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HEALTH AND SAFETY (520 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: 22)
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: 5)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 3)
AJOB Primary Research     Partially Free   (Followers: 3)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Health Economics     Full-text available via subscription   (Followers: 12)
American Journal of Health Education     Hybrid Journal   (Followers: 28)
American Journal of Health Promotion     Hybrid Journal   (Followers: 23)
American Journal of Health Studies     Full-text available via subscription   (Followers: 10)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 186)
American Journal of Public Health Research     Open Access   (Followers: 28)
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: 9)
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   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 2)
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: 6)
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: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 1)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 7)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 18)
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: 16)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 12)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 11)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 19)
Case Reports in Women's Health     Open Access   (Followers: 3)
Case Studies in Fire Safety     Open Access   (Followers: 12)
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: 11)
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: 2)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 2)
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: 5)
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: 1)
Epidemics     Open Access   (Followers: 3)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 4)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 19)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 1)
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 2)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 9)
Evidence-based Medicine & Public Health     Open Access   (Followers: 5)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     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: 5)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 11)
Frontiers in Public Health     Open Access   (Followers: 7)
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: 5)
Global Health Promotion     Hybrid Journal   (Followers: 16)
Global Journal of Health Science     Open Access   (Followers: 9)
Global Journal of Public Health     Open Access   (Followers: 12)
Global Medical & Health Communication     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 15)
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: 7)
Health and Social Work     Hybrid Journal   (Followers: 48)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 14)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 12)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Policy     Hybrid Journal   (Followers: 35)
Health Policy and Technology     Hybrid Journal   (Followers: 1)
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 21)
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: 46)
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: 10)
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: 2)
Health Systems     Hybrid Journal   (Followers: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 11)
Health, Risk & Society     Hybrid Journal   (Followers: 11)
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: 4)
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: 2)
Indonesian Journal for 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: 5)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 33)
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: 20)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 16)
International Journal of Health & Allied Sciences     Open Access   (Followers: 3)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 9)
International Journal of Health Geographics     Open Access   (Followers: 6)
International Journal of Health Policy and Management     Open Access   (Followers: 3)
International Journal of Health Professions     Open Access   (Followers: 2)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 13)

        1 2 3 | Last

Journal Cover International Journal of Environmental Research and Public Health
  [SJR: 0.883]   [H-I: 47]   [20 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 1660-4601
   Published by MDPI Homepage  [154 journals]
  • IJERPH, Vol. 14, Pages 973: Young People’s Use of E-Cigarettes across
           the United Kingdom: Findings from Five Surveys 2015–2017

    • Authors: Linda Bauld, Anne MacKintosh, Brian Eastwood, Allison Ford, Graham Moore, Martin Dockrell, Deborah Arnott, Hazel Cheeseman, Ann McNeill
      First page: 973
      Abstract: Concern has been expressed about the use of e-cigarettes among young people. Our study reported e-cigarette and tobacco cigarette ever and regular use among 11–16 year olds across the UK. Data came from five large scale surveys with different designs and sampling strategies conducted between 2015 and 2017: The Youth Tobacco Policy Survey; the Schools Health Research Network Wales survey; two Action on Smoking and Health (ASH) Smokefree Great Britain-Youth Surveys; and the Scottish Schools Adolescent Lifestyle and Substance Use Survey. Cumulatively these surveys collected data from over 60,000 young people. For 2015/16 data for 11–16 year olds: ever smoking ranged from 11% to 20%; regular (at least weekly) smoking between 1% and 4%; ever use of e-cigarettes 7% to 18%; regular (at least weekly) use 1% to 3%; among never smokers, ever e-cigarette use ranged from 4% to 10% with regular use between 0.1% and 0.5%; among regular smokers, ever e-cigarette use ranged from 67% to 92% and regular use 7% to 38%. ASH surveys showed a rise in the prevalence of ever use of e-cigarettes from 7% (2016) to 11% (2017) but prevalence of regular use did not change remaining at 1%. In summary, surveys across the UK show a consistent pattern: most e-cigarette experimentation does not turn into regular use, and levels of regular use in young people who have never smoked remain very low.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-29
      DOI: 10.3390/ijerph14090973
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 974: Association between Blood Pressure and Birth
           Weight among Rural South African Children: Ellisras Longitudinal Study

    • Authors: Kotsedi Monyeki, Han Kemper, Alfred Mogale, Leon Hay, Machoene Sekgala, Tshephang Mashiane, Suzan Monyeki, Betty Sebati
      First page: 974
      Abstract: The aim of this cross-sectional study was to investigate the association between birth weight, underweight, and blood pressure (BP) among Ellisras rural children aged between 5 and 15 years. Data were collected from 528 respondents who participated in the Ellisras Longitudinal Study (ELS) and had their birth weight recorded on their health clinic card. Standard procedure was used to measure the anthropometric measurements and BP. Linear regression was used to assess BP, underweight variables, and birth weight. Logistic regression was used to assess the association of hypertension risks, low birth weight, and underweight. The association between birth weight and BP was not statistically significant. There was a significant (p < 0.05) association between mean BP and the sum of four skinfolds (β = 0.26, 95% CI 0.15–0.23) even after adjusting for age (β = 0.18, 95% CI 0.01–0.22). Hypertension was significantly associated with weight for age z-scores (OR = 5.13, 95% CI 1.89–13.92) even after adjusting for age and sex (OR = 5.26, 95% CI 1.93–14.34). BP was significantly associated with the sum of four skinfolds, but not birth weight. Hypertension was significantly associated with underweight. Longitudinal studies should confirm whether the changes in body weight we found can influence the risk of cardiovascular diseases.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-29
      DOI: 10.3390/ijerph14090974
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 975: Transnational Research Networks in Chinese
           Scientific Production. An Investigation on Health-Industry Related Sectors

    • Authors: Lauretta Rubini, Chiara Pollio, Marco Di Tommaso
      First page: 975
      Abstract: Transnational research networks (TRN) are becoming increasingly complex. Such complexity may have both positive and negative effects on the quality of research. Our work studies the evolution over time of Chinese TRN and the role of complexity on the quality of Chinese research, given the leading role this country has recently acquired in international science. We focus on the fields of geriatrics and gerontology. We build an original dataset of all scientific publications of China in these areas in 2009, 2012 and 2015, starting from the ISI Web of Knowledge (ISI WoK) database. Using Social Network Analysis (SNA), we analyze the change in scientific network structure across time. Second, we design indices to control for the different aspects of networks complexity (number of authors, country heterogeneity and institutional heterogeneity) and we perform negative binomial regressions to identify the main determinants of research quality. Our analysis shows that research networks in the field of geriatrics and gerontology have gradually become wider in terms of countries and have become more balanced. Furthermore, our results identify that different forms of complexity have different impacts on quality, including a reciprocal moderating effect. In particular, according to our analysis, research quality benefits from complex research networks both in terms of countries and of types of institutions involved, but that such networks should be “compact” in terms of number of authors. Eventually, we suggest that complexity should be carefully taken into account when designing policies aimed at enhancing the quality of research.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-29
      DOI: 10.3390/ijerph14090975
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 976: Pharmaceutical Industry in Vietnam: Sluggish
           Sector in a Growing Market

    • Authors: Antonio Angelino, Do Khanh, Nguyen An Ha, Tuan Pham
      First page: 976
      Abstract: Vietnam is a fast growing economy in the Asian region with a significantly high population (over 92 million in 2015). Although still expanding (about 1.1% on average during 2000–2015), the Vietnamese population is considered to be entering the ageing stage at a very high rate. The rapid expansion of the middle-income urban class and the ageing people ratio have dramatically pushed up the demand for healthcare goods, particularly in terms of pharmaceutical products. Since the early 1990s the government has addressed the necessities of rising demand for healthcare products by formulating a series of policies aimed at promoting the development of the pharmaceutical industry. However, the implementation of such policies does not seem to have been completely efficient given that the country still needs to import up to 90% of its pharmaceutical consumption. This paper aims to explore the development of the pharmaceutical industry during the years 1990–2015 and to identify a series of weaknesses in the government promotion of the industry. Future developments will also be discussed on how the Vietnamese pharmaceutical industry could increase its participation in the regional supply chain, which is currently being dominated by big players like India and China.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-29
      DOI: 10.3390/ijerph14090976
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 977: Bioaccessibility and Human Exposure Assessment
           of Cadmium and Arsenic in Pakchoi Genotypes Grown in Co-Contaminated Soils

    • Authors: Yanyan Wei, Xiaoman Zheng, Md. Shohag, Minghua Gu
      First page: 977
      Abstract: In many countries cadmium (Cd) and arsenic (As) commonly coexist in soils contaminated by mining activities, and can easily enter the human body via consumption of leafy vegetables, like the popularly consumed pakchoi (Brassica chinensis L.), causing major health concerns. In the present study, bioaccessibility and human exposure of Cd and As were assessed in twenty genotypes of pakchoi cultured at two different levels of co-contamination to identify low health risk genotypes. The bioaccessibilities of Cd and As represent a fraction of the total metals content could be bioaccessible for human, in the present study, significant differences in pakchoi Cd and As bioaccessibility were observed among all tested genotypes and co-contaminated levels. Cd and As bioaccessibility of pakchoi were in the ranges of 24.0–87.6% and 20.1–82.5%, respectively, for in the high level co-contaminated soils, which was significantly higher than for low level co-contaminated soils with 7.9–71.8% for Cd bioaccessibility and 16.1–59.0% for As bioaccessibility. The values of bioaccessible established daily intakes (BEDI) and the total bioaccessible target hazard quotients (TBTHQ) of Cd and As were also considerably higher in high level co-contaminated soils than in low level co-contaminated soils. Two genotypes (Meiguanqinggengcai and Zhenqing60F1) contained relatively low concentrations and bioaccessible Cd and As and, their BEDI and TBTHQ for Cd and As ranged below the tolerable limits set by the FAO/WHO (BEDI of Cd < 0.83 μg kg−1 bw day−1, BEDI of As < 3 μg kg−1 bw day−1) and United States Environmental Protection Agency (TBTHQ for Cd and As < 1), this applied for both levels of co-contaminated soils for adults and children. Consequently, these findings suggest identification of safe genotypes in leafy vegetable with low health risk via genotypic screening and breeding methods could be a useful strategy to ensure the safety of food crops grown in those Cd and As co-contaminated fields due to mining activities.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-29
      DOI: 10.3390/ijerph14090977
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 978: Job Stress and Presenteeism among Chinese
           Healthcare Workers: The Mediating Effects of Affective Commitment

    • Authors: Tianan Yang, Yina Guo, Mingxu Ma, Yaxin Li, Huilin Tian, Jianwei Deng
      First page: 978
      Abstract: Background: Presenteeism affects the performance of healthcare workers. This study examined associations between job stress, affective commitment, and presenteeism among healthcare workers. Methods: To investigate the relationship between job stress, affective commitment, and presenteeism, structural equation modeling was used to analyze a sample of 1392 healthcare workers from 11 Class A tertiary hospitals in eastern, central, and western China. The mediating effect of affective commitment on the association between job stress and presenteeism was examined with the Sobel test. Results: Job stress was high and the level of presenteeism was moderate among healthcare workers. Challenge stress and hindrance stress were strongly correlated (β = 0.62; p < 0.05). Affective commitment was significantly and directly inversely correlated with presenteeism (β = −0.27; p < 0.001). Challenge stress was significantly positively correlated with affective commitment (β = 0.15; p < 0.001) but not with presenteeism. Hindrance stress was significantly inversely correlated with affective commitment (β = −0.40; p < 0.001) but was significantly positively correlated with presenteeism (β = 0.26; p < 0.001). Conclusions: This study provides important empirical data on presenteeism among healthcare workers. Presenteeism can be addressed by increasing affective commitment and challenge stress and by limiting hindrance stress among healthcare workers in China.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-29
      DOI: 10.3390/ijerph14090978
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 979: Investigation on Indoor Air Pollution and
           Childhood Allergies in Households in Six Chinese Cities by Subjective
           Survey and Field Measurements

    • Authors: Jinhua Hu, Nianping Li, Yang Lv, Jing Liu, Jingchao Xie, Huibo Zhang
      First page: 979
      Abstract: Greater attention is currently being paid to the relationship between indoor environment and childhood allergies, however, the lack of reliable data and the disparity among different areas hinders reliable assessment of the relationship. This study focuses on the effect of indoor pollution on Chinese schoolchildren and the relationship between specific household and health problems suffered. The epidemiological questionnaire survey and the field measurement of the indoor thermal environment and primary air pollutants including CO2, fine particulate matter (PM2.5), chemical pollutants and fungi were performed in six Chinese cities. A total of 912 questionnaires were eligible for statistical analyses and sixty houses with schoolchildren aged 9–12 were selected for field investigation. Compared with Chinese national standards, inappropriate indoor relative humidity (<30% or >70%), CO2 concentration exceeding 1000 ppm and high PM2.5 levels were found in some monitored houses. Di(2-ethylhexyl) phthalate (DEHP) and dibutyl phthalate (DBP) were the most frequently detected semi-volatile organic compounds (SVOCs) in house dust. Cladosporium, Aspergillus and Penicillium were detected in both indoor air and house dust. This study indicates that a thermal environment with CO2 exceeding 1000 ppm, DEHP and DBP exceeding 1000 μg/g, and high level of PM2.5, Cladosporium, Aspergillus and Penicillium increases the risk of children’s allergies.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-29
      DOI: 10.3390/ijerph14090979
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 980: Peri-Urbanism in Globalizing India: A Study of
           Pollution, Health and Community Awareness

    • Authors: Linda Waldman, Ramila Bisht, Rajashree Saharia, Abhinav Kapoor, Bushra Rizvi, Yasir Hamid, Meghana Arora, Ima Chopra, Kumud Sawansi, Ritu Priya, Fiona Marshall
      First page: 980
      Abstract: This paper examines the intersection between environmental pollution and people’s acknowledgements of, and responses to, health issues in Karhera, a former agricultural village situated between the rapidly expanding cities of New Delhi (India’s capital) and Ghaziabad (an industrial district in Uttar Pradesh). A relational place-based view is integrated with an interpretive approach, highlighting the significance of place, people’s emic experiences, and the creation of meaning through social interactions. Research included surveying 1788 households, in-depth interviews, participatory mapping exercises, and a review of media articles on environment, pollution, and health. Karhera experiences both domestic pollution, through the use of domestic waste water, or gandapani, for vegetable irrigation, and industrial pollution through factories’ emissions into both the air and water. The paper shows that there is no uniform articulation of any environment/health threats associated with gandapani. Some people take preventative actions to avoid exposure while others do not acknowledge health implications. By contrast, industrial pollution is widely noted and frequently commented upon, but little collective action addresses this. The paper explores how the characteristics of Karhera, its heterogeneous population, diverse forms of environmental pollution, and broader governance processes, limit the potential for citizen action against pollution.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-30
      DOI: 10.3390/ijerph14090980
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 981: Poverty and Child Behavioral Problems: The
           Mediating Role of Parenting and Parental Well-Being

    • Authors: Till Kaiser, Jianghong Li, Matthias Pollmann-Schult, Anne Song
      First page: 981
      Abstract: The detrimental impact of poverty on child behavioral problems is well-established, but the mechanisms that explain this relationship are less well-known. Using data from the Families in Germany Study on parents and their children at ages 9–10 (middle childhood), this study extends previous research by examining whether or not and to what extent different parenting styles and parents’ subjective well-being explain the relationship between poverty and child behavior problems. The results show that certain parenting styles, such as psychological control, as well as mothers’ life satisfaction partially mediate the correlation between poverty and child behavioral problems.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-30
      DOI: 10.3390/ijerph14090981
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 982: The Canadian Atlas of Child and Youth Injury:
           Mobilizing Injury Surveillance Data to Launch a National Knowledge
           Translation Tool

    • Authors: Ian Pike, Jennifer Smith, Samar Al-Hajj, Pamela Fuselli, Alison Macpherson
      First page: 982
      Abstract: Child and youth injury prevention research in Canada has lagged behind other Organisation for Economic Co-operation and Development nations, despite existing surveillance systems and longitudinal data. A critical need to improve access to the available data, as well as need to tailor its display and interpretation, was identified by injury prevention stakeholders involved in research, policy, and practice. The Canadian Atlas of Child and Youth Injury Prevention (“the Atlas”) was developed to address this need. Following a series of iterative consultation meetings and a pilot testing session, the Atlas was scaled up with national data. Two testing sessions were held to evaluate the tools. The Atlas is comprised of three main components: data, indicators, and visualizations. The accessibility of the dashboard is enhanced by customization of data visualizations and data outputs to suit the user’s needs. Overall feedback indicated that the tools were easy to use, and that the interface was intuitive and visually appealing. The Canadian Atlas of Child and Youth Injury Prevention provides readily accessible information to injury prevention practitioners, policy makers and researchers, helping to chart pathways to success in improving the child and youth injury prevention system in Canada.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-30
      DOI: 10.3390/ijerph14090982
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 983: Longitudinal Study-Based Dementia Prediction
           for Public Health

    • Authors: HeeChel Kim, Hong-Woo Chun, Seonho Kim, Byoung-Youl Coh, Oh-Jin Kwon, Yeong-Ho Moon
      First page: 983
      Abstract: The issue of public health in Korea has attracted significant attention given the aging of the country’s population, which has created many types of social problems. The approach proposed in this article aims to address dementia, one of the most significant symptoms of aging and a public health care issue in Korea. The Korean National Health Insurance Service Senior Cohort Database contains personal medical data of every citizen in Korea. There are many different medical history patterns between individuals with dementia and normal controls. The approach used in this study involved examination of personal medical history features from personal disease history, sociodemographic data, and personal health examinations to develop a prediction model. The prediction model used a support-vector machine learning technique to perform a 10-fold cross-validation analysis. The experimental results demonstrated promising performance (80.9% F-measure). The proposed approach supported the significant influence of personal medical history features during an optimal observation period. It is anticipated that a biomedical “big data”-based disease prediction model may assist the diagnosis of any disease more correctly.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-30
      DOI: 10.3390/ijerph14090983
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 984: The Non-Linear Relationship between BMI and

