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  Subjects -> HEALTH AND SAFETY (Total: 1278 journals)
    - CIVIL DEFENSE (18 journals)
    - DRUG ABUSE AND ALCOHOLISM (87 journals)
    - HEALTH AND SAFETY (509 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (379 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (106 journals)
    - PHYSICAL FITNESS AND HYGIENE (99 journals)
    - WOMEN'S HEALTH (80 journals)

HEALTH AND SAFETY (509 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 9)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal  
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 19)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 4)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 2)
AJOB Primary Research     Partially Free   (Followers: 2)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Health Economics     Full-text available via subscription   (Followers: 13)
American Journal of Health Education     Hybrid Journal   (Followers: 25)
American Journal of Health Promotion     Hybrid Journal   (Followers: 24)
American Journal of Health Studies     Full-text available via subscription   (Followers: 8)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 174)
American Journal of Public Health Research     Open Access   (Followers: 27)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 8)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 2)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 1)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 5)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 1)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 1)
Behavioral Healthcare     Full-text available via subscription   (Followers: 4)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 6)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 9)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 19)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 15)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 11)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 10)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 18)
Case Reports in Women's Health     Open Access   (Followers: 2)
Case Studies in Fire Safety     Open Access   (Followers: 11)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 1)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 1)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 1)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 13)
East African Journal of Public Health     Full-text available via subscription   (Followers: 2)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 3)
Education for Health     Open Access   (Followers: 4)
electronic Journal of Health Informatics     Open Access   (Followers: 4)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 4)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access  
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 3)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 18)
Ethics, Medicine and Public Health     Full-text available via subscription  
Ethiopian Journal of Health Development     Open Access   (Followers: 9)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 8)
Ethnicity & Health     Hybrid Journal   (Followers: 14)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 1)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 8)
Evidence-based Medicine & Public Health     Open Access   (Followers: 4)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 3)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 10)
Frontiers in Public Health     Open Access   (Followers: 8)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 4)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 5)
Global Journal of Public Health     Open Access   (Followers: 9)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 7)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 14)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 9)
Health and Social Work     Hybrid Journal   (Followers: 46)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 11)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 10)
Health Issues     Full-text available via subscription   (Followers: 1)
Health Policy     Hybrid Journal   (Followers: 32)
Health Policy and Technology     Hybrid Journal  
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 20)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10)
Health Promotion Practice     Hybrid Journal   (Followers: 15)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 47)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 39)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 9)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 1)
Health Services Insights     Open Access   (Followers: 1)
Health Systems     Hybrid Journal   (Followers: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 10)
Health, Risk & Society     Hybrid Journal   (Followers: 9)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 9)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 2)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 6)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 4)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 32)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 7)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 19)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 13)
International Journal of Health & Allied Sciences     Open Access   (Followers: 1)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 7)
International Journal of Health Geographics     Open Access   (Followers: 6)
International Journal of Health Policy and Management     Open Access   (Followers: 2)
International Journal of Health Professions     Open Access   (Followers: 2)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 12)
International Journal of Health Sciences Education     Open Access   (Followers: 2)
International Journal of Health Services     Full-text available via subscription   (Followers: 9)
International Journal of Health Studies     Open Access   (Followers: 3)
International Journal of Health System and Disaster Management     Open Access   (Followers: 2)
International Journal of Healthcare Delivery Reform Initiatives     Full-text available via subscription   (Followers: 1)

        1 2 3 | Last

Journal Cover International Journal of Environmental Research and Public Health
  [SJR: 0.883]   [H-I: 47]   [19 followers]  Follow
    
  This is an Open Access Journal Open Access journal
   ISSN (Print) 1660-4601
   Published by MDPI Homepage  [148 journals]
  • IJERPH, Vol. 14, Pages 326: Text Messaging: An Intervention to Increase
           Physical Activity among African American Participants in a Faith-Based,
           Competitive Weight Loss Program

    • Authors: Pamela McCoy, Sophia Leggett, Azad Bhuiyan, David Brown, Patricia Frye, Bryman Williams
      First page: 326
      Abstract: African American adults are less likely to meet the recommended physical activity guidelines for aerobic and muscle-strengthening activity than Caucasian adults. The purpose of this study was to assess whether a text message intervention would increase physical activity in this population. This pilot study used a pre-/post-questionnaire non-randomized design. Participants in a faith-based weight loss competition who agreed to participate in the text messaging were assigned to the intervention group (n = 52). Participants who declined to participate in the intervention, but agreed to participate in the study, were assigned to the control group (n = 30). The text messages provided strategies for increasing physical activity and were based on constructs of the Health Belief Model and the Information-Motivation-Behavioral Skills Model. Chi square tests determined the intervention group participants increased exercise time by approximately eight percent (p = 0.03), while the control group’s exercise time remained constant. The intervention group increased walking and running. The control group increased running. Most participants indicated that the health text messages were effective. The results of this pilot study suggest that text messaging may be an effective method for providing options for motivating individuals to increase physical activity.
      PubDate: 2017-03-29
      DOI: 10.3390/ijerph14040326
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 349: Improving Suicide Prevention in Dutch Regions
           by Creating Local Suicide Prevention Action Networks (SUPRANET): A Study
           Protocol

    • Authors: Renske Gilissen, Derek De Beurs, Jan Mokkenstorm, Saskia Mérelle, Gé Donker, Sanne Terpstra, Carla Derijck, The SUPRANET (Suicide Prevention Action Network) Research Group, Gerdien Franx
      First page: 349
      Abstract: The European Alliance against Depression (EAAD) program is to be introduced in The Netherlands from 2017 onwards. This program to combat suicide consists of interventions on four levels: (1) increasing the awareness of suicide by local media campaigns; (2) training local gatekeepers, such as teachers or police officers; (3) targeting high-risk persons in the community; and (4) training and support of professionals in primary care settings. The implementation starts in seven Dutch pilot regions. Each region is designated as a Suicide Prevention Action NETwork (SUPRANET). This paper describes the SUPRANET program components and the evaluation of its feasibility and impact. The findings will be used to facilitate the national implementation of EAAD in The Netherlands and to add new findings to the existing literature on EAAD.
      PubDate: 2017-03-28
      DOI: 10.3390/ijerph14040349
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 352: Pathways to Suicide in Australian Farmers: A
           Life Chart Analysis

    • Authors: Lisa Kunde, Kairi Kõlves, Brian Kelly, Prasuna Reddy, Diego De Leo
      First page: 352
      Abstract: Farmers have been found to be at increased risk of suicide in Australia. The Interpersonal-Psychological Theory of Suicidal Behaviour suggests that the proximal factors leading to the suicidal desire or ideation include an individual’s experiences of both perceived burdensomeness and thwarted belongingness. Suicidal desire with acquired capability to engage in lethal self-injury is predictive of suicidal behaviour. This study investigates the pathways to suicide of 18 Australian male farmers in order to understand the suicidal process and antecedents to suicide in Australian male farmers. The psychological autopsy (PA) method was used to generate life charts. Two pathways with distinct suicidal processes were identified: acute situational (romantic relationship problems and financial concerns/pending retirement) and protracted (long-term psychiatric disorder). Long working hours, interpersonal conflicts, physical illnesses and pain, alcohol abuse, access to firearms, and exposure to drought were additional common factors identified. An understanding of the interrelatedness of diverse distal and proximal risk factors on suicidal pathways in the wider environmental context for male farmers is required when developing and implementing rural suicide prevention activities.
      PubDate: 2017-03-28
      DOI: 10.3390/ijerph14040352
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 354: Urinary Concentrations of Insecticide and
           Herbicide Metabolites among Pregnant Women in Rural Ghana: A Pilot Study

    • Authors: Blair Wylie, Kenneth Ae-Ngibise, Ellen Boamah, Mohammed Mujtaba, Carmen Messerlian, Russ Hauser, Brent Coull, Antonia Calafat, Darby Jack, Patrick Kinney, Robin Whyatt, Seth Owusu-Agyei, Kwaku Asante
      First page: 354
      Abstract: Use of pesticides by households in rural Ghana is common for residential pest control, agricultural use, and for the reduction of vectors carrying disease. However, few data are available about exposure to pesticides among this population. Our objective was to quantify urinary concentrations of metabolites of organophosphate (OP), pyrethroid, and select herbicides during pregnancy, and to explore exposure determinants. In 2014, 17 pregnant women from rural Ghana were surveyed about household pesticide use and provided weekly first morning urine voids during three visits (n = 51 samples). A total of 90.1% (46/51) of samples had detectable OP metabolites [geometric mean, GM (95% CI): 3,5,6-trichloro-2-pyridinol 0.54 µg/L (0.36–0.81), para-nitrophenol 0.71 µg/L (0.51–1.00)], 75.5% (37/49) had detectable pyrethroid metabolites [GM: 3-phenoxybenzoic acid 0.23 µg/L (0.17, 0.32)], and 70.5% (36/51) had detectable 2,4-dichlorophenoxyacetic acid levels, a herbicide [GM: 0.46 µg/L (0.29–0.73)]. Concentrations of para-nitrophenol and 2,4-dichlorophenoxyacetic acid in Ghanaian pregnant women appear higher when compared to nonpregnant reproductive-aged women in a reference U.S. population. Larger studies are necessary to more fully explore predictors of exposure in this population.
      PubDate: 2017-03-29
      DOI: 10.3390/ijerph14040354
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 355: Incidence of Breast, Prostate, Testicular, and
           Thyroid Cancer in Italian Contaminated Sites with Presence of Substances
           with Endocrine Disrupting Properties

    • Authors: Marta Benedetti, Amerigo Zona, Eleonora Beccaloni, Mario Carere, Pietro Comba
      First page: 355
      Abstract: The aim of the present study was to investigate the incidence of breast (females), prostate, testicular, and thyroid cancer in the Italian National Priority Contaminated Sites (NPCSs), served by cancer registries, where the presence of endocrine disruptors (EDs), reported to be linked to these tumours, was documented. Evidence of carcinogenicity of EDs present in NPCSs was assessed based on evaluation by international scientific institutions and committees. Standardized Incidence Ratios (SIRs) were computed for each NPCS and cancer site between 1996 and 2005. Excess incidence of one or more cancer site studied was found in twelve out of fourteen NPCSs. Significantly increased SIRs were found for breast cancer in eight NPCSs, for prostate cancer in six, for thyroid cancer (both gender) in four, and for testicular cancer in two. Non-significantly increased SIRs were found in five NPCSs for testicular cancer and in two for thyroid cancer (males). In a small number of instances a significant deficit was reported, mainly for thyroid and prostate cancer. Although increased incidence of one or more cancer sites studied were found in several NPCSs, the ecological study design and the multifactorial aetiology of the considered tumours do not permit concluding causal links with environmental contamination. Regarding the observation of some excesses in SIRs, continuing epidemiological surveillance is warranted.
      PubDate: 2017-03-29
      DOI: 10.3390/ijerph14040355
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 356: Demand and Signing of General Practitioner
           Contract Service among the Urban Elderly: A Population-Based Analysis in
           Zhejiang Province, China

    • Authors: Yanrong Zhao, Junfen Lin, Yinwei Qiu, Qing Yang, Xinyi Wang, Xiaopeng Shang, Xiaoping Xu
      First page: 356
      Abstract: This study aims to examine whether the urban elderly in the Zhejiang Province of China signed contracts with their general practitioner (GP) based on their health service needs, and to further identify the determinants of their demand and signing decisions. A community-based cross-sectional study was conducted in 16 community health service (CHS) institutions in Zhejiang Province, China. The urban elderly over 60 years of age were enrolled when visiting the sampled CHS. Baseline characteristics were compared between participants using Chi-Square tests for categorical variables. Univariate and multivariable logistic regression analyses were used to identify determinants of the GP contract service demand and signing decisions, respectively. Among the 1440 urban elderly, 56.67% had signed contracts with their GP, and 55.35% had a demand of the GP contract service. The influencing factors of demand were a history of diabetes or cardiovascular disease (OR = 1.33, 95% CI, 1.05–1.68); urban resident basic medical insurance (URBMI) vs. urban employee basic medical insurance (UEBMI) (OR = 1.96, 95% CI, 1.46–2.61); and middle-income vs. low-income (OR = 0.67, 95% CI, 0.50–0.90 for RMB 1001–3000; OR = 0.59, 95% CI, 0.39–0.90 for RMB 3001–5000). Having a demand for the GP contract service was the strongest determinant of signing decisions (OR = 13.20, 95% CI, 10.09–17.27). Other factors also contributed to these decisions, including gender, caregiver, and income. The urban elderly who had signed contracts with GPs were mainly based on their health care needs. Elderly people with a history of diabetes or cardiovascular disease, as well as those with URBMI, were found to have stronger needs of a GP contract service. It is believed that the high-income elderly should be given equal priority to those of low-income.
      PubDate: 2017-03-29
      DOI: 10.3390/ijerph14040356
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 357: Heat Wave Vulnerability Mapping for India

    • Authors: Gulrez Azhar, Shubhayu Saha, Partha Ganguly, Dileep Mavalankar, Jaime Madrigano
      First page: 357
      Abstract: Assessing geographic variability in heat wave vulnerability forms the basis for planning appropriate targeted adaptation strategies. Given several recent deadly heatwaves in India, heat is increasingly being recognized as a public health problem. However, to date there has not been a country-wide assessment of heat vulnerability in India. We evaluated demographic, socioeconomic, and environmental vulnerability factors and combined district level data from several sources including the most recent census, health reports, and satellite remote sensing data. We then applied principal component analysis (PCA) on 17 normalized variables for each of the 640 districts to create a composite Heat Vulnerability Index (HVI) for India. Of the total 640 districts, our analysis identified 10 and 97 districts in the very high and high risk categories (> 2SD and 2-1SD HVI) respectively. Mapping showed that the districts with higher heat vulnerability are located in the central parts of the country. On examination, these are less urbanized and have low rates of literacy, access to water and sanitation, and presence of household amenities. Therefore, we concluded that creating and mapping a heat vulnerability index is a useful first step in protecting the public from the health burden of heat. Future work should incorporate heat exposure and health outcome data to validate the index, as well as examine sub-district levels of vulnerability.
      PubDate: 2017-03-30
      DOI: 10.3390/ijerph14040357
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 358: Multiphysics and Thermal Response Models to
           Improve Accuracy of Local Temperature Estimation in Rat Cortex under
           Microwave Exposure

    • Authors: Sachiko Kodera, Jose Gomez-Tames, Akimasa Hirata, Hiroshi Masuda, Takuji Arima, Soichi Watanabe
      First page: 358
      Abstract: The rapid development of wireless technology has led to widespread concerns regarding adverse human health effects caused by exposure to electromagnetic fields. Temperature elevation in biological bodies is an important factor that can adversely affect health. A thermophysiological model is desired to quantify microwave (MW) induced temperature elevations. In this study, parameters related to thermophysiological responses for MW exposures were estimated using an electromagnetic-thermodynamics simulation technique. To the authors’ knowledge, this is the first study in which parameters related to regional cerebral blood flow in a rat model were extracted at a high degree of accuracy through experimental measurements for localized MW exposure at frequencies exceeding 6 GHz. The findings indicate that the improved modeling parameters yield computed results that match well with the measured quantities during and after exposure in rats. It is expected that the computational model will be helpful in estimating the temperature elevation in the rat brain at multiple observation points (that are difficult to measure simultaneously) and in explaining the physiological changes in the local cortex region.
      PubDate: 2017-03-30
      DOI: 10.3390/ijerph14040358
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 359: The Associations between Types of Ambient
           PM2.5 and Under-Five and Maternal Mortality in Africa

    • Authors: Patrick Owili, Wei-Hung Lien, Miriam Muga, Tang-Huang Lin
      First page: 359
      Abstract: Exploring the effects of different types of PM2.5 is necessary to reduce associated deaths, especially in low- and middle-income countries (LMICs). Hence we determined types of ambient PM2.5 before exploring their effects on under-five and maternal mortality in Africa. The spectral derivate of aerosol optical depth (AOD) from Moderate Resolution Imaging Spectroradiometer (MODIS) products from 2000 to 2015 were employed to determine the aerosol types before using Generalized Linear and Additive Mixed-Effect models with Poisson link function to explore the associations and penalized spline for dose-response relationships. Four types of PM2.5 were identified in terms of mineral dust, anthropogenic pollutant, biomass burning and mixture aerosols. The results demonstrate that biomass PM2.5 increased the rate of under-five mortality in Western and Central Africa, each by 2%, and maternal mortality in Central Africa by 19%. Anthropogenic PM2.5 increased under-five and maternal deaths in Northern Africa by 5% and 10%, respectively, and maternal deaths by 4% in Eastern Africa. Dust PM2.5 increased under-five deaths in Northern, Western, and Central Africa by 3%, 1%, and 10%, respectively. Mixture PM2.5 only increased under-five deaths and maternal deaths in Western (incidence rate ratio = 1.01, p < 0.10) and Eastern Africa (incidence rate ratio = 1.06, p < 0.01), respectively. The findings indicate the types of ambient PM2.5 are significantly associated with under-five and maternal mortality in Africa where the exposure level usually exceeds the World Health Organization’s (WHO) standards. Appropriate policy actions on protective and control measures are therefore suggested and should be developed and implemented accordingly.
      PubDate: 2017-03-30
      DOI: 10.3390/ijerph14040359
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 360: Severe Pneumonia Caused by Influenza A (H1N1)
           Virus Successfully Managed with Extracorporeal Life Support in a Comorbid
           Former Preterm Infant

    • Authors: Genny Raffaeli, Giacomo Cavallaro, Lorenza Pugni, Ernesto Leva, Andrea Artoni, Simona Neri, Chiara Baracetti, Mauro Cotza, Valerio Gentilino, Leonardo Terranova, Susanna Esposito, Fabio Mosca
      First page: 360
      Abstract: Influenza A (H1N1) virus infection is a global health burden, leading to significant pediatric morbidity and mortality. Prematurity, young age and comorbidities are important risk factors for unfavorable outcomes. Preventive strategies, such as healthcare workers and household contacts vaccination as well as the implementation of infection control practices during the epidemic season, are crucial to protect the most vulnerable populations. Early diagnosis, timely administration of antiviral drugs and supportive therapy are crucial to lead to a complete recovery. When conventional treatment fails, extracorporeal life support (ECLS) may be employed. In neonates and young infants, this high-tech support is burdened by specific technical complexity. Despite the potential risks related to this aggressive approach, ECLS is a life-saving procedure in 65% of pediatric viral pneumonia and in 73% of sepsis cases. Here, we report the successful outcome of a 51-day formerly preterm infant, suffering from a surgical necrotizing enterocolitis (NEC), complicated with hospital-acquired pneumonia due to influenza A (H1N1) virus. She developed a severe respiratory failure, unresponsive to conventional therapy, and successfully treated with ECLS. To our knowledge, this is the first report on the use of ECLS in a formerly preterm infant, suffering from NEC complicated by influenza A (H1N1) virus infection.
      PubDate: 2017-03-31
      DOI: 10.3390/ijerph14040360
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 361: The Promise and the Challenge of
           Technology-Facilitated Methods for Assessing Behavioral and Cognitive
           Markers of Risk for Suicide among U.S. Army National Guard Personnel

