This article presents a telemonitoring tool based on computer games, aimed at money management skill improvement for people with Intellectual Disabilities (ID). The presented tool is divided into two parts: on one hand, some training activities related to payments and currency discrimination based on Serious Games are proposed to the user using a multitouch device. On the other hand, the psychologists and specialist who work with them, can access to the Serious Games results using an online application in order to evaluate their evolution. The results are measured according to the number of errors they have during the proposed activities, the time they need to complete them and the score. The article show the results of an experiment made with a clinical sample of 12 users with ID between 12 and 15 years, taking into account that all of them are capable of correct oral communication and they do not have severe physical coordination problems. Only two users completed all the games without errors. Males obtained a mean of 28.25 errors, whereas females obtained a mean of 17.75. The results show significant difference between the selection of games 1, 2 or 3, because all of them prefer the game 1 related with “Payments” probably because it permits more interaction using the multitouch device. The authors also made a qualitative evaluation and the results have been very promising and satisfactory. Full article

Industrial effluent containing heavy metals discharged into streams may pose high toxicity risks to aquatic organisms and to human health. Therefore, it is important to understand how to change the amount of effluent with heavy metals discharged from industries into open aquatic ecosystems both for effective management of heavy metals and to foster sustainable ecosystems. This study was conducted to characterize the release of heavy metals from industries based on the Pollutant Release and Transfer Registers database in Korea from 1999 to 2010. From the database, we selected nine heavy metals (Pb, Cd, Mn, Sb, Cu, Zn, Cr, Sn, and Ni) and compared the differences in their effluent for different types of industries. The heavy metal effluents released into freshwater ecosystems were classified into four clusters through the learning process of the self-organizing map. Cluster 1 was characterized by the relatively higher effluent volumes of heavy metals, whereas cluster 4 had lower effluent volumes. The different patterns of the effluent volumes in heavy metals were closely associated with the differences of industrial types, and the changes of effluents of heavy metals reflected the changes in regulations and laws for aquatic ecosystem management. Full article

This study aims to estimate the number of life years gained with quitting smoking in Italian smokers of both sexes, by number of cigarettes smoked per day (cig/day) and age at cessation. All-cause mortality tables by age, sex and smoking status were computed, based on Italian smoking data, and the survival curves of former and current smokers were compared. The more cig/day a man/woman smokes, and the younger his/her age of quitting smoking, the more years of life he/she gains with cessation. In fact, cessation at age 30, 40, 50, or 60 years gained, respectively, about 7, 7, 6, or 5, and 5, 5, 4, or 3 years of life, respectively, for men and women that smoked 10–19 cig/day. The gain in life years was higher for heavy smokers (9 years for >20 cig/day) and lower for light smokers (4 years for 1–9 cig/day). Consistently with prospective studies conducted worldwide, quitting smoking increases life expectancy regardless of age, gender and number of cig/day. The estimates of the number of years of life that could be gained by quitting smoking, when computed specifically for a single smoker, could be used by physicians and health professionals to promote a quit attempt. Full article

Preschool can have positive effects on the development of a healthy lifestyle. The present study analysed to what extent different conditions, structures and behavioural models in preschool and family—children’s central social microsystems—can lead to differences in children’s health resources. Using a cross-sectional mixed methods approach, contrast analyses of “preschools with systematic physical activity programmes” versus “preschools without physical activity programmes” were conducted to assess the extent to which children’s physical activity, quality of life and social behaviour differ between preschools with systematic and preschools without physical activity programmes. Differences in children’s physical activity according to parental behaviour were likewise assessed. Data on child-related outcomes and parent-related factors were collected via parent questionnaires and child interviews. A qualitative focused ethnographic study was performed to obtain deeper insight into the quantitative survey data. Two hundred and twenty seven (227) children were interviewed at 21 preschools with systematic physical activity programmes, and 190 at 25 preschools without physical activity programmes. There was no significant difference in children’s physical activity levels between the two preschool types (p = 0.709). However, the qualitative data showed differences in the design and quality of programmes to promote children’s physical activity. Data triangulation revealed a strong influence of parental behaviour. The triangulation of methods provided comprehensive insight into the nature and extent of physical activity programmes in preschools and made it possible to capture the associations between systematic physical activity promotion and children’s health resources in a differential manner. Full article

Aerobic granules were cultivated in a sequencing batch reactor (SBR). COD and ammonia nitrogen removal rate were 94% and 99%, respectively. The diameter, settling velocity and SVI₁₀ of granules ranged from 2 to 5 mm, 80 to 110 m/h and about 40 mL/g, respectively. Freezing microtome images, DO concentration profiles by microelectrode, distribution of bacteria and EPS by confocal laser scanning microscopy (CLSM) show that the aerobic granules have a three-layer structure. Each layer has different thickness, character, bacteria, and DO transfer rate. A hypothesis for granule structure is proposed: the first layer, the surface of the granule, is composed mostly of heterotrophic organisms for organic matter removal, with a thickness range from 150 to 350 μm; the second layer, mostly composed of autotrophic organisms for ammonia nitrogen removal, with a thickness range from 250 to 450 μm; the third layer, located in the core of the granule, has mostly an inorganic composition and contains pores and channels. Full article

In the Amazon Basin, naturally occurring methylmercury bioaccumulates in fish, which is a key source of protein consumed by riverine populations. The hydroelectric power-plant project at Santo Antônio Falls allows us to compare the Hg exposure of riverine populations sparsely distributed on both sides of the Madeira river before the area is to be flooded. From 2009 to 2011, we concluded a population survey of the area (N = 2,008; representing circa 80% of community residents) that estimated fish consumption and mercury exposure of riverine populations with different degrees of lifestyle related to fish consumption. Fish samples from the Madeira river (N = 1,615) and 110 species were analyzed for Hg. Hair-Hg was significantly lower (p < 0.001) in less isolated communities near to the capital of Porto Velho (median 2.32 ppm) than in subsistence communities in the Cuniã Lake, 180 km from Porto Velho city (median 6.3 ppm). Fish Hg concentrations ranged from 0.01 to 6.06 µg/g, depending on fish size and feeding behavior. Currently available fish in the Madeira river show a wide variability in Hg concentrations. Despite cultural similarities, riparians showed hair-Hg distribution patterns that reflect changes in fish-eating habits driven by subsistence characteristics. Full article

Taxation has been suggested as a possible preventive strategy to address the serious public health concern of childhood obesity. Understanding the public’s viewpoint on the potential role of taxation is vital to inform policy decisions if they are to be acceptable to the wider community. A Citizens’ Jury is a deliberative method for engaging the public in decision making and can assist in setting policy agendas. A Citizens’ Jury was conducted in Brisbane, Australia in May 2013 to answer the question: Is taxation on food and drinks an acceptable strategy to the public in order to reduce rates of childhood obesity? Citizens were randomly selected from the electoral roll and invited to participate. Thirteen members were purposively sampled from those expressing interest to broadly reflect the diversity of the Australian public. Over two days, participants were presented with evidence on the topic by experts, were able to question witnesses and deliberate on the evidence. The jurors unanimously supported taxation on sugar-sweetened drinks but generally did not support taxation on processed meats, snack foods and foods eaten/ purchased outside the home. They also supported taxation on snack foods on the condition that traffic light labelling was also introduced. Though they were not specifically asked to deliberate strategies outside of taxation, the jurors strongly recommended more nutritional information on all food packaging using the traffic light and teaspoon labelling systems for sugar, salt and fat content. The Citizens’ Jury suggests that the general public may support taxation on sugar-sweetened drinks to reduce rates of obesity in children. Regulatory reforms of taxation on sugar-sweetened drinks and improved labelling of nutritional information on product packaging were strongly supported by all members of the jury. These reforms should be considered by governments to prevent childhood obesity and the future burden on society from the consequences of obesity. Full article

The effects of cold air on cardiovascular and cerebrovascular diseases were investigated in an experimental study examining blood pressure and biochemical indicators. Zhangye, a city in Gansu Province, China, was selected as the experimental site. Health screening and blood tests were conducted, and finally, 30 cardiovascular disease patients and 40 healthy subjects were recruited. The experiment was performed during a cold event during 27–28 April 2013. Blood pressure, catecholamine, angiotensin II (ANG-II), cardiac troponin I (cTnI), muscle myoglobin (Mb) and endothefin-1 (ET-1) levels of the subjects were evaluated 1 day before, during the 2nd day of the cold exposure and 1 day after the cold air exposure. Our results suggest that cold air exposure increases blood pressure in cardiovascular disease patients and healthy subjects via the sympathetic nervous system (SNS) that is activated first and which augments ANG-II levels accelerating the release of the norepinephrine and stimulates the renin-angiotensin system (RAS). The combined effect of these factors leads to a rise in blood pressure. In addition, cold air exposure can cause significant metabolism and secretion of Mb, cTnI and ET-1 in subjects; taking the patient group as an example, ET-1 was 202.7 ng/L during the cold air exposure, increased 58 ng/L compared with before the cold air exposure, Mb and cTnI levels remained relatively high (2,219.5 ng/L and 613.2 ng/L, increased 642.1 ng/L and 306.5 ng/L compared with before the cold air exposure, respectively) 1-day after the cold exposure. This showed that cold air can cause damage to patients’ heart cells, and the damage cannot be rapidly repaired. Some of the responses related to the biochemical markers indicated that cold exposure increased cardiovascular strain and possible myocardial injury. Full article

