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  Subjects -> HEALTH AND SAFETY (Total: 1283 journals)
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HEALTH AND SAFETY (514 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: 20)
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: 3)
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: 23)
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: 177)
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: 2)
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: 3)
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: 5)
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: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
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: 6)
Global Journal of Public Health     Open Access   (Followers: 9)
Global Medical & Health Communication     Open Access  
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: 45)
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: 2)
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: 10)
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)

        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 439: Developing a Water Quality Index (WQI) for an
           Irrigation Dam

    • Authors: Celia De La Mora-Orozco, Hugo Flores-Lopez, Hector Rubio-Arias, Alvaro Chavez-Duran, Jesus Ochoa-Rivero
      First page: 439
      Abstract: Pollution levels have been increasing in water ecosystems worldwide. A water quality index (WQI) is an available tool to approximate the quality of water and facilitate the work of decision-makers by grouping and analyzing numerous parameters with a single numerical classification system. The objective of this study was to develop a WQI for a dam used for irrigation of about 5000 ha of agricultural land. The dam, La Vega, is located in Teuchitlan, Jalisco, Mexico. Seven sites were selected for water sampling and samples were collected in March, June, July, September, and December 2014 in an initial effort to develop a WQI for the dam. The WQI methodology, which was recommended by the Mexican National Water Commission (CNA), was used. The parameters employed to calculate the WQI were pH, electrical conductivity (EC), dissolved oxygen (DO), total dissolved solids (TDS), total hardness (TH), alkalinity (Alk), total phosphorous (TP), Cl−, NO3, SO4, Ca, Mg, K, B, As, Cu, and Zn. No significant differences in WQI values were found among the seven sampling sites along the dam. However, seasonal differences in WQI were noted. In March and June, water quality was categorized as poor. By July and September, water quality was classified as medium to good. Quality then decreased, and by December water quality was classified as medium to poor. In conclusion, water treatment must be applied before waters from La Vega dam reservoir can be used for irrigation or other purposes. It is recommended that the water quality at La Vega dam is continually monitored for several years in order to confirm the findings of this short-term study.
      PubDate: 2017-04-29
      DOI: 10.3390/ijerph14050439
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 454: The Effects of Taekwondo Training on
           Peripheral Neuroplasticity-Related Growth Factors, Cerebral Blood Flow
           Velocity, and Cognitive Functions in Healthy Children: A Randomized
           Controlled Trial

    • Authors: Su-Youn Cho, Wi-Young So, Hee-Tae Roh
      First page: 454
      Abstract: Although regular Taekwondo (TKD) training has been reported to be effective for improving cognitive function in children, the mechanism underlying this improvement remains unclear. The purpose of the present study was to observe changes in neuroplasticity-related growth factors in the blood, assess cerebral blood flow velocity, and verify the resulting changes in children’s cognitive function after TKD training. Thirty healthy elementary school students were randomly assigned to control (n = 15) and TKD (n = 15) groups. The TKD training was conducted for 60 min at a rating of perceived exertion (RPE) of 11–15, 5 times per week, for 16 weeks. Brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1) levels were measured by blood sampling before and after the training, and the cerebral blood flow velocities (peak systolic [MCAs], end diastolic [MCAd], mean cerebral blood flow velocities [MCAm], and pulsatility index [PI]) of the middle cerebral artery (MCA) were measured using Doppler ultrasonography. For cognitive function assessment, Stroop Color and Word Tests (Word, Color, and Color-Word) were administered along with other measurements. The serum BDNF, VEGF, and IGF-1 levels and the Color-Word test scores among the sub-factors of the Stroop Color and Word Test scores were significantly higher in the TKD group after the intervention (p < 0.05). On the other hand, no statistically significant differences were found in any factors related to cerebral blood flow velocities, or in the Word test and Color test scores (p > 0.05). Thus, 16-week TKD training did not significantly affect cerebral blood flow velocities, but the training may have been effective in increasing children’s cognitive function by inducing an increase in the levels of neuroplasticity-related growth factors.
      PubDate: 2017-04-25
      DOI: 10.3390/ijerph14050454
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 455: Exclusive Breastfeeding Practice and Its
           Association among Mothers of under 5 Children in Kwango District, DR Congo

    • Authors: Sarita Dhakal, Tae Lee, Eun Nam
      First page: 455
      Abstract: The benefit of the breastfeeding has been well-established. In comparison to partial breast feeding, exclusive breastfeeding has even more benefits. The aim of this study was to identify the factors associated with breastfeeding exclusivity during the first 6 months of life in order to better target public health interventions in this community towards healthier infant nutrition and address child mortality in this population. A cross-sectional survey among 1145 random households was conducted in the Kwango district of the Democratic Republic of the Congo (DRC) during 2 November 2015 to 13 November 2015. Women of reproductive age from 15–49 years and having less than 5 years old child were selected for the study. Chi-squared test and bivariate and multivariate analyses were performed using SPSS. A major finding of this study is 49.2% of the mothers are exclusively breastfeeding their children, and marital status, literacy, place of delivery, knowledge of exclusive breastfeeding and access to radio are the key indicators for exclusive breastfeeding. Exclusive breastfeeding rate is almost equivalent to the national prevalence rate for the DRC. Providing adequate knowledge to raise awareness of exclusive breast feeding and increase involvement of health care providers in enhancing knowledge through antenatal care and during delivery and postnatal care will be the best approaches to increase exclusive breastfeeding practice.
      PubDate: 2017-04-25
      DOI: 10.3390/ijerph14050455
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 456: Levels and Distribution of Pollutants in the
           Waters of an Aquatic Ecosystem in Northern Mexico

    • Authors: Jesús Ochoa-Rivero, Ana Reyes-Fierro, Ma. Peralta-Pérez, Francisco Zavala-Díaz de la Serna, Lourdes Ballinas-Casarrubias, Ivan Salmerón, Héctor Rubio-Arias, Beatriz Rocha-Gutiérrez
      First page: 456
      Abstract: The availability of good quality water resources is essential to ensure healthy crops and livestock. The objective of this study was to evaluate the level of pollution in Bustillos Lagoon in northern Mexico. Physical-chemical parameters like sodium, chloride, sulfate, electrical conductivity, nitrates, and the pesticide dichlorodiphenyltrichloroethane (DDT) were analyzed to determine the water quality available in the lagoon. Although DDT has been banned in several countries, it is still used for agricultural purposes in Mexico and its presence in this area had not been analyzed previously. Bustillos Lagoon was divided into three zones for the evaluation: (1) industrial; (2) communal lands; and (3) agricultural. The highest concentrations of sodium (2360 mg/L) and SAR (41 meq/L) reported in the industrial zone are values exceeding the United Nations Food and Agricultural Organization (FAO) irrigation water quality guidelines. DDT and its metabolites were detected in all of the 21 sites analyzed, in the agricultural zone ∑DDTs = 2804 ng/mL, this level is much higher than those reported for other water bodies in Mexico and around the world where DDT has been used heavily. The water in the communal zone is the least contaminated, but can only be recommended for irrigation of plants with high stress tolerance and not for crops.
      PubDate: 2017-04-25
      DOI: 10.3390/ijerph14050456
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 457: Designing Fit for Purpose Health and Social
           Services for Ageing Populations

    • Authors: Jean Woo
      First page: 457
      Abstract: Population ageing is occurring in all countries, regardless of the level of economic development. While the rising burden of chronic diseases and disabilities as a consequence of this demographic transition is well recognized, the increasing prevalence of geriatric syndromes as a public health issue is not as well recognized. Recently the World Health Organization’s World Health and Ageing Report emphasized functional ability as an important outcome for aging populations, highlighting the concept of raising intrinsic capacity throughout the life course. The complementary perspective is the prevention of frailty, which has physical, cognitive, social and psychological dimensions. Therefore, services for older people should encompass medical as well as social components. The need and evolution for a transition in health and social services in Hong Kong, a special administrative region of China which has a population with the world’s highest life expectancy, is presented as an example of how one developed economy attempts to meet the challenges of population ageing. There is a need to shift to integrated care in the community instead of specialty dominated hospital care, and to establish regular activities in the community to adopt and maintain a lifestyle that reduces frailty and disability (or promotes intrinsic capacity). A top down approach with financial incentives, together with public education to help drive policy changes, are key drivers of change. It is expected that there will be much heterogeneity between different countries in terms of barriers and facilitators, such that each country needs to document their needs and design appropriate services.
      PubDate: 2017-04-25
      DOI: 10.3390/ijerph14050457
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 458: Association between Sleep and Body Weight: A
           Panel Data Model Based on a Retrospective Longitudinal Cohort of Chinese

    • Authors: Tingting Sha, Yan Yan, Xiao Gao, Shiting Xiang, Guangyu Zeng, Shiping Liu, Qiong He
      First page: 458
      Abstract: The focus of this article is on sleep duration and sleep problems in infants and their association with body weight. A retrospective birth cohort of 519 infants was enrolled in a community-based study conducted in Changsha, China. Infant weight and other health-related information were collected during regular standard checkups at the Community Health Service Centers when infants were 1, 3, 6, 8, and 12 months old. The sleep duration and sleep problems of infants were assessed by maternal self-reports. Panel data model was used to evaluate the association of sleep duration and sleep problems with infant body weight. Significant relevance between self-reported sleep duration and weight of infants has been reported in the literature tested by the fixed effects model (p < 0.01). However, this study indicated that sleep problems of infants had no effect on their weight (p = 0.151), after adjusting feeding patterns and socioeconomic factors of their families. This paper argues that, as a potentially modifiable risk factor, infant sleep duration deserves more attention from their parents and families in order to prevent and control overweight or obesity in infants as well as reducing the incidence of obesity in adults.
      PubDate: 2017-04-25
      DOI: 10.3390/ijerph14050458
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 459: Immunization Strategies Targeting Newly
           Arrived Migrants in Non-EU Countries of the Mediterranean Basin and Black

    • Authors: Cristina Giambi, Martina Del Manso, Maria Dente, Christian Napoli, Carmen Montaño-Remacha, Flavia Riccardo, Silvia Declich, Network for the control of cross-border health threats in the Mediterranean Basin; Black Sea for the ProVacMed project
      First page: 459
      Abstract: Background: The World Health Organization recommends that host countries ensure appropriate vaccinations to refugees, asylum seekers and migrants. However, information on vaccination strategies targeting migrants in host countries is limited. Methods: In 2015–2016 we carried out a survey among national experts from governmental bodies of 15 non-EU countries of the Mediterranean and Black Sea in order to document and share national vaccination strategies targeting newly arrived migrants. Results: Four countries reported having regulations/procedures supporting the immunization of migrants at national level, one at sub-national level and three only targeting specific population groups. Eight countries offer migrant children all the vaccinations included in their national immunization schedule; three provide only selected vaccinations, mainly measles and polio vaccines. Ten and eight countries also offer selected vaccinations to adolescents and adults respectively. Eight countries provide vaccinations at the community level; seven give priority vaccines in holding centres or at entry sites. Data on administered vaccines are recorded in immunization registries in nine countries. Conclusions: Although differing among countries, indications for immunizing migrants are in place in most of them. However, we cannot infer from our findings whether those strategies are currently functioning and whether barriers to their implementation are being faced. Further studies focusing on these aspects are needed to develop concrete and targeted recommendations for action. Since migrants are moving across countries, development of on-line registries and cooperation between countries could allow keeping track of administered vaccines in order to appropriately plan immunization series and avoid unnecessary vaccinations.
      PubDate: 2017-04-25
      DOI: 10.3390/ijerph14050459
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 460: Hyponatremia Is Associated with Worse Outcomes
           from Fall Injuries in the Elderly

    • Authors: Spencer Kuo, Pao-Jen Kuo, Cheng-Shyuan Rau, Shao-Chun Wu, Shiun-Yuan Hsu, Ching-Hua Hsieh
      First page: 460
      Abstract: Background: Hyponatremia has been proposed as a contributor to falls in the elderly, which have become a major global issue with the aging of the population. This study aimed to assess the clinical presentation and outcomes of elderly patients with hyponatremia admitted due to fall injuries in a Level I trauma center. Methods: We retrospectively reviewed data obtained from the Trauma Registry System for trauma admissions from January 2009 through December 2014. Hyponatremia was defined as a serum sodium level <135 mEq/L, and only patients who had sustained a fall at ground level (<1 m) were included. We used Chi-square tests, Student t-tests, and Mann-Whitney U tests to compare elderly patients (age ≥65 years) with hyponatremia (n = 492) to those without (n = 2002), and to adult patients (age 20–64 years) with hyponatremia (n = 125). Results: Significantly more elderly patients with hyponatremia presented to the emergency department (ED) due to falls compared to elderly patients without hyponatremia (73.7% vs. 52.6%; OR: 2.5, 95% CI: 2.10–3.02; p < 0.001). Elderly patients with hyponatremia presented with a worse outcome, measured by significantly higher odds of intubation (OR: 2.4, 95% CI: 1.15–4.83; p = 0.025), a longer in-hospital length of stay (LOS) (11 days vs. 9 days; p < 0.001), higher proportion of intensive care unit (ICU) admission (20.9% vs. 16.2%; OR: 1.4, 95% CI: 1.07–1.76; p = 0.013), and higher mortality (OR: 2.5, 95% CI: 1.53–3.96; p < 0.001), regardless of adjustment by Injury Severity Scores (ISS) (AOR: 2.4, 95% CI: 1.42–4.21; p = 0.001). Conclusions: Our results show that hyponatremia is associated with worse outcome from fall-related injuries in the elderly, with an increased ISS, longer LOS, and a higher risk of death.
      PubDate: 2017-04-26
      DOI: 10.3390/ijerph14050460
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 461: Association of Long-Term Near-Highway Exposure
           to Ultrafine Particles with Cardiovascular Diseases, Diabetes and

    • Authors: Yu Li, Kevin Lane, Laura Corlin, Allison Patton, John Durant, Mohan Thanikachalam, Mark Woodin, Molin Wang, Doug Brugge
      First page: 461
      Abstract: Ultrafine particle (UFP) concentrations are elevated near busy roadways, however, their effects on prevalence of cardiovascular diseases, diabetes, and hypertension are not well understood. To investigate these associations, data on demographics, diseases, medication use, and time of activities were collected by in-home surveys for 704 participants in three pairs of near-highway and urban background neighborhoods in and near Boston (MA, USA). Body mass index (BMI) was measured for a subset of 435 participants. Particle number concentration (PNC, a measure of UFP) was collected by mobile monitoring in each area. Intra-neighborhood spatial-temporal regression models (approximately 20 m resolution) were used to estimate hourly ambient PNC at the residences of participants. We used participant time activity information to adjust annual average residential PNC values and assign individualized time activity adjusted annual average PNC exposures (TAA-PNC). Using multivariate logistic regression models, we found an odds ratio (OR) of 1.35 (95% CI: 0.83, 2.22) of TAA-PNC with stroke and ischemic heart diseases (S/IHD), an OR of 1.14 (95% CI: 0.81, 1.62) with hypertension, and an OR of 0.71 (95% CI: 0.46, 1.10) for diabetes. A subset analysis controlling for BMI produced slightly stronger associations for S/IHD (OR = 1.61, 95% CI: 0.88, 2.92) and hypertension (OR = 1.28, 95% CI: 0.81, 2.02), and no association with diabetes (OR = 1.09, 95% CI = 0.61, 1.96). Further research is needed with larger sample sizes and longitudinal follow-up.
      PubDate: 2017-04-26
      DOI: 10.3390/ijerph14050461
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 462: Impact of Land Use on PM2.5 Pollution in a
           Representative City of Middle China

    • Authors: Haiou Yang, Wenbo Chen, Zhaofeng Liang
      First page: 462
      Abstract: Fine particulate matter (PM2.5) pollution has become one of the greatest urban issues in China. Studies have shown that PM2.5 pollution is strongly related to the land use pattern at the micro-scale and optimizing the land use pattern has been suggested as an approach to mitigate PM2.5 pollution. However, there are only a few researches analyzing the effect of land use on PM2.5 pollution. This paper employed land use regression (LUR) models and statistical analysis to explore the effect of land use on PM2.5 pollution in urban areas. Nanchang city, China, was taken as the study area. The LUR models were used to simulate the spatial variations of PM2.5 concentrations. Analysis of variance and multiple comparisons were employed to study the PM2.5 concentration variances among five different types of urban functional zones. Multiple linear regression was applied to explore the PM2.5 concentration variances among the same type of urban functional zone. The results indicate that the dominant factor affecting PM2.5 pollution in the Nanchang urban area was the traffic conditions. Significant variances of PM2.5 concentrations among different urban functional zones throughout the year suggest that land use types generated a significant impact on PM2.5 concentrations and the impact did not change as the seasons changed. Land use intensity indexes including the building volume rate, building density, and green coverage rate presented an insignificant or counter-intuitive impact on PM2.5 concentrations when studied at the spatial scale of urban functional zones. Our study demonstrates that land use can greatly affect the PM2.5 levels. Additionally, the urban functional zone was an appropriate spatial scale to investigate the impact of land use type on PM2.5 pollution in urban areas.
      PubDate: 2017-04-26
      DOI: 10.3390/ijerph14050462
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 463: Does an Empty Nest Affect Elders’ Health?
           Empirical Evidence from China