    • Authors: Michael Laxy, Renée Stark, Annette Peters, Hans Hauner, Rolf Holle, Christina Teuner
      First page: 984
      Abstract: This study aims to analyse the non-linear relationship between Body Mass Index (BMI) and direct health care costs, and to quantify the resulting cost fraction attributable to obesity in Germany. Five cross-sectional surveys of cohort studies in southern Germany were pooled, resulting in data of 6757 individuals (31–96 years old). Self-reported information on health care utilisation was used to estimate direct health care costs for the year 2011. The relationship between measured BMI and annual costs was analysed using generalised additive models, and the cost fraction attributable to obesity was calculated. We found a non-linear association of BMI and health care costs with a continuously increasing slope for increasing BMI without any clear threshold. Under the consideration of the non-linear BMI-cost relationship, a shift in the BMI distribution so that the BMI of each individual is lowered by one point is associated with a 2.1% reduction of mean direct costs in the population. If obesity was eliminated, and the BMI of all obese individuals were lowered to 29.9 kg/m2, this would reduce the mean direct costs by 4.0% in the population. Results show a non-linear relationship between BMI and health care costs, with very high costs for a few individuals with high BMI. This indicates that population-based interventions in combination with selective measures for very obese individuals might be the preferred strategy.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-30
      DOI: 10.3390/ijerph14090984
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 985: Determinants of FDI Localization in China: A
           County-Level Analysis for the Pharmaceutical Industry

    • Authors: Su Li, Antonio Angelino, Haitao Yin, Francesca Spigarelli
      First page: 985
      Abstract: Foreign direct investments (FDIs) have been widely recognized as a crucial feature of the Chinese industrial development process. Over the past decades, China has been attracting huge amounts of inward FDIs as a consequence of both spontaneous market dynamics and place-based preferential policies at the sub-national level. However, the Chinese market exhibits large dissimilarities in terms of FDI localization across territories that are worth investigating at a more disaggregated level. In this regards, our study explores the determinants of attraction of inward FDIs in China, at the county level. It focuses on the pharmaceutical industry and attempts to assess whether factors related to location advantages, agglomeration dynamics, information cost effects and environmental regulation costs affect foreign firms’ localization choices as well as invested amounts in that location. By means of discrete choice models, our paper confirms the findings of the prevalent literature about the positive effects of location advantages on pharmaceutical FDI attraction. Different from our expectations, a higher proportion of foreign enterprises do not stimulate significant effects on FDI localization, while preferential policies and sectoral agglomeration are positively correlated with the localization of pharmaceutical foreign firms. Finally, our results suggest that investing firms tend to avoid areas with strict environment regulation.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-30
      DOI: 10.3390/ijerph14090985
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 986: Identification of Potential High-Risk Habitats
           within the Transmission Reach of Oncomelania hupensis after Floods Based
           on SAR Techniques in a Plane Region in China

    • Authors: Yuanyuan Shi, Juan Qiu, Rendong Li, Qiang Shen, Duan Huang
      First page: 986
      Abstract: Schistosomiasis japonica is an infectious disease caused by Schistosoma japonicum, and it remains endemic in China. Flooding is the main hazard factor, as it causes the spread of Oncomelania hupensis, the only intermediate host of Schistosoma japonicum, thereby triggering schistosomiasis outbreaks. Based on multi-source real-time remote sensing data, we used remote sensing (RS) technology, especially synthetic aperture radar (SAR), and geographic information system (GIS) techniques to carry out warning research on potential snail habitats within the snail dispersal range following flooding. Our research result demonstrated: (1) SAR data from Sentinel-1A before and during a flood were used to identify submerged areas rapidly and effectively; (2) the likelihood of snail survival was positively correlated with the clay proportion, core area standard deviation, and ditch length but negatively correlated with the wetness index, NDVI (normalized difference vegetation index), elevation, woodland area, and construction land area; (3) the snail habitats were most abundant near rivers and ditches in paddy fields; (4) the rivers and paddy irrigation ditches in the submerged areas must be the focused of mitigation efforts following future floods.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-30
      DOI: 10.3390/ijerph14090986
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 987: Diurnal Changes in Distribution
           Characteristics of Salivary Cortisol and Immunoglobulin A Concentrations

    • Authors: Hiromitsu Kobayashi, Chorong Song, Harumi Ikei, Bum-Jin Park, Takahide Kagawa, Yoshifumi Miyazaki
      First page: 987
      Abstract: Salivary cortisol and secretory immunoglobulin A (S-IgA) are important biomarkers for environmental and public health research. The present study investigated the diurnal variations of these salivary biomarkers, with a focus on the change of distribution characteristics (i.e., skewness and kurtosis) of the concentrations. The participants in this study were 113 healthy young males. Salivary samples were collected in the morning (6:30–7:30 a.m.) and afternoon (1:00–4:00 p.m.). The skewness and kurtosis of salivary cortisol concentrations in afternoon samples (skewness = 1.06, kurtosis = 4.78) were significantly higher than those in morning samples (skewness = 0.49, kurtosis = 2.80). The differences in skewness and kurtosis of S-IgA concentrations were non-significant; however, the standard deviation and interquartile ranges for afternoon S-IgA concentrations were significantly smaller than those for morning S-IgA concentrations. Logarithmic transformation improved the distribution of afternoon cortisol values, making it an almost normal distribution, but the transformation showed no improvement in the distribution of morning cortisol or S-IgA values. The present study explored diurnal changes in the distribution characteristics of salivary cortisol and S-IgA. Consideration of a possible diurnal change in the distribution characteristics is needed when we compare the difference in these salivary biomarkers between different times of day.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-31
      DOI: 10.3390/ijerph14090987
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 988: Thyroid Cancer Incidence around the Belgian
           Nuclear Sites, 2000–2014

    • Authors: Claire Demoury, Tom De Smedt, Harlinde De Schutter, Michel Sonck, Nancy Van Damme, Kaatje Bollaerts, Geert Molenberghs, Lodewijk Van Bladel, An Van Nieuwenhuyse
      First page: 988
      Abstract: The present study investigates whether there is an excess incidence of thyroid cancer among people living in the vicinity of the nuclear sites in Belgium. Adjusted Rate Ratios were obtained from Poisson regressions for proximity areas of varying sizes. In addition, focused hypothesis tests and generalized additive models were performed to test the hypothesis of a gradient in thyroid cancer incidence with increasing levels of surrogate exposures. Residential proximity to the nuclear site, prevailing dominant winds frequency from the site, and simulated radioactive discharges were used as surrogate exposures. No excess incidence of thyroid cancer was observed around the nuclear power plants of Doel or Tihange. In contrast, increases in thyroid cancer incidence were found around the nuclear sites of Mol-Dessel and Fleurus; risk ratios were borderline not significant. For Mol-Dessel, there was evidence for a gradient in thyroid cancer incidence with increased proximity, prevailing winds, and simulated radioactive discharges. For Fleurus, a gradient was observed with increasing prevailing winds and, to a lesser extent, with increasing simulated radioactive discharges. This study strengthens earlier findings and suggests increased incidences in thyroid cancer around two of the four Belgian nuclear sites. Further analyses will be performed at a more detailed geographical level.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-31
      DOI: 10.3390/ijerph14090988
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 989: Erratum: Haraux, E., et al. Maternal Exposure
           to Domestic Hair Cosmetics and Occupational Endocrine Disruptors Is
           Associated with a Higher Risk of Hypospadias in the Offspring. Int. J.
           Environ. Res. Public Health 2016, 14, 27

    • Authors: Elodie Haraux, Karine Braun, Philippe Buisson, Erwan Stéphan-Blanchard, Camille Devauchelle, Jannick Ricard, Bernard Boudailliez, Pierre Tourneux, Richard Gouron, Karen Chardon
      First page: 989
      Abstract: Due to an error during production, some data presented in Table 1 in the Experimental section of the published paper [1] were incorrect.[...]
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-31
      DOI: 10.3390/ijerph14090989
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 990: Arsenic Speciation and Extraction and the
           Significance of Biodegradable Acid on Arsenic Removal—An Approach for
           Remediation of Arsenic-Contaminated Soil

    • Authors: Thinh Nguyen Van, Yasuhito Osanai, Hai Do Nguyen, Kiyoshi Kurosawa
      First page: 990
      Abstract: A series of arsenic remediation tests were conducted using a washing method with biodegradable organic acids, including oxalic, citric and ascorbic acids. Approximately 80% of the arsenic in one sample was removed under the effect of the ascorbic and oxalic acid combination, which was roughly twice higher than the effectiveness of the ascorbic and citric acid combination under the same conditions. The soils treated using biodegradable acids had low remaining concentrations of arsenic that are primarily contained in the crystalline iron oxides and organic matter fractions. The close correlation between extracted arsenic and extracted iron/aluminum suggested that arsenic was removed via the dissolution of Fe/Al oxides in soils. The fractionation of arsenic in four contaminated soils was investigated using a modified sequential extraction method. Regarding fractionation, we found that most of the soil contained high proportions of arsenic (As) in exchangeable fractions with phosphorus, amorphous oxides, and crystalline iron oxides, while a small amount of the arsenic fraction was organic matter-bound. This study indicated that biodegradable organic acids can be considered as a means for arsenic-contaminated soil remediation.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-31
      DOI: 10.3390/ijerph14090990
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 991: Selective Removal of the Genotoxic Compound
           2-Aminopyridine in Water using Molecularly Imprinted Polymers Based on
           Magnetic Chitosan and β-Cyclodextrin

    • Authors: Wei Zhang, Zhiliang Zhu, Hua Zhang, Yanling Qiu
      First page: 991
      Abstract: To develop efficient materials with enhanced adsorption and selectivity for genotoxic 2-aminopyridine in water, based on magnetic chitosan (CTs) and β-cyclodextrin (β-CD), the magnetic molecularly imprinted polymers (MMIPs) of Fe3O4-CTs@MIP and Fe3O4-MAH-β-CD@MIP were synthesized by a molecular imprinting technique using 2-aminopyridine as a template. The selective adsorption experiments for 2-aminopyridine were performed by four analogues including pyridine, aniline, 2-amino-5-chloropyridine and phenylenediamine. Results showed the target 2-aminopyridine could be selectively adsorbed and quickly separated by the synthesized MMIPs in the presence of the above structural analogues. The coexisting ions including Na+, K+, Mg2+, Ca2+, Cl− and SO42− showed little effect on the adsorption of 2-aminopyridine. The maximum adsorption capacity of 2-aminopyridine on Fe3O4-CTs@MIP and Fe3O4-MAH-β-CD@MIP was 39.2 mg·g−1 and 46.5 mg·g−1, respectively, which is much higher than values in previous reports. The comparison result with commercial activated carbon showed the obtained MMIPs had higher adsorption ability and selectivity for 2-aminopyridine. In addition, the synthesized MMIPs exhibited excellent performance of regeneration, which was used at least five times with little adsorption capacity loss. Therefore, the synthesized MMIPs are potential effective materials in applications for selective removal and analysis of the genotoxic compound aminopyridine from environmental water.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-31
      DOI: 10.3390/ijerph14090991
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 992: Heat Health Messages: A Randomized Controlled
           Trial of a Preventative Messages Tool in the Older Population of South

    • Authors: Monika Nitschke, Antoinette Krackowizer, Alana Hansen, Peng Bi, Graeme Tucker
      First page: 992
      Abstract: This study explores the efficacy of providing targeted information to older individuals to prevent adverse health outcomes during extreme heat. Participants ≥65 years of age (n = 637) were recruited from previous population-based studies and randomized into intervention and control groups. The intervention group received evidence-based information leaflets and summarised “Beat the Heat” tips. Post summer 2013–2014, participants responded to questions about their behaviours and their health experiences. Chi square analysis and risk ratios (RR) were used to determine the difference in effects. Responses were received from 216 intervention subjects and 218 controls. Behaviour modification during extreme heat was similar in both groups except for significant increases in the use of cooling systems and the use of a wet cloth to cool the skin in the intervention group. Both actions were recommended in the information package. More people in the intervention group also claimed to have had adequate heat health information. After adjusting for confounders, the RR for self-reported heat stress experienced during summer 2014 indicated a 63% (RR 0.37; 95% CI: 0.22–0.63) reduction in the intervention group compared to the control group. Access to intensive prevention information may have contributed to this positive outcome, indicating the potential usefulness of targeted heat-health information for seniors.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-31
      DOI: 10.3390/ijerph14090992
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 993: Relationship between Social Support Networks
           and Physical Functioning in Older Community-Dwelling Mexicans

    • Authors: Víctor Mendoza-Núñez, Fabiola González-Mantilla, Elsa Correa-Muñoz, Raquel Retana-Ugalde
      First page: 993
      Abstract: Some studies have demonstrated the relationship between social support networks (SSNs) and health status. In this sense, it has been considered that physical and mental functioning is a key indicator of the health in the age people. The aim of this study was to determine the association between social support networks and physical functioning. A cross-sectional study was carried out including a convenience sample of 150 older community-dwelling Mexicans. We assessed the familial, extra-familial and institutional SSNs; social contacts; the activities of daily living (ADL); the instrumental activities of daily living (IADLs); and physical functioning task (PFT) performance among study participants. Of the 150 older subjects, 53 reported living alone (35%), 113 (75%) reported having few SSNs, and 37 (25%) reported having enough SSNs. Persons with few familial SSNs were at increased odds of demonstrating dependence in at least one of the ADL (OR = 3.25, 95% CI 1.06–9.92, p < 0.05). Likewise, persons with few institutional SSNs and few social contacts were at increased odds of demonstrating dependence in at least one of the IADL (OR = 6.96, 95% CI 1.57–30.7, p < 0.01; OR = 5.02, 95% CI 1.44–17.5, p < 0.01, respectively). We also observed that having few extra-familial SSNs and few social contacts were the main risk factors for PFT dependence, with ORs of 3.70 (95% CI 1.21–11.2, p < 0.05) and 3.85 (95% CI 1.10–13.5, p < 0.05), respectively. Our findings suggest that having few SSNs could be a significant risk factor for reduced physical functioning in older adults.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-31
      DOI: 10.3390/ijerph14090993
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 994: Spatial Variability of Geriatric Depression
           Risk in a High-Density City: A Data-Driven Socio-Environmental
           Vulnerability Mapping Approach

    • Authors: Hung Ho, Kevin Lau, Ruby Yu, Dan Wang, Jean Woo, Timothy Kwok, Edward Ng
      First page: 994
      Abstract: Previous studies found a relationship between geriatric depression and social deprivation. However, most studies did not include environmental factors in the statistical models, introducing a bias to estimate geriatric depression risk because the urban environment was found to have significant associations with mental health. We developed a cross-sectional study with a binomial logistic regression to examine the geriatric depression risk of a high-density city based on five social vulnerability factors and four environmental measures. We constructed a socio-environmental vulnerability index by including the significant variables to map the geriatric depression risk in Hong Kong, a high-density city characterized by compact urban environment and high-rise buildings. Crude and adjusted odds ratios (ORs) of the variables were significantly different, indicating that both social and environmental variables should be included as confounding factors. For the comprehensive model controlled by all confounding factors, older adults who were of lower education had the highest geriatric depression risks (OR: 1.60 (1.21, 2.12)). Higher percentage of residential area and greater variation in building height within the neighborhood also contributed to geriatric depression risk in Hong Kong, while average building height had negative association with geriatric depression risk. In addition, the socio-environmental vulnerability index showed that higher scores were associated with higher geriatric depression risk at neighborhood scale. The results of mapping and cross-section model suggested that geriatric depression risk was associated with a compact living environment with low socio-economic conditions in historical urban areas in Hong Kong. In conclusion, our study found a significant difference in geriatric depression risk between unadjusted and adjusted models, suggesting the importance of including environmental factors in estimating geriatric depression risk. We also developed a framework to map geriatric depression risk across a city, which can be used for identifying neighborhoods with higher risk for public health surveillance and sustainable urban planning.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-31
      DOI: 10.3390/ijerph14090994
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 995: Fitness, Fatness and Active School Commuting
           among Liverpool Schoolchildren

    • Authors: Robert J. Noonan, Lynne M. Boddy, Zoe R. Knowles, Stuart J. Fairclough
      First page: 995
      Abstract: This study investigated differences in health outcomes between active and passive school commuters, and examined associations between parent perceptions of the neighborhood environment and active school commuting (ASC). One hundred-ninety-four children (107 girls), aged 9–10 years from ten primary schools in Liverpool, England, participated in this cross-sectional study. Measures of stature, body mass, waist circumference and cardiorespiratory fitness (CRF) were taken. School commute mode (active/passive) was self-reported and parents completed the neighborhood environment walkability scale for youth. Fifty-three percent of children commuted to school actively. Schoolchildren who lived in more deprived neighborhoods perceived by parents as being highly connected, unaesthetic and having mixed land-use were more likely to commute to school actively (p < 0.05). These children were at greatest risk of being obese and aerobically unfit(p < 0.01). Our results suggest that deprivation may explain the counterintuitive relationship between obesity, CRF and ASC in Liverpool schoolchildren. These findings encourage researchers and policy makers to be equally mindful of the social determinants of health when advocating behavioral and environmental health interventions. Further research exploring contextual factors to ASC, and examining the concurrent effect of ASC and diet on weight status by deprivation is needed.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-31
      DOI: 10.3390/ijerph14090995
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 996: How Economic Analysis Can Contribute to
           Understanding the Links between Housing and Health

    • Authors: Ralph Chapman, Nicholas Preval, Philippa Howden-Chapman
      First page: 996
      Abstract: An economic analysis of housing’s linkages to health can assist policy makers and researchers to make better decisions about which housing interventions and policies are the most cost-beneficial. The challenge is to include cobenefits. The adoption in 2015 of the UN Sustainable Development Goals underscores the importance of understanding how policies interact, and the merit of comprehensively evaluating cobenefits. We explain our approach to the empirical assessment of such cobenefits in the housing and health context, and consider lessons from empirical economic appraisals of the impact of housing on health outcomes. Critical assumptions relating to cobenefits are explicitly examined. A key finding is that when wider policy outcome measures are included, such as mental health impacts and carbon emission reductions, it is important that effects of assumptions on outcomes are considered. Another is that differing values underlie appraisal, for example, the weight given to future generations through the discount rate. Cost-benefit analyses (CBAs) can better facilitate meaningful debate when they are based on explicit assumptions about values. In short, the insights drawn from an economic framework for housing-and-health studies are valuable, but nonetheless contingent. Given that housing interventions typically have both health and other cobenefits, and incorporate social value judgements, it is important to take a broad view but be explicit about how such interventions are assessed.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-08-31
      DOI: 10.3390/ijerph14090996
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 997: Delay Discounting as an Index of Sustainable
           Behavior: Devaluation of Future Air Quality and Implications for Public