Stinging jellyfish outbreaks represent a health hazard, causing contact dermatitis and systemic reactions. This study investigated the epidemiology, severity, and treatment protocols of jellyfish stings in a coastal area with high tourist development and frequent stinging jellyfish outbreaks of the central Mediterranean (Salento, Southern Italy), and the associated costs for the Italian National Health Service. In 2007–2011, 1,733 bathers (mostly children and females) sought medical assistance following jellyfish stings, the main cause of human pathologies due to contact with marine organisms. The majority of events were reported in the years 2007–2009, whereas the occurrence of cnidarian jellyfish outbreaks has been increasingly reported in the same area since summer 2010. Most symptoms were limited to local and cutaneous reactions; conversely, 8.7% of cases evoked complications, mainly due to allergic reactions. The main drugs used were corticosteroids, locally applied and systemic (46% and 43%, respectively), and with ammonia (74%) as the main non-pharmacological treatment. The estimated cost of jellyfish-related first-aid services along the Salento coastline over the 5-year period was approximately 400,000 Euros. Therefore the management of jellyfish outbreak phenomena need coordinated research efforts towards a better understanding of underlying ecological mechanisms, together with the adoption of effective prevention policy, mitigation strategies, and appropriate planning of health services at tourist hot spots. Full article

The construction of large-scale infrastructures such as nature gas/oil pipelines involves extensive disturbance to regional ecosystems. Few studies have documented the soil degradation and heavy metal contamination caused by pipeline construction. In this study, chromium (Cr), cadmium (Cd), copper (Cu), nickel (Ni), lead (Pb) and zinc (Zn) levels were evaluated using Index of Geo-accumulation (I_geo) and Potential Ecological Risk Index (RI) values, and human health risk assessments were used to elucidate the level and spatial variation of heavy metal pollution risks. The results showed that the impact zone of pipeline installation on soil heavy metal contamination was restricted to pipeline right-of-way (RoW), which had higher I_geo of Cd, Cu, Ni and Pb than that of 20 m and 50 m. RI showed a declining tendency in different zones as follows: trench > working zone > piling area > 20 m > 50 m. Pipeline RoW resulted in higher human health risks than that of 20 m and 50 m, and children were more susceptible to non-carcinogenic hazard risk. Cluster analysis showed that Cu, Ni, Pb and Cd had similar sources, drawing attention to the anthropogenic activity. The findings in this study should help better understand the type, degree, scope and sources of heavy metal pollution from pipeline construction to reduce pollutant emissions, and are helpful in providing a scientific basis for future risk management. Full article

Concentrations of the environmentally sensitive elements (ESEs) As, Co, Cu, Mn, Ni, Pb, V and Zn in smaller than 100 μm street dust particles from Xining were measured using X-ray fluorescence spectrometry and their contamination levels were assessed based on enrichment factor (EF), geoaccumulation index (I_geo) and pollution load index (PLI). The concentrations of As, Co, Cu, Mn, Ni, Pb, V and Zn in smaller than 100 μm street dust particles from Xining are 0.1–0.8, 2.7–10.9, 0.7–5.2, 0.3–1.1, 0.6–2.5, 1.2–11.1, 0.7–1.3 and 0.4–2.9 times the background values of Qinghai soil, respectively. The calculated EF and I_geo values reveal the order Co > Pb > Cu > Zn > V > Ni > Mn > As. The EF and I_geo values of Co, Cu, Pb and Zn are higher indicating that there is considerable pollution by these elements in smaller than 100 μm street dust particles, especially for Co. The EF and I_geo of Mn, Ni and V are lower and the assessment results indicate an absence of distinct Mn, Ni and V pollution in the studied samples. The mean value of PLI_site is 1.14, indicating a slightly pollution in the whole city of Xining. The order of PLI_area for the five tested districts is Center District (CD) > East District (ED) > West District (WD) > North District (ND) > South District (SD), showing that ESEs pollution in the South District is the lightest while it is the highest in the Central District. Full article

Ecological security and environmental sustainability are the foundations of sustainable development. With the acceleration of urbanization, increasing human activities have promoted greater impacts on the eco-spaces that maintain ecological security. Regional key eco-space has become the primary need to maintain environmental sustainability and can offer society with continued ecosystem services. In this paper, considering the security of water resources, biodiversity conservation, disaster avoidance and protection and natural recreation, an integrated index of eco-space importance was established and a method for identifying key eco-space was created using GIS, with Lanzhou City, China as a case study. The results show that the area of core eco-space in the Lanzhou City is approximately 50,908.7 hm², accounting for 40% of the region’s total area. These areas mainly consist of geological hazard protection zones and the core zones of regional river systems, wetlands, nature reserves, forest parks and scenic spots. The results of this study provide some guidance for the management of ecological security, ecological restoration and environmental sustainability. Full article

Heavy metals in high concentrations can cause health and environmental damage. Nanosilver is an emerging heavy metal which has a bright future of use in many applications. Here we report on the levels of silver and other heavy metals in municipal sewage sludge. Five towns in Limpopo province of South Africa were selected and the sludge from their wastewater treatment plants (WWTPs) was collected and analysed. The acid digested sewage sludge samples were analysed using Inductively Coupled Plasma-Optical Emission Spectroscopy (ICP-OES) and Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) methods. The concentrations of silver found were low, but significant, in the range 0.22 to 21.93 mg/kg dry mass. The highest concentration of silver was found in Louis Trichardt town with a concentration of 21.93 ± 0.38 mg/kg dry mass while the lowest was Thohoyandou with a concentration of 6.13 ± 0.12 mg/kg dry mass. A control sludge sample from a pit latrine had trace levels of silver at 0.22 ± 0.01 mg/kg dry mass. The result showed that silver was indeed present in the wastewater sewage sludge and at present there is no DWAF guideline standard. The average Cd concentration was 3.10 mg/kg dry mass for Polokwane municipality. Polokwane and Louis Trichardt municipalities exhibited high levels of Pb, in excess DWAF guidelines, in sludge at 102.83 and 171.87 mg/kg respectfully. In all the WWTPs the zinc and copper concentrations were in excess of DWAF guidelines. The presence of heavy metals in the sewage sludge in excess of DWAF guidelines presents environmental hazards should the sludge be applied as a soil ameliorant. Full article

During the last decades huge amounts of data have been collected in clinical databases representing patients’ health states (e.g., as laboratory results, treatment plans, medical reports). Hence, digital information available for patient-oriented decision making has increased drastically but is often scattered across different sites. As as solution, personal health record systems (PHRS) are meant to centralize an individual’s health data and to allow access for the owner as well as for authorized health professionals. Yet, expert-oriented language, complex interrelations of medical facts and information overload in general pose major obstacles for patients to understand their own record and to draw adequate conclusions. In this context, recommender systems may supply patients with additional laymen-friendly information helping to better comprehend their health status as represented by their record. However, such systems must be adapted to cope with the specific requirements in the health domain in order to deliver highly relevant information for patients. They are referred to as health recommender systems (HRS). In this article we give an introduction to health recommender systems and explain why they are a useful enhancement to PHR solutions. Basic concepts and scenarios are discussed and a first implementation is presented. In addition, we outline an evaluation approach for such a system, which is supported by medical experts. The construction of a test collection for case-related recommendations is described. Finally, challenges and open issues are discussed. Full article

Based on ecological analyses we proposed in 2003 the relation of Kawasaki Disease (KD) onset causing acute febrile systemic vasculitis, and pollen exposure. This study was aimed at investigating the correlation between pollen release and the change in the numbers of KD patients from 1991 to 2002 in Kanagawa, Japan. Short-term changes in the number of KD patients and medium- to long-term trends were analyzed separately. Short-term changes in the number of KD patients showed a significant positive cross correlation (CC) with 9- to 10-month delay following pollen releases, and a smaller but significant CC with 3- to 4-month delay. Further, a temporal relationship revealed by positive CC distribution showed that pollen release preceded KD development, suggesting that pollen release leads to KD development. A trend in patient numbers was fitted by an exponential curve with the time constant of 0.005494. We hypothesized that the trend was caused by the cumulative effects of pollen exposure for elapsed months on patients who may develop KD. By comparing the time constants of fitted exponential curve for each pollen accumulation period with 0.005494, the exposure period was estimated to be 21.4 months, which explains why approximately 50% of patients developed KD within 24 months from birth. Full article

The upper layer of forest soils (0–20 cm depth) were collected from urban, suburban, and rural areas in the Pearl River Delta of Southern China to estimate the distribution and the possible sources of polycyclic aromatic hydrocarbons (PAHs). Total concentrations of PAHs in the forest soils decreased significantly along the urban–suburban–rural gradient, indicating the influence of anthropogenic emissions on the PAH distribution in forest soils. High and low molecular weight PAHs dominated in the urban and rural forest soils, respectively, implying the difference in emission sources between the areas. The values of PAH isomeric diagnostic ratios indicated that forest soil PAHs were mainly originated from traffic emissions, mixed sources and coal/wood combustion in the urban, suburban and rural areas, respectively. Principal component analysis revealed that traffic emissions, coal burning and residential biomass combustion were the three primary contributors to forest soil PAHs in the Pearl River Delta. Long range transportation of PAHs via atmosphere from urban area might also impact the PAHs distribution in the forest soils of rural area. Full article

The aim of this paper is to study certain factors that may be determinant in the emergence of workplace bullying among managers—employees with a recognized and privileged position to exercise power—adopting the individual perspective of the subject, the bullied manager. Individual, organizational, and contextual factors integrate the developed global model, and the methodology utilized to accomplish our research objectives is based on the binary logistic regression model. A sample population of 661 managers was obtained from the micro data file of the 5th European Working Conditions Survey-2010 (European Foundation for the Improvement of Living and Working Conditions) and utilized to conduct the present research. The results indicate that the chance for a manager to refer to him/herself as bullied increases among women that hold managerial positions and live with children under 15 at home, and among subjects that work at night, on a shift system, suffering from work stress, enjoying little satisfaction from their working conditions, and not perceiving opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes, within the usual course of events, that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist directors/general directors in facilitating, to some extent, good social relationships among managers. Full article