    • Authors: Min Gao, Yanyu Li, Shengfa Zhang, Linni Gu, Jinsui Zhang, Zhuojun Li, Weijun Zhang, Donghua Tian
      First page: 463
      Abstract: The “empty-nest” elderly family has become increasingly prevalent among old people in China. This study aimed to explore the causality between empty nests and elders’ health using effective instrumental variables, including “whether old parents talk with their families when they are upset” and “ownership of housing”. The results showed that empty nests had a significantly adverse influence on elders’ physical health, cognitive ability and psychological health. Furthermore, urban elders’ cognitive ability was more influenced by empty nests than that of rural elders. Additionally, the effects of an empty nest on elders” health were more significant among female, single elders and senior rural elders. “Living resources”, “availability of medical treatment” and “social activity engagement” were found to be significant mediators between empty nests and elders’ health, accounting for 35% of the total effect.
      PubDate: 2017-04-27
      DOI: 10.3390/ijerph14050463
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 464: Assessing Diabetes and Factors Associated with
           Foregoing Medical Care among Persons with Diabetes: Disparities Facing
           American Indian/Alaska Native, Black, Hispanic, Low Income, and Southern
           Adults in the U.S. (2011–2015)

    • Authors: Samuel Towne, Jane Bolin, Alva Ferdinand, Emily Nicklett, Matthew Smith, Marcia Ory
      First page: 464
      Abstract: Objective: Identify individual- and place-based factors associated with diagnosed diabetes and forgone medical care among those diagnosed with diabetes. Background: Diabetes affects millions of individuals globally. In the U.S. alone the prevalence rate of diagnosed diabetes has more than doubled over the past 20 years (4.2% in 1994 to 10% in 2014). Methods: The Behavioral Risk Factor Surveillance System (2011–2015) was used to identify factors associated with self-reported diabetes diagnoses (ever diagnosed) among U.S. adults. Logistic regression modeled: (1) the likelihood of having diabetes; (2) the likelihood of forgone medical care among those with diabetes, given appropriate medical care has been linked to preventing complications associated with diabetes. Results: Rates of diabetes remained relatively stable from 2011 to 2015. The likelihood of diabetes was higher (p < 0.01) among racial and ethnic minority groups, men, those with lower incomes and those with lower education. Place-based disparities indicating a higher likelihood of having a diagnosis of diabetes were found for those living in rural areas (urban versus rural, unadjusted OR = 0.844–0.908; p < 0.01) and those living in the South (North, Midwest, and Western/Pacific regions versus the South, unadjusted OR = 0.794–0.889; p < 0.01). Similar results were found with forgone medical care among those diagnosed with diabetes being more likely in the South (North, Midwest, and Western/Pacific regions versus the South, unadjusted OR = 0.542–0.819). In fully-adjusted analyses, the prevalence of diabetes and forgone medical care among those diagnosed with diabetes was higher for those with lower incomes, from several racial/ethnic minority groups, and in the South versus most other regions. Conclusions: Identifying at-risk groups informs targets for prevention and assists efforts to address chronic disease self-management among those already diagnosed with diabetes.
      PubDate: 2017-04-26
      DOI: 10.3390/ijerph14050464
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 465: Prevalence and Correlates of Suspected
           Nonalcoholic Fatty Liver Disease in Chinese Children

    • Authors: Peige Song, Jinyue Yu, Manli Wang, Xinlei Chang, Jiawen Wang, Lin An
      First page: 465
      Abstract: Nonalcoholic fatty liver disease (NAFLD) has become a serious public health problem worldwide; however, the availability of information on the prevalence of NAFLD in the general pediatric population is still limited. The primary aim of this study was to reveal the prevalence and correlates of suspected NAFLD in Chinese children at the national level. Data from the China Health and Nutrition Surveys (CHNS) was used. Weight, height, waist circumference (WC), blood pressure (BP) were measured for children aged 7–18 years. Blood samples were collected and analyzed. Children were classified as having suspected NAFLD if common causes of liver disease were excluded, and serum alanine aminotransferase (ALT) values were above the established thresholds (>22.1 IU/L for girls and >25.8 IU/L for boys). A percentage of 9.03% (75 out of 831) of Chinese children was found to have suspected NAFLD. Overweight and obesity according to BMI percentiles, abdominal obesity, hyperuricemia (uric acid (UA) > 327 μmol/L), and elevated total cholesterol (TC) were all detected as the correlates of childhood suspected NAFLD when adjusting for other factors. Our study revealed the prevalence of suspected NAFLD in general Chinese children at the national level for the first time. Our findings indicate that suspected NAFLD in children is associated with increasing childhood morbidities, further studies are needed to better understand the prevalence of childhood NAFLD and its correlates, and large-scale programs should be launched to screen NAFLD in the pediatric population in China.
      PubDate: 2017-04-27
      DOI: 10.3390/ijerph14050465
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 466: Determinants of Work Performance in Workers
           with Depression and Anxiety: A Cross-Sectional Study

    • Authors: Ivana Ivandic, Kaloyan Kamenov, Diego Rojas, Gloria Cerón, Dennis Nowak, Carla Sabariego
      First page: 466
      Abstract: Depression and anxiety are highly prevalent disorders with an impact on existential aspects of person’s life, including employment i.e., work performance (WP). In order to develop appropriate strategies, it is essential to identify determinants of WP. The objective of this study was to identify the built, social, attitudinal and health system-related environmental determinants of WP in workers with anxiety or depression in total (N = 1211) and regarding the level of disability. Hierarchical binary logistic regression was performed on data obtained from implementation of the WHO Model Disability Survey (MDS) in Chile in 2015. Hindering aspects of means of transportation and workplace, and the use of personal assistance were determinants of WP for all workers with anxiety or depression. Results differed with level of disability. Hindering aspects of means of transportation and workplace, and discrimination were determinants of WP for persons with mild to moderate disability, while hindering aspects of the workplace and dwelling, and the use of personal assistance were determinants of WP for persons with severe disability. Our results emphasize the need for a broader understanding of determinants of WP and the requirement for an integrative approach in developing both universal and specific strategies that go beyond workplace settings.
      PubDate: 2017-04-26
      DOI: 10.3390/ijerph14050466
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 467: Viability of Legionella pneumophila in Water
           Samples: A Comparison of Propidium Monoazide (PMA) Treatment on Membrane
           Filters and in Liquid

    • Authors: Sara Bonetta, Cristina Pignata, Silvia Bonetta, Lorenza Meucci, Donatella Giacosa, Elena Marino, Giorgio Gilli, Elisabetta Carraro
      First page: 467
      Abstract: Legionella pneumophila is a ubiquitous microorganism widely distributed in aquatic environments and can cause Legionellosis in humans. A promising approach to detect viable cells in water samples involves the use of quantitative polymerase chain reaction (qPCR) in combination with photoactivatable DNA intercalator propidium monoazide (PMA). However, the PMA efficiency could be different depending on the experimental conditions used. The aim of this study was to compare two PMA exposure protocols: (A) directly on the membrane filter or (B) in liquid after filter washing. The overall PMA-induced qPCR means reductions in heat-killed L. pneumophila cells were 2.42 and 1.91 log units for exposure protocols A and B, respectively. A comparison between the results obtained reveals that filter exposure allows a higher PMA-qPCR signal reduction to be reached, mainly at low concentrations (p < 0.05). This confirms the potential use of this method to quantify L. pneumophila in water with low contamination.
      PubDate: 2017-04-27
      DOI: 10.3390/ijerph14050467
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 468: Assessing Greenhouse Gas Emissions and Health
           Co-Benefits: A Structured Review of Lifestyle-Related Climate Change
           Mitigation Strategies

    • Authors: Vivian Quam, Joacim Rocklöv, Mikkel Quam, Rebekah Lucas
      First page: 468
      Abstract: This is the first structured review to identify and summarize research on lifestyle choices that improve health and have the greatest potential to mitigate climate change. Two literature searches were conducted on: (1) active transport health co-benefits, and (2) dietary health co-benefits. Articles needed to quantify both greenhouse gas emissions and health or nutrition outcomes resulting from active transport or diet changes. A data extraction tool (PRISMA) was created for article selection and evaluation. A rubric was devised to assess the biases, limitations and uncertainties of included articles. For active transport 790 articles were retrieved, nine meeting the inclusion criteria. For diet 2524 articles were retrieved, 23 meeting the inclusion criteria. A total of 31 articles were reviewed and assessed using the rubric, as one article met the inclusion criteria for both active transport and diet co-benefits. Methods used to estimate the effect of diet or active transport modification vary greatly precluding meta-analysis. The scale of impact on health and greenhouse gas emissions (GHGE) outcomes depends predominately on the aggressiveness of the diet or active transport scenario modelled, versus the modelling technique. Effective mitigation policies, infrastructure that supports active transport and low GHGE food delivery, plus community engagement are integral in achieving optimal health and GHGE outcomes. Variation in culture, nutritional and health status, plus geographic density will determine which mitigation scenario(s) best suit individual communities.
      PubDate: 2017-04-27
      DOI: 10.3390/ijerph14050468
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 469: Prospective Study on the Impact of Fear of
           Falling on Functional Decline among Community Dwelling Elderly Women

    • Authors: Kyungwon Choi, Gyeong-Suk Jeon, Sung-il Cho
      First page: 469
      Abstract: Fear of falling (FOF) is expected to have effects on functional decline in the elderly. In this study, we examined over 2 years the effect of change in FOF on functional decline in community dwelling elderly. We conducted a secondary analysis using data from elderly women, 70 years of age and older, who participated in the Korean Longitudinal Study of Aging (KLoSA). Participants were divided into four categories according to change in FOF between the 2010 and 2012 surveys. Multiple logistic regression analysis was conducted regarding the effects of changes in FOF on functional decline after controlling for variables as known risk factors for functional decline. Rates of functional decline were highest in the “consistently having FOF” group, whereas they were lowest in the “consistently no FOF” group in both 2010 and 2012. Characteristics independently associated with functional decline were change in FOF, depressive symptoms, low frequency of meeting friends, and fear-induced activity avoidance. Longer exposure to FOF was associated with an increased risk of functional decline. FOF is an important health problem that deserves attention in its own right. Public health approaches for elderly persons should address early detection, prevention, and intervention programs for FOF.
      PubDate: 2017-04-27
      DOI: 10.3390/ijerph14050469
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 470: Does Unstable Employment Have an Association
           with Suicide Rates among the Young?

    • Authors: Chungah Kim, Youngtae Cho
      First page: 470
      Abstract: Although a growing body of literature has indicated that unemployment has a positive association with suicide, the dynamic aspects of unstable employment have not yet been considered in suicidology. This study explored the association between employment stability and completed suicide among people aged 25–34 years in 20 OECD (Organization for Economic Cooperation and Development) countries with time-series data (1994–2010). In order to consider the different aspects of unstable employment, we tested the impacts of employment protection legislation indicators as another proxy of job insecurity (employed, but unstable) apart from unemployment rates. Covariates, including economic growth rates, GDP per capita, fertility rates, and divorce rate, were controlled for. The analysis was designed to be gender- and age-specific, where observations with ages of 25–29 were separated from those with ages of 30–34. Random effect models were applied to examine changes over time in suicide rates, and other models were presented to check robustness. The results showed that it is a low level of employment protection, rather than unemployment itself, that was associated with increased suicide rates among all of the studied populations. The magnitude of the effect differed by gender.
      PubDate: 2017-04-28
      DOI: 10.3390/ijerph14050470
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 471: The Relationship of PM Variation with
           Visibility and Mixing-Layer Height under Hazy/Foggy Conditions in the
           Multi-Cities of Northeast China

    • Authors: Hujia Zhao, Huizheng Che, Yanjun Ma, Yangfeng Wang, Hongbin Yang, Yuche Liu, Yaqiang Wang, Hong Wang, Xiaoye Zhang
      First page: 471
      Abstract: The variations of visibility, PM-mass concentration and mixing-layer height (MLH) in four major urban/industry regions (Shenyang, Anshan, Benxi and Fushun) of central Liaoning in Northeast China are evaluated from 2009 to 2012 to characterize their dynamic effect on air pollution. The annual mean visibilities are about 13.7 ± 7.8, 13.5 ± 6.5, 12.8 ± 6.1 and 11.5 ± 6.8 km in Shenyang, Anshan, Benxi and Fushun, respectively. The pollution load (PM × MLH) shows a weaker vertical diffusion in Anshan, with a higher PM concentration near the surface. High concentrations of fine-mode particles may be partially attributed to the biomass-burning emissions from September in Liaoning Province and surrounding regions in Northeast China as well as the coal burning during the heating period with lower MLH in winter. The visibility on non-hazy fog days is about 2.5–3.0 times higher than that on hazy and foggy days. The fine-particle concentrations of PM2.5 and PM1.0 on hazy and foggy days are ~1.8–1.9 times and ~1.5 times higher than those on non-hazy foggy days. The MLH declined more severely during fog pollution than in haze pollution. The results of this study can provide useful information to better recognize the effects of vertical pollutant diffusion on air quality in the multi-cities of central Liaoning Province in Northeast China.
      PubDate: 2017-04-29
      DOI: 10.3390/ijerph14050471
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 472: Care-Seeking Patterns and Direct Economic
           Burden of Injuries in Bangladesh

    • Authors: Natalia Alfonso, Olakunle Alonge, Dewan Md Emdadul Hoque, Kamran Baset, Adnan Hyder, David Bishai
      First page: 472
      Abstract: This study provides a comprehensive review of the care-seeking patterns and direct economic burden of injuries from the victims’ perspective in rural Bangladesh using a 2013 household survey covering 1.17 million people. Descriptive statistics and bivariate analyses were used to derive rates and test the association between variables. An analytic model was used to estimate total injury out-of-pocket (OOP) payments and a multivariate probit regression model assessed the relationship between financial distress and injury type. Results show non-fatal injuries occur to 1 in 5 people in our sample per year. With average household size of 4.5 in Bangladesh--every household has an injury every year. Most non-fatally injured patients sought healthcare from drug sellers. Less than half of fatal injuries sought healthcare and half of those with care were hospitalized. Average OOP payments varied significantly (range: $8–$830) by injury type and outcome (fatal vs. non-fatal). Total injury OOP expenditure was $$355,795 and $5000 for non-fatal and fatal injuries, respectively, per 100,000 people. The majority of household heads with injuries reported financial distress. This study can inform injury prevention advocates on disparities in healthcare usage, OOP costs and financial distress. Reallocation of resources to the most at risk populations can accelerate reduction of preventable injuries and prevent injury related catastrophic payments and impoverishment.
      PubDate: 2017-04-29
      DOI: 10.3390/ijerph14050472
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 473: 6MWT Performance and its Correlations with VO2
           and Handgrip Strength in Home-Dwelling Mid-Aged and Older Chinese

    • Authors: Qing Zhang, Hailin Lu, Shiqin Pan, Yuan Lin, Kun Zhou, Li Wang
      First page: 473
      Abstract: Six-minute walk test (6MWT) performance is more commonly used in clinic patients with chronic cardiopulmonary diseases but not in home-dwelling individuals of similar age, and its correlations with oxygen uptake (VO2) and muscle strength require further investigation. The current study determined the 6MWT performance of 106 home-dwelling residents (mean age of 62 years) in Suzhou, China. VO2 at a respiratory exchange ratio (R) of 1 was measured through graded cycling exercise tests on 46 participants. Handgrip strength of all participants was tested. 6MWT distance measured 543.4 ± 67.2 m (total work 351.0 ± 62.8 kJ) with similar distances ambulated each minute. Heart rate, blood pressure, and rate of perceived exertion scores significantly increased after 6MWT. VO2 at R = 1 reached 1238 ± 342 mL/min (18.6 ± 4.7 mL/kg/min), whereas handgrip strength totaled 29.8 ± 9.6 kg. 6MWT distance showed strong correlations with VO2 (r = 0.549, p ≤ 0.001) and handgrip strength (r = 0.359, p < 0.001). Aside from providing reference values for 6MWT performance (~543 m, ~559 m in males and ~533 in females) for home-dwelling Chinese residents, our results suggest that as a parameter of exercise endurance, 6MWT performance correlates with both aerobic capacity and muscle fitness.
      PubDate: 2017-04-29
      DOI: 10.3390/ijerph14050473
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 474: Accessing Disadvantaged Pregnant Women in
           Houston, Texas, and Characterizing Biomarkers of Metal Exposure: A
           Feasibility Study

    • Authors: Kristina W. Whitworth, Inkyu Han, Masoud Afshar, Yuan Mei, Pamela D. Berens, Shreela V. Sharma, Elaine Symanski
      First page: 474
      Abstract: : Communities of color or low socioeconomic status are disproportionately affected by metal exposure given spatial variability of the ambient levels of these contaminants. Despite this, there is little research characterizing metal concentrations in blood among disadvantaged populations in the U.S., especially among pregnant women who are particularly vulnerable and difficult to access. Thus, we conducted a pilot study among disadvantaged pregnant women in Houston, Texas to assess willingness to participate in key activities of an epidemiologic study and characterize exposures to 16 metals. Thirty-one women attending a Medicaid-serving prenatal clinic were included in this pilot study and completed an interviewer-administered questionnaire. We obtained and measured metal compounds in whole blood samples for 22 of these women during third-trimester prenatal visits. Median whole blood concentrations of Ni, As, Cd, and Pb were 27, 1.4, 0.6, and 6.3 µg/L, respectively. Most women were willing to participate in critical aspects of a research study, including wearing a personal air-sampling badge for 2–3 days (87.1%), receiving ultrasounds (83.9%), and providing blood draws (64.5%). Despite the small sample, our results provide evidence of women’s metal exposure and their willingness to participate in future research studies to elucidate exposure pathways and explore related health effects experienced among this population of disadvantaged pregnant women.
      PubDate: 2017-04-29
      DOI: 10.3390/ijerph14050474
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 475: Stress in School. Some Empirical Hints on the
           Circadian Cortisol Rhythm of Children in Outdoor and Indoor Classes

