International Journal of Environmental Research and Public Health

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Open AccessArticle

A mHealth Application for Chronic Wound Care: Findings of a User Trial

by Marcia R. Friesen, Carole Hamel and Robert D. McLeod

Int. J. Environ. Res. Public Health 2013, 10(11), 6199-6214; https://doi.org/10.3390/ijerph10116199 - 19 Nov 2013

Cited by 44 | Viewed by 10322

This paper reports on the findings of a user trial of a mHealth application for pressure ulcer (bedsore) documentation. Pressure ulcers are a leading iatrogenic cause of death in developed countries and significantly impact quality of life for those affected. Pressure ulcers will [...] Read more.

This paper reports on the findings of a user trial of a mHealth application for pressure ulcer (bedsore) documentation. Pressure ulcers are a leading iatrogenic cause of death in developed countries and significantly impact quality of life for those affected. Pressure ulcers will be an increasing public health concern as the population ages. Electronic information systems are being explored to improve consistency and accuracy of documentation, improve patient and caregiver experience and ultimately improve patient outcomes. A software application was developed for Android Smartphones and tablets and was trialed in a personal care home in Western Canada. The software application provides an electronic medical record for chronic wounds, replacing nurses’ paper-based charting and is positioned for integration with facility’s larger eHealth framework. The mHealth application offers three intended benefits over paper-based charting of chronic wounds, including: (1) the capacity for remote consultation (telehealth between facilities, practitioners, and/or remote communities), (2) data organization and analysis, including built-in alerts, automatically-generated text-based and graph-based wound histories including wound images, and (3) tutorial support for non-specialized caregivers. The user trial yielded insights regarding the software application’s design and functionality in the clinical setting, and highlighted the key role of wound photographs in enhancing patient and caregiver experiences, enhancing communication between multiple healthcare professionals, and leveraging the software’s telehealth capacities. Full article

(This article belongs to the Special Issue Advances in Telehealthcare)

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Open AccessArticle

Attitudes of COPD Patients towards Tele-Rehabilitation: A Cross-Sector Case Study

by Birthe Dinesen, Lotte Huniche and Egon Toft

Int. J. Environ. Res. Public Health 2013, 10(11), 6184-6198; https://doi.org/10.3390/ijerph10116184 - 15 Nov 2013

Cited by 33 | Viewed by 10809

Abstract

The aim of this paper is to describe patients’ attitudes towards tele-rehabilitation in the Danish TELEKAT (for Telehomecare, Chronic Patients and the Integrated Healthcare System) project, in order to better understand patients’ behavior when performing tele-rehabilitation activities in home surroundings. A total of [...] Read more.

The aim of this paper is to describe patients’ attitudes towards tele-rehabilitation in the Danish TELEKAT (for Telehomecare, Chronic Patients and the Integrated Healthcare System) project, in order to better understand patients’ behavior when performing tele-rehabilitation activities in home surroundings. A total of 111 COPD patients were included in the study, and they were randomized into an intervention group (n = 60) and a control group (n = 51). However, a non-randomized design was used to analyze the qualitative perspectives of the patients’ attitudes towards tele-rehabilitation. From the intervention group, 22 COPD patients were selected for qualitative interviews and participant observation in their homes. The theoretical framework for this study is based on learning theory and the “communities of practice” approach inspired by Etienne Wenger. COPD patients exhibit four types of attitudes about their tele-rehabilitation: indifference, learning as part of situations in everyday life, feeling of security and motivation for performing physical training. The patients express the view that they circulate between these attitudes depending on their physical and emotional state as they perform their training. The COPD patients and healthcare professionals have created a community of tele-rehabilitation across sectors, exchanging experiences, stories and strategies for how to manage rehabilitation in home surroundings. Full article

(This article belongs to the Special Issue Advances in Telehealthcare)

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Open AccessReview

Methods for Recovering Microorganisms from Solid Surfaces Used in the Food Industry: A Review of the Literature

by Rached Ismaïl, Florence Aviat, Valérie Michel, Isabelle Le Bayon, Perrine Gay-Perret, Magdalena Kutnik and Michel Fédérighi

Int. J. Environ. Res. Public Health 2013, 10(11), 6169-6183; https://doi.org/10.3390/ijerph10116169 - 14 Nov 2013

Cited by 88 | Viewed by 12974

Abstract

Various types of surfaces are used today in the food industry, such as plastic, stainless steel, glass, and wood. These surfaces are subject to contamination by microorganisms responsible for the cross-contamination of food by contact with working surfaces. The HACCP-based processes are now [...] Read more.

Various types of surfaces are used today in the food industry, such as plastic, stainless steel, glass, and wood. These surfaces are subject to contamination by microorganisms responsible for the cross-contamination of food by contact with working surfaces. The HACCP-based processes are now widely used for the control of microbial hazards to prevent food safety issues. This preventive approach has resulted in the use of microbiological analyses of surfaces as one of the tools to control the hygiene of products. A method of recovering microorganisms from different solid surfaces is necessary as a means of health prevention. No regulation exists for surface microbial contamination, but food companies tend to establish technical specifications to add value to their products and limit contamination risks. The aim of this review is to present the most frequently used methods: swabbing, friction or scrubbing, printing, rinsing or immersion, sonication and scraping or grinding and describe their advantages and drawbacks. The choice of the recovery method has to be suitable for the type and size of the surface tested for microbiological analysis. Today, quick and cheap methods have to be standardized and especially easy to perform in the field. Full article

(This article belongs to the Special Issue Food Safety and Public Health)

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Open AccessArticle

Toxicology Testing in Fatally Injured Workers: A Review of Five Years of Iowa FACE Cases

by Marizen Ramirez, Ronald Bedford, Ryan Sullivan, T. Renee Anthony, John Kraemer, Brett Faine and Corinne Peek-Asa

Int. J. Environ. Res. Public Health 2013, 10(11), 6154-6168; https://doi.org/10.3390/ijerph10116154 - 14 Nov 2013

Cited by 12 | Viewed by 6977

Abstract

Toxicology testing of fatally injured workers is not routinely conducted. We completed a case-series study of 2005–2009 occupational fatalities captured by Iowa’s Fatality Assessment and Control Evaluation (FACE) Program. The goals of our research were to: (1) measure the proportion of FACE cases [...] Read more.