Our aim was to validate a 16-item food intake questionnaire (16-FIQ) and create an easy to use method to estimate patients’ nutrient intake in primary health care. Participants (52 men, 25 women) completed a 7-day food record and a 16-FIQ. Food and nutrient intakes were calculated and compared using Spearman correlation. Further, nutrient intakes were compared using kappa-statistics and exact and opposite agreement of intake tertiles. The results indicated that the 16-FIQ reliably categorized individuals according to their nutrient intakes. Methods to estimate nutrient intake based on the answers given in 16-FIQ were created. In linear regression models nutrient intake estimates from the food records were used as the dependent variables and sum variables derived from the 16-FIQ were used as the independent variables. Valid regression models were created for the energy proportion of fat, saturated fat, and sucrose and the amount of fibre (g), vitamin C (mg), iron (mg), and vitamin D (μg) intake. The 16-FIQ is a valid method for estimating nutrient intakes in group level. In addition, the 16-FIQ could be a useful tool to facilitate identification of people in need of dietary counselling and to monitor the effect of counselling in primary health care. Full article

The Heihe River Basin (HRB) is the second largest inland river basin in arid Northwest China. The expanding agricultural irrigation, growing industrialization, and increasing urban development in the middle reach have depleted much of the river flow to the lower reach, degrading the corresponding ecosystems. Since the enactment of the State Council of China’s new HRB water allocation policy in 2000 tremendous land use and land cover (LULC) changes have taken place to reduce water consumption in the middle reach and deliver more water downstream. This paper analyzes LULC changes during the period of 2000–2009 to understand how the changing land use patterns have altered water resource dynamics in the region. Results, while yet to be further verified in the field, show that from 2000 to 2009, urban, agricultural land, rangeland, and forest areas have increased, and barren area has decreased. Within the cropland, rice (a high water consumption crop) planting area decreased, while corn and wheat (relatively lower water consumption crops) planting areas increased. These changes in land use patterns, especially in the agricultural zones, have ensured the discharge of the required amount of water to the lower reach. Full article

Background: The Zhejiang Immunization Information System (ZJIIS) was established in 2004. This study described the coverage rates of NIP vaccines in Zhejiang Province using the ZJIIS. Methods: Children aged 1–7 years (born from 1 January 2005 to 31 December 2011) registered in ZJIIS were enrolled in this study. All immunization records were obtained from the ZJIIS on 31 December 2012. The cohort method had been used for identifying trends and patterns in vaccine administration. Immunization coverage estimates were analyzed for both individual NIP vaccines and “Fully immunized” by age group, birth cohort, immigration status, and geography area. We also examined the timeliness vaccination for the 2010 birth cohort. Results: A total of 3,579,896 children were registered in ZJIIS. All the vaccines and doses which scheduled to be given at ≤12 months of age exceeded 90%. There was substantial decrease trend in the vaccines scheduled at >12 months of age and most of these vaccines were below 90%. The coverage of migrant children was lower than for resident children and the coverage of WenZhou (WZ), Zhoushan (ZS) and TaiZhou (TZ) was lower than other municipalities for most of vaccines across all the birth cohorts. Nearly 20%–30% of children of 2010 birth cohort delayed for the primary series vaccination scheduled at ≤12 months of age, especially among migrant children. Conclusions: The ZJIIS is useful in tracking vaccine coverage of children aged 1–7 years and the data provided by ZJIIS reflected the fact that NIP delivery was improving in Zhejiang Province, while identifying some areas for improvement. We recommend continuing surveillance to estimate of vaccine coverage through ZJIIS. Immunization strategies such as Assessment, Feedback, Incentives, and Exchange program, reminder/recall activity, home visits, school entry requirements and school-based clinics could be used to reach a higher coverage of the population. Full article

This study aims to model road traffic noise levels and estimate the human exposure at the 25 districts in the metropolitan Seoul, Republic of Korea. The SoundPLAN^® Version 7.1 software package was used to model noise levels and simulated road traffic noise maps were created. The people exposed to daytime/nighttime road traffic noise were also estimated. The proportions of the population exposed to road traffic noise in major cities in the EU were also estimated and compared. Eight (8) districts show the exceeded rate (percentage of the exposed population exceeding the daytime standard) of 20% or more, and eleven (11) districts show 10%-20% and six (6) districts show less than 10%, which indicates considerable variation among districts. Two districts (Nowon-gu and Yangcheon-gu) show the highest exposure rate during the daytime (35.2%). For nighttime noise levels, fourteen (14) districts show the exceeded rate (percentage of exposed population exceeding the nighttime standard) over 30%. The average percentages of the exposed population exceeding the daytime/nighttime standards in Seoul and the EU were 16.6%/34.8% and 13.0%/16.1%, respectively. The results show that road traffic noise reduction measures should urgently be taken for the nighttime traffic noise in Seoul. When the grid noise map and the 3-D façade noise map were compared, the 3-D façade noise map was more accurate in estimating exposed population in citywide noise mapping. Full article

In this paper we describe an algorithm for clustering multivariate time series with variables taking both categorical and continuous values. Time series of this type are frequent in health care, where they represent the health trajectories of individuals. The problem is challenging because categorical variables make it difficult to define a meaningful distance between trajectories. We propose an approach based on Hidden Markov Models (HMMs), where we first map each trajectory into an HMM, then define a suitable distance between HMMs and finally proceed to cluster the HMMs with a method based on a distance matrix. We test our approach on a simulated, but realistic, data set of 1,255 trajectories of individuals of age 45 and over, on a synthetic validation set with known clustering structure, and on a smaller set of 268 trajectories extracted from the longitudinal Health and Retirement Survey. The proposed method can be implemented quite simply using standard packages in R and Matlab and may be a good candidate for solving the difficult problem of clustering multivariate time series with categorical variables using tools that do not require advanced statistic knowledge, and therefore are accessible to a wide range of researchers. Full article

In this study of autoimmunity among a population of Gullah African Americans in South Carolina, the links between environmental exposures and autoimmunity (presence of antinuclear antibodies (ANA)) have been assessed. The study population included patients with systemic lupus erythematosus (n = 10), their first degree relatives (n = 61), and unrelated controls (n = 9) where 47.5% (n = 38) were ANA positive. This paper presents the methodology used to model ANA status as a function of individual environmental influences, both self-reported and measured, while controlling for known autoimmunity risk factors. We have examined variable dimension reduction and selection methods in our approach. Following the dimension reduction and selection methods, we fit logistic spatial Bayesian models to explore the relationship between our outcome of interest and environmental exposures adjusting for personal variables. Our analysis also includes a validation “strip” where we have interpolated information from a specific geographic area for a subset of the study population that lives in that vicinity. Our results demonstrate that residential proximity to exposure site is important in this form of analysis. The use of a validation strip network demonstrated that even with small sample numbers some significant exposure-outcome relationships can be detected. Full article

The aim of this study was to investigate oral and hand hygiene behaviour and risk factors among 13 to 15 year-old in-school adolescents in four Southeast Asian countries. Data were collected by self-reported questionnaire from nationally representative samples (total 13,824) of school children aged 13 to 15 years in India, Indonesia, Myanmar and Thailand. Results indicate that overall, 22.4% of school children reported sub-optimal oral hygiene (<twice a day tooth brushing), 45.2% did not always wash their hands before meals, 26.5% after toileting and 59.8% washing their hands with soap (59.8%). In multivariate analysis, male gender, health risk behaviours and lack of protective factors were associated with sub-optimal tooth brushing, and lower socioeconomic status, health risk behaviours, psychological distress and lack of protective factors were found to be associated with sub-optimal hand washing hygiene behaviour. As a conclusion, the cross-national data on oral and hand hygiene behaviour from four Southeast Asian countries found sub-optimal hygiene behaviour. Several determinants of sub-optimal hygiene behaviour were identified that can inform programmes in order to improve oral and hand hygiene behaviour of this adolescent population. Full article

Objective: To quantify the radiation dose in the thyroid attributable to different CT scans and to estimate the thyroid cancer risk in pediatric patients. Methods: The information about pediatric patients who underwent CT scans was abstracted from the radiology information system in one general hospital between 1 January 2012 and 31 December 2012. The radiation doses were calculated using the ImPACT Patient Dosimetry Calculator and the lifetime attributable risk (LAR) of thyroid cancer incidence was estimated based on the National Academies Biologic Effects of Ionizing Radiation VII model. Results: The subjects comprised 922 children, 68% were males, and received 971 CT scans. The range of typical radiation dose to the thyroid was estimated to be 0.61–0.92 mG_y for paranasal sinus CT scans, 1.10–2.45 mG_y for head CT scans, and 2.63–5.76 mG_y for chest CT scans. The LAR of thyroid cancer were as follows: for head CT, 1.1 per 100,000 for boys and 8.7 per 100,000 for girls; for paranasal sinus CT scans, 0.4 per 100,000 for boys and 2.7 per 100,000 for girls; for chest CT scans, 2.2 per 100,000 for boys and 14.2 per 100,000 for girls. The risk of thyroid cancer was substantially higher for girls than for the boys, and from chest CT scans was higher than that from head or paransal sinus CT scans. Conclusions: Chest CT scans caused higher thyroid dose and the LAR of thyroid cancer incidence, compared with paransal sinus or head CT scans. Therefore, physicians should pay more attention to protect the thyroid when children underwent CT scans, especially chest CT scans. Full article

There is a lack of comparable health-related quality of life (HRQoL) and utility data across all mental disorders and all inpatient and outpatient settings. Our objective was to investigate the HRQoL and utility scores of people with mental disorders in France, treated in outpatient and inpatient settings, and to identify the HRQoL and utility score losses attributable to mental disorders compared to the non-mentally ill general population. A cross-sectional survey was conducted to assess HRQoL (SF-12) and utility scores of patients with mental disorders and followed in four psychiatric sectors in France. Scores were described by demographic and clinical characteristics and were then adjusted on age and gender and compared with those of the non-mentally ill general population. Median HRQoL and utility scores were significantly lower in patients with mental disorders than in the non-mentally ill general population; median differences amounted to 5.4 for the HRQoL physical score, to 11.8 for the HRQoL mental score and to 0.125 for the utility score. Our findings underscore the negative impact of mental disorders on HRQoL in France and provide a baseline to assess the global impact of current and future organizational changes in the mental health care system. Full article