    • Authors: Ulrich Dettweiler, Christoph Becker, Bjørn H. Auestad, Perikles Simon, Peter Kirsch
      First page: 475
      Abstract: This prospective longitudinal survey compared the stress levels of students taught using an outdoor curriculum in a forest, with children in a normal school setting. We were especially interested in the effect outdoor teaching might have on the children’s normal diurnal cortisol rhythm. 48 children (mean age = 11.23; standard deviation (SD) = 0.46) were enrolled, with 37 in the intervention group (IG), and 11 in the control group (CG). The intervention consisted of one full school day per week in the forest over the school year. Stress levels were measured in cortisol with three samples of saliva per day. Furthermore, the data allowed for statistical control of physical activity (PA) values. For data analysis, we used a linear mixed-effects model (LMM) with random intercept and general correlation matrix for the within-unit residuals. The LMM yields that IG have expected greater decline of cortisol compared to CG; rate 0.069 µg/L vs. 0.0102 µg/L (log-units/2 h), p = 0.009. PA does not show a statistically significant interaction with cortisol (p = 0.857), despite being higher in the intervention group (p < 0.001). The main effect in our measures was that the IG had a steady decline of cortisol during the school day. This is in accordance with a healthy child’s diurnal rhythm, with a significant decline of cortisol from morning to noon. This effect is constant over the school year. The CG does not show this decline during either measurement day. Further research is needed to fully explain this interesting phenomenon.
      PubDate: 2017-04-30
      DOI: 10.3390/ijerph14050475
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 476: Individuals’ Acceptance to Free-Floating
           Electric Carsharing Mode: A Web-Based Survey in China

    • Authors: Yun Wang, Xuedong Yan, Yu Zhou, Qingwan Xue, Li Sun
      First page: 476
      Abstract: Carsharing is growing rapidly in popularity worldwide. When the vehicles involved are Battery Electric Vehicles (BEV), carsharing has been proven to remarkably contribute to easing energy and environment crises. In this study, individuals’ acceptance to carsharing in China was measured from three aspects: carsharing mode choice behavior, highest acceptable price to use carsharing, and willingness to forgo car purchases. The data were collected by a web-based survey. The hierarchical tree-based regression (HTBR) method was applied to explore the effects of potential influencing factors on individuals’ acceptance, and some interesting findings were obtained: participants who know about carsharing were more likely to use carsharing, pay higher prices and forgo car purchases; the most competitive trip purpose and trip distance for choosing carsharing were, respectively, business activities and 11–20 km; most participants (47.1%) were willing to pay 1–2 Yuan per minute to use carsharing, and males or participants with higher income-level could accept higher price; and when car purchase restrain policy (CPRP) was carried out in a city or the urban public transport service level (UPTSL) was high, participants were more willing to forgo car purchases. Based on the above findings, corresponding policies were proposed to provide guidance for successful establishment of carsharing in China.
      PubDate: 2017-05-02
      DOI: 10.3390/ijerph14050476
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 477: Epidemiology and Management of Acute
           Haematogenous Osteomyelitis in a Tertiary Paediatric Center

    • Authors: Elena Chiappini, Caterina Camposampiero, Simone Lazzeri, Giuseppe Indolfi, Maurizio De Martino, Luisa Galli
      First page: 477
      Abstract: Background: Paediatric acute hematogenous osteomyelitis (AHOM) is a serious disease requiring early diagnosis and treatment. To review the clinical presentation, management and organisms responsible for AHOM, and to explore risk factors for complicated AHOM, a large cohort referring to a single center over a 6-year period was evaluated. Methods: Data from children with AHOM, hospitalized between 2010 and 2015, and aged > 1 month, were retrospectively collected and analyzed. Results: 121 children (median age 4.8 years; 55.4% males) were included. Fever at onset was present in 55/121 children (45.5%); the lower limb was most frequently affected (n = 68/121; 56.2%). Microbiological diagnosis (by culture and/or polymerase chain reaction (PCR)) was reached in 33.3% cases. Blood and pus/biopsy culture sensitivities were 32.4% and 46.4%, respectively. PCR sensitivity was 3.6% (2/55) on blood, and 66.6% (16/24) on pus/biopsy sample. Staphylococcus aureus was the most commonly identified pathogen (n = 20); no methicillin-resistant Staphylococcus aureus (MRSA) was isolated, 10.0% (n = 2) strains were Panton-Valentine-Leukocidin (PVL) producer; 48.8% (59/121) cases were complicated. At univariate analysis, factors associated with complicated AHOM were: recent fever episode, fever at onset, upper limb involvement, white blood count (WBC) ≥ 12,000/µL, C reactive protein (CRP) ≥ 10 mg/L, S. aureus infection. At multivariate analyses S. aureus infection remained the only risk factor for complicated AHOM (aOR = 3.388 (95%CI: 1.061–10.824); p-value = 0.039). Conclusions: In this study microbiological diagnosis was obtained in over one third of cases. Empiric treatment targeting methicillin-sensitive Staphylococcus aureus seems to be justified by available microbiological data.
      PubDate: 2017-05-04
      DOI: 10.3390/ijerph14050477
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 478: The Australian National Pollutant Inventory
           Fails to Fulfil Its Legislated Goals

    • Authors: Nathan Cooper, Donna Green, Katrin Meissner
      First page: 478
      Abstract: Publically accessible pollution databases, such as the Australian National Pollutant Inventory, contain information on chemical emissions released by industrial facility and diffuse sources. They are meant to enable public scrutiny of industrial activity, which in turn, is meant to lead to industries reducing their pollution. In Australia, however, concerns have been consistently raised that this process is not occurring. To assess whether Australia’s National Pollutant Inventory is fulfilling its legislated goals, we examined the accuracy and consistency of the largest facility and diffuse source of airborne lead, a major pollutant of concern for public health. Our analysis found that the emissions estimates provided by the Inventory were not accurate and were not consistent with other sources of emissions within the Inventory, potentially distorting any user interpretation of emissions estimates provided by the National Pollutant Inventory. We conclude that for at least these important public health pollution sources, the Inventory does not fulfil its legislated goals.
      PubDate: 2017-05-04
      DOI: 10.3390/ijerph14050478
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 479: Bacterial Pollution in River Waters and
           Gastrointestinal Diseases

    • Authors: Lilia Rodríguez-Tapia, Jorge Morales-Novelo
      First page: 479
      Abstract: Currently, one of Mexico’s most severe environmental problems is the high levels of pollution of many of its rivers. The present article focuses on the relationship between total coliform bacteria levels and the increase of human digestive tract diseases in the highly polluted Atoyac River in the central Mexican states of Puebla and Tlaxcala. Pollution has become a potential health hazard for people living in nearby river communities. Based on data collected from six of the most contaminated riverside municipalities, two environmental models were developed taking into consideration the health of the entire population, not simply that of its individual members. Such models estimate a health-disease function that confirm the link between Atoyac River pollution and the incidence of gastrointestinal diseases. The causal relation between pollution and gastrointestinal disease incentivizes the creation of epidemiological and public health programs aimed at reducing the environmental health impact of the pollution associated with the Atoyac River. The results presented here are the first of their kind of this river and will serve as basis for future research exploring other similarly contaminated riparian communities. As the causes of pollution are directly related to the economic development and population growth of the region, further research should be conducted for prevention of diseases, educational programs, water remediation and conservation programs that will have a positive impact on the quality of life of the population presently at risk.
      PubDate: 2017-05-04
      DOI: 10.3390/ijerph14050479
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 480: Sustainable Methods for Decontamination of
           Microcystin in Water Using Cold Plasma and UV with Reusable TiO2
           Nanoparticle Coating

    • Authors: Xuewen Jiang, Seungjun Lee, Chulkyoon Mok, Jiyoung Lee
      First page: 480
      Abstract: Microcystins (MCs) are a family of cyanotoxins and pose detrimental effects on human, animal, and ecological health. Conventional water treatment processes have limited success in removing MCs without producing harmful byproducts. Therefore, there is an urgent need for cost-effective and environmentally-friendly methods for treating MCs. The objective of this study was to develop sustainable and non-chemical-based methods for controlling MCs, such as using cold plasma and ultra violet (UV) light with titanium dioxide (TiO2) coating, which can be applied for diverse scale and settings. MCs, extracted from Microcystis aeruginosa, were treated with cold plasma or UV at irradiance of 1470 μW/cm2 (high) or 180 μW/cm2 (low). To assess synergistic effects, the outside of the UV treatment chamber was coated with nanoparticles (TiO2) prior to irradiation, which can be reused for a long time. The degradation efficiency of UV was enhanced by the reusable TiO2 coating at lower irradiance (70.41% [UV] vs. 79.61% [UV+TiO2], 120 min), but no significant difference was observed at higher irradiance. Cold plasma removed MCs rapidly under experimental conditions (92%, 120 min), indicating that it is a promising candidate for controlling MCs in water without generating harmful disinfection byproducts. It can be also easily and practically used in household settings during emergency situations.
      PubDate: 2017-05-05
      DOI: 10.3390/ijerph14050480
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 481: Comment on Sundseth et al. Global Sources and
           Pathways of Mercury in the Context of Human Health. Int. J. Environ. Res.
           Public Health 2017, 14, 105

    • Authors: S. Mortazavi, Ghazal Mortazavi, Maryam Paknahad
      First page: 481
      Abstract: n/a
      PubDate: 2017-05-05
      DOI: 10.3390/ijerph14050481
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 482: Prevalence of Rotavirus Genogroup A and
           Norovirus Genogroup II in Bassaseachic Falls National Park Surface Waters
           in Chihuahua, Mexico

    • Authors: Ma. Delgado-Gardea, Patricia Tamez-Guerra, Ricardo Gomez-Flores, Aurora Mendieta-Mendoza, Francisco Zavala-Díaz de la Serna, Juan Contreras-Cordero, Gilberto Erosa-de la Vega, María Pérez-Recoder, Blanca Sánchez-Ramírez, Carmen González-Horta, Rocío Infante-Ramírez
      First page: 482
      Abstract: In areas lacking potable water treatment, drinking contaminated water may represent a public health threat. In addition to enteropathogenic bacteria and parasites, fecal contamination in water environments is associated with the transmission of enteric viruses and other causal agents of infectious disease. Rotavirus and norovirus are the main enteric viral agents responsible for diarrheic outbreaks. The aim of the present study was to detect seasonal variation of rotavirus and norovirus in the surface water at Bassaseachic Falls National Park during 2013. Rivers and streams within and nearby this park were sampled once in each season during 2013. Viral concentration was carried out by a handmade filtration equipment, using a commercial electropositive membrane coupled with the virus absortion elution technique (VIRADEL©). Detection of rotavirus and norovirus was performed by SYBR Green reverse transcription-real time polymerase chain reaction (SYBR GREEN© RT-qPCR) analyses. Norovirus genogroup II was detected in samples collected in June and October 2013. In the case of rotavirus, genogroup A was detected in March and June. The presence of rotavirus and norovirus was related to viral acute diarrhea in children less than five years of age, who were inhabiting the sampled areas. This may indicates that the contaminated water was potentially a risk factor for regional diarrheic outbreaks.
      PubDate: 2017-05-05
      DOI: 10.3390/ijerph14050482
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 483: The Effect of Dog-Assisted Intervention on
           Student Well-Being, Mood, and Anxiety

    • Authors: Dasha Grajfoner, Emma Harte, Lauren Potter, Nicola McGuigan
      First page: 483
      Abstract: This novel, exploratory study investigated the effect of a short, 20 min, dog-assisted intervention on student well-being, mood, and anxiety. One hundred and thirty-two university students were allocated to either an experimental condition or one of two control conditions. Each participant completed the Warwick–Edinburgh Mental Well-Being Scale (WEMBS), the State Trait Anxiety Scale (STAI), and the UWIST Mood Adjective Checklist (UMACL) both before, and after, the intervention. The participants in the experimental condition interacted with both the dogs and their handlers, whereas the control groups interacted with either the dog only, or the handler only. The analyses revealed a significant difference across conditions for each measure, with those conditions in which a dog was present leading to significant improvements in mood and well-being, as well as a significant reduction in anxiety. Interestingly, the presence of a handler alongside the dog appeared to have a negative, and specific, effect on participant mood, with greater positive shifts in mood being witnessed when participants interacted with the dog alone, than when interacting with both the dog and the handler. These findings show that even a short 20 min session with a therapy dog can be an effective alternative intervention to improve student well-being, anxiety, and mood.
      PubDate: 2017-05-05
      DOI: 10.3390/ijerph14050483
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 484: Modeling Geospatial Patterns of Late-Stage
           Diagnosis of Breast Cancer in the US

    • Authors: Lee Mobley, Tzy-Mey Kuo, Lia Scott, Yamisha Rutherford, Srimoyee Bose
      First page: 484
      Abstract: In the US, about one-third of new breast cancers (BCs) are diagnosed at a late stage, where morbidity and mortality burdens are higher. Health outcomes research has focused on the contribution of measures of social support, particularly the residential isolation or segregation index, on propensity to utilize mammography and rates of late-stage diagnoses. Although inconsistent, studies have used various approaches and shown that residential segregation may play an important role in cancer morbidities and mortality. Some have focused on any individuals living in residentially segregated places (place-centered), while others have focused on persons of specific races or ethnicities living in places with high segregation of their own race or ethnicity (person-centered). This paper compares and contrasts these two approaches in the study of predictors of late-stage BC diagnoses in a cross-national study. We use 100% of U.S. Cancer Statistics (USCS) Registry data pooled together from 40 states to identify late-stage diagnoses among ~1 million new BC cases diagnosed during 2004–2009. We estimate a multilevel model with person-, county-, and state-level predictors and a random intercept specification to help ensure robust effect estimates. Person-level variables in both models suggest that non-White races or ethnicities have higher odds of late-stage diagnosis, and the odds of late-stage diagnosis decline with age, being highest among the <age 50 group. After controlling statistically for all other factors, we examine place-centered isolation and find for anyone living in an isolated Asian community there is a large beneficial association (suggesting lower odds of late-stage diagnosis) while for anyone living in an isolated White community there is a large detrimental association (suggesting greater odds of late-stage diagnosis). By contrast, living in neighborhoods among others of one’s own race or ethnicity (person-centered isolation) is associated with greater odds of late-stage diagnosis, as this measure is dominated by Whites (the majority). At the state level, living in a state that allows unfettered access to a specialist is associated with a somewhat lower likelihood of being diagnosed at a late stage of BC. Geographic factors help explain the likelihood of late-stage BC diagnosis, which varies considerably across the U.S. as heterogeneous compositional and contextual factors portray very different places and potential for improving information and outcomes. The USCS database is expanding to cover more states and is expected to be a valuable resource for ongoing and future place-based cancer outcomes research.
      PubDate: 2017-05-05
      DOI: 10.3390/ijerph14050484
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 485: Effects of Regular Classes in Outdoor
           Education Settings: A Systematic Review on Students’ Learning, Social
           and Health Dimensions

    • Authors: Christoph Becker, Gabriele Lauterbach, Sarah Spengler, Ulrich Dettweiler, Filip Mess
      First page: 485
      Abstract: Background: Participants in Outdoor Education Programmes (OEPs) presumably benefit from these programmes in terms of their social and personal development, academic achievement and physical activity (PA). The aim of this systematic review was to identify studies about regular compulsory school- and curriculum-based OEPs, to categorise and evaluate reported outcomes, to assess the methodological quality, and to discuss possible benefits for students. Methods: We searched online databases to identify English- and German-language peer-reviewed journal articles that reported any outcomes on a student level. Two independent reviewers screened studies identified for eligibility and assessed the methodological quality. Results: Thirteen studies were included for analysis. Most studies used a case-study design, the average number of participants was moderate (mean valued (M) = 62.17; standard deviation (SD) = 64.12), and the methodological quality was moderate on average for qualitative studies (M = 0.52; SD = 0.11), and low on average for quantitative studies (M = 0.18; SD = 0.42). Eight studies described outcomes in terms of social dimensions, seven studies in learning dimensions and four studies were subsumed under additional outcomes, i.e., PA and health. Eleven studies reported positive, one study positive as well as negative, and one study reported negative effects. PA and mental health as outcomes were underrepresented. Conclusion: Tendencies were detected that regular compulsory school- and curriculum-based OEPs can promote students in respect of social, academic, physical and psychological dimensions. Very little is known concerning students’ PA or mental health. We recommend conducting more quasi-experimental design and longitudinal studies with a greater number of participants, and a high methodological quality to further investigate these tendencies.
      PubDate: 2017-05-05
      DOI: 10.3390/ijerph14050485
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 486: Assessing the Racial and Ethnic Disparities in
           Breast Cancer Mortality in the United States