    • Authors: Brian Baucom, Panayiotis Georgiou, Craig Bryan, Eric Garland, Feea Leifker, Alexis May, Alexander Wong, Shrikanth Narayanan
      First page: 361
      Abstract: Suicide was the 10th leading cause of death for Americans in 2015 and rates have been steadily climbing over the last 25 years. Rates are particularly high amongst U.S. military personnel. Suicide prevention efforts in the military are significantly hampered by the lack of: (1) assessment tools for measuring baseline risk and (2) methods to detect periods of particularly heightened risk. Two specific barriers to assessing suicide risk in military personnel that call for innovation are: (1) the geographic dispersion of military personnel from healthcare settings, particularly amongst components like the Reserves; and (2) professional and social disincentives to acknowledging psychological distress. The primary aim of this paper is to describe recent technological developments that could contribute to risk assessment tools that are not subject to the limitations mentioned above. More specifically, Behavioral Signal Processing can be used to assess behaviors during interaction and conversation that likely indicate increased risk for suicide, and computer-administered, cognitive performance tasks can be used to assess activation of the suicidal mode. These novel methods can be used remotely and do not require direct disclosure or endorsement of psychological distress, solving two challenges to suicide risk assessment in military and other sensitive settings. We present an introduction to these technologies, describe how they can specifically be applied to assessing behavioral and cognitive risk for suicide, and close with recommendations for future research.
      PubDate: 2017-03-31
      DOI: 10.3390/ijerph14040361
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 362: Proximity to Industrial Food Animal Production
           and Asthma Exacerbations in Pennsylvania, 2005–2012

    • Authors: Sara Rasmussen, Joan Casey, Karen Bandeen-Roche, Brian Schwartz
      First page: 362
      Abstract: The research on industrial food animal production (IFAP) and asthma exacerbations in the United States has relied on small sample sizes and/or self-reported outcomes. We assessed associations of proximity to large-scale and densely stocked swine and dairy/veal IFAP with three types of asthma exacerbations: hospitalizations, emergency encounters, and oral corticosteroid (OCS) medication orders from Geisinger Clinic in Pennsylvania. We used a diagnosis code (International Classification of Diseases, 9th Revision, Clinical Modification code 493.x) and medication orders from electronic health records to identify these exacerbations among asthma patients (n = 35,269) from 2005–2012. We compared residential proximity to swine or dairy/veal IFAP (dichotomized as <3 miles (4.8 km) or ≥3 miles) among asthma patients with and without exacerbations and estimated odds ratios using multilevel logistic regression. In adjusted models, proximity to IFAP was associated (odds ratio (95% confidence interval)) with OCS orders (1.11 (1.04–1.19)) and hospitalizations (1.29 (1.15–1.46)), but not emergency encounters (1.12 (0.91–1.37)). This study contributes to growing evidence that IFAP may impact health, in this case clinically-documented asthma exacerbations. No prior study has evaluated the association of IFAP and clinically-documented asthma exacerbations in the United States.
      PubDate: 2017-03-31
      DOI: 10.3390/ijerph14040362
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 363: A Risk Assessment Matrix for Public Health
           Principles: The Case for E-Cigarettes

    • Authors: Daniela Saitta, Azim Chowdhury, Giancarlo Ferro, Federico Nalis, Riccardo Polosa
      First page: 363
      Abstract: Besides nicotine replacement therapies, a realistic alternative for smoking cessation or for smoking substitution may come from electronic cigarettes (ECs), whose popularity has been steadily growing. As for any emerging behaviour associated with exposure to inhalational agents, there is legitimate cause for concern and many health organizations and policy makers have pushed for restrictive policy measures ranging from complete bans to tight regulations of these products. Nonetheless, it is important to reframe these concerns in context of the well-known harm caused by cigarette smoking. In this article, we discuss key public health principles that should be considered when regulating ECs. These include the concept of tobacco harm reduction, importance of relative risk and risk continuum, renormalization of smoking, availability of low-risk product, proportionate taxation, and reassessment of the role of non-tobacco flavours. These public health principles may be systematically scrutinized using a risk assessment matrix that allows: (1) to determine the measure of certainty that a risk will occur; and (2) to estimate the impact of such a risk on public health. Consequently, the ultimate goal of responsible ECs regulation should be that of maximizing the favourable impact of these reduced-risk products whilst minimizing further any potential risks. Consumer perspectives, sound EC research, continuous post-marketing surveillance and reasonable safety and quality product standards should be at the very heart of future regulatory schemes that will address concerns while minimizing unintended consequences of ill-informed regulation.
      PubDate: 2017-03-31
      DOI: 10.3390/ijerph14040363
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 364: Individual and Store Characteristics
           Associated with Brand Choices in Select Food Category Redemptions among
           WIC Participants in Virginia

    • Authors: Qi Zhang, Chuanyi Tang, Patrick McLaughlin, Leigh Diggs
      First page: 364
      Abstract: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) often allows participants to redeem food benefits for various brands at different costs. To aid the program’s food cost containment efforts, it is important to understand the individual and store characteristics associated with brand choices. This study used the WIC Electronic Benefit Transfer (EBT) data for 239,062 Virginia WIC participants’ brand choices in infant fruits and vegetables (F&Vs) and whole grain bread in May 2014–February 2015, one of the first such data sets available in the U.S. for research purposes. Mixed effects logistic regression models were used to analyze the choice of higher-priced brands over lower-priced brands. Minority participants were significantly more likely to redeem higher-priced brands of infant F&Vs, but more likely to choose lower-priced brands of bread. Participants shopping in urban stores or midsized stores (with 5–9 registers) were less likely to choose higher-priced brands compared to rural stores or large stores (with 9+ registers). Race/ethnicity and store characteristics may be significant factors in participants’ brand choices. The results can help develop interventions that encourage targeted participants to redeem lower-priced but equivalently healthy brands. This may not only help contain WIC program costs, but help participants manage their own non-WIC food expenses as well.
      PubDate: 2017-03-31
      DOI: 10.3390/ijerph14040364
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 365: Socio-Economic Position and Suicidal Ideation
           in Men

    • Authors: Jane Pirkis, Dianne Currier, Peter Butterworth, Allison Milner, Anne Kavanagh, Holly Tibble, Jo Robinson, Matthew Spittal
      First page: 365
      Abstract: People in low socio-economic positions are over-represented in suicide statistics and are at heightened risk for non-fatal suicidal thoughts and behaviours. Few studies have tried to tease out the relationship between individual-level and area-level socio-economic position, however. We used data from Ten to Men (the Australian Longitudinal Study on Male Health) to investigate the relationship between individual-level and area-level socio-economic position and suicidal thinking in 12,090 men. We used a measure of unemployment/employment and occupational skill level as our individual-level indicator of socio-economic position. We used the Index of Relative Socio-Economic Disadvantage (a composite multidimensional construct created by the Australian Bureau of Statistics that combines information from a range of area-level variables, including the prevalence of unemployment and employment in low skilled occupations) as our area-level indicator. We assessed suicidal thinking using the Patient Health Questionnaire (PHQ-9). We found that even after controlling for common predictors of suicidal thinking; low individual-level and area-level socio-economic position heightened risk. Individual-level socio-economic position appeared to exert the greater influence of the two; however. There is an onus on policy makers and planners from within and outside the mental health sector to take individual- and area-level socio-economic position into account when they are developing strategic initiatives.
      PubDate: 2017-03-31
      DOI: 10.3390/ijerph14040365
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 366: Proactive Approach for Safe Use of
           Antimicrobial Coatings in Healthcare Settings: Opinion of the COST Action
           Network AMiCI

    • Authors: Merja Ahonen, Anne Kahru, Angela Ivask, Kaja Kasemets, Siiri Kõljalg, Paride Mantecca, Ivana Vinković Vrček, Minna Keinänen-Toivola, Francy Crijns
      First page: 366
      Abstract: Infections and infectious diseases are considered a major challenge to human health in healthcare units worldwide. This opinion paper was initiated by EU COST Action network AMiCI (AntiMicrobial Coating Innovations) and focuses on scientific information essential for weighing the risks and benefits of antimicrobial surfaces in healthcare settings. Particular attention is drawn on nanomaterial-based antimicrobial surfaces in frequently-touched areas in healthcare settings and the potential of these nano-enabled coatings to induce (eco)toxicological hazard and antimicrobial resistance. Possibilities to minimize those risks e.g., at the level of safe-by-design are demonstrated.
      PubDate: 2017-03-31
      DOI: 10.3390/ijerph14040366
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 367: Knowledge, Attitudes, and Practices about the
           Prevention of Mosquito Bites and Zika Virus Disease in Pregnant Women in
           Greece

    • Authors: Varvara Mouchtouri, Dimitrios Papagiannis, Antonios Katsioulis, Georgios Rachiotis, Konstantinos Dafopoulos, Christos Hadjichristodoulou
      First page: 367
      Abstract: A survey among 573 pregnant women in Greece was conducted through self-completion of a questionnaire in July 2016. Traveling abroad the last six months was declared by 10.5% and 13.0% of pregnant women and their male sex partners, respectively, while 77.4% (441/570) had heard about Zika virus disease (ZVD). A lack of knowledge about sexual transmission of ZVD was identified in 63.3% of pregnant women, and 24.1% of responders did not know the risks to the fetus and baby. Approximately 73% of responders believed that the mosquito bites can affect their fetus and baby and 18% did not take measures to prevent mosquito bites routinely. Multivariable logistic regression models showed that traveling abroad the last six months by pregnant women correlated with correctly answering the question about the transmission of ZVD through bites of infected mosquitoes (Odds Ratio, OR = 10.47, 95% CI = 1.11–98.41). Traveling abroad with a male sex partner over the last six months correlated (OR = 2.05, 95% CI = 0.99–4.23) with responding correctly to the four key questions about the transmission of ZVD through mosquito bites, the risk of microcephaly, and the risks of traveling to the affected countries. A score of ≥5 for the nine responses given to questions of knowledge and attitudes was associated with a Bachelor of Science degree (OR = 1.54, 95% CI = 1.09–2.18), antenatal care at a public hospital (OR = 2.26, 95% CI = 1.28–3.98), being a civil servant as occupation (OR = 1.96, 95% CI = 1.10–3.48), and having gotten information about ZVD from the public health sector (OR = 2.04, 95% CI = 1.05–3.98). In conclusion, we found considerable knowledge gaps related to ZVD among Greek pregnant women. These study results are useful in targeting pregnant women for the prevention of potential Zika virus infections.
      PubDate: 2017-03-31
      DOI: 10.3390/ijerph14040367
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 368: The Salutary Influence of Forest Bathing on
           Elderly Patients with Chronic Heart Failure

    • Authors: Genxiang Mao, Yongbao Cao, Bozhong Wang, Sanying Wang, Zhuomei Chen, Jirong Wang, Wenmin Xing, Xiaoxu Ren, Xiaoling Lv, Jianhua Dong, Shasha Chen, Xiuyuan Chen, Guofu Wang, Jing Yan
      First page: 368
      Abstract: Abstract: The aim of the current study was to test the hypothesis that forest bathing would be beneficial for elderly patients with chronic heart failure (CHF) as an adjunctive therapy. Two groups of participants with CHF were simultaneously sent to the forest or an urban control area for a four-day trip, respectively. Subjects exposed to the forest site showed a significant reduction of brain natriuretic peptide (BNP) in comparison to that of the city group and their own baseline levels. The values for the cardiovascular disease related pathological factors, including endothelin-1 (ET-1), and constituents of the renin-angiotensin system (RAS), including renin, angiotensinogen (AGT), angiotensin II (ANGII), and ANGII receptor type 1 or 2 (AT1 or AT2) in subjects exposed to the forest environment were lower than those in the urban control group. Obviously, a decreased level of inflammatory cytokines and improved antioxidant function was observed in the forest group rather than in the city group. The assessment of the profile of mood states (POMS) indicated that the negative emotional mood state was alleviated after forest bathing. As anticipated, a better air quality in the forest site was observed according to the detection of PM2.5 (particulate matter <2.5 μm) and negative ions. These results provided direct evidence that forest bathing has a beneficial effect on CHF patients, and thus may pave the way for potential development of forest bathing as an effective adjunctive therapy on cardiovascular disorders.
      PubDate: 2017-03-31
      DOI: 10.3390/ijerph14040368
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 369: Time Trend and Demographic and Geographic
           Disparities in Childhood Obesity Prevalence in China—Evidence from
           Twenty Years of Longitudinal Data

    • Authors: Peng Jia, Hong Xue, Ji Zhang, Youfa Wang
      First page: 369
      Abstract: Childhood overweight and obesity (ow/ob) has become a serious threat to many countries, including China. However, limited evidence was obtained from longitudinal data in China. This study examined the secular trends and geographic variation in the prevalence of ow/ob and obesity only, and age, gender, and urban-rural disparities among school-aged children across China. Data from children aged 6–17 surveyed in China Health and Nutrition Survey (CHNS) from 1991 (n = 2712) to 2011 (n = 1054) were used. Overweight and obesity were defined based on the International Obesity Task Force (IOTF) recommended Asian age-sex-specific BMI cut-off-points. We found that: (1) childhood ow/ob and obesity prevalence increased from 11.7% to 25.2% and from 2.8% to 10.1% during 1991–2011, respectively; (2) children aged 6–12 experienced a 1.3 and 1.6 times increase in ow/ob and obesity prevalence than children aged 13–17, respectively; (3) the urban-rural gap in ow/ob prevalence widened; (4) ow/ob prevalence in boys was higher and increased faster than in girls, especially in an urban setting; and (5) geographic variation was observed with faster increases in more economically developed east, central and northeast regions than in the less developed west. The findings added more nuances to the picture of temporal changes in ow/ob prevalence among Chinese children.
      PubDate: 2017-03-31
      DOI: 10.3390/ijerph14040369
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 370: Health of the Elderly Migration Population in
           China: Benefit from Individual and Local Socioeconomic Status?

    • Authors: Qing Wang
      First page: 370
      Abstract: The study aims to estimate the relationship between the individual/local socioeconomic status and the health of internal elderly migrants in China. A multilevel logistic model was used to estimate this association. The estimations were undertaken for 11,111 migrants aged over 60 years, using nationally representative data: the 2015 Migrant Dynamics Monitoring Survey (MDMS), which was carried out in China. Odds ratios with 95% confidence intervals were reported. Both the household income per capita and the area-level average wage were positively associated with migrants’ self-reported health; however, public service supply was not significantly related to their health. In addition, given the household income, migrants living in communities with a higher average wage were more likely to report poor health. Migrants’ health benefited from individual socioeconomic status, but not from the local socioeconomic status, which the migrants cannot enjoy. This study highlights the importance of multilevel and non-discriminatory policies between migrants and local residents.
      PubDate: 2017-04-01
      DOI: 10.3390/ijerph14040370
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 371: Hand Hygiene Intervention Strategies to Reduce
           Diarrhoea and Respiratory Infections among Schoolchildren in Developing
           Countries: A Systematic Review

    • Authors: Balwani Mbakaya, Paul Lee, Regina Lee
      First page: 371
      Abstract: Effective and appropriate hand-washing practice for schoolchildren is important in preventing infectious diseases such as diarrhoea, which is the second most common cause of death among school-age children in sub-Saharan Africa. The objective of the review was to identify hand hygiene intervention strategies to reduce infectious diseases such as diarrhoea and respiratory tract infections among schoolchildren aged 6–12 years in developing countries. Published research articles were searched from databases covering a period from as far back as the creation of the databases to November 2015. Eight randomized controlled trials (RCT/CRCT) from developing countries met the inclusion criteria. The Jadad Scale for appraising RCT/CRCT studies revealed methodological challenges in most studies, such that 75% (6/8) were rated as low-quality articles. The review found that hand hygiene can reduce the incidence of diarrhoea and respiratory conditions. Three hand hygiene intervention strategies utilized were training, funding and policy, with training and funding implemented more commonly than policy. These strategies were not only used in isolation but also in combination, and they qualified as multi-level interventions. Factors that influenced hand washing were contextual, psychosocial and technological. Findings can inform school health workers in categorizing and prioritizing activities into viable strategies when implementing multi-level hand-washing interventions. This review also adds to the existing evidence that multi-level hand-washing interventions can reduce the incidence of diarrhoea, respiratory infections, and school absenteeism. Further evidence-based studies are needed with improved methodological rigour in developing countries, to inform policy in this area.
      PubDate: 2017-04-01
      DOI: 10.3390/ijerph14040371
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 372: Are Structural Changes in Polish Rural Areas
           Fostering Leisure-Time Physical Activity?

