the focus of this manuscript. Using multistage sampling, women with varied education levels completed a baseline assessment in a longitudinal study of women aged 30 to 50 years. This study was conducted in low-SES areas of South King County, Washington State. This study included 530 Caucasian and 510 Hispanic women. Fruit and vegetable consumption was positively associated and soft drink consumption inversely associated with the level of education in Caucasian women. In contrast, percentage calories from fat was positively associated with the level of education in Hispanic women. In Hispanic women, level of education interacted significantly with food security in relation to percentage calories from fat, and with eating norms in relation to soft drink consumption. Neighborhood presence of ethnic food stores was associated with outcomes for Hispanic women, but for Caucasians, presence of fast food restaurants was important. Education was consistently associated with two of the three obesogenic dietary behaviors studied among Caucasian women. Education played a moderating role in the associations of food security and eating norms, independent of area level food availability, in two of three obesogenic dietary behaviors studied. However, these patterns differed for Hispanic women, indicating the need for more research into important variables to support change in Hispanic women. Women of differing ethnic groups did not respond similarly to environmental conditions and policy-relevant surroundings. These data have meaning for considering urban policy that impacts obesity levels in the population. Full article

Reducing sedentary behaviours can help prevent non-communicable diseases, particularly among young adolescents with long term illnesses or disabilities (LTID). Much of young people’s voluntary sedentary time is related to screen-time behaviours (STBs) such as TV viewing, playing computer games, and using the computer for other activities. Although public health data on adolescents’ STB is growing, information about adolescents with LTID is currently lacking in a European context. The purpose of this study is to compare time on STBs between adolescents with and without LTID in European Countries through the HBSC 2013/14 study. Young adolescents (n = 61,329; boys 47.8%) from 15 European countries reported the time spent on TV viewing, playing computer games, and using the computer for other purposes on weekdays and the weekend. STBs were dichotomised based on international recommendations of less than 2 h per day, and Chi-square tests of independence were performed to investigate differences. STB time was combined to produce a sum score as dependent variable in multiple analysis of covariance with age and family affluence as covariates. There were statistically significant differences in computer gaming among boys and other computer use among girls for both weekdays and weekends, whereby adolescents with LTID reported higher use. In addition, both boys and girls with LTID spent more time on STBs than their same sex peers without LTID (Boys, F = 28.17, p < 0.001; Girls, F = 9.60, p = 0.002). The results of this study indicate a need for preventive strategies to address high levels of STB among young adolescents with LTID and reduce the risk of poor health outcomes associated with higher levels of sedentary behaviour. Full article

Disasters have substantial consequences for population mental health. We used Twitter to (1) extract negative emotions indicating discomfort in New York City (NYC) before, during, and after Superstorm Sandy in 2012. We further aimed to (2) identify whether pre- or peri-disaster discomfort were associated with peri- or post-disaster discomfort, respectively, and to (3) assess geographic variation in discomfort across NYC census tracts over time. Our sample consisted of 1,018,140 geo-located tweets that were analyzed with an advanced sentiment analysis called ”Extracting the Meaning Of Terse Information in a Visualization of Emotion” (EMOTIVE). We calculated discomfort rates for 2137 NYC census tracts, applied spatial regimes regression to find associations of discomfort, and used Moran’s I for spatial cluster detection across NYC boroughs over time. We found increased discomfort, that is, bundled negative emotions after the storm as compared to during the storm. Furthermore, pre- and peri-disaster discomfort was positively associated with post-disaster discomfort; however, this association was different across boroughs, with significant associations only in Manhattan, the Bronx, and Queens. In addition, rates were most prominently spatially clustered in Staten Island lasting pre- to post-disaster. This is the first study that determined significant associations of negative emotional responses found in social media posts over space and time in the context of a natural disaster, which may guide us in identifying those areas and populations mostly in need for care. Full article

Individuals with intellectual disabilities (ID) are at high risk for high levels of sedentary behaviour. To inform the development of programmes to reduce sedentary behaviour, insight into the correlates is needed. Therefore, the aim of this study is to review the evidence on correlates of sedentary behaviour in adults with ID. We performed a systematic literature search in Ovid Medline, Ovid Embase, Web of Science and Google Scholar up to 19 January 2018, resulting in nine included studies that were published from 2011 to 2018. Correlates were categorized according to the ecological model. Studies predominantly focused on individual level correlates. Of those correlates studied in more than one study, having epilepsy was associated with less sedentary behaviour and inconsistent results were found for sex, genetic syndromes, weight status, physical health, mobility, level of ID, and mental health. Of the few interpersonal and environmental factors studied, only living arrangements were studied in more than one study, with inconsistent results. To date, we have limited and inconclusive evidence about correlates of sedentary behaviour in adults with ID. Only when future studies unravel correlates and determinants, across all domains of the ecological model, will the potential opportunities to improve health by reducing sedentary behaviour come within reach. Full article