    • Authors: Meredith Berry, Norma Nickerson, Amy Odum
      First page: 997
      Abstract: Poor air quality and resulting annual deaths represent significant public health concerns. Recently, rapid delay discounting (the devaluation of future outcomes) of air quality has been considered a potential barrier for engaging in long term, sustainable behaviors that might help to reduce emissions (e.g., reducing private car use, societal support for clean air initiatives). Delay discounting has been shown to be predictive of real world behavior outside of laboratory settings, and therefore may offer an important framework beyond traditional variables thought to measure sustainable behavior such as importance of an environmental issue, or environmental attitudes/values, although more research is needed in this area. We examined relations between discounting of air quality, respiratory health, and monetary gains and losses. We also examined, relations between discounting and self-reported importance of air quality and respiratory health, and nature relatedness. Results showed rapid delay discounting of all outcomes across the time frames assessed, and significant positive correlations between delay discounting of air quality, respiratory health, and monetary outcomes. Steeper discounting of monetary outcomes relative to air quality and respiratory health outcomes was observed in the context of gains; however, no differences in discounting were observed across losses of monetary, air quality, and respiratory health. Replicating the sign effect, monetary outcomes were discounted more steeply than monetary losses. Importance of air quality, respiratory health and nature relatedness were significantly and positively correlated with one another, but not with degree of delay discounting of any outcome, demonstrating the need for more comprehensive measures that predict pro-environmental behaviors that might benefit individuals and public health over time. These results add to our understanding of decision-making, and demonstrate alarming rates of delay discounting of air quality and health. These results implicate a major public health concern and potential barriers to individual and societal behavior that reduce pollution and emissions for conservation of clean air.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-01
      DOI: 10.3390/ijerph14090997
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 998: Identification of a Group’s Physiological
           Synchronization with Earth’s Magnetic Field

    • Authors: Inga Timofejeva, Rollin McCraty, Mike Atkinson, Roza Joffe, Alfonsas Vainoras, Abdullah Alabdulgader, Minvydas Ragulskis
      First page: 998
      Abstract: A new analysis technique for the evaluation of the degree of synchronization between the physiological state of a group of people and changes in the Earth’s magnetic field based on their cardiac inter-beat intervals was developed and validated. The new analysis method was then used to identify clusters of similar synchronization patterns in a group of 20 individuals over a two-week period. The algorithm for the identification of slow wave dynamics for every person was constructed in order to determine meaningful interrelationships between the participants and the local magnetic field data. The results support the hypothesis that the slow wave rhythms in heart rate variability can synchronize with changes in local magnetic field data, and that the degree of synchronization is affected by the quality of interpersonal relationships.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-01
      DOI: 10.3390/ijerph14090998
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 999: Stress and Depressive Symptoms in Cancer
           Survivors and Their Family Members: Korea Community Health Survey, 2012

    • Authors: Mi Han
      First page: 999
      Abstract: This study examined the prevalence of perceived stress and depressive symptoms in cancer survivors and their family members compared with subjects without cancer and without family members with cancer. The subjects of this cross-sectional study were adults ≥19 years old who participated in the 2012 Korea Community Health Survey. Stress and depressive symptoms in cancer survivors and their family members were assessed and compared to symptoms in control groups by chi-square tests and multiple logistic regression analyses. Of the 6783 cancer survivors, 26.9% and 8.7% reported having stress and depressive symptoms, respectively, and 27.7% and 5.9% of family members of cancer survivors reported having stress and depressive symptoms, respectively. Cancer survivors showed higher adjusted odds ratio (aOR) for stress (aOR = 1.26, 95% confidence interval (CI) = 1.16–1.37) and depressive symptoms (aOR = 1.82, 95% CI = 1.57–2.11) than subjects without cancer history. Family members of cancer survivors showed a higher OR for stress and depressive symptoms than subjects without a family member who survived cancer. Cancer survivors and family members of cancer survivors had more stress and depressive symptoms than controls. Careful management for cancer patients and their family members should include screening for stress and depression to improve mental health associated with cancer survivorship.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-01
      DOI: 10.3390/ijerph14090999
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1000: The Effect of Taichi Practice on Attenuating
           Bone Mineral Density Loss: A Systematic Review and Meta-Analysis of
           Randomized Controlled Trials

    • Authors: Liye Zou, Chaoyi Wang, Kevin Chen, Yankai Shu, Xiaoan Chen, Lin Luo, Xitang Zhao
      First page: 1000
      Abstract: Objective: The purpose of this study was to determine the effects of practicing Taichi on attenuating bone mineral density (BMD) loss. Methods: Both electronic and manual searches were performed for randomized controlled trials (RCTs) examining Taichi for bone health. Two review authors independently performed study selection and data extraction according to inclusion criteria. A third party (Lin Luo) emerged to discuss with the two review authors and resolve a disagreement. Results: Twenty RCTs were found to meet the inclusion criteria and used for meta-analysis with a total effective sample of 1604. The aggregated results from this systematic review have shown significant benefits in favour of Taichi on BMD at lumbar spine (Standard Mean Difference, SMD) = 0.29; 95% CI 0.15 to 0.43; p < 0.0001), femur neck (SMD = 0.56; 95% CI 0.38 to 0.75; p < 0.00001), femur trochanter (SMD = 0.04; 95% CI 0.01 to 0.07; p = 0.007), total hip BMD (SMD = 0.46; 95% CI 0.16 to 0.76; p = 0.003). Conclusions: The aggregated results from this systematic review suggests that Taichi is effective on attenuating BMD loss at the regions of lumbar spine and proximal femur neck in special populations (e.g., older adults, perimenopausal and postmenopausal women, people with osteoarthritis, and cancer survivors). Researchers should further examine the effect of Taichi on the proximal femur trochanter and total hip so that a more definitive claim can be made regarding the beneficial effects for attenuating BMD loss in these musculoskeletal regions.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-01
      DOI: 10.3390/ijerph14091000
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1001: Antimicrobial Susceptibility of
           Staphylococcus aureus Isolated from Recreational Waters and Beach Sand in
           Eastern Cape Province of South Africa

    • Authors: Olufemi Emmanuel Akanbi, Henry Akum Njom, Justine Fri, Anthony C. Otigbu, Anna M. Clarke
      First page: 1001
      Abstract: Background: Resistance of Staphylococcus aureus to commonly used antibiotics is linked to their ability to acquire and disseminate antimicrobial-resistant determinants in nature, and the marine environment may serve as a reservoir for antibiotic-resistant bacteria. This study determined the antibiotic sensitivity profile of S. aureus isolated from selected beach water and intertidal beach sand in the Eastern Cape Province of South Africa. Methods: Two hundred and forty-nine beach sand and water samples were obtained from 10 beaches from April 2015 to April 2016. Staphylococcus aureus was isolated from the samples using standard microbiological methods and subjected to susceptibility testing to 15 antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA) was detected by susceptibility to oxacillin and growth on Brilliance MRSA II agar. Antibiotic resistance genes including mecA, femA rpoB, blaZ, ermB, ermA, ermC, vanA, vanB, tetK and tetM were screened. Results: Thirty isolates (12.3%) were positive for S. aureus by PCR with over 50% showing phenotypic resistance to methicillin. Resistance of S. aureus to antibiotics varied considerably with the highest resistance recorded to ampicillin and penicillin (96.7%), rifampicin and clindamycin (80%), oxacillin (73.3%) and erythromycin (70%). S. aureus revealed varying susceptibility to imipenem (96.7%), levofloxacin (86.7%), chloramphenicol (83.3%), cefoxitin (76.7%), ciprofloxacin (66.7%), gentamycin (63.3%), tetracycline and sulfamethoxazole-trimethoprim (56.7%), and vancomycin and doxycycline (50%). All 30 (100%) S. aureus isolates showed multiple antibiotic-resistant patterns (resistant to three or more antibiotics). The mecA, femA, rpoB, blaZ, ermB and tetM genes were detected in 5 (22.7%), 16 (53.3%), 11 (45.8%), 16 (55.2%), 15 (71.4%), and 8 (72.7%) isolates respectively; Conclusions: Results from this study indicate that beach water and sand from the Eastern Cape Province of South Africa may be potential reservoirs of antibiotic-resistant S. aureus which could be transmitted to exposed humans and animals.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-01
      DOI: 10.3390/ijerph14091001
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1002: Public Health Services Utilization and Its
           Determinants among Internal Migrants in China: Evidence from a Nationally
           Representative Survey

    • Authors: Jingya Zhang, Senlin Lin, Di Liang, Yi Qian, Donglan Zhang, Zhiyuan Hou
      First page: 1002
      Abstract: There have been obstacles for internal migrants in China in accessing local public health services for some time. This study aimed to estimate the utilization of local public health services and its determinants among internal migrants. Data were from the 2014 and 2015 nationally representative cross-sectional survey of internal migrants in China. Multivariate logistic regressions were used to estimate the relationship between socioeconomic, migration, and demographic characteristics and public health services utilization. Our results showed that internal migrants in more developed eastern regions used less public health services. Those with higher socioeconomic status were more likely to use public health services. The years of living in the city of residence were positively associated with the utilization of public health services. Compared to migration within the city, migration across provinces significantly reduced the probability of using health records (OR = 0.88, 95% CI: 0.86–0.90), health education (OR = 0.97, 95% CI: 0.94–1.00), and health education on non–communicable diseases (OR = 0.92, 95% CI: 0.89–0.95) or through the Internet (OR = 0.96, 95% CI: 0.94–0.99). This study concludes that public health services coverage for internal migrants has seen great improvement due to government subsidies. Internal migrants with lower socioeconomic status and across provinces need to be targeted. More attention should be given to the local government in the developed eastern regions in order to narrow the regional gaps.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-01
      DOI: 10.3390/ijerph14091002
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1003: Variations in the Rate of Infestations of
           Dogs with Zoonotic Nematodes and the Contamination of Soil in Different

    • Authors: Maria Bernadeta Studzińska, Marta Demkowska-Kutrzepa, Anna Borecka, Michał Meisner, Krzysztof Tomczuk, Monika Roczeń-Karczmarz, Teresa Kłapeć, Zahrai Abbass, Alicja Cholewa
      First page: 1003
      Abstract: Companion animals are an important aspect in human life. However, they may also be considered a source of pathogens. An example of zoonotic parasitoses is toxocarosis or cutaneous larva migrans (CLM). The aim of the study was to detect zoonotic nematodes of dogs living in different areas and the intensity of contamination in parasite polluted environments that are hazardous to human health. The fecal samples were examined using standard flotation and decantation methods as well as McMaster’s quantitative technique. The soil samples in urban and rural areas were examined using a modified flotation method as described by Quinn et al. Statistical analyses were performed by IBM SPSS Statistics Version 23. The overall prevalence of parasites in dogs was 38%, 17.02% and 56.60% from urban and rural areas, respectively. The percentage values of nematodes important for human health (Toxocara canis, Ancylostomatidae, Trichuris vulpis) remained at the same level (16%). The infected dogs were dominated by a single parasite species, the main was T. canis (28.95%). In total, 54.30% of the soil samples were contaminated with parasite eggs. The contamination of urban and rural sandpits was 40% and 60%, respectively. The molecular examinations of soil samples using LAMP (loop-mediated isothermal amplification) confirmed the presence of nematode eggs of the species T. canis in all samples previously classified as positive
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-01
      DOI: 10.3390/ijerph14091003
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1004: An Assessment of the Food and Nutrition
           Security Status of Weaned 7–12 Months Old Children in Rural and
           Peri-Urban Communities of Gauteng and Limpopo Provinces, South Africa

    • Authors: Sithandiwe Ntila, Muthulisi Siwela, Unathi Kolanisi, Hafiz Abdelgadir, Ashwell Ndhlala
      First page: 1004
      Abstract: This study assessed the food and nutrition security status of children receiving complementary food in rural and peri-urban communities. A group of 106 mothers from Lebowakgomo village and Hammanskraal Township, respectively, participated in the survey. Additionally, six focus group discussions were conducted per study area to assess the mothers’ perceptions about children’s food access. The Children’s Food Insecurity Access Scale (CFIAS) was used to assess the food security status (access) of the children. The Individual Dietary Diversity Score (IDDS) together with the unquantified food consumption frequency survey were used as a proxy measure of the nutritional quality of the children’s diets. The age and weight of the children obtained from the children’s clinic health cards were used to calculate Weight-for-Age Z scores (WAZ) in order to determine the prevalence of underweight children. The findings showed that a large percentage of children were severely food-insecure, 87% and 78%, in rural and peri-urban areas, respectively. Additionally, Lebowakgomo children (23.6%) and Hammanskraal children (17.9%) were severely underweight. Overall, children’s diets in both study areas was characterized by nutrient-deficient complementary foods. Cheaper foods with a longer stomach-filling effect such as white maize meal and sugar were the most commonly purchased and used. Hence, the children consumed very limited amounts of foods rich in proteins, minerals, and vitamins, which significantly increased the risk of their being malnourished.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-01
      DOI: 10.3390/ijerph14091004
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1005: Enhancing Youth Participation Using the PREP
           Intervention: Parents’ Perspectives

    • Authors: Dana Anaby, Coralie Mercerat, Stephanie Tremblay
      First page: 1005
      Abstract: Pathways and Resources for Engagement and Participation (PREP), an innovative intervention aimed at modifying the environment and coaching youth/parents, was found to be effective in improving youth participation in chosen community activities. In order to complement existing quantitative evidence, this study examined parents’ perspectives on the PREP approach. Twelve parents of youth with physical disabilities (12 to 18 years old) who received the PREP approach participated in individual semi-structured interviews following the 12-week intervention delivered by an occupational therapist. Thematic analysis revealed three inter-linked themes, the first of which was informative, describing the “nature of intervention”, and led to two reflective themes: “multi-faceted effects of care” and “process of care”. Parents highlighted the effect of the PREP intervention in a broad sense, extending beyond the accomplishment of the selected activities. This involved improvements on the physical, emotional, and social levels as well as in autonomy. Parents also discussed how their own needs were acknowledged through the intervention and recognized the unique role of the occupational therapist in supporting this process. The findings provide additional information about the usefulness of the PREP approach and describe the various benefits generated by a single intervention. Such knowledge can expand the therapeutic options for positive, health-promoting participation.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-02
      DOI: 10.3390/ijerph14091005
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1006: Gene Drive for Mosquito Control: Where Did It
           Come from and Where Are We Headed'

    • Authors: Vanessa Macias, Johanna Ohm, Jason Rasgon
      First page: 1006
      Abstract: Mosquito-borne pathogens place an enormous burden on human health. The existing toolkit is insufficient to support ongoing vector-control efforts towards meeting disease elimination and eradication goals. The perspective that genetic approaches can potentially add a significant set of tools toward mosquito control is not new, but the recent improvements in site-specific gene editing with CRISPR/Cas9 systems have enhanced our ability to both study mosquito biology using reverse genetics and produce genetics-based tools. Cas9-mediated gene-editing is an efficient and adaptable platform for gene drive strategies, which have advantages over innundative release strategies for introgressing desirable suppression and pathogen-blocking genotypes into wild mosquito populations; until recently, an effective gene drive has been largely out of reach. Many considerations will inform the effective use of new genetic tools, including gene drives. Here we review the lengthy history of genetic advances in mosquito biology and discuss both the impact of efficient site-specific gene editing on vector biology and the resulting potential to deploy new genetic tools for the abatement of mosquito-borne disease.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-02
      DOI: 10.3390/ijerph14091006
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1007: Combining Theory-Driven Evaluation and Causal
           Loop Diagramming for Opening the ‘Black Box’ of an Intervention in the
           Health Sector: A Case of Performance-Based Financing in Western Uganda

    • Authors: Dimitri Renmans, Nathalie Holvoet, Bart Criel
      First page: 1007
      Abstract: Increased attention on “complexity” in health systems evaluation has resulted in many different methodological responses. Theory-driven evaluations and systems thinking are two such responses that aim for better understanding of the mechanisms underlying given outcomes. Here, we studied the implementation of a performance-based financing intervention by the Belgian Technical Cooperation in Western Uganda to illustrate a methodological strategy of combining these two approaches. We utilized a systems dynamics tool called causal loop diagramming (CLD) to generate hypotheses feeding into a theory-driven evaluation. Semi-structured interviews were conducted with 30 health workers from two districts (Kasese and Kyenjojo) and with 16 key informants. After CLD, we identified three relevant hypotheses: “success to the successful”, “growth and underinvestment”, and “supervision conundrum”. The first hypothesis leads to increasing improvements in performance, as better performance leads to more incentives, which in turn leads to better performance. The latter two hypotheses point to potential bottlenecks. Thus, the proposed methodological strategy was a useful tool for identifying hypotheses that can inform a theory-driven evaluation. The hypotheses are represented in a comprehensible way while highlighting the underlying assumptions, and are more easily falsifiable than hypotheses identified without using CLD.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-03
      DOI: 10.3390/ijerph14091007
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1008: Fine-Scale Spatial Variability of
           Pedestrian-Level Particulate Matters in Compact Urban Commercial Districts
           in Hong Kong

    • Authors: Yuan Shi, Edward Ng
      First page: 1008
      Abstract: Particulate matters (PM) at the pedestrian level significantly raises the health impacts in the compact urban environment of Hong Kong. A detailed investigation of the fine-scale spatial variation of pedestrian-level PM is necessary to assess the health risk to pedestrians in the outdoor environment. However, the collection of PM data is difficult in the compact urban environment of Hong Kong due to the limited amount of roadside monitoring stations and the complicated urban context. In this study, we measured the fine-scale spatial variability of the PM in three of the most representative commercial districts of Hong Kong using a backpack outdoor environmental measuring unit. Based on the measurement data, 13 types of geospatial interpolation methods were examined for the spatial mapping of PM2.5 and PM10 with a group of building geometrical covariates. Geostatistical modelling was adopted as the basis of spatial interpolation of the PM. The results show that the original cokriging with the exponential kernel function provides the best performance in the PM mapping. Using the fine-scale building geometrical features as covariates slightly improves the interpolation performance. The study results also imply that the fine-scale, localized pollution emission sources heavily influence pedestrian exposure to PM.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-03
      DOI: 10.3390/ijerph14091008
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1009: Microbiological Impact of the Use of
           Reclaimed Wastewater in Recreational Parks