Toxicology testing of fatally injured workers is not routinely conducted. We completed a case-series study of 2005–2009 occupational fatalities captured by Iowa’s Fatality Assessment and Control Evaluation (FACE) Program. The goals of our research were to: (1) measure the proportion of FACE cases that undergo toxicology testing, and describe the factors associated with being tested, and (2) measure the rate of positive toxicology tests, the substances identified and the demographics and occupations of victims who tested positive. Case documents and toxicology laboratory reports were reviewed. There were 427 occupational deaths from 2005 to 2009. Only 69% underwent toxicology testing. Younger workers had greater odds of being tested. Among occupational groups, workers in farming, fishing and forestry had half the odds of being tested compared to other occupational groups. Of the 280 cases with toxicology tests completed, 22% (n = 61) were found to have positive toxicology testing. Commonly identified drug classes included cannabinoids and alcohols. Based on the small number of positive tests, older victims (65+ years) tested positive more frequently than younger workers. Management, business, science, arts, service and sales/office workers had proportionately more positive toxicology tests (almost 30%) compared with other workers (18–22%). These results identify an area in need of further research efforts and a potential target for injury prevention strategies. Full article

(This article belongs to the Special Issue Occupational Health)

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Open AccessReview

Mobile, Cloud, and Big Data Computing: Contributions, Challenges, and New Directions in Telecardiology

by Jui-Chien Hsieh, Ai-Hsien Li and Chung-Chi Yang

Int. J. Environ. Res. Public Health 2013, 10(11), 6131-6153; https://doi.org/10.3390/ijerph10116131 - 13 Nov 2013

Cited by 77 | Viewed by 14478

Abstract

Many studies have indicated that computing technology can enable off-site cardiologists to read patients’ electrocardiograph (ECG), echocardiography (ECHO), and relevant images via smart phones during pre-hospital, in-hospital, and post-hospital teleconsultation, which not only identifies emergency cases in need of immediate treatment, but also [...] Read more.

Many studies have indicated that computing technology can enable off-site cardiologists to read patients’ electrocardiograph (ECG), echocardiography (ECHO), and relevant images via smart phones during pre-hospital, in-hospital, and post-hospital teleconsultation, which not only identifies emergency cases in need of immediate treatment, but also prevents the unnecessary re-hospitalizations. Meanwhile, several studies have combined cloud computing and mobile computing to facilitate better storage, delivery, retrieval, and management of medical files for telecardiology. In the future, the aggregated ECG and images from hospitals worldwide will become big data, which should be used to develop an e-consultation program helping on-site practitioners deliver appropriate treatment. With information technology, real-time tele-consultation and tele-diagnosis of ECG and images can be practiced via an e-platform for clinical, research, and educational purposes. While being devoted to promote the application of information technology onto telecardiology, we need to resolve several issues: (1) data confidentiality in the cloud, (2) data interoperability among hospitals, and (3) network latency and accessibility. If these challenges are overcome, tele-consultation will be ubiquitous, easy to perform, inexpensive, and beneficial. Most importantly, these services will increase global collaboration and advance clinical practice, education, and scientific research in cardiology. Full article

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Open AccessArticle

IAServ: An Intelligent Home Care Web Services Platform in a Cloud for Aging-in-Place

by Chuan-Jun Su and Chang-Yu Chiang

Int. J. Environ. Res. Public Health 2013, 10(11), 6106-6130; https://doi.org/10.3390/ijerph10116106 - 12 Nov 2013

Cited by 32 | Viewed by 9585

Abstract

As the elderly population has been rapidly expanding and the core tax-paying population has been shrinking, the need for adequate elderly health and housing services continues to grow while the resources to provide such services are becoming increasingly scarce. Thus, increasing the efficiency [...] Read more.

As the elderly population has been rapidly expanding and the core tax-paying population has been shrinking, the need for adequate elderly health and housing services continues to grow while the resources to provide such services are becoming increasingly scarce. Thus, increasing the efficiency of the delivery of healthcare services through the use of modern technology is a pressing issue. The seamless integration of such enabling technologies as ontology, intelligent agents, web services, and cloud computing is transforming healthcare from hospital-based treatments to home-based self-care and preventive care. A ubiquitous healthcare platform based on this technological integration, which synergizes service providers with patients’ needs to be developed to provide personalized healthcare services at the right time, in the right place, and the right manner. This paper presents the development and overall architecture of IAServ (the Intelligent Aging-in-place Home care Web Services Platform) to provide personalized healthcare service ubiquitously in a cloud computing setting to support the most desirable and cost-efficient method of care for the aged-aging in place. The IAServ is expected to offer intelligent, pervasive, accurate and contextually-aware personal care services. Architecturally the implemented IAServ leverages web services and cloud computing to provide economic, scalable, and robust healthcare services over the Internet. Full article

(This article belongs to the Special Issue Next Generation of Interoperability in Health Care: Standards and Application)

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Open AccessReview

Impediments to Comprehensive Research on Climate Change and Health

by Anthony J. McMichael

Int. J. Environ. Res. Public Health 2013, 10(11), 6096-6105; https://doi.org/10.3390/ijerph10116096 - 12 Nov 2013

Cited by 23 | Viewed by 7020

Abstract

During every climatic era Life on Earth is constrained by a limited range of climatic conditions, outside which thriving and then surviving becomes difficult. This applies at both planetary and organism (species) levels. Further, many causal influences of climate change on human health [...] Read more.

During every climatic era Life on Earth is constrained by a limited range of climatic conditions, outside which thriving and then surviving becomes difficult. This applies at both planetary and organism (species) levels. Further, many causal influences of climate change on human health entail changes—often disruptive, sometimes irreversible—in complex system functioning. Understanding the diverse health risks from climate change, and their influence pathways, presents a challenge to environmental health researchers whose prior work has been in a more definable, specific and quantitative milieu. Extension of the research agenda and conceptual framework to assess present and future health risks from climate change may be constrained by three factors: (i) lack of historically-informed understanding of population-health sensitivity to climatic changes; (ii) an instinctual ‘epidemiologising’ tendency to choose research topics amenable to conventional epidemiological analysis and risk estimation; and (iii) under-confidence in relation to interdisciplinary collaborative scenario-based modeling of future health risks. These constraints must be recognized and remedied. And environmental researchers must argue for heightened public attention to today’s macro-environmental threats to present and future population health—emphasising the ecological dimension of these determinants of long-term health that apply to whole populations and communities, not just to individuals and social groupings. Full article

(This article belongs to the Special Issue Climate Change and Human Health)

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Open AccessArticle

How Do Grass Species, Season and Ensiling Influence Mycotoxin Content in Forage?

by Jiri Skladanka, Vojtech Adam, Petr Dolezal, Jan Nedelnik, Rene Kizek, Hana Linduskova, Jhonny Edison Alba Mejia and Adam Nawrath

Int. J. Environ. Res. Public Health 2013, 10(11), 6084-6095; https://doi.org/10.3390/ijerph10116084 - 12 Nov 2013

Cited by 19 | Viewed by 6776

Abstract

Mycotoxins are secondary metabolites produced by fungal species that have harmful effects on mammals. The aim of this study was to assess the content of mycotoxins in fresh-cut material of selected forage grass species both during and at the end of the growing [...] Read more.