    • Authors: Elżbieta Biernat, Piotr Bartkiewicz, Sonia Buchholtz
      First page: 372
      Abstract: Background: In this study, we analyze the determinants of leisure-time physical activity (LTPA) of farmers and non-farmers living in rural areas. Methods: We use statistical analysis to describe urban and rural populations, as well as econometric techniques (Heckman regressions and propensity score matching) to assess the role of rural lifestyle in physical activity. Results: World Health Organization (WHO) pro-health PA (physical activity) recommendations are not met by 66% of farmers and 49% of other dwellers in rural areas. Approximately two thirds of them are completely inactive. Farmers enjoy vigorous PA (VPA), cycling and recreational walking less than their non-farming counterparts and are 46% less likely to be active than them; however the difference disappears when they take up an activity. The amount of PA is negatively correlated with age, but tends to increase for older people compared to those in middle age. Women are 6%–7% less active than men, yet the odds of being active at all are higher for women than for men. Household size is negatively correlated with LTPA. Conclusion: Considering the structural changes, rural area dwellers, especially farmers, require public intervention aimed at increasing their awareness of the advantages of LTPA.
      PubDate: 2017-04-01
      DOI: 10.3390/ijerph14040372
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 373: Requalification of a Brazilian Trichoderma
           Collection and Screening of Its Capability to Decolourise Real Textile
           Effluent

    • Authors: Dianny Silva Lisboa, Cledir Santos, Renan Barbosa, Oliane Magalhães, Laura Paiva, Keila Moreira, Nelson Lima, Cristina Souza-Motta
      First page: 373
      Abstract: Water contamination with large amounts of industrial textile coloured effluents is an environmental concern. For the treatment of textile effluents, white-rot fungi have received extensive attention due to their powerful capability to produce oxidative (e.g., ligninolytic) enzymes. In addition, other groups of fungi, such as species of Aspergillus and Trichoderma, have also been used for textile effluents treatment. The main aim of the present study was to requalify a Brazilian Trichoderma culture collection of 51 Trichoderma strains, isolated from different sources in Brazil and preserved in the oldest Latin-American Fungal Service Culture Collection, The Micoteca URM WDCM 804 (Recife, Brazil). Fungal isolates were re-identified through a polyphasic approach including macro- and micro-morphology and molecular biology, and screened for their capability to decolourise real effluents collected directly from storage tanks of a textile manufacture. Trichoderma atroviride URM 4950 presented the best performance on the dye decolourisation in real textile effluent and can be considered in a scale-up process at industrial level. Overall, the potential of Trichoderma strains in decolourising real textile dye present in textile effluent and the production of the oxidative enzymes Lac, LiP and MnP was demonstrated. Fungal strains are available in the collection e-catalogue to be further explored from the biotechnological point of view.
      PubDate: 2017-04-01
      DOI: 10.3390/ijerph14040373
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 374: Pollutants’ Release, Redistribution and
           Remediation of Black Smelly River Sediment Based on Re-Suspension and Deep
           Aeration of Sediment

    • Authors: Lin Zhu, Xun Li, Chen Zhang, Zengqiang Duan
      First page: 374
      Abstract: Heavily polluted sediment is becoming an important part of water pollution, and this situation is particularly acute in developing countries. Sediment has gradually changed from being the pollution adsorbent to the release source and has influenced the water environment and public health. In this study, we evaluated the pollutant distribution in sediment in a heavily polluted river and agitated the sediment in a heavily polluted river to re-suspend it and re-release pollutants. We found that the levels of chemical oxygen demand (COD), NH4+-N, total nitrogen (TN), and total phosphorus (TP) in overlying water were significantly increased 60 min after agitation. The distribution of the pollutants in the sediment present high concentrations of pollutants congregated on top of the sediment after re-settling, and their distribution decreased with depth. Before agitation, the pollutants were randomly distributed throughout the sediment. Secondly, deep sediment aeration equipment (a micro-porous air diffuser) was installed during the process of sedimentation to study the remediation of the sediment by continuous aeration. The results revealed that deep sediment aeration after re-suspension significantly promoted the degradation of the pollutants both in overlying water and sediment, which also reduced the thickness of the sediment from 0.9 m to 0.6 m. Therefore, sediment aeration after suspension was efficient, and is a promising method for sediment remediation applications.
      PubDate: 2017-04-01
      DOI: 10.3390/ijerph14040374
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 375: Leptin Receptor Gene Polymorphism and the Risk
           of Cardiovascular Disease: A Systemic Review and Meta-Analysis

    • Authors: Lei Wu, Dali Sun
      First page: 375
      Abstract: Objective: Few studies have assessed the association between leptin receptor (LEPR) gene polymorphism and the risk of cardiovascular disease (CVD). Of the few epidemiological studies on this topic, the results are still controversial. Methods: PubMed and Embase were screened for studies from their inception to 9 October 2016. The pooled odds ratio (OR) with the corresponding confidence intervals (CI) were used to measure the effect size for studies that reported the association under allelic, homozygous, and dominant models. Pre-specified characteristics were conducted in the subgroup analysis. Heterogeneity between subgroups was evaluated by meta-regression analysis. Results: Seven eligible studies involving 44,133 participants were included in our meta-analysis. Borderline significant association was observed between the LEPR gene polymorphism (rs1137101, rs1137100, rs6700896, and rs8179183) and the increased risk of CVD with considerable heterogeneity under the allelic model, and the overall pooled OR (95% CI) was 1.10 (0.99, 1.22). The LEPR gene variant rs6700896, 109G allele, and 109GG genotype were significantly associated with the increased risk of CVD. Furthermore, stratified group analysis revealed that the association was more pronounced for stroke. Race-differences might also cause the considerable heterogeneity and non-significant association. Conclusions: This is the first systematic review and meta-analysis to investigate the association between LEPR gene variants and CVD risk. Some LEPR gene variants were significantly associated with the increased risk of CVD. However, the present study is limited in its small number of included studies, considerable heterogeneity, and observational study design. Further research is still warranted to confirm the magnitude of the association.
      PubDate: 2017-04-03
      DOI: 10.3390/ijerph14040375
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 376: The Prevalence of Hypertension Accompanied by
           High Homocysteine and its Risk Factors in a Rural Population: A
           Cross-Sectional Study from Northeast China

    • Authors: Ye Chang, Yuan Li, Xiaofan Guo, Yintao Chen, Dongxue Dai, Yingxian Sun
      First page: 376
      Abstract: Previous studies found that hypertension and high homocysteine (HHcy) exhibited a synergistic effect on the risk of cardiovascular diseases. This study aimed to investigate the prevalence of hypertension accompanied by HHcy and its risk factors in the rural areas of northeast China. This study was conducted using a stratified cluster random sampling method, and included 6529 subjects with complete data. Demographic characteristics were obtained from a questionnaire. Blood pressure and anthropometric indices were measured, and serum indices were analyzed. Hypertension accompanied by HHcy was defined as hypertension plus HHcy [homocysteine (Hcy) > 10 µmol/L]. The mean concentration of Hcy was 17.29 μmol/L in the general population. The prevalence of hypertension accompanied by HHcy was so high that it reached 45.1% of our study population and accounted for 86.8% of the total participants with hypertension. Multiple logistic regression analysis indicated that the modifiable risk factors of hypertension accompanied by HHcy included obesity, diabetes, dyslipidemia, and inactive physical activities. We found that the mean level of Hcy, and the prevalences of HHcy and hypertension accompanied by HHcy were very high among the rural population of northeast China. Obesity, diabetes, dyslipidemia, and inactive physical activities were modifiable risk factors of hypertension accompanied by HHcy.
      PubDate: 2017-04-03
      DOI: 10.3390/ijerph14040376
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 377: Why Do People Exercise in Natural
           Environments? Norwegian Adults’ Motives for Nature-, Gym-, and
           Sports-Based Exercise

    • Authors: Giovanna Calogiuri, Lewis Elliott
      First page: 377
      Abstract: Exercise in natural environments (“green exercise”) confers numerous health benefits, but little is known about why people engage in green exercise. This study examined the importance of nature experiences as a motive for physical activity and the motivational profile of people who engage in green exercise compared to gym- and sports-based exercise. Physical activity motives and typical times spent in different domains of physical activity were reported by 2168 Norwegian adults in a survey. Experiencing nature was generally rated as the second-most important physical activity motive, exceeded only by convenience motives, and it was especially important for older adults and those who engage in greater amounts of instrumental physical activity. Green exercisers reported stronger motives concerning convenience and experiencing nature, whereas gym- or sports-based exercisers reported stronger motives for physical health and sociability. The motives associated with different leisure-time exercise domains may assist in understanding optimal promotion of green exercise.
      PubDate: 2017-04-04
      DOI: 10.3390/ijerph14040377
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 378: Can Urbanization, Social and Spatial
           Disparities Help to Understand the Rise of Cardiometabolic Risk Factors in
           Bobo-Dioulasso? A Study in a Secondary City of Burkina Faso, West Africa

    • Authors: Augustin Zeba, Marceline Yaméogo, Somnoma Tougouma, Daouda Kassié, Florence Fournet
      First page: 378
      Abstract: Background: Unplanned urbanization plays a key role in chronic disease growth. This population-based cross-sectional study assessed the occurrence of cardiometabolic risk factors in Bobo-Dioulasso and their association with urbanization conditions. Methods: Through spatial sampling, four Bobo-Dioulasso sub-spaces were selected for a population survey to measure the adult health status. Yéguéré, Dogona, Tounouma and Secteur 25 had very different urbanization conditions (position within the city; time of creation and healthcare structure access). The sample size was estimated at 1000 households (250 for each sub-space) in which one adult (35 to 59-year-old) was randomly selected. Finally, 860 adults were surveyed. Anthropometric, socioeconomic and clinical data were collected. Arterial blood pressure was measured and blood samples were collected to assess glycemia. Results: Weight, body mass index and waist circumference (mean values) and serum glycemia (83.4 mg/dL ± 4.62 mmol/L) were significantly higher in Tounouma, Dogona, and Secteur 25 than in Yéguéré; the poorest and most rural-like sub-space (p = 0.001). Overall, 43.2%, 40.5%, 5.3% and 60.9% of participants had overweight, hypertension, hyperglycemia and one or more cardiometabolic risk markers, respectively. Conclusions: Bobo-Dioulasso is unprepared to face this public health issue and urgent responses are needed to reduce the health risks associated with unplanned urbanization.
      PubDate: 2017-04-04
      DOI: 10.3390/ijerph14040378
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 379: How to Tackle Key Challenges in the Promotion
           of Physical Activity among Older Adults (65+): The AEQUIPA Network
           Approach

    • Authors: Sarah Forberger, Karin Bammann, Jürgen Bauer, Susanne Boll, Gabriele Bolte, Tilman Brand, Andreas Hein, Frauke Koppelin, Sonia Lippke, Jochen Meyer, Claudia Pischke, Claudia Voelcker-Rehage, Hajo Zeeb
      First page: 379
      Abstract: The paper introduces the theoretical framework and methods/instruments used by the Physical Activity and Health Equity: Primary Prevention for Healthy Ageing (AEQUIPA) prevention research network as an interdisciplinary approach to tackle key challenges in the promotion of physical activity among older people (65+). Drawing on the social-ecological model, the AEQUIPA network developed an interdisciplinary methodological design including quantitative/qualitative studies and systematic reviews, while combining expertise from diverse fields: public health, psychology, urban planning, sports sciences, health technology and geriatrics. AEQUIPA tackles key challenges when promoting physical activity (PA) in older adults: tailoring of interventions, fostering community readiness and participation, strengthening intersectoral collaboration, using new technological devices and evaluating intervention generated inequalities. AEQUIPA aims to strengthen the evidence base for age-specific preventive PA interventions and to yield new insights into the explanatory power of individual and contextual factors. Currently, the empirical work is still underway. First experiences indicate that thenetwork has achieved a strong regional linkage with communities, local stakeholders and individuals. However, involving inactive persons and individuals from minority groups remained challenging. A review of existing PA intervention studies among the elderly revealed the potential to assess equity effects. The results will add to the theoretical and methodological discussion on evidence-based age-specific PA interventions and will contribute to the discussion about European and national health targets.
      PubDate: 2017-04-04
      DOI: 10.3390/ijerph14040379
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 380: Evaluation of the “Eat Better Feel Better”
           Cooking Programme to Tackle Barriers to Healthy Eating

    • Authors: Ada Garcia, Rebecca Reardon, Elizabeth Hammond, Alison Parrett, Anne Gebbie-Diben
      First page: 380
      Abstract: We evaluated a 6-week community-based cooking programme, “Eat Better Feel Better”, aimed at tackling barriers to cooking and healthy eating using a single-group repeated measures design. 117 participants enrolled, 62 completed baseline and post-intervention questionnaires, and 17 completed these and a 3–4 months follow-up questionnaire. Most participants were female, >45 years, and socioeconomically deprived. Confidence constructs changed positively from baseline to post-intervention (medians, scale 1 “not confident” to 7 “very confident”): “cooking using raw ingredients” (4, 6 p < 0.003), “following simple recipe” (5, 6 p = 0.003), “planning meals before shopping” (4, 5 p = <0.001), “shopping on a budget (4, 5 p = 0.044), “shopping healthier food” (4, 5 p = 0.007), “cooking new foods” (3, 5 p < 0.001), “cooking healthier foods” (4, 5 p = 0.001), “storing foods safely” (5, 6 p = 0.002); “using leftovers” (4, 5 p = 0.002), “cooking raw chicken” (5, 6 p = 0.021), and “reading food labels” (4, 5 p < 0.001). “Microwaving ready-meals” decreased 46% to 39% (p = 0.132). “Preparing meals from scratch” increased 48% to 59% (p = 0.071). Knowledge about correct portion sizes increased 47% to 74% (p = 0.002). Spending on ready-meals/week decreased. Follow-up telephone interviewees (n = 42) reported developing healthier eating patterns, spending less money/wasting less food, and preparing more meals/snacks from raw ingredients. The programme had positive effects on participants’ cooking skills confidence, helped manage time, and reduced barriers of cost, waste, and knowledge.)
      PubDate: 2017-04-04
      DOI: 10.3390/ijerph14040380
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 381: Epidemiology of Burns in Rural Bangladesh: An
           Update

    • Authors: Siran He, Olakunle Alonge, Priyanka Agrawal, Shumona Sharmin, Irteja Islam, Saidur Mashreky, Shams Arifeen
      First page: 381
      Abstract: Each year, approximately 265,000 deaths occur due to burns on a global scale. In Bangladesh, around 173,000 children under 18 sustain a burn injury. Since most epidemiological studies on burn injuries in low and middle-income countries are based on small-scale surveys or hospital records, this study aims to derive burn mortality and morbidity measures and risk factors at a population level in Bangladesh. A household survey was conducted in seven rural sub-districts of Bangladesh in 2013 to assess injury outcomes. Burn injuries were one of the external causes of injury. Epidemiological characteristics and risk factors were described using descriptive as well as univariate and multivariate logistic regression analyses. The overall mortality and morbidity rates were 2 deaths and 528 injuries per 100,000 populations. Females had a higher burn rate. More than 50% of injuries were seen in adults 25 to 64 years of age. Most injuries occurred in the kitchen while preparing food. 88% of all burns occurred due to flame. Children 1 to 4 years of age were four times more likely to sustain burn injuries as compared to infants. Age-targeted interventions, awareness of first aid protocols, and improvement of acute care management would be potential leads to curb death and disability due to burn injuries.
      PubDate: 2017-04-05
      DOI: 10.3390/ijerph14040381
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 382: A Comparative Health Risk Assessment of
           Electronic Cigarettes and Conventional Cigarettes

    • Authors: Jinsong Chen, Chris Bullen, Kim Dirks
      First page: 382
      Abstract: Background: Although some studies have identified hazardous substances in electronic cigarette (EC) liquids and emissions, there is limited information about the health risks of using ECs. Methods: In this study, the U.S. Environmental Protection Agency (EPA) health risk assessment model and findings of a literature review were used to determine and profile hazards. Focus was put on the toxicants reported in the literature on conventional cigarette (CC) smoke that most strongly associated with adverse health effects. To evaluate their health risks, dose-response relationships and standard-use conditions were used to estimate average hazard exposures and to calculate the overall health risks of ECs and CCs, benchmarked against international guideline levels for each hazard. Results: Four hazards (acrolein, diethylene glycol, propylene glycol and cadmium) reported in EC emissions and seven hazards (acetaldehyde, acrolein, formaldehyde, cadmium, CO, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), N′-nitrosonornicotine (NNN)) reported in CC emissions had maximum exposure levels higher than the guideline levels. Two hazards (acrolein, propylene glycol) in EC emissions and five hazards (acetaldehyde, acrolein, formaldehyde, cadmium, NNN) in CC emissions had average exposure levels higher than the guideline levels. Conclusions: Based on the conditions of use, ECs should be a safer nicotine-delivery product than CCs.
      PubDate: 2017-04-05
      DOI: 10.3390/ijerph14040382
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 383: Television Viewing and Its Association with
           Sedentary Behaviors, Self-Rated Heath and Academic Performance among
           Secondary School Students in Peru

    • Authors: Bimala Sharma, Rosemary Cosme Chavez, Ae Jeong, Eun Nam
      First page: 383
      Abstract: The study assessed television viewing >2 h a day and its association with sedentary behaviors, self-rated health, and academic performance among secondary school adolescents. A cross-sectional survey was conducted among randomly selected students in Lima in 2015. We measured self-reported responses of students using a standard questionnaire, and conducted in-depth interviews with 10 parents and 10 teachers. Chi-square test, correlation and multivariate logistic regression analysis were performed among 1234 students, and thematic analysis technique was used for qualitative information. A total of 23.1% adolescents reported watching television >2 h a day. Qualitative findings also show that adolescents spend most of their leisure time watching television, playing video games or using the Internet. Television viewing had a significant positive correlation with video game use in males and older adolescents, with Internet use in both sexes, and a negative correlation with self-rated health and academic performance in females. Multivariate logistic regression analysis shows that television viewing >2 h a day, independent of physical activity was associated with video games use >2 h a day, Internet use >2 h a day, poor/fair self-rated health and poor self-reported academic performance. Television viewing time and sex had a significant interaction effect on both video game use >2 h a day and Internet use >2 h a day. Reducing television viewing time may be an effective strategy for improving health and academic performance in adolescents.
      PubDate: 2017-04-05
      DOI: 10.3390/ijerph14040383
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 384: Building Health Promotion into the Job of Home
           Care Aides: Transformation of the Workplace Health Environment

    • Authors: Naoko Muramatsu, Lijuan Yin, Ting-Ti Lin
      First page: 384
      Abstract: Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients’ homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs’ work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) (p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs’ job is feasible and can effectively promote HCAs’ health, especially among older HCAs.
      PubDate: 2017-04-05
      DOI: 10.3390/ijerph14040384
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 385: How Does Ambient Air Temperature Affect
           Diabetes Mortality in Tropical Cities?