With regional socio-economic development and increasing population, the structure and function of terrestrial ecosystem environments on the earth’s surface have changed markedly. Ecological shelter zone reconstruction (ESZR) is an ecosystem restoration and conservation project, which aims to ensure the safety of the ecological environments of—regions and basins. We selected the upper reaches of the Yangtze River (from Yibin to Chongqing) as the study area and determined the connotation of ESZR. At the same time, the planning scope and construction content of the ecological barrier in this specific region have been preliminarily explored. Meanwhile, a set of related planning methods was proposed, the ecological effects of which were quantitatively assessed and confirmed through the calculation of ESVs. Compared with the conditions in 2005, the study showed that the value of the services of the whole ecosystem augmented significantly under the slope classification, increasing by 103.23%. At the same time, the land use pattern has been optimized, and the vegetation coverage has been enhanced. The ESZR can effectively improve the ecosystem service function of slope land (mainly slope > 25°) and the regional ecological environment, solve the rocky desertification of the study area and provide an effective decision in relation to supporting regional green sustainable development. Full article

The aging population is a big challenge all over the world. However, there are few studies to date investigating the effects of trace element and mineral levels in drinking water and soil (especially in karst areas) on longevity. This study aims to examine temporal and spatial variations in longevity in Hechi (which is recognized as a longevity city) and to investigate relationships between longevity and trace element and mineral levels in drinking water and soils in this city (the karst landscape). Population data were collected from relevant literature and four national population censuses in 1982, 1990, 2000 and 2010. Drinking water and soil samples from Hechi were collected and analyzed. The results demonstrated an obvious clustered distribution for the longevity population in Hechi that has existed stably for decades. The longevity index tended to be significantly positively correlated with H₂SiO₃, Ca and Fe in drinking water and significantly negatively correlated with Sr in soil, indicating that drinking water characteristics contributed significantly to the observed regional longevity. The karst landscape is responsible for abundant trace elements in underground rivers in Hechi, which are beneficial to human health when consumed as drinking water. Good quality and slightly alkaline drinking water rich in trace elements such as H₂SiO₃, Ca, Fe, Na, Mg and low in heavy metals such as Pb and Cd might be an important factor contributing to the longevity phenomenon in Hechi. Full article

Analysis of the suitability of hydrothermal conditions for vegetation growth would benefit the ecological barrier construction, water resources protection and climate change adaptation. The suitability of hydrothermal conditions in Naqu Prefecture was studied based on the spatial displacement of 500 mm precipitation and 2000 °C accumulated temperature contours. Results showed that the 500 mm precipitation contour had a shifting trend toward the southwest, with a 3.3-year and 7.1-year period, respectively, in the longitudinal and latitudinal direction, and the longitude changed suddenly around 1996. The 2000 °C accumulated temperature contour had a shifting trend toward the northwest, with a 1.8-year period and a 7-year sub-period in the longitudinal direction; the longitude had a catastrophe point between 1966 and 1967, while the latitude had a catastrophe point between 2005 and 2006. When located in the same vegetation zone, the annual precipitation in Naqu Prefecture was higher than the national average, while the accumulated temperature was lower than the national average, indicating that areas with suitable hydrothermal conditions suitable for vegetation growth showed a northwestward shift tendency. This research would help to support some recommendations for plants’ ecological system protection in alpine areas, and also provide guidelines for climate change adaptation. Full article

In marine environments, microplastics have become a focus in scientific research in the last decade due to the global threat this pollutant poses to the marine environment. Corals in Hong Kong are under threat due to the degradation of the marine environment caused by human activities. This study investigated the occurrence, abundance and composition of microplastic debris (0.3–5 mm) in seabed sediments adjacent to coral communities in Hong Kong. Twenty-four benthic sediment samples were collected from four study sites located along the northeastern and eastern shores of Hong Kong. Microplastic concentrations ranged from 169 ± 48 to 221 ± 45 items/kg, and the mean concentration of microplastics in the seabed sediments was 189 ± 50 items/kg, which was comparable to similar studies in other regions. Microplastics accounted for 95.4% of particles extracted from benthic sediment samples using 40× light microscopy. ATR-FTIR spectroscopy analysis showed that polyethylene (PE) and polyethylene terephthalate (PET) comprised the majority of polymer types, contributing 45.3% and 29.3%, respectively. The proportion of microplastics made from PE and PET in seabed sediments was significantly higher than that observed in local beach sediments. The proportion of microplastics made from PE and low-density polyethylene (LDPE) and polypropylene (PP) together in the seabed sediments was much higher than that of PET and polyvinyl chloride (PVC). The results have provided information with reference to environmental concentrations of microplastics for fringe reef habitat close to urban areas, which can be applied in studies concerning ecotoxicity of microplastics. Full article

Dry eye disease (DED) has become a common eye disease in recent years and appears to be influenced by environmental factors. This study aimed to examine the association between the first occurrence of DED, air pollution and weather changes in Taiwan. We used the systematic sampling cohort database containing 1,000,000 insureds of the National Health Insurance of Taiwan from 2004 to 2013, and identified a total of 25,818 eligible DED subjects. Environmental data, including those of air pollutants, temperature and relative humidity, were retrieved from the environmental monitoring stations adjacent to subjects’ locations of clinics as exposure information. We applied the case-crossover design, which used the same subjects experiencing exposures on diagnosis days as cases and those on other days as controls. The descriptive statistics showed that the first occurrences of DED were the most for the elderly by age (53.6%), women by gender (68.9%), and spring by season (25.9%). Multivariate conditional logistic regression analyses indicated that carbon monoxide (CO), nitrogen dioxide (NO₂), and temperature were positively associated with DED (p < 0.05), while relative humidity was negatively related (p < 0.001). Because CO and NO₂ together are considered a surrogate of traffic emission, which is easier to control than the uprising temperature, it is suggested that efficient management and control of traffic emission may lower the probability of DED occurrence. Full article