Mycotoxins are secondary metabolites produced by fungal species that have harmful effects on mammals. The aim of this study was to assess the content of mycotoxins in fresh-cut material of selected forage grass species both during and at the end of the growing season. We further assessed mycotoxin content in subsequently produced first-cutting silages with respect to the species used in this study: Lolium perenne (cv. Kentaur), Festulolium pabulare (cv. Felina), Festulolium braunii (cv. Perseus), and mixtures of these species with Festuca rubra (cv. Gondolin) or Poa pratensis (Slezanka). The mycotoxins deoxynivalenol, zearalenone and T-2 toxin were mainly detected in the fresh-cut grass material, while fumonisin and aflatoxin contents were below the detection limits. July and October were the most risky periods for mycotoxins to occur. During the cold temperatures in November and December, the occurrence of mycotoxins in fresh-cut material declined. Although June was a period with low incidence of mycotoxins in green silage, contents of deoxynivalenol and zearalenone in silages from the first cutting exceeded by several times those determined in their biomass collected directly from the field. Moreover, we observed that use of preservatives or inoculants did not prevent mycotoxin production. Full article

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Open AccessReview

Flaviviruses in Europe: Complex Circulation Patterns and Their Consequences for the Diagnosis and Control of West Nile Disease

by Cécile Beck, Miguel Angel Jimenez-Clavero, Agnès Leblond, Benoît Durand, Norbert Nowotny, Isabelle Leparc-Goffart, Stéphan Zientara, Elsa Jourdain and Sylvie Lecollinet

Int. J. Environ. Res. Public Health 2013, 10(11), 6049-6083; https://doi.org/10.3390/ijerph10116049 - 12 Nov 2013

Cited by 148 | Viewed by 18377

Abstract

In Europe, many flaviviruses are endemic (West Nile, Usutu, tick-borne encephalitis viruses) or occasionally imported (dengue, yellow fever viruses). Due to the temporal and geographical co-circulation of flaviviruses in Europe, flavivirus differentiation by diagnostic tests is crucial in the adaptation of surveillance and [...] Read more.

In Europe, many flaviviruses are endemic (West Nile, Usutu, tick-borne encephalitis viruses) or occasionally imported (dengue, yellow fever viruses). Due to the temporal and geographical co-circulation of flaviviruses in Europe, flavivirus differentiation by diagnostic tests is crucial in the adaptation of surveillance and control efforts. Serological diagnosis of flavivirus infections is complicated by the antigenic similarities among the Flavivirus genus. Indeed, most flavivirus antibodies are directed against the highly immunogenic envelope protein, which contains both flavivirus cross-reactive and virus-specific epitopes. Serological assay results should thus be interpreted with care and confirmed by comparative neutralization tests using a panel of viruses known to circulate in Europe. However, antibody cross-reactivity could be advantageous in efforts to control emerging flaviviruses because it ensures partial cross-protection. In contrast, it might also facilitate subsequent diseases, through a phenomenon called antibody-dependent enhancement mainly described for dengue virus infections. Here, we review the serological methods commonly used in WNV diagnosis and surveillance in Europe. By examining past and current epidemiological situations in different European countries, we present the challenges involved in interpreting flavivirus serological tests and setting up appropriate surveillance programs; we also address the consequences of flavivirus circulation and vaccination for host immunity. Full article

(This article belongs to the Special Issue Epidemiology of West Nile Virus)

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Open AccessCommunication

Lithium in Tap Water and Suicide Mortality in Japan

by Norio Sugawara, Norio Yasui-Furukori, Nobuyoshi Ishii, Noboru Iwata and Takeshi Terao

Int. J. Environ. Res. Public Health 2013, 10(11), 6044-6048; https://doi.org/10.3390/ijerph10116044 - 12 Nov 2013

Cited by 56 | Viewed by 12842

Abstract

Lithium has been used as a mood-stabilizing drug in people with mood disorders. Previous studies have shown that natural levels of lithium in drinking water may protect against suicide. This study evaluated the association between lithium levels in tap water and the suicide [...] Read more.

Lithium has been used as a mood-stabilizing drug in people with mood disorders. Previous studies have shown that natural levels of lithium in drinking water may protect against suicide. This study evaluated the association between lithium levels in tap water and the suicide standardized mortality ratio (SMR) in 40 municipalities of Aomori prefecture, which has the highest levels of suicide mortality rate in Japan. Lithium levels in the tap water supplies of each municipality were measured using inductively coupled plasma-mass spectrometry. After adjusting for confounders, a statistical trend toward significance was found for the relationship between lithium levels and the average SMR among females. These findings indicate that natural levels of lithium in drinking water might have a protective effect on the risk of suicide among females. Future research is warranted to confirm this association. Full article

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Open AccessReview

Assessment of Infantile Mineral Imbalances in Autism Spectrum Disorders (ASDs)

by Hiroshi Yasuda and Toyoharu Tsutsui

Int. J. Environ. Res. Public Health 2013, 10(11), 6027-6043; https://doi.org/10.3390/ijerph10116027 - 11 Nov 2013

Cited by 72 | Viewed by 11604

Abstract

The interactions between genes and the environment are now regarded as the most probable explanation for autism. In this review, we summarize the results of a metallomics study in which scalp hair concentrations of 26 trace elements were examined for 1,967 autistic children [...] Read more.

The interactions between genes and the environment are now regarded as the most probable explanation for autism. In this review, we summarize the results of a metallomics study in which scalp hair concentrations of 26 trace elements were examined for 1,967 autistic children (1,553 males and 414 females aged 0–15 years-old), and discuss recent advances in our understanding of epigenetic roles of infantile mineral imbalances in the pathogenesis of autism. In the 1,967 subjects, 584 (29.7%) and 347 (17.6%) were found deficient in zinc and magnesium, respectively, and the incidence rate of zinc deficiency was estimated at 43.5% in male and 52.5% in female infantile subjects aged 0–3 years-old. In contrast, 339 (17.2%), 168 (8.5%) and 94 (4.8%) individuals were found to suffer from high burdens of aluminum, cadmium and lead, respectively, and 2.8% or less from mercury and arsenic. High toxic metal burdens were more frequently observed in the infants aged 0–3 years-old, whose incidence rates were 20.6%, 12.1%, 7.5%, 3.2% and 2.3% for aluminum, cadmium, lead, arsenic and mercury, respectively. These findings suggest that infantile zinc- and magnesium-deficiency and/or toxic metal burdens may be critical and induce epigenetic alterations in the genes and genetic regulation mechanisms of neurodevelopment in the autistic children, and demonstrate that a time factor “infantile window” is also critical for neurodevelopment and probably for therapy. Thus, early metallomics analysis may lead to early screening/estimation and treatment/prevention for the autistic neurodevelopment disorders. Full article

(This article belongs to the Special Issue The Environment Risk of Autism)

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Open AccessArticle

Fine Particulate Air Pollution and Hospital Admissions for Chronic Obstructive Pulmonary Disease: A Case-Crossover Study in Taipei

by Shang-Shyue Tsai, Chih-Ching Chang and Chun-Yuh Yang

Int. J. Environ. Res. Public Health 2013, 10(11), 6015-6026; https://doi.org/10.3390/ijerph10116015 - 11 Nov 2013

Cited by 95 | Viewed by 8890

Abstract

We undertook this study to investigate whether there is an association between atmospheric fine particles (PM_2.5) levels and inpatient admissions for chronic obstructive pulmonary disease (COPD) in Taipei, Taiwan. Data on inpatient admissions for COPD and ambient on air pollution levels [...] Read more.