    • Authors: Xerxes Seposo, Tran Dang, Yasushi Honda
      First page: 385
      Abstract: Diabetes is well-known as one of the many chronic diseases that affect different age groups. Currently, most studies that evaluated the effects of temperature on diabetes mortality focused on temperate and subtropical settings, but no study has been conducted to assess the relationship in a tropical setting. We conducted the first multi-city study carried out in tropical cities, which evaluated the temperature–diabetes relationship. We collected daily diabetes mortality (ICD E10–E14) of four Philippine cities from 2006 to 2011. Same period meteorological data were obtained from the National Oceanic and Atmospheric Administration. We used a generalized additive model coupled with a distributed lag non-linear model (DLNM) in determining the relative risks. Results showed that both low and high temperatures pose greater risks among diabetics. Likewise, the study was able to observe the: (1) high risk brought about by low temperature, aside from the largely observed high risks by high temperature; and (2) protective effects in low temperature percentile. These results provide significant policy implications with strategies related to diabetes risk groups in relation to health service and care strategies.
      PubDate: 2017-04-05
      DOI: 10.3390/ijerph14040385
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 386: Antibiotic Resistance in an Indian Rural
           Community: A ‘One-Health’ Observational Study on Commensal Coliform
           from Humans, Animals, and Water

    • Authors: Manju Purohit, Salesh Chandran, Harshada Shah, Vishal Diwan, Ashok Tamhankar, Cecilia Stålsby Lundborg
      First page: 386
      Abstract: Antibiotic-resistant bacteria are an escalating grim menace to global public health. Our aim is to phenotype and genotype antibiotic-resistant commensal Escherichia coli (E. coli) from humans, animals, and water from the same community with a ‘one-health’ approach. The samples were collected from a village belonging to demographic surveillance site of Ruxmaniben Deepchand (R.D.) Gardi Medical College Ujjain, Central India. Commensal coliforms from stool samples from children aged 1–3 years and their environment (animals, drinking water from children's households, common source- and waste-water) were studied for antibiotic susceptibility and plasmid-encoded resistance genes. E. coli isolates from human (n = 127), animal (n = 21), waste- (n = 12), source- (n = 10), and household drinking water (n = 122) carried 70%, 29%, 41%, 30%, and 30% multi-drug resistance, respectively. Extended spectrum beta-lactamase (ESBL) producers were 57% in human and 23% in environmental isolates. Co-resistance was frequent in penicillin, cephalosporin, and quinolone. Antibiotic-resistance genes blaCTX-M-9 and qnrS were most frequent. Group D-type isolates with resistance genes were mainly from humans and wastewater. Colistin resistance, or the mcr-1 gene, was not detected. The frequency of resistance, co-resistance, and resistant genes are high and similar in coliforms from humans and their environment. This emphasizes the need to mitigate antibiotic resistance with a ‘one-health’ approach.
      PubDate: 2017-04-06
      DOI: 10.3390/ijerph14040386
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 387: Relative Association of Multi-Level Supportive
           Environments on Poor Health among Older Adults

    • Authors: Nelda Mier, Marcia Ory, Samuel Towne, Matthew Smith
      First page: 387
      Abstract: Background: The aging of the United States population poses significant challenges to American healthcare and informal caregiving systems. Additional research is needed to understand how health promotion programs and policies based on a socio-ecological perspective impact the health and well-being of older persons. The purpose of this study was to investigate personal characteristics and supportive environments associated with poor health among older individuals aged 65 and over. Methods: This study used a cross-sectional design and was guided by a conceptual framework developed by the authors to depict the relationship between personal characteristics and environments associated with poor health status. Environment types included in this study were family, home, financial, neighborhood, and healthcare. The sample was comprised of 1319 adults aged 65 years and older residing in Central Texas. From a random selection of households, participants were administered a mail-based survey created by a community collaborative effort. Descriptive statistics and three binary logistic regression models were fitted to examine associations with poor health status (i.e., physical, mental, and combined physical/mental). Results: Two personal characteristics (number of chronic conditions and educational level) were consistently related (p < 0.05) to health outcomes. Supportive family, home, financial, neighborhood, and health care environmental factors were shown to be related (p < 0.05) to various aspects of physical or mental health outcomes. Conclusions: Multidimensional factors including personal characteristics and protective environments are related to health status among older individuals. The unique roles of each environment can help inform public health interventions to create and enhance support for older adults to engage in healthful activities and improve their physical and mental health.
      PubDate: 2017-04-06
      DOI: 10.3390/ijerph14040387
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 388: Low-Level Toxic Metal Exposure in Healthy
           Weaning-Age Infants: Association with Growth, Dietary Intake, and Iron
           Deficiency

    • Authors: Jungil Choi, Ju Chang, Jeana Hong, Sue Shin, Jeong Park, Sohee Oh
      First page: 388
      Abstract: Even low levels of toxic metal exposure (As, Cd, Hg, and Pb) in infancy might be harmful to children’s development. This study investigated toxic metal exposure on healthy weaning-age infants and its relationship with growth, diet, and iron/anemia status. The weight, height, head circumference, whole blood levels of four toxic metals, hemoglobin, and serum ferritin of healthy infants was measured. Among 210 infants with a median age of 11.4 months (interquartile range: 10.5–12.0), the median levels of As, Cd, Hg, and Pb were 1.2 μg/L, 0.05 μg/L, 0.8 μg/L, and 0.83 μg/dL, respectively. In adjusted linear regression models, post-birth weight gain (Pb) and current head circumference (As, Pb) were negatively associated with toxic metal levels. In multiple linear regression or logistic regression analysis, the duration of breastfeeding (all four metals), perceived adequacy of rice-based food intake (As), regular fish intake (As, Hg), and iron deficiency with/without anemia (Cd, Pb) were associated with increased toxic metal levels. Although levels of toxic metals may not usually be high in this population, individual exposure risk may need to be assessed after considering the type of feeding or intake of complementary foods and the iron/anemia status while evaluating growth status during late infancy.
      PubDate: 2017-04-06
      DOI: 10.3390/ijerph14040388
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 389: An Overview of Literature Topics Related to
           Current Concepts, Methods, Tools, and Applications for Cumulative Risk
           Assessment (2007–2016)

    • Authors: Mary Fox, L. Brewer, Lawrence Martin
      First page: 389
      Abstract: Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. The first context is the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search and discusses a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications.
      PubDate: 2017-04-07
      DOI: 10.3390/ijerph14040389
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 390: Regretting Ever Starting to Smoke: Results
           from a 2014 National Survey

    • Authors: Pratibha Nayak, Terry Pechacek, Paul Slovic, Michael Eriksen
      First page: 390
      Abstract: Background: The majority of smokers regret ever starting to smoke, yet the vast majority continue to smoke despite the fact that smoking kills nearly 50% of lifetime users. This study examined the relationships between regret and smoker characteristics, quit history, risk perceptions, experiential thinking, and beliefs and intentions at time of smoking initiation. Methods: Data from the 2014 Tobacco Products and Risk Perceptions Survey, a nationally representative survey of United States adults, were analyzed to provide the latest prevalence estimates of regret and potential predictors. Relationships among predictor variables and regret were analyzed using correlations, t-tests, and multinomial logistic regression. Results: The majority of smokers (71.5%) regretted starting to smoke. Being older and non-Hispanic white were significant predictors of regret. Smokers having a high intention to quit, having made quit attempts in the past year, worrying about getting lung cancer, believing smoking every day can be risky for your health, perceiving a risk of being diagnosed with lung cancer during one’s lifetime, and considering themselves addicted to cigarettes were significant predictors of regret for smoking initiation. Conclusions: This study provides updated prevalence data on regret using a national sample, and confirms that regret is associated with perceived risk. The findings from this study can be used to inform smoking intervention programs and support the inclusion of smoker regret in cost–benefit analyses of the economic impact of tobacco regulations.
      PubDate: 2017-04-06
      DOI: 10.3390/ijerph14040390
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 391: Association between Indices of Body
           Composition and Abnormal Metabolic Phenotype in Normal-Weight Chinese
           Adults

    • Authors: Lili Xia, Fen Dong, Haiying Gong, Guodong Xu, Ke Wang, Fen Liu, Li Pan, Ling Zhang, Yuxiang Yan, Herbert Gaisano, Yan He, Guangliang Shan
      First page: 391
      Abstract: We aimed to determine the association of indices of body composition with abnormal metabolic phenotype, and to examine whether the strength of association was differentially distributed in different age groups in normal-weight Chinese adults. A total of 3015 normal-weight adults from a survey of Chinese people encompassing health and basic physiological parameters was included in this cross-sectional study. We investigated the association of body composition measured by bioelectrical impedance analysis and conventional body indices with metabolically unhealthy normal-weight (MUHNW) adults, divided by age groups and gender. Associations were assessed by multiple logistic regression analysis. We found abnormal metabolism in lean Chinese adults to be associated with higher adiposity indices (body mass index, BMI), waist circumference, and percentage body fat), lower skeletal muscle %, and body water %. Body composition was differentially distributed in age groups within the metabolically healthy normal weight (MHNW)/MUHNW groups. The impact of factors related to MUHNW shows a decreasing trend with advancing age in females and disparities of factors (BMI, body fat %, skeletal muscle %, and body water %) associated with the MUHNW phenotype in the elderly was noticed. Those factors remained unchanged in males throughout the age range, while the association of BMI, body fat %, skeletal muscle %, and body water % to MUHNW attenuated and grip strength emerged as a protective factor in elderly females. These results suggest that increased adiposity and decreased skeletal muscle mass are associated with unfavorable metabolic traits in normal-weight Chinese adults, and that MUHNW is independent of BMI, while increased waist circumference appears to be indicative of an abnormal metabolic phenotype in elderly females.
      PubDate: 2017-04-07
      DOI: 10.3390/ijerph14040391
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 392: Disparities in HIV Clinical Outcomes among a
           Cohort of HIV-Infected Persons Receiving Care—Mississippi

    • Authors: Ali Dehghani Firouzabadi, Tiffany McDonald, Tametria Samms, Reza Sirous, Kendra Johnson
      First page: 392
      Abstract: Increasing patients’ cluster of differentiation 4 (CD4) count and achieving viral suppression are the ultimate goals of the human immunodeficiency virus (HIV) care and treatment, yet disparities in these HIV clinical outcomes exist among subpopulations of HIV-infected persons. We aimed to assess potential disparities in viral suppression and normal CD4 count among HIV-infected persons receiving care in Mississippi using Mississippi Medical Monitoring Project (MMP) data from 2009 to 2014 (N = 1233) in this study. Outcome variables in this study were suppressed, recent and durable viral load, and normal CD4 count. Patients’ characteristics in this study were race, gender, age, annual income, education, insurance, and length of diagnosis. Descriptive statistics, Chi square tests, and logistic regression analyses were conducted using the SAS 9.4 Proc Survey procedure. Our findings indicate that those aged 50 years or older were more likely to have suppressed recent viral load (adjusted Odds Ratio (aOR) = 2.4) and durable viral loads (aOR = 2.9), compared to those aged 18–24 years. In addition, women were more likely to have a normal CD4 count than men (aOR = 1.4). In conclusion, we found that age and gender disparities in HIV clinical outcomes may be used to develop and implement multifaceted interventions to improve health equity among all HIV-infected patients.
      PubDate: 2017-04-07
      DOI: 10.3390/ijerph14040392
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 393: Life Course Trajectories of Later-Life
           Cognitive Functions: Does Social Engagement in Old Age Matter?

    • Authors: Sojung Park, Eunsun Kwon, Hyunjoo Lee
      First page: 393
      Abstract: This study identified differential patterns of later-life cognitive function trajectories and examined to what extent life course factors and social engagement are associated with group trajectories. Data came from seven waves of the Health and Retirement Study (HRS 1998–2010; n = 7374; Observations = 41,051). Latent class growth analysis identified cognitive function trajectory groups, and multinomial logistic regression was used to examine the factors associated with group trajectories. Five heterogeneous trajectories were identified: stable high, stable moderate, stable low, high-to-moderate, and moderate-to-low. Findings suggest that, after adjusting for life course factors, individuals who became volunteers were more likely to belong to one of the two least vulnerable trajectories, stable high or high-to-moderate. Our findings suggest that, despite the cumulative life course factors evident in cognitive decline, social engagement in old age may serve as a potential protective resource.
      PubDate: 2017-04-07
      DOI: 10.3390/ijerph14040393
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 394: Urban–Rural Variations in Quality-of-Life in
           Breast Cancer Survivors Prescribed Endocrine Therapy

    • Authors: Caitriona Cahir, Audrey Thomas, Stephan Dombrowski, Kathleen Bennett, Linda Sharp
      First page: 394
      Abstract: The number of breast cancer survivors has increased as a result of rising incidence and increased survival. Research has revealed significant urban–rural variation in clinical aspects of breast cancer but evidence in the area of survivorship is limited. We aimed to investigate whether quality of life (QoL) and treatment-related symptoms vary between urban and rural breast cancer survivors prescribed endocrine therapy. Women with a diagnosis of stages I–III breast cancer prescribed endocrine therapy were identified from the National Cancer Registry Ireland and invited to complete a postal survey (N = 1606; response rate = 66%). A composite measure of urban–rural classification was created using settlement size, population density and proximity to treatment hospital. QoL was measured using the Functional Assessment of Cancer Therapy (FACT-G) and an endocrine subscale. The association between urban–rural residence/status and QoL and endocrine symptoms was assessed using linear regression with adjustment for socio-demographic and clinical covariates. In multivariable analysis, rural survivors had a statistically significant higher overall QoL (β = 3.81, standard error (SE) 1.30, p < 0.01), emotional QoL (β = 0.70, SE 0.21, p < 0.01) and experienced a lower symptom burden (β = 1.76, SE 0.65, p < 0.01) than urban survivors. QoL in breast cancer survivors is not simply about proximity and access to healthcare services but may include individual and community level psychosocial factors.
      PubDate: 2017-04-07
      DOI: 10.3390/ijerph14040394
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 395: Screening for Cd-Safe Cultivars of Chinese
           Cabbage and a Preliminary Study on the Mechanisms of Cd Accumulation

    • Authors: Jingjie Wang, Nan Yu, Guangmao Mu, Kamran Shinwari, Zhenguo Shen, Luqing Zheng
      First page: 395
      Abstract: With the rapid progress of industrialization, the effects of environmental contamination on plant toxicity, and subsequently on human health, is a growing concern. For example, the heavy metal pollution of soil such as that caused by cadmium (Cd) is a serious threat. Therefore, screening for pollution-safe edible plants is an essential approach for growing plants under heavy metal-contaminated soils. In the current study, 35 Chinese cabbage (Brassica pekinensis L.) cultivars were selected with the aim of screening for Cd-safe cultivars (CSCs), analyzing their safety, and exploring the mechanism of Cd accumulation. Our field-culture experiments revealed that the Cd content in the edible parts of the cultivars were varied and were determined to possibly be CSCs. Hydroponics experiments were used to simulate six different degrees of soil contamination (high and low Cd concentrations) on possible CSCs. The results indicated a significant difference (p < 0.05) in Cd concentration in the cultivars, and verified the safety of these possible CSCs. The analyses of the transport coefficient and expression levels showed that the differences in Cd accumulation among the Chinese cabbage cultivars were related to the expression of genes involved in absorption and transport rather than a root-to-shoot translocation limitation.
      PubDate: 2017-04-07
      DOI: 10.3390/ijerph14040395
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 396: Modeling Fire Occurrence at the City Scale: A
           Comparison between Geographically Weighted Regression and Global Linear
           Regression

    • Authors: Chao Song, Mei-Po Kwan, Jiping Zhu
      First page: 396
      Abstract: An increasing number of fires are occurring with the rapid development of cities, resulting in increased risk for human beings and the environment. This study compares geographically weighted regression-based models, including geographically weighted regression (GWR) and geographically and temporally weighted regression (GTWR), which integrates spatial and temporal effects and global linear regression models (LM) for modeling fire risk at the city scale. The results show that the road density and the spatial distribution of enterprises have the strongest influences on fire risk, which implies that we should focus on areas where roads and enterprises are densely clustered. In addition, locations with a large number of enterprises have fewer fire ignition records, probably because of strict management and prevention measures. A changing number of significant variables across space indicate that heterogeneity mainly exists in the northern and eastern rural and suburban areas of Hefei city, where human-related facilities or road construction are only clustered in the city sub-centers. GTWR can capture small changes in the spatiotemporal heterogeneity of the variables while GWR and LM cannot. An approach that integrates space and time enables us to better understand the dynamic changes in fire risk. Thus governments can use the results to manage fire safety at the city scale.
      PubDate: 2017-04-08
      DOI: 10.3390/ijerph14040396
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 397: Towards a Long-Term Strategy for
           Voluntary-Based Internal Radiation Contamination Monitoring: A
           Population-Level Analysis of Monitoring Prevalence and Factors Associated
           with Monitoring Participation Behavior in Fukushima, Japan

    • Authors: Shuhei Nomura, Masaharu Tsubokura, Akihiko Ozaki, Michio Murakami, Susan Hodgson, Marta Blangiardo, Yoshitaka Nishikawa, Tomohiro Morita, Tomoyoshi Oikawa
      First page: 397
      Abstract: Following Japan’s 2011 Fukushima nuclear incident, we assessed voluntary-based monitoring behavior in Minamisoma City—located 10–40 km from the Fukushima nuclear plant—to inform future monitoring strategies. The monitoring in Minamisoma included occasional free of charge internal-radiation-exposure measurements. Out of around 70,000 individuals residing in the city before the incident, a total of 45,788 residents (female: 52.1%) aged ≥21 were evaluated. The monitoring prevalence in 2011–2012 was only 30.2%, and this decreased to 17.9% in 2013–2014. Regression analyses were performed to estimate factors associated with the monitoring prevalence and participation behavior. The results show that, in comparison with the age cohort of 21–30 years, the cohort of 71–80 and ≥81 years demonstrated significantly lower monitoring prevalence; female residents had higher monitoring prevalence than male residents; those who were living in evacuation zones at the time of the incident had higher monitoring prevalence than those who lived outside any of the evacuation zones; for those living outside Fukushima and neighboring Prefectures post-incident monitoring prevalence decreased significantly in 2013–2014. Our findings inform the discussion on the concepts of radiation risk perception and accessibility to monitoring and societal decision-making regarding the maintenance of the monitoring program with low monitoring prevalence. We also stress the possibility that the monitoring can work both to check that internal contamination levels are within acceptable limits, and as a risk communication tool, alleviating individuals’ concern and anxiety over radiation contamination.
      PubDate: 2017-04-09
      DOI: 10.3390/ijerph14040397
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 398: Attractive Toxic Sugar Bait (ATSB) For Control
           of Mosquitoes and Its Impact on Non-Target Organisms: A Review

    • Authors: Jodi M. Fiorenzano, Philip G. Koehler, Rui-De Xue
      First page: 398
      Abstract: Mosquito abatement programs contend with mosquito-borne diseases, insecticidal resistance, and environmental impacts to non-target organisms. However, chemical resources are limited to a few chemical classes with similar modes of action, which has led to insecticide resistance in mosquito populations. To develop a new tool for mosquito abatement programs that control mosquitoes while combating the issues of insecticidal resistance, and has low impacts of non-target organisms, novel methods of mosquito control, such as attractive toxic sugar baits (ATSBs), are being developed. Whereas insect baiting to dissuade a behavior, or induce mortality, is not a novel concept, as it was first introduced in writings from 77 AD, mosquito baiting through toxic sugar baits (TSBs) had been quickly developing over the last 60 years. This review addresses the current body of research of ATSB by providing an overview of active ingredients (toxins) include in TSBs, attractants combined in ATSB, lethal effects on mosquito adults and larvae, impact on non-target insects, and prospects for the use of ATSB.
      PubDate: 2017-04-10
      DOI: 10.3390/ijerph14040398
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 399: Vitamin D Deficiency among Adults with History
           of Pulmonary Tuberculosis in Korea Based on a Nationwide Survey

    • Authors: Mi Joo, Mi Han, Sun Park, Hwan Shin
      First page: 399
      Abstract: We investigated the prevalence of vitamin D deficiency among individuals who have a history of tuberculosis (TB) diagnosis in Korea. Using the 5th Korean National Health and Nutrition Examination Survey, we selected 805 individuals with a history of TB diagnosis and 16,049 controls without a history of TB. Vitamin D deficiency was defined as a 25(OH)D level less than 20 ng/mL. Vitamin D deficiency was revealed in 71.7% of the individuals with a history of TB diagnosis and in 72.1% of the controls. Vitamin D deficiency was more likely in women than in men, in people who engaged in other jobs or were unemployed than in people who engaged in skilled agricultural, forestry, and fishery jobs, and in people who walked 3–5 days per week than in people who walked 6–7 days per week. Vitamin D deficiency was highly prevalent in the TB group. Regular examination and strategies to increase vitamin D levels in individuals with a history of TB are needed, as vitamin D is associated with TB conditions and bone disease.
      PubDate: 2017-04-10
      DOI: 10.3390/ijerph14040399
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 400: Sodium p-Aminosalicylic Acid Reverses
           Sub-Chronic Manganese-Induced Impairments of Spatial Learning and Memory
           Abilities in Rats, but Fails to Restore γ-Aminobutyric Acid Levels