    • Authors: Clement Yedjou, Paul Tchounwou, Marinelle Payton, Lucio Miele, Duber Fonseca, Leroy Lowe, Richard Alo
      First page: 486
      Abstract: Breast cancer is the second leading cause of cancer related deaths among women aged 40–55 in the United States and currently affects more than one in ten women worldwide. It is also one of the most diagnosed cancers in women both in wealthy and poor countries. Fortunately, the mortality rate from breast cancer has decreased in recent years due to increased emphasis on early detection and more effective treatments in White population. Although the mortality rates have declined in some ethnic populations, the overall cancer incidence among African American and Hispanic populations has continued to grow. The goal of the present review article was to highlight similarities and differences in breast cancer morbidity and mortality rates primarily among African American women compared to White women in the United States. To reach our goal, we conducted a search of articles in journals with a primary focus on minority health, and authors who had published articles on racial/ethnic disparity related to breast cancer patients. A systematic search of original research was conducted using MEDLINE, PUBMED and Google Scholar databases. We found that racial/ethnic disparities in breast cancer may be attributed to a large number of clinical and non-clinical risk factors including lack of medical coverage, barriers to early detection and screening, more advanced stage of disease at diagnosis among minorities, and unequal access to improvements in cancer treatment. Many African American women have frequent unknown or unstaged breast cancers than White women. These risk factors may explain the differences in breast cancer treatment and survival rate between African American women and White women. New strategies and approaches are needed to promote breast cancer prevention, improve survival rate, reduce breast cancer mortality, and ultimately improve the health outcomes of racial/ethnic minorities.
      PubDate: 2017-05-05
      DOI: 10.3390/ijerph14050486
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 487: Dietary Patterns and Obesity among Chinese
           Adults: Results from a Household-Based Cross-Sectional Study

    • Authors: Yan Zou, Ronghua Zhang, Shichang Xia, Lichun Huang, Jia Meng, Yueqiang Fang, Gangqiang Ding
      First page: 487
      Abstract: The key dietary pattern other than dietary factors influencing obesity has been reported by several large epidemiological studies. This study was carried out between 2010 and 2012 including 1613 adult residents in Zhejiang Province. Dietary patterns were extracted by factor analysis based on 24-h dietary recall. Associations with dietary patterns and obesity were examined and adjusted for age and gender by logistic regression. Five dietary patterns were identified by factor analysis with their eigenvalues greater than 1: ‘cereal, animal, and plant food’, ‘high protein food’, ‘plant food’, ‘poultry’, and ‘beverage’. After adjustment for age and gender, the ‘cereal, animal, and plant food’ and ‘beverage’ pattern was associated with obesity (OR = 2.924, 3.257; 95% CI = 1.147–7.463, 1.372–7.692). In conclusion, ‘cereal, animal, and plant food’ and ‘beverage’ dietary patterns may be associated with increased risk of obesity. ‘Cereal, animal, and plant food’ dietary patterns may be associated with increased risk of obesity resulting from increased total energy intake by increased protein and fat intake; while a ‘beverage’ dietary pattern may be associated with increased risk of obesity resulting from increased total energy intake by increased carbohydrate intake. The findings are valuable in targeting future nutrition education.
      PubDate: 2017-05-05
      DOI: 10.3390/ijerph14050487
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 488: Epidemiology of Drowning in Bangladesh: An

    • Authors: Aminur Rahman, Olakunle Alonge, Al-Amin Bhuiyan, Priyanka Agrawal, Shumona Salam, Abu Talab, Qazi Rahman, Adnan Hyder
      First page: 488
      Abstract: Over one-quarter of deaths among 1–4 year-olds in Bangladesh were due to drowning in 2003, and the proportion increased to 42% in 2011. This study describes the current burden and risk factors for drowning across all demographics in rural Bangladesh. A household survey was carried out in 51 union parishads of rural Bangladesh between June and November 2013, covering 1.17 million individuals. Information on fatal and nonfatal drowning events was collected by face-to-face interviews using a structured questionnaire. Fatal and non-fatal drowning rates were 15.8/100,000/year and 318.4/100,000/6 months, respectively, for all age groups. The highest rates of fatal (121.5/100,000/year) and non-fatal (3057.7/100,000/6 months) drowning were observed among children 1 to 4 years of age. These children had higher rates of fatal (13 times) and non-fatal drowning (16 times) compared with infants. Males had slightly higher rates of both fatal and non-fatal drowning. Individuals with no education had 3 times higher rates of non-fatal drowning compared with those with high school or higher education. Non-fatal drowning rates increased significantly with decrease in socio-economic status (SES) quintiles, from the highest to the lowest. Drowning is a major public health issue in Bangladesh, and is now a major threat to child survival.
      PubDate: 2017-05-05
      DOI: 10.3390/ijerph14050488
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 489: Survival Analysis of Coal Workers’
           Pneumoconiosis (CWP) Patients in a State-Owned Mine in the East of China
           from 1963 to 2014

    • Authors: Lei Han, Qianqian Gao, Jingjin Yang, Qiuyun Wu, Baoli Zhu, Hengdong Zhang, Bangmei Ding, Chunhui Ni
      First page: 489
      Abstract: To investigate the mortality probability, life expectancy of coal workers’ pneumoconiosis (CWP), and related factors of life expectancy, a total of 495 patients with CWP were diagnosed and reported from 1963 to 2014 in a state-owned mine in the east of China. The life table method, log rank method, and Cox regression model were used for survival analysis. 95 out of 495 CWP died during this period. The mortality rate was 19.19%. The average life span was 12.1 (0.0–33.2) years and average death age was 57.4 (33.0–83.0) years. The life table indicated that overall mortality probability increased with the age of CWP patients. Life expectancy of CWP patients was prolonged to 4.3, 1.4, 1.2, and 1.4 years without death caused by pneumoconiosis, tuberculosis, lung cancer, and pulmonary heart disease respectively. The survival curve of CWP patients without pulmonary tuberculosis was higher (average 37.9 years) than patients with pulmonary tuberculosis (average 34.1 years). There was significant difference observed (χ2 = 6.196, p < 0.05). Three risk factors that include initial dust exposure year, age of onset, and first diagnostic stage were put into the Cox regression model for evaluation. The data indicated that prevention and treatment of CWP complication is important to improve patients’ survival rates.
      PubDate: 2017-05-06
      DOI: 10.3390/ijerph14050489
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 490: Childhood Attachment to Pets: Associations
           between Pet Attachment, Attitudes to Animals, Compassion, and Humane

    • Authors: Roxanne Hawkins, Joanne Williams, Scottish Society for the Prevention of Cruelty to Animals (Scottish SPCA)
      First page: 490
      Abstract: Attachment to pets has an important role in children’s social, emotional, and cognitive development, mental health, well-being, and quality of life. This study examined associations between childhood attachment to pets and caring and friendship behaviour, compassion, and attitudes towards animals. This study also examined socio-demographic differences, particularly pet ownership and pet type. A self-report survey of over one thousand 7 to 12 year-olds in Scotland, UK, revealed that the majority of children are strongly attached to their pets, but attachment scores differ depending on pet type and child gender. Analysis revealed that attachment to pets is facilitated by compassion and caring and pet-directed friendship behaviours and that attachment to pets significantly predicts positive attitudes towards animals. The findings have implications for the promotion of prosocial and humane behaviour. Encouraging children to participate in pet care behaviour may promote attachment between children and their pet, which in turn may have a range of positive outcomes for both children (such as reduced aggression, better well-being, and quality of life) and pets (such as humane treatment). This study enhances our understanding of childhood pet attachment and has implications for humane education and promoting secure emotional attachments in childhood.
      PubDate: 2017-05-06
      DOI: 10.3390/ijerph14050490
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 491: Nocturnal Road Traffic Noise Exposure and
           Children’s Sleep Duration and Sleep Problems

    • Authors: Kjell Weyde, Norun Krog, Bente Oftedal, Jorunn Evandt, Per Magnus, Simon Øverland, Charlotte Clark, Stephen Stansfeld, Gunn Aasvang
      First page: 491
      Abstract: Almost half of the European Union (EU)’s population is exposed to road traffic noise above levels that constitute a health risk. Associations between road traffic noise and impaired sleep in adults have consistently been reported. Less is known about effects of noise on children’s sleep. The aim of this study was to examine the association between nocturnal road traffic noise exposure and children’s parental-reported sleep duration and sleep problems. The present cross-sectional study used data from The Norwegian Mother and Child Cohort Study. Parental report of children’s sleep duration and sleep problems at age 7 was linked to modelled levels of residential night-time road traffic noise. The study population included 2665 children from Oslo, Norway. No association was found between road traffic noise and sleep duration in the total study population (odds ratio (OR): 1.05, 95% confidence interval (CI): [0.94, 1.17]), but a statistically significant association was observed in girls (OR: 1.21, 95% CI: [1.04, 1.41]). For sleep problems, the associations were similar (OR: 1.36, 95% CI: [0.85, 2.16]) in girls. The ORs are presented for an increase of 10 dB. The findings suggest there is an association between road traffic noise and sleep for girls, underlining the importance of protecting children against excessive noise levels.
      PubDate: 2017-05-06
      DOI: 10.3390/ijerph14050491
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 492: Perception, Knowledge and Behaviors Related to

    • Authors: Wenchao Zhang, Wei Wang, Junfen Lin, Ying Zhang, Xiaopeng Shang, Xin Wang, Meilin Huang, Shike Liu, Wei Ma
      First page: 492
      Abstract: (1) The objective of this study was to assess the risk perceptions, attitudes, knowledge, and behaviors related to typhoon among rural residents in Zhejiang province of China. A cross-sectional study was conducted among rural residents in Zhejiang province, China. Information was collected from 659 participants using a structured questionnaire. Univariate analysis and multivariable analysis were used to analyze the data. Participants were most concerned about property damage, followed by their health and life. Television, short message service (SMS), relatives and friends were the most common information sources. Most people had not been educated with disaster prevention measures. The complementary log–log (CLL) model showed that understanding typhoon warning signal, preparation time, risk perception of health damage and life threat, and fears of typhoon were independent predictors of adoption of coping behaviors. We found that: 1. Residents’ risk perception of health and life threat caused by typhoon is inadequate; 2. There is a gap between residents’ cognition or knowledge and behavior in rural areas; 3. The government should further make strategies to develop educational activities, in order to eliminate the gap and improve the ability of preparing for typhoon among rural residents.
      PubDate: 2017-05-06
      DOI: 10.3390/ijerph14050492
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 493: Beverage Intake, Smoking Behavior, and Alcohol
           Consumption in Contemporary China—A Cross-Sectional Analysis from the
           2011 China Health and Nutrition Survey

    • Authors: Yen-Han Lee, Zhi Wang, Timothy Chiang, Ching-Ti Liu
      First page: 493
      Abstract: Chinese residents enjoy various types of beverages in their daily life. With the rapid Westernization of contemporary China, several adverse health concerns—such as diabetes linked to sweetened beverages—have emerged. Until now, no research that examines associations between beverage consumption and smoking/drinking behaviors has been made available, despite the large Chinese populations partaking in such activities. We conducted a cross-sectional study to explore the association between beverage intake frequencies and smoking/drinking behaviors in 12,634 adult respondents who participated in the latest wave (2011) of the China Health and Nutrition Survey (CHNS). Further, we applied Tukey’s Honest Significance test for pairwise comparisons. We defined the consumption categories as daily (at least one serving per day), weekly (less than one serving per day, at least one serving per week), monthly (less than one serving per week, at least one serving per month), and less than monthly or none—for sweetened beverage, water, tea, and coffee consumptions. The data showed that both tea and sweetened beverages are associated with smoking/drinking behaviors. Compared to respondents who consume tea and sweetened beverages daily, the odds of smoking behaviors are lower for those who consume such beverages less frequently. Further policy implications are discussed, including higher taxes on sweetened beverages and lessons from other countries.
      PubDate: 2017-05-07
      DOI: 10.3390/ijerph14050493
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 494: Infectious Diseases and Tropical Cyclones in
           Southeast China

    • Authors: Jietao Zheng, Weixiao Han, Baofa Jiang, Wei Ma, Ying Zhang
      First page: 494
      Abstract: Southeast China is frequently hit by tropical cyclones (TCs) with significant economic and health burdens each year. However, there is a lack of understanding of what infectious diseases could be affected by tropical cyclones. This study aimed to examine the impacts of tropical cyclones on notifiable infectious diseases in southeast China. Disease data between 2005 and 2011 from four coastal provinces in southeast China, including Guangdong, Hainan, Zhejiang, and Fujian province, were collected. Numbers of cases of 14 infectious diseases were compared between risk periods and reference periods for each tropical cyclone. Risk ratios (RRs) were calculated to estimate the risks. TCs were more likely to increase the risk of bacillary dysentery, paratyphoid fever, dengue fever and acute hemorrhagic conjunctivitis (ps < 0.05) than to decrease the risk, more likely to decrease the risk of measles, mumps, varicella and vivax malaria (ps < 0.05) than to increase the risk. In conclusion, TCs have mixed effects on the risk of infectious diseases. TCs are more likely to increase the risk of intestinal and contact transmitted infectious diseases than to decrease the risk, and more likely to decrease the risk of respiratory infectious diseases than to increase the risk. Findings of this study would assist in developing public health strategies and interventions for the reduction of the adverse health impacts from tropical cyclones.
      PubDate: 2017-05-07
      DOI: 10.3390/ijerph14050494
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 495: Hospitalizations in Pediatric and Adult
           Patients for All Cancer Type in Italy: The EPIKIT Study under the E.U.
           COHEIRS Project on Environment and Health

    • Authors: Prisco Piscitelli, Immacolata Marino, Andrea Falco, Matteo Rivezzi, Roberto Romano, Restituta Mazzella, Cosimo Neglia, Giulia Della Rosa, Giuseppe Pellerano, Giuseppe Militerno, Adriana Bonifacino, Gaetano Rivezzi, Roberto Romizi, Giuseppe Miserotti, Maurizio Montella, Fabrizio Bianchi, Alessandra Marinelli, Antonella De Donno, Giovanni De Filippis, Giuseppe Serravezza, Gianluca Di Tanna, Dennis Black, Valerio Gennaro, Mario Ascolese, Alessandro Distante, Ernesto Burgio, Massimo Crespi, Annamaria Colao
      First page: 495
      Abstract: Background: Cancer Registries (CRs) remain the gold standard for providing official epidemiological estimations. However, due to CRs’ partial population coverage, hospitalization records might represent a valuable tool to provide additional information on cancer occurrence and expenditures at national/regional level for research purposes. The Epidemiology of Cancer in Italy (EPIKIT) study group has been built up, within the framework of the Civic Observers for Health and Environment: Initiative of Responsibility and Sustainability (COHEIRS) project under the auspices of the Europe for Citizens Program, to assess population health indicators. Objective: To assess the burden of all cancers in Italian children and adults. Methods: We analyzed National Hospitalization Records from 2001 to 2011. Based on social security numbers (anonymously treated), we have excluded from our analyses all re-hospitalizations of the same patients (n = 1,878,109) over the entire 11-year period in order to minimize the overlap between prevalent and incident cancer cases. To be more conservative, only data concerning the last five years (2007–2011) have been taken into account for final analyses. The absolute number of hospitalizations and standardized hospitalization rates (SHR) were computed for each Italian province by sex and age-groups (0–19 and 20–49). Results: The EPIKIT database included a total of 4,113,169 first hospital admissions due to main diagnoses of all tumors. The annual average number of hospital admissions due to cancer in Italy has been computed in 2362 and 43,141 hospitalizations in pediatric patients (0–19 years old) and adults (20–49 years old), respectively. Women accounted for the majority of cancer cases in adults aged 20–49. As expected, the big city of Rome presented the highest average annual number of pediatric cancers (n = 392, SHR = 9.9), followed by Naples (n = 378; SHR = 9.9) and Milan (n = 212; SHR = 7.3). However, when we look at SHR, minor cities (i.e., Imperia, Isernia and others) presented values >10 per 100,000, with only 10 or 20 cases per year. Similar figures are shown also for young adults aged 20–49. Conclusions: In addition to SHR, the absolute number of incident cancer cases represents a crucial piece of information for planning adequate healthcare services and assessing social alarm phenomena. Our findings call for specific risk assessment programs at local level (involving CRs) to search for causal relations with environmental exposures.
      PubDate: 2017-05-09
      DOI: 10.3390/ijerph14050495
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 496: Evaluation of Drought Implications on
           Ecosystem Services: Freshwater Provisioning and Food Provisioning in the
           Upper Mississippi River Basin