We undertook this study to investigate whether there is an association between atmospheric fine particles (PM_2.5) levels and inpatient admissions for chronic obstructive pulmonary disease (COPD) in Taipei, Taiwan. Data on inpatient admissions for COPD and ambient on air pollution levels in Taipei were obtained for years 2006 to 2010. We estimated the relative risk of inpatient admissions for COPD using a case-crossover design with the following control variables: weather measures, day of the week, seasonality, and long-term time trends. For the single-pollutant model (not controlling for other atmospheric pollutants), COPD admissions were significantly and positively associated with higher PM_2.5 levels during both warm days (>23 °C) and cool days (<23 °C), with an interquartile range increase of 12% (95% CI = 8–16%) and 3% (95% CI = 0–7%) in COPD admissions, respectively. In the two-pollutant models, PM_2.5 remained significant even controlling for SO₂ or O₃ on both warm and cool days. Taken as a whole, our study demonstrates that higher levels of PM_2.5 may increase the risk of inpatient admissions for COPD. Full article

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Open AccessArticle

Twelve-Months Follow-up of Supervised Exercise after Percutaneous Transluminal Angioplasty for Intermittent Claudication: A Randomised Clinical Trial

by Elisabeth Bø, Jonny Hisdal, Milada Cvancarova, Einar Stranden, Jørgen J. Jørgensen, Gunnar Sandbæk, Ole J. Grøtta and Astrid Bergland

Int. J. Environ. Res. Public Health 2013, 10(11), 5998-6014; https://doi.org/10.3390/ijerph10115998 - 11 Nov 2013

Cited by 20 | Viewed by 8106

Abstract

The aim of this study was to explore the effects during 12 months follow-up of 12 weeks of supervised exercise therapy (SET) after percutaneous transluminal angioplasty (PTA) compared to PTA alone on physical function, limb hemodynamics and health-related quality of life (HRQoL) in [...] Read more.

The aim of this study was to explore the effects during 12 months follow-up of 12 weeks of supervised exercise therapy (SET) after percutaneous transluminal angioplasty (PTA) compared to PTA alone on physical function, limb hemodynamics and health-related quality of life (HRQoL) in patients with intermittent claudication. Fifty patients were randomised to an intervention or a control group. Both groups received usual post-operative care and follow-up measurements at three, six and 12 months after PTA. The intervention group performed 12 weeks of SET after PTA. The control group did not receive any additional follow-up regarding exercise. During the 12 months’ follow-up, the members of the intervention group had significantly better walking distance than the control group. The intervention group had a significantly higher HRQoL score in the physical component score of the SF-36, and the domains of physical function, bodily pain and vitality. For limb hemodynamics, there was a non-significant trend towards better results in the intervention group compared to the control group. Conclusion: SET after PTA yielded statistically significantly better results for walking distance and HRQoL in the intervention group than the control group during the 12 months of follow-up. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessArticle

by Marie-Louise Bird, Jane K. Pittaway, Isobel Cuisick, Megan Rattray and Kiran D. K. Ahuja

Int. J. Environ. Res. Public Health 2013, 10(11), 5989-5997; https://doi.org/10.3390/ijerph10115989 - 11 Nov 2013

Cited by 50 | Viewed by 8443

Abstract

As the population ages, fall rates are expected to increase, leading to a rise in accidental injury and injury-related deaths, and placing an escalating burden on health care systems. Sixty-nine independent community-dwelling adults (60–85 years, 18 males) had their leg strength, physical activity [...] Read more.

As the population ages, fall rates are expected to increase, leading to a rise in accidental injury and injury-related deaths, and placing an escalating burden on health care systems. Sixty-nine independent community-dwelling adults (60–85 years, 18 males) had their leg strength, physical activity levels and their annual fall rate assessed at two timepoints over three years, (summer 2010 and summer 2013) monitoring balance. Force platform measures of medio-lateral sway range increased significantly under conditions of eyes open (mean difference MD 2.5 cm; 95% CI 2.2 to 2.8 cm) and eyes closed (MD 3.2 cm; 95% CI 2.8 to 3.6 cm), respectively (all p < 0.001) indicating worsening static balance control. Dynamic balance showed similar changes (p < 0.036). Leg strength was not significantly different between visits (p > 0.26). Physical activity reduced significantly (MD −909 Cal/week; 95% CI −347 to −1,470 Cal/week; p = 0.002) during the course of the study. Participants maintained aerobic activities, however resistance and balance exercise levels decreased non-significantly. The likelihood of falling was higher at the end of the study compared to the first timepoint (odds ratio 1.93, 95% CI 0.94 to 3.94; p = 0.07). Results of this study indicate that despite maintenance of leg strength there was an increase in medio-lateral sway over a relatively short time frame, with higher than expected increases in fall rates. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessReview

Economic Rationality in Choosing between Short-Term Bad-Health Choices and Longer-Term Good-Health Choices

by David Campbell

Int. J. Environ. Res. Public Health 2013, 10(11), 5971-5988; https://doi.org/10.3390/ijerph10115971 - 8 Nov 2013

Cited by 10 | Viewed by 7578

Abstract

Non-contagious, chronic disease has been identified as a global health risk. Poor lifestyle choices, such as smoking, alcohol, drug and solvent abuse, physical inactivity, and unhealthy diet have been identified as important factors affecting the increasing incidence of chronic disease. The following focuses [...] Read more.