Understanding the spatial point pattern of human settlements and their geographical associations are important for understanding the drivers of land use and land cover change and the relationship between environmental and ecological processes on one hand and cultures and lifestyles on the other. In this study, a Geographic Information System (GIS) approach, Ripley’s K function and Monte Carlo simulation were used to investigate human settlement point patterns. Remotely sensed tools and regression models were employed to identify the effects of geographical determinants on settlement locations in the Wen-Tai region of eastern coastal China. Results indicated that human settlements displayed regular-random-cluster patterns from small to big scale. Most settlements located on the coastal plain presented either regular or random patterns, while those in hilly areas exhibited a clustered pattern. Moreover, clustered settlements were preferentially located at higher elevations with steeper slopes and south facing aspects than random or regular settlements. Regression showed that influences of topographic factors (elevation, slope and aspect) on settlement locations were stronger across hilly regions. This study demonstrated a new approach to analyzing the spatial patterns of human settlements from a wide geographical prospective. We argue that the spatial point patterns of settlements, in addition to the characteristics of human settlements, such as area, density and shape, should be taken into consideration in the future, and land planners and decision makers should pay more attention to city planning and management. Conceptual and methodological bridges linking settlement patterns to regional and site-specific geographical characteristics will be a key to human settlement studies and planning. Full article

The northward spread of leishmaniasis from Mediterranean to Continental Europe affects our area where it is typically associated with Leishmania infantum infection. In this study a 22-year survey was performed in patients (including both patients with and without history of travel through endemic areas other than Italy) attending the University Hospital of Parma, Northern Italy, in order to make a contribution to describe the cases of the visceral leishmaniasis (VL) and cutaneous leishmaniasis (CL) diagnosed in this area. One hundred fifty-six samples from 134 patients with clinical suspicion of leishmaniasis (96 suspected of having VL, 37 CL and one both VL and CL) were analyzed in our laboratory during 1992–2013 by microscopy, culture and, from 2005, also by real-time PCR. Leishmania spp. were detected in 23 samples of 15 patients (seven with VL and eight with CL), representing an infection rate of 11.2%. The figure of the cases of leishmaniasis herein reported, even if not comparable to that described for Italian areas other than Parma, underlines that suitable tools are mandatory for correct diagnosis. Moreover, the severity of this disease, particularly VL with its documented northward spread, requires physicians of continental Europe to increase their attention about the possibility of suspecting leishmaniasis in patients reporting related signs and symptoms and/or risk factors. Full article

This study examined the prevalence and the determinants of risky sexual behavior (defined as having multiple sex partners and paying for sex) among male rural-to-urban migrants in China. An anonymous questionnaire was used to collect information on socio-demographics, knowledge, attitudes, and behavior associated with increased risk of risky sexual behavior from 4,069 subjects. In total 1,132 (27.8%) participants reported two or more sex partners and 802 (19.7%) participants paid for sex. A considerable proportion (29.6%–41.5%) did not use a condom during risky sexual behavior. Logistic regression analysis revealed that unmarried status (OR: 0.62, CI: 0.42–0.85 for married), earlier age at first sexual experience (OR: 0.67, 95% CI: 0.31–0.91 for ≥22 years old), poor perception of risk of acquiring HIV/AIDS (OR: 1.51, 95% CI: 1.33–1.96 for unlikely; OR: 2.38, 95% CI: 1.61–3.70 for impossible), frequent exposure to pornography (OR: 0.67, 95% CI: 0.60–0.81 for sometimes; OR: 0.31, 95% CI: 0.11–0.43 for never), attitudes toward legalization of commercial sex (OR: 0.39, 95% CI: 0.21–0.59 for no), peer influence (OR: 0.51, 95% CI: 0.27–0.88 for no), and not knowing someone who had/had died from HIV/AIDS (OR: 0.35, 95% CI: 0.20–0.53 for yes) were all significantly associated with having multiple sex partners. Those who paid for sex showed similar findings. Full article

This study aimed to quantify the effect of duration time of a nuclear accident on the radiation dose of a densely populated area and the resulting acute health effects. In the case of nuclear accidents, the total emissions of radioactive materials can be classified into several categories. Therefore, the release information is very important for the assessment of risk to the public. We confirmed that when the duration time of the emissions are prolonged to 7 hours, the concentrations of radioactive substances in the ambient air are reduced by 50% compared to that when the duration time of emission is one hour. This means that the risk evaluation using only the first wind direction of an accident is very conservative, so it has to be used as a screening level for the risk assessment. Furthermore, it is judged that the proper control of the emission time of a nuclear accident can minimize the health effects on residents. Full article

The impact of polyphosphate-accumulating organism (PAO) and glycogen-accumulating organism (GAO) populations as well as of the chemical profile on the performance of Unit-3 (open elutriation tanks) and Unit-5 (covered elutriation tank) of the City of Johannesburg Northern Wastewater Treatment Works was determined. Physicochemical parameters of wastewater samples were measured using standard methods. Bacterial diversity was determined using 16S rRNA gene amplicon pyrosequencing of the variable region V1-3. Results showed soluble COD concentrations from settled sewage for Unit-3 at 192.8 mg COD/L and for Unit-5 at 214.6 mg COD/L, which increased to 301.8 mg COD/L and 411.6 mg COD/L in the overflow from elutriation tanks and decreased to 170.9 mg COD/L and 256.3 mg COD/L at the division boxes, respectively. Both long-chain volatile fatty acids (heptanoic acid, isobutyric acid, 3-methylbutanoic acid, pentanoic acid, 4-methylpentanoic acid, methylheptanoic acid) and short-chain volatile fatty acids (acetic acid, propionic acid, isobutyric acid) were present within concentration ranges of 17.19 mg/L to 54.98 mg/L and 13.64 mg/L to 87.6 mg/L for Unit 3 and 38.61 mg/L to58.85 mg/L and 21.63 mg/L to 92.39 mg/L for Unit 5, respectively. In the secondary settling tanks, the phosphate-removal efficiency in Unit-5 appeared to be slightly higher (0.08 mg P/L) compared to that of Unit-3 (0.11 mg P/L). The average DO concentrations (2.1 mg/L and 2.2 mg/L) as well as the pH values (pH 7 to pH 7.5) were found to be slightly higher in Unit-5 in the aerobic zones. The high presence of PAOs in the bioreactors (Unit-5: Dechloromonas (14.96%), Acinetobacter (6.3%), Zoogloea (4.72%) in the anaerobic zone and Dechloromonas (22.37 %) in the aerobic zone; Unit-3: Dechloromonas (37.25%) in the anaerobic zone and Dechloromonas (23.97%) in the aerobic zone) confirmed the phosphate-removal efficiencies of both units. Negligible GAOs were found in the aerobic zones (Defluviicoccus spp.: 0.33% for Unit-5 and 0.68% for Unit-3) and in the anaerobic zones (Defluviicoccus: 9.8% for Unit-3). The high microbial diversity and a negligible percentage of GAOs in Unit-5 could contribute to its high phosphate-removal efficiency, although results did not indicate statistically significant differences between the unit with a covered elutriation tank (Unit-5) and that with open elutriation tanks (Unit-3). Full article

Objective: To explore the relationship between serum uric acid (SUA) and metabolic syndrome (MS) in men, premenopausal women and postmenopausal women. Methods: A cross-sectional study was conducted in 1,834 community-based Southern Chinese participants from June to October 2012. Sex-specific SUA quartiles were used as follows: <345, 345–<400, 400–<468, ≥468 µmol/L in males; and <248, 248–<288, 288–<328, ≥328 µmol/L in females. MS was defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) Criteria. The association between SUA and MS was then analyzed using the STATA software. Results: The odds ratio (OR) for having MS in the highest versus lowest quartiles of SUA levels was 2.46 (95% confidence interval [CI], 1.39 to 4.34, p = 0.002) in men after adjusting for age, sex, history of coronary heart disease, history of stroke, current current smoking, current alcohol use, physical inactivity, education status, and BMI. Further adjusting for above confounders, hypertension and diabetes, the OR for having MS in the highest versus lowest quartiles of SUA was 3.06 (95% CI, 1.64 to 5.70, p < 0.001). The OR for having MS in the highest versus lowest quartiles of SUA was 3.45 (95% CI, 1.38 to 8.64, p = 0.008) and 1.98 (95% CI, 1.16 to 3.37, p = 0.08) in premenopausal women and postmenopausal women after adjusting for age, sex, history of coronary heart disease, history of stroke, current smoking, current alcohol use, physical inactivity, education status, and BMI. Further adjusting for above confounders, hypertension and diabetes, the OR for having MS in the highest versus lowest quartiles of SUA was 3.42 (95% CI, 1.15 to 10.18, p = 0.03) and 1.87 (95% CI, 1.05 to 3.33, p = 0.03) in premenopausal women and postmenopausal women. Conclusions: Higher SUA levels are positively associated with the presence of MS in males and females. Higher SUA levels had a higher risk of having MS in premenopausal women than in postmenopausal women. Full article

Some jurisdictions have reduced workforce and reallocated responsibilities for public health preparedness and emergency management to more efficiently use resources and improve planning and response. Key informant interviews were conducted in six counties in North Carolina (USA) to discuss perceptions of the challenges and opportunities provided by the new shared positions. Respondents feel that planning and response have improved, but that requirements related to activities or equipment that are eligible for funding (particularly on the public health side) can present an impediment to consolidating public health preparedness and emergency management roles. As the financial resources available for public health preparedness and emergency management continue to be reduced, the merging of the roles and responsibilities of public health preparedness and emergency management may present jurisdictions with an effective alternative to reducing staff, and potentially, readiness. Full article