    • Authors: Oskar Palacios, Francisco Zavala-Díaz de la Serna, María Ballinas-Casarrubias, María Espino-Valdés, Guadalupe Nevárez-Moorillón
      First page: 1009
      Abstract: Reclaimed wastewater for irrigation is an opportunity for recovery of this natural resource. In this study, microbial risk from the use of treated wastewater for irrigation of recreational parks in the city of Chihuahua, evaluating the effect of distribution distance, season, and presence of storage tanks, was analyzed. Escherichia coli, Salmonella, and multidrug-resistant bacteria were recovered from samples of reclaimed water and soils at recreational parks in Chihuahua by the membrane filtration method, using selected agars for microbial growth. Samples were taken at three different seasons. No correlation in the presence of microbial indicators and multidrug-resistant bacteria (p > 0.05) was found between the distance from the wastewater treatment plant to the point of use. Presence of storage tanks in parks showed a significant effect (p < 0.05) with a higher level of E. coli. The highest count in wastewater occurred in summer. We isolated 392 multidrug-resistant bacteria from water and soil; cluster analysis showed that the microorganisms at each location were of different origins. Irrigation with reclaimed wastewater did not have a negative effect on the presence of microbial indicators of the quality of soils in the parks. However, the prevalence of multidrug-resistant bacteria still represents a potential risk factor for human health.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-04
      DOI: 10.3390/ijerph14091009
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1010: Association between Functional Movements
           Skills and Health Indicators in Children Aged between 9 and 12 Years Old

    • Authors: Megan Comeau, Danielle Bouchard, Cindy Levesque, Michel Jonhson, Brittany Rioux, Andrea Mayo, Martin Sénéchal
      First page: 1010
      Abstract: Background: Children’s health is a current concern and data suggests that poor fundamental movement skills (FMS) could be associated with poor health, which may or may not be mediated by low physical activity level. However, tools to assess FMS have not been standardized, and could consequently lead to different associations between FMS and health indicators. Objective: The primary objective of this study was to evaluate the associations between FMS and health indicators using two different FMS measurement tools often used in Canada. Methods: A total of 145 children between the ages of 9 to 12 were recruited from schools, after school programs, and summer camps in 2016. FMS were evaluated using the Passport for Life (bound, plank, run, kick, throw) and the PLAYbasic (run, hop, throw, kick, and balance). The association between each test and an average score for each tool were tests with health indicators including anthropometric measures, grip strength, cardiorespiratory fitness, and percent body fat. Results: Participants were composed of 54.2% boys aged 10.4 ± 1.2 years with an average body mass index of 18.8 ± 3.8 kg/m2. The association between the average score of both tools was 0.77 (p < 0.01), body mass index was significantly associated with 67% of FMS elements using the Passport for Life (r ranging from −0.18 to −0.32; p < 0.05), and 60% of FMS using the PLAYbasic (r ranging from −0.15 to −0.30; p < 0.05). There were no significant differences between the associations of the health indicators with FMS and either FMS assessment tool (Passport for Life and PLAYbasic) (p = 0.05). Average score of FMS was significantly associated with all health indicators using both PLAYbasic and Passport for Life (all p < 0.05). Conclusions: Health indicators in children are associated with FMS regardless of whether the Passport for Life or the PLAYbasic was used as the assessment tool. It is worth investigating if interventions that improve FMS lead to improvements in these health indicators.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-04
      DOI: 10.3390/ijerph14091010
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1011: Spatial Distribution and Fuzzy Health Risk
           Assessment of Trace Elements in Surface Water from Honghu Lake

    • Authors: Fei Li, Zhenzhen Qiu, Jingdong Zhang, Chaoyang Liu, Ying Cai, Minsi Xiao
      First page: 1011
      Abstract: Previous studies revealed that Honghu Lake was polluted by trace elements due to anthropogenic activities. This study investigated the spatial distribution of trace elements in Honghu Lake, and identified the major pollutants and control areas based on the fuzzy health risk assessment at screening level. The mean total content of trace elements in surface water decreased in the order of Zn (18.04 μg/L) > Pb (3.42 μg/L) > Cu (3.09 μg/L) > Cr (1.63 μg/L) > As (0.99 μg/L) > Cd (0.14 μg/L), within limits of Drinking Water Guidelines. The results of fuzzy health risk assessment indicated that there was no obvious non-carcinogenic risk to human health, while carcinogenic risk was observed in descending order of As > Cr > Cd > Pb. As was regarded to have the highest carcinogenic risk among selected trace elements because it generally accounted for 64% of integrated carcinogenic risk. Potential carcinogenic risk of trace elements in each sampling site was approximately at medium risk level (10−5 to 10−4). The areas in the south (S4, S13, and S16) and northeast (S8, S18, and S19) of Honghu Lake were regarded as the risk priority control areas. However, the corresponding maximum memberships of integrated carcinogenic risk in S1, S3, S10–S13, S15, and S18 were of relatively low credibility (50–60%), and may mislead the decision-makers in identifying the risk priority areas. Results of fuzzy assessment presented the subordinate grade and corresponding reliability of risk, and provided more full-scale results for decision-makers, which made up for the deficiency of certainty assessment to a certain extent.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-04
      DOI: 10.3390/ijerph14091011
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1012: On Consistency Test Method of Expert Opinion
           in Ecological Security Assessment

    • Authors: Zaiwu Gong, Lihong Wang
      First page: 1012
      Abstract: To reflect the initiative design and initiative of human security management and safety warning, ecological safety assessment is of great value. In the comprehensive evaluation of regional ecological security with the participation of experts, the expert’s individual judgment level, ability and the consistency of the expert’s overall opinion will have a very important influence on the evaluation result. This paper studies the consistency measure and consensus measure based on the multiplicative and additive consistency property of fuzzy preference relation (FPR). We firstly propose the optimization methods to obtain the optimal multiplicative consistent and additively consistent FPRs of individual and group judgments, respectively. Then, we put forward a consistency measure by computing the distance between the original individual judgment and the optimal individual estimation, along with a consensus measure by computing the distance between the original collective judgment and the optimal collective estimation. In the end, we make a case study on ecological security for five cities. Result shows that the optimal FPRs are helpful in measuring the consistency degree of individual judgment and the consensus degree of collective judgment.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-04
      DOI: 10.3390/ijerph14091012
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1013: Barriers to Effective Municipal Solid Waste
           Management in a Rapidly Urbanizing Area in Thailand

    • Authors: Nachalida Yukalang, Beverley Clarke, Kirstin Ross
      First page: 1013
      Abstract: This study focused on determining the barriers to effective municipal solid waste management (MSWM) in a rapidly urbanizing area in Thailand. The Tha Khon Yang Subdistrict Municipality is a representative example of many local governments in Thailand that have been facing MSWM issues. In-depth interviews with individuals and focus groups were conducted with key informants including the municipality staff, residents, and external organizations. The major influences affecting waste management were categorized into six areas: social-cultural, technical, financial, organizational, and legal-political barriers and population growth. SWOT analysis shows both internal and external factors are playing a role in MSWM: There is good policy and a reasonably sufficient budget. However, there is insufficient infrastructure, weak strategic planning, registration, staff capacity, information systems, engagement with programs; and unorganized waste management and fee collection systems. The location of flood prone areas has impacted on location and operation of landfill sites. There is also poor communication between the municipality and residents and a lack of participation in waste separation programs. However, external support from government and the nearby university could provide opportunities to improve the situation. These findings will help inform municipal decision makers, leading to better municipal solid waste management in newly urbanized areas.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-04
      DOI: 10.3390/ijerph14091013
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1014: Active Transportation on a Complete Street:
           Perceived and Audited Walkability Correlates

    • Authors: Wyatt Jensen, Barbara Brown, Ken Smith, Simon Brewer, Jonathan Amburgey, Brett McIff
      First page: 1014
      Abstract: Few studies of walkability include both perceived and audited walkability measures. We examined perceived walkability (Neighborhood Environment Walkability Scale—Abbreviated, NEWS-A) and audited walkability (Irvine–Minnesota Inventory, IMI) measures for residents living within 2 km of a “complete street”—one renovated with light rail, bike lanes, and sidewalks. For perceived walkability, we found some differences but substantial similarity between our final scales and those in a prior published confirmatory factor analysis. Perceived walkability, in interaction with distance, was related to complete street active transportation. Residents were likely to have active transportation on the street when they lived nearby and perceived good aesthetics, crime safety, and traffic safety. Audited walkability, analyzed with decision trees, showed three general clusters of walkability areas, with 12 specific subtypes. A subset of walkability items (n = 11), including sidewalks, zebra-striped crosswalks, decorative sidewalks, pedestrian signals, and blank walls combined to cluster street segments. The 12 subtypes yielded 81% correct classification of residents’ active transportation. Both perceived and audited walkability were important predictors of active transportation. For audited walkability, we recommend more exploration of decision tree approaches, given their predictive utility and ease of translation into walkability interventions.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-05
      DOI: 10.3390/ijerph14091014
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1015: Changes in Daily Steps and Body Mass Index
           and Waist to Height Ratio during Four Year Follow-Up in Adults:
           Cardiovascular Risk in Young Finns Study

    • Authors: Kasper Salin, Mirja Hirvensalo, Costan Magnussen, Risto Telama, Nina Hutri-Kähönen, Jorma Viikari, Olli Raitakari, Tuija Tammelin
      First page: 1015
      Abstract: Aims: Over the study years, there was a significant increase in body mass index (BMI) and waist-to-height ratio (WtHR) in middle aged Finnish adults. Methods: Data were obtained from 1033 Finnish adults from the Cardiovascular Risk in Young Finns Study in 2007 and 2011. Cohort study participants wore an Omron Walking Style One (HJ-152R-E) pedometer for five days and were grouped into those who increased, maintained and decreased their steps between 2007 and 2011. Paired samples t-test was used to compare body mass index (BMI) and waist-to-height ratio (WtHR) change values between the change groups in study years. Results: Among study population BMI and WtHR increase between study years was statistically significant (p < 0.001). Only those, who increased their total steps for at least 2000 steps, maintained their BMI in the same level, while people who decreased or maintained their total steps in the same level, BMI and WtHR increased during four years follow-up. Conclusions: This data suggests that increasing steps in middle age is associated with maintaining BMI at the same level.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-05
      DOI: 10.3390/ijerph14091015
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1016: Evaluation of VIIRS Land Aerosol Model
           Selection with AERONET Measurements

    • Authors: Wei Wang, Zengxin Pan, Feiyue Mao, Wei Gong, Longjiao Shen
      First page: 1016
      Abstract: The Visible Infrared Imaging Radiometer Suite (VIIRS) is a next-generation polar-orbiting operational environmental sensor with a capability for global aerosol observations. Identifying land aerosol types is important because aerosol types are a basic input in retrieving aerosol optical properties for VIIRS. The VIIRS algorithm can automatically select the optimal land aerosol model by minimizing the residual between the derived and expected spectral surface reflectance. In this study, these selected VIIRS aerosol types are evaluated using collocated aerosol types obtained from the Aerosol Robotic Network (AERONET) level 1.5 from 23 January 2013 to 28 February 2017. The spatial distribution of VIIRS aerosol types and the aerosol optical depth bias (VIIRS minus AERONET) demonstrate that misidentifying VIIRS aerosol types may lead to VIIRS retrieval being overestimated over the Eastern United States and the developed regions of East Asia, as well as underestimated over Southern Africa, India, and Northeastern China. Approximately 22.33% of VIIRS aerosol types are coincident with that of AERONET. The agreements between VIIRS and AERONET for fine non-absorbing and absorbing aerosol types are approximately 36% and 57%, respectively. However, the agreement between VIIRS and AERONET is extremely low (only 3.51%). The low agreement for coarse absorbing dust may contribute to the poor performance of VIIRS retrieval under the aerosol model (R = 0.61). Results also show that an appropriate aerosol model can improve the retrieval performance of VIIRS over land, particularly for dust type (R increases from 0.61 to 0.72).
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-05
      DOI: 10.3390/ijerph14091016
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1017: Effects of Visual Stimulation with Bonsai
           Trees on Adult Male Patients with Spinal Cord Injury

    • Authors: Hiroko Ochiai, Chorong Song, Harumi Ikei, Michiko Imai, Yoshifumi Miyazaki
      First page: 1017
      Abstract: Nature therapy has been demonstrated to induce physiological relaxation. The psychophysiological effects of nature therapy (stimulation with bonsai trees) on adult male patients with spinal cord injury (SCI) were examined. Oxyhemoglobin concentration changes in the prefrontal cortex were measured using near-infrared spectroscopy, and heart rate variability was analyzed. Psychological responses were evaluated using the modified semantic differential method and Profile of Mood States (POMS) subscale scores. Visual stimulation of adult male patients with SCI elicited significantly decreased left prefrontal cortex activity, increased parasympathetic nervous activity, decreased sympathetic nervous activity, increased positive feelings, and resulted in lower negative POMS subscale scores. Nature therapy can lead to a state of physiological and psychological relaxation in patients with SCI.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-05
      DOI: 10.3390/ijerph14091017
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1018: Extraction of Rice Heavy Metal Stress Signal
           Features Based on Long Time Series Leaf Area Index Data Using Ensemble
           Empirical Mode Decomposition

    • Authors: Lingwen Tian, Xiangnan Liu, Biyao Zhang, Ming Liu, Ling Wu
      First page: 1018
      Abstract: The use of remote sensing technology to diagnose heavy metal stress in crops is of great significance for environmental protection and food security. However, in the natural farmland ecosystem, various stressors could have a similar influence on crop growth, therefore making heavy metal stress difficult to identify accurately, so this is still not a well resolved scientific problem and a hot topic in the field of agricultural remote sensing. This study proposes a method that uses Ensemble Empirical Mode Decomposition (EEMD) to obtain the heavy metal stress signal features on a long time scale. The method operates based on the Leaf Area Index (LAI) simulated by the Enhanced World Food Studies (WOFOST) model, assimilated with remotely sensed data. The following results were obtained: (i) the use of EEMD was effective in the extraction of heavy metal stress signals by eliminating the intra-annual and annual components; (ii) LAIdf (The first derivative of the sum of the interannual component and residual) can preferably reflect the stable feature responses to rice heavy metal stress. LAIdf showed stability with an R2 of greater than 0.9 in three growing stages, and the stability is optimal in June. This study combines the spectral characteristics of the stress effect with the time characteristics, and confirms the potential of long-term remotely sensed data for improving the accuracy of crop heavy metal stress identification.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-06
      DOI: 10.3390/ijerph14091018
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1019: Multimorbidity in Chronic Conditions: Public
           Primary Care Patients in Four Greater Mekong Countries

    • Authors: Supa Pengpid, Karl Peltzer
      First page: 1019
      Abstract: The aim of this study was to explore the prevalence, pattern, and social determinants of chronic conditions multimorbidity among chronic disease primary care patients in four Greater Mekong countries (Cambodia, Myanmar, Thailand, and Vietnam). In a cross-sectional survey, chronic disease patients accessing primary care were recruited if they had been diagnosed with any of 21 chronic conditions in the past 12 months, and were interviewed with a structured questionnaire on anxiety, depression, alcohol use, tobacco use, dietary behaviour, physical activity, and quality of life. The sample included 6236 public primary care patients (32.8% men and 67.2% women), with a mean age of 53.0 years (SD = 16.8). From 21 chronic conditions, the three most common were hypertension (37.4%), depression (34.4%), and digestive diseases (32.0%). In all, 27.4% had one chronic condition, 28.6% had two, 22.4% had three, and 21.6% had four or more chronic conditions. The percentage with the highest comorbidity was depression (47.3%), hypertension (43.4%), and digestive diseases (34.1%). The highest mean multimorbidity reported was for mental illness (4.44), kidney disease (4.11), and Parkinson’s disease (4.10), and the lowest multimorbidity for epilepsy (2.43) and cancer (2.80). Compared to those who had only one chronic condition, being male, older age, lower education, and lower quality of life were associated with having two and three or more chronic conditions. Multimorbidity is a prevalent problem among chronic condition primary care patients—a finding with implications for health care delivery, management, and research.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-06
      DOI: 10.3390/ijerph14091019
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1020: Effects of Hyporheic Water Fluxes and
           Sediment Grain Size on the Concentration and Diffusive Flux of Heavy
           Metals in the Streambed

    • Authors: Qi Liu, Jinxi Song, Guotao Zhang, Weize Wang, Weiqiang Guo, Bin Tang, Feihe Kong, Aidi Huo
      First page: 1020
      Abstract: The hyporheic zone regulates physicochemical processes in surface-groundwater systems and can be an important source of heavy metals in fluvial systems. This study assesses the pore water concentrations and diffusive fluxes of heavy metals with respect to the vertical water exchange flux (VWEF) and sediment grain size. Water and sediment samples were collected on August 2016 from upstream Site 1 and downstream Site 2 along the Juehe River in Shaanxi Province, China. Streambed vertical hydraulic conductivity (Kv) and the VWEF were estimated via the standpipe permeameter test method and Darcy’s law. The heavy metal concentrations in the pore water were measured and the diffusive fluxes were calculated using Fick’s first law. The VWEF patterns were dominated by upward flow, and Site 1 featured higher values of Kv and VWEF. Higher Cu and Zn concentrations occurred near the channel centre with coarse sand and gravel and greater upward VWEFs because coarser sediment and greater upward VWEFs cause stronger metal desorption capacity. Additionally, Cu and Zn at the two sites generally diffused from pore water to surface water, potentially due to the upward VWEF. The VWEF and sediment grain size are likely crucial factors influencing the heavy metal concentrations and diffusive fluxes.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-06
      DOI: 10.3390/ijerph14091020
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1021: Endocrine Disruptors and Pregnancy:
           Knowledge, Attitudes and Prevention Behaviors of French Women