Non-contagious, chronic disease has been identified as a global health risk. Poor lifestyle choices, such as smoking, alcohol, drug and solvent abuse, physical inactivity, and unhealthy diet have been identified as important factors affecting the increasing incidence of chronic disease. The following focuses on the circumstance affecting the lifestyle or behavioral choices of Aboriginal and Torres Strait Islander peoples in remote-/very remote Australia. Poor behavioral choices are the result of endogenous characteristics that are influenced by a range of stressful exogenous variables making up the psychosocial determinants including social disenfranchisement, cultural loss, insurmountable tasks, the loss of volitional control and resource constraints. It is shown that poor behavioral choices can be economically rational; especially under highly stressful conditions. Stressful circumstances erode individual capacity to commit to long-term positive health alternatives such as self-investment in education. Policies directed at removing the impediments and providing incentives to behaviors involving better health choices can lead to reductions in smoking and alcohol consumption and improved health outcomes. Multijurisdictional culturally acceptable policies directed at distal variables relating to the psychosocial determinants of health and personal mastery and control can be cost effective. While the content of this paper is focused on the conditions of colonized peoples, it has broader relevance. Full article

(This article belongs to the Special Issue Economics of Prevention of Alcohol and Tobacco Related Harms)

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Open AccessArticle

A General Model of Dioxin Contamination in Breast Milk: Results from a Study on 94 Women from the Caserta and Naples Areas in Italy

by Gaetano Rivezzi, Prisco Piscitelli, Giampiero Scortichini, Armando Giovannini, Gianfranco Diletti, Giacomo Migliorati, Roberta Ceci, Giulia Rivezzi, Lorenzo Cirasino, Pietro Carideo, Dennis M. Black, Carmine Garzillo and Umberto Giani

Int. J. Environ. Res. Public Health 2013, 10(11), 5953-5970; https://doi.org/10.3390/ijerph10115953 - 8 Nov 2013

Cited by 25 | Viewed by 8086

Abstract

Background: The Caserta and Naples areas in Campania Region experience heavy environmental contamination due to illegal waste disposal and burns, thus representing a valuable setting to develop a general model of human contamination with dioxins (PCDDs-PCDFs) and dioxin-like-PCBs (dl-PCBs). Methods: 94 [...] Read more.

Background: The Caserta and Naples areas in Campania Region experience heavy environmental contamination due to illegal waste disposal and burns, thus representing a valuable setting to develop a general model of human contamination with dioxins (PCDDs-PCDFs) and dioxin-like-PCBs (dl-PCBs). Methods: 94 breastfeeding women (aged 19–32 years; mean age 27.9 ± 3.0) were recruited to determine concentrations of PCDDs-PCDFs and dl-PCBs in their milk. Individual milk samples were collected and analyzed according to standard international procedures. A generalized linear model was used to test potential predictors of pollutant concentration in breast milk: age, exposure to waste fires, cigarette smoking, diet, and residence in high/low risk area (defined at high/low environmental pressure by a specific 2007 WHO report). A Structural Equation Model (SEM) analysis was carried out by taking into account PCDDs-PCDFs and dl-PCBs as endogenous variables and age, waste fires, risk area and smoking as exogenous variables. Results: All milk samples were contaminated by PCDDs-PCDFs (8.6 pg WHO-TEQ/98g fat ± 2.7; range 3.8–19) and dl-PCBs (8.0 pg WHO-TEQ/98g fat ± 3.7; range 2.5–24), with their concentrations being associated with age and exposure to waste fires (p < 0.01). Exposure to fires resulted in larger increases of dioxins concentrations in people living in low risk areas than those from high risk areas (p < 0.01). Conclusions: A diffuse human exposure to persistent organic pollutants was observed in the Caserta and Naples areas. Dioxins concentration in women living in areas classified at low environmental pressure in 2007 WHO report was significantly influenced by exposure to burns. Full article

(This article belongs to the Special Issue Recent Advances on Environmental and Toxicologic Pathology)

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Open AccessArticle

Biomedical Progress Rates as New Parameters for Models of Economic Growth in Developed Countries

by Alex Zhavoronkov and Maria Litovchenko

Int. J. Environ. Res. Public Health 2013, 10(11), 5936-5952; https://doi.org/10.3390/ijerph10115936 - 8 Nov 2013

Cited by 18 | Viewed by 15345

Abstract

While the doubling of life expectancy in developed countries during the 20th century can be attributed mostly to decreases in child mortality, the trillions of dollars spent on biomedical research by governments, foundations and corporations over the past sixty years are also yielding [...] Read more.

While the doubling of life expectancy in developed countries during the 20th century can be attributed mostly to decreases in child mortality, the trillions of dollars spent on biomedical research by governments, foundations and corporations over the past sixty years are also yielding longevity dividends in both working and retired population. Biomedical progress will likely increase the healthy productive lifespan and the number of years of government support in the old age. In this paper we introduce several new parameters that can be applied to established models of economic growth: the biomedical progress rate, the rate of clinical adoption and the rate of change in retirement age. The biomedical progress rate is comprised of the rejuvenation rate (extending the productive lifespan) and the non-rejuvenating rate (extending the lifespan beyond the age at which the net contribution to the economy becomes negative). While staying within the neoclassical economics framework and extending the overlapping generations (OLG) growth model and assumptions from the life cycle theory of saving behavior, we provide an example of the relations between these new parameters in the context of demographics, labor, households and the firm. Full article

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Open AccessArticle

Did We Get Our Money’s Worth? Bridging Economic and Behavioral Measures of Program Success in Adolescent Drug Prevention

by Kevin N. Griffith and Lawrence M. Scheier

Int. J. Environ. Res. Public Health 2013, 10(11), 5908-5935; https://doi.org/10.3390/ijerph10115908 - 8 Nov 2013

Cited by 2 | Viewed by 6424

Abstract

The recent U.S. Congressional mandate for creating drug-free learning environments in elementary and secondary schools stipulates that education reform rely on accountability, parental and community involvement, local decision making, and use of evidence-based drug prevention programs. By necessity, this charge has been paralleled [...] Read more.

The recent U.S. Congressional mandate for creating drug-free learning environments in elementary and secondary schools stipulates that education reform rely on accountability, parental and community involvement, local decision making, and use of evidence-based drug prevention programs. By necessity, this charge has been paralleled by increased interest in demonstrating that drug prevention programs net tangible benefits to society. One pressing concern is precisely how to integrate traditional scientific methods of program evaluation with economic measures of “cost efficiency”. The languages and methods of each respective discipline don’t necessarily converge on how to establish the true benefits of drug prevention. This article serves as a primer for conducting economic analyses of school-based drug prevention programs. The article provides the reader with a foundation in the relevant principles, methodologies, and benefits related to conducting economic analysis. Discussion revolves around how economists value the potential costs and benefits, both financial and personal, from implementing school-based drug prevention programs targeting youth. Application of heterogeneous costing methods coupled with widely divergent program evaluation findings influences the feasibility of these techniques and may hinder utilization of these practices. Determination of cost-efficiency should undoubtedly become one of several markers of program success and contribute to the ongoing debate over health policy. Full article

(This article belongs to the Special Issue Economics of Prevention of Alcohol and Tobacco Related Harms)

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Open AccessReview

The Role of Environmental Reservoirs in Human Campylobacteriosis

by Harriet Whiley, Ben Van den Akker, Steven Giglio and Richard Bentham

Int. J. Environ. Res. Public Health 2013, 10(11), 5886-5907; https://doi.org/10.3390/ijerph10115886 - 8 Nov 2013

Cited by 121 | Viewed by 9785

Abstract

Campylobacteriosis is infection caused by the bacteria Campylobacter spp. and is considered a major public health concern. Campylobacter spp. have been identified as one of the most common causative agents of bacterial gastroenteritis. They are typically considered a foodborne pathogen and have been [...] Read more.