Tungsten-based materials have been proposed as replacements for depleted uranium in armor-penetrating munitions and for lead in small-arms ammunition. A recent report demonstrated that a military-grade composition of tungsten, nickel, and cobalt induced a highly-aggressive, metastatic rhabdomyosarcoma when implanted into the leg muscle of laboratory rats to simulate a shrapnel wound. The early genetic changes occurring in response to embedded metal fragments are not known. In this study, we utilized two cultured rodent myoblast cell lines, exposed to soluble tungsten alloys and the individual metals comprising the alloys, to study the genotoxic effects. By profiling cell transcriptomes using microarray, we found slight, yet distinct and unique, gene expression changes in rat myoblast cells after 24 h metal exposure, and several genes were identified that correlate with impending adverse consequences of ongoing exposure to weapons-grade tungsten alloy. These changes were not as apparent in the mouse myoblast cell line. This indicates a potential species difference in the cellular response to tungsten alloy, a hypothesis supported by current findings with in vivo model systems. Studies examining genotoxic-associated gene expression changes in cells from longer exposure times are warranted. Full article

The objectives of this study were to assess prevalence of children’s respiratory health conditions and to measure and describe social disparities in children’s respiratory problems and access to health resources for asthma/wheezing management. Data were collected through a cross-sectional, observational mail survey of all primary caretakers of 4th and 5th grade children in El Paso Independent School District (El Paso, TX, USA). 6295 primary caretakers received surveys at their home address and 1904 surveys were completed and returned for a 30% response rate. El Paso children have high rates of asthma (17%) and allergies (51%). In terms of social disparities, children that are male, not poor, obese, Hispanic, born in El Paso, have a US-born caretaker, and have a caretaker who has lower levels Spanish proficiency have increased odds of respiratory problems. Among children with asthma and wheezing, disparities exist in access to care; those that are poor, with a Spanish-speaking caretaker, or with a foreign-born caretaker had increased odds of seeking care in urgent care center, emergency rooms and hospitals. Results have scholarly and practical implications for broader trends in terms of increasing prevalence of respiratory health problems across multiple scales (from El Paso to the US context to worldwide) and health disparities experienced within the rapidly growing US Hispanic population. Full article

This study investigated the effect of proximity to city parks on blood pressure categories during the first trimester of pregnancy. This cross-sectional study included 3,416 female residents of the city of Kaunas, Lithuania, who were enrolled in the FP7 PHENOTYPE project study. The women were classified into four blood pressure categories: optimal, normal, high-normal blood pressure, and hypertension. Multinomial regression models were used to investigate the association between three women’s groups with respect to the residence distances from city parks (300, >300–1,000, and >1,000 m) and four blood pressure categories. When using the optimal blood pressure as the reference group, the crude and adjusted odds ratios (OR) for normal blood pressure and for high-normal blood pressure proved to be statistically significantly higher after the inclusion of the selected covariates into the regression analysis. The probability of normal blood pressure increased by 9%, and that of high-normal blood pressure—by 14% for every 300 m increase in the distance to green spaces. The findings of this study suggest a beneficial impact of nearby city parks on blood pressure amongst 20- to 45-year-old women. This relationship has important implications for the prevention of hypertension and the reduction of hypertension-related morbidity. Full article

Taiwan suffers from energy insecurity and the threat of potential damage from global climate changes. Finding ways to alleviate these forces is the key to Taiwan’s future social and economic development. This study examines the economic and environmental impacts when ethanol, conventional electricity and pyrolysis-based electricity are available alternatives. Biochar, as one of the most important by-product from pyrolysis, has the potential to provide significant environmental benefits. Therefore, alternative uses of biochar are also examined in this study. In addition, because planting energy crops would change the current land use pattern, resulting in significant land greenhouse gases (GHG) emissions, this important factor is also incorporated. Results show that bioenergy production can satisfy part of Taiwan’s energy demand, but net GHG emissions offset declines if ethanol is chosen. Moreover, at high GHG price conventional electricity and ethanol will be driven out and pyrolysis will be a dominant technology. Fast pyrolysis dominates when ethanol and GHG prices are low, but slow pyrolysis is dominant at high GHG price, especially when land GHG emissions are endogenously incorporated. The results indicate that when land GHG emission is incorporated, up to 3.8 billion kWh electricity can be produced from fast pyrolysis, while up to 2.2 million tons of CO₂ equivalent can be offset if slow pyrolysis is applied. Full article

Suites of Best Management Practices (BMPs) are usually selected to be economically and environmentally efficient in reducing nonpoint source (NPS) pollutants from agricultural areas in a watershed. The objective of this research was to compare the selection and placement of BMPs in a pasture-dominated watershed using multiobjective optimization and targeting methods. Two objective functions were used in the optimization process, which minimize pollutant losses and the BMP placement areas. The optimization tool was an integration of a multi-objective genetic algorithm (GA) and a watershed model (Soil and Water Assessment Tool—SWAT). For the targeting method, an optimum BMP option was implemented in critical areas in the watershed that contribute the greatest pollutant losses. A total of 171 BMP combinations, which consist of grazing management, vegetated filter strips (VFS), and poultry litter applications were considered. The results showed that the optimization is less effective when vegetated filter strips (VFS) are not considered, and it requires much longer computation times than the targeting method to search for optimum BMPs. Although the targeting method is effective in selecting and placing an optimum BMP, larger areas are needed for BMP implementation to achieve the same pollutant reductions as the optimization method. Full article

Management decisions related with water quality in lakes and reservoirs require a combined land-water processes study approach. This study reports on an integrated watershed-reservoir modeling methodology: the Soil and Water Assessment Tool (SWAT) model to estimate the nutrient input loads from the watershed, used afterwards as boundary conditions to the reservoir model, CE-QUAL-W2. The integrated modeling system was applied to the Torrão reservoir and drainage basin. The objective of the study was to quantify the total maximum input load that allows the reservoir to be classified as mesotrophic. Torrão reservoir is located in the Tâmega River, one of the most important tributaries of the Douro River in Portugal. The watershed is characterized by a variety of land uses and urban areas, accounting for a total Waste Water Treatment Plants (WWTP) discharge of ~100,000 p.e. According to the criteria defined by the National Water Institute (based on the WWTP Directive), the Torrão reservoir is classified as eutrophic. Model estimates show that a 10% reduction in nutrient loads will suffice to change the state to mesotrophic, and should target primarily WWTP effluents, but also act on diffuse sources. The method applied in this study should provide a basis for water environmental management decision-making. Full article

Objective: The present study investigates the use expectations, prevalence and frequency of neuroenhancement drug (ND) use among the Swiss male population, separating college students from others. Methods: Young Swiss men were invited to participate in the Cohort Study on Substance Use Risk Factors. A total of 5,967 participants responded to questions on six types of NDs (wakefulness medication, antidepressants, Alzheimer’s disease medication, Parkinson’s disease medication, attention deficit-hyperactivity disorder (ADHD) medication, and beta-blockers). The frequency of use depending on five expectations (to enhance wakefulness, attention, memory, concentration and stress reduction) was analyzed for a twelve-month period. Results: (1) About 3% of the sample indicated use of at least one ND; (2) ADHD medication was the most prevalent; (3) The type of ND preferred differed depending on academic status (4). Quantitatively, over the year, college student users used ND much less frequently than other users. Conclusions: Prevalence of ND use is low in Switzerland relative to other countries such as the United States. Patterns of ND use differed depending on academic status, suggesting that while college student ND users tended to do so rarely (probably to enhance cognitive abilities for exams), non-college male users used other NDs more frequently (probably to “get high”). Full article

This study examined the performance of veterans and active duty personnel who served in Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF) on a basic associative learning task. Eighty-eight individuals participated in this study. All received a comprehensive clinical evaluation to determine the presence and severity of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). The eyeblink conditioning task was composed of randomly intermixed delay and trace conditioned stimulus (CS) and unconditioned stimulus (US) pairs (acquisition) followed by a series of CS only trials (extinction). Results revealed that those with a clinical diagnosis of PTSD or a diagnosis of PTSD with comorbid mTBI acquired delay and trace conditioned responses (CRs) to levels and at rates similar to a deployed control group, thus suggesting intact basic associative learning. Differential extinction impairment was observed in the two clinical groups. Acquisition of CRs for both delay and trace conditioning, as well as extinction of trace CRs, was associated with alcoholic behavior across all participants. These findings help characterize the learning and memory function of individuals with PTSD and mTBI from OEF/OIF and raise the alarming possibility that the use of alcohol in this group may lead to more significant cognitive dysfunction. Full article

Women are advised to be vaccinated for influenza during pregnancy and may receive vaccine at any time during their pregnancy. In observational studies evaluating vaccine safety in pregnancy, to account for such time-varying vaccine exposure, a time-dependent predictor can be used in a proportional hazards model setting for outcomes such as spontaneous abortion or preterm delivery. Also, due to the observational nature of pregnancy exposure cohort studies and relatively low event rates, propensity score (PS) methods are often used to adjust for potential confounders. Using Monte Carlo simulation experiments, we compare two different ways to model the PS for vaccine exposure: (1) logistic regression treating the exposure status as binary yes or no; (2) Cox regression treating time to exposure as time-to-event. Coverage probability of the nominal 95% confidence interval for the exposure effect is used as the main measure of performance. The performance of the logistic regression PS depends largely on how the exposure data is generated. In contrast, the Cox regression PS consistently performs well across the different data generating mechanisms that we have considered. In addition, the Cox regression PS allows adjusting for potential time-varying confounders such as season of the year or exposure to additional vaccines. The application of the Cox regression PS is illustrated using data from a recent study of the safety of pandemic H1N1 influenza vaccine during pregnancy. Full article