Background: The purpose of this study was to examine the convergent validity of the Polar Active Watch (PAW), a consumer-grade wrist-worn activity monitor, against waist- and wrist-worn research-grade monitors, the ActiGraph GT3X+/GT9X accelerometers, in children. Methods: Fifty-one children (18 boys; mean age = 10.30 ± 0.91 years) wore the three monitors (PAW, GT3X+, and GT9X) during an 80-min afterschool program across five school days. Time spent in sedentary, light-intensity (LPA), and moderate- and vigorous-intensity physical activity (MVPA) were estimated from each monitor. The correlation, mixed model, mean absolute percentage error, equivalence testing, and Bland-Altman analyses were used to examine the comparability of PA estimates of the PAW with GT3X+/GT9X accelerometers. Results: Moderate to strong correlations for sedentary and MVPA minutes, and weak correlation for LPA were observed between the PAW and GT3X+/GT9X accelerometers. Significant mean differences were found, where the PAW tended to overestimate time in sedentary and MVPA and underestimate LPA minutes, compared to the GT3X+/GT9X accelerometers. However, a non-significant mean difference in MVPA minutes was observed when using an adjusted MET threshold (≥4 METs) for the PAW, compared to the GT3X+ accelerometer. Conclusions: The PAW showed moderate convergent validity for sedentary and MVPA minutes against the GT3X+/GT9X accelerometers. However, caution is needed in the direct comparison between the monitors due to relatively large mean differences and within-group variability. Full article

Australia has one of the world’s highest life expectancy rates, and there is a rapidly growing need for informal caregivers to support individuals who are ageing, have chronic illness or a lifelong disability. These informal carers themselves face numerous physical and psychological stressors in attempting to balance the provision of care with their personal life, their work commitments and family responsibilities. However, little is known about the specific challenges facing rural carers and the barriers that limit their capacity to provide ongoing support. A cross-sectional survey composed of open-ended responses and demographic/socioeconomic measures used routinely by the Australian Bureau of Statistics (ABS) and the Australian Institute of Health & Welfare (AIHW) was used with a cohort of 225 rurally-based carers within New South Wales, Australia. Demographic questions specified the respondents’ age, gender, employment, caregiving status, condition of and relationship to the care recipient, postcode, residency status, and distance and frequency travelled to provide care. Open-ended comments sections were provided to allow participants to describe any issues and problems associated with caregiving including employment, travel, residency, carer support groups and any other general information. The results show that most rural carers were middle-aged women supporting a spouse or a child. Unpredictability associated with providing care exacerbated demands on carers’ time, with many reporting significant employment consequences associated with inflexibility and limited job options in rural locations. Specific issues associated with travel requirements to assist with care were reported, as were the impacts of care provision on the respondents’ own personal health. The majority of carers were aware of the social supports available in their local rural community, but did not access them, leaving the carers vulnerable to marginalisation. Problems associated with employment were noted as resulting in financial pressures and associated personal stress and anxiety for the caregivers. While this issue is not necessarily limited to rural areas, it would appear that the lack of opportunity and flexibility evident in rural areas would exacerbate this problem for non-metropolitan residents. The participants also identified specific barriers to the provision of care in rural areas, including the significant impact of travel. Access to support services, such as carer groups, were rarely accessed due to a mix of factors including inaccessibility, poor timing and a lack of anonymity. Financially, there was considerable evidence of hardship, and there is an urgent need for a comprehensive review of government and community-based support to better meet the needs of rural carers. Full article

Background: Anthropogenic global warming, interacting with social and other environmental determinants, constitutes a profound health risk. This paper reports a comprehensive literature review for 1989–2013 (inclusive), the first 25 years in which this topic appeared in scientific journals. It explores the extent to which articles have identified potentially catastrophic, civilization-endangering health risks associated with climate change. Methods: PubMed and Google Scholar were primarily used to identify articles which were then ranked on a three-point scale. Each score reflected the extent to which papers discussed global systemic risk. Citations were also analyzed. Results: Of 2143 analyzed papers 1546 (72%) were scored as one. Their citations (165,133) were 82% of the total. The proportion of annual papers scored as three was initially high, as were their citations but declined to almost zero by 1996, before rising slightly from 2006. Conclusions: The enormous expansion of the literature appropriately reflects increased understanding of the importance of climate change to global health. However, recognition of the most severe, existential, health risks from climate change was generally low. Most papers instead focused on infectious diseases, direct heat effects and other disciplinary-bounded phenomena and consequences, even though scientific advances have long called for more inter-disciplinary collaboration. Full article