Campylobacteriosis is infection caused by the bacteria Campylobacter spp. and is considered a major public health concern. Campylobacter spp. have been identified as one of the most common causative agents of bacterial gastroenteritis. They are typically considered a foodborne pathogen and have been shown to colonise the intestinal mucosa of all food-producing animals. Much emphasis has been placed on controlling the foodborne pathway of exposure, particularly within the poultry industry, however, other environmental sources have been identified as important contributors to human infection. This paper aims to review the current literature on the sources of human exposure to Campylobacter spp. and will cover contaminated poultry, red meat, unpasteurised milk, unwashed fruit and vegetables, compost, wild bird faeces, sewage, surface water, ground water and drinking water. A comparison of current Campylobacter spp. identification methods from environmental samples is also presented. The review of literature suggests that there are multiple and diverse sources for Campylobacter infection. Many environmental sources result in direct human exposure but also in contamination of the food processing industry. This review provides useful information for risk assessment. Full article

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Open AccessCommunication

Urban Ecosystem Health Assessment: Perspectives and Chinese Practice

by Meirong Su, Yan Zhang, Gengyuan Liu, Linyu Xu, Lixiao Zhang and Zhifeng Yang

Int. J. Environ. Res. Public Health 2013, 10(11), 5874-5885; https://doi.org/10.3390/ijerph10115874 - 6 Nov 2013

Cited by 24 | Viewed by 7230

Abstract

The concept of ecosystem health is a way to assess the holistic operations and development potential of urban ecosystems. Accelerated by the practical need for integrated ecosystem management, assessment of urban ecosystem health has been greatly developed and extensively applied in urban planning [...] Read more.

The concept of ecosystem health is a way to assess the holistic operations and development potential of urban ecosystems. Accelerated by the practical need for integrated ecosystem management, assessment of urban ecosystem health has been greatly developed and extensively applied in urban planning and management. Development is aimed at comprehensively evaluating the performance of urban ecosystems, identifying the limiting factors, and providing suggestions for urban regulation. The time has come for reviewing and establishing an instructional framework for urban ecosystem health assessment to shed light on certain essential issues of urban ecosystem health. Based on literature reviews and series of practice, a holistic framework of urban ecosystem health assessment is proposed. The framework covers the essential elements of urban ecosystem health and integrates three dimensions: theoretical foundation, assessment method, and practical application. Concrete assessment methods are also established, focusing on both external performance and internal metabolic processes. The practice of urban ecosystem health assessment in China is illustrated to briefly demonstrate the application of the established framework and methods. Some prospects are discussed for urban ecosystem health assessment and its application in urban planning and management. Full article

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Open AccessArticle

Psychosocial Job Strain and Sleep Quality Interaction Leading to Insufficient Recovery

by Leif W. Rydstedt and Jason J. Devereux

Int. J. Environ. Res. Public Health 2013, 10(11), 5863-5873; https://doi.org/10.3390/ijerph10115863 - 5 Nov 2013

Cited by 5 | Viewed by 5802

Abstract

The purpose of the study was to assess the impact of job strain and sleep quality on the diurnal pattern of cortisol reactivity, measured by awakening and evening (10 PM) saliva cortisol. The sample consisted of 76 British white-collar workers (24 women, 52 [...] Read more.

The purpose of the study was to assess the impact of job strain and sleep quality on the diurnal pattern of cortisol reactivity, measured by awakening and evening (10 PM) saliva cortisol. The sample consisted of 76 British white-collar workers (24 women, 52 men; mean age 45.8 years). Sleep quality and job strain were assessed in a survey distributed just before the cortisol sampling. Both input variables were dichotomized about the median and factorial ANOVA was used for the statistical analysis. Low sleep quality was significantly associated with lower morning cortisol secretion. While job strain had no main effects on the cortisol reactivity there was a significant interaction effect between the input variables on morning cortisol secretion. These findings tentatively support the hypothesis that lack of sleep for workers with high job strain may result in a flattened diurnal cortisol reactivity. Full article

(This article belongs to the Special Issue Job Stress and Health)

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Open AccessArticle

NO₂ and Cancer Incidence in Saudi Arabia

by Khalid Al-Ahmadi and Ali Al-Zahrani

Int. J. Environ. Res. Public Health 2013, 10(11), 5844-5862; https://doi.org/10.3390/ijerph10115844 - 4 Nov 2013

Cited by 51 | Viewed by 11482

Abstract

Air pollution exposure has been shown to be associated with an increased risk of specific cancers. This study investigated whether the number and incidence of the most common cancers in Saudi Arabia were associated with urban air pollution exposure, specifically NO₂. [...] Read more.

Air pollution exposure has been shown to be associated with an increased risk of specific cancers. This study investigated whether the number and incidence of the most common cancers in Saudi Arabia were associated with urban air pollution exposure, specifically NO₂. Overall, high model goodness of fit (GOF) was observed in the Eastern, Riyadh and Makkah regions. The significant coefficients of determination (r²) were higher at the regional level (r² = 0.32–0.71), weaker at the governorate level (r² = 0.03–0.43), and declined slightly at the city level (r² = 0.17–0.33), suggesting that an increased aggregated spatial level increased the explained variability and the model GOF. However, the low GOF at the lowest spatial level suggests that additional variation remains unexplained. At different spatial levels, associations between NO₂ concentration and the most common cancers were marginally improved in geographically weighted regression (GWR) analysis, which explained both global and local heterogeneity and variations in cancer incidence. High coefficients of determination were observed between NO₂ concentration and lung and breast cancer incidences, followed by prostate, bladder, cervical and ovarian cancers, confirming results from other studies. These results could be improved using individual explanatory variables such as environmental, demographic, behavioral, socio-economic, and genetic risk factors. Full article

(This article belongs to the Special Issue Spatial Epidemiology)

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Open AccessArticle

Assessing the Mobility of Lead, Copper and Cadmium in a Calcareous Soil of Port-au-Prince, Haiti

by Urbain Fifi, Thierry Winiarski and Evens Emmanuel

Int. J. Environ. Res. Public Health 2013, 10(11), 5830-5843; https://doi.org/10.3390/ijerph10115830 - 4 Nov 2013

Cited by 31 | Viewed by 7306

Abstract

The presence of heavy metals in the environment constitutes a potential source of both soil and groundwater pollution. This study has focused on the reactivity of lead (Pb), copper (Cu) and Cadmium (Cd) during their transfer in a calcareous soil of Port-au-Prince (Haiti). [...] Read more.