Schistosomiasis japonica, transmitted by the intermediate host snail Oncomelania hupensis of the causative agent Schistosoma japonicum, remains a major public-health concern in China, and control of this snail is one of the major approaches used in attempts to interrupt the transmission of this neglected tropical disease. Niclosamide is currently the only commercial molluscicide available for the control of O. hupensis snails in China. The purpose of this study was to evaluate the current sensitivity of O. hupensis to niclosamide in China. O. hupensis snails derived from 17 sampling sites from eight schistosomiasis-endemic provinces of China were used for the molluscicidal tests. Active adult snails (10 for each drug concentration), were immersed in solutions of 1, 0.5, 0.25, 0.125, 0.063, 0.032, 0.016 and 0.008 mg/L of 50% wettable powder of niclosamide ethanolamine salt (WPN) for 24 and 48 h at 25°C, and then the snail mortality was estimated and LC₅₀ values were calculated. All field-derived O. hupensis snails were dead following immersion in 0.5 and 1 mg/L WPN for 24 h, whereas no death was observed after immersion in 0.008 mg/L WPN for 24 h. Immersion in 0.5, 0.25, 0.125, 0.063, 0.032 and 0.016 mg/L WPN for 24 h resulted in 80%–100%, 63.33%–100%, 0%–85%, 0%–50%, 0%–15%, and 0%–5% snail mortalities, respectively. The 24 h WPN LC₅₀ values for the O. hupensis snails derived from the 17 sampling sites in China ranged from 0.0743 to 0.2285 mg/L, and no significant difference was detected by the Kolmogorov-Smirnov test (p = 0.2). The results indicate that there is no regional variation in the current susceptibility to niclosamide in O. hupensis populations in China. It is suggested that the current sensitivity of niclosamide against O. hupensis remains high and has not changed after more than two decades of repeated, extensive application for snail control in the main endemic areas of China. Full article

Passive smoking has contributed increased risks of cardiovascular disease, mental health, and mortality, but the cumulative effects from work or other households were less studied. Therefore, it was aimed to model the effects of indoor passive smoking from own home, work, and other households in a country-wide, population-based setting. Data in the Scottish Health Survey between 2008 and 2011 after the law banning smoking in public places were analyzed. Information including demographics, lifestyle factors, and self-reported cardiovascular disease and mental health was obtained by household interview. Analyses included chi-square test and survey-weighted logistic regression modeling. After full adjustment, it was observed that being exposed to indoor passive smoking, in particular in more than two places of exposure, was significantly associated with risks of stroke, angina, heart attack, abnormal heart rhythms, and GHQ ≥ 12. The significance remained for angina, GHQ ≥ 12 and probably heart attack in never smokers. The cumulative risks also impacted on sleep problems, self-recognition, making decisions, self-confidence, under strain constantly, depressed, happiness and self-worth. The significance remained for sleep problems, self-confidence, under strain constantly, depressed, and happiness in never smokers. Elimination of indoor passive smoking from different sources should still be a focus in future public health programs. Full article

This paper concentrates on the HFMD data of China from March 2009 to December 2012. We set up a mathematical model to fit those data with the goodness of fit and obtain the optimal parameter values of the model. By the Chi-square test of statistical inference, the optimal parameter values of the model are reasonable. We obtained the basic reproductive number of the disease for each year, and it is larger than 1. Thus, we conclude that HFMD will persist in China under the current conditions, so we investigate the preventive measures to control the HFMD. If the preventive measures proposed in our paper were implemented, HFMD would be controlled quickly and the number of infections would decline rapidly over a period of time. Full article

Due to the emerging environmental issues related to e-waste there is concern about the quality of paddy soils near e-waste workshops. The levels of heavy metals and PCBs and their influence on the enzyme activity and microbial community of paddy soils obtained from the immediate vicinity of an e-waste workshop were investigated in the present study. The results indicated that the heavy metal and PCB pollution did not differ significantly with an increase of the sampling point distances (5 to 30 m). The concentration of Cd (2.16 mg·kg⁻¹) and Cu (69.2 mg·kg⁻¹) were higher, and the PCB pollution was also serious, ranging from 4.9 to 21.6 μg·kg⁻¹. The highest enzyme activity was found for urease compared to phosphatase and catalase, and a fluctuating trend in soil enzyme activity was observed in soils from different sampling sites. The microbial analysis revealed that there was no apparent correlation between the microbial community and the pollutants. However, a slight influence for soil microbial communities could be found based on DGGE, the Shannon index and PCA analysis. The present study suggests that the contamination stress of heavy metals and PCBs might have a slight influence on microbial activity in paddy soils. This study provides the baseline data for enzyme activities and microbial communities in paddy soil under the influence of mixed contamination. Full article

Fluoride is a naturally occurring contaminant in groundwater in Estonia. There are several regions in Estonia with fluoride contents in public water supplies as high as 7 mg/L. Long-term exposure to high-fluoride drinking water may have several adverse health effects, primarily dental fluorosis. The opportunities for exposure reduction rely highly on water treatment technologies. Since 2004 public water suppliers in Estonia have made efforts to diminish fluoride content in drinking water systems. A follow-up study on a country level was carried out in 2004–2012 to analyze the changes in population exposure to excessive (over 1.5 mg/L) fluoride in drinking water and to get information about the reduction methods applied by public water supplies (PWS) to optimize the fluoride levels in public water system. The results showed that bigger PWS have been more effective in fluoride reduction measures than small PWS. The main methods used to lower the fluoride content were reverse osmosis technology and replacement of water sources with new ones (new drilled wells). As a result of all the measures taken the overall high-fluoride exposure has been reduced substantially (82%). Full article

Background: Hepatoma associated with hepatitis B infection is a major public health problem in Shenzhen (China) and worldwide. China has the largest number of people infected with the hepatitis B virus (HBV), and many studies have demonstrated that HBV infection is associated with hepatoma development. Shenzhen officials have been attempting to monitor and control these diseases for many years. The methodology and the results of this study may be useful in developing a system to monitor, prevent and control these diseases. Methods: The aim of the study was to analyze HBV infection and hepatoma distribution characteristics and patterns in Shenzhen by combining geographic information system (GIS) technology and spatial analysis. The study used data from patients at the district level from the 2010–2012 population censuses. Results: Only one-third of the patients were female, and 70.7% of all cases were 20–50 years of age. There was no global spatial correlation of the distribution of hepatitis B infections and hepatomas; however, there was a local spatial correlation, and certain sub-districts of the Nanshan district had significant agglomeration effects. Based on incidence density and rate maps, we can conclude that the Shenzhen special zone had a higher incidence density and rate of hepatitis B infections and hepatomas compared with the area outside of the Shenzhen special zone during 2010–2012. Conclusions: This study demonstrated substantial geographic variation in the incidence of hepatitis B infection and hepatoma in Shenzhen. The prediction and control of hepatitis B infections and hepatoma development and interventions for these diseases should focus on disadvantaged areas to reduce disparities. GIS and spatial analysis play an important role in public health risk-reduction programs and may become integral components in the epidemiologic description, analysis and risk assessment of hepatitis B and hepatoma. Full article

Phthalates, widely used in flexible plastics and consumer products, have become ubiquitous contaminants worldwide. This study evaluated the acute toxicity and estrogenic endocrine disrupting activity of butyl benzyl phthalate (BBP), di(n-butyl) phthalate (DBP), bis(2-ethylhexyl) phthalate (DEHP), diisodecyl phthalate (DIDP), diisononyl phthalate (DINP), di-n-octyl phthalate (DNOP) and their mixtures. Using a 72 h zebrafish embryo toxicity test, the LC₅₀ values of BBP, DBP and a mixture of the six phthalates were found to be 0.72, 0.63 and 0.50 ppm, respectively. The other four phthalates did not cause more than 50% exposed embryo mortality even at their highest soluble concentrations. The typical toxicity symptoms caused by phthalates were death, tail curvature, necrosis, cardio edema and no touch response. Using an estrogen-responsive ChgH-EGFP transgenic medaka (Oryzias melastigma) eleutheroembryos based 24 h test, BBP demonstrated estrogenic activity, DBP, DEHP, DINP and the mixture of the six phthalates exhibited enhanced-estrogenic activity and DIDP and DNOP showed no enhanced- or anti-estrogenic activity. These findings highlighted the developmental toxicity of BBP and DBP, and the estrogenic endocrine disrupting activity of BBP, DBP, DEHP and DINP on intact organisms, indicating that the widespread use of these phthalates may cause potential health risks to human beings. Full article

Oral diseases are a major burden on individuals and health systems. The aim of this study was to determine whether consumption of tobacco and alcohol were associated with the prevalence of oral/dental problems in Mexican adults. Using data from the National Performance Evaluation Survey 2003, a cross-sectional study part of the World Health Survey, dental information from a representative sample of Mexico (n = 22,229, N = 51,155,740) was used to document self-reported oral/dental problems in the 12 months prior to the survey. Questionnaires were used to collect information related to sociodemographic, socioeconomic, and other risk factors. Three models were generated for each age group (18–30, 31–45 and 46–98 years). The prevalence of oral/dental conditions was 25.7%. Adjusting for sex, schooling, socioeconomic position, diabetes, and self-reported health, those who used tobacco (sometimes or daily) (OR = 1.15, p = 0.070; OR = 1.24, p < 0.01; and OR = 1.16, p < 0.05, for each age group respectively) or alcohol (moderate or high) (OR = 1.26, p < 0.001; OR = 1.18, p < 0.01 and OR = 1.30, p < 0.001, for each age group respectively) had a higher risk of reporting oral/dental problems. Because tobacco and alcohol use were associated with self-reported oral/dental problems in one out of four adults, it appears advisable to ascertain how direct is such link; more direct effects would lend greater weight to adopting measures to reduce consumption of tobacco and alcohol for the specific purpose of improving oral health. Full article

Based on Life Cycle Assessment (LCA) and Eco-indicator 99 method, a LCA model was applied to conduct environmental impact and end-of-life treatment policy analysis for secondary batteries. This model evaluated the cycle, recycle and waste treatment stages of secondary batteries. Nickel-Metal Hydride (Ni-MH) batteries and Lithium ion (Li-ion) batteries were chosen as the typical secondary batteries in this study. Through this research, the following results were found: (1) A basic number of cycles should be defined. A minimum cycle number of 200 would result in an obvious decline of environmental loads for both battery types. Batteries with high energy density and long life expectancy have small environmental loads. Products and technology that help increase energy density and life expectancy should be encouraged. (2) Secondary batteries should be sorted out from municipal garbage. Meanwhile, different types of discarded batteries should be treated separately under policies and regulations. (3) The incineration rate has obvious impact on the Eco-indicator points of Nickel-Metal Hydride (Ni-MH) batteries. The influence of recycle rate on Lithium ion (Li-ion) batteries is more obvious. These findings indicate that recycling is the most promising direction for reducing secondary batteries’ environmental loads. The model proposed here can be used to evaluate environmental loads of other secondary batteries and it can be useful for proposing policies and countermeasures to reduce the environmental impact of secondary batteries. Full article