    • Authors: Ping Li, Nina Omani, Indrajeet Chaubey, Xiaomei Wei
      First page: 496
      Abstract: Drought is one of the most widespread extreme climate events with a potential to alter freshwater availability and related ecosystem services. Given the interconnectedness between freshwater availability and many ecosystem services, including food provisioning, it is important to evaluate the drought implications on freshwater provisioning and food provisioning services. Studies about drought implications on streamflow, nutrient loads, and crop yields have been increased and these variables are all process-based model outputs that could represent ecosystem functions that contribute to the ecosystem services. However, few studies evaluate drought effects on ecosystem services such as freshwater and food provisioning and quantify these services using an index-based ecosystem service approach. In this study, the drought implications on freshwater and food provisioning services were evaluated for 14 four-digit HUC (Hydrological Unit Codes) subbasins in the Upper Mississippi River Basin (UMRB), using three drought indices: standardized precipitation index (SPI), standardized soil water content index (SSWI), and standardized streamflow index (SSI). The results showed that the seasonal freshwater provisioning was highly affected by the precipitation deficits and/or surpluses in summer and autumn. A greater importance of hydrological drought than meteorological drought implications on freshwater provisioning was evident for the majority of the subbasins, as evidenced by higher correlations between freshwater provisioning and SSI12 than SPI12. Food provisioning was substantially affected by the precipitation and soil water deficits during summer and early autumn, with relatively less effect observed in winter. A greater importance of agricultural drought effects on food provisioning was evident for most of the subbasins during crop reproductive stages. Results from this study may provide insights to help make effective land management decisions in responding to extreme climate conditions in order to protect and restore freshwater provisioning and food provisioning services in the UMRB.
      PubDate: 2017-05-08
      DOI: 10.3390/ijerph14050496
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 497: Chemical Characterization of the Indoor Air
           Quality of a University Hospital: Penetration of Outdoor Air Pollutants

    • Authors: Paul Scheepers, Luuk Van Wel, Gwendolyn Beckmann, Rob Anzion
      First page: 497
      Abstract: For healthcare centers, local outdoor sources of air pollution represent a potential threat to indoor air quality (IAQ). The aim of this study was to study the impact of local outdoor sources of air pollution on the IAQ of a university hospital. IAQ was characterized at thirteen indoor and two outdoor locations and source samples were collected from a helicopter and an emergency power supply. Volatile organic compounds (VOC), acrolein, formaldehyde, nitrogen dioxide (NO2), respirable particulate matter (PM-4.0 and PM-2.5) and their respective benz(a)pyrene contents were determined over a period of two weeks. Time-weighted average concentrations of NO2 (4.9–17.4 μg/m3) and formaldehyde (2.5–6.4 μg/m3) were similar on all indoor and outdoor locations. The median concentration VOC in indoor air was 119 μg/m3 (range: 33.1–2450 μg/m3) and was fivefold higher in laboratories (316 μg/m3) compared to offices (57.0 μg/m3). PM-4.0 and benzo(a)pyrene concentration were lower in buildings serviced by a >99.95% efficiency particle filter, compared to buildings using a standard 80–90% efficiency filter (p < 0.01). No indications were found that support a significant contribution of known local sources such as fuels or combustion engines to any of the IAQ parameters measured in this study. Chemical IAQ was primarily driven by known indoor sources and activities.
      PubDate: 2017-05-08
      DOI: 10.3390/ijerph14050497
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 498: Dogs in the Workplace: A Review of the
           Benefits and Potential Challenges

    • Authors: Anne Foreman, Margaret Glenn, B. Meade, Oliver Wirth
      First page: 498
      Abstract: Pet dogs, therapy dogs, and service dogs can be seen in workplaces with increasing frequency. Although dogs may provide many benefits to employees and employers, their presence may introduce additional hazards and concerns to the work environment. Therefore, decisions to accept dogs in the workplace may include many considerations including the health, safety, and well-being of employees, legal and cultural sensitivities, and animal welfare. The present paper serves to introduce the issue of dogs in the workplace and outline the potential benefits and challenges to their presence. The legal accommodations afforded to certain types of dogs in workplace settings are discussed, and the research findings pertaining to the potential benefits of dogs on human health and well-being are summarized. The paper concludes with considerations for human resource management personnel in the areas of diversity, employee relations, ethics and corporate responsibility, organizational and employee development, safety and security, and legal considerations, as well as suggested topics for future research.
      PubDate: 2017-05-08
      DOI: 10.3390/ijerph14050498
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 499: Pattern of Visits to Older Family Physicians
           in Taiwan

    • Authors: Hao-Yen Liu, Cheng-Chieh Liu, Tzu-Hsiang Shen, Yi-Jen Wang, Jui-Yao Liu, Tzeng-Ji Chen, Li-Fang Chou, Shinn-Jang Hwang
      First page: 499
      Abstract: Many family physicians still practice at an old age. Nevertheless, their practice patterns have scarcely been studied. To address this lack of research, the current study analyzed claims data for a total of 2,018,440 visits to 171 family physicians in 2011 sourced from Taiwan’s National Health Insurance Research Database. Family physicians aged 65 years and over had fewer patients (mean: 2330, standard deviation (SD): 2019) and visits (mean: 9220, SD: 8600) than younger physicians had. Furthermore, the average age of the patients who visited physicians aged 65 years and over was 51.9 (SD: 21.5) years, significantly higher than that of patients who visited younger physicians. However, the proportions of visits for upper respiratory tract infections, hypertension, diabetes mellitus, and dyslipidemia did not differ significantly among different age groups of physicians. In the future, the manpower planning of physicians should take into consideration the age structure and work profile of physicians.
      PubDate: 2017-05-08
      DOI: 10.3390/ijerph14050499
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 500: The Presence of Anti-Angiotensin II Type-1
           Receptor Antibodies Adversely Affect Kidney Graft Outcomes

    • Authors: Jian Zhang, Mingxu Wang, Jun Liang, Ming Zhang, Xiao-Hong Liu, Le Ma
      First page: 500
      Abstract: The aim of this study was to determine whether anti-angiotensin type 1 receptor antibodies (AT1R-Abs) are related to acute rejection (AR) and kidney graft failure in renal transplantation. We searched electronic databases including MEDLINE, EMBASE, and the ISI Web of Science databases for all studies on the association between anti-angiotensin type 1 receptor antibodies and kidney allograft outcomes updated to November 2016. Reference lists from included articles were also reviewed. The pooled relative risks (RRs) with 95% confidence intervals (CIs) were extracted or calculated using a random-effects model. The potential sources of heterogeneity and publication bias were estimated. Nine studies enrolling 1771 subjects were retrieved in the meta-analysis. AT1R-Abs showed significant associations with increased risk of AR (RR = 1.66; 95% CI, 1.23–2.09). In addition, a significant relationship was found between AT1R-Abs and kidney graft failure compared with AR (RR = 3.02; 95% CI, 1.77–4.26). The results were essentially consistent among subgroups stratified by participant characteristics. These results demonstrated that the AT1R-Abs were associated with an elevated risk of kidney allograft outcomes, especially with kidney graft failure. Large-scale studies are still required to further verify these findings.
      PubDate: 2017-05-09
      DOI: 10.3390/ijerph14050500
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 501: Break in Sedentary Behavior Reduces the Risk
           of Noncommunicable Diseases and Cardiometabolic Risk Factors among Workers
           in a Petroleum Company

    • Authors: Chutima Jalayondeja, Wattana Jalayondeja, Keerin Mekhora, Petcharatana Bhuanantanondh, Asadang Dusadi-Isariyavong, Rujiret Upiriyasakul
      First page: 501
      Abstract: Although prolonged sitting appears as a novel risk factor related to health outcomes for all ages, its association needs to be replicated in occupational conditions. This study explored the associations between sedentary behavior and four noncommunicable diseases (NCDs) as well as two cardiometabolic risk factors (CMRFs) among workers in a petroleum company, Thailand. All workers were invited to complete the online self-report questionnaire. Sedentary behavior was measured as the amount of time sitting at work, during recreation, and while commuting. Out of 3365 workers contacted, 1133 (34%) participated. Prevalence of NCDs and CMRFs was 36% and was positively associated with sedentary behavior. After adjusting for age, BMI, and exercise, the risk of NCDs and CMRFs for sedentary office work was 40% greater compared with more active field work. Those who took a break without sitting more than twice a day and commuted by walking or cycling had less risk of NCDs and CMRFs. The total duration of sedentary behavior was 10 h/day, and two-thirds of that total was workplace sitting. This was significantly associated with NCDs and CMRFs (p < 0.001). Day-and-night rotating shiftwork was negatively associated with NCDs and CMRFs (p < 0.001). Sedentary behavior should be considered a health risk among workers. Hence, to promote a healthy lifestyle and safe workplace, organizations should encourage standing activities during break and physically active commutes, and have workers avoid prolonged sitting.
      PubDate: 2017-05-09
      DOI: 10.3390/ijerph14050501
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 502: Differences in Sleep Duration among Four
           Different Population Groups of Older Adults in South Africa

    • Authors: Karl Peltzer
      First page: 502
      Abstract: The study aims to investigate sleep duration in four different population groups in a national probability sample of older South Africans who participated in the Study of Global Ageing and Adult Health (SAGE) Wave 1. A national population-based cross-sectional study with a sample of 3284 aged 50 years or older in South Africa was conducted in 2008. The questionnaire included socio-demographic characteristics, health variables, and self-reported sleep duration. Results indicate that White Africans compared to other population groups had the lowest mean sleep duration (7.88 h among men and 7.46 h among women). The prevalence of short sleep was the highest among both men and women among the White African (18.8% in men and 16.9% in women) and Indian or Asian African population groups (14.5% in men and 17.1% in women), and lowest among both men and women in the Black African (7.0% in men and 6.5% in women) and multi-ancestry population groups (15.6% in men and 12.7% in women). The prevalence of long sleep was among both men and women the highest in the Black African population group (56.2% in men and 58.5% in women), and the lowest in the White African population group (36.4% in men and 24.3% in women). In a Poisson regression model, adjusted for sociodemographics and chronic disease status, coming from the male and female White African population group was associated with short sleep. In addition, coming from the Indian or Asian African population group was associated with short sleep. No population group differences were found regarding long sleep prevalence. White Africans reported more short sleep duration than the other population groups, while there were no racial or ethnic differences in long sleep. White Africans are more likely to have sleep durations that are associated with negative health outcomes. An explanation of the high short sleep prevalence among White Africans may be related to their racial or ethnic minority status in South Africa.
      PubDate: 2017-05-09
      DOI: 10.3390/ijerph14050502
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 503: Extensions to Multivariate Space Time Mixture
           Modeling of Small Area Cancer Data

    • Authors: Rachel Carroll, Andrew Lawson, Christel Faes, Russell Kirby, Mehreteab Aregay, Kevin Watjou
      First page: 503
      Abstract: Oral cavity and pharynx cancer, even when considered together, is a fairly rare disease. Implementation of multivariate modeling with lung and bronchus cancer, as well as melanoma cancer of the skin, could lead to better inference for oral cavity and pharynx cancer. The multivariate structure of these models is accomplished via the use of shared random effects, as well as other multivariate prior distributions. The results in this paper indicate that care should be taken when executing these types of models, and that multivariate mixture models may not always be the ideal option, depending on the data of interest.
      PubDate: 2017-05-09
      DOI: 10.3390/ijerph14050503
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 504: The Relationship between Environmental Tobacco
           Smoke Exposure and Cardiovascular Disease and the Potential Modifying
           Effect of Diet in a Prospective Cohort among American Indians: The Strong
           Heart Study

    • Authors: Sarah Rajkumar, Amanda Fretts, Barbara Howard, Fawn Yeh, Maggie Clark
      First page: 504
      Abstract: American Indians experience high rates of cardiovascular diseases (CVD). Environmental tobacco smoke (ETS) has been linked to CVD, possibly due to pro-inflammatory and oxidative stress pathways. We examined the relationship between self-reported exposure to ETS and fatal and nonfatal CVD incidence using Cox proportional hazards models among 1843 non-smoking American Indians participating in the Strong Heart Study. We also evaluated potential modifying effects of several dietary nutrients high in anti-inflammatory and anti-oxidant properties with ETS exposure on fatal and nonfatal CVD by creating interaction terms between ETS exposure and the dietary variable. Participants exposed to ETS had a higher hazard (hazard ratio: 1.22; 95% confidence interval, 1.03 to 1.44) for developing CVD compared to persons not exposed. Interaction analyses suggested stronger effects of ETS on CVD incidence among those consuming diets lower in vitamin E as compared to those consuming higher amounts, particularly on the additive scale. Additional research is recommended to clarify whether public health prevention strategies should simultaneously target reductions in ETS exposures and improvements in diets that may exceed the expected benefits of targeting these risk factors separately.
      PubDate: 2017-05-09
      DOI: 10.3390/ijerph14050504
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 505: Apolipoprotein C-I Polymorphism and Its
           Association with Serum Lipid Levels and Longevity in the Bama Population

    • Authors: You Li, Yongquan Huang, Xue Liang, Bingshuang Long, Shiyi Chen, Jiahao Lian, Yi Wei, Zhiyong Zhang, Jian Qin
      First page: 505
      Abstract: This study aims to determine the association between the apolipoprotein C-I polymorphism and the longevity and genetic variants in ApoC-I that can influence the serum lipid levels in Bama. ApoC-I genotypes were determined by Taqman single nucleotide polymorphism (SNP) genotyping assays in 178 long-lived inhabitants (longevity group aged from 90 to 110 years), 147 healthy controls (Control 1 group aged from 40 to 79 years old) from Bama County, and 190 healthy controls (Control 2 group aged from 40 to 79 years old) from Nandan County without a family history of longevity. Statistical analysis was conducted using SPSS 16.0. All genotype distributions of rs584007 and rs4420638 were consistent with the Hardy–Weinberg equilibrium (p > 0.05). Significant differences were observed in the frequencies of the three genotypes (GG, AG, and AA) among the longevity and the two control groups (χ2 = 11.238, p = 0.024) for rs584007. No significant differences were observed in the frequencies of the three genotypes (GG, AG, and AA) among the longevity and the two control groups (χ2 = 4.587, p = 0.318) for rs4420638. The levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-c), and low-density lipoprotein-cholesterol (LDL-c) were not different among the three genotypes of rs584007 in the three groups. The levels of HDL-c for GG, AG, and AA were significantly different (the highest being in the longevity group), while the levels of TG for AA and AG genotypes (the lowest being in the longevity group) and the levels of LDL-c for AG were significantly different (p < 0.05) among the three groups for rs584007. The levels of TG and HDL-c were significantly different among the three rs4420638 genotypes in the longevity group. The levels of TC for GG, AG, and AA were significantly different in the Control 2 group, while the levels of TG and HDL-c for AA and AG genotypes were significantly different (p < 0.05) among the three groups for rs4420638. The level of HDL-c was highest in the longevity group for AA and AG genotypes, and the level of TG was highest in the Control 2 group for rs4420638. Serum lipid parameters were related to environmental factors, including age, gender, BMI, DBP, SBP, rs4420638, and rs584007. The ApoC-I polymorphism might be one of the genetic factors of longevity in Bama. The ApoC-I rs4420638 and rs584007 SNPs are associated with serum TG and HDL-c levels in the longevous population.
      PubDate: 2017-05-09
      DOI: 10.3390/ijerph14050505
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 506: Association between Pesticide Profiles Used on
           Agricultural Fields near Maternal Residences during Pregnancy and IQ at
           Age 7 Years

    • Authors: Eric Coker, Robert Gunier, Asa Bradman, Kim Harley, Katherine Kogut, John Molitor, Brenda Eskenazi
      First page: 506
      Abstract: We previously showed that potential prenatal exposure to agricultural pesticides was associated with adverse neurodevelopmental outcomes in children, yet the effects of joint exposure to multiple pesticides is poorly understood. In this paper, we investigate associations between the joint distribution of agricultural use patterns of multiple pesticides (denoted as “pesticide profiles”) applied near maternal residences during pregnancy and Full-Scale Intelligence Quotient (FSIQ) at 7 years of age. Among a cohort of children residing in California’s Salinas Valley, we used Pesticide Use Report (PUR) data to characterize potential exposure from use within 1 km of maternal residences during pregnancy for 15 potentially neurotoxic pesticides from five different chemical classes. We used Bayesian profile regression (BPR) to examine associations between clustered pesticide profiles and deficits in childhood FSIQ. BPR identified eight distinct clusters of prenatal pesticide profiles. Two of the pesticide profile clusters exhibited some of the highest cumulative pesticide use levels and were associated with deficits in adjusted FSIQ of −6.9 (95% credible interval: −11.3, −2.2) and −6.4 (95% credible interval: −13.1, 0.49), respectively, when compared with the pesticide profile cluster that showed the lowest level of pesticides use. Although maternal residence during pregnancy near high agricultural use of multiple neurotoxic pesticides was associated with FSIQ deficit, the magnitude of the associations showed potential for sub-additive effects. Epidemiologic analysis of pesticides and their potential health effects can benefit from a multi-pollutant approach to analysis.
      PubDate: 2017-05-09
      DOI: 10.3390/ijerph14050506
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 507: Human Indoor Exposure to Airborne Halogenated
           Flame Retardants: Influence of Airborne Particle Size