The presence of heavy metals in the environment constitutes a potential source of both soil and groundwater pollution. This study has focused on the reactivity of lead (Pb), copper (Cu) and Cadmium (Cd) during their transfer in a calcareous soil of Port-au-Prince (Haiti). Kinetic, monometal and competitive batch tests were carried out at pH 6.0. Two simplified models including pseudo-first-order and pseudo-second-order were used to fit the experimental data from kinetics adsorption batch tests. A good fit of these data was found with pseudo-second-order kinetic model which indicates the applicability of this model to describe the adsorption rates of these metals on the soil. Monometal batch tests indicated that both Langmuir and Freundlich models allowed a good fit for experimental data. On the basis of the maximum adsorption capacity (q_max), the order affinity of Pb, Cu and Cd for the studied soil was Pb²⁺ > Cu²⁺ > Cd²⁺. Competitive sorption has proved that the competition between two or several cations on soils for the same active sites can decrease their q_max. These results show that, at high metal concentrations, Cd may pose more threat in soils and groundwater of Port-au-Prince than Pb and Cu. Full article

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Open AccessArticle

Use of a Time-of-Flight Camera With an Omek Beckon™ Framework to Analyze, Evaluate and Correct in Real Time the Verticality of Multiple Sclerosis Patients during Exercise

by Gonzalo Eguíluz and Begoña García Zapirain

Int. J. Environ. Res. Public Health 2013, 10(11), 5807-5829; https://doi.org/10.3390/ijerph10115807 - 4 Nov 2013

Cited by 7 | Viewed by 8974

Abstract

Any person with Multiple Sclerosis (MS), regardless of the severity of their disability, needs regular physical activity. Poorly performed exercises could aggravate muscle imbalances and worsen the patient’s health. In this paper, we propose a human body verticality detection system using a time-of-flight [...] Read more.

Any person with Multiple Sclerosis (MS), regardless of the severity of their disability, needs regular physical activity. Poorly performed exercises could aggravate muscle imbalances and worsen the patient’s health. In this paper, we propose a human body verticality detection system using a time-of-flight camera as a tool to detect incorrect postures and improve them in real time. The prototype uses Omek’s Beckon™ Framework to analyze and evaluate the position of patients during exercise. Preliminary results, based on objective questionnaires, indicate an improvement in patients’ evolution through better positions and performance of the exercises. Full article

(This article belongs to the Special Issue Advances in Telehealthcare)

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Open AccessReview

Overview of Evidence in Prevention and Aetiology of Food Allergy: A Review of Systematic Reviews

by Caroline J. Lodge, Katrina J. Allen, Adrian J. Lowe and Shyamali C. Dharmage

Int. J. Environ. Res. Public Health 2013, 10(11), 5781-5806; https://doi.org/10.3390/ijerph10115781 - 4 Nov 2013

Cited by 21 | Viewed by 8200

Abstract

The worldwide prevalence of food allergy appears to be increasing. Early life environmental factors are implicated in the aetiology of this global epidemic. The largest burden of disease is in early childhood, where research efforts aimed at prevention have been focused. Evidence synthesis [...] Read more.

The worldwide prevalence of food allergy appears to be increasing. Early life environmental factors are implicated in the aetiology of this global epidemic. The largest burden of disease is in early childhood, where research efforts aimed at prevention have been focused. Evidence synthesis from good quality systematic reviews is needed. We performed an overview of systematic reviews concerning the prevention and aetiology of food allergy, retrieving 14 systematic reviews, which covered three broad topics: formula (hydrolysed or soy) for the prevention of food allergy or food sensitization; maternal and infant diet and dietary supplements for the prevention of food allergy or food sensitization and hygiene hypothesis-related interventions. Using the AMSTAR criteria for assessment of methodological quality, we found five reviews to be of high quality, seven of medium quality and two of low quality. Overall we found no compelling evidence that any of the interventions that had been systematically reviewed were related to the risk of food allergy. Updating of existing reviews, and production of new systematic reviews, are needed in areas where evidence is emerging for interventions and environmental associations. Furthermore, additional primary studies, with greater numbers of participants and objective food allergy definitions are urgently required. Full article

(This article belongs to the Special Issue Food Allergy, Genes and Environment)

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Open AccessReview

Simulation Models for Socioeconomic Inequalities in Health: A Systematic Review

by Niko Speybroeck, Carine Van Malderen, Sam Harper, Birgit Müller and Brecht Devleesschauwer

Int. J. Environ. Res. Public Health 2013, 10(11), 5750-5780; https://doi.org/10.3390/ijerph10115750 - 4 Nov 2013

Cited by 26 | Viewed by 11180

Abstract

Background: The emergence and evolution of socioeconomic inequalities in health involves multiple factors interacting with each other at different levels. Simulation models are suitable for studying such complex and dynamic systems and have the ability to test the impact of policy interventions [...] Read more.

Background: The emergence and evolution of socioeconomic inequalities in health involves multiple factors interacting with each other at different levels. Simulation models are suitable for studying such complex and dynamic systems and have the ability to test the impact of policy interventions in silico. Objective: To explore how simulation models were used in the field of socioeconomic inequalities in health. Methods: An electronic search of studies assessing socioeconomic inequalities in health using a simulation model was conducted. Characteristics of the simulation models were extracted and distinct simulation approaches were identified. As an illustration, a simple agent-based model of the emergence of socioeconomic differences in alcohol abuse was developed. Results: We found 61 studies published between 1989 and 2013. Ten different simulation approaches were identified. The agent-based model illustration showed that multilevel, reciprocal and indirect effects of social determinants on health can be modeled flexibly. Discussion and Conclusions: Based on the review, we discuss the utility of using simulation models for studying health inequalities, and refer to good modeling practices for developing such models. The review and the simulation model example suggest that the use of simulation models may enhance the understanding and debate about existing and new socioeconomic inequalities of health frameworks. Full article

(This article belongs to the Special Issue Inequalities in Health)

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Open AccessArticle

Effect of Urinary Bisphenol A on Androgenic Hormones and Insulin Resistance in Preadolescent Girls: A Pilot Study from the Ewha Birth & Growth Cohort

by Hye Ah Lee, Young Ju Kim, Hwayoung Lee, Hye Sun Gwak, Eun Ae Park, Su Jin Cho, Hae Soon Kim, Eun Hee Ha and Hyesook Park

Int. J. Environ. Res. Public Health 2013, 10(11), 5737-5749; https://doi.org/10.3390/ijerph10115737 - 1 Nov 2013

Cited by 20 | Viewed by 6444

Abstract

To assess the effect of urinary bisphenol A (BPA) on repeated measurements of androgenic hormones and metabolic indices, we used multivariate analysis of variance (MANOVA) adjusted for potential confounders at baseline. During July to August 2011, 80 preadolescent girls enrolled in the Ewha [...] Read more.