Understanding the spatial pattern of soil lead (Pb) levels is essential to protecting human health. Most previous studies have examined soil Pb distributions by either urbanization gradient or land-use type. Few studies, however, have examined both factors together. It remains unclear whether the impacts of land use on soil Pb levels are consistent along the urbanization gradient. To fill this gap, we investigated variations in soil Pb level under different land-use types along the urbanization gradient in Beijing, China. We classified the degree of urbanization as the urban core, transitional zone, or suburban area and the land-use type as industrial area, roadside, residential area, institutional area, road greenbelt, park, or forest. Our results showed that the range of soil Pb levels in Beijing is <1 mg/kg–292 mg/kg, with a mean of 22 mg/kg. Along the urbanization gradient, the mean soil Pb level increased from the suburban area to the urban core. Land-use types have an impact on soil Pb levels, however, when the degree of urbanization is considered, the impact from land use on soil Pb level was only significant in the transitional zone. Parks and road greenbelts were found to have lower soil Pb, primarily due to soil restoration. Roadside and residential areas were found to have higher soil Pb because of traffic emissions, leaded paint, and previous industrial contamination. In the urban core and suburban area, the soil Pb level showed no significant differences among various land-use types. Given the results of soil Pb in various land-use types, we suggest that future studies consider the urbanization gradient in which different land-use samples are located. Full article

Scientific interpretation of the mechanism of land use change is important for government planning and management activities. This study analyzes the land use change in Jiangsu Province using three land use maps of 2000, 2005 and 2008. The study results show that there was a significant change in land use. The change was mainly characterized by a continuous built-up land expansion primarily at the expense of cropland loss, and the trend became increasingly rapid. There was an obvious regional difference, as most of the cropland loss or built-up land expansion took place in southern Jiangsu, where the rate of built-up land expansion was faster than in central and northern Jiangsu. Meanwhile, the spatial pattern changed remarkably; in general, the number of patches (NumP) showed a declining trend, and the mean patch size (MPS) and patch size standard deviation (PSSD) displayed increase trends. Furthermore, the relative importance of selected driven factors was identified by principal component analysis (PCA) and general linear model (GLM). The results showed that not only the relative importance of a specific driving factor may vary, but the driven factors may as well. The most important driven factor changed from urban population (UP), secondary gross domestic product (SGDP) and gross domestic product (GDP) during 2000–2005 to resident population (RP), population density (POD) and UP during 2005–2008, and the deviance explained (DE) decreased from 91.60% to 81.04%. Policies also had significant impacts on land use change, which can be divided into direct and indirect impacts. Development policies usually had indirect impacts, particularly economic development policies, which promote the economic development to cause land use change, while land management policies had direct impacts. We suggest that the government should think comprehensively and cautiously when proposing a new development strategy or plan. Full article

There is an arising and concerning issue in the field of bacterial resistance, which is confirmed by the number of deaths associated with drug-resistant bacterial infections. The aim of this study was to compare the effects of antibiotics on Staphylococcus aureus non-resistant strain and strains resistant to cadmium or lead ions. Metal resistant strains were created by the gradual addition of 2 mM solution of metal ions (cadmium or lead) to the S. aureus culture. An increasing antimicrobial effect of ampicillin, streptomycin, penicillin and tetracycline (0, 10, 25, 50, 75, 150, 225 and 300 µM) on the resistant strains was observed using a method of growth curves. A significant growth inhibition (compared to control) of cadmium resistant cells was observed in the presence of all the four different antibiotics. On the other hand, the addition of streptomycin and ampicillin did not inhibit the growth of lead resistant strain. Other antibiotics were still toxic to the bacterial cells. Significant differences in the morphology of cell walls were indicated by changes in the cell shape. Our data show that the presence of metal ions in the urban environment may contribute to the development of bacterial strain resistance to other substances including antibiotics, which would have an impact on public health. Full article

Infrastructure degradation in many post-industrial cities has increased the availability of potential mosquito habitats, including container habitats that support infestations of invasive disease-vectors. This study is unique in examining both immature and adult mosquito abundance across the fine-scale variability in socio-economic condition that occurs block-to-block in many cities. We hypothesized that abundant garbage associated with infrastructure degradation would support greater mosquito production but instead, found more mosquito larvae and host-seeking adults (86%) in parcels across the higher socio-economic, low-decay block. Aedes albopictus and Culex pipiens were 5.61 (p < 0.001) and 4.60 (p = 0.001) times more abundant, respectively. Most discarded (garbage) containers were dry during peak mosquito production, which occurred during the 5th hottest July on record. Containers associated with human residence were more likely to hold water and contain immature mosquitoes. We propose that mosquito production switches from rain-fed unmanaged containers early in the season to container habitats that are purposefully shaded or watered by mid-season. This study suggests that residents living in higher socioeconomic areas with low urban decay may be at greater risk of mosquito-borne disease during peak mosquito production when local container habitats are effectively decoupled from environmental constraints. Full article

This study investigated the feasibility of using Ag-TiO₂ photocatalyst supported on glass fiber (Ag-TiO₂/GF) prepared by a sol-gel method as an indoor air germicide. An experimental model was designed to investigate the bacterial disinfection efficiency of Staphylococcus (Staph), the most popular bacterium in hospitals in Korea, by the Ag-TiO₂/GF photocatalyst. The silver content in Ag/TiO₂ was altered from 1 to 10% to investigate the optimal ratio of Ag doped on TiO₂/glass fiber (TiO₂/GF) for photocatalytic disinfection of Staph. This study confirmed that Ag in Ag-TiO₂/GF could work as an electron sink or donor to increase photocatalytic activity and promote the charge separation of electron-hole pairs generated from TiO₂ after photon absorption. Ag also acts as an intermediate agent for the transfer of photo-generated electrons from the valence band of TiO₂ to an acceptor (O₂ gas) to promote photo-oxidation processes. The photocatalytic disinfection activity of Ag-TiO₂/GF under visible light increased with the increase in silver content up to 7.5% and then slightly decreased with further increasing silver content. The highest disinfection efficiency and disinfection capacity of Staph using 7.5% Ag-TiO₂/GF were 75.23% and 20 (CFU∙s⁻¹∙cm⁻²) respectively. The medium level of humidity of 60% ± 5% showed better photocatalytic disinfection than the lower (40% ± 5%) or higher (80% ± 5%) levels. Full article

The purpose of this study was to explore Hong Kong nurses’ perceptions of competencies required for disaster nursing. Focus group interviews and written inquiry were adopted to solicit nurses’ perceived required competencies for disaster care. A total of 15 nurses were interviewed and 30 nurses completed the written inquiry on their perceived competencies related to disaster nursing. The International Council for Nurses’ (ICN) framework of disaster nursing competencies, consisting of four themes and ten domains, was used to tabulate the perceived competencies for disaster nursing reported by nurses. The most mentioned required competencies were related to disaster response; with the ethical and legal competencies for disaster nursing were mostly neglected by nurses in Hong Kong. With the complexity nature of disasters, special competencies are required if nurses are to deal with adverse happenings in their serving community. Nurses’ perceived disaster nursing competencies reported by nurses were grossly inadequate, demonstrating the needs to develop a comprehensive curriculum for public health. The establishment of a set of tailor-made disaster nursing core competencies for the community they served is the first step in preparing nurses to deal with disastrous situations for the health of the public. Full article

In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (AT_max) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages <65 and ≥65 during the months May–October for years 2000–2008. The most robust relationship was between AT_max on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (AT_max = 90–97 °F; 32.2‒36.1 °C) were below local median seasonal temperatures in the study period (AT_max = 99.5 °F; 37.5 °C). Heat threshold was defined as AT_max at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (AT_max = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (AT_max = 109 °F; 42.8 °C) and for all-cause mortality in females (AT_max = 107 °F; 41.7 °C) and males <65 years (AT_max = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide. Full article

During the last decades the disease vector Aedes albopictus (Asian tiger mosquito) has rapidly spread around the globe. Global shipment of goods contributes to its permanent introduction. Invaded regions are facing novel and serious public health concerns, especially regarding the transmission of formerly non-endemic arboviruses such as dengue and chikungunya. The further development and potential spread to other regions depends largely on their climatic suitability. Here, we have developed a tool for identifying and prioritizing European areas at risk for the establishment of Aedes albopictus by taking into account, for the first time, the freight imports from this mosquito’s endemic countries and the climate suitability at harbors and their surrounding regions. In a second step we consider the further transport of containers by train and inland waterways because these types of transport can be well controlled. We identify European regions at risk, where a huge amount of transported goods meet climatically suitable conditions for the disease vector. The current and future suitability of the climate for Aedes albopictus was modeled by a correlative niche model approach and the Regional Climate Model COSMO-CLM. This risk assessment combines impacts of globalization and global warming to improve effective and proactive interventions in disease vector surveillance and control actions. Full article

Utilization of services is an important indicator for estimating access to healthcare. In Norway, the General Practitioner Scheme, a patient list system, was established in 2001 to enable a stable doctor-patient relationship. Although satisfaction with the system is generally high, people often choose a more accessible but inferior solution for routine care: emergency wards. The aim of the article is to investigate contact patterns in primary health care situations for the total population in urban and remote areas of Norway and for major immigrant groups in Oslo. The primary regression model had a cross-sectional study design analyzing 2,609,107 consultations in representative municipalities across Norway, estimating the probability of choosing the emergency ward in substitution to a general practitioner. In a second regression model comprising 625,590 consultations in Oslo, we calculated this likelihood for immigrants from the 14 largest groups. We noted substantial differences in emergency ward utilization between ethnic Norwegians both in rural and remote areas and among the various immigrant groups residing in Oslo. Oslo utilization of emergency ward services for the whole population declined, and so did this use among all immigrant groups after 2009. Other municipalities, while overwhelmingly ethnically Norwegian, showed diverse patterns including an increase in some and a decrease in others, results which we were unable to explain. Full article

In recent years, there has been a dramatic increase in obesity in low and middle income countries. However, there is limited research in these countries showing the prevalence and determinants of obesity. In this study, we examine the socioeconomic inequalities in obesity among South African adults. We use nationally representative data from the South Africa National Income Dynamic Survey of 2008 to: (1) construct an asset index using multiple correspondence analyses (MCA) as a proxy for socioeconomic status; (2) estimate concentration indices (CI) to measure socioeconomic inequalities in obesity; and (3) perform a decomposition analysis to determine the factors that contribute to socioeconomic related inequalities. Consistent with other studies, we find that women are more obese than men. The findings show that obesity inequalities exist in South Africa. Rich men are more likely to be obese than their poorer counterparts with a concentration index of 0.27. Women on the other hand have similar obesity patterns, regardless of socioeconomic status with CI of 0.07. The results of the decomposition analysis suggest that asset index contributes positively and highly to socio-economic inequality in obesity among females; physical exercise contributes negatively to the socio-economic inequality. In the case of males, educational attainment and asset index contributed more to socio-economic inequalities in obesity. Our findings suggest that focusing on economically well-off men and all women across socioeconomic status is one way to address the obesity problem in South Africa. Full article

Hand, foot and mouth disease (HFMD) is a common infectious disease, causing thousands of deaths among children in China over the past two decades. Environmental risk factors such as meteorological factors, population factors and economic factors may affect the incidence of HFMD. In the current paper, we used a novel model—geographical detector technique to analyze the effect of these factors on the incidence of HFMD in China. We collected HFMD cases from 2,309 counties during May 2008 in China. The monthly cumulative incidence of HFMD was calculated for children aged 0–9 years. Potential risk factors included meteorological factors, economic factors, and population density factors. Four geographical detectors (risk detector, factor detector, ecological detector, and interaction detector) were used to analyze the effects of some potential risk factors on the incidence of HFMD in China. We found that tertiary industry and children exert more influence than first industry and middle school students on the incidence of HFMD. The interactive effect of any two risk factors increases the hazard for HFMD transmission. Full article

Objective: to investigate the prevalence and antimicrobial resistance of Enterococcus species isolated from a university hospital, and explore the mechanisms underlying the antimicrobial resistance, so as to provide clinical evidence for the inappropriate clinical use of antimicrobial agents and the control and prevention of enterococcal infections. Methods: a total of 1,157 enterococcal strains isolated from various clinical specimens from January 2010 to December 2012 in the General Hospital of Ningxia Medical University were identified to species level with a VITEK-2 COMPACT fully automated microbiological system, and the antimicrobial susceptibility of Enterococcus species was determined using the Kirby-Bauer disc diffusion method. The multiple-drug resistant enterococcal isolates were screened from the clinical isolates of Enterococcus species from the burns department. The minimal inhibitory concentration (MIC) of Enterococcus species to the three fluoroquinolones, including ciprofloxacin, gatifloxacin and levofloxacin was determined with the agar dilution method, and the changes in the MIC of Enterococcus species to the three fluoroquinolones following reserpine treatment were evaluated. The β-lactam, aminoglycoside, tetracycline, macrolide, glycopeptide resistance genes and the efflux pump emeA genes were detected in the enterococcal isolates using a polymerase chain reaction (PCR) assay. Results: the 1,157 clinical isolates of Enterococcus species included 679 E. faecium isolates (58.7%), 382 E. faecalis isolates (33%), 26 E. casseliflavus isolates (2.2%), 24 E. avium isolates (2.1%), and 46 isolates of other Enterococcus species (4%). The prevalence of antimicrobial resistance varied significantly between E. faecium and E. faecalis, and ≤1.1% of these two Enterococcus species were found to be resistant to vancomycin, teicoplanin or linezolid. In addition, the Enterococcus species isolated from different departments of the hospital exhibited various resistances to the same antimicrobial agent, while reserpine treatment reduced the resistance of Enterococcus species to ciprofloxacin, gatifloxacin and levofloxacin. The β-lactamase gene TEM, aminoglycoside-modifying-enzyme genes aac(6')-aph(2"), aph(3')-III, ant(6)-I and ant(2")-I, tetracycline resistance gene tetM, erythromycin resistance gene ermB, vancomycin resistance gene vanA and the enterococcal multidrug resistance efflux emeA gene were detected in 77%, 62%, 26%, 13%, 36%, 31%, 66%, 5% and 55% of the 100 multiple-drug resistant enterococcal isolates. Conclusions: similar to previous findings, E. faecium and E. faecalis are predominant conditionally pathogenic bacteria that cause hospital-acquired infections that can cause urinary and respiratory system infections. Multiple and high-level antimicrobial resistance is highly prevalent in the hospital isolates of Enterococcus species. Reserpine treatment inhibits the active efflux of Enterococcus species to ciprofloxacin, gatifloxacin and levofloxacin in vitro and reduces the MIC of Enterococcus species to these three fluoroquinolones. The presence of the enterococcal multidrug resistance efflux emeA gene is associated with the resistance to antibiotics in Enterococcus species. The monitoring of the prevalence and antimicrobial resistance of Enterococcus species is of great significance to guide the control and prevention of enterococcal infections. Full article

Purpose: Despite the growing evidence that ecological factors contribute to substance use, the relationship of ecological factors and illicit drugs such as marijuana use is not well understood, particularly among adolescents in Latin America. Guided by social disorganization and social stress theories, we prospectively examined the association of disaggregated neighborhood characteristics with marijuana use among adolescents in Santiago, Chile, and tested if these relationships varied by sex. Methods: Data for this study are from 725 community-dwelling adolescents participating in the Santiago Longitudinal Study, a study of substance using behaviors among urban adolescents in Santiago, Chile. Adolescents completed a two-hour interviewer administered questionnaire with questions about drug use and factors related to drug using behaviors. Results: As the neighborhood levels of drug availability at baseline increased, but not crime or noxious environment, adolescents had higher odds of occasions of marijuana use at follow up, approximately 2 years later (odds ratio [OR] = 1.39; 95% CI = 1.16–1.66), even after controlling for the study’s covariates. No interactions by sex were significant. Discussion: The findings suggest that “poverty”, “crime”, and “drug problems” may not be synonyms and thus can be understood discretely. As Latin American countries re-examine their drug policies, especially those concerning decriminalizing marijuana use, the findings suggest that attempts to reduce adolescent marijuana use in disadvantaged neighborhoods may do best if efforts are concentrated on specific features of the “substance abuse environment”. Full article

Green space is now widely viewed as a health-promoting characteristic of residential environments, and has been linked to mental health benefits such as recovery from mental fatigue and reduced stress, particularly through experimental work in environmental psychology. Few population level studies have examined the relationships between green space and mental health. Further, few studies have considered the role of green space in non-urban settings. This study contributes a population-level perspective from the United States to examine the relationship between environmental green space and mental health outcomes in a study area that includes a spectrum of urban to rural environments. Multivariate survey regression analyses examine the association between green space and mental health using the unique, population-based Survey of the Health of Wisconsin database. Analyses were adjusted for length of residence in the neighborhood to reduce the impact of neighborhood selection bias. Higher levels of neighborhood green space were associated with significantly lower levels of symptomology for depression, anxiety and stress, after controlling for a wide range of confounding factors. Results suggest that “greening” could be a potential population mental health improvement strategy in the United States. Full article

Unhealthy eating is the leading risk for death and disability globally. As a result, the World Health Organization (WHO) has called for population health interventions. One of the proposed interventions is to ensure healthy foods are available by implementing healthy food procurement policies. The objective of this systematic review was to evaluate the evidence base assessing the impact of such policies. A comprehensive review was conducted by searching PubMed and Medline for policies that had been implemented and evaluated the impact of food purchases, food consumption, and behaviors towards healthy foods. Thirty-four studies were identified and found to be effective at increasing the availability and purchases of healthy food and decreasing purchases of unhealthy food. Most policies also had other components such as education, price reductions, and health interventions. The multiple gaps in research identified by this review suggest that additional research and ongoing evaluation of food procurement programs is required. Implementation of healthy food procurement policies in schools, worksites, hospitals, care homes, correctional facilities, government institutions, and remote communities increase markers of healthy eating. Prior or simultaneous implementation of ancillary education about healthy eating, and rationale for the policy may be critical success factors and additional research is needed. Full article

Recent physical activity (PA) and fitness transitions, identified as behavioural shifts from traditionally active lifestyles to more industralised and sedentary lifestyles, have been observed among school-aged children. There is a wealth of supporting evidence of such behavioural transitions in high income countries; however, a paucity of data on lower income countries exists. These transitions pose a particular threat to the welfare of children by accelerating the onset of chronic diseases. This systematic review investigated the evidence for a PA and fitness transition among Sub-Saharan Africa’s school-aged children. Temporal trends and correlates of PA, SB, and fitness were examined. Studies were identified by searching the Medline, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases, and were included if they measured outcomes of interest in apparently healthy samples of children (5‒17 years). A total of 71 articles met the inclusion criteria (40 informed PA, 17 informed SB, and 37 informed fitness). Vast heterogeneity in study methodology complicated analysis of transitions over time and no temporal trends were immediately discernible. However, higher socioeconomic status, urban living, and female children were found to engage in lower levels of PA, higher SB, and performed worse on aerobic fitness measures compared to lower socioeconomic status, rural living, and male children. Data revealed that urbanization was associated with a trend towards decreased PA, increased SB, and decreased aerobic fitness over time. Representative, temporally sequenced data examining a PA and fitness transition are lacking in this region (PROSPERO Registration Number: CRD42013004399). Full article