    • Authors: Steeve Rouillon, Chloé Deshayes-Morgand, Line Enjalbert, Sylvie Rabouan, Jean-Benoit Hardouin, Group DisProSE, Virginie Migeot, Marion Albouy-Llaty
      First page: 1021
      Abstract: Endocrine disrupting chemicals (EDC) are environmental exposure factors that are rarely reported in clinical practice, particularly during pregnancy. This study aimed to describe women’s knowledge, attitudes and behaviors towards EDC exposure. A study was conducted in the French Department of Vienne between 2014 and 2016 and comprised semi-structured interviews with pregnant women, a focus group of professionals in perinatology and environmental health, and the administration of a psychosocial questionnaire comprising scores in 300 pregnant or in postpartum period women. The mean score of knowledge was 42.9 ± 9.8 out of 100 (from 13.5 to 75.7). Exposure attitude was determined by risk perception. Mean level of cues to action to reduce their EDC exposure was estimated at 56.9 ± 22.5 out of 100 (from 0 to 100). Anxiety was significantly increased after the questionnaire. Anxiety about EDC was associated with a high score of knowledge (OR = 2.30, 95% CI (1.12–4.71)) and with no pregnancy anxiety (OR = 0.57, 95% CI (0.34–0.95)). Our findings suggest that healthcare providers should consider pregnant women’s knowledge and perceptions, possibilities of action, and be careful not to increase their anxiety when advising them about EDC and environmental exposure.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-06
      DOI: 10.3390/ijerph14091021
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1022: Is the Effect of Body Mass Index on
           Hypertension Modified by the Elevation' A Cross-Sectional Study of
           Rural Areas in Japan

    • Authors: Tsuyoshi Hamano, Yoshiya Shiotani, Miwako Takeda, Takafumi Abe, Kristina Sundquist, Toru Nabika
      First page: 1022
      Abstract: Obesity is an established independent risk factor for developing hypertension. A recent study showed that the effect of obesity on hypertension varies by the elevation of the residence area. Thus, we hypothesized that the interaction effect of body mass index (BMI) and elevation has a significant association with hypertension. The first aim of this cross-sectional study was to examine whether BMI was associated with hypertension, after adjustment for covariates. The second aim was to examine whether the interaction term between BMI and elevation was associated with hypertension, after adjustment for covariates. Data were collected from a cross-sectional study conducted in a rural area of Japan in 2016. After excluding participants with missing data (n = 2), data from 729 participants were analyzed. We found that BMI was significantly associated with hypertension. In addition, the interaction term between BMI and elevation had a significant association with hypertension. The findings of the present study support the recent evidence that high BMI is an independent risk factor for hypertension, but its effect varies by elevation. Thus, context-specific interventions could be an effective approach to prevent hypertension in this area.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-07
      DOI: 10.3390/ijerph14091022
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1023: Variations in Obesity Rates between US
           Counties: Impacts of Activity Access, Food Environments, and Settlement

    • Authors: Peter Congdon
      First page: 1023
      Abstract: There is much ongoing research about the effect of the urban environment as compared with individual behaviour on growing obesity levels, including food environment, settlement patterns (e.g., sprawl, walkability, commuting patterns), and activity access. This paper considers obesity variations between US counties, and delineates the main dimensions of geographic variation in obesity between counties: by urban-rural status, by region, by area poverty status, and by majority ethnic group. Available measures of activity access, food environment, and settlement patterns are then assessed in terms of how far they can account for geographic variation. A county level regression analysis uses a Bayesian methodology that controls for spatial correlation in unmeasured area risk factors. It is found that environmental measures do play a significant role in explaining geographic contrasts in obesity.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-07
      DOI: 10.3390/ijerph14091023
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1024: Modeling Burns for Pre-Cooled Skin Flame

    • Authors: Torgrim Log
      First page: 1024
      Abstract: On a television show, a pre-cooled bare-skinned person (TV host) passed through engulfing kerosene flames. The assumption was that a water film should protect him during 0.74 s flame exposure in an environment of 86 kW/m2 heat flux. The TV host got light burn inflammation on the back, arms and legs. The present work studies skin temperatures and burn damage integral of such dangerous flame exposure. The skin temperature distribution during water spray pre-cooling, transport to the flames, flame exposure, transport to the water pool, and final water pool cooling is modelled numerically. Details of the temperature development of the skin layers are presented, as well as the associated damage integral. It is shown that 5 °C water spray applied for a 30 s period pre-cooled the skin sufficiently to prevent severe skin injury. Soot marks indicate that the water layer evaporated completely in some areas resulting in skin flame contact. This exposed dry skin directly to the flames contributing significantly to the damage integral. It is further analyzed how higher water temperature, shorter pre-cooling period or longer flame exposure influence the damage integral. It is evident that minor changes in conditions could lead to severe burns and that high heat flux levels at the end of the exposure period are especially dangerous. This flame stunt should never be repeated.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-07
      DOI: 10.3390/ijerph14091024
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1025: Risk Assessment of Metals in Urban Soils from
           a Typical Industrial City, Suzhou, Eastern China

    • Authors: Gang Wang, Hou-Qi Liu, Yu Gong, Yang Wei, Ai-Jun Miao, Liu-Yan Yang, Huan Zhong
      First page: 1025
      Abstract: Risk of metals in urban soils is less studied, compared to that in other types of soils, hindering accurate assessment of human exposure to metals. In this study, the concentrations of five metals (As, Cd, Cr, Pb, and Hg) were analyzed in 167 surface soil samples collected from Suzhou city and their potential ecological and human health risks were assessed. The mean concentrations of As, Cd, Pb, and Hg except Cr, were higher than the background values in Jiangsu Province. Metal concentrations varied among districts, where sites of high contamination showed a punctate distribution. Principal components and correlation analyses revealed that As, Pb, and Cd could originate from the same sources. The geo-accumulation (Igeo) and potential ecological risk indices (RI) were calculated and the relatively low values of Igeo (<0) and RI (<150) suggested generally low ecological risk. The noncarcinogenic risks of the metals were relatively low for Suzhou residents (i.e., average hazard index or HI: 0.1199 for adults and 0.5935 for children, <1), while the total carcinogenic risks (TCR) of Cr and As were acceptable (TCR in the range of 1.0 × 10−6 to 1.0 × 10−4). Children faced a higher threat than adults. Results of Monte-Carlo simulations were lower than those obtained from models using deterministic parameters. Of all the uncertain parameters, the ingestion rate and body weight were the most sensitive for adults and children, respectively, while As was an important factor for both. The results as well as the factors controlling risks of metals could help better understand the risks of metals in urban soils of industrial cities in China.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-07
      DOI: 10.3390/ijerph14091025
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1026: Poor Hand Hygiene Procedure Compliance among
           Polish Medical Students and Physicians—The Result of an Ineffective
           Education Basis or the Impact of Organizational Culture'

    • Authors: Marta Wałaszek, Małgorzata Kołpa, Zdzisław Wolak, Anna Różańska, Jadwiga Wójkowska-Mach
      First page: 1026
      Abstract: Objective: The objective of the study was to examine the knowledge of Polish physicians and medical students about the role of hand hygiene (HH) in healthcare-associated infection (HAI) prevention. Study design: A survey was conducted using an author-prepared questionnaire, which was filled out on the first day of hospital work (or internship) by newly admitted physicians who had worked in other hospitals and students of different medical schools in Poland. Methods: 100 respondents participated in the study: 28 students, 18 medical interns and 54 physicians. Results: As many as 3/4 of physicians and students did not use the HH techniques correctly. The respondents declared that they perform HH in the following situations: 74.4% of respondents before an aseptic task; 60.8% before patient contact; 57.0% after patient contact; 11.5% after body fluid exposure risk, and only two respondents (1.1%) after contact with patient surroundings. 64% of respondents declared that their supervisor checked their knowledge of the HH technique when they were touching patients, but their supervisors checked the five instances for HH only in the case of 27 respondents (27%). Students experienced any control of HH in the workplace less often. Interns and physicians mentioned that the most important preventive action in HAI is HH, but for students it is the use of gloves. Conclusions: The level of knowledge and skills of physicians and students in the field of HH is insufficient. Deficiencies in skills and knowledge of HH were identified as early as at the level of the first internship.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-07
      DOI: 10.3390/ijerph14091026
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1027: Sedentary and Physical Activity Patterns in
           Adults with Intellectual Disability

    • Authors: Guillermo Oviedo, Noémie Travier, Myriam Guerra-Balic
      First page: 1027
      Abstract: Little is known about the patterns of sedentary time (ST) and physical activity (PA) levels throughout the week among adults and older adults with Intellectual Disability (ID). We analyzed ST and PA patterns of adults and older adults with ID. Forty-two adults and 42 older adults with mild to severe ID participated in this study. Height and weight were obtained to calculate Body Mass Index (BMI). Body fat and fat-free mass percentages were also obtained. Patterns of PA levels and ST were assessed with GT3X Actigraph accelerometers. Adults performed higher amounts of total PA and moderate to vigorous PA than older adults during the week, on weekdays and in center time (all p > 0.05). No differences between males and females were found for either PA levels or ST. Only 10.7% of the participants met the global recommendations on PA for health. The participants of the current study showed low PA levels and a high prevalence of ST. Interestingly, when comparing age and/or sex groups, no differences were observed for ST. Our findings provide novel and valuable information to be considered in future interventions aiming to increase PA levels and reduce ST.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-07
      DOI: 10.3390/ijerph14091027
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1028: Analysis of Baseline Computerized
           Neurocognitive Testing Results among 5–11-Year-Old Male and Female
           Children Playing Sports in Recreational Leagues in Florida

    • Authors: Karen Liller, Barbara Morris, Jessica Fillion, Yingwei Yang, Omonigho Bubu
      First page: 1028
      Abstract: There is a paucity of data related to sports injuries, concussions, and computerized neurocognitive testing (CNT) among very young athletes playing sports in recreational settings. The purpose of this study was to report baseline CNT results among male and female children, ages 5–11, playing sports in Hillsborough County, Florida using ImPACT Pediatric, which is specifically designed for this population. Data were collected from 2016 to 2017. The results show that 657 baseline tests were conducted and t-tests and linear regression were used to assess mean significant differences in composite scores with sex and age. Results showed that females scored better on visual memory and in general as age increased, baseline scores improved. The results can be used to build further studies on the use of CNT in recreational settings and their role in concussion treatment, management, and interventions.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-07
      DOI: 10.3390/ijerph14091028
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1029: How Social Care Beneficiaries in Poland Rate
           Relative Harmfulness of Various Tobacco and Nicotine-Containing Products

    • Authors: Marek Milcarz, Kinga Polańska, Leokadia Bak-Romaniszyn, Dorota Kaleta
      First page: 1029
      Abstract: The aim of the study was to examine how social care beneficiaries rate the relative harmfulness of tobacco/nicotine-containing products compared to traditional cigarettes. This information is crucial for the development of effective tobacco control strategies targeting disadvantaged populations. The cross-sectional study covered 1817 respondents who were taking advantage of social aid services offered by the local social care institutions in the Piotrkowski district, via face-to-face interviews. The linear regression analysis indicated that relative to women, men consider slim cigarettes, smokeless tobacco and e-cigarettes to be more harmful than traditional cigarettes (p < 0.05). The smokers of traditional cigarettes reported menthol cigarettes to be less harmful than traditional cigarettes, relative to the non-smokers (p = 0.05). The current results demonstrate that social care beneficiaries are not aware of the fact that some products are less harmful than others. Education concerning tobacco/nicotine products should include advice on how to reduce the adverse health effects of smoking (e.g., avoiding inhalation of combusted products), while driving the awareness that no nicotine-containing products are safe.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-07
      DOI: 10.3390/ijerph14091029
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1030: Evaluation of a Pilot Implementation to
           Integrate Alcohol-Related Care within Primary Care

    • Authors: Jennifer Bobb, Amy Lee, Gwen Lapham, Malia Oliver, Evette Ludman, Carol Achtmeyer, Rebecca Parrish, Ryan Caldeiro, Paula Lozano, Julie Richards, Katharine Bradley
      First page: 1030
      Abstract: Alcohol use is a major cause of disability and death worldwide. To improve prevention and treatment addressing unhealthy alcohol use, experts recommend that alcohol-related care be integrated into primary care (PC). However, few healthcare systems do so. To address this gap, implementation researchers and clinical leaders at Kaiser Permanente Washington partnered to design a high-quality Program of Sustained Patient-centered Alcohol-related Care (SPARC). Here, we describe the SPARC pilot implementation, evaluate its effectiveness within three large pilot sites, and describe the qualitative findings on barriers and facilitators. Across the three sites (N = 74,225 PC patients), alcohol screening increased from 8.9% of patients pre-implementation to 62% post-implementation (p < 0.0001), with a corresponding increase in assessment for alcohol use disorders (AUD) from 1.2 to 75 patients per 10,000 seen (p < 0.0001). Increases were sustained over a year later, with screening at 84.5% and an assessment rate of 81 patients per 10,000 seen across all sites. In addition, there was a 50% increase in the number of new AUD diagnoses (p = 0.0002), and a non-statistically significant 54% increase in treatment within 14 days of new diagnoses (p = 0.083). The pilot informed an ongoing stepped-wedge trial in the remaining 22 PC sites.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-08
      DOI: 10.3390/ijerph14091030
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1031: The Relationship between Survival Sex and

    • Authors: Jerreed Ivanich, Melissa Welch-Lazoritz, Kirk Dombrowski
      First page: 1031
      Abstract: Engaging in survival sex and mental illness are overrepresented within homeless populations. This article assesses the relationship between symptoms of borderline personality disorder (BPD) and engaging in survival sex among homeless women. One hundred and fifty-eight homeless women completed surveys on self-reported BPD symptomology and sexual history. Bivariate and multivariate analyses conducted in this study provided insights into the association of experiencing BPD symptoms and engaging in survival sex. Results indicate that some symptoms of BPD are robustly correlated with engaging in survival sex among homeless adult women. Implications for service agencies and others working with at-risk female populations are discussed.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-08
      DOI: 10.3390/ijerph14091031
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1032: The Burden of Suicide in Rural Bangladesh:
           Magnitude and Risk Factors

    • Authors: Shumona Sharmin Salam, Olakunle Alonge, Md Islam, Dewan Hoque, Shirin Wadhwaniya, Md Ul Baset, Saidur Mashreky, Shams El Arifeen
      First page: 1032
      Abstract: The aim of the paper is to quantify the burden and risk factors of fatal and non-fatal suicidal behaviors in rural Bangladesh. A census was carried out in seven sub-districts encompassing 1.16 million people. Face-to-face interviews were conducted at the household level. Descriptive analyses were done to quantify the burden and Poisson regression was run to determine on risk factors. The estimated rates of fatal and non-fatal suicide were 3.29 and 9.86 per 100,000 person years (PY) observed, respectively. The risk of suicide was significantly higher by 6.31 times among 15–17 and 4.04 times among 18–24 olds compared to 25–64 years old. Married adolescents were 22 times more likely to commit suicide compared to never-married people. Compared to Chandpur/Comilla district, the risk of suicide was significantly higher in Narshingdi. Students had significantly lower risk of non-fatal suicidal behavior compared to skilled laborers. The risk of non-fatal suicidal behavior was lower in Sherpur compared to Chandpur/Comilla. Among adolescents, unskilled laborers were 16 times more likely to attempt suicide than students. The common methods for fatal and non-fatal suicidal behaviors were hanging and poisoning. Suicide is a major public health problem in Bangladesh that needs to be addressed with targeted interventions.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-09
      DOI: 10.3390/ijerph14091032
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1033: Migration and Accumulation of

    • Authors: Min Liao, Yan-Hong Shi, Hai-Qun Cao, Qing-Kui Fang, Jin-Jing Xiao, Ri-Mao Hua
      First page: 1033
      Abstract: The migration and accumulation of octachlorodipropyl ether (OCDPE) in soil-tea systems were investigated using a gas chromatography-electron capture detector (GC-ECD) method in young and old tea gardens. When the residual concentration of OCDPE was 100 g a.i. hm−2 in soils, the peak concentrations of OCDPE in fresh leaves of young and old tea plants were 0.365 mg/kg and 0.144 mg/kg, taking 45 days and 55 days, respectively. Equations for the accumulation curves of OCDPE in fresh leaves of young and old tea plants were Ct = 0.0227e0.0566t (R2 = 0.9154) and Ct = 0.0298e−0.0306t (R2 = 0.7156), and were Ct = 3.8435e0.055t (R2 = 0.9698) and Ct = 1.5627e−0.048t (R2 = 0.9634) for dissipation curves, with a half-life of 14.4 days and 12.6 days, respectively. These results have practical guiding significance for controlling tea food safety.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-08
      DOI: 10.3390/ijerph14091033
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1034: Prevalence, Causes and Social Factors of
           Visual Impairment among Chinese Adults: Based on a National Survey

    • Authors: Chao Guo, Zhenjie Wang, Ping He, Gong Chen, Xiaoying Zheng
      First page: 1034
      Abstract: Visual impairment has become a global challenge, especially for developing countries. This study aims to estimate the prevalence, causes and social factors of visual impairment among Chinese adults. Data were from a nationally representative population-based cross-sectional study. The study population were 1,909,199 non-institutionalized adults aged 18 years and older in mainland China. In the survey, low vision and blindness were checked by ophthalmologists according to the WHO best-corrected visual acuity (BCVA) criteria. Population weighted numbers and prevalence of low vision and blindness with 95% confidence intervals (CIs) were estimated where appropriate. Multivariable logistic regression analysis was used to identify the social factors of visual impairment. The weighted prevalence of visual impairment was 17.17 (95% CI, 16.84–17.50) per 1000 Chinese adults aged 18 years and older. Cataract (57.35%), disorders of choroid and retina (9.80%), and disorders of cornea (6.49%) contributed more than 70 percent to the visual impairment in Chinese adults. Older age groups, young or middle-aged male adults, female elders, illiterate, rural dwellers, non-eastern residents, singles, unemployment, and from family with lower income were associated with visual impairment. More efforts are warranted to enhance treatment and rehabilitation among people with eye disorders to prevent visual impairment.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-08
      DOI: 10.3390/ijerph14091034
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1035: Work-Related Noise Exposure in a Cohort of
           Patients with Chronic Tinnitus: Analysis of Demographic and Audiological

    • Authors: Massimo Ralli, Maria Paola Balla, Antonio Greco, Giancarlo Altissimi, Pasquale Ricci, Rosaria Turchetta, Armando de Virgilio, Marco de Vincentiis, Serafino Ricci, Giancarlo Cianfrone
      First page: 1035
      Abstract: Work-related noise exposure is one of the major factors contributing to the development of adult-onset hearing loss and tinnitus. The aim of this study was to analyze, in patients with chronic tinnitus and long-term occupational noise exposure, (A) characteristics of hearing loss, tinnitus, comorbidities, demographic characteristics and a history of work-related noise exposure and (B) differences among individuals employed in occupations with high and low risk of developing work-related noise-induced hearing loss (NIHL). One hundred thirty six patients with chronic tinnitus and at least a 10 year-long working history were divided into two groups based on the risk of their profession to induce NIHL. Individuals employed in jobs at high risk for NIHL were mostly males and exhibited a poorer hearing threshold, more evident in the left ear. Tinnitus was mostly bilateral; the next largest presentation was left-sided; patients described their tinnitus as buzzing or high-pitched. Correlation between age, length of tinnitus and worse hearing was found. Patients with a higher degree of hearing impairment were mostly males and were more likely to have a family history of hearing loss and at least one cardiovascular comorbidity. Our study shows some differences in individuals with tinnitus and a history of a profession associated with increased exposure to NIHL compared to those without such a history.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-08
      DOI: 10.3390/ijerph14091035
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1036: Exploring the Relationship between Housing
           and Health for Refugees and Asylum Seekers in South Australia: A
           Qualitative Study

    • Authors: Anna Ziersch, Moira Walsh, Clemence Due, Emily Duivesteyn
      First page: 1036
      Abstract: Housing is an important social determinant of health; however, little is known about the impact of housing experiences on health and wellbeing for people from refugee and asylum-seeking backgrounds. In this paper, we outline a qualitative component of a study in South Australia examining these links. Specifically, interviews were conducted with 50 refugees and asylum seekers who were purposively sampled according to gender, continent and visa status, from a broader survey. Interviews were analysed thematically. The results indicated that housing was of central importance to health and wellbeing and impacted on health through a range of pathways including affordability, the suitability of housing in relation to physical aspects such as condition and layout, and social aspects such as safety and belonging and issues around security of tenure. Asylum seekers in particular reported that living in housing in poor condition negatively affected their health. Our research reinforces the importance of housing for both the physical and mental health for asylum seekers and refugees living in resettlement countries. Improving housing quality, affordability and tenure security all have the potential to lead to more positive health outcomes.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-08
      DOI: 10.3390/ijerph14091036
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1037: Family Social Environment and Parenting
           Predictors of Alcohol Use among Adolescents in Lithuania

    • Authors: Linas Šumskas, Apolinaras Zaborskis
      First page: 1037
      Abstract: The role of the family as the social environment in shaping adolescent lifestyle has recently received substantial attention. This study was focused on investigating the association between familial and parenting predictors and alcohol use in school-aged children. Adolescents aged 13- and 15-year from a representative sample (N = 3715) of schools in Lithuania were surveyed during the spring of 2014. The methodology of the cross-national Health Behaviour in School-aged Children (HBSC) study was applied. HBSC international questionnaires were completed in the classroom anonymously for obtaining information about drinking of alcoholic beverages and family characteristics—family’s affluence and structure, style of communication in the family, parenting style, parental monitoring, family time together, etc. Univariate and multivariate logistic regression analysis was applied for assessment of the association between familial variables and weekly alcohol use. Analysis has demonstrated that adolescents from non-intact families tended to show significantly higher risk of being weekly drinkers (OR = 1.69; 95% CI: 1.30–2.19). The following parenting factors were associated with weekly use of alcohol: father’s and mother’s low monitoring, father’s authoritarian-repressive and mother’s permissive-neglectful parenting style. Frequent family time together and frequent electronic media communication with parents showed an inverse negative effect than was predicted. The study suggests that alcohol misuse among adolescents could be associated with a non-intact family structure as well as with complex family and parenting determinants which should be investigated more thoroughly by further studies.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-08
      DOI: 10.3390/ijerph14091037
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1038: The Short-term Effects of a Cyberbullying
           Prevention Intervention for Parents of Middle School Students

    • Authors: Anthony Roberto, Jen Eden, Douglas Deiss, Matthew Savage, Leslie Ramos-Salazar
      First page: 1038
      Abstract: This study experimentally evaluated the short-term effects of the Arizona Attorney General’s cybersafety promotion presentation, a key component of which is cyberbullying prevention. Fifty-one parents of children attending a middle school in the southwestern United States participated in the study. Results reveal parents who viewed the presentation believed their children to be more susceptible to cyberbullying, and indicated that they were more likely to talk to their children about saving evidence, not retaliating, and telling an adult compared to parents who had not viewed the presentation. The theoretical and practical implications of these results are discussed.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-09
      DOI: 10.3390/ijerph14091038
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1039: The Impact of a City-Level Minimum-Wage
           Policy on Supermarket Food Prices in Seattle-King County

    • Authors: Jennifer Otten, James Buszkiewicz, Wesley Tang, Anju Aggarwal, Mark Long, Jacob Vigdor, Adam Drewnowski
      First page: 1039
      Abstract: Background: Many states and localities throughout the U.S. have adopted higher minimum wages. Higher labor costs among low-wage food system workers could result in higher food prices. Methods: Using a market basket of 106 foods, food prices were collected at affected chain supermarket stores in Seattle and same-chain unaffected stores in King County (n = 12 total, six per location). Prices were collected at 1 month pre- (March 2015) and 1-month post-policy enactment (May 2015), then again 1-year post-policy enactment (May 2016). Unpaired t-tests were used to detect price differences by location at fixed time while paired t-tests were used to detect price difference across time with fixed store chain. A multi-level, linear differences-in-differences model, was used to detect the changes in the average market basket item food prices over time across regions, overall and by food group. Results: There were no significant differences in overall market basket or item-level costs at one-month (−$0.01, SE = 0.05, p = 0.884) or one-year post-policy enactment (−$0.02, SE = 0.08, p = 0.772). No significant increases were observed by food group. Conclusions: There is no evidence of change in supermarket food prices by market basket or increase in prices by food group in response to the implementation of Seattle’s minimum wage ordinance.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-09
      DOI: 10.3390/ijerph14091039
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1040: The Effects of Socioeconomic Vulnerability,
           Psychosocial Services, and Social Service Spending on Family
           Reunification: A Multilevel Longitudinal Analysis

    • Authors: Tonino Esposito, Ashleigh Delaye, Martin Chabot, Nico Trocmé, David Rothwell, Sonia Hélie, Marie-Joelle Robichaud
      First page: 1040
      Abstract: Socio-environmental factors such as poverty, psychosocial services, and social services spending all could influence the challenges faced by vulnerable families. This paper examines the extent to which socioeconomic vulnerability, psychosocial service consultations, and preventative social services spending impacts the reunification for children placed in out-of-home care. This study uses a multilevel longitudinal research design that draws data from three sources: (1) longitudinal administrative data from Quebec’s child protection agencies; (2) 2006 and 2011 Canadian Census data; and, (3) intra-province health and social services data. The final data set included all children (N = 39,882) placed in out-of-home care for the first time between 1 April 2002 and 31 March 2013, and followed from their initial out-of-home placement. Multilevel hazard results indicate that socioeconomic vulnerability, controlling for psychosocial services and social services spending, contributes to the decreased likelihood of reunification. Specifically, socioeconomic vulnerability, psychosocial services, and social services spending account for 24.0% of the variation in jurisdictional reunification for younger children less than 5 years of age, 12.5% for children age 5 to 11 years and 21.4% for older children age 12 to 17 years. These findings have implications for decision makers, funding agencies, and child protection agencies to improve jurisdictional resources to reduce the socioeconomic vulnerabilities of reunifying families.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-09
      DOI: 10.3390/ijerph14091040
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1041: Lipid Profiles, Glycated Hemoglobin, and
           Diabetes in People Living at High Altitude in Nepal

    • Authors: Nirmal Aryal, Mark Weatherall, Yadav Bhatta, Stewart Mann
      First page: 1041
      Abstract: This study aimed to describe lipid profiles and the distribution of glycated hemoglobin (HbA1c) in a sample of a high altitude population of Nepal and to explore associations between these metabolic risk variables and altitude. A cross-sectional survey of cardiovascular disease and associated risk factors was conducted among 521 people living at four different altitude levels, all above 2800 m, in the Mustang and Humla districts of Nepal. Urban participants (residents at 2800 m and 3620 m) had higher total cholesterol (TC) and triglyceride (TG) than rural participants. A high ratio of TC to high-density lipoprotein-cholesterol (HDL) (TC/HDL ≥ 5.0) was found in 23.7% (95% CI 19.6, 28.2) and high TG (≥1.7 mmol/L) in 43.3% (95% CI 38.4, 48.3) of participants overall. Mean HbA1c levels were similar at all altitude levels although urban participants had a higher prevalence of diabetes. Overall, 6.9% (95% CI 4.7, 9.8) of participants had diabetes or were on hypoglycaemic treatment. There was no clear association between lipid profiles or HbA1c and altitude in a multivariate analysis adjusted for possible confounding variables. Residential settings and associated lifestyle practices are more strongly associated with lipid profiles and HbA1c than altitude amongst high altitude residents in Nepal.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-10
      DOI: 10.3390/ijerph14091041
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1042: Assessment of Heavy Metal Pollution and
           Health Risks in the Soil-Plant-Human System in the Yangtze River Delta,

    • Authors: Bifeng Hu, Xiaolin Jia, Jie Hu, Dongyun Xu, Fang Xia, Yan Li
      First page: 1042
      Abstract: Heavy metal (HM) contamination and accumulation is a serious problem around the world due to the toxicity, abundant sources, non-biodegradable properties, and accumulative behaviour of HMs. The degree of soil HM contamination in China, especially in the Yangtze River Delta, is prominent. In this study, 1822 pairs of soil and crop samples at corresponding locations were collected from the southern Yangtze River Delta of China, and the contents of Ni, Cr, Zn, Cd, As, Cu, Hg, and Pb were measured. The single pollution index in soil (SPI) and Nemerow composite pollution index (NCPI) were used to assess the degree of HM pollution in soil, and the crop pollution index (CPI) was used to explore the degree of HM accumulation in crops. The bioaccumulation factor (BAF) was used to investigate the translocation of heavy metals in the soil-crop system. The health risks caused by HMs were calculated based on the model released by the U.S. Environmental Protection Agency. The SPIs of all elements were at the unpolluted level. The mean NCPI was at the alert level. The mean CPIs were in the following decreasing order: Ni (1.007) > Cr (0.483) > Zn (0.335) > Cd (0.314) > As (0.232) > Cu (0.187) > Hg (0.118) > Pb (0.105). Only the mean content of Ni in the crops exceeded the national standard value. The standard exceeding rates were used to represent the percentage of samples whose heavy metal content is higher than the corresponding national standard values. The standard exceeding rates of Cu, Hg, and Cd in soil were significantly higher than corresponding values in crops. Meanwhile, the standard exceeding rates of Ni, As, and Cr in crops were significantly higher than corresponding values in soil. The chronic daily intake (CDI) of children (13.8 × 10−3) was the largest among three age groups, followed by adults (6.998 × 10−4) and seniors (5.488 × 10−4). The bioaccumulation factors (BAFs) of all crops followed the order Cd (0.249) > Zn (0.133) > As (0.076) > Cu (0.064) > Ni (0.018) > Hg (0.011) > Cr (0.010) > Pb (0.001). Therefore, Cd was most easily absorbed by crops, and different crops had different capacities to absorb HMs. The hazard quotient (HQ) represents the potential non-carcinogenic risk for an individual HM and it is an estimation of daily exposure to the human population that is not likely to represent an appreciable risk of deleterious effects during a lifetime. All the HQs of the HMs for the different age groups were significantly less than the alert value of 1.0 and were at a safe level. This indicated that citizens in the study area face low potential non-carcinogenic risk caused by HMs. The total carcinogens risks (TCRs) for children, adults, and seniors were 5.24 × 10−5, 2.65 × 10−5, and 2.08 × 10−5, respectively, all of which were less than the guideline value but at the alert level. Ingestion was the main pathway of carcinogen risk to human health.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-10
      DOI: 10.3390/ijerph14091042
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1043: The Effect of Vitamin A on Fracture Risk: A
           Meta-Analysis of Cohort Studies

    • Authors: Xinge Zhang, Rui Zhang, Justin Moore, Yueqiao Wang, Hanyi Yan, Yingru Wu, Anran Tan, Jialin Fu, Ziqiong Shen, Guiyu Qin, Rui Li, Guoxun Chen
      First page: 1043
      Abstract: This meta-analysis evaluated the influence of dietary intake and blood level of vitamin A (total vitamin A, retinol or β-carotene) on total and hip fracture risk. Cohort studies published before July 2017 were selected through English-language literature searches in several databases. Relative risk (RR) with corresponding 95% confidence interval (CI) was used to evaluate the risk. Heterogeneity was checked by Chi-square and I2 test. Sensitivity analysis and publication bias were also performed. For the association between retinol intake and total fracture risk, we performed subgroup analysis by sex, region, case ascertainment, education level, age at menopause and vitamin D intake. R software was used to complete all statistical analyses. A total of 319,077 participants over the age of 20 years were included. Higher dietary intake of retinol and total vitamin A may slightly decrease total fracture risk (RR with 95% CI: 0.95 (0.91, 1.00) and 0.94 (0.88, 0.99), respectively), and increase hip fracture risk (RR with 95% CI: 1.40 (1.02, 1.91) and 1.29 (1.06, 1.57), respectively). Lower blood level of retinol may slightly increase total fracture risk (RR with 95% CI: 1.11 (0.94, 1.30)) and hip fracture risk (RR with 95% CI: 1.27 (1.05, 1.53)). In addition, higher β-carotene intake was weakly associated with the increased risk of total fracture (RR with 95% CI: 1.07 (0.97, 1.17)). Our data suggest that vitamin A intake and level may differentially influence the risks of total and hip fractures. Clinical trials are warranted to confirm these results and assess the clinical applicability.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-10
      DOI: 10.3390/ijerph14091043
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1044: The Effect of Bisphenol A on Puberty: A
           Critical Review of the Medical Literature

    • Authors: Alberto Leonardi, Marta Cofini, Donato Rigante, Laura Lucchetti, Clelia Cipolla, Laura Penta, Susanna Esposito
      First page: 1044
      Abstract: Many scientific studies have revealed a trend towards an earlier onset of puberty and have disclosed an increasing number of children that display precocious puberty. As an explanation, some authors have considered the global socio-economic improvement across different populations, and other authors have considered the action of endocrine disrupting chemicals (EDCs). Among these, bisphenol A (BPA), an aromatic compound largely used worldwide as a precursor of some plastics and chemical additives, is well known for its molecular oestrogen-like and obesogenic actions. We reviewed the medical literature of the previous 20 years that examined associations between BPA exposure and the age of puberty in humans, considering only those referring to clinical or epidemiological data. Of 19 studies, only 7 showed a correlation between BPA and puberty. In particular, the possible disruptive role of BPA on puberty may be seen in those with central precocious puberty or isolated premature breast development aged 2 months to 4 years old, even if the mechanism is undefined. Some studies also found a close relationship between urinary BPA, body weight, and early puberty, which can be explained by the obesogenic effect of BPA itself. The currently available data do not allow establishment of a clear role for BPA in pubertal development because of the conflicting results among all clinical and epidemiological studies examined. Further research is needed to fully understand the potential role of exposure to EDCs and their adverse endocrine health outcomes.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-10
      DOI: 10.3390/ijerph14091044
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1045: Polytrauma Defined by the New Berlin

    • Authors: Cheng-Shyuan Rau, Shao-Chun Wu, Pao-Jen Kuo, Yi-Chun Chen, Peng-Chen Chien, Hsiao-Yun Hsieh, Ching-Hua Hsieh
      First page: 1045
      Abstract: Background: Polytrauma patients are expected to have a higher risk of mortality than that obtained by the summation of expected mortality owing to their individual injuries. This study was designed to investigate the outcome of patients with polytrauma, which was defined using the new Berlin definition, as cases with an Abbreviated Injury Scale (AIS) ≥ 3 for two or more different body regions and one or more additional variables from five physiologic parameters (hypotension [systolic blood pressure ≤ 90 mmHg], unconsciousness [Glasgow Coma Scale score ≤ 8], acidosis [base excess ≤ −6.0], coagulopathy [partial thromboplastin time ≥ 40 s or international normalized ratio ≥ 1.4], and age [≥70 years]). Methods: We retrieved detailed data on 369 polytrauma patients and 1260 non-polytrauma patients with an overall Injury Severity Score (ISS) ≥ 18 who were hospitalized between 1 January 2009 and 31 December 2015 for the treatment of all traumatic injuries, from the Trauma Registry System at a level I trauma center. Patients with burn injury or incomplete registered data were excluded. Categorical data were compared with two-sided Fisher exact or Pearson chi-square tests. The unpaired Student t-test and the Mann–Whitney U-test was used to analyze normally distributed continuous data and non-normally distributed data, respectively. Propensity-score matched cohort in a 1:1 ratio was allocated using the NCSS software with logistic regression to evaluate the effect of polytrauma on patient outcomes. Results: The polytrauma patients had a significantly higher ISS than non-polytrauma patients (median (interquartile range Q1–Q3), 29 (22–36) vs. 24 (20–25), respectively; p < 0.001). Polytrauma patients had a 1.9-fold higher odds of mortality than non-polytrauma patients (95% CI 1.38–2.49; p < 0.001). Compared to non-polytrauma patients, polytrauma patients had a substantially longer hospital length of stay (LOS). In addition, a higher proportion of polytrauma patients were admitted to the intensive care unit (ICU), spent longer LOS in the ICU, and had significantly higher total medical expenses. Among 201 selected propensity score-matched pairs of polytrauma and non-polytrauma patients who showed no significant difference in sex, age, co-morbidity, AIS ≥ 3, and Injury Severity Score (ISS), the polytrauma patients had a significantly higher mortality rate (OR 17.5, 95% CI 4.21–72.76; p < 0.001), and a higher proportion of patients admitted to the ICU (84.1% vs. 74.1%, respectively; p = 0.013) with longer stays in the ICU (10.3 days vs. 7.5 days, respectively; p = 0.003). The total medical expenses for polytrauma patients were 35.1% higher than those of non-polytrauma patients. However, there was no significant difference in the LOS between polytrauma and non-polytrauma patients (21.1 days vs. 19.8 days, respectively; p = 0.399). Conclusions: The findings of this propensity-score matching study suggest that the new Berlin definition of polytrauma is feasible and applicable for trauma patients.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-11
      DOI: 10.3390/ijerph14091045
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1046: A Multivariate Dynamic Spatial Factor Model
           for Speciated Pollutants and Adverse Birth Outcomes

    • Authors: Kimberly Kaufeld, Montse Fuentes, Brian Reich, Amy Herring, Gary Shaw, Maria Terres
      First page: 1046
      Abstract: Evidence suggests that exposure to elevated concentrations of air pollution during pregnancy is associated with increased risks of birth defects and other adverse birth outcomes. While current regulations put limits on total PM2.5 concentrations, there are many speciated pollutants within this size class that likely have distinct effects on perinatal health. However, due to correlations between these speciated pollutants, it can be difficult to decipher their effects in a model for birth outcomes. To combat this difficulty, we develop a multivariate spatio-temporal Bayesian model for speciated particulate matter using dynamic spatial factors. These spatial factors can then be interpolated to the pregnant women’s homes to be used to model birth defects. The birth defect model allows the impact of pollutants to vary across different weeks of the pregnancy in order to identify susceptible periods. The proposed methodology is illustrated using pollutant monitoring data from the Environmental Protection Agency and birth records from the National Birth Defect Prevention Study
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-11
      DOI: 10.3390/ijerph14091046
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1047: Study of the Relevance of the Quality of
           Care, Operating Efficiency and Inefficient Quality Competition of Senior
           Care Facilities

    • Authors: Jwu-Rong Lin, Ching-Yu Chen, Tso-Kwei Peng
      First page: 1047
      Abstract: The purpose of this research is to examine the relation between operating efficiency and the quality of care of senior care facilities. We designed a data envelopment analysis, combining epsilon-based measure and metafrontier efficiency analyses to estimate the operating efficiency for senior care facilities, followed by an iterative seemingly unrelated regression to evaluate the relation between the quality of care and operating efficiency. In the empirical studies, Taiwan census data was utilized and findings include the following: Despite the greater operating scale of the general type of senior care facilities, their average metafrontier technical efficiency is inferior to that of nursing homes. We adopted senior care facility accreditation results from Taiwan as a variable to represent the quality of care and examined the relation of accreditation results and operating efficiency. We found that the quality of care of general senior care facilities is negatively related to operating efficiency; however, for nursing homes, the relationship is not significant. Our findings show that facilities invest more in input resources to obtain better ratings in the accreditation report. Operating efficiency, however, does not improve. Quality competition in the industry in Taiwan is inefficient, especially for general senior care facilities.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-11
      DOI: 10.3390/ijerph14091047
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1048: Health Effects of Ambient Air Pollution in
           Developing Countries

    • Authors: Pier Mannucci, Massimo Franchini
      First page: 1048
      Abstract: The deleterious effects of ambient air pollution on human health have been consistently documented by many epidemiologic studies worldwide, and it has been calculated that globally at least seven million deaths are annually attributable to the effects of air pollution. The major air pollutants emitted into the atmosphere by a number of natural processes and human activities include nitrogen oxides, volatile organic compounds, and particulate matter. In addition to the poor ambient air quality, there is increasing evidence that indoor air pollution also poses a serious threat to human health, especially in low-income countries that still use biomass fuels as an energy resource. This review summarizes the current knowledge on ambient air pollution in financially deprived populations.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-12
      DOI: 10.3390/ijerph14091048
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1049: Association between Childhood Diarrhoeal
           Incidence and Climatic Factors in Urban and Rural Settings in the Health
           District of Mbour, Senegal

    • Authors: Sokhna Thiam, Aminata Diène, Ibrahima Sy, Mirko Winkler, Christian Schindler, Jacques Ndione, Ousmane Faye, Penelope Vounatsou, Jürg Utzinger, Guéladio Cissé
      First page: 1049
      Abstract: We assessed the association between childhood diarrhoeal incidence and climatic factors in rural and urban settings in the health district of Mbour in western Senegal. We used monthly diarrhoeal case records among children under five years registered in 24 health facilities over a four-year period (2011–2014). Climatic data (i.e., daily temperature, night temperature and rainfall) for the same four-year period were obtained. We performed a negative binomial regression model to establish the relationship between monthly diarrhoeal incidence and climatic factors of the same and the previous month. There were two annual peaks in diarrhoeal incidence: one during the cold dry season and one during the rainy season. We observed a positive association between diarrhoeal incidence and high average temperature of 36 °C and above and high cumulative monthly rainfall at 57 mm and above. The association between diarrhoeal incidence and temperature was stronger in rural compared to urban settings, while higher rainfall was associated with higher diarrhoeal incidence in the urban settings. Concluding, this study identified significant health–climate interactions and calls for effective preventive measures in the health district of Mbour. Particular attention should be paid to urban settings where diarrhoea was most common in order to reduce the high incidence in the context of climatic variability, which is expected to increase in urban areas in the face of global warming.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-12
      DOI: 10.3390/ijerph14091049
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1050: Artificial Turf: Contested Terrains for
           Precautionary Public Health with Particular Reference to Europe'

    • Authors: Andrew Watterson
      First page: 1050
      Abstract: Millions of adults, children and teenagers use artificial sports pitches and playgrounds globally. Pitches are artificial grass and bases may be made up of crumb rubber from recycled tires or new rubber and sand. Player injury on pitches was a major concern. Now, debates about health focus on possible exposure and uptake of chemicals within pitch and base materials. Research has looked at potential risks to users from hazardous substances such as metals, volatile organic compounds, polycyclic aromatic hydrocarbons including benzo (a) (e) pyrenes and phthalates: some are carcinogens and others may be endocrine disruptors and have developmental reproductive effects. Small environmental monitoring and modelling studies, often with significant data gaps about exposure, range of substances monitored, occupational exposures, types of surfaces monitored and study length across seasons, indicated little risk to sports people and children but some risk to installation workers. A few, again often small, studies indicated potentially harmful human effects relating to skin, respiration and cancers. Only one widely cited biomonitoring study has been done and no rigorous cancer epidemiological studies exist. Unravelling exposures and uptake over decades may prove complex. European regulators have strengthened controls over crumb rubber chemicals, set different standards for toys and crumb rubber pitches. Bigger US studies now underway attempting to fill some of the data gaps will report between 2017 and 2019. Public health professionals in the meantime may draw on established principles to support greater caution in setting crumb rubber exposure limits and controls.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-12
      DOI: 10.3390/ijerph14091050
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1051: Applying Nonparametric Methods to Analyses of
           Short-Term Fine Particulate Matter Exposure and Hospital Admissions for
           Cardiovascular Diseases among Older Adults

    • Authors: Xiaobin Liu, Liuhua Shi, Ke Zu, Julie Goodman
      First page: 1051
      Abstract: Short-term exposure to fine particulate matter (PM2.5) has been associated with increased risks of cardiovascular diseases (CVDs), but whether such associations are supportive of a causal relationship is unclear, and few studies have employed formal causal analysis methods to address this. We employed nonparametric methods to examine the associations between daily concentrations of PM2.5 and hospital admissions (HAs) for CVD among adults aged 75 years and older in Texas, USA. We first quantified the associations in partial dependence plots generated using the random forest approach. We next used a Bayesian network learning algorithm to identify conditional dependencies between CVD HAs of older men and women and several predictor variables. We found that geographic location (county), time (e.g., month and year), and temperature satisfied necessary information conditions for being causes of CVD HAs among older men and women, but daily PM2.5 concentrations did not. We also found that CVD HAs of disjoint subpopulations were strongly predictive of CVD HAs among older men and women, indicating the presence of unmeasured confounders. Our findings from nonparametric analyses do not support PM2.5 as a direct cause of CVD HAs among older adults.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-12
      DOI: 10.3390/ijerph14091051
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1052: Effect of Sex and Body Mass Index on
           Children’s Physical Activity Intensity during Free Play at an Indoor
           Soft Play Center: An Exploratory Study

    • Authors: Michelle Jones
      First page: 1052
      Abstract: Background: Indoor soft play can provide a safe but exciting physical activity opportunity regardless of environmental conditions. Relatively little is known about the quality or quantity of physical activity engaged in by children during indoor free soft play. The aim of this study was to evaluate the contribution indoor free soft play can make in enabling children to meet physical activity guidelines and to evaluate the effects of sex and body mass index category. Methods: Seventy-two boys and girls aged five to 10 years engaged in un-controlled indoor free soft play with a mean duration of 120.7 (27.1) min, during which physical activity was monitored using Actigraph accelerometers. Results: Children spent an average of 61.7 (24.2) min engaging in moderate to vigorous physical activity (MVPA) and 51.4% (n = 37) achieved the recommended 60 min of MVPA through the single visit to the indoor soft play center. Boys (68.3 (25.7) min) engaged in significantly (p < 0.05) more MVPA than girls (55.8 (21.4) min). Normal weight (65.7 (23.3) min) children engaged in significantly more MVPA than overweight children (48.0 (18.9) min). Conclusions: Attendance at a soft play indoor center has the potential to support children to engage in sufficient MVPA and overcome environmental factors that can restrict physical activity opportunities.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-12
      DOI: 10.3390/ijerph14091052
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1053: Trauma Affecting Asian-Pacific Islanders in
           the San Francisco Bay Area

    • Authors: Pollie Bith-Melander, Nagia Chowdhury, Charulata Jindal, Jimmy Efird
      First page: 1053
      Abstract: Trauma is a transgenerational process that overwhelms the community and the ability of family members to cope with life stressors. An anthropologist trained in ethnographic methods observed three focus groups from a non-profit agency providing trauma and mental health services to Asian Americans living in the San Francisco Bay Area of United States. Supplemental information also was collected from staff interviews and notes. Many of the clients were immigrants, refugees, or adult children of these groups. This report consisted of authentic observations and rich qualitative information to characterize the impact of trauma on refugees and immigrants. Observations suggest that collective trauma, direct or indirect, can impede the success and survivability of a population, even after many generations.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-12
      DOI: 10.3390/ijerph14091053
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1054: Food and Beverage Marketing in Schools: A
           Review of the Evidence

    • Authors: Cayley Velazquez, Jennifer Black, Monique Potvin Kent
      First page: 1054
      Abstract: Despite growing interest from government agencies, non-governmental organizations and school boards in restricting or regulating unhealthy food and beverage marketing to children, limited research has examined the emerging knowledge base regarding school-based food and beverage marketing in high-income countries. This review examined current approaches for measuring school food and beverage marketing practices, and evidence regarding the extent of exposure and hypothesized associations with children’s diet-related outcomes. Five databases (MEDLINE, Web of Science, CINAHL, Embase, and PsycINFO) and six grey literature sources were searched for papers that explicitly examined school-based food and beverage marketing policies or practices. Twenty-seven papers, across four high-income countries including Canada (n = 2), Ireland (n = 1), Poland (n = 1) and United States (n = 23) were identified and reviewed. Results showed that three main methodological approaches have been used: direct observation, self-report surveys, and in-person/telephone interviews, but few studies reported on the validity or reliability of measures. Findings suggest that students in the U.S. are commonly exposed to a broad array of food and beverage marketing approaches including direct and indirect advertising, although the extent of exposure varies widely across studies. More pervasive marketing exposure was found among secondary or high schools compared with elementary/middle schools and among schools with lower compared with higher socio-economic status. Three of five studies examining diet-related outcomes found that exposure to school-based food and beverage marketing was associated with food purchasing or consumption, particularly for minimally nutritious items. There remains a need for a core set of standard and universal measures that are sufficiently rigorous and comprehensive to assess the totality of school food and beverage marketing practices that can be used to compare exposure between study contexts and over time. Future research should examine the validity of school food and beverage marketing assessments and the impacts of exposure (and emerging policies that reduce exposure) on children’s purchasing and diet-related knowledge, attitudes and behaviors in school settings.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-12
      DOI: 10.3390/ijerph14091054
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1055: Effects of Heat Stress on Construction Labor
           Productivity in Hong Kong: A Case Study of Rebar Workers

    • Authors: Wen Yi, Albert Chan
      First page: 1055
      Abstract: Global warming is bringing more frequent and severe heat waves, and the result will be serious for vulnerable populations such as construction workers. Excessive heat stress has profound effects on physiological responses, which cause occupational injuries, fatalities and low productivity. Construction workers are particularly affected by heat stress, because of the body heat production caused by physically demanding tasks, and hot and humid working conditions. Field studies were conducted between August and September 2016 at two construction training grounds in Hong Kong. Onsite wet-bulb globe temperature (WBGT), workers’ heart rate (HR), and labor productivity were measured and monitored. Based on the 378 data sets of synchronized environmental, physiological, construction labor productivity (CLP), and personal variables, a CLP-heat stress model was established. It was found that WBGT, percentage of maximum HR, age, work duration, and alcohol drinking habits were determining factors for predicting the CLP (adjusted R2 = 0.68, p < 0.05). The model revealed that heat stress reduces CLP, with the percentage of direct work time decreasing by 0.33% when the WBGT increased by 1 °C. The findings in this study extend the existing practice notes by providing scientific data that may be of benefit to the industry in producing solid guidelines for working in hot weather.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-12
      DOI: 10.3390/ijerph14091055
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1056: Collaborative Visual Analytics: A Health
           Analytics Approach to Injury Prevention

    • Authors: Samar Al-Hajj, Brian Fisher, Jennifer Smith, Ian Pike
      First page: 1056
      Abstract: Background: Accurate understanding of complex health data is critical in order to deal with wicked health problems and make timely decisions. Wicked problems refer to ill-structured and dynamic problems that combine multidimensional elements, which often preclude the conventional problem solving approach. This pilot study introduces visual analytics (VA) methods to multi-stakeholder decision-making sessions about child injury prevention; Methods: Inspired by the Delphi method, we introduced a novel methodology—group analytics (GA). GA was pilot-tested to evaluate the impact of collaborative visual analytics on facilitating problem solving and supporting decision-making. We conducted two GA sessions. Collected data included stakeholders’ observations, audio and video recordings, questionnaires, and follow up interviews. The GA sessions were analyzed using the Joint Activity Theory protocol analysis methods; Results: The GA methodology triggered the emergence of ‘common ground’ among stakeholders. This common ground evolved throughout the sessions to enhance stakeholders’ verbal and non-verbal communication, as well as coordination of joint activities and ultimately collaboration on problem solving and decision-making; Conclusions: Understanding complex health data is necessary for informed decisions. Equally important, in this case, is the use of the group analytics methodology to achieve ‘common ground’ among diverse stakeholders about health data and their implications.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-12
      DOI: 10.3390/ijerph14091056
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1057: Implementing Low-Cost, Community-Based
           Exercise Programs for Middle-Aged and Older Patients with Type 2 Diabetes:
           What Are the Benefits for Glycemic Control and Cardiovascular Risk'

    • Authors: Romeu Mendes, Nelson Sousa, Victor Reis, Jose Themudo-Barata
      First page: 1057
      Abstract: Background: The purpose of this study was to analyze the effects of a long-term, community-based, combined exercise program developed with low-cost exercise strategies on glycemic control and cardiovascular risk factors in middle-aged and older patients with type 2 diabetes. Methods: Participants (n = 124; 63.25 ± 7.20 years old) engaged in either a 9-month supervised exercise program (n = 39; consisting of combined aerobic, resistance, agility/balance, and flexibility exercise; three sessions per week; 70 min per session) or a control group (n = 85) who maintained their usual care. Glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease were assessed before and after the 9-month intervention. Results: A significant time * group interaction effect (p < 0.001) was identified in the values of the glycated hemoglobin, fasting plasma glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, and the 10-year risk of coronary artery disease. Conclusions: A long-term, community-based, combined exercise program developed with low-cost exercise strategies was effective in inducing significant benefits on glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease in middle-aged and older patients with type 2 diabetes. Clinical Trial Identification Number: ISRCTN09240628.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-13
      DOI: 10.3390/ijerph14091057
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1058: Community Capacity Building for Physical
           Activity Promotion among Older Adults—A Literature Review

    • Authors: Tobias Ubert, Sarah Forberger, Dirk Gansefort, Hajo Zeeb, Tilman Brand
      First page: 1058
      Abstract: Community-based interventions to promote physical activity (PA) among older adults are of high interest in health promotion since they promise to be effective strategies to reach this population group. Community capacity building, that is, the local promotion of knowledge, skills, commitment, structures, and leadership, is among the recommended core strategies. However, little guidance is provided on how to achieve a high degree of community capacity. This study aims to identify practical strategies to enhance community capacities for PA promotion among older adults (50 years or older) and to evaluate their success. A literature review was conducted using scientific databases (PsycInfo and Web of Sciences) and grey literature (national and international project databases), and 14 studies (16 articles) were identified. Five groups of capacity building strategies emerged from the literature: (1) building community coalitions and networks, (2) training of professionals, (3) training of laypersons, (4) strengthening competence and awareness in the target population, and (5) allocation of financial resources. All studies used more than one strategy. Coalition building and strengthening competence and awareness were most frequently used. Feasibility and acceptability of the capacity building strategies were demonstrated. However, intervention effects on PA behavior and other relevant outcomes were inconsistent. The one study that systematically compared different capacity building approaches did not find any evidence for beneficial effects of intensified capacity building. More rigorous research evaluating the efficacy of specific strategies to enhance community capacities for PA promotion is needed.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-13
      DOI: 10.3390/ijerph14091058
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1059: Distribution of Non-Persistent Endocrine
           Disruptors in Two Different Regions of the Human Brain

    • Authors: Thomas P. van der Meer, Francisco Artacho-Cordón, Dick F. Swaab, Dicky Struik, Konstantinos C. Makris, Bruce H. R. Wolffenbuttel, Hanne Frederiksen, Jana V. van Vliet-Ostaptchouk
      First page: 1059
      Abstract: Non-persistent endocrine disrupting chemicals (npEDCs) can affect multiple organs and systems in the body. Whether npEDCs can accumulate in the human brain is largely unknown. The major aim of this pilot study was to examine the presence of environmental phenols and parabens in two distinct brain regions: the hypothalamus and white-matter tissue. In addition, a potential association between these npEDCs concentrations and obesity was investigated. Post-mortem brain material was obtained from 24 individuals, made up of 12 obese and 12 normal-weight subjects (defined as body mass index (BMI) > 30 and BMI < 25 kg/m2, respectively). Nine phenols and seven parabens were measured by isotope dilution TurboFlow-LC-MS/MS. In the hypothalamus, seven suspect npEDCs (bisphenol A, triclosan, triclocarban and methyl-, ethyl-, n-propyl-, and benzyl paraben) were detected, while five npEDCs (bisphenol A, benzophenone-3, triclocarban, methyl-, and n-propyl paraben) were found in the white-matter brain tissue. We observed higher levels of methylparaben (MeP) in the hypothalamic tissue of obese subjects as compared to controls (p = 0.008). Our findings indicate that some suspected npEDCs are able to cross the blood–brain barrier. Whether the presence of npEDCs can adversely affect brain function and to which extent the detected concentrations are physiologically relevant needs to be further investigated.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-13
      DOI: 10.3390/ijerph14091059
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1060: Development and Evaluation of a Manganese and
           Iron Food Frequency Questionnaire for Pediatrics

    • Authors: Frida Zipkin, Grace Falciglia, Pierce Kuhnell, Erin Haynes
      First page: 1060
      Abstract: Manganese (Mn) is an essential nutrient, but overexposure can lead to neurotoxicity. Given the essentiality of Mn in the diet, particularly during children’s growth and development, it is imperative to quantify dietary Mn intake in populations that may be exposed to industrial sources of Mn. Dietary absorption of Mn is inversely associated with iron (Fe) stores, yet there is currently no food frequency questionnaire (FFQ) to assess dietary Mn and Fe intake. The study objective was to develop and evaluate the validity of a FFQ to measure dietary Mn and Fe intake in pediatrics by comparing the estimated intakes of Mn and Fe with biomarkers: Mn in blood and hair and Fe in serum. This study utilized a subset of the Communities Actively Researching Exposure Study (CARES) population residing in Guernsey County, Ohio. Dietary Mn was not correlated with either blood or hair Mn; however, dietary Mn and serum ferritin were significantly correlated, with a correlation coefficient of 0.51, p < 0.01. Moreover, dietary Fe and serum ferritin were also significantly correlated, with a correlation coefficient of 0.51, p < 0.01. This FFQ is a valid measurement tool for Fe intake as measured by serum ferritin; however, Mn intake did not correlate with either blood or hair Mn.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-14
      DOI: 10.3390/ijerph14091060
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1061: Comment on: Maternal Exposure to Domestic
           Hair Cosmetics and Occupational Endocrine Disruptors Is Associated with a
           Higher Risk of Hypospadias in the Offspring. Int. J. Environ. Res. Public
           Health 2017, 14, 27

    • Authors: Mark Elwood, Dillon O’Brien, Katie-Anne Budgen
      First page: 1061
      Abstract: There are considerable inconsistencies in the results of Haraux et al. [1].[...]
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-14
      DOI: 10.3390/ijerph14091061
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1062: Hospital Costs of Foreign Non-Resident
           Patients: A Comparative Analysis in Catalonia, Spain

    • Authors: Elena Arroyo-Borrell, Gemma Renart-Vicens, Marc Saez, Marc Carreras
      First page: 1062
      Abstract: Although patient mobility has increased over the world, in Europe there is a lack of empirical studies. The aim of the study was to compare foreign non-resident patients versus domestic patients for the particular Catalan case, focusing on patient characteristics, hospitalisation costs and differences in costs depending on the typology of the hospital they are treated. We used data from the 2012 Minimum Basic Data Set-Acute Care hospitals (CMBD-HA) in Catalonia. We matched two case-control groups: first, foreign non-resident patients versus domestic patients and, second, foreign non-resident patients treated by Regional Public Hospitals versus other type of hospitals. Hospitalisation costs were modelled using a GLM Gamma with a log-link. Our results show that foreign non-resident patients were significantly less costly than domestic patients (12% cheaper). Our findings also suggested differences in the characteristics of foreign non-resident patients using Regional Public Hospitals or other kinds of hospitals although we did not observe significant differences in the healthcare costs. Nevertheless, women, 15–24 and 35–44 years old patients and the days of stay were less costly in Regional Public Hospitals. In general, acute hospitalizations of foreign non-resident patients while they are on holiday cost substantially less than domestic patients. The typology of hospital is not found to be a relevant factor influencing costs.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-14
      DOI: 10.3390/ijerph14091062
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1063: Disaster Governance for Community Resilience
           in Coastal Towns: Chilean Case Studies

    • Authors: Paula Villagra, Carolina Quintana
      First page: 1063
      Abstract: This study aimed to further our understanding of a characteristic of Community Resilience known as Disaster Governance. Three attributes of Disaster Governance—redundancy, diversity, and overlap—were studied in four coastal towns in southern Chile that are at risk of tsunamis. Overall, we explored how different spatial structures of human settlements influence Disaster Governance. Using the Projective Mapping Technique, the distribution of emergency institutions (N = 32) and uses given to specific sites (e.g., for refuge, sanitary purposes and medical attention) were mapped. Content and GIS analyses (Directional Distribution and Kernel Density Index) were used to explore the dispersion and concentration of institutions and uses in each town. Disaster Governance was found to be highly influenced by decisions taken during regional, urban, and emergency planning. Governance is better in towns of higher order in the communal hierarchical structure. Most of the emergency institutions were found to be located in central and urban areas, which, in turn, assures more redundancy, overlap, and diversity in governance in the event of a tsunami. Lack of flexibility of emergency plans also limits governance in rural and indigenous areas. While the spatial relationships found in this study indicate that urban sectors have better Disaster Governance than rural and indigenous sectors, the influence of resource availability after tsunamis, the role and responsibility of different levels of governments, and the politics of disaster also play an important role in Disaster Governance for determining Community Resilience. These findings shed light on emergency planning and aspects of the Disaster Management cycle.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-14
      DOI: 10.3390/ijerph14091063
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1064: Public Health Network Structure and
           Collaboration Effectiveness during the 2015 MERS Outbreak in South Korea:
           An Institutional Collective Action Framework

    • Authors: KyungWoo Kim, Simon Andrew, Kyujin Jung
      First page: 1064
      Abstract: Following the 2015 Middle East Respiratory Syndrome (MERS) outbreak in South Korea, this research aims to examine the structural effect of public health network explaining collaboration effectiveness, which is defined as joint efforts to improve quality of service provision, cost savings, and coordination. We tested the bonding and bridging effects on collaboration effectiveness during the MERS outbreak response by utilizing an institutional collective action framework. The analysis results of 114 organizations responding during the crisis show a significant association between the bonding effect and the effectiveness of collaboration, as well as a positive association between risk communication in disseminating public health information and the effectiveness of collaboration.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-15
      DOI: 10.3390/ijerph14091064
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1065: Use of Principal Components Analysis and
           Kriging to Predict Groundwater-Sourced Rural Drinking Water Quality in

    • Authors: Lianne McLeod, Lalita Bharadwaj, Tasha Epp, Cheryl Waldner
      First page: 1065
      Abstract: Groundwater drinking water supply surveillance data were accessed to summarize water quality delivered as public and private water supplies in southern Saskatchewan as part of an exposure assessment for epidemiologic analyses of associations between water quality and type 2 diabetes or cardiovascular disease. Arsenic in drinking water has been linked to a variety of chronic diseases and previous studies have identified multiple wells with arsenic above the drinking water standard of 0.01 mg/L; therefore, arsenic concentrations were of specific interest. Principal components analysis was applied to obtain principal component (PC) scores to summarize mixtures of correlated parameters identified as health standards and those identified as aesthetic objectives in the Saskatchewan Drinking Water Quality Standards and Objective. Ordinary, universal, and empirical Bayesian kriging were used to interpolate arsenic concentrations and PC scores in southern Saskatchewan, and the results were compared. Empirical Bayesian kriging performed best across all analyses, based on having the greatest number of variables for which the root mean square error was lowest. While all of the kriging methods appeared to underestimate high values of arsenic and PC scores, empirical Bayesian kriging was chosen to summarize large scale geographic trends in groundwater-sourced drinking water quality and assess exposure to mixtures of trace metals and ions.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-15
      DOI: 10.3390/ijerph14091065
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1066: New Methods to Address Old Challenges: The
           Use of Administrative Data for Longitudinal Replication Studies of Child

    • Authors: Emily Hurren, Anna Stewart, Susan Dennison
      First page: 1066
      Abstract: Administrative data are crucial to the “big data” revolution of social science and have played an important role in the development of child maltreatment research. These data are also of value to administrators, policy makers, and clinicians. The focus of this paper is the use of administrative data to produce and replicate longitudinal studies of child maltreatment. Child protection administrative data have several advantages. They are often population-based, and allow longitudinal examination of child maltreatment and complex multi-level analyses. They also allow comparison across subgroups and minority groups, remove burden from individuals to disclose traumatic experiences, and can be less biased than retrospective recall. Finally, they can be linked to data from other agencies to explore comorbidity and outcomes, and are comparatively cost and time effective. The benefits and challenges associated with the use of administrative data for longitudinal child maltreatment research become magnified when these data are used to produce replications. Techniques to address challenges and support future replication efforts include developing a biographical understanding of the systems from which the data are drawn, using multiple data sources to contextualize the data and research results, recognizing and adopting various approaches to replication, and documenting all data coding and manipulation processes. These techniques are illustrated in this paper via a case study of previous replication work.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-15
      DOI: 10.3390/ijerph14091066
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1067: Perception of Radiation Risk as a Predictor
           of Mid-Term Mental Health after a Nuclear Disaster: The Fukushima Health
           Management Survey

    • Authors: Itaru Miura, Masato Nagai, Masaharu Maeda, Mayumi Harigane, Senta Fujii, Misari Oe, Hirooki Yabe, Yuriko Suzuki, Hideto Takahashi, Tetsuya Ohira, Seiji Yasumura, Masafumi Abe
      First page: 1067
      Abstract: Predictive factors including risk perception for mid-term mental health after a nuclear disaster remain unknown. The purpose of this study was to examine the association between perceived radiation risk and other factors at baseline and mid-term mental health after the Fukushima Daiichi nuclear disaster of 2011 in Japan. A mail-based questionnaire survey was conducted in January 2012 and January 2013. Mental health status was assessed using the K6 scale. Psychological distress over the 2-year period was categorized into the following four groups: chronic, recovered, resistant, or worsened. Most participants (80.3%) were resistant to the disaster. A positive association was found between the radiation risk perception regarding immediate effects and the worsened group in women. Baseline post-traumatic stress disorder (PTSD) or a history of psychiatric disease predicted being in the chronic or worsened group in mid-term course. These results suggest that evacuees who believed that their health was substantially affected by the nuclear disaster were at an increased risk of having poor mid-term mental health in women. Careful assessment of risk perception after a nuclear disaster, including the presence of PTSD or a history of psychiatric disease, is needed for appropriate interventions.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-15
      DOI: 10.3390/ijerph14091067
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1068: Screening for Autochthonous Phytoextractors
           in a Heavy Metal Contaminated Coal Mining Area

    • Authors: Kuangjia Li, Zijian Lun, Lin Zhao, Qilong Zhu, Yansheng Gu, Manzhou Li
      First page: 1068
      Abstract: In order to protect public health and crops from soil heavy metal (HM) contamination at a coal mining area in Henan, central China, HM pollution investigation and screening of autochthonous HM phytoextractors were conducted. The concentrations of cadmium (Cd), lead (Pb), copper (Cu) and zinc (Zn) in surface soils exceeded the corresponding local background values and the China National Standard (CNS). The maximum potential ecological risk (RI) was 627.30, indicating very high ecological risk. The monomial risk of Cd contributed the most to the RI, varying from 85.48% to 96.48%. The plant community structure in the study area was simple, and was composed of 24 families, 37 genera and 40 species. B. pilosa, A. roxburghiana, A. argyi, A. hispidus were found to be the most dominant species at considerable risk sites. Based on the comprehensive analysis of Cd concentration, bioconcentration factor, translocation factor and adaptability factor, B. pilosa and A. argyi had potential for phytoextraction at considerable risk sites. A. roxburghiana had potential for Cd phytoextraction at moderately risk sites and A. hispidus seemed suitable for phytostabilization. The results could contribute to the phytoremediation of the similar sites.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-15
      DOI: 10.3390/ijerph14091068
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1069: Gender Differences in Problematic Alcohol
           Consumption in University Professors

    • Authors: Pablo Ruisoto, Silvia Vaca, José López-Goñi, Raúl Cacho, Iván Fernández-Suárez
      First page: 1069
      Abstract: The role of job satisfaction and other psychosocial variables in problematic alcohol consumption within professional settings remains understudied. The aim of this study is to assess the level of problematic alcohol consumption among male and female university professors and associated psychosocial variables. A total of 360 professors (183 men and 177 women) of a large private university in Ecuador were surveyed using standardized instruments for the following psychosocial measures: alcohol consumption, job satisfaction, psychological stress, psychological flexibility, social support and resilience. Problematic alcohol consumption was found in 13.1% of participants, although this was significantly higher (χ2 = 15.6; d.f. = 2, p < 0.001) in men (19.1%) than women (6.8%). Problematic alcohol consumption was reported in men with higher perceived stress and job satisfaction. However, 83.3% of women with problematic alcohol use reported lower job satisfaction and higher psychological inflexibility. Results suggest that job satisfaction itself did not prevent problematic alcohol consumption in men; stress was associated with problematic consumption in men and psychological inflexibility in women. Findings from this study support the need to assess aspects of alcohol consumption and problematic behavior differently among men and women. Intervention strategies aimed at preventing or reducing problematic alcohol consumption in university professors must be different for men and women.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-15
      DOI: 10.3390/ijerph14091069
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1070: Phylogenetic Analysis and Antimicrobial
           Profiles of Cultured Emerging Opportunistic Pathogens (Phyla
           Actinobacteria and Proteobacteria) Identified in Hot Springs

    • Authors: Jocelyn Jardine, Akebe Abia, Vuyo Mavumengwana, Eunice Ubomba-Jaswa
      First page: 1070
      Abstract: Hot spring water may harbour emerging waterborne opportunistic pathogens that can cause infections in humans. We have investigated the diversity and antimicrobial resistance of culturable emerging and opportunistic bacterial pathogens, in water and sediment of hot springs located in Limpopo, South Africa. Aerobic bacteria were cultured and identified using 16S ribosomal DNA (rDNA) gene sequencing. The presence of Legionella spp. was investigated using real-time polymerase chain reaction. Isolates were tested for resistance to ten antibiotics representing six different classes: β-lactam (carbenicillin), aminoglycosides (gentamycin, kanamycin, streptomycin), tetracycline, amphenicols (chloramphenicol, ceftriaxone), sulphonamides (co-trimoxazole) and quinolones (nalidixic acid, norfloxacin). Gram-positive Kocuria sp. and Arthrobacter sp. and gram-negative Cupriavidus sp., Ralstonia sp., Cronobacter sp., Tepidimonas sp., Hafnia sp. and Sphingomonas sp. were isolated, all recognised as emerging food-borne pathogens. Legionella spp. was not detected throughout the study. Isolates of Kocuria, Arthrobacter and Hafnia and an unknown species of the class Gammaproteobacteria were resistant to two antibiotics in different combinations of carbenicillin, ceftriaxone, nalidixic acid and chloramphenicol. Cronobacter sp. was sensitive to all ten antibiotics. This study suggests that hot springs are potential reservoirs for emerging opportunistic pathogens, including multiple antibiotic resistant strains, and highlights the presence of unknown populations of emerging and potential waterborne opportunistic pathogens in the environment.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-15
      DOI: 10.3390/ijerph14091070
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1071: Response to Elwood, M. et al., Comment on:
           Maternal Exposure to Domestic Hair Cosmetics and Occupational Endocrine
           Disruptors Is Associated with a Higher Risk of Hypospadias in the
           Offspring. Int. J. Environ. Res. Public Health 2017, 14, 27

    • Authors: Elodie Haraux, Karine Braun, Philippe Buisson, Erwan Stéphan-Blanchard, Camille Devauchelle, Jannick Ricard, Bernard Boudailliez, Pierre Tourneux, Richard Gouron, Karen Chardon
      First page: 1071
      Abstract: Dear Editor, Thank you for inviting us to reply to a “Comment” paper to our published paper “Maternal Exposure to Domestic Hair Cosmetics and Occupational Endocrine Disruptors Is Associated with a Higher Risk of Hypospadias in the Offspring” (
      Authors : Elodie Haraux, Karine Braun, Philippe Buisson, Erwan Stéphan-Blanchard, Jannick Ricard, Camille Devauchelle, Bernard Boudailliez, Pierre Tourneux, Richard Gouron, Karen Chardon).[...]
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-15
      DOI: 10.3390/ijerph14091071
      Issue No: Vol. 14, No. 9 (2017)
  • IJERPH, Vol. 14, Pages 1072: Smoothed Temporal Atlases of Age-Gender
           All-Cause Mortality in South Africa

    • Authors: Samuel O. M Manda, Nada Abdelatif
      First page: 1072
      Abstract: Most mortality maps in South Africa and most contried of the sub-Saharan region are static, showing aggregated count data over years or at specific years. Lack of space and temporral dynamanics in these maps may adversely impact on their use and application for vigorous public health policy decisions and interventions. This study aims at describing and modeling sub-national distributions of age–gender specific all-cause mortality and their temporal evolutions from 1997 to 2013 in South Africa. Mortality information that included year, age, gender, and municipality administrative division were obtained from Statistics South Africa for the period. Individual mortality level data were grouped by three ages groups (0–14, 15–64, and 65 and over) and gender (male, female) and aggregated at each of the 234 municipalities in the country. The six age-gender all-cause mortality rates may be related due to shared common social deprivation, health and demographic risk factors. We undertake a joint analysis of the spatial-temporal variation of the six age-gender mortality risks. This is done within a shared component spatial model construction where age-gender common and specific spatial and temporal trends are estiamted using a hierarchical Bayesian spatial model. The results show municipal and temporal differentials in mortality risk profiles between age and gender groupings. High rates were seen in 2005, especially for the 15–64 years age group for both males and females. The dynamic geographical and time distributions of subnational age-gender all-cause mortality contribute to a better understanding of the temporal evolvement and geographical variations in the relationship between demographic composition and burden of diseases in South Africa. This provides useful information for effective monitoring and evaluation of public health policies and programmes targeting mortality reduction across time and sub-populations in the country.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2017-09-15
      DOI: 10.3390/ijerph14091072
      Issue No: Vol. 14, No. 9 (2017)
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