Recurrent heat waves, already a concern in rapidly growing and urbanizing South Asia, will very likely worsen in a warming world. Coordinated adaptation efforts can reduce heat’s adverse health impacts, however. To address this concern in Ahmedabad (Gujarat, India), a coalition has been formed to develop an evidence-based heat preparedness plan and early warning system. This paper describes the group and initial steps in the plan’s development and implementation. Evidence accumulation included extensive literature review, analysis of local temperature and mortality data, surveys with heat-vulnerable populations, focus groups with health care professionals, and expert consultation. The findings and recommendations were encapsulated in policy briefs for key government agencies, health care professionals, outdoor workers, and slum communities, and synthesized in the heat preparedness plan. A 7-day probabilistic weather forecast was also developed and is used to trigger the plan in advance of dangerous heat waves. The pilot plan was implemented in 2013, and public outreach was done through training workshops, hoardings/billboards, pamphlets, and print advertisements. Evaluation activities and continuous improvement efforts are ongoing, along with plans to explore the program’s scalability to other Indian cities, as Ahmedabad is the first South Asian city to address heat-health threats comprehensively. Full article

This study investigated injury patterns and the use of computed tomography (CT) among Chinese children with mild traumatic brain injury (MTBI). We enrolled children with MTBI who were treated within 24 hours of head trauma in the emergency department of Wuhan Medical Care Center for Women and Children in Wuhan, China. Characteristics of MTBIs were analyzed by age and gender. Results of cranial CT scan and clinically-important brain injury (ciTBI) for children were obtained. The definition of ciTBI was: death from TBI, intubation for more than 24 h for TBI, neurosurgery, or hospital admission of 2 nights or more. Of 455 eligible patients with MTBI, ciTBI occurred in two, and no one underwent neurosurgical intervention. CT scans were performed for 441 TBI patients (96.9%), and abnormal findings were reported for 147 patients (33.3%, 95% CI 29.0–37.8). Falls were the leading cause of MTBI (61.5%), followed by blows (18.9%) and traffic collisions (14.1%) for children in the 0–2 group and 10–14 group. For children aged between 3 and 9, the top three causes of TBI were falls, traffic collisions and blows. Leisure activity was the most reported activity when injuries occurred for all age groups. Sleeping/resting and walking ranked in the second and third place for children between 0 and 2 years of age, and walking and riding for the other two groups. The places where the majority injuries occurred were the home for the 0–2 and 3–9 years of age groups, and school for the 10–14 years of age group. There was no statistical difference between boys and girls with regard to the activity that caused the MTBI. This study highlights the important roles that parents and school administrators in the development of preventive measures to reduce the risk of traumatic brain injury in children. Also, identifying children who had a head trauma at very low risk of clinically important TBI for whom CT might be unnecessary is a priority area of research in China. Full article

A large number of parameters are acquired during practical water quality monitoring. If all the parameters are used in water quality assessment, the computational complexity will definitely increase. In order to reduce the input space dimensions, a fuzzy rough set was introduced to perform attribute reduction. Then, an attribute recognition theoretical model and entropy method were combined to assess water quality in the Harbin reach of the Songhuajiang River in China. A dataset consisting of ten parameters was collected from January to October in 2012. Fuzzy rough set was applied to reduce the ten parameters to four parameters: BOD₅, NH₃-N, TP, and F. coli (Reduct A). Considering that DO is a usual parameter in water quality assessment, another reduct, including DO, BOD₅, NH₃-N, TP, TN, F, and F. coli (Reduct B), was obtained. The assessment results of Reduct B show a good consistency with those of Reduct A, and this means that DO is not always necessary to assess water quality. The results with attribute reduction are not exactly the same as those without attribute reduction, which can be attributed to the α value decided by subjective experience. The assessment results gained by the fuzzy rough set obviously reduce computational complexity, and are acceptable and reliable. The model proposed in this paper enhances the water quality assessment system. Full article

We compared six methods for regression on log-normal heteroscedastic data with respect to the estimated associations with explanatory factors (bias and standard error) and the estimated expected outcome (bias and confidence interval). Method comparisons were based on results from a simulation study, and also the estimation of the association between abdominal adiposity and two biomarkers; C-Reactive Protein (CRP) (inflammation marker,) and Insulin Resistance (HOMA-IR) (marker of insulin resistance). Five of the methods provide unbiased estimates of the associations and the expected outcome; two of them provide confidence intervals with correct coverage. Full article

Background: Previous research showed that there was a significant increase in psychiatric hospital admission of postpartum mothers. The aim of the current study is to describe the length of hospital stays and patient days for mental and behavioural disorders (MBD) of new mothers in the first year after birth. Method: This was a cohort study based on linked population data between the New South Wales (NSW) Midwives Data Collection (MDC) and the NSW Admitted Patients Data Collection (APDC). The study population included primiparous mothers aged from 18 to 44 who gave birth between 1 July 2000 and 31 December 2005. The Kaplan–Meier method was used to describe the length of hospital stay for MBD. Results: For principal diagnoses of MBD, the entire length of hospital stay in the first year postpartum was 11.38 days (95% CI: 10.70–12.06) for mean and 6 days (95% CI: 5.87–6.13) for median. The length of hospital stay per admission was 8.47 days (95% CI: 8.03–8.90) for mean and 5 days (95% CI: 4.90–5.10) for median. There were 5,129 patient days of hospital stay per year for principal diagnoses of postpartum MBD in new mothers between 1 July 2000 and 31 December 2005 in NSW, Australia. Conclusions: MBD, especially unipolar depressions, adjustment disorders, acute psychotic episodes, and schizophrenia, or schizophrenia-like disorders during the first year after birth, placed a significant burden on hospital services due to long hospital stays and large number of admissions. Full article

Sludge retention time (SRT) is an important factor affecting not only the performance of the nutrient removal and sludge characteristics, but also the production of secondary pollutants such as nitrous oxide (N₂O) in biological nutrient removal (BNR) processes. Four laboratory-scale sequencing batch reactors (SBRs), namely, SBR5, SBR10, SBR20 and SBR40 with the SRT of 5 d, 10 d, 20 d and 40 d, respectively, were operated to examine effects of SRT on nutrient removal, activated sludge characteristics and N₂O emissions. The removal of chemical oxygen demand or total phosphorus was similar under SRTs of 5–40 d, SRT mainly affected the nitrogen removal and the optimal SRT for BNR was 20 d. The molecular weight distribution of the effluent organic matters was in the range of 500–3,000 Da under SRTs of 5–40 d. The lowest concentration of the effluent soluble microbial products concentration was obtained at the SRT of 5 d. Nitrifier growth was limited at a short SRT and nitrite existed in the effluent of SBR5. With increasing SRTs, mixed liquor suspended solids concentration increased while the excess sludge production was reduced due to the high endogenous decay rate at high SRTs. Endogenous decay coefficients were 0.020 d⁻¹, 0.036 d⁻¹, 0.037 d⁻¹ and 0.039 d⁻¹ under SRTs of 5–40 d, respectively. In BNR, the N₂O emission occurred mainly during the aerobic phase and its emission ratio decreased with increasing SRTs. The ratio between the N₂O-N emission and the removed ammonium nitrogen in the aerobic phase was 5%, 3%, 1.8% and 0.8% at the SRT of 5 d, 10 d, 20 d and 40 d, respectively. With low concentrations of dissolved oxygen and high concentrations of oxidized nitrogen, the N₂O emission was significantly accelerated due to heterotrophic denitrification activities. Full article