    • Authors: Mark La Guardia, Erika Schreder, Nancy Uding, Robert Hale
      First page: 507
      Abstract: Inhalation of halogenated flame-retardants (HFRs) released from consumer products is an important route of exposure. However, not all airborne HFRs are respirable, and thus interact with vascular membranes within the gas exchange (alveolar) region of the lung. HFRs associated with large (>4 µm), inhalable airborne particulates are trapped on the mucosal lining of the respiratory tract and then are expelled or swallowed. The latter may contribute to internal exposure via desorption from particles in the digestive tract. Exposures may also be underestimated if personal activities that re-suspend particles into the breathing zone are not taken into account. Here, samples were collected using personal air samplers, clipped to the participants’ shirt collars (n = 18). We observed that the larger, inhalable air particulates carried the bulk (>92%) of HFRs. HFRs detected included those removed from commerce (i.e., polybrominated diphenyl ethers (Penta-BDEs: BDE-47, -85, -100, -99, and -153)), their replacements; e.g., 2-ethylhexyl 2,3,4,5-tetrabromobenzoate (TBB or EH-TBB); bis(2-ethylhexyl) 3,4,5,6-tetrabromophthalate (TBPH or BEH-TEBP) and long-produced chlorinated organophosphate-FRs (ClOPFRs): tris(2-chloroethyl)phosphate (TCEP), tris(1-chloro-2-propyl)phosphate (TCPP or TCIPP), and tris(1,3-dichloro-2-propyl)phosphate (TDCPP or TDCIPP). Our findings suggest estimates relying on a single exposure route, i.e., alveolar gas exchange, may not accurately estimate HFR internal dosage, as they ignore contributions from larger inhalable particulates that enter the digestive tract. Consideration of the fate and bioavailability of these larger particulates resulted in higher dosage estimates for HFRs with log Koa < 12 (i.e., Penta-BDEs and ClOPFRs) and lower estimates for those with log Koa > 12 (i.e., TBB and TBPH) compared to the alveolar route exposure alone. Of those HFRs examined, the most significant effect was the lower estimate by 41% for TBPH. The bulk of TBPH uptake from inhaled particles was estimated to be through the digestive tract, with lower bioavailability. We compared inhalation exposure estimates to chronic oral reference doses (RfDs) established by several regulatory agencies. The U.S. Environmental Protection Agency (EPA) RfD levels for several HFRs are considered outdated; however, BDE-99 levels exceeded those suggested by the Dutch National Institute for Public Health and the Environment (RIVM) by up to 26 times. These findings indicate that contributions and bioavailability of respirable and inhalable airborne particulates should both be considered in future risk assessments.
      PubDate: 2017-05-09
      DOI: 10.3390/ijerph14050507
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 508: Spatial Analysis of Ambient PM2.5 Exposure and
           Bladder Cancer Mortality in Taiwan

    • Authors: Hsin-Ling Yeh, Shang-Wei Hsu, Yu-Chia Chang, Ta-Chien Chan, Hui-Chen Tsou, Yen-Chen Chang, Po-Huang Chiang
      First page: 508
      Abstract: Fine particulate matter (PM2.5) is an air pollutant that is receiving intense regulatory attention in Taiwan. In previous studies, the effect of air pollution on bladder cancer has been explored. This study was conducted to elucidate the effect of atmospheric PM2.5 and other local risk factors on bladder cancer mortality based on available 13-year mortality data. Geographically weighted regression (GWR) was applied to estimate and interpret the spatial variability of the relationships between bladder cancer mortality and ambient PM2.5 concentrations, and other variables were covariates used to adjust for the effect of PM2.5. After applying a GWR model, the concentration of ambient PM2.5 showed a positive correlation with bladder cancer mortality in males in northern Taiwan and females in most of the townships in Taiwan. This is the first time PM2.5 has been identified as a risk factor for bladder cancer based on the statistical evidence provided by GWR analysis.
      PubDate: 2017-05-10
      DOI: 10.3390/ijerph14050508
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 509: Underweight, Stunting and Wasting among
           Children in Kilimanjaro Region, Tanzania; a Population-Based
           Cross-Sectional Study

    • Authors: Melina Mgongo, Nikolas Chotta, Tamara Hashim, Jacqueline Uriyo, Damian Damian, Babill Stray-Pedersen, Sia Msuya, Margareta Wandel, Siri Vangen
      First page: 509
      Abstract: This study assessed the prevalence and risk factors associated with underweight, stunting and wasting among children aged 0–24 months in six districts of Kilimanjaro region, northern Tanzania. A cross-sectional population-based study using a multistage, proportionate to size sampling was conducted from June 2010 to March 2011. A structured questionnaire was used to collect sociodemographic, economic, feeding and child information. Anthropometric data were collected by trained field workers, and the data were used to assess child nutritional status. A total of 1870 children were enrolled in this study. The prevalence of children classified as underweight was 46.0%, stunting was 41.9%, and wasting was 24.7%. About 33% were both underweight and stunted, and 12% had all three conditions. In a multivariate logistic regression, child age, child being ill and birth weight were associated with all anthropometric indices. Child being breastfed was associated with being underweight and wasting. Mother’s education was associated with being underweight and stunting. Fathers aged 35+ years, and living in the Hai district was associated with stunting, and being female was associated with wasting. The prevalence of child undernutrition is high in this region. Strategies that target each risk factor for child undernutrition may help to reduce the problem in the region.
      PubDate: 2017-05-10
      DOI: 10.3390/ijerph14050509
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 510: What Type of Transitional Care Effectively
           Reduced Mortality and Improved ADL of Stroke Patients? A Meta-Analysis

    • Authors: Yuncui Wang, Fen Yang, Hao Shi, Chongming Yang, Hui Hu
      First page: 510
      Abstract: Stroke is a major cause of disability and mortality worldwide; yet; prior to this study; there had been no sufficient evidence to support the effectiveness of various transitional care interventions (TCI) on the disability and mortality of stroke survivors. This meta-analysis aimed to assess the effectiveness of TCI in reducing mortality and improving the activities of daily life (ADL) of stroke patients. PubMed; Web of Science; OVID; EMBASE; CINAHL; and Sino-Med were searched for articles published before November 2016. Thirty-one randomized controlled trials (RCTs) were identified in the study. This analysis showed that the total effect of TCI on reducing mortality was limited (Risk Ratio (RR) = 0.86; 95% Confidence Interval (CI): 0.75–0.98); that only home-visiting programs could reduce mortality rates (RR = 0.34; 95% CI: 0.17–0.67) compared with usual care; and that the best intervention was led by a multidisciplinary team (MT) ≤3 months (RR = 0.19; 95% CI: 0.05–0.71). In addition; home-visiting programs also produced ADL benefit (RR = 0.56; 95% CI: 0.31–0.81). Overall; there was a statistically significant difference in improving patients’ independence between TCI and usual care (RR = 1.12; 95% CI: 1.02–1.23). However; none of the interventions was effective when they were differentiated in the analysis. It is the conclusion of this study that home-visiting programs; especially those led by MTs; should receive the greatest consideration by healthcare systems or providers for implementing TCI to stroke survivors.
      PubDate: 2017-05-10
      DOI: 10.3390/ijerph14050510
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 511: Validity of Research-Grade Actigraphy Unit for
           Measuring Exercise Intensity

    • Authors: Ke-Tsung Han, Po-Ching Wang
      First page: 511
      Abstract: This study was conducted in a free-living setting to investigate the measurement validity of a research-based actigraph for strolling and jogging, and to provide a reference for actual practice and research. Because inadequate physical activity (PA) or sedentary lifestyle has become the fourth leading risk factor for mortality worldwide, many countries have been vigorously promoting the concept of “active living”, and the public has been investing greater effort into intensifying their PA. Although research-grade actigraphs have been widely applied to evaluate PA in routine environments, the measurement results may not accurately reflect the wearers’ PA. Unlike most relevant research, which is conducted in well-controlled laboratory environments, the present study was implemented in the field to examine the sensitivity and convergent validity of the MicroMini Motionlogger® Actigraph during strolling and jogging. The following results were revealed: (1) Although the exercise movement speed while jogging was significantly faster than that while strolling, the actigraph readings showed no significant difference between strolling and jogging; (2) The actigraph readings were (significantly or nonsignificantly) negatively correlated with metabolic heat and nonsignificantly correlated with movement speeds. Hence, the actigraph validity for measuring PA intensity while strolling and jogging remains debatable.
      PubDate: 2017-05-10
      DOI: 10.3390/ijerph14050511
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 512: A Study Protocol for Applying User

    • Authors: Anna Åberg, Kjartan Halvorsen, Ingrid From, Åsa Bruhn, Lars Oestreicher, Anita Melander-Wikman
      First page: 512
      Abstract: The eBalance project is based on the idea that serious exergames—i.e., computer gaming systems with an interface that requires physical exertion to play—that are well adapted to users, can become a substantial part of a solution to recognized problems of insufficient engagement in fall-prevention exercise and the high levels of fall-related injuries among older people. This project is carried out as a collaboration between eight older people who have an interest in balance training and met the inclusion criteria of independence in personal activities of daily living, access to and basic knowledge of a computer, four staff working with the rehabilitation of older adults, and an interdisciplinary group of six research coordinators covering the areas of geriatric care and rehabilitation, as well as information technology and computer science. This paper describes the study protocol of the project’s initial phase which aims to develop a working partnership with potential users of fall-prevention exergames, including its conceptual underpinnings. The qualitative methodology was inspired by an ethnographical approach implying combining methods that allowed the design to evolve through the study based on the participants’ reflections. A participatory and appreciative action and reflection (PAAR) approach, accompanied by inquiries inspired by the Normalization Process Theory (NPT) was used in interactive workshops, including exergame testing, and between workshop activities. Data were collected through audio recordings, photos, and different types of written documentation. The findings provide a description of the methodology thus developed and applied. They display a methodology that can be useful for the design and development of care service and innovations for older persons where user participation is in focus.
      PubDate: 2017-05-10
      DOI: 10.3390/ijerph14050512
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 513: Hydration, Fluid Intake, and Related Urine
           Biomarkers among Male College Students in Cangzhou, China: A
           Cross-Sectional Study—Applications for Assessing Fluid Intake and
           Adequate Water Intake

    • Authors: Na Zhang, Songming Du, Zhenchuang Tang, Mengqi Zheng, Ruixia Yan, Yitang Zhu, Guansheng Ma
      First page: 513
      Abstract: The objectives of this study were to assess the associations between fluid intake and urine biomarkers and to determine daily total fluid intake for assessing hydration status for male college students. A total of 68 male college students aged 18–25 years recruited from Cangzhou, China completed a 7-day cross-sectional study. From day 1 to day 7; all subjects were asked to complete a self-administered 7-day 24-h fluid intake record. The foods eaten by subjects were weighed and 24-h urine was collected for three consecutive days on the last three consecutive days. On the sixth day, urine osmolality, specific gravity (USG), pH, and concentrations of potassium, sodium, and chloride was determined. Subjects were divided into optimal hydration, middle hydration, and hypohydration groups according to their 24-h urine osmolality. Strong relationships were found between daily total fluid intake and 24-h urine biomarkers, especially for 24-h urine volume (r = 0.76; p < 0.0001) and osmolality (r = 0.76; p < 0.0001). The percentage of the variances in daily total fluid intake (R2) explained by PLS (partial least squares) model with seven urinary biomarkers was 68.9%; two urine biomarkers—24-h urine volume and osmolality—were identified as possible key predictors. The daily total fluid intake for assessing optimal hydration was 2582 mL, while the daily total fluid intake for assessing hypohydration was 2502 mL. Differences in fluid intake and urine biomarkers were found among male college students with different hydration status. A strong relationship existed between urine biomarkers and fluid intake. A PLS model identified that key variables for assessing daily total fluid intake were 24-h urine volume and osmolality. It was feasibility to use total fluid intake to judge hydration status.
      PubDate: 2017-05-11
      DOI: 10.3390/ijerph14050513
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 514: Two Single Nucleotide Polymorphisms (rs2431697
           and rs2910164) of miR-146a Are Associated with Risk of Coronary Artery

    • Authors: Yaqin Wang, Xintong Wang, Zhenyu Li, Lulu Chen, Luping Zhou, Chaopeng Li, Dong-sheng Ouyang
      First page: 514
      Abstract: The coronary artery disease (CAD) is one of the most severe cardiovascular diseases. MicroRNA-146a (miR-146a) influences the pathology of cardiovascular diseases. Two single nucleotide polymorphisms (SNPs) of miR-146a (rs2431697 and rs2910164) have been reported to alter the function or expression of microRNA. The purpose of this study is to evaluate the association between miR-146a gene polymorphism and the risk of CAD in the Chinese population. A total of 353 CAD patients and 368 controls were recruited, and SNPs were analyzed by the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and Sequenom MassARRAY system. The gene frequencies of rs2431697 and rs2910164 were significantly different between the two groups. The mutant type (T allele) of rs2431697 and wild type (C allele) of rs2910164 were more frequent in CAD patients. T allele carriers in rs2431697 had an increased CAD risk, while G allele of rs2910164 decreased the risk of CAD significantly. In conclusion, we found that the T allele of rs2431697 was a risk factor of CAD in the Chinese population. Meanwhile, we demonstrated that the G allele of rs2910164 decreased the susceptibility of CAD.
      PubDate: 2017-05-10
      DOI: 10.3390/ijerph14050514
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 515: Caregiver Supervision Practices and Risk of
           Childhood Unintentional Injury Mortality in Bangladesh

    • Authors: Khaula Khatlani, Olakunle Alonge, Aminur Rahman, Dewan Hoque, Al-Amin Bhuiyan, Priyanka Agrawal, Fazlur Rahman
      First page: 515
      Abstract: Unintentional injury-related mortality rate, including drowning among children under five, is disproportionately higher in low- and middle-income countries. The evidence links lapse of supervision with childhood unintentional injury deaths. We determined the relationship between caregiver supervision and unintentional injury mortality among children under five in rural Bangladesh. We conducted a nested, matched, case-control study within the cohort of a large-scale drowning prevention project in Bangladesh, “SOLID—Saving of Children’s Lives from Drowning”. From the baseline survey of the project, 126 cases (children under five with unintentional injury deaths) and 378 controls (alive children under five) were selected at case-control ratio of 1:3 and individually matched on neighborhood. The association between adult caregiver supervision and fatal injuries among children under five was determined in a multivariable conditional logistic regression analysis, and reported as adjusted matched odds ratio (MOR) with 95% confidence intervals (CIs). Children under five experiencing death due to unintentional injuries, including drowning, had 3.3 times increased odds of being unsupervised as compared with alive children (MOR = 3.3, 95% CI: 1.6–7.0), while adjusting for children’s sex, age, socioeconomic index, and adult caregivers’ age, education, occupation, and marital status. These findings are concerning and call for concerted, multi-sectoral efforts to design community-level prevention strategies. Public awareness and promotion of appropriate adult supervision strategies are needed.
      PubDate: 2017-05-11
      DOI: 10.3390/ijerph14050515
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 516: Nasal Irrigation: An Imprecisely Defined
           Medical Procedure

    • Authors: Nicola Principi, Susanna Esposito
      First page: 516
      Abstract: Nasal irrigation (NI) is an old practice of upper respiratory tract care that likely originated in the Ayurvedic medical tradition. It is used alone or in association with other therapies in several conditions—including chronic rhinosinusitis and allergic rhinitis—and to treat and prevent upper respiratory tract infections, especially in children. However, despite it being largely prescribed in everyday clinical practice, NI is not included or is only briefly mentioned by experts in the guidelines for treatment of upper respiratory tract diseases. In this review, present knowledge about NI and its relevance in clinical practice is discussed to assist physicians in understanding the available evidence and the potential use of this medical intervention. Analysis of the literature showed that NI seems to be effective in the treatment of several acute and chronic sinonasal conditions. However, although in recent years several new studies have been performed, most of the studies that have evaluated NI have relevant methodologic problems. Only multicenter studies enrolling a great number of subjects can solve the problem of the real relevance of NI, and these studies are urgently needed. Methods for performing NI have to be standardized to determine which solutions, devices and durations of treatment are adequate to obtain favorable results. This seems particularly important for children that suffer a great number of sinonasal problems and might benefit significantly from an inexpensive and simple preventive and therapeutic measure such as NI.
      PubDate: 2017-05-11
      DOI: 10.3390/ijerph14050516
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 517: Synthetic Receptors Induce Anti Angiogenic and
           Stress Signaling on Human First Trimester Cytotrophoblast Cells

    • Authors: Ahmed Pantho, Mason Price, AHM Ashraf, Umaima Wajid, Maryam Khansari, Afsana Jahan, Syeda Afroze, Md Rhaman, Corey Johnson, Thomas Kuehl, Md. Hossain, Mohammad Uddin
      First page: 517
      Abstract: The cytotrophoblast (CTB) cells of the human placenta have membrane receptors that bind certain cardiotonic steroids (CTS) found in blood plasma. One of these, marinobufagenin, is a key factor in the etiology of preeclampsia. Herein, we used synthetic receptors (SR) to study their effectiveness on the angiogenic profile of human first trimester CTB cells. The humanextravillous CTB cells (Sw.71) used in this study were derived from first trimester chorionic villus tissue. Culture media of CTB cells treated with ≥1 nM SR level revealed sFlt-1 (Soluble fms-like tyrosine kinase-1) was significantly increased while VEGF (vascular endothelial growth factor) was significantly decreased in the culture media (* p < 0.05 for each) The AT2 receptor (Angiotensin II receptor type 2) expression was significantly upregulated in ≥1 nM SR-treated CTB cells as compared to basal; however, the AT1 (Angiotensin II receptor, type 1) and VEGFR-1 (vascular endothelial growth factor receptor 1) receptor expression was significantly downregulated (* p < 0.05 for each). Our results show that the anti-proliferative and anti-angiogenic effects of SR on CTB cells are similar to the effects of CTS. The observed anti angiogenic activity of SR on CTB cells demonstrates that the functionalized-urea/thiourea molecules may be useful as potent inhibitors to prevent CTS-induced impairment of CTB cells.
      PubDate: 2017-05-11
      DOI: 10.3390/ijerph14050517
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 518: Environmental Barriers to Participation of
           Preschool Children with and without Physical Disabilities