    • Authors: Shao-Jun Li, Chao-Yan Ou, Sheng-Nan He, Xiao-Wei Huang, Hai-Lan Luo, Hao-Yang Meng, Guo-Dong Lu, Yue-Ming Jiang, Tanara Vieira Peres, Yi-Ni Luo, Xiang-Fa Deng
      First page: 400
      Abstract: Excessive manganese (Mn) exposure is not only a health risk for occupational workers, but also for the general population. Sodium para-aminosalicylic acid (PAS-Na) has been successfully used in the treatment of manganism, but the involved molecular mechanisms have yet to be determined. The present study aimed to investigate the effects of PAS-Na on sub-chronic Mn exposure-induced impairments of spatial learning and memory, and determine the possible involvements of γ-aminobutyric acid (GABA) metabolism in vivo. Sprague-Dawley male rats received daily intraperitoneal injections MnCl2 (as 6.55 mg/kg Mn body weight, five days per week for 12 weeks), followed by daily subcutaneous injections of 100, 200, or 300 mg/kg PAS-Na for an additional six weeks. Mn exposure significantly impaired spatial learning and memory ability, as noted in the Morris water maze test, and the following PAS-Na treatment successfully restored these adverse effects to levels indistinguishable from controls. Unexpectedly, PAS-Na failed to recover the Mn-induced decrease in the overall GABA levels, although PAS-Na treatment reversed Mn-induced alterations in the enzyme activities directly responsible for the synthesis and degradation of GABA (glutamate decarboxylase and GABA-transaminase, respectively). Moreover, Mn exposure caused an increase of GABA transporter 1 (GAT-1) and decrease of GABA A receptor (GABAA) in transcriptional levels, which could be reverted by the highest dose of 300 mg/kg PAS-Na treatment. In conclusion, the GABA metabolism was interrupted by sub-chronic Mn exposure. However, the PAS-Na treatment mediated protection from sub-chronic Mn exposure-induced neurotoxicity, which may not be dependent on the GABA metabolism.
      PubDate: 2017-04-10
      DOI: 10.3390/ijerph14040400
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 401: Gender-Specific Impact of Cadmium Exposure on
           Bone Metabolism in Older People Living in a Cadmium-Polluted Area in
           Thailand

    • Authors: Muneko Nishijo, Kowit Nambunmee, Dhitiwass Suvagandha, Witaya Swaddiwudhipong, Werawan Ruangyuttikarn, Yoshikazu Nishino
      First page: 401
      Abstract: To elucidate the influence of cadmium exposure on bone metabolism, associations between urinary/blood cadmium and bone resorption/formation markers were investigated in older cadmium exposed men and women. Increased urinary cross-linked N-telopeptide of type I collagen (NTx), a bone resorption marker, was found to be associated with increased levels of parathyroid hormone, fractional excretion of calcium, and urinary/blood cadmium after adjusting for confounding factors in men. In women, urinary NTx was significantly associated with only urinary cadmium and a strong relationship with increased fractional excretion of calcium. Risk for bone metabolic disorders, indicated by high urinary NTx, significantly increased in men with blood cadmium ≥ 10 μg/L or urinary cadmium ≥ 10 μg/g creatinine. Increased osteocalcin level was significantly associated with increased blood cadmium in men. In conclusion, cadmium exposure appeared to have an influence on bone remodeling both bone resorption and formation in this population of older Thai men, and blood cadmium was more closely associated with bone metabolism than urinary cadmium.
      PubDate: 2017-04-10
      DOI: 10.3390/ijerph14040401
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 402: Relationship between Occupational Stress,
           5-HT2A Receptor Polymorphisms and Mental Health in Petroleum Workers in
           the Xinjiang Arid Desert: A Cross-Sectional Study

    • Authors: Ting Jiang, Hua Ge, Jian Sun, Rong Li, Rui Han, Jiwen Liu
      First page: 402
      Abstract: At present, there is growing interest in research examining the relationship between occupational stress and mental health. Owing to the socioeconomic impact of occupational stress and the unique environment of petroleum workers in Xinjiang, a cross-sectional study was carried out between April and December 2015 to investigate the relationship between occupational stress, 5-hydroxytryptamine receptor (5-HTR2A) genotype, and mental health. A total of 1485 workers were selected. The Symptom Checklist 90 was used to assess nine classes of psychological symptoms. Work-related stressors were evaluated using the Occupational Stress Inventory-Revised Edition. Levels of 5-HTR2A (the Tl02C and A-1438G single nucleotide polymorphism in the 5-HTR2A gene) were measured by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). The findings of the present study revealed a high prevalence rate of mental health problems (40.29%) in petroleum workers stationed in the arid desert, and suggested a strong correlation between occupational stress and mental health. The TC and CC genotype of Tl02C were found to be protective factors against mental health problems (odds ratio (OR) = 0.455, 95% confidence interval (CI): = 0.269–0.771, odds ratio (OR) = 0.340, 95% confidence interval (CI): 0.162–0.716). AG and GG genotype of A-1438G [odds ratio (OR) 1 = 2.729, 95% confidence interval (CI): 1.433–5.195; odds ratio (OR) 2 = 2.480, 95% confidence interval (CI): 1.221–5.037] were revealed as risk factors. These data provide evidence that occupational stress and 5-HTR2A gene polymorphism contributes to the incidence of mental health problems.
      PubDate: 2017-04-10
      DOI: 10.3390/ijerph14040402
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 403: The Life Course Implications of Ready to Use
           Therapeutic Food for Children in Low-Income Countries

    • Authors: Alessandra Bazzano, Kaitlin Potts, Lydia Bazzano, John Mason
      First page: 403
      Abstract: The development of ready-to-use therapeutic food (RUTF) for the treatment of uncomplicated cases of severe acute malnutrition in young children from 6 months to 5 years old has greatly improved survival through the ability to treat large numbers of malnourished children in the community setting rather than at health facilities during emergencies. This success has led to a surge in demand for RUTF in low income countries that are frequently food insecure due to environmental factors such as cyclical drought. Worldwide production capacity for the supply of RUTF has increased dramatically through the expansion and development of new manufacturing facilities in both low and high income countries, and new business ventures dedicated to ready-to-use foods have emerged not only for emergencies, but increasingly, for supplementing caloric intake of pregnant women and young children not experiencing acute undernutrition. Due to the lack of evidence on the long term health impact these products may have, in the midst of global nutrition transitions toward obesity and metabolic dysfunction, the increased use of manufactured, commercial products for treatment and prevention of undernutrition is of great concern. Using a framework built on the life course health development perspective, the current research presents several drawbacks and limitations of RUTF for nutrition of mothers and young children, especially in non-emergency situations. Recommendations follow for potential strategies to limit the use of these products to the treatment of acute undernutrition only, study the longer term health impacts of RUTF, prevent conflict of interests arising for social enterprises, and where possible, ensure that whole foods are supported for life-long health and nutrition, as well as environmental sustainability.
      PubDate: 2017-04-11
      DOI: 10.3390/ijerph14040403
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 404: Geospatial Analysis of Inflammatory Breast
           Cancer and Associated Community Characteristics in the United States

    • Authors: Lia Scott, Lee Mobley, Dora Il’yasova
      First page: 404
      Abstract: Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer, almost always diagnosed at late stage where mortality outcomes and morbidity burdens are known to be worse. Missed by mammography screening, IBC progresses rapidly and reaches late stage by the time of diagnosis. With an unknown etiology and poor prognosis, it is crucial to evaluate the distribution of the disease in the population as well as identify area social and economic contextual risk factors that may be contributing to the observed patterns of IBC incidence. In this study, we identified spatial clustering of county-based IBC rates among US females and examined the underlying community characteristics associated with the clusters. IBC accounted for ~1.25% of all primary breast cancers diagnoses in 2004–2012 and was defined by the Collaborative Stage (CS) Extension code 710 and 730. Global and local spatial clusters of IBC rates were identified and mapped. The Mann-Whitney U test was used to compare median differences in key contextual variables between areas with high and low spatial clusters of IBC rates. High clusters are counties and their neighbors that all exhibit above average rates, clustered together in a fashion that would be extremely unlikely to be observed by chance, and conversely for low clusters. There was statistically significant evidence of spatial clustering into high and low rate clusters. The average rate in the high rate clusters (n = 46) was approximately 12 times the average rate in low rate clusters (n = 126), and 2.2 times the national average across all counties. Significant differences were found in the medians of the underlying race, poverty, and urbanicity variables when comparing the low cluster counties with the high cluster counties (p < 0.05). Cluster analysis confirms that IBC rates differ geographically and may be influenced by social and economic environmental factors. Particular attention may need to be paid to race, urbanicity and poverty when considering risk factors for IBC and when developing interventions and alternative prevention strategies.
      PubDate: 2017-04-11
      DOI: 10.3390/ijerph14040404
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 405: Remote Sensing, Crowd Sensing, and Geospatial
           Technologies for Public Health: An Editorial

    • Authors: Jamal Arsanjani
      First page: 405
      Abstract: n/a
      PubDate: 2017-04-11
      DOI: 10.3390/ijerph14040405
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 406: Mapping Patterns and Trends in the Spatial
           Availability of Alcohol Using Low-Level Geographic Data: A Case Study in
           England 2003–2013

    • Authors: Colin Angus, John Holmes, Ravi Maheswaran, Mark Green, Petra Meier, Alan Brennan
      First page: 406
      Abstract: Much literature examines the relationship between the spatial availability of alcohol and alcohol-related harm. This study aims to address an important gap in this evidence by using detailed outlet data to examine recent temporal trends in the sociodemographic distribution of spatial availability for different types of alcohol outlet in England. Descriptive analysis of measures of alcohol outlet density and proximity using extremely high resolution market research data stratified by outlet type and quintiles of area-level deprivation from 2003, 2007, 2010 and 2013 was undertaken and hierarchical linear growth models fitted to explore the significance of socioeconomic differences. We find that overall availability of alcohol changed very little from 2003 to 2013 (density +1.6%), but this conceals conflicting trends by outlet type and area-level deprivation. Mean on-trade density has decreased substantially (−2.2 outlets within 1 km (Inter-Quartile Range (IQR) −3–0), although access to restaurants has increased (+1.0 outlets (IQR 0–1)), while off-trade access has risen substantially (+2.4 outlets (IQR 0–3)). Availability is highest in the most deprived areas (p < 0.0001) although these areas have also seen the greatest falls in on-trade outlet availability (p < 0.0001). This study underlines the importance of using detailed, low-level geographic data to understand patterns and trends in the spatial availability of alcohol. There are significant variations in these trends by outlet type and deprivation level which may have important implications for health inequalities and public health policy.
      PubDate: 2017-04-12
      DOI: 10.3390/ijerph14040406
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 407: Soil Lead and Children’s Blood Lead
           Disparities in Pre- and Post-Hurricane Katrina New Orleans (USA)

    • Authors: Howard Mielke, Christopher Gonzales, Eric Powell
      First page: 407
      Abstract: This study appraises New Orleans soil lead and children’s lead exposure before and ten years after Hurricane Katrina flooded the city. Introduction: Early childhood exposure to lead is associated with lifelong and multiple health, learning, and behavioral disorders. Lead exposure is an important factor hindering the long-term resilience and sustainability of communities. Lead exposure disproportionately affects low socioeconomic status of communities. No safe lead exposure is known and the common intervention is not effective. An essential responsibility of health practitioners is to develop an effective primary intervention. Methods: Pre- and post-Hurricane soil lead and children’s blood lead data were matched by census tract communities. Soil lead and blood lead data were described, mapped, blood lead graphed as a function of soil lead, and Multi-Response Permutation Procedures statistics established disparities. Results: Simultaneous decreases occurred in soil lead accompanied by an especially large decline in children’s blood lead 10 years after Hurricane Katrina. Exposure disparities still exist between children living in the interior and outer areas of the city. Conclusions: At the scale of a city, this study demonstrates that decreasing soil lead effectively reduces children’s blood lead. Primary prevention of lead exposure can be accomplished by reducing soil lead in the urban environment.
      PubDate: 2017-04-12
      DOI: 10.3390/ijerph14040407
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 408: Study on the Health Status and Health Service
           Utilization of the Elderly of a Remote and Poor Village in a Mountainous
           Area in Jinzhai, Anhui

    • Authors: Chaoqun Hu, Wenya Yu, Yipeng Lv, Haiping Chen, Qiangyu Deng, Lulu Zhang
      First page: 408
      Abstract: Background: Despite the rapid development of China’s economy, a number of poor areas in China continue to exist. The health status of the elderly in the poor areas is a matter of concern. This study aims to explore the status of the elderly in terms of their health status, health service needs, and utilization among rural residents of a remote and poor village in a mountainous area in Jinzhai, Anhui. Furthermore, this study aims to explore the differences between the nation rural area average level and the remote and poor village in the mountainous area in terms of health status and health service utilization. Methods: Cluster sampling was used to obtain the sample. A total of 110 elderly people were selected from the village, and face-to-face interviews were conducted with questionnaires by trained investigators to collect data. Results: All items except vision, language disability, and self-care disability were found to be higher than the national average level. In terms of mental health, Zishu Village has a ratio of 44.1% for the symptoms of anxiety and depression, which is higher than the average for the national rural areas. The two-week prevalence rate, prevalence of chronic diseases, and non-hospitalization rate of those who need hospitalization (%) in Zishu Village was 62.7%, 88.2%, and 47.6% respectively, which was higher than the rural values of the National Survey (2008). Most of the outpatient visits were to the village clinics, while the hospitalizations were mainly to county hospitals. The two-week visiting rate was 24.1%, which was lower than 2008. The hospitalization rate in Zishu Village was 10.8%, which is similar to the level of 2008. Conclusions: The health level and the utilization of health services of the people in Zishu Village, Jinzhai, are generally lower than the national average. Financial difficulties continue to remain the major factor affecting the utilization of hospitalization services of this remote and poor village in Jinzhai, Anhui.
      PubDate: 2017-04-12
      DOI: 10.3390/ijerph14040408
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 409: Differential Gender Effects in the
           Relationship between Perceived Immune Functioning and Autistic Traits

    • Authors: Marlou Mackus, Deborah Kruijff, Leila Otten, Aletta Kraneveld, Johan Garssen, Joris Verster
      First page: 409
      Abstract: Altered immune functioning has been demonstrated in individuals with autism spectrum disorder (ASD). The current study explores the relationship between perceived immune functioning and experiencing ASD traits in healthy young adults. N = 410 students from Utrecht University completed a survey on immune functioning and autistic traits. In addition to a 1-item perceived immune functioning rating, the Immune Function Questionnaire (IFQ) was completed to assess perceived immune functioning. The Dutch translation of the Autism-Spectrum Quotient (AQ) was completed to examine variation in autistic traits, including the domains “social insights and behavior”, “difficulties with change”, “communication”, “phantasy and imagination”, and “detail orientation”. The 1-item perceived immune functioning score did not significantly correlate with the total AQ score. However, a significant negative correlation was found between perceived immune functioning and the AQ subscale “difficulties with change” (r = −0.119, p = 0.019). In women, 1-item perceived immune functioning correlated significantly with the AQ subscales “difficulties with change” (r = −0.149, p = 0.029) and “communication” (r = −0.145, p = 0.032). In men, none of the AQ subscales significantly correlated with 1-item perceived immune functioning. In conclusion, a modest relationship between perceived immune functioning and several autistic traits was found.
      PubDate: 2017-04-12
      DOI: 10.3390/ijerph14040409
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 410: Association of Motorcycle Use with Risk of
           Overweight in Taiwanese Urban Adults

    • Authors: Chien-Yu Lin, Yung Liao, Jong-Hwan Park
      First page: 410
      Abstract: Sedentary transport is known to adversely affect health. Few studies have focused on motorcycle use. This study examines the association of motorcycle use with overweight in urban adults in Taiwan. Cross-sectional data from 1069 Taiwanese adults aged 20–64 years in three urban cities were collected in 2015. Data on self-reported body mass index, time spent in motorcycle use, lifestyle behavioral factors, and sociodemographic variables were obtained. Unadjusted and adjusted logistic regression models were applied. In Model 1, adults who spent more time using a motorcycle (third quartile, odds ratio (OR) = 1.17; fourth quartile, OR = 1.60) were more likely to be overweight compared with the first quartile. In Model 2, after adjusting for the covariates, only the fourth quartile of motorcycle use (OR = 1.50) was associated with a higher risk of overweight. Higher time spent in motorcycle use is related to higher risk of being overweight, even after adjustment for potential demographic and behavioral confounders. Intervention and behavioral change strategies targeting motorcycle use should be considered.
      PubDate: 2017-04-12
      DOI: 10.3390/ijerph14040410
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 411: Effectiveness of a Culturally-Tailored Smoking
           Cessation Intervention for Arab-American Men

    • Authors: Linda Haddad, Ahmad Al-Bashaireh, Anastasiya Ferrell, Roula Ghadban
      First page: 411
      Abstract: To date, no smoking cessation programs are available for Arab American (ARA) men, who are a vulnerable population with high rates of smoking. Thus, the primary aim of this one group pre-test/post-test study was to assess the effectiveness of Sehatack—a culturally and linguistically tailored smoking cessation program for ARA men. The study sample was 79 ARA men with a mean age of 43 years who smoked between 5 and 40 cigarettes (mean = 19.75, SD = 9.1) per day (98.7%). All of the participants reported more interest in smoking cessation post-intervention and many of the participants in the baseline (38.5%) and post-intervention phases (47.7%) wanted to quit smoking ”very much”. For daily smokers who completed the smoking cessation program, the median number of cigarettes smoked daily was significantly lower than those in the post-intervention phase (Z = −6.915, p < 0.001). Results of this preliminary study indicate that: (a) Sehatack may be a promising way for ARA men to quit smoking, and (b) culturally relevant smoking cessation counselors can be trained to recruit and retain ARA smokers in an intensive group smoking cessation program. Strengths of this study were community engagement and rapport between three faith organizations and the University of Florida College of Nursing. However, a larger trial is needed to address study limitations and to confirm benefits in this population.
      PubDate: 2017-04-13
      DOI: 10.3390/ijerph14040411
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 412: Smoke-Free Laws and Hazardous Drinking: A
           Cross-Sectional Study among U.S. Adults

    • Authors: Nan Jiang, Mariaelena Gonzalez, Pamela Ling, Kelly Young-Wolff, Stanton Glantz
      First page: 412
      Abstract: Tobacco and alcohol use are strongly associated. This cross-sectional study examined the relationship of smoke-free law coverage and smoke-free bar law coverage with hazardous drinking behaviors among a representative sample of U.S. adult drinkers (n = 17,057). We merged 2009 National Health Interview Survey data, American Nonsmokers’ Rights Foundation U.S. Tobacco Control Laws Database, and Census Population Estimates. Hazardous drinking outcomes included heavy drinking (>14 drinks/week for men; >7 drinks/week for women) and binge drinking (≥5 drinks on one or more days during past year). Chi-square tests compared hazardous drinking by sociodemographic factors. Multivariable logistic regression models were used to examine if smoke-free law and bar law coverages were associated with hazardous drinking, controlling for sociodemographics and smoking status. Subset analyses were conducted among drinkers who also smoked (n = 4074) to assess the association between law coverages and hazardous drinking. Among all drinkers, smoke-free law coverage was not associated with heavy drinking (adjusted odds ratio (AOR) = 1.22, 95% confidence interval (CI) = 0.99–1.50) or binge drinking (AOR = 1.09, 95% CI = 0.93–1.26). Smoke-free bar law coverage was also found to be unrelated to hazardous drinking. Similar results were found among those drinkers who smoked. Findings suggest that smoke-free laws and bar laws are not associated with elevated risk for alcohol-related health issues.
      PubDate: 2017-04-13
      DOI: 10.3390/ijerph14040412
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 413: Lead Exposure Assessment among Pregnant Women,
           Newborns, and Children: Case Study from Karachi, Pakistan

    • Authors: Zafar Fatmi, Ambreen Sahito, Akihiko Ikegami, Atsuko Mizuno, Xiaoyi Cui, Nathan Mise, Mai Takagi, Yayoi Kobayashi, Fujio Kayama
      First page: 413
      Abstract: Lead (Pb) in petrol has been banned in developed countries. Despite the control of Pb in petrol since 2001, high levels were reported in the blood of pregnant women and children in Pakistan. However, the identification of sources of Pb has been elusive due to its pervasiveness. In this study, we assessed the lead intake of pregnant women and one- to three-year-old children from food, water, house dust, respirable dust, and soil. In addition, we completed the fingerprinting of the Pb isotopic ratios (LIR) of petrol and secondary sources (food, house-dust, respirable dust, soil, surma (eye cosmetics)) of exposure within the blood of pregnant women, newborns, and children. Eight families, with high (~50 μg/dL), medium (~20 μg/dL), and low blood levels (~10 μg/dL), were selected from 60 families. The main sources of exposure to lead for children were food and house-dust, and those for pregnant women were soil, respirable dust, and food. LIR was determined by inductively coupled plasma quadrupole mass spectrometry (ICP-QMS) with a two sigma uncertainty of ±0.03%. The LIR of mothers and newborns was similar. In contrast, surma, and to a larger extent petrol, exhibited a negligible contribution to both the child’s and mother’s blood Pb. Household wet-mopping could be effective in reducing Pb exposure. This intake assessment could be replicated for other developing countries to identify sources of lead and the burden of lead exposure in the population.
      PubDate: 2017-04-13
      DOI: 10.3390/ijerph14040413
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 414: U.S. Trends of ED Visits for Pediatric
           Traumatic Brain Injuries: Implications for Clinical Trials

    • Authors: Cheng Chen, Junxin Shi, Rachel Stanley, Eric Sribnick, Jonathan Groner, Henry Xiang
      First page: 414
      Abstract: Our goal in this paper was to use the 2006–2013 Nationwide Emergency Department Sample (NEDS) database to describe trends of annual patient number, patient demographics and hospital characteristics of pediatric traumatic brain injuries (TBI) treated in U.S. emergency departments (EDs); and to use the same database to estimate the available sample sizes for various clinical trials of pediatric TBI cases. National estimates of patient demographics and hospital characteristics were calculated for pediatric TBI. Simulation analyses assessed the potential number of pediatric TBI cases from randomly selected hospitals for inclusion in future clinical trials under different scenarios. Between 2006 and 2013, the NEDS database estimated that of the 215,204,932 children who visited the ED, 6,089,930 (2.83%) had a TBI diagnosis. During the study period in the US EDs, pediatric TBI patients increased by 34.1%. Simulation analyses suggest that hospital EDs with annual TBI ED visits >1000, Levels I and II Trauma Centers, pediatric hospitals, and teaching hospitals will likely provide ample cases for pediatric TBI studies. However, recruiting severe pediatric TBI cases for clinical trials from a limited number of hospital EDs will be challenging due to small sample sizes. Pediatric TBI-related ED visits in the U.S. increased by over 30% from 2006 to 2013. Including unspecified head injury cases with ICD-9-CM code 959.01 would significantly change the national estimates and demographic patterns of pediatric TBI cases. Future clinical trials of children with TBI should conduct a careful feasibility assessment to estimate their sample size and study power in selected study sites.
      PubDate: 2017-04-13
      DOI: 10.3390/ijerph14040414
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 415: Lunch Salad Bars in New Orleans’ Middle and
           High Schools: Student Intake of Fruit and Vegetables

    • Authors: Carolyn Johnson, Leann Myers, Adrienne Mundorf, Keelia O’Malley, Lori Spruance, Diane Harris
      First page: 415
      Abstract: The school lunch salad bar (SB) is a recommended food environmental strategy to increase access to, and consumption of fruit and vegetables (F/V). In a study to examine use of school lunch SBs, middle and high school students provided data via the Automated Self-Administered 24-h dietary recall (24HDR) tool for kids (ASA24-Kids-2012), a web-based data collection platform. Kilocalories were computed, food groups were assigned and F/V sources were obtained. Students (n = 718) from 12 schools with SBs and nine schools without SBs were approximately 87% African American, over 64% female and most were 7th and 8th graders. SB school students had higher median energy consumption at lunch but a higher percent of non-SB students reported eating fruit at lunch compared to SB students. Most students reporting eating F/V at lunch obtained F/V from the cafeteria main line; only 19.6% reported eating F/V exclusively from the SB. In SB schools median intake of cups F/V was higher among students using the SB (0.92) compared to those not using the SB (0.53). Results of this study are mixed, but encouraging. Additional factors, e.g., nutrition education, marketing, and kinds of foods offered on the SB need to be examined for potential influence on SB use.
      PubDate: 2017-04-13
      DOI: 10.3390/ijerph14040415
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 416: Spatio-Temporal Pattern and Risk Factor
           Analysis of Hand, Foot and Mouth Disease Associated with Under-Five
           Morbidity in the Beijing–Tianjin–Hebei Region of China

    • Authors: Chengdong Xu
      First page: 416
      Abstract: n/a
      PubDate: 2017-04-13
      DOI: 10.3390/ijerph14040416
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 417: One-Year Results of a Synthetic Intervention
           Model for the Primary Prevention of T2D among Elderly Individuals with
           Prediabetes in Rural China

    • Authors: Zhao Hu, Lulu Qin, Huilan Xu
      First page: 417
      Abstract: Objective: The objective of this study was to evaluate the effectiveness of a synthetic intervention model aimed at preventing type 2 diabetes and controlling plasma glucose, body weight and waist circumference in elderly individuals with prediabetes in rural China. Methods: We randomly assigned 434 (180 men and 254 women; mean age, 69 years; mean body mass index, 23.6 kg/m2) with prediabetes to either the intervention group or the control group. Each participant in the intervention group received synthetic intervention for 1 year. Results: The incidence of diabetes was 4.2% in the intervention group, versus 19.7% in the control group at the end of 1 year (p < 0.001). Compared with the control group, the intervention group experienced a great decrease in fasting glucose (−3.9 vs. 2.2 mg/dL, p < 0.001), body weight (−3.2 vs. 1.7 kg, p < 0.001), waist circumference (−2.4 vs. 1.0 cm, p < 0001), total cholesterol (−9.1 vs. −4.6 mg/dL. p = 0.014) and HbA1c (−1.0 vs. 0.1 mg %, p = 0.002) at the end of 1 year. Conclusions: The incidence of diabetes of the control group was higher than that of the intervention group. Besides, the synthetic intervention contributes to weight loss and glucose decrease, and may be effective in reducing the risk of diabetes among elderly individuals with prediabetes in rural China.
      PubDate: 2017-04-14
      DOI: 10.3390/ijerph14040417
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 418: Comparison of Biogenic Amines and Mycotoxins
           in Alfalfa and Red Clover Fodder Depending on Additives

    • Authors: Jiri Skladanka, Vojtech Adam, Ondrej Zitka, Veronika Mlejnkova, Libor Kalhotka, Pavel Horky, Klara Konecna, Lucia Hodulikova, Daniela Knotova, Marie Balabanova, Petr Slama, Petr Skarpa
      First page: 418
      Abstract: In the production of fermented feed, each crop can be contaminated with a variety of microorganisms that may produce natural pollutants. Biogenic amines, mycotoxins, and undesirable organic acids can decrease health feed safety. The aim of this study was to compare the counts of microorganisms, levels of biogenic amines, and the mycotoxins in forage legumes, and also to compare the occurrence of microorganisms and levels of mycotoxins in green fodder and subsequently produced silage and the influence of additives on the content of natural harmful substances in silage. The experimental plot was located in Troubsko and Vatín, in the Czech Republic. Two varieties of Medicago sativa and one variety of Trifolium pratense were compared. Green fodder and subsequently produced silage reaching up to 23% of dry matter were evaluated and prepared using a bio-enzymatic additive and a chemical additive. Green fodder of Medicago sativa was more contaminated by Enterococci than Trifolium pratense fodder. The obvious difference was determined by the quality of silage leachate. The silage prepared from Medicago sativa fodder was more contaminated with butyric acid. Fungi were present in higher counts in the anaerobic environment of green fodder and contaminated it with zearalenone and deoxynivalenol. Lower counts of fungi were found in silage, although the zearalenone content did not change. Lower content of deoxynivalenol was detected in silage, compared with green fodder. Silages treated with a chemical additive were found not to contain butyric acid. Lower ethanol content was determined, and the tendency to reduce the risk of biogenic amines occurrence was evident. The additives proved to have no influence on the content of mycotoxins.
      PubDate: 2017-04-14
      DOI: 10.3390/ijerph14040418
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 419: Construct Validity of an Obesity Risk
           Screening Tool in Two Age Groups

    • Authors: Karissa Peyer, Greg Welk
      First page: 419
      Abstract: Home environment influences child health, but the impact varies as children move into adolescence. The Family Nutrition and Physical Activity (FNPA) screening tool has been used to evaluate home environments, but studies have not compared the utility of the tool in different age groups. The purpose of this study was to examine the efficacy of the FNPA tool in first and tenth grade samples. Parents of first grade (n = 250) and tenth grade (n = 99) students completed the FNPA and results were linked to body mass index (BMI) data. FNPA scores were examined by gender, income, race, and school-level socioeconomic status (SES). Correlations examined associations between FNPA scores and several BMI indicators. Logistic and linear regression analyses evaluated the construct validity of the FNPA in both groups. Mean FNPA score differed by age group, by SES in both age groups, and by race in the first grade sample only. Correlations between FNPA score and BMI indicators were higher in the first grade sample, but SES was significantly associated with BMI only in tenth graders. The FNPA has stronger utility in younger children, while school SES is a stronger predictor of adolescent weight status.
      PubDate: 2017-04-14
      DOI: 10.3390/ijerph14040419
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 420: Assessment of the Occupational Health and Food
           Safety Risks Associated with the Traditional Slaughter and Consumption of
           Goats in Gauteng, South Africa

    • Authors: Daniel Qekwana, Cheryl McCrindle, James Oguttu, Delia Grace
      First page: 420
      Abstract: Background: This study assessed the occupational health and food safety risks associated with the traditional slaughter of goats and the consumption of such meat in Tshwane, South Africa. Methods: A convenience sample of 105 respondents agreed to be interviewed using structured questionnaires. Results: A high proportion (62.64%) of practitioners admitted to not wearing protective clothing during slaughter. Slaughtering was mainly carried out by males (99%) with experience (62.2%). Forty-four percent of practitioners only changed the clothes they wore while slaughtering when they got home. During the actual slaughter, up to seven people may be involved. The majority (58.9%) of slaughters occurred early in the morning and none of the goats were stunned first. In 77.5% of cases, the health status of the persons who performed the slaughtering was not known. The majority (57.3%) of the slaughters were performed on a corrugated iron roof sheet (zinc plate). In 83.3% of the cases, the carcass was hung up to facilitate bleeding, flaying, and evisceration. Meat inspection was not practiced by any of the respondents. Throughout the slaughter process, the majority used the same knife (84.3) and 84.7% only cleaned the knife when it became soiled. A total of 52.0% of the respondents processed the carcass and cooked the meat immediately. The majority (80.0%) consumed the meat within 30 min of cooking. Conclusions: Men are at a higher risk of occupational health hazards associated with traditional slaughter, which can be transferred to their households. Unhygienic methods of processing and the lack of any form of post-mortem examination increase the risk of food-borne illness following the consumption of such meat.
      PubDate: 2017-04-14
      DOI: 10.3390/ijerph14040420
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 421: Temporary Black Henna Tattoos and
           Sensitization to para-Phenylenediamine (PPD): Two Paediatric Case Reports
           and a Review of the Literature

    • Authors: Elisa Panfili, Susanna Esposito, Giuseppe Di Cara
      First page: 421
      Abstract: Background: The use of temporary henna tattoos has increased dramatically in recent years, especially in children and adolescents. To obtain a darker colour and prolong the life of the tattoo, red henna, a plant-derived substance, is typically added to para-phenylenediamine (PPD). The mixture is called temporary black henna tattoo (TBHT). Because of its molecular characteristics, PPD can induce skin sensitization that may cause various clinical manifestations with successive exposures, among which the most common is allergic contact dermatitis (ACD). This report describes two paediatric cases of PPD sensitization and ACD after the exposure to TBHT and summarizes the literature on this emerging clinical problem. Case Presentation: We describe two cases of childhood-onset ACD that occurred 2 and 10 days, respectively, after the application of a TBHT during the summer holidays. Patch tests showed an evident positive response to 1% PPD in both cases. Sensitization to PPD occurred in the first case because a previous henna tattoo did not result in overt symptoms; in the second case, the reaction occurred after the same tattoo was retouched. In both cases, hypopigmentation persisted and both the patients and their families were advised to avoid further contact with PPD-containing materials and substances that could lead to cross-reactions. Conclusions: Sensitization to PPD is a growing phenomenon in children. The most common cause appears to be exposure to TBHT in which PPD might be present at unknown or high concentrations. Once sensitization occurs, patients may experience severe clinical symptoms which can present with a persistent hypopigmentation when they are re-exposed to substances that contain or cross-react with PPD. Given the widespread use of PPD, TBHT could adversely affect the daily life of paediatric patients; thus, for this reason, this practice as a fashion accessory must be discouraged. In addition, it is extremely important to provide scientific information on the risks of TBHT to consumers, especially to adolescents and to the parents of younger children to prevent PPD sensitization.
      PubDate: 2017-04-14
      DOI: 10.3390/ijerph14040421
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 422: A Cross-Sectional Study on Selected Correlates
           of High risk Sexual Behavior in Polish Migrants Resident in the United
           Kingdom

    • Authors: Maria Ganczak, Grażyna Czubińska, Marcin Korzeń, Zbigniew Szych
      First page: 422
      Abstract: Objective: To assess the correlates of the high risk sexual behaviors of Polish migrants in the United Kingdom (UK) after 2004, and to compare such behaviors before/after immigration. Methods: In 2013, a cross-sectional study was conducted through the use of a Computer-assisted web interviewing surveying technique with the use of a self-administered questionnaire. Results: Among 408 respondents (56.9% women), with a median age of 32 years, significantly more admitted to having unprotected sexual contact with a casual partner while in the UK (p < 0.0001) than while in Poland; more were engaged in sex after the use of recreational drugs and alcohol (p < 0.0001 and p = 0.001 respectively). Being a male was associated with greater odds of unprotected sex, sex after the use of alcohol, and having multiple partners. Being single and having only been a resident for a short time in the UK, presenting a lower self-esteem, were predictors of unprotected sex. A total of 19.6% of the respondents admitted to having been tested while in Poland, a lower (p < 0.0001) frequency than while in the UK (49.5%); this referred to both genders; 1.2% (95% CI: 0.79–2.83%) reported that they were HIV positive. Conclusions: Migration can create a vulnerability to STIs, especially for single male migrants with low self-esteem, staying in the UK for less than two years. The results point to strengthening strategies which help reduce high risk sexual behavior among Polish migrants, and to introduce interventions to promote an awareness of HIV sero-status.
      PubDate: 2017-04-14
      DOI: 10.3390/ijerph14040422
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 423: Ambient Air Pollution and Out-of-Hospital
           Cardiac Arrest in Beijing, China

    • Authors: Ruixue Xia, Guopeng Zhou, Tong Zhu, Xueying Li, Guangfa Wang
      First page: 423
      Abstract: Air pollutants are associated with cardiovascular death; however, there is limited evidence of the effects of different pollutants on out-of-hospital cardiac arrests (OHCAs) in Beijing, China. We aimed to investigate the associations of OHCAs with the air pollutants PM2.5–10 (coarse particulate matter), PM2.5 (particles ≤2.5 μm in aerodynamic diameter), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) between 2013 and 2015 using a time-stratified case-crossover study design. We obtained health data from the nationwide emergency medical service database; 4720 OHCA cases of cardiac origin were identified. After adjusting for relative humidity and temperature, the highest odds ratios of OHCA for a 10 μg/m3 increase in PM2.5 were observed at Lag Day 1 (1.07; 95% confidence interval (CI): 1.04–1.10), with strong associations with advanced age (aged ≥70 years) (1.09; 95% CI: 1.05–1.13) and stroke history (1.11; 95% CI: 1.06–1.16). PM2.5–10 and NO2 also showed significant associations with OHCAs, whereas SO2, CO, and O3 had no effects. After simultaneously adjusting for NO2 and SO2 in a multi-pollutant model, PM2.5 remained significant. The effects of PM2.5 in the single-pollutant models for cases with hypertension, respiratory disorders, diabetes mellitus, and heart disease were higher than those for cases without these complications; however, the differences were not statistically significant. The results support that elevated PM2.5 exposure contributes to triggering OHCA, especially in those who are advanced in age and have a history of stroke.
      PubDate: 2017-04-14
      DOI: 10.3390/ijerph14040423
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 424: Work Characteristics Associated with Physical
           Functioning in Women

    • Authors: Aimee Palumbo, Anneclaire De Roos, Carolyn Cannuscio, Lucy Robinson, Jana Mossey, Julie Weitlauf, Lorena Garcia, Robert Wallace, Yvonne Michael
      First page: 424
      Abstract: Women make up almost half of the labor force with older women becoming a growing segment of the population. Work characteristics influence physical functioning and women are at particular risk for physical limitations. However, little research has explored the effects of work characteristics on women’s physical functioning. U.S. women between the ages of 50 and 79 were enrolled in the Women’s Health Initiative Observational Study between 1993 and 1998. Women provided job titles and years worked at their three longest-held jobs (n = 79,147). Jobs were linked to characteristics in the Occupational Information Network. Three categories of job characteristics related to substantive complexity, physical demand, and social collaboration emerged. The association between job characteristics and physical limitations in later life, measured using a SF-36 Physical Functioning score <25th percentile, was examined using modified Poisson regression. After controlling for confounding variables, high physical demand was positively associated with physical limitations (RR = 1.09 CI: 1.06–1.12) and substantively complex work was negatively associated (RR = 0.94, CI: 0.91–0.96). Jobs requiring complex problem solving, active learning, and critical thinking were associated with better physical functioning. Employers should explore opportunities to reduce strain from physically demanding jobs and incorporate substantively complex tasks into women’s work to improve long-term health.
      PubDate: 2017-04-15
      DOI: 10.3390/ijerph14040424
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 425: Gaseous Elemental Mercury and Total and
           Leached Mercury in Building Materials from the Former Hg-Mining Area of
           Abbadia San Salvatore (Central Italy)

    • Authors: Orlando Vaselli, Barbara Nisi, Daniele Rappuoli, Jacopo Cabassi, Franco Tassi
      First page: 425
      Abstract: Mercury has a strong environmental impact since both its organic and inorganic forms are toxic, and it represents a pollutant of global concern. Liquid Hg is highly volatile and can be released during natural and anthropogenic processes in the hydrosphere, biosphere and atmosphere. In this study, the distribution of Gaseous Elemental Mercury (GEM) and the total and leached mercury concentrations on paint, plaster, roof tiles, concrete, metals, dust and wood structures were determined in the main buildings and structures of the former Hg-mining area of Abbadia San Salvatore (Siena, Central Italy). The mining complex (divided into seven units) covers a surface of about 65 ha and contains mining structures and managers’ and workers’ buildings. Nine surveys of GEM measurements were carried out from July 2011 to August 2015 for the buildings and structures located in Units 2, 3 and 6, the latter being the area where liquid mercury was produced. Measurements were also performed in February, April, July, September and December 2016 in the edifices and mining structures of Unit 6. GEM concentrations showed a strong variability in time and space mostly depending on ambient temperature and the operational activities that were carried out in each building. The Unit 2 surveys carried out in the hotter period (from June to September) showed GEM concentrations up to 27,500 ng·m−3, while in Unit 6, they were on average much higher, and occasionally, they saturated the GEM measurement device (>50,000 ng·m−3). Concentrations of total (in mg·kg−1) and leached (in μg·L−1) mercury measured in different building materials (up to 46,580 mg·kg−1 and 4470 mg·L−1, respectively) were highly variable, being related to the edifice or mining structure from which they were collected. The results obtained in this study are of relevant interest for operational cleanings to be carried out during reclamation activities.
      PubDate: 2017-04-15
      DOI: 10.3390/ijerph14040425
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 426: Health-Related Quality of Life of the General
           German Population in 2015: Results from the EQ-5D-5L

    • Authors: Manuel Huber, Julia Felix, Martin Vogelmann, Reiner Leidl
      First page: 426
      Abstract: The EQ-5D-5L is a widely used generic instrument to measure health-related quality of life. This study evaluates health perception in a representative sample of the general German population from 2015. To compare results over time, a component analysis technique was used that separates changes in the description and valuation of health states. The whole sample and also subgroups, stratified by sociodemographic parameters as well as disease affliction, were analyzed. In total, 2040 questionnaires (48.4% male, mean age 47.3 year) were included. The dimension with the lowest number of reported problems was self-care (93.0% without problems), and the dimension with the highest proportion of impairment was pain/discomfort (71.2% without problems). Some 64.3% of the study population were identified as problem-free. The visual analog scale (VAS) mean for all participants was 85.1. Low education was connected with significantly lower VAS scores, but the effect was small. Depression, heart disease, and diabetes had a strong significant negative effect on reported VAS means. Results were slightly better than those in a similar 2012 survey; the most important driver was the increase in the share of the study population that reported to be problem-free. In international comparisons, health perception of the general German population is relatively high and, compared with previous German studies, fairly stable over recent years. Elderly and sick people continue to report significant reductions in perceived health states.
      PubDate: 2017-04-16
      DOI: 10.3390/ijerph14040426
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 427: Advanced Stage at Presentation Remains a Major
           Factor Contributing to Breast Cancer Survival Disparity between Public and
           Private Hospitals in a Middle-Income Country

    • Authors: Yek-Ching Kong, Nirmala Bhoo-Pathy, Shridevi Subramaniam, Nanthini Bhoo-Pathy, Nur Taib, Suniza Jamaris, Kiran Kaur, Mee-Hoong See, Gwo-Fuang Ho, Cheng-Har Yip
      First page: 427
      Abstract: Background: Survival disparities in cancer are known to occur between public and private hospitals. We compared breast cancer presentation, treatment and survival between a public academic hospital and a private hospital in a middle-income country. Methods: The demographics, clinical characteristics, treatment and overall survival (OS) of 2767 patients with invasive breast carcinoma diagnosed between 2001 and 2011 in the public hospital were compared with 1199 patients from the private hospital. Results: Compared to patients in the private hospital, patients from the public hospital were older at presentation, and had more advanced cancer stages. They were also more likely to receive mastectomy and chemotherapy but less radiotherapy. The five-year OS in public patients was significantly lower than in private patients (71.6% vs. 86.8%). This difference was largely attributed to discrepancies in stage at diagnosis and, although to a much smaller extent, to demographic differences and treatment disparities. Even following adjustment for these factors, patients in the public hospital remained at increased risk of mortality compared to their counterparts in the private hospital (Hazard Ratio: 1.59; 95% Confidence Interval: 1.36–1.85). Conclusion: Late stage at diagnosis appears to be a major contributing factor explaining the breast cancer survival disparity between public and private patients in this middle-income setting.
      PubDate: 2017-04-16
      DOI: 10.3390/ijerph14040427
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 428: The Effects of PM2.5 from Asian Dust Storms on
           Emergency Room Visits for Cardiovascular and Respiratory Diseases

    • Authors: Ssu-Ting Liu, Chu-Yung Liao, Cheng-Yu Kuo, Hsien-Wen Kuo
      First page: 428
      Abstract: A case-crossover study examined how PM2.5 from Asian Dust Storms (ADS) affects the number of emergency room (ER) admissions for cardiovascular diseases (CVDs) and respiratory diseases (RDs). Our data indicated that PM2.5 concentration from ADS was highly correlated with ER visits for CVDs and RDs. The odds ratios (OR) increased by 2.92 (95% CI: 1.22–5.08) and 1.86 (95% CI: 1.30–2.91) per 10 µg/m3 increase in PM2.5 levels, for CVDs and RDs, respectively. A 10 µg/m3 increase in PM2.5 from ADSs was significantly associated with an increase in ER visits for CVDs among those 65 years of age and older (an increase of 2.77 in OR) and for females (an increase of 3.09 in OR). In contrast, PM2.5 levels had a significant impact on RD ER visits among those under 65 years of age (OR = 1.77). The risk of ER visits for CVDs increased on the day when the ADS occurred in Taiwan and the day after (lag 0 and lag 1); the corresponding risk increase for RDs only increased on the fifth day after the ADS (lag 5). In Taiwan’s late winter and spring, the severity of ER visits for CVDs and RDs increases. Environmental protection agencies should employ an early warning system for ADS to reduce high-risk groups’ exposure to PM2.5.
      PubDate: 2017-04-16
      DOI: 10.3390/ijerph14040428
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 429: Health Risk Assessment of Indoor Air Quality,
           Socioeconomic and House Characteristics on Respiratory Health among Women
           and Children of Tirupur, South India

    • Authors: Krassi Rumchev, Yun Zhao, Jeffery Spickett
      First page: 429
      Abstract: Background: Indoor air pollution is still considered as one of the leading causes of morbidity and mortality worldwide and especially in developing countries, including India. This study aims to assess social, housing, and indoor environmental factors associated with respiratory health among mothers and children. Methods: The study was conducted in the city of Tirupur, South India. We quantitatively assessed the indoor exposure to fine particulate matter (PM2.5) and carbon monoxide in relation to respiratory health among women and children. Information on health status, household characteristics and socioeconomic factors was collected using a modified standardised questionnaire. Results: This study demonstrates the significant health impact of housing and socioeconomic characteristics on the burden of respiratory illness among women and children in urban South India. Increased respiratory symptoms were recorded among women and children from low income households, and those who allowed smoking inside. The mean PM2.5 concentration measured in this study was 3.8 mg/m3 which exceeded the World Health Organization (WHO) 24 h guideline value of 0.025 mg/m3. Conclusions: This study is the first to our knowledge carried out in urban South India and the findings can be used for future intervention studies.
      PubDate: 2017-04-17
      DOI: 10.3390/ijerph14040429
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 430: Using Moss to Assess Airborne Heavy Metal
           Pollution in Taizhou, China

    • Authors: Xiaoli Zhou, Qin Chen, Chang Liu, Yanming Fang
      First page: 430
      Abstract: Bryophytes act as bioindicators and bioaccumulators of metal deposition in the environment. To understand the atmospheric deposition of heavy metals (cadmium (Cd), chromium (Cr), copper (Cu), mercury (Hg), nickel (Ni), lead (Pb), and zinc (Zn)) in Taizhou, East China, samples of moss (Haplocladium microphyllum) were collected from 60 sites selected by a systematic sampling method during the summer of 2012, and the concentrations of these heavy metals were determined by inductively coupled plasma atomic emission spectroscopy (ICP-AES). The results suggested that the concentrations of these metals varied moderately among different sites, indicating a similar contamination level for each element throughout the monitoring region. The mean values under investigation were higher than those from neighboring cities, such as Wuxi, Xuzhou, and Nanjing, and much higher than those in Europe based on a 2010 survey. Significant (p < 0.01) correlations were identified among some of the heavy metals, suggesting that these originated from identical sources. There was no statistically significant correlation between Hg and all the other elements. Spatial distribution maps of the elements over the sampled territory were created using Arc-GIS 9.0. The potential ecological risk index indicated that the air was heavily polluted by Cd and Hg, and that there was a considerable potential ecological risk from all the heavy metals studied.
      PubDate: 2017-04-17
      DOI: 10.3390/ijerph14040430
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 431: Demographic and Environmental Factors
           Associated with Mental Health: A Cross-Sectional Study

    • Authors: Jayeun Kim, Ho Kim
      First page: 431
      Abstract: Relevant demographic and environmental conditions need to be understood before tailoring policies to improve mental health. Using community health survey data from 25 communities in Seoul, 2013, cross-sectional associations between mental health and community level environments were assessed. Mental health outcomes (self-rated stress levels (SRS) and depressive symptoms (DS)) were analyzed. Community environmental factors included green space, green facilities, and annual PM10 level (AnnPM10); socio-demographic factors included sex, age, education, labor market participation, comorbidity, sleep hours, physical activity, smoking, and drinking. A total of 23,139 people with the following characteristics participated: men (44.2%); age groups 19−39 (36.0%), 40−59 (39.4%), 60−74 (19.2%), and 75+ (5.4%). Women had higher odds ratios (OR) for SRS [OR 1.22, 95% Confidence interval (CI) 1.17–1.27] and DS [OR 1.55, 95% CI 1.42–1.71]. Regular physical activity predicted SRS [OR 0.90, 95% CI 0.84–0.95] and DS [OR 0.98, 95% CI 0.88–1.10]; current smoking and drinking were adversely associated with both SRS and DS. Higher accessibility to green space (Q4) was inversely associated with DS [OR 0.89, 95% CI 0.81−0.97] compared to lower accessibility (Q1). AnnPM10, annual levels for particles of aerodynamic diameter <10 µm (PM10), among communities was associated with poorer SRS [OR 1.02, 95% CI 1.00–1.04] by 10 μg/m3 increases. Therefore, both demographic and environmental factors should be considered to understand mental health conditions among the general population.
      PubDate: 2017-04-17
      DOI: 10.3390/ijerph14040431
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 432: Association between Blood Lead Levels and
           Delta-Aminolevulinic Acid Dehydratase in Pregnant Women

    • Authors: Osmel La-Llave-León, Edna Méndez-Hernández, Francisco Castellanos-Juárez, Eloísa Esquivel-Rodríguez, Fernando Vázquez-Alaniz, Ada Sandoval-Carrillo, Gonzalo García-Vargas, Jaime Duarte-Sustaita, Jorge Candelas-Rangel, José Salas-Pacheco
      First page: 432
      Abstract: Blood lead levels (BLLs) and delta-aminolevulinic acid dehydratase (ALAD) activity are considered biomarkers of lead exposure and lead toxicity, respectively. The present study was designed to investigate the association between BLLs and ALAD activity in pregnant women from Durango, Mexico. A total of 633 pregnant women aged 13–43 years participated in this study. Blood lead was measured by a graphite furnace atomic absorption spectrometer. ALAD activity was measured spectrophotometrically. Mean blood lead was 2.09 ± 2.34 µg/dL; and 26 women (4.1%) crossed the Centers for Disease Control (CDC) recommended level of 5 µg/dL. ALAD activity was significantly lower in women with levels of lead ≥5 µg/dL compared to those with BLLs < 5 µg/dL (p = 0.002). To reduce the influence of extreme values on the statistical analysis, BLLs were analyzed by quartiles. A significant negative correlation between blood lead and ALAD activity was observed in the fourth quartile of BLLs (r = −0.113; p < 0.01). Among women with blood lead concentrations ≥2.2 µg/dL ALAD activity was negatively correlated with BLLs (r = −0.413; p < 0.01). Multiple linear regression demonstrated that inhibition of ALAD in pregnant women may occur at levels of lead in blood above 2.2 µg/dL.
      PubDate: 2017-04-18
      DOI: 10.3390/ijerph14040432
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 433: Erratum: Wong, L.P., et al. The
           Self-Regulation Model of Illness: Comparison between Zika and Dengue and
           Its Application to Predict Mosquito Prevention Behaviours in Malaysia, a
           

    • Authors: Li Wong, Haridah Alias, Nasrin Aghamohammadi, I-Ching Sam, Sazaly Abu Bakar
      First page: 433
      Abstract: n/a
      PubDate: 2017-04-19
      DOI: 10.3390/ijerph14040433
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 434: How Sensors Might Help Define the External
           Exposome

    • Authors: Miranda Loh, Dimosthenis Sarigiannis, Alberto Gotti, Spyros Karakitsios, Anjoeka Pronk, Eelco Kuijpers, Isabella Annesi-Maesano, Nour Baiz, Joana Madureira, Eduardo Oliveira Fernandes, Michael Jerrett, John Cherrie
      First page: 434
      Abstract: The advent of the exposome concept, the advancement of mobile technology, sensors, and the “internet of things” bring exciting opportunities to exposure science. Smartphone apps, wireless devices, the downsizing of monitoring technologies, along with lower costs for such equipment makes it possible for various aspects of exposure to be measured more easily and frequently. We discuss possibilities and lay out several criteria for using smart technologies for external exposome studies. Smart technologies are evolving quickly, and while they provide great promise for advancing exposure science, many are still in developmental stages and their use in epidemiology and risk studies must be carefully considered. The most useable technologies for exposure studies at this time relate to gathering exposure-factor data, such as location and activities. Development of some environmental sensors (e.g., for some air pollutants, noise, UV) is moving towards making the use of these more reliable and accessible to research studies. The possibility of accessing such an unprecedented amount of personal data also comes with various limitations and challenges, which are discussed. The advantage of improving the collection of long term exposure factor data is that this can be combined with more “traditional” measurement data to model exposures to numerous environmental factors.
      PubDate: 2017-04-18
      DOI: 10.3390/ijerph14040434
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 435: Economic Burden of Obesity: A Systematic
           Literature Review

    • Authors: Maximilian Tremmel, Ulf-G. Gerdtham, Peter Nilsson, Sanjib Saha
      First page: 435
      Abstract: Background: The rising prevalence of obesity represents an important public health issue. An assessment of its costs may be useful in providing recommendations for policy and decision makers. This systematic review aimed to assess the economic burden of obesity and to identify, measure and describe the different obesity-related diseases included in the selected studies. Methods: A systematic literature search of studies in the English language was carried out in Medline (PubMed) and Web of Science databases to select cost-of-illness studies calculating the cost of obesity in a study population aged ≥18 years with obesity, as defined by a body mass index of ≥30 kg/m², for the whole selected country. The time frame for the analysis was January 2011 to September 2016. Results: The included twenty three studies reported a substantial economic burden of obesity in both developed and developing countries. There was considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives. This prevents an informative comparison between most of the studies. Specifically, there was great variety in the included obesity-related diseases and complications among the studies. Conclusions: There is an urgent need for public health measures to prevent obesity in order to save societal resources. Moreover, international consensus is required on standardized methods to calculate the cost of obesity to improve homogeneity and comparability. This aspect should also be considered when including obesity-related diseases.
      PubDate: 2017-04-19
      DOI: 10.3390/ijerph14040435
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 436: Non-Responsive Feeding Practices, Unhealthy
           Eating Behaviors, and Risk of Child Overweight and Obesity in Southeast
           Asia: A Systematic Review

    • Authors: Ana Cristina Lindsay, Somporn Sitthisongkram, Mary Greaney, Sherrie Wallington, Praewrapee Ruengdej
      First page: 436
      Abstract: Childhood obesity is increasing dramatically in many Southeast Asian countries, and becoming a significant public health concern. This review summarizes the evidence on associations between parental feeding practices, child eating behaviors, and the risk of overweight and obesity in Southeast Asian children 2–12 years old. We systematically searched five electronic academic/research (PubMed, PsycINFO, ProQuest Nursing, Medline, and CINAHL) databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for peer-reviewed studies published in English between January 2000 and December 2016. Fourteen observational studies met the inclusion criteria and were reviewed. Reviewed studies were examined separately for preschool- and school-aged children and revealed that non-responsive parental feeding practices and unhealthy child eating behaviors were associated with a risk of child overweight and obesity in several Southeast Asian countries. Nonetheless, due to the small number of identified studies (n = 14) and because only about half of the Southeast Asian countries (Thailand, Vietnam, Singapore, the Philippines, and Malaysia) were represented (5/11) in the examined studies, additional research is needed to further understand the factors associated with childhood obesity among children in Southeast Asia to develop interventions that are tailored to the specific needs of Southeast Asian countries and designed to address practices and behaviors that may promote childhood obesity.
      PubDate: 2017-04-19
      DOI: 10.3390/ijerph14040436
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 437: Association between Serum Selenium
           Concentrations and Levels of Proinflammatory and Profibrotic
           Cytokines—Interleukin-6 and Growth Differentiation Factor-15, in
           Patients with Alcoholic Liver Cirrhosis

    • Authors: Andrzej Prystupa, Paweł Kiciński, Dorota Luchowska-Kocot, Anna Błażewicz, Jarosław Niedziałek, Grzegorz Mizerski, Mariusz Jojczuk, Andrzej Ochal, Jarosław Sak, Wojciech Załuska
      First page: 437
      Abstract: According to some authors, serum selenium levels are strongly associated with the severity of liver diseases, including liver cirrhosis. The aim of this study was to determine the relationship between the concentration of selenium and pro-inflammatory and profibrotic cytokines—interleukin-6 (IL-6) and growth differentiation factor 15 (GDF-15) in patients with alcoholic liver cirrhosis. The parameters studied were determined in the serum of 99 patients with alcoholic liver cirrhosis divided based on the severity of disease according to the Child-Turcotte-Pugh criteria. In patients with liver cirrhosis, the serum selenium concentration was statistically lower, whereas serum IL-6 and GDF-15 concentrations were higher than those in the control group. Moreover, the concentration of selenium negatively correlated with the levels of GDF-15 and IL-6. The above results may indicate a role of selenium deficiency in the pathogenesis and progression of alcoholic liver disease.
      PubDate: 2017-04-21
      DOI: 10.3390/ijerph14040437
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 438: A Little Bug with a Big Bite: Impact of
           Hemlock Woolly Adelgid Infestations on Forest Ecosystems in the Eastern
           USA and Potential Control Strategies

    • Authors: Amanda Letheren, Stephanie Hill, Jeanmarie Salie, James Parkman, Jiangang Chen
      First page: 438
      Abstract: Hemlock woolly adelgid (Adelges tsugae Annand, HWA) remains the single greatest threat to the health and sustainability of hemlock in the eastern USA. The loss of hemlock trees leads to further negative impacts on the diversity and stability of ecosystems in the eastern part of North America. It is, therefore, urgent to develop effective control measures to reduce HWA populations and promote overall hemlock health. Currently available individual and integrated approaches should continue to be evaluated in the laboratory and in the field along with the development of other new and innovative methods.
      PubDate: 2017-04-19
      DOI: 10.3390/ijerph14040438
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 440: Evaluation of the Effects of Airborne
           Particulate Matter on Bone Marrow-Mesenchymal Stem Cells (BM-MSCs):
           Cellular, Molecular and Systems Biological Approaches

    • Authors: Muhammad Abu-Elmagd, Mansour Alghamdi, Magdy Shamy, Mamdouh Khoder, Max Costa, Mourad Assidi, Roaa Kadam, Haneen Alsehli, Mamdooh Gari, Peter Pushparaj, Gauthaman Kalamegam, Mohammed Al-Qahtani
      First page: 440
      Abstract: Particulate matter (PM) contains heavy metals that affect various cellular functions and gene expression associated with a range of acute and chronic diseases in humans. However, the specific effects they exert on the stem cells remain unclear. Here, we report the effects of PM collected from the city of Jeddah on proliferation, cell death, related gene expression and systems of biological analysis in bone marrow mesenchymal stem cells (BM-MSCs), with the aim of understanding the underlying mechanisms. PM2.5 and PM10 were tested in vitro at various concentrations (15 to 300 µg/mL) and durations (24 to 72 h). PMs induced cellular stress including membrane damage, shrinkage and death. Lower concentrations of PM2.5 increased proliferation of BM-MSCs, while higher concentrations served to decrease it. PM10 decreased BM-MSCs proliferation in a concentration-dependent manner. The X-ray fluorescence spectrometric analysis showed that PM contains high levels of heavy metals. Ingenuity Pathway Analysis (IPA) and hierarchical clustering analyses demonstrated that heavy metals were associated with signaling pathways involving cell stress/death, cancer and chronic diseases. qRT-PCR results showed differential expression of the apoptosis genes (BCL2, BAX); inflammation associated genes (TNF-α and IL-6) and the cell cycle regulation gene (p53). We conclude that PM causes inflammation and cell death, and thereby predisposes to chronic debilitating diseases.
      PubDate: 2017-04-20
      DOI: 10.3390/ijerph14040440
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 441: Water Access, Sanitation, and Hygiene
           Conditions and Health Outcomes among Two Settlement Types in Rural Far
           North Cameroon

    • Authors: Tyler Gorham, Joshua Yoo, Rebecca Garabed, Arabi Mouhaman, Jiyoung Lee
      First page: 441
      Abstract: The Far North region in Cameroon has been more heavily impacted by cholera than any other region over the past decade, but very little has been done to study the drivers of waterborne diseases in the region. We investigated the relationship between water, sanitation, and hygiene (WASH) parameters, microbial and antibiotic resistance (AR) contamination levels in drinking water, and health outcomes using health survey and molecular analysis during June and July of 2014 in two settlement types (agro-pastoralist villages and transhumant pastoralist camps). Quantitative polymerase chain reaction was used to determine fecal contamination sources, enteric pathogens, and antibiotic resistance genes. Ruminant-associated fecal contamination was widespread in both settlement types (81.2%), with human-associated contamination detected in 21.7% of the samples. Salmonella spp. (59.4%) and Shiga toxin-producing E. coli (stx1 44.9% and stx2 31.9%) were detected across all samples. Tetracycline resistance was found only in village samples. A significant difference in diarrheal incidence within the past 28 days among young children was found between camps (31.3%) and villages (0.0%). Our findings suggest that water contamination may play an important role in contributing to gastrointestinal illness, supporting the need for future research and public health intervention to reduce gastrointestinal illness in the area.
      PubDate: 2017-04-20
      DOI: 10.3390/ijerph14040441
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 442: A Systematic Review: Costing and Financing of
           Water, Sanitation, and Hygiene (WASH) in Schools

    • Authors: Shannon McGinnis, Thomas McKeon, Richa Desai, Akudo Ejelonu, Stanley Laskowski, Heather Murphy
      First page: 442
      Abstract: Despite the success of recent efforts to increase access to improved water, sanitation, and hygiene (WASH) globally, approximately one-third of schools around the world still lack adequate WASH services. A lack of WASH in schools can lead to the spread of preventable disease and increase school absences, especially among women. Inadequate financing and budgeting has been named as a key barrier for integrating successful and sustainable WASH programs into school settings. For this reason, the purpose of this review is to describe the current knowledge around the costs of WASH components as well as financing models that could be applied to WASH in schools. Results show a lack of information around WASH costing, particularly around software elements as well as a lack of data overall for WASH in school settings as compared to community WASH. This review also identifies several key considerations when designing WASH budgets or selecting financing mechanisms. Findings may be used to advise future WASH in school programs.
      PubDate: 2017-04-20
      DOI: 10.3390/ijerph14040442
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 443: Acceptable Risk Analysis for Abrupt
           Environmental Pollution Accidents in Zhangjiakou City, China

    • Authors: Xi Du, Zhijiao Zhang, Lei Dong, Jing Liu, Alistair Borthwick, Renzhi Liu
      First page: 443
      Abstract: Abrupt environmental pollution accidents cause considerable damage worldwide to the ecological environment, human health, and property. The concept of acceptable risk aims to answer whether or not a given environmental pollution risk exceeds a societally determined criterion. This paper presents a case study on acceptable environmental pollution risk conducted through a questionnaire survey carried out between August and October 2014 in five representative districts and two counties of Zhangjiakou City, Hebei Province, China. Here, environmental risk primarily arises from accidental water pollution, accidental air pollution, and tailings dam failure. Based on 870 valid questionnaires, demographic and regional differences in public attitudes towards abrupt environmental pollution risks were analyzed, and risk acceptance impact factors determined. The results showed females, people between 21–40 years of age, people with higher levels of education, public servants, and people with higher income had lower risk tolerance. People with lower perceived risk, low-level risk knowledge, high-level familiarity and satisfaction with environmental management, and without experience of environmental accidents had higher risk tolerance. Multiple logistic regression analysis indicated that public satisfaction with environmental management was the most significant factor in risk acceptance, followed by perceived risk of abrupt air pollution, occupation, perceived risk of tailings dam failure, and sex. These findings should be helpful to local decision-makers concerned with environmental risk management (e.g., selecting target groups for effective risk communication) in the context of abrupt environmental accidents.
      PubDate: 2017-04-20
      DOI: 10.3390/ijerph14040443
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 444: The Cost of Arbovirus Disease Prevention in
           Europe: Area-Wide Integrated Control of Tiger Mosquito, Aedes albopictus,
           in Emilia-Romagna, Northern Italy

    • Authors: Massimo Canali, Stefano Rivas-Morales, Philippe Beutels, Claudio Venturelli
      First page: 444
      Abstract: Aedes albopictus (tiger mosquito) has become the most invasive mosquito species worldwide, in addition to being a well-known vector of diseases, with a proven capacity for the transmission of chikungunya and dengue viruses in Europe as well as the Zika virus in Africa and in laboratory settings. This research quantifies the cost that needs to be provided by public-health systems for area-wide prevention of arboviruses in Europe. This cost has been calculated by evaluating the expenditure of the plan for Aedes albopictus control set up in the Emilia-Romagna region (Northern Italy) after a chikungunya outbreak occurred in 2007. This plan involves more than 280 municipalities with a total of 4.2 million inhabitants. Public expenditure for plan implementation in 2008–2011 was examined through simple descriptive statistics. Annual expenditure was calculated to be approximately €1.3 per inhabitant, with a declining trend (from a total of €7.6 million to €5.3 million) and a significant variability at the municipality level. The preventative measures in the plan included antilarval treatments (about 75% of total expenditure), education for citizens and in schools, entomological surveillance, and emergency actions for suspected viremias. Ecological factors and the relevance of tourism showed a correlation with the territorial variability in expenditure. The median cost of one antilarval treatment in public areas was approximately €0.12 per inhabitant. Organizational aspects were also analyzed to identify possible improvements in resource use.
      PubDate: 2017-04-20
      DOI: 10.3390/ijerph14040444
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 445: The Impact of Hyposalivation on Quality of
           Life (QoL) and Oral Health in the Aging Population of Al Madinah Al
           Munawarrah

    • Authors: Mohammad Ahmad, Ahmed Bhayat, Muhammad Zafar, Khalid Al-Samadani
      First page: 445
      Abstract: Hyposalivation (HS) affects aging individuals by causing pain and discomfort in the oral cavity. The aim here was to determine the impact of hyposalivation and the saliva pH on the quality of life and caries status of geriatrics population. A total of 138 male outpatients attending the Taibah University College of Dentistry (TUCoD) dental clinic were included in the study. The saliva flow, pH, Quality of Life (QoL), and caries status were recorded. The QoL was measured using the Arabic version of the Oral Health Impact Profile-14 (OHIP-14), and the caries status was recorded using the Decayed, Missed, Filled Teeth (DMFT) index. The mean age was 67.5 years and 64% were classified as having hyposalivation. The older respondents tended to have a lower saliva flow and pH compared to their younger counterparts. There was a significant inverse association (p = 0.02) between the caries status and mean saliva flow rate. There was also a significant (p < 0.001) positive correlation between caries and the OHIP-14 scores (Spearman’s ρ = 0.293). The prevalence of hyposalivation was relatively high and there was an inverse relationship between the age, the saliva flow, and pH. Those with more caries reported significantly poor QoL.
      PubDate: 2017-04-20
      DOI: 10.3390/ijerph14040445
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 446: Prospective Analysis of the Influence of Sport
           and Educational Factors on the Prevalence and Initiation of Smoking in
           Older Adolescents from Croatia

    • Authors: Natasa Zenic, Djivo Ban, Sanja Jurisic, Mladen Cubela, Jelena Rodek, Ljerka Ostojic, Mario Jelicic, Antonino Bianco, Damir Sekulic
      First page: 446
      Abstract: The prevalence of smoking among Croatian adolescents is alarmingly high, but no previous study has prospectively examined the sport- and academic-factors associated with smoking and smoking initiation. This study aimed to prospectively examine the associations between scholastic (educational) achievement and sport factors and smoking in 16- to 18-year-old adolescents. This two-year prospective cohort study included 644 adolescents who were 16 years of age at baseline (46% females). Baseline testing was implemented at the beginning of the 3rd year of high school (September 2014) when participants were 16 years old. Follow-up testing was completed at the end of the fourth year of high school, which occurred 20 months later. The evaluated predictor variables were educational-achievement- and sport-related-factors. The outcome variables were (i) smoking at baseline; (ii) smoking at follow-up; and (iii) smoking initiation over the course of the study. We assessed the associations between predictors and outcomes using logistic regression models adjusted for age, gender, socioeconomic status, and conflict with parents. The educational variables were consistently associated with smoking, with lower grade-point-average (Baseline: odd ratio (OR): 2.01, 95% confidence interval (CI): 1.61–2.55; Follow-up: 1.59, 1.31–1.94), more frequent absence from school (Baseline: OR: 1.40, 95% CI: 1.19–1.69; Follow-up: 1.30, 1.08–1.58), and lower behavioral grades (Baseline: OR: 1.80, 95% CI: 1.10–2.89; Follow-up: 1.57, 1.03–2.41) in children who smoke. Adolescents who reported quitting sports were at greater odds of being smokers (Baseline: 2.07, 1.31–3.32; Follow-up: 1.66, 1.09–2.56). Sport competitive achievement at baseline was protective against smoking initiation during following two-year period (0.45, 0.21–0.91). While the influence of the educational variables on smoking initiation has been found to be established earlier; sport achievement was identified as a significant protective factor against initiating smoking in older adolescents. Results should be used in development of an anti-smoking preventive campaign in older adolescents.
      PubDate: 2017-04-20
      DOI: 10.3390/ijerph14040446
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 447: Environmental Tobacco Smoke Exposure and
           Smoke-Free Rules in Homes among Socially-Disadvantaged Populations in
           Poland

    • Authors: Katarzyna Milcarz, Leokadia Bak-Romaniszyn, Dorota Kaleta
      First page: 447
      Abstract: This study aims to examine the prevalence of exposure to environmental tobacco smoke (ETS) in homes among socially-disadvantaged populations in Poland, along with the prevalence and correlates of voluntary implementation of smoke-free home rules. Data concerning 1617 respondents from a cross-sectional study completed in the Piotrkowski District were used, which was part of the “Reducing Social Inequalities in Health” program. Overall, 19.4% of the respondents declared exposure to ETS at home. In the non-smokers group, 15.5%, including 6.6% males and 18.3% females, were exposed to ETS in their place of residence (p < 0.0001). Complete smoke-free rules were adopted by 22.1% of the study participants. Two factors, smoker status and lack of ETS-associated health risk awareness, were found to be significantly associated with no adoption of total smoking bans at home. Socially-disadvantaged non-smokers, especially females from rural areas in Poland, still constitute a large population exposed to ETS in their homes—a challenge from the perspective of public health. Focused efforts are required to address social norms around exposing others to ETS.
      PubDate: 2017-04-21
      DOI: 10.3390/ijerph14040447
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 448: Who Is Using Outdoor Fitness Equipment and
           How? The Case of Xihu Park

    • Authors: Hsueh-wen Chow, Andrew Mowen, Guan-lin Wu
      First page: 448
      Abstract: Outdoor fitness equipment (OFE) placed in public parks has the potential to encourage physical activity. However, little is known about OFE users and use patterns. This study employed onsite and video observations of OFE usage to describe user characteristics and patterns in Xihu Park. Results indicate that OFE in this park attracted considerable use, particularly in the early morning and late afternoon. During these peak-hour observations, approximately 12 users per hour used the OFE, with the majority being females and seniors. The triple arm stretch and air walker were the most popular stations. However, most OFE users interacted with less than three of the available six OFE stations. Furthermore, users spent an average of less than nine minutes on all OFE stations combined. While OFE equipment was well-used in this urban park, it appears users did not interact with OFE at rates to produce a sufficient bout or level of physical activity during their park visit. Further investigations of OFE are encouraged to determine their health impact.
      PubDate: 2017-04-21
      DOI: 10.3390/ijerph14040448
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 449: Associations between Temperature and Hospital
           Admissions for Subarachnoid Hemorrhage in Korea

    • Authors: Suji Lee, Matthias Guth
      First page: 449
      Abstract: The relationship between temperature and subarachnoid hemorrhage (SAH) is less studied than that between temperature and myocardial infarction or other cardiovascular diseases. This study investigated the association between daily temperature and risk of SAH by analyzing the hospital admission records of 111,316 SAH patients from 2004 to 2012 in Korea. A Poisson regression model was used to examine the association between temperature and daily SAH hospital admissions. To analyze data and identify vulnerable groups, we used the following subgroups: sex, age, insurance type, area (rural or urban), and different climate zones. We confirmed a markedly higher SAH risk only for people of low socioeconomic status in both hot and cold temperatures; the relative risk (RR) in the Medicaid group was significantly increased and ranged from 1.04 to 1.11 for cold temperatures and 1.10 to 1.11 for hot temperatures. For the National Health Insurance group, the RR was increased to 1.02 for the maximum temperature only. The increased risk for SAH was highest in the temperate zone. An increase above the heat threshold temperature and a decrease below the cold threshold temperature were correlated with an increased risk of SAH in susceptible populations and were associated with different lag effects and RRs.
      PubDate: 2017-04-21
      DOI: 10.3390/ijerph14040449
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 450: A National Study of Social Media, Television,
           Radio, and Internet Usage of Adults by Sexual Orientation and Smoking
           Status: Implications for Campaign Design

    • Authors: Andrew Seidenberg, Catherine Jo, Kurt Ribisl, Joseph Lee, Francisco Butchting, Yoonsang Kim, Sherry Emery
      First page: 450
      Abstract: Background: Smoking rates among lesbian, gay, and bisexual (LGB) people significantly exceed that of heterosexuals. Media interventions are an important part of tobacco control efforts, but limited information is available on LGB people’s media use. Methods: A nationally representative sample of 12,900 U.S. adults completed an online questionnaire assessing media use, smoking status, and demographic information. Multivariable logistic regression was used to assess relationships between media use with sexual orientation and smoking status. Results: A total of 590 (4.6%) respondents identified as LGB, of which 29% were smokers. Regardless of sexual orientation and smoking status, the Internet was the most popular media channel used, followed by television and radio. LGB respondents had significantly greater odds of having accounts on social media websites, accessing Facebook daily, and being a frequent Internet user, compared to heterosexual respondents. Similar media use was found between smokers and non-smokers, but smokers had greater odds of being frequent television viewers and frequent Internet users, compared to non-smokers. Conclusions: Compared to heterosexuals, LGB respondents reported greater use of the Internet, especially social media. Media campaigns targeting LGB populations can maximize reach by utilizing social media alongside traditional media channels.
      PubDate: 2017-04-21
      DOI: 10.3390/ijerph14040450
      Issue No: Vol. 14, No. 4 (2017)
       
  • IJERPH, Vol. 14, Pages 451: Job Strain and Casual Blood Pressure
           Distribution: Looking beyond the Adjusted Mean and Taking Gender, Age, and
           Use of Antihypertensives into Account. Results from ELSA-Brasil

    • Authors: Leidjaira Juvanhol, Enirtes Melo, Marilia Carvalho, Dóra Chor, José Mill, Rosane Griep
      First page: 451
      Abstract: Methodological issues are pointed to as the main sources of inconsistencies in studies about the association between job strain and blood pressure (BP)/hypertension. Our aim was to analyze the relationship between job strain and the whole BP distribution, as well as potential differences by gender, age, and use of antihypertensives. Additionally, we addressed issues relating to the operationalization of the exposure and outcome variables that influence the study of their inter-relations. We evaluated the baseline date of 12,038 participants enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) (2008–2010), a multicenter cohort study of 35–74-year-old civil servants. Job strain was assessed by the Demand-Control-Support Questionnaire. The distribution of casual BP by categories of job strain was compared by a combination of exploratory techniques. Participants were classified into three subgroups (normotensives, medicated hypertensives, and unmedicated hypertensives), and analyses were stratified by gender and age. The relationship between job strain and casual BP varied along the whole outcome distribution. Hypertensive participants had greater differences in casual BP by job strain category, especially medicated hypertensives. Differences in casual BP were also greater for systolic than for diastolic BP and for older participants. No differences were encountered by gender. The exclusion of participants susceptible to misclassification for the exposure and outcome variables increased the differences observed between the categories of low and high job strain. In conclusion, the relationship between job strain and casual BP varied along the whole outcome distribution and by use of antihypertensive drugs, age, and BP parameter evaluated. Misclassification for exposure and outcome variables should be considered in analyses of this topic.
      PubDate: 2017-04-22
      DOI: 10.3390/ijerph14040451
      Issue No: Vol. 14, No. 4 (2017)
       
 
 
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