To assess the effect of urinary bisphenol A (BPA) on repeated measurements of androgenic hormones and metabolic indices, we used multivariate analysis of variance (MANOVA) adjusted for potential confounders at baseline. During July to August 2011, 80 preadolescent girls enrolled in the Ewha Birth & Growth Cohort study participated in a follow-up study and then forty-eight of them (60.0%) came back one year later. Baseline levels of estradiol and androstenedione were higher in the BPA group than in the non-BPA group. One year later, girls in the high BPA exposure group showed higher levels of androstenedione, testosterone, estradiol, and insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) index, than those in the other groups (p < 0.05). In MANOVA, estradiol and androstenedione showed significant differences among groups, while dehydroepiandrosterone, insulin, and HOMA-IR showed marginally significant differences. Exposure to BPA may affect endocrine metabolism in preadolescents. However, further investigation is required to elucidate the mechanisms linking BPA with regulation of androgenic hormones. Full article

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Open AccessArticle

Estimated Fluoride Doses from Toothpastes Should be Based on Total Soluble Fluoride

by Maria José L. Oliveira, Carolina C. Martins, Saul M. Paiva, Livia M. A. Tenuta and Jaime A. Cury

Int. J. Environ. Res. Public Health 2013, 10(11), 5726-5736; https://doi.org/10.3390/ijerph10115726 - 1 Nov 2013

Cited by 18 | Viewed by 8490

Abstract

The fluoride dose ingested by young children may be overestimated if based on levels of total fluoride (TF) rather than levels of bioavailable fluoride (total soluble fluoride—TSF) in toothpaste. The aim of the present study was to compare doses of fluoride intake based [...] Read more.

The fluoride dose ingested by young children may be overestimated if based on levels of total fluoride (TF) rather than levels of bioavailable fluoride (total soluble fluoride—TSF) in toothpaste. The aim of the present study was to compare doses of fluoride intake based on TF and TSF. Fluoride intake in 158 Brazilian children aged three and four years was determined after tooth brushing with their usual toothpaste (either family toothpaste (n = 80) or children’s toothpaste (n = 78)). The estimated dose (mg F/day/Kg of body weight) of TF or TSF ingested was calculated from the chemical analysis of the toothpastes. Although the ingested dose of TF from the family toothpastes was higher than that from the children’s toothpastes (0.074 ± 0.007 and 0.039 ± 0.003 mg F/day/Kg, respectively; p < 0.05), no difference between types of toothpaste was found regarding the ingested dose based on TSF (0.039 ± 0.005 and 0.039 ± 0.005 mg F/day/Kg, respectively; p > 0.05). The fluoride dose ingested by children from toothpastes may be overestimated if based on the TF of the product. This finding suggests that the ingested dose should be calculated based on TSF. Dose of TSF ingested by children is similar whether family or children’s toothpaste is used. Full article

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Open AccessArticle

Active Transportation Safety Features around Schools in Canada

by Bryn Pinkerton, Andrei Rosu, Ian Janssen and William Pickett

Int. J. Environ. Res. Public Health 2013, 10(11), 5711-5725; https://doi.org/10.3390/ijerph10115711 - 31 Oct 2013

Cited by 3 | Viewed by 6516

Abstract

The purpose of this study was to describe the presence and quality of active transportation safety features in Canadian school environments that relate to pedestrian and bicycle safety. Variations in these features and associated traffic concerns as perceived by school administrators were examined [...] Read more.

The purpose of this study was to describe the presence and quality of active transportation safety features in Canadian school environments that relate to pedestrian and bicycle safety. Variations in these features and associated traffic concerns as perceived by school administrators were examined by geographic status and school type. The study was based on schools that participated in 2009/2010 Health Behaviour in School-aged Children (HBSC) survey. ArcGIS software version 10 and Google Earth were used to assess the presence and quality of ten different active transportation safety features. Findings suggest that there are crosswalks and good sidewalk coverage in the environments surrounding most Canadian schools, but a dearth of bicycle lanes and other traffic calming measures (e.g., speed bumps, traffic chokers). Significant urban/rural inequities exist with a greater prevalence of sidewalk coverage, crosswalks, traffic medians, and speed bumps in urban areas. With the exception of bicycle lanes, the active transportation safety features that were present were generally rated as high quality. Traffic was more of a concern to administrators in urban areas. This study provides novel information about active transportation safety features in Canadian school environments. This information could help guide public health efforts aimed at increasing active transportation levels while simultaneously decreasing active transportation injuries. Full article

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Open AccessArticle

A Telerehabilitation Program Improves Postural Control in Multiple Sclerosis Patients: A Spanish Preliminary Study

by Rosa Ortiz-Gutiérrez, Roberto Cano-de-la-Cuerda, Fernando Galán-del-Río, Isabel María Alguacil-Diego, Domingo Palacios-Ceña and Juan Carlos Miangolarra-Page

Int. J. Environ. Res. Public Health 2013, 10(11), 5697-5710; https://doi.org/10.3390/ijerph10115697 - 31 Oct 2013

Cited by 85 | Viewed by 12397

Abstract

Postural control disorders are among the most frequent motor disorder symptoms associated with multiple sclerosis. This study aims to demonstrate the potential improvements in postural control among patients with multiple sclerosis who complete a telerehabilitation program that represents a feasible alternative to physical [...] Read more.

Postural control disorders are among the most frequent motor disorder symptoms associated with multiple sclerosis. This study aims to demonstrate the potential improvements in postural control among patients with multiple sclerosis who complete a telerehabilitation program that represents a feasible alternative to physical therapy for situations in which conventional treatment is not available. Fifty patients were recruited. Control group (n = 25) received physiotherapy treatment twice a week (40 min per session). Experimental group (n = 25) received monitored telerehabilitation treatment via videoconference using the Xbox 360^®and Kinect console. Experimental group attended 40 sessions, four sessions per week (20 min per session).The treatment schedule lasted 10 weeks for both groups. A computerized dynamic posturography (Sensory Organization Test) was used to evaluate all patients at baseline and at the end of the treatment protocol. Results showed an improvement over general balance in both groups. Visual preference and the contribution of vestibular information yielded significant differences in the experimental group. Our results demonstrated that a telerehabilitation program based on a virtual reality system allows one to optimize the sensory information processing and integration systems necessary to maintain the balance and postural control of people with multiple sclerosis. We suggest that our virtual reality program enables anticipatory PC and response mechanisms and might serve as a successful therapeutic alternative in situations in which conventional therapy is not readily available. Full article

(This article belongs to the Special Issue Advances in Telehealthcare)

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Int. J. Environ. Res. Public Health, Volume 10, Issue 11 (November 2013) – 52 articles , Pages 5257-6214

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