    • Authors: Lin-Ju Kang, Ming-Chieh Hsieh, Hua-Fang Liao, Ai-Wen Hwang
      First page: 518
      Abstract: Environment plays a vital role in affecting participation of young children in home, school, and community. Knowledge of environmental barriers helps to develop solutions or strategies that enable participation. The study compared the environmental barriers perceived by parents of preschool children with physical disabilities (PD, n = 142) and with typical development (TD, n = 192) in Taiwan. Parents identified environmental barriers by structured interview using the Chinese version of the Child and Adolescent Scale of Environment (CASE-C). The CASE-C is an 18-item measure of the impact of problems with physical, social, and attitudinal environmental features. Differences between the PD and TD groups in the summary scores for the CASE-C and the percentages of parents who perceived a problem for each item were examined by the analysis of covariance (ANCOVA) and Chi-square test. Parents of children with PD more often identified barriers related to family resources and community programs or services, social attitudes, assistance and supports outside of home, physical design of home and community, transportation, and assistive devices or equipment. Greater impacts of barriers were also reported by parents of preschool children with PD. Our findings provide evidence of environmental barriers that inform practice and policies to modify the barriers and provide an accessible and inclusive environment for families with young children.
      PubDate: 2017-05-11
      DOI: 10.3390/ijerph14050518
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 519: Mercury in Children: Current State on Exposure
           through Human Biomonitoring Studies

    • Authors: Flavia Ruggieri, Costanza Majorani, Francesco Domanico, Alessandro Alimonti
      First page: 519
      Abstract: Mercury (Hg) in children has multiple exposure sources and the toxicity of Hg compounds depends on exposure routes, dose, timing of exposure, and developmental stage (be it prenatal or postnatal). Over the last decades, Hg was widely recognized as a threat to the children’s health and there have been acknowledgements at the international level of the need of a global policy intervention—like the Minamata treaty—aimed at reducing or preventing Hg exposure and protecting the child health. National human biomonitoring (HBM) data has demonstrated that low levels of exposure of Hg are still an important health concern for children, which no one country can solve alone. Although independent HBM surveys have provided the basis for the achievements of exposure mitigation in specific contexts, a new paradigm for a coordinated global monitoring of children’s exposure, aimed at a reliable decision-making tool at global level is yet a great challenge for the next future. The objective of the present review is to describe current HBM studies on Hg exposure in children, taking into account the potential pathways of Hg exposure and the actual Hg exposure levels assessed by different biomarkers.
      PubDate: 2017-05-12
      DOI: 10.3390/ijerph14050519
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 520: The Health Risk of Cd Released from Low-Cost

    • Authors: Miloslav Pouzar, Magdalena Zvolská, Oldřich Jarolím, Lenka Audrlická Vavrušová
      First page: 520
      Abstract: The composition of the surface layer of 13 low-cost jewelry samples with a high Cd content was analyzed using an energy-dispersive X-ray fluorescence spectrometer (ED XRF). The analyzed jewels were obtained in cooperation with the Czech Environmental Inspectorate. The jewels were leached in two types of artificial sweat (acidic and alkaline) for 7 days. Twenty microliters of the resulting solution was subsequently placed on a paper carrier and analyzed by an LIBS (Laser-Induced Breakdown Spectrometry) spectrometer after drying. The Cd content in the jewelry surface layer detected by using ED XRF ranged from 13.4% to 44.6% (weight per weight—w/w). The samples were subsequently leached in artificial alkaline, and the acidic sweat and leachates were analyzed using laser-induced breakdown spectrometry (LIBS). The amount of released Cd into alkaline sweat ranged from 24.0 to 370 µg Cd per week, respectively 3.23–61.7 µg/cm2/week. The amount of released Cd into acidic sweat ranged from 16.4 to 1517 µg Cd per week, respectively 3.53–253 µg/cm2/week. The limit of Cd for dermal exposure is not unequivocally determined in the countries of the EU (European Union) or in the U.S. Based on the US EPA (United States Environmental Protection Agency) approach used to establish the reference dose (RfD) for Cd contained in food and information about the bioavailability of Cd after dermal exposure, we assessed our own value of dermal RfD. The value was compared with the theoretical amount of Cd, which can be absorbed into the organism from jewelry in contact with the skin. The calculation was based on the amount of Cd that was released into acidic and alkaline sweat. The highest amount of Cd was released into acidic sweat, which represents 0.1% of dermal RfD and into alkaline sweat, 0.5% of dermal RfD. These results indicate that the analyzed jewelry contains Cd over the limit for composition of jewelry available within the territory of the EU. The determined amount of Cd in analyzed jewelry does not, however, pose a threat in terms of carcinogenic toxic effects.
      PubDate: 2017-05-12
      DOI: 10.3390/ijerph14050520
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 521: Nutritional Potential of Selected Insect
           Species Reared on the Island of Sumatra

    • Authors: Anna Adámková, Jiří Mlček, Lenka Kouřimská, Marie Borkovcová, Tomáš Bušina, Martin Adámek, Martina Bednářová, Jan Krajsa
      First page: 521
      Abstract: Inhabitants of the Indonesian island of Sumatra are faced with the problem of insufficient food supplies and the consequent risk of undernourishment and health issues. Edible insects as a traditional and readily available food source could be part of the solution. The nutritional value of insects depends on many factors, e.g., species, developmental stage, sex, diet, and climatic conditions. However, edible insects bred in Sumatra for human consumption have never before been assessed with regard to their nutritional value. Our study involved analyses of crude protein, chitin, fat and selected fatty acid contents of giant mealworm larvae (Zophobas morio), larvae of the common mealworm (Tenebrio molitor) and nymphs of the field cricket (Gryllus assimilis). Crude protein content in the samples ranged from 46% to 56%. Highest (35%) and lowest (31%) amounts of fat were recorded in giant mealworm larvae and larvae of the common mealworm, respectively. Chitin amounts ranged from 6% to 13%. Based on these values, which are comparable to those known from other food insects reared in different regions of the world, the edible species bred in Sumatra could become food sources with a potential to help stave off hunger and undernourishment.
      PubDate: 2017-05-12
      DOI: 10.3390/ijerph14050521
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 522: Replication of High Fetal Alcohol Spectrum
           Disorders Prevalence Rates, Child Characteristics, and Maternal Risk
           Factors in a Second Sample of Rural Communities in South Africa

    • Authors: Philip May, Marlene De Vries, Anna-Susan Marais, Wendy Kalberg, David Buckley, Colleen Adnams, Julie Hasken, Barbara Tabachnick, Luther Robinson, Melanie Manning, Heidre Bezuidenhout, Margaret Adam, Kenneth Jones, Soraya Seedat, Charles Parry, H. Hoyme
      First page: 522
      Abstract: Background: Prevalence and characteristics of fetal alcohol syndrome (FAS) and total fetal alcohol spectrum disorders (FASD) were studied in a second sample of three South African rural communities to assess change. Methods: Active case ascertainment focused on children with height, weight and/or head circumference ≤25th centile and randomly-selected children. Final diagnoses were based on dysmorphology, neurobehavioral scores, and maternal risk interviews. Results: Cardinal facial features, head circumference, and total dysmorphology scores differentiated specific FASD diagnostic categories in a somewhat linear fashion but all FASD traits were significantly worse than those of randomly-selected controls. Neurodevelopmental delays were significantly worse for children with FASD than controls. Binge alcohol use was clearly documented as the proximal maternal risk factor for FASD, and significant distal risk factors were: low body mass, education, and income; high gravidity, parity, and age at birth of the index child. FAS rates continue to extremely high in these communities at 9–129 per 1000 children. Total FASD affect 196–276 per 1000 or 20–28% of the children in these communities. Conclusions: Very high rates of FASD persist in these general populations where regular, heavy drinking, often in a binge fashion, co-occurs with low socioeconomic conditions.
      PubDate: 2017-05-12
      DOI: 10.3390/ijerph14050522
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 523: Geographical Variation in Breast Cancer

    • Authors: Peter Baade
      First page: 523
      Abstract: n/a
      PubDate: 2017-05-12
      DOI: 10.3390/ijerph14050523
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 524: Income-Related Inequalities in Access to
           Dental Care Services in Japan

    • Authors: Akemi Nishide, Misuzu Fujita, Yasunori Sato, Kengo Nagashima, Sho Takahashi, Akira Hata
      First page: 524
      Abstract: Background: This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods: The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 to 31 March 2015. The presence or absence of dental visits and number of days spent on dental care services during the year were calculated using insurance claims submitted. Equivalent household income was calculated using individual income data from 1 January to 31 December 2013, declared for taxation. Results: Of the 216,211 enrolled subjects, 50.3% had dental care during the year. Among those with dental visits, the average number of days (standard deviation) spent on dental care services per year was 7.7 (7.1). Low income was associated with a decreased rate of dental care utilization regardless of age and sex. However, there was a significant inverse linear association between the number of days spent on dental care services and income levels for both sexes. Conclusions: There were income-related inequalities in access to dental care services, regardless of the age group or sex, within the Japanese universal health insurance system.
      PubDate: 2017-05-12
      DOI: 10.3390/ijerph14050524
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 525: Assessing the Risk of Hg Exposure Associated
           with Rice Consumption in a Typical City (Suzhou) in Eastern China

    • Authors: Gang Wang, Yu Gong, Yi-Xin Zhu, Ai-Jun Miao, Liu-Yan Yang, Huan Zhong
      First page: 525
      Abstract: Recent studies have revealed that not only fish but also rice consumption may significantly contribute to human exposure to mercury (Hg) in Asian countries. It is therefore essential to assess dietary exposure to Hg in rice and its associated health risk. However, risk assessments of Hg in rice in non-contaminated areas are generally lacking in Asian countries. In the present study, Hg concentrations were measured in rice samples collected from markets and supermarkets in Suzhou, a typical city in Eastern China. In addition, the rice ingestion rates (IR) were assessed via a questionnaire-based survey of Suzhou residents. The data were then used to assess the risk of Hg exposure associated with rice consumption, by calculating the hazard quotient (HQ). Hg contents in rice samples were well below the national standard (20 μg/kg), ranging from 1.46 to 8.48 ng/g. They were also significantly (p > 0.05) independent of the area of production and place of purchase (markets vs. supermarkets in the different districts). Our results indicate a low risk of Hg exposure from rice in Suzhou (HQ: 0.005–0.05), despite the generally high personal IR (0.05–0.4 kg/day). The risk of Hg associated with rice consumption for Suzhou residents was not significantly affected by the age or sex of the consumer (p > 0.05). Overall, our results provide a study of human exposure to Hg in rice in Chinese cities not known to be contaminated with Hg. Future studies should examine Hg exposure in different areas in China and in potentially vulnerable major food types.
      PubDate: 2017-05-12
      DOI: 10.3390/ijerph14050525
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 526: Risk Assessment of Florists Exposed to
           Pesticide Residues through Handling of Flowers and Preparing Bouquets

    • Authors: Khaoula Toumi, Laure Joly, Christiane Vleminckx, Bruno Schiffers
      First page: 526
      Abstract: Flowers are frequently treated with pesticides and, as a result, florists handling daily a large number of flowers can be exposed to pesticide residues. A study was conducted among twenty volunteer florists located in Namur Province and in the Brussels Capital Region of Belgium in order to assess their potential dermal exposure to dislodgeable pesticide residues transferred from flowers to hands. Two pairs of cotton gloves were worn during two consecutive half days while handling flowers and preparing bouquets (from min 2 h to max 3 h/day). The residual pesticide deposits on the glove samples were extracted with a multi-residue Quick Easy Cheap Effective Rugged Safe (QuEChERS) method and analyzed by a combination of gas and liquid chromatography tandem mass spectrometry (GC-MS/MS and LC-MS/MS) by an accredited laboratory. A total of 111 active substances (mainly insecticides and fungicides) were detected, with an average of 37 active substances per sample and a total concentration per glove sample of 22.22 mg/kg. Several predictive levels of contamination were considered to assess the risk. The potential dermal exposures (PDE) of florists were estimated at the average, for different percentiles, and at the maximum concentration of residues in samples. At the PDE P90 and at the PDEMAX (or worst case) values, three and five active substances respectively exceed the Acceptable Operator Exposure Level (AOEL), indicating risk situations. For the systemic exposure (SE), one active substance (clofentezine) exceeds the AOEL at the P90 predictive level. In the worst case, SEMAX (at the maximum concentrations), four active substances (clofentezine, famoxadone, methiocarb, and pyridaben) exceed their respective AOEL values. Among the 14 most frequently detected active substances, two have SEMAX values exceeding the AOEL. Exposure could be particularly critical for clofentezine with an SEMAX value four times higher than the AOEL (393%). The exposure of florists appeared to be an example of a unique professional situation in which workers are exposed regularly to both a very high number of toxic chemicals and rather high concentration levels. Therefore the priority should be to raise the level of awareness among the florists who must change their habits and practices if they want to minimize their exposure.
      PubDate: 2017-05-13
      DOI: 10.3390/ijerph14050526
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 527: A New Method for the Fast Analysis of
           Trihalomethanes in Tap and Recycled Waters Using Headspace Gas
           Chromatography with Micro-Electron Capture Detection

    • Authors: Lydon Alexandrou, Barry Meehan, Paul Morrison, Oliver Jones
      First page: 527
      Abstract: Chemical disinfection of water supplies brings significant public health benefits by reducing microbial contamination. The process can however, result in the formation of toxic compounds through interactions between disinfectants and organic material in the source water. These new compounds are termed disinfection by-products (DBPs). The most common are the trihalomethanes (THMs) such as trichloromethane (chloroform), dichlorobromomethane, chlorodibromomethane and tribromomethane (bromoform); these are commonly reported as a single value for total trihalomethanes (TTHMs). Analysis of DBPs is commonly performed via time- and solvent-intensive sample preparation techniques such as liquid–liquid and solid phase extraction. In this study, a method using headspace gas chromatography with micro-electron capture detection was developed and applied for the analysis of THMs in drinking and recycled waters from across Melbourne (Victoria, Australia). The method allowed almost complete removal of the sample preparation step whilst maintaining trace level detection limits (>1 ppb). All drinking water samples had TTHM concentrations below the Australian regulatory limit of 250 µg/L but some were above the U.S. EPA limit of 60 µg/L. The highest TTHM concentration was 67.2 µg/L and lowest 22.9 µg/L. For recycled water, samples taken directly from treatment plants held significantly higher concentrations (153.2 µg/L TTHM) compared to samples from final use locations (4.9–9.3 µg/L).
      PubDate: 2017-05-15
      DOI: 10.3390/ijerph14050527
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 528: Family Planning and the Samburu: A Qualitative
           Study Exploring the Thoughts of Men on a Population Health and Environment
           Programme in Rural Kenya

    • Authors: Loren Kock, Audrey Prost
      First page: 528
      Abstract: Population Health and Environment (PHE) strategies are argued to improve ecosystem and human health by addressing family size and its effects on natural resource use, food security, and reproductive health. This study investigates men’s views on a PHE family planning (FP) programme delivered among the pastoral Samburu tribe in rural northern Kenya. Three focus group discussions and nine semi-structured interviews were conducted with 27 Samburu men. These discussions revealed support for environmentally-sensitised family planning promotion. Men highlighted their dependency on natural resources and challenges faced in providing for large families and maintaining livestock during drought. These practices were said to lead to natural resource exhaustion, environmental degradation, and wildlife dispersal, undermining key economic benefits of environmental and wildlife conservation. Relating family size to the environment is a compelling strategy to improve support for FP among Samburu men. Kenyan policy-makers should consider integrating community-based PHE strategies among underserved pastoral groups living in fragile ecosystems.
      PubDate: 2017-05-13
      DOI: 10.3390/ijerph14050528
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 529: Perceived Health Benefits and Willingness to
           Pay for Parks by Park Users: Quantitative and Qualitative Research

    • Authors: Claire Henderson-Wilson, Kah-Ling Sia, Jenny Veitch, Petra Staiger, Penny Davidson, Peter Nicholls
      First page: 529
      Abstract: Whilst a growing body of evidence demonstrates people derive a range of health and wellbeing benefits from visiting parks, only a limited number of attempts have been made to provide a complementary economic assessment of parks. The aim of this exploratory study was to directly estimate the perceived health and wellbeing benefits attained from parks and the economic value assigned to parks by park users in Victoria, Australia. The research employed a mixed methods approach (survey and interviews) to collect primary data from a selection of 140 park users: 100 from two metropolitan parks in Melbourne and 40 from a park on the urban fringe of Melbourne, Victoria. Our findings suggest that park users derive a range of perceived physical, mental/spiritual, and social health benefits, but park use was predominantly associated with physical health benefits. Overall, our exploratory study findings suggest that park users are willing to pay for parks, as they highly value them as places for exercising, socialising, and relaxing. Importantly, most people would miss parks if they did not exist. The findings aim to provide park managers, public health advocates, and urban policy makers with evidence about the perceived health and wellbeing benefits of park usage and the economic value park visitors place on parks.
      PubDate: 2017-05-15
      DOI: 10.3390/ijerph14050529
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 530: Mental Health Problems and Related Factors in
           Ecuadorian College Students

    • Authors: Claudia Torres, Patricia Otero, Byron Bustamante, Vanessa Blanco, Olga Díaz, Fernando Vázquez
      First page: 530
      Abstract: Although the mental health problems of college students have been the subject of increasing research, there are no studies about its prevalence in Ecuadorian college students. The aim of this study was to determine the mental health problems and their associated factors in Ecuadorian freshmen university students. A sample of 1092 students (53.7% women; mean age = 18.3 years) were recruited from the Technical Particular University of Loja (Ecuador). Socio-demographic, academic, and clinical characteristics were gathered, as well as information on the participants’ mental health through a number of mental health screens. Prevalence of positive screens was 6.2% for prevalence of major depressive episodes, 0.02% for generalized anxiety disorders, 2.2% for panic disorders, 32.0% for eating disorders, 13.1% for suicidal risk. Mental health problems were significantly associated with sex, area of study, self-esteem, social support, personality and histories of mental health problems. The findings offer a starting point for identifying useful factors to target prevention and intervention strategies aimed at university students.
      PubDate: 2017-05-15
      DOI: 10.3390/ijerph14050530
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 531: Self-Management Group Exercise Extends Healthy
           Life Expectancy in Frail Community-Dwelling Older Adults

    • Authors: Minoru Yamada, Hidenori Arai
      First page: 531
      Abstract: Preventing frailty and its adverse health outcomes is crucial in countries with a large elderly population, such as Japan. Since the long-term care insurance (LTCI) system was launched, the number of certified older adults with LTCI service requirement has continued to increase. This is a serious problem, because the LTCI service requirement certification is equivalent to disability. The aim of this study was to evaluate the effect of a self-management group intervention on new LTCI service requirement certifications in community-dwelling older adults in Japan. We analyzed the cohort data from a prospective study. In this study, we recruited community-dwelling adults aged 65 years and older who were independent in a city in Kyoto prefecture in 2012. The subjects in the participation group (n = 1620) attended 60-min group training sessions once or twice every two weeks from December 2012 to December 2016. The exercise sessions consisted of mild-intensity aerobic exercise, mild strength training, flexibility and balance exercises, and cool-down activities. These exercise classes were facilitated by well-trained volunteer staff. The outcome measure was the number of new LTCI requirement certifications during a four-year follow-up period. During the four-year follow-up period, 247 subjects (15.2%) in the participation group and 334 (20.6%) in the control group were newly certified for LTCI service requirements. The hazard ratio for new LTCI service requirements in the participation group compared with the control group was 0.73 (95% CI = 0.62–0.86) in the four-year follow-up period. These results indicate the usefulness of self-management group exercise to reduce the incidence of disability in older adults. Thus, increasing self-management group activities in each community should be encouraged.
      PubDate: 2017-05-15
      DOI: 10.3390/ijerph14050531
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 532: Influence of Nano-Hydroxyapatite on the Metal
           Bioavailability, Plant Metal Accumulation and Root Exudates of Ryegrass
           for Phytoremediation in Lead-Polluted Soil

    • Authors: Ling Ding, Jianbing Li, Wei Liu, Qingqing Zuo, Shu-xuan Liang
      First page: 532
      Abstract: Lead is recognized as one of the most widespread toxic metal contaminants and pervasive environmental health concerns in the environment. In this paper, the effects of nano-hydroxyapatite (NHAP) on remediation in artificially Pb-contaminated soils and ryegrass were studied in a pot experiment. The addition of NHAP decreased the water- and acid-soluble, exchangeable, and reducible fractions of Pb, extracted using the Community Bureau of Reference (BCR) method, whilst greatly increasing the residual fraction of Pb. Oxidizable Pb was increased slightly. No significant increase in soil pH was caused by the application of NHAP. Compared to conditions without NHAP, the addition of NHAP decreased the Pb content in ryegrass shoots and roots by 13.19–20.3% and 2.86–21.1%, respectively. Therefore, the application of NHAP reduced the mobility and bioavailability of Pb in the soil. In addition, the application of NHAP improved the fresh weight of shoots and roots, and promoted the growth of ryegrass. NHAP played a positive role in stimulating ryegrass to secrete tartaric acid.
      PubDate: 2017-05-16
      DOI: 10.3390/ijerph14050532
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 533: Promoting Healthy Lifestyle and Well-Being in
           Adolescents through Outdoor Physical Activity

    • Authors: Karel Fromel, Michal Kudlacek, Dorota Groffik, Zbynek Svozil, Adam Simunek, Wieslaw Garbaciak
      First page: 533
      Abstract: Health-enhancing physical activities (PA) performed outdoors could markedly contribute to the adoption of a healthy lifestyle in adolescence. The differences between PA preferences and actual opportunities for these PA are an issue that has received frequent attention. To date, the extent to which these differences are reflected in adolescents meeting PA recommendations and their well-being has not been explored. In total, 10,086 respondents took part in an on-line research project regarding PA preferences. Of them, 2446 also completed the International Physical Activity Questionnaire (Long Form) and the World Health Organization (WHO) W-5 questionnaire to assess well-being. Finally, 1278 of these respondents were involved in objective PA monitoring using pedometers. The study aimed to explore the prevalence and trends regarding outdoor PA. Moreover, we assessed whether the agreement between preferred PA and PA actually undertaken was associated with higher odds for meeting PA recommendations and achieving a higher level of well-being. Of a selection of outdoor activities, Czech and Polish boys preferred cycling, swimming, and downhill skiing, while girls preferred swimming activities, skating, and cycling. The agreement between preferred and PA actually undertaken was associated with higher odds for meeting the weekly PA recommendations and higher levels of well-being both in boys and girls. Evaluation of outdoor PA preferences and taking these preferred activities into account when forming conditions for them was important in the efficient promotion of the physical and mental health of adolescents.
      PubDate: 2017-05-17
      DOI: 10.3390/ijerph14050533
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 534: Predictors of Segmented School Day Physical
           Activity and Sedentary Time in Children from a Northwest England
           Low-Income Community

    • Authors: Sarah Taylor, Whitney Curry, Zoe Knowles, Robert Noonan, Bronagh McGrane, Stuart Fairclough
      First page: 534
      Abstract: Background: Schools have been identified as important settings for health promotion through physical activity participation, particularly as children are insufficiently active for health. The aim of this study was to investigate the child and school-level influences on children′s physical activity levels and sedentary time during school hours in a sample of children from a low-income community; Methods: One hundred and eighty-six children (110 boys) aged 9–10 years wore accelerometers for 7 days, with 169 meeting the inclusion criteria of 16 h∙day−1 for a minimum of three week days. Multilevel prediction models were constructed to identify significant predictors of sedentary time, light, and moderate to vigorous physical activity during school hour segments. Child-level predictors (sex, weight status, maturity offset, cardiorespiratory fitness, physical activity self-efficacy, physical activity enjoyment) and school-level predictors (number on roll, playground area, provision score) were entered into the models; Results: Maturity offset, fitness, weight status, waist circumference-to-height ratio, sedentary time, moderate to vigorous physical activity, number of children on roll and playground area significantly predicted physical activity and sedentary time; Conclusions: Research should move towards considering context-specific physical activity and its correlates to better inform intervention strategies.
      PubDate: 2017-05-16
      DOI: 10.3390/ijerph14050534
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 535: Quality over Quantity: Contribution of Urban
           Green Space to Neighborhood Satisfaction

    • Authors: Yang Zhang, Agnes Van den Berg, Terry Van Dijk, Gerd Weitkamp
      First page: 535
      Abstract: There is increasing evidence that the quality of green space significantly contributes to neighborhood satisfaction and well-being, independent of the mere amount of green space. In this paper, we examined residents’ perceptions of the quality and beneficial affordances of green space in relation to objectively assessed accessibility and usability. We used data from a survey in two neighborhoods (N = 223) of a medium-sized city in the Netherlands, which were similar in the amount of green space and other physical and socio-demographic characteristics, but differed in the availability of accessible and usable green spaces. Results show that residents of the neighborhood with a higher availability of accessible and usable green spaces were more satisfied with their neighborhood. This difference was statistically mediated by the higher level of perceived green space quality. Neighborhood satisfaction was significantly positively related to well-being. However, residents of the two neighborhoods did not differ in self-reported well-being and beneficial affordances of green space. These analyses contribute to a further understanding of how the accessibility and usability of green spaces may increase people’s neighborhood satisfaction. It highlights the importance of perceived quality in addition to the amount of green space when examining the beneficial effects of green space.
      PubDate: 2017-05-16
      DOI: 10.3390/ijerph14050535
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 536: Chronic Exposure to Uranium from Gestation:
           Effects on Behavior and Neurogenesis in Adulthood

    • Authors: Céline Dinocourt, Cécile Culeux, Marie Legrand, Christelle Elie, Philippe Lestaevel
      First page: 536
      Abstract: Uranium exposure leads to cerebral dysfunction involving for instance biochemical, neurochemical and neurobehavioral effects. Most studies have focused on mechanisms in uranium-exposed adult animals. However, recent data on developing animals have shown that the developing brain is also sensitive to uranium. Models of uranium exposure during brain development highlight the need to improve our understanding of the effects of uranium. In a model in which uranium exposure began from the first day of gestation, we studied the neurobehavioral consequences as well as the progression of hippocampal neurogenesis in animals from dams exposed to uranium. Our results show that 2-month-old rats exposed to uranium from gestational day 1 displayed deficits in special memory and a prominent depressive-like phenotype. Cell proliferation was not disturbed in these animals, as shown by 5-bromo-2′deoxyuridine (BrdU)/neuronal specific nuclear protein (NeuN) immunostaining in the dentate gyrus. However, in some animals, the pyramidal cell layer was dispersed in the CA3 region. From our previous results with the same model, the hypothesis of alterations of neurogenesis at prior stages of development is worth considering, but is probably not the only one. Therefore, further investigations are needed to correlate cerebral dysfunction and its underlying mechanistic pathways.
      PubDate: 2017-05-17
      DOI: 10.3390/ijerph14050536
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 538: Cu Isotopic Composition in Surface
           Environments and in Biological Systems: A Critical Review

    • Authors: Zhuhong Wang, Jiubin Chen, Ting Zhang
      First page: 538
      Abstract: Copper (Cu) is a transition metal and an essential micronutrient for organisms, but also one of the most widespread toxic inorganic contaminants at very high content. The research on Cu isotopes has grown rapidly in the last decade. Hitherto, a large number of studies have been published on the theoretical fractionation mechanisms, experimental data and natural variations of Cu isotopes in variable environments and ecosystems. These studies reported a large variation of δ65Cu (−16.49 to +20.04‰) in terrestrial samples and showed that Cu isotopes could be fractionated by various biogeochemical processes to different extent. Several papers have previously reviewed the coupling of Cu and Zn isotope systematics, and we give here a tentative review of the recent publications only on Cu isotopesin variable surface repositories, animals and human beings, with a goal to attract much attention to research on Cu (and other metals) behaviors in the environment and biological systems.
      PubDate: 2017-05-18
      DOI: 10.3390/ijerph14050538
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 539: Inorganic Macro- and Micronutrients in
           “Superberries” Black Chokeberries (Aronia melanocarpa) and Related

    • Authors: Iva Juranović Cindrić, Michaela Zeiner, Darija Mihajlov-Konanov, Gerhard Stingeder
      First page: 539
      Abstract: Black chokeberries (Aronia melanocarpa) are considered to be functional food containing high amounts of anthocyanins, phenols, antioxidants, vitamins and minerals. Whereas organic compounds are well studied, there is little research on the mineral composition of the chokeberries. Thus, the presented study is focused on the determination of Al, As, Ba, Ca, Cd, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Ni, Pb, Se, Sr and Zn in black chokeberry fruits and infusions to study the metals’ extractability. The nutrients Ca, K and Mg are present in the fruits (dried matter) at g/kg level, whereas the other elements are present from µg/kg up to mg/kg level. The extraction yields of the metals from the infusion range from 4 (Al, Mn) up to 44% (Na). The toxic elements present do not pose any health risk when berries or infusions are consumed. Concluding, Aronia berries, as well as infusions derived from them, are a good dietary source of essential metals in addition to the organic compounds also contained.
      PubDate: 2017-05-18
      DOI: 10.3390/ijerph14050539
      Issue No: Vol. 14, No. 5 (2017)
  • IJERPH, Vol. 14, Pages 540: Is Increasing Coal Seam Gas Well Development
           Activity Associated with Increasing Hospitalisation Rates in Queensland,
           Australia? An Exploratory Analysis 1995–2011

    • Authors: Angela Werner, Cate Cameron, Kerrianne Watt, Sue Vink, Paul Jagals, Andrew Page
      First page: 540
      Abstract: The majority of Australia’s coal seam gas (CSG) reserves are in Queensland, where the industry has expanded rapidly in recent years. Despite concerns, health data have not been examined alongside CSG development. This study examined hospitalisation rates as a function of CSG development activity in Queensland, during the period 1995–2011. Admissions data were examined with CSG well numbers, which served as a proxy for CSG development activity. Time series models were used to assess changes in hospitalisation rates for periods of “low”, “medium”, “high”, and “intense” activity compared to a period of “very low” activity, adjusting for covariates. “All-cause” hospitalisation rates increased monotonically with increasing gas well development activity in females (324.0 to 390.3 per 1000 persons) and males (294.2 to 335.4 per 1000 persons). Hospitalisation rates for “Blood/immune” conditions generally increased for both sexes. Female and male hospitalisation rates for “Circulatory” conditions decreased with increasing CSG activity. Hospitalisation rates were generally low for reproductive and birth outcomes; no clear associations were observed. This study showed some outcomes were associated with increasing CSG development activity. However, as a condition of data access, the population and outcomes were aggregated to a broad geographic study area rather than using higher geographic resolution data. Higher resolution data, as well as other data sources, should be explored. Further research should be conducted with an expanded time period to determine if these trends continue as the industry grows.
      PubDate: 2017-05-18
      DOI: 10.3390/ijerph14050540
      Issue No: Vol. 14, No. 5 (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 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

    • 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

    • 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)
  • IJERPH, Vol. 14, Pages 452: Breast Cancer Screening Programmes across the
           WHO European Region: Differences among Countries Based on National Income

    • Authors: Emma Altobelli, Leonardo Rapacchietta, Paolo Angeletti, Luca Barbante, Filippo Profeta, Roberto Fagnano
      First page: 452
      Abstract: Breast cancer (BC) is the most frequent tumour affecting women all over the world. In low- and middle-income countries, where its incidence is expected to rise further, BC seems set to become a public health emergency. The aim of the present study is to provide a systematic review of current BC screening programmes in WHO European Region to identify possible patterns. Multiple correspondence analysis was performed to evaluate the association among: measures of occurrence; GNI level; type of BC screening programme; organization of public information and awareness campaigns regarding primary prevention of modifiable risk factors; type of BC screening services; year of screening institution; screening coverage and data quality. A key difference between High Income (HI) and Low and Middle Income (LMI) States, emerging from the present data, is that in the former screening programmes are well organized, with approved screening centres, the presence of mobile units to increase coverage, the offer of screening tests free of charge; the fairly high quality of occurrence data based on high-quality sources, and the adoption of accurate methods to estimate incidence and mortality. In conclusion, the governments of LMI countries should allocate sufficient resources to increase screening participation and they should improve the accuracy of incidence and mortality rates.
      PubDate: 2017-04-23
      DOI: 10.3390/ijerph14040452
      Issue No: Vol. 14, No. 4 (2017)
  • IJERPH, Vol. 14, Pages 453: Fat Mass Is Positively Associated with
           Estimated Hip Bone Strength among Chinese Men Aged 50 Years and above with
           Low Levels of Lean Mass

    • Authors: Guiyuan Han, Yu-Ming Chen, Hua Huang, Zhanyong Chen, Lipeng Jing, Su-Mei Xiao
      First page: 453
      Abstract: This study investigated the relationships of fat mass (FM) and lean mass (LM) with estimated hip bone strength in Chinese men aged 50–80 years (median value: 62.0 years). A cross-sectional study including 889 men was conducted in Guangzhou, China. Body composition and hip bone parameters were generated by dual-energy X-ray absorptiometry (DXA). The relationships of the LM index (LMI) and the FM index (FMI) with bone phenotypes were detected by generalised additive models and multiple linear regression. The associations between the FMI and the bone variables in LMI tertiles were further analysed. The FMI possessed a linear relationship with greater estimated hip bone strength after adjustment for the potential confounders (p < 0.05). Linear relationships were also observed for the LMI with most bone phenotypes, except for the cross-sectional area (p < 0.05). The contribution of the LMI (4.0%–12.8%) was greater than that of the FMI (2.0%–5.7%). The associations between the FMI and bone phenotypes became weaker after controlling for LMI. Further analyses showed that estimated bone strength ascended with FMI in the lowest LMI tertile (p < 0.05), but not in the subgroups with a higher LMI. This study suggested that LM played a critical role in bone health in middle-aged and elderly Chinese men, and that the maintenance of adequate FM could help to promote bone acquisition in relatively thin men.
      PubDate: 2017-04-24
      DOI: 10.3390/ijerph14040453
      Issue No: Vol. 14, No. 4 (2017)
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