eHealth has been identified as a useful approach to disseminate HIV/AIDS information. Together with Consumer Health Informatics (CHI), the Web-to-Public Knowledge Transfer Model (WPKTM) has been applied as a theoretical framework to identify consumer needs for AfroAIDSinfo, a South African Web portal. As part of the CHI practice, regular eSurveys are conducted to determine whether these needs are changing and are continually being met. eSurveys show high rates of satisfaction with the content as well as the modes of delivery. The nature of information is thought of as reliable to reuse; both for education and for referencing of information. Using CHI and the WPKTM as a theoretical framework, it ensures that needs of consumers are being met and that they find the tailored methods of presenting the information agreeable. Combining ICTs and theories in eHealth interventions, this approach can be expanded to deliver information in other sectors of public health. Full article

Increased body weight as well as type 2 diabetes (T2D) are found to be associated with increased incidence of hypertension, although the mechanisms facilitating hypertension in T2D or nondiabetic individuals are not clear. Therefore, in this study we compared the levels of insulin resistance (IR:OGIS), plasma insulin (PI:RIA) levels, and pro-inflammatory cytokines (IL-6 and TNF-α: ELISA), being risk factors previously found to be associated with hypertension, in T2D patients showing increased body weight (obese and overweight, BMI ≥ 25 kg/m²) with hypertension (group A, N = 30), or without hypertension (group B, N = 30), and in nonobese (BMI < 25 kg/m²), normotensive controls (group C, N = 15). We found that OGIS index was the lowest (A: 267 ± 35.42 vs. B: 342.89 ± 32.0, p < 0.01) and PI levels were the highest (A: 31.05 ± 8.24 vs. B: 17.23 ± 3.23, p < 0.01) in group A. In addition, IL-6 levels were higher in group A (A: 15.46 ± 5.15 vs. B: 11.77 ± 6.09; p < 0.05) while there was no difference in TNF-α levels. Our results have shown that appearance of hypertension in T2D patients with increased body weight was dependent on further increase in IR which was associated with the rise in pro-inflammatory IL-6 cytokine. The results imply that lifestyle intervention aimed to decrease IR might be beneficial in reducing the risk for hypertension in those T2D individuals. Full article

The interest in equestrian sports has increased substantially during the last decades, resulting in increased number of horse facilities around urban areas. In Sweden, new guidelines for safe distance have been decided based on the size of the horse facility (e.g., number of horses) and local conditions, such as topography and meteorology. There is therefore an increasing need to estimate dispersion of horse allergens to be used, for example, in the planning processes for new residential areas in the vicinity of horse facilities. The aim of this study was to develop a method for calculating short- and long-term emissions and dispersion of horse allergen and odor around horse facilities. First, a method was developed to estimate horse allergen and odor emissions at hourly resolution based on field measurements. Secondly, these emission factors were used to calculate concentrations of horse allergen and odor by using 3-D dispersion modeling. Results from these calculations showed that horse allergens spread up to about 200 m, after which concentration levels were very low (<2 U/m³). Approximately 10% of a study-group detected the smell of manure at 60m, while the majority—80%–90%—detected smell at 60 m or shorter distance from the manure heap. Modeling enabled horse allergen exposure concentrations to be determined with good time resolution. Full article

The regional management of trace elements in soils requires understanding the interaction between the natural system and human socio-economic activities. In this study, a social-ecological patterns of heavy metals (SEPHM) approach was proposed to identify the heavy metal concentration patterns and processes in different ecoregions of Beijing (China) based on a self-organizing map (SOM). Potential ecological risk index (RI) values of Cr, Ni, Zn, Hg, Cu, As, Cd and Pb were calculated for 1,018 surface soil samples. These data were averaged in accordance with 253 communities and/or towns, and compared with demographic, agriculture structure, geomorphology, climate, land use/cover, and soil-forming parent material to discover the SEPHM. Multivariate statistical techniques were further applied to interpret the control factors of each SEPHM. SOM application clustered the 253 towns into nine groups on the map size of 12 × 7 plane (quantization error 1.809; topographic error, 0.0079). The distribution characteristics and Spearman rank correlation coefficients of RIs were strongly associated with the population density, vegetation index, industrial and mining land percent and road density. The RIs were relatively high in which towns in a highly urbanized area with large human population density exist, while low RIs occurred in mountainous and high vegetation cover areas. The resulting dataset identifies the SEPHM of Beijing and links the apparent results of RIs to driving factors, thus serving as an excellent data source to inform policy makers for legislative and land management actions. Full article

The aim of this study was to investigate the effect of influenza vaccination (and annual revaccination) on the risk of stroke admissions. We conducted a population-based case-control study in Taiwan. Cases consisted of patients >65 years of age who had a first-time diagnosis of stroke during the influenza seasons from 2006 to 2009. Controls were selected by matching age, sex, and index date to cases. Multiple logistic regression analysis was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Ever vaccinated individuals in the current vaccination season were associated with a reduced risk of ischemic stroke admissions (OR = 0.76, 95% CI = 0.60–0.97). Compared with individuals never vaccinated against influenza during the past 5 years, the adjusted ORs were 0.92 (95% CI = 0.68–1.23) for the group with 1 or 2 vaccinations, 0.73 (95% CI = 0.54–1.00) for the group with 3 or 4 vaccinations, and 0.56 (95% CI = 0.38–0.83) for the group with 5 vaccinations. There was a significant trend of decreasing risk of ischemic stroke admissions with an increasing number of vaccinations. This study provides evidence that vaccination against influenza may reduce the risk of hospitalization for ischemic stroke and that annual revaccination provides greater protection. Full article

Alterations of fish behavioral responses are sensitive indicators to identify accidental chemical pollution. In this research, a series of exposure tests were conducted to investigate behavioral changes of adult zebrafish (Danio rerio) exposed to deltamethrin (DM) in six concentrations of 0, 0.15, 1.5, 3.75, 7.5 and 15 μg/L. Swimming changes in zebrafish were detected at a concentration as low as 1% of the LC_50-24h within five hours. Hyperactivity was the first response, followed by a second response of fish surfacing. The change patterns of swimming speed in zebrafish were similar in all exposure groups, but the degree increased with increasing concentrations. Swimming speed and depth were altered within the first two hours after exposure, which was regarded as the most vital phase for water quality monitoring. The duration of hyperactivity and the time of zebrafish surfacing were both logarithmically correlated with exposure concentrations, which was helpful to distinguish the level of pollution. Full article

First, the urinary metabolic profiling by gas chromatography-mass spectrometry (GC-MS), was performed to compare ten cadmium (Cd) toxicosis cases from a Cd-polluted area in Mae Sot (Thailand) with gender-matched healthy controls. Orthogonal partial list square-discrimination analysis was used to identify new biomarker candidates in highly Cd exposed toxicosis cases with remarkable renal tubular dysfunction. The results of the first step of this study showed that urinary citrate was a negative marker and myo-inositol was a positive marker for Cd toxicosis in Thailand. In the second step, we measured urinary citrate in the residents (168 Cd-exposed subjects and 100 controls) and found significantly lower levels of urinary citrate and higher ratios of calcium/citrate and magnesium/citrate, which are risk factors for nephrolithiasis, in highly Cd-exposed residents. Additionally, this inverse association of urinary citrate with urinary Cd was observed after adjustment for age, smoking and renal tubular dysfunction, suggesting a direct effect of Cd on citrate metabolism. These results indicate that urinary citrate is a useful biomarker for the adverse health effects of Cd exposure in a Thai population with a high prevalence of nephrolithiasis. Full article

The aim of this study was exploratory and sought to examine the effect on blood pressure (BP), heart rate (HR) and mood state responses in primary school children of moderate intensity cycling whilst viewing a green environment compared to exercise alone. Following ethics approval and parental informed consent, 14 children (seven boys, seven girls, Mean age ± SD = 10 ± 1 years) undertook two, 15 min bouts of cycling at a moderate exercise intensity in a counterbalanced order. In one bout they cycled whilst viewing a film of cycling in a forest setting. In the other condition participants cycled with no visual stimulus. Pre-, immediately post-exercise and 15 min post-exercise, BP, HR and Mood state were assessed. Analysis of variance, indicated significant condition X time interaction for SBP (p = 0.04). Bonferroni post-hoc pairwise comparisons indicated that systolic blood pressure (SBP) 15 min post exercise was significantly lower following green exercise compared to the control condition (p = 0.01). There were no significant differences in diastolic blood pressure (DBP) (all p > 0.05). HR immediately post exercise was significantly higher than HR pre exercise irrespective of green exercise or control condition (p = 0.001). Mood scores for fatigue were significantly higher and scores for vigor lower 15 min post exercise irrespective of green exercise or control condition (both p = 0.0001). Gender was not significant in any analyses (p > 0.05). Thus, the present study identifies an augmented post exercise hypotensive effect for children following green exercise compared to exercise alone. Full article

The ability of bacteria isolated from a fixed-film bioreactor to precipitate phosphate crystals for the treatment of domestic wastewater in both artificial and natural media was studied. When this was demonstrated in artificial solid media for crystal formation, precipitation took place rapidly, and crystal formation began 3 days after inoculation. The percentage of phosphate-forming bacteria was slightly higher than 75%. Twelve major colonies with phosphate precipitation capacity were the dominant heterotrophic platable bacteria growing aerobically in artificial media. According to their taxonomic affiliations (based on partial sequencing of the 16S rRNA), the 12 strains belonged to the following genera of Gram-negative bacteria: Rhodobacter, Pseudoxanthobacter, Escherichia, Alcaligenes, Roseobacter, Ochrobactrum, Agromyce, Sphingomonas and Paracoccus. The phylogenetic tree shows that most of the identified populations were evolutionarily related to the Alphaproteobacteria (91.66% of sequences). The minerals formed were studied by X-ray diffraction, scanning electron microscopy (SEM), and energy dispersive X-ray microanalysis (EDX). All of these strains formed phosphate crystals and precipitated struvite (MgNH₄PO₄·6H₂O), bobierrite [Mg₃(PO₄)₂·8H₂O] and baricite [(MgFe)₃(PO₄)₂·8H₂O]. The results obtained in this study show that struvite and spherulite crystals did not show any cell marks. Moreover, phosphate precipitation was observed in the bacterial mass but also near the colonies. Our results suggest that the microbial population contributed to phosphate precipitation by changing the media as a consequence of their metabolic activity. Moreover, the results of this research suggest that bacteria play an active role in the mineral precipitation of soluble phosphate from urban wastewater in submerged fixed-film bioreactors. Full article

Objective: The association between Kawasaki disease and autism has rarely been studied in Asian populations. By using a nationwide Taiwanese population-based claims database, we tested the hypothesis that Kawasaki disease may increase the risk of autism in Taiwan. Materials and Methods: Our study cohort consisted of patients who had received the diagnosis of Kawasaki disease (ICD-9-CM: 446.1) between 1997 and 2005 (N = 563). For a comparison cohort, five age- and gender-matched control patients for every patient in the study cohort were selected using random sampling (N = 2,815). All subjects were tracked for 5 years from the date of cohort entry to identify whether they had developed autism (ICD-9-CM code 299.0) or not. Cox proportional hazard regressions were then performed to evaluate 5-year autism-free survival rates. Results: The main finding of this study was that patients with Kawasaki disease seem to not be at increased risk of developing autism. Of the total patients, four patients developed autism during the 5-year follow-up period, among whom two were Kawasaki disease patients and two were in the comparison cohort. Further, the adjusted hazard ratios (AHR) (AHR: 4.81; 95% confidence interval: 0.68–34.35; P = 0.117) did not show any statistical significance between the Kawasaki disease group and the control group during the 5-year follow-up. Conclusion: Our study indicated that patients with Kawasaki disease are not at increased risk of autism. Full article

Only half of adults with chronic obstructive pulmonary disease (COPD) report a smoking quit attempt in the past year. Adults with COPD have frequent encounters with the healthcare system that are opportunities for health behavior interventions that support quit attempts. The purpose of this research was to examine individual- and clinical-level factors associated with smoking quit attempts in adults with COPD. Cross-sectional data were from the 2011 Behavioral Risk Factor Surveillance System. Race-stratified, weighted logistic regression examined factors associated with quit attempt among current smokers with COPD. Overall, quit attempt was reported by 65% (95% confidence interval (CI): 61.9, 67.5) of adults and was more likely among blacks than whites (p < 0.0001). Among whites with COPD quit attempt was associated with: Female gender (adjusted odds ratio (AOR) = 1.3; CI: 1.0, 1.7), exercise (AOR = 2.0; CI: 1.5, 2.5), and medications for COPD (AOR = 1.6; CI: 1.3, 2.2). Among black adults with COPD quit attempt was associated with: Having a partner (AOR = 4.5; CI: 1.3, 15.0), exercise (AOR = 3.7; CI: 1.6, 8.7), spirometry (AOR = 9.5; CI: 3.2, 28.7), and having a personal doctor (AOR = 6.4; CI: 1.8, 22.5). Individual and clinical-factors associated with quit attempt varied by race. These findings suggest an impact of the healthcare system that supports quit attempts in blacks but not whites with COPD. Full article

The main object of the present study was to explore the effect of perinatal bisphenol A (BPA) exposure on glucose metabolism in early and later life of male rat offspring, and to establish the potential mechanism of BPA-induced dysglycemia. Pregnant rats were treated with either vehicle or BPA by drinking water at concentrations of 1 and 10 µg/mL BPA from gestation day 6 through the end of lactation. We measured the levels of fasting serum glucose, insulin, adiponectin and parameters of oxidative stress on postnatal day (PND) 50 and PND100 in male offspring, and adiponectin mRNA and protein expression in adipose tissue were also examined. Our results showed that perinatal exposure to 1 or 10 µg/mL BPA induced hyperglycemia with insulin resistance on PND100, but only 10 µg/mL BPA exposure had similar effects as early as PND50. In addition, increased oxidative stress and decreased adiponectin production were also observed in BPA exposed male offspring. Our findings indicated that perinatal exposure to BPA resulted in abnormal glucose metabolism in later life of male offspring, with an earlier and more exacerbated effect at higher doses. Down-regulated expression of adiponectin gene and increased oxidative stress induced by BPA may be associated with insulin resistance. Full article

Few data exist on the concurrent exposures of young children to past-use and current-use pesticides in their everyday environments. In this further analysis of study data, we quantified the potential exposures and intake doses of 129 preschool children, ages 20 to 66 months, to 16 pesticides (eight organochlorines, two organophosphates, three pyrethroids, and three acid herbicides). Environmental samples (soil, dust, outdoor air, and indoor air) and personal samples (hand wipes, solid food, and liquid food) were collected at 129 homes and 13 daycare centers in six counties in North Carolina between 2000 and 2001. α-Chlordane, γ-chlordane, heptachlor, chlorpyrifos, diazinon, cis-permethrin, trans-permethrin, and 2,4-dichlorophenoxyacetic acid (2,4-D) were detected ≥50% in two or more media in both settings. Of these pesticides, the children’s estimated median potential intake doses through dietary ingestion, nondietary ingestion, and inhalation routes were the highest for 2,4-D and cis/trans-permethrin (both 4.84 ng/kg/day), cis/trans-permethrin (2.39 ng/kg/day), and heptachlor (1.71 ng/kg/day), respectively. The children’s estimated median potential aggregate intake doses by all three routes were quantifiable for chlorpyrifos (4.6 ng/kg/day), cis/trans-permethrin (12.5 ng/kg/day), and 2,4-D (4.9 ng/kg/day). In conclusion, these children were likely exposed daily to several pesticides from several sources and routes at their homes and daycares. Full article

Spatial health inequalities have often been analyzed in terms of socioeconomic and environmental factors. The present study aimed to evaluate spatial relationships between spatial data collected at different spatial scales. The approach was illustrated using health outcomes (mortality attributable to cancer) initially aggregated to the county level, district socioeconomic covariates, and exposure data modeled on a regular grid. Geographically weighted regression (GWR) was used to quantify spatial relationships. The strongest associations were found when low deprivation was associated with lower lip, oral cavity and pharynx cancer mortality and when low environmental pollution was associated with low pleural cancer mortality. However, applying this approach to other areas or to other causes of death or with other indicators requires continuous exploratory analysis to assess the role of the modifiable areal unit problem (MAUP) and downscaling the health data on the study of the relationship, which will allow decision-makers to develop interventions where they are most needed. Full article

Floods are a devastating kind of natural disaster. About half of the population in China lives in rural areas. Therefore, it is necessary to assess the flood disaster risk of rural housings. The results are valuable for guiding the rescue and relief goods layout. In this study, we take the severe flood disaster that happened at Kouqian Town in Jilin, China in 2010 as an example to build an risk assessment system for flood disaster on rural housings. Based on the theory of natural disaster risk formation and “3S” technology (remote sensing, geography information systems and global positioning systems), taking the rural housing as the bearing body, we assess the flood disaster risk from three aspects: hazard, exposure and vulnerability. The hazard presented as the flood submerging range and depth. The exposure presented as the values of the housing and the property in it. The vulnerability presented as the relationship between the losses caused by flood and flood depth. We validate the model by the field survey after the flood disaster. The risk assessment results highly coincide with the field survey losses. This model can be used to assess the risk of other flood events in this area. Full article

The purpose of this study was to identify subgroups of university students with the highest likelihood of remaining at elevated levels of depressive symptoms six months following the receipt of a depressive prevention intervention on the basis of known risk factors and participation in one of two depression prevention programs. Data from a randomized controlled trial evaluating depression prevention among 133 college students with elevated depressive symptoms were analyzed. Participants were randomized to a cognitive-behavioral or relaxation training group preventive intervention. Classification tree analysis showed that older age was the strongest risk factor for persistently elevated depression. Additional risk factors were: (1) for younger students, fewer daily pleasant activities; (2) for those with higher level of pleasant activities, higher level of stressful events; and (3) for those with higher level of stressful events, lower assertiveness. Results offer directions for prevention foci, identify specific subgroups of college students to target for depression prevention efforts, and suggest that research aim to help older, non-traditional students or graduating students manage the transition from college to the work force. Full article

Cardiovascular patients consult doctors for advice regarding regular exercise, whereas obese patients must self-manage their weight. Because a system for permanently monitoring and tracking patients’ exercise intensities and workouts is necessary, a system for recognizing gait and estimating walking exercise intensity was proposed. For gait recognition analysis, αβ filters were used to improve the recognition of athletic attitude. Furthermore, empirical mode decomposition (EMD) was used to filter the noise of patients’ attitude to acquire the Fourier transform energy spectrum. Linear discriminant analysis was then applied to this energy spectrum for training and recognition. When the gait or motion was recognized, the walking exercise intensity was estimated. In addition, this study addressed the correlation between inertia and exercise intensity by using the residual function of the EMD and quadratic approximation to filter the effect of the baseline drift integral of the acceleration sensor. The increase in the determination coefficient of the regression equation from 0.55 to 0.81 proved that the accuracy of the method for estimating walking exercise intensity proposed by Kurihara was improved in this study. Full article

Globally, excess winter morbidity from ischemic heart disease (IHD) is reported. In subtropical regions, there is a need to quantify the difference in the adverse effect of cold winters compared with hot summers, particularly among the older people. Our objectives were to: (i) compare the effect of winter on IHD hospitalizations with that of summer; (ii) examine temporal trends in the excess winter hospitalizations; and (iii) investigate the effect of age, gender, and meteorological factors on predicting such excess. Inpatient admissions due to IHD as principal cause during June 2000 to February 2009 in public hospitals of Hong Kong were extracted for the population aged ≥65. An Excess Hospitalization in Winter vs. Summer (EHWS) Index was used to contrast the adverse effect of weather on hospitalizations in winter vs. summer. Multiple linear regressions were used to investigate the trend and the predictors of such index. It was found that in a subtropical city, greater effect of winter on IHD hospitalizations than summer was observed, particularly among the oldest old (an index of 61.5% (95% CI: 49.5%–74.4%) for men aged ≥85 and 32.3% (95% CI: 25.5%–39.5%) for women aged ≥85). There was significant increasing trend in the index among those aged ≥85 but the age difference was less prominent among the women. Absolute level of coldness was not a significant factor, whereas the change in temperature was a significant factor, which implies that great fluctuation in temperature within a winter day had greater impact on occurrence of circulatory disease than an absolute temperature threshold. Full article

Objectives: This study’s objective was to assess the effects of a 12-month physical exercise intervention on work ability (WAI) and cardiorespiratory fitness (CRF) in healthy working adults. Methods: The study group had 371 participants, of which 338 (212 women and 126 men) were allocated in the exercise group and 33 (17 women and 16 men) in the control group. The exercise group underwent a 12-month exercise program followed by a 12-month follow-up. WAI and CRF were evaluated at baseline, and at 4, 8, 12, and 24 study months, in both exercise and control groups. The exercise group was divided into subgroups according to baseline WAI classifications (poor/moderate, good, excellent). Results: During the 12-month exercise intervention, the exercise group increased their leisure-time physical activity by 71% (p = 0.016) and improved the mean WAI by 3% and CRF by 7% (p < 0.0001, in both), while WAI and CRF decreased in the control group (ANCOVA using age, sex and BMI as covariates, for WAI, p = 0.013 and for CRF, p = 0.008). The changes in WAI and CRF between the exercise group and control group were significantly different during the intervention (baseline vs. 12-months, p = 0.028 and p = 0.007) and after the follow-up (p = 0.001 and p = 0.040), respectively. A light positive correlation between the changes in WAI and in CRF (r = 0.19, p < 0.01) existed. WAI improvement was the highest (13%, p < 0.0001) in the subgroup having poor/moderate WAI at baseline (ANCOVA, p < 0.001). Conclusions: The improvement of WAI associated with CRF. These results suggest that a physical exercise intervention may improve work ability. Full article

Surveillance is critical to understanding the epidemiology and control of infectious diseases. The growing concern over climate and other drivers that may increase infectious disease threats to future generations has stimulated a review of the surveillance systems and environmental data sources that might be used to assess future health impacts from climate change in Europe. We present an overview of organizations, agencies and institutions that are responsible for infectious disease surveillance in Europe. We describe the surveillance systems, tracking tools, communication channels, information exchange and outputs in light of environmental and climatic drivers of infectious diseases. We discuss environmental and climatic data sets that lend themselves to epidemiological analysis. Many of the environmental data sets have a relatively uniform quality across EU Member States because they are based on satellite measurements or EU funded FP6 or FP7 projects with full EU coverage. Case-reporting systems for surveillance of infectious diseases should include clear and consistent case definitions and reporting formats that are geo-located at an appropriate resolution. This will allow linkage to environmental, social and climatic sources that will enable risk assessments, future threat evaluations, outbreak management and interventions to reduce disease burden. Full article

Spatial analyses of HIV/AIDS related outcomes are growing in popularity as a tool to understand geographic changes in the epidemic and inform the effectiveness of community-based prevention and treatment programs. The Urban Health Study was a serial, cross-sectional epidemiological study of injection drug users (IDUs) in San Francisco between 1987 and 2005 (N = 29,914). HIV testing was conducted for every participant. Participant residence was geocoded to the level of the United States Census tract for every observation in dataset. Local indicator of spatial autocorrelation (LISA) tests were used to identify univariate and bivariate Census tract clusters of HIV positive IDUs in two time periods. We further compared three tract level characteristics (% poverty, % African Americans, and % unemployment) across areas of clustered and non-clustered tracts. We identified significant spatial clustering of high numbers of HIV positive IDUs in the early period (1987–1995) and late period (1996–2005). We found significant bivariate clusters of Census tracts where HIV positive IDUs and tract level poverty were above average compared to the surrounding areas. Our data suggest that poverty, rather than race, was an important neighborhood characteristic associated with the spatial distribution of HIV in SF and its spatial diffusion over time. Full article

Aim: This article examined the association between dietary patterns and cardiovascular risk factors in Chinese older adults. Methods: For this study, older adults with one or more cardiovascular risk factors or a history of cardiovascular disease were randomly selected using health check medical records from the Changshu and Beijing Fangshan Centers for Disease Control and Prevention. Exploratory factor analysis and cluster analysis was used to extract dietary pattern factors. Log binomial regression analysis was used to analyse the association between dietary patterns and chronic disease related risk factors. Results: Four factors were found through factor analysis. A high level of internal consistency was obtained, with a high Cronbach’s alpha coefficient of 0.83. Cluster analysis identified three dietary patterns: healthy diet, Western diet, and balanced diet. Findings in this sample of Chinese adults correspond to those reported in previous studies, indicating that a Western diet is significantly related to likelihood of having obesity, hypertension and the metabolic syndrome. The identification of distinct dietary patterns among Chinese older adults and the nutritional status of people with chronic diseases suggest that the three dietary patterns have a reasonable level of discriminant validity. Conclusions: This study provides evidence that a FFQ is a valid and reliable tool to assess the dietary patterns of individuals with chronic diseases in small- to medium-size urban and rural settings in China. It also validates the significant association between dietary pattern and cardiovascular disease risk factors, including body mass index, blood pressure, triglycerides, and metabolic conditions. Clinical diagnosis of chronic disease further confirmed this relationship in Chinese older adults. Full article

In this prospective study we wanted to determine whether perceived stress over time among students in the Preparatory Year of King Saud University (KSU) predisposes them to cardiometabolic abnormalities. A total of 110 apparently healthy Saudi students (35 men and 75 women enrolled during the 2010−2011 academic year) were included. Perceived stress was determined at baseline and 1 year later. Anthropometrics were obtained and morning fasting serum glucose, lipid profile and cortisol were measured at both times. Perceived stress was noted among 48.2% of subjects at baseline and was not significantly different after follow-up, with 45.4% scoring high. In men, the prevalence of perceived stress was 48.6% at baseline (13 out of 35) and 37.1% at follow-up (13 out of 35), while in women it was 48% at baseline and 49.3% at follow-up. Interestingly, significant improvements in the blood pressure and lipid profiles, with the exception of HDL-cholesterol, were observed in both men and women, while fasting glucose also improved in women. Serum cortisol was inversely associated to fasting glucose, and total- and LDL-cholesterol (p-values 0.007, 0.04 and 0.04, respectively). These data are opposite to findings in students entering Western universities, in whom increasing stress and a deteriorating cardiometabolic profile have been repeatedly noted. Perceived stress and morning cortisol levels among students of the Preparatory Year in KSU remained constant for both genders over time, yet an improved cardiometabolic profile was observed, suggesting good adaptation among our pre-college students in their first year of university life. Full article

This research quantifies the lag effects and vulnerabilities of temperature effects on cardiovascular disease in Changsha—a subtropical climate zone of China. A Poisson regression model within a distributed lag nonlinear models framework was used to examine the lag effects of cold- and heat-related CVD mortality. The lag effect for heat-related CVD mortality was just 0–3 days. In contrast, we observed a statistically significant association with 10–25 lag days for cold-related CVD mortality. Low temperatures with 0–2 lag days increased the mortality risk for those ≥65 years and females. For all ages, the cumulative effects of cold-related CVD mortality was 6.6% (95% CI: 5.2%–8.2%) for 30 lag days while that of heat-related CVD mortality was 4.9% (95% CI: 2.0%–7.9%) for 3 lag days. We found that in Changsha city, the lag effect of hot temperatures is short while the lag effect of cold temperatures is long. Females and older people were more sensitive to extreme hot and cold temperatures than males and younger people. Full article

The intensive use of pesticides has attracted great attention from the Chinese government. However, current regulations have had limited influence on their safe use. Although the acute neurologic effects of pesticides have been well documented, little is known about their cumulative effects. Knowledge of the impact of pesticides on health may convince farmers to minimize their use. We conducted a cross-sectional study in three provinces of China to evaluate the relationship between pesticide exposure and neurological dysfunction. Crop farmers were divided into two groups depending on their level of pesticide exposure. A total of 236 participants were assessed by questionnaire and neurological examination for symptoms and signs of neuropathy. Characteristics of neurologic dysfunction following cumulative low-level exposure were assessed with logistic regression analysis. Farmers exposed to high-level pesticide use had greater risk of developing sensations of numbness or prickling (odds ratio (OR) 2.62, 95% confidence interval (CI): 1.08–6.36). After adjusting for recent exposure, the risk of numbness or prickling symptoms (OR 2.55, 95% CI: 1.04–6.25) remained statistically significant. Loss of muscle strength and decreased deep tendon reflexes had OR > 2, however, this did not reach statistical significance. These findings suggest that overuse of pesticides increased risk of neurologic dysfunction among farmers, with somatosensory small fibers most likely affected. Measures that are more efficient should be taken to curb excessive use of pesticides. Full article

The discipline of economics plays a varied role in informing the understanding of the problem of obesity and the impact of different interventions aimed at addressing it. This paper discusses the causes of the obesity epidemic from an economics perspective, and outlines various justifications for government intervention in this area. The paper then focuses on the potential contribution of health economics in supporting resource allocation decision making for obesity prevention/treatment. Although economic evaluations of single interventions provide useful information, evaluations undertaken as part of a priority setting exercise provide the greatest scope for influencing decision making. A review of several priority setting examples in obesity prevention/treatment indicates that policy (as compared with program-based) interventions, targeted at prevention (as compared with treatment) and focused “upstream” on the food environment, are likely to be the most cost-effective options for change. However, in order to further support decision makers, several methodological advances are required. These include the incorporation of intervention costs/benefits outside the health sector, the addressing of equity impacts, and the increased engagement of decision makers in the priority setting process. Full article

In order to calculate the dose for nanoparticles (NP), (i) relevant information about the dose metrics and (ii) a proper dose concept are crucial. Since the appropriate metrics for NP toxicity are yet to be elaborated, a general dose calculation model for nanomaterials is not available. Here we propose how to develop a dose assessment model for NP in analogy to the radiation protection dose calculation, introducing the so-called “deposited and the equivalent dose”. As a dose metric we propose the total deposited NP surface area (SA), which has been shown frequently to determine toxicological responses e.g. of lung tissue. The deposited NP dose is proportional to the total surface area of deposited NP per tissue mass, and takes into account primary and agglomerated NP. By using several weighting factors the equivalent dose additionally takes into account various physico-chemical properties of the NP which are influencing the biological responses. These weighting factors consider the specific surface area, the surface textures, the zeta-potential as a measure for surface charge, the particle morphology such as the shape and the length-to-diameter ratio (aspect ratio), the band gap energy levels of metal and metal oxide NP, and the particle dissolution rate. Furthermore, we discuss how these weighting factors influence the equivalent dose of the deposited NP. Full article

This study aimed to analyse the impact of obesity in type 2 diabetes (T2D) on adipocytokines (adiponectin, leptin and resistin) and inflammatory markers (TNF-α, IL-6 and hsCRP) as cardiovascular risk factors. A cross-sectional study comparing the basal levels of adipocytokines and inflammatory markers was done in 18 obese (BMI ≥ 30 kg/m²) (group A), 21 overweight (25 kg/m² ≤ BMI < 30 kg/m²) (group B), 25 non-obese T2D patients (group C) and 15 non-obese controls (group D). The lowest levels of adiponectin and the highest levels of leptin, resistin, TNF-α, IL-6 and hsCRP were found in group A. Adiponectin levels were significantly lower, and resistin, TNF-α, and hsCRP levels were elevated in group C vs. D. However, leptin and IL-6 levels differed significantly between groups A and B, but not between groups C and D. Moreover, we found a significant negative correlation between adiponectin and TNF-α, but not with other markers, which was independent of the presence of obesity. In contrast, leptin and resistin correlated with the inflammatory markers, and this correlation was obesity-dependent. Our results suggest that obesity influences cardiovascular risk primarily through changes in leptin and resistin and less efficiently at the level of adiponectin. Full article

Anthropogenic heat generated by human activity contributes to urban and regional climate warming. Due to the resolution and accuracy of existing anthropogenic heat data, it is difficult to analyze and simulate the corresponding effects. This study exploited a new method to estimate high spatial and temporal resolutions of anthropogenic heat based on long-term data of energy consumption and the US Air Force Defense Meteorological Satellite Program-Operational Linescan System (DMSP-OLS) data from 1992 to 2010 across China. Our results showed that, throughout the entire study period, there are apparent increasing trends in anthropogenic heat in three major metropoli, i.e., the Beijing-Tianjin region, the Yangzi River delta and the Pearl River delta. The annual mean anthropogenic heat fluxes for Beijing, Shanghai and Guangzhou in 2010 were 17 Wm⁻², 19 and 7.8 Wm⁻², respectively. Comparisons with previous studies indicate that DMSP-OLS data could provide a better spatial proxy for estimating anthropogenic heat than population density and our analysis shows better performance at large scales for estimation of anthropogenic heat. Full article

There are very few norms to evaluate and monitor the health and functioning of the elderly. This paper proposes a compact spatial representation of 25 health measurements of European citizens older than 50 years. Data from 44,285 unique individuals were obtained from the EU-wide Survey of Health, Ageing and Retirement in Europe(SHARE) data collected in 2004–2007 and were analyzed by homogeneity analysis, a form of non-linear principal components analysis. The resulting configuration of persons shows a remarkable three-dimensional shape that resembles a fountain. The three components explain 13.7, 5.8 and 4.6 percent of the total variation, respectively. Component 1 is driven by age and by the disabilities that come with old age. Component 2 portrays differences in health that are independent of age, with the high scores in relatively good health, given age. Component 3 distinguishes specific types of functional decline from general complaints that impact on daily life. The shape suggests that the elderly keep on maturing as they grow older, actually becoming more diverse as a group. We show how the solution may be used to develop and support profiles for the elderly. Another potential application is to track the individual development of the elderly, thereby objectifying personalized medicine. Full article

Arsenic contamination in a large area of agricultural fields on the Guandu Plain of northern Taiwan was confirmed in a survey conducted in 2006, but research concerning the relationship between bioavailable As concentrations in contaminated soils and crop production in Taiwan is not available. Pot experiments were conducted to examine the growth and accumulation of As in four vegetable crops grown in As-contaminated soils and to assess As intake through consumption. The phytotoxic effects of As in soils were not shown in the pot experiments in which vegetable crops were grown in soils contaminated with different As levels in situ collected from Guandu Plain (120–460 mg/kg) or artificially spiked As-contaminated soils (50–170 mg/kg). Experimental results showed that the bioavailable As extracted with 0.5M NaHCO₃ from soils can be used to estimate As concentrations in vegetables. The As concentrations in the vegetables were compared with data shown in the literature and As limits calculated from drinking water standards and the provisional tolerance weekly intake (PTWI) of inorganic As established by the Food and Agriculture Organization of the United Nations/World Health Organization (FAO/WHO). Although the As levels in the vegetables were not high and the bioavailability of As in the soils was quite low, long-term consumption may result in higher As intake in the human body. Full article

Optimization methods usually obtain the travel direction of the solution by substituting the solutions into the objective function. However, if the solution space is too large, this search method may be time consuming. In order to address this problem, this study incorporated the Taguchi method into the solution space search process of the optimization method, and used the characteristics of the Taguchi method to sequence the effects of the variation of decision variables on the system. Based on the level of effect, this study determined the impact factor of decision variables and the optimal solution for the model. The integration of the Taguchi method and the solution optimization method successfully obtained the optimal solution of the optimization problem, while significantly reducing the solution computing time and enhancing the river water quality. The results suggested that the basin with the greatest water quality improvement effectiveness is the Dahan River. Under the optimal strategy of this study, the severe pollution length was reduced from 18 km to 5 km. Full article

This paper examines the effectiveness of the Penn Resiliency Program (PRP) in an urban Indian setting. The PRP is a program to prevent depression in early adolescence and has proved successful in changing children’s attributional style of life events. While the program has been successful in preventing symptoms of depression in Western populations, the current study explored whether this program could be effective with an Indian sample. The aim of the current study was twofold; first, to study the attributional style of early adolescents in India and identify negative effects (if any) and second, to gain insights in using the PRP as a tool to change explanatory styles in Indian children. A total of 58 children participated in the study (Intervention group n = 29 and Control group n = 29). An Analysis of Covariance comparing post-test scores on Children’s Attributional Style Questionnaire (CASQ) while controlling for baseline scores indicated that children in the intervention group exhibited a significant reduction in pessimistic explanatory style and an increase in optimistic orientation compared to children in the control group. This indicates that the program was effective in changing negative attribution styles among upper-class Indian school children. Future work may look into the longer impact of the program as well as further considerations into adapting the program for a middle class population. Full article

The aim of this study was to estimate the social cost of the leptospirosis cases that were attributed to the natural disaster of January 2011 in Nova Friburgo (State of Rio de Janeiro, Brazil) through a partial economic assessment. This study utilized secondary data supplied by the Municipal Health Foundation of Nova Friburgo. Income scenarios based on the national and state minimum wages and on average income of the local population were employed. The total social cost of leptospirosis cases attributed to the 2011 disaster may range between US$21,500 and US$66,000 for the lower income scenario and between US$23,900 and US$100,800 for that of higher income. Empirical therapy represented a total avoided cost of US$14,800, in addition to a reduction in lethality. An estimated 31 deaths were avoided among confirmed cases of the disease, and no deaths resulted from the leptospirosis cases attributed to the natural disaster. There has been a significant post-disaster rise in leptospirosis incidence in the municipality, which illustrates the potential for increased cases—and hence costs—of this illness following natural disasters, which justifies the adoption of preventive measures in environmental health. Full article

It is valuable to study the spatiotemporal pattern of Japanese encephalitis (JE) and its association with the contextual risk factors in southwest China, which is the most endemic area in China. Using data from 2004 to 2009, we applied GISmapping and spatial autocorrelation analysis to analyze reported incidence data of JE in 438 counties in southwest China, finding that JE cases were not randomly distributed, and a Bayesian hierarchical spatiotemporal model identified the east part of southwest China as a high risk area. Meanwhile, the Bayesian hierarchical spatial model in 2006 demonstrated a statistically significant association between JE and the agricultural and climatic variables, including the proportion of rural population, the pig-to-human ratio, the monthly precipitation and the monthly mean minimum and maximum temperatures. Particular emphasis was placed on the time-lagged effect for climatic factors. The regression method and the Spearman correlation analysis both identified a two-month lag for the precipitation, while the regression method found a one-month lag for temperature. The results show that the high risk area in the east part of southwest China may be connected to the agricultural and climatic factors. The routine surveillance and the allocation of health resources should be given more attention in this area. Moreover, the meteorological variables might be considered as possible predictors of JE in southwest China. Full article

Cardiovascular diseases (CVD) are a major public health concern as they are the leading cause of death in developed countries. Primary care is considered to be the ideal setting for CVD prevention. Therefore, more than 4,000 German primary care physicians (PCPs) were asked about their attitudes towards and their activities regarding the prevention of CVD in the nationwide ÄSP-kardio Study. The focus of the study was on health behavior modification. Two thirds of the participating PCPs stated that they routinely provided brief inventions to assist patients in reducing both their tobacco (72%) and alcohol (61%) consumption, to encourage them to increase their levels of physical activity (72%), and to assist them in adjusting to a more healthy diet (66%), and in achieving a healthy body weight (69%). However, only between 23% (quitting smoking) and 49% (diet modification) of PCPs felt that they had been successful in helping patients modify their lifestyles. Insufficient reimbursement, cultural diversity and a lack of time were reported to be the most problematic barriers to successful intervention in the primary care setting. Despite these obstacles, the majority of German PCPs was engaged in prevention and health behavior intervention to reduce the incidence and progression of CVD. Full article

Falls are the primary cause of accidents among the elderly and frequently cause fatal and non-fatal injuries associated with a large amount of medical costs. Fall detection using wearable wireless sensor nodes has the potential of improving elderly telecare. This investigation proposes a ZigBee-based location-aware fall detection system for elderly telecare that provides an unobstructed communication between the elderly and caregivers when falls happen. The system is based on ZigBee-based sensor networks, and the sensor node consists of a motherboard with a tri-axial accelerometer and a ZigBee module. A wireless sensor node worn on the waist continuously detects fall events and starts an indoor positioning engine as soon as a fall happens. In the fall detection scheme, this study proposes a three-phase threshold-based fall detection algorithm to detect critical and normal falls. The fall alarm can be canceled by pressing and holding the emergency fall button only when a normal fall is detected. On the other hand, there are three phases in the indoor positioning engine: path loss survey phase, Received Signal Strength Indicator (RSSI) collection phase and location calculation phase. Finally, the location of the faller will be calculated by a k-nearest neighbor algorithm with weighted RSSI. The experimental results demonstrate that the fall detection algorithm achieves 95.63% sensitivity, 73.5% specificity, 88.62% accuracy and 88.6% precision. Furthermore, the average error distance for indoor positioning is 1.15 ± 0.54 m. The proposed system successfully delivers critical information to remote telecare providers who can then immediately help a fallen person. Full article

Objectives: To quantitatively identify the perception of dentists regarding comprehensiveness and its domains of “patient welcoming”, “bonding” and “quality of care” in primary dental care settings of a large Brazilian city. Methods: A questionnaire was administered to all dentists comprising the primary health care service to Belo Horizonte with tenured jobs and 40 work hours per week, totalling a population of 207 professionals. The response rate was 90.34%. A pilot test was conducted with 44 dentists working in primary care for at least two years and who did not participate in the main study. Descriptive statistical analysis involved calculating proportions. No confidence intervals were calculated because this was a census study. Results: In most items (79.0%), professionals’ perceptions about the comprehensiveness were overwhelmingly positive. When we stratified the analysis by domain and checked those items about which dentists had a less favourable perception, 22.7% were in the patient welcoming domain, 25.0% were in the bonding domain and 12.5% were in quality of care. Conclusions: Comprehensiveness, as an approach in health care practice, needs to be enhanced, and there is evidence that these dentists are aware of its importance. Full article

Telehealth is an important issue in the medical and healthcare domains. Although a number of systems have been developed to meet the demands of emerging telehealth services, the following problems still remain to be addressed: (1) most systems do not monitor/predict the vital signs states so that they are able to send alarms to caregivers in real-time; (2) most systems do not focus on reducing the amount of work that caregivers need to do, and provide patients with remote care; and (3) most systems do not recommend guidelines for caregivers. This study thus proposes a framework for a real-time and Continua-based Care Guideline Recommendation System (Cagurs) which utilizes mobile device platforms to provide caregivers of chronic patients with real-time care guideline recommendations, and that enables vital signs data to be transmitted between different devices automatically, using the Continua standard. Moreover, the proposed system adopts the episode mining approach to monitor/predict anomalous conditions of patients, and then offers related recommended care guidelines to caregivers so that they can offer preventive care in a timely manner. Full article

Objectives: To evaluate the performance of the Visual Analogue Scale (VAS), in measuring overall health-related Quality of Life (HRQoL) in children with oral clefts relative to the Pediatric Quality of Life Inventory 4.0 (PedsQL^TM) Generic Core Scales, one of the most validated and commonly used methods to measure pediatric HRQoL. Methods: The study included a population-based sample of 307 children aged 5 to 10 years who were born in Iowa, New York, and Arkansas with non-syndromic oral clefts. Data on HRQoL were obtained using a VAS and PedsQL^TM via self-administered interviews with the parents. We evaluated the correlations between the VAS and PedsQL^TM total scores, and the correlations of each of these two scales with a series of child health and wellbeing indicators. Results: The VAS and PedsQL^TM scores were well-correlated (r = 0.67). There were no prominent differences between the correlations of VAS and PedsQL^TM with the selected indicators of child health and wellbeing; differences in correlations were less than 0.1. Differences in HRQoL by cleft type were more pronounced on the PedsQL^TM. Conclusions: Our study finds the VAS to perform relatively well in measuring overall HRQoL among children with oral clefts. The VAS may be useful as a screening tool to identify children with oral clefts at risk of low HRQoL for referral into more comprehensive evaluations and for measuring average HRQoL across a sample of children. Full article

Purpose: To investigate the occurrence and types of motor vehicle accident eye trauma in north Israel. Methods: The records between the years 2007–2011 of the Ophthalmology Emergency Room of one medical center were searched. Eye injuries due to motor vehicle accidents were classified according to type, severity of injury and demographic data of patients. Results: Nearly five percents of ER presentations were due to motor vehicle accidents. Most motor vehicle accident-related eye injuries were mild. Conclusion: Efforts should be taken to prevention and to minimize the severity of motor vehicle accident-related eye injuries. Full article

Leptospira has been a major public health concern in New Caledonia for decades. However, few multidisciplinary studies addressing the zoonotic pattern of this disease were conducted so far. Here, pig, deer and dog samples were collected. Analyses were performed using molecular detection and genotyping. Serological analyses were also performed for dogs. Our results suggest that deer are a reservoir of L. borgpetersenii Hardjobovis and pigs a reservoir of L. interrogans Pomona. Interestingly, 4.4% of dogs were renal carriers of Leptospira. In dog populations, MAT results confirmed the circulation of the same Leptospira serogroups involved in human cases. Even if not reservoirs, dogs might be of significance in human contamination by making an epidemiological link between wild or feral reservoirs and humans. Dogs could bring pathogens back home, shedding Leptospira via their urine and in turn increasing the risk of human contamination. We propose to consider dog as a vector, particularly in rural areas where seroprevalence is significantly higher than urban areas. Our results highlight the importance of animal health in improving leptospirosis prevention in a One Health approach. Full article

Emissions of volatile organic compounds (VOCs) and carbonyls from three types of commercially available wallpapers (i.e., PVC-coated, paper-backed, natural material-coated) in Korea were evaluated using a 20 L small chamber. A total of 332 products were tested for emission factors, frequencies of occurrence and composition ratios. Toluene and formaldehyde concentrations were below Korean standard values for all products; however, the total VOC (TVOC) concentrations exceeded current standards (4.0 mg/m²·h) for 30 products. The TVOC emission factor for PVC-coated wallpapers, for which polymer materials are used in the manufacturing process, was seven and 16 times higher than those of paper-backed and natural material-coated wallpapers, respectively. The detection frequencies for toluene and formaldehyde were the highest (82.5%) and fourth highest (79.5%), respectively among the 50 target chemical species. The composition ratios for BTEX ranged from 0.3% to 5.1% and unidentified VOCs, which were not qualitatively analyzed using standard gas methods, ranged from 90.2% to 94.8%. Among six carbonyl compounds (acrolein was not detected in any type of wallpaper), acetone had the highest concentrations in PVC-coated (44.6%) and paper-backed (66.6%) wallpapers. Formaldehyde emissions were highest (64.6%) for natural material-coated wallpapers, a result of the formaldehyde-based resin used in the manufacturing process for these products. Full article

As reclaimed water use expands, it is important to evaluate potential occupational health risks from exposure to this alternative water source. We compared odds of colonization with methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible S. aureus (MSSA), vancomycin-resistant enterococci (VRE), and vancomycin-susceptible enterococci (VSE) between spray irrigation workers using reclaimed water and office worker controls. Nasal and dermal swabs from 19 spray irrigation workers and 24 office worker controls were collected and analyzed for MRSA, MSSA, VRE, and VSE. Isolates were confirmed using standard biochemical tests and polymerase chain reaction assays. Antimicrobial susceptibility testing was performed by Sensititre^® microbroth dilution. Data were analyzed by two-sample proportion, chi-square, Fisher’s exact tests, and logistic regression. No MRSA or VRE were detected in any samples. MSSA was detected in 26% and 29% of spray irrigators and controls, respectively. VSE was detected in 11% and 0% of spray irrigation workers and controls, respectively. The adjusted odds of MSSA, multidrug-resistant MSSA, and either MSSA or VSE colonization were greater among spray irrigation workers, however results were not statistically significant. Future studies with larger sample sizes are needed to further evaluate this relationship. Full article

Background: Electronic cigarette (EC) use has grown exponentially over the past few years. The purpose of this survey was to assess the characteristics and experiences of a large sample of EC users and examine the differences between those who partially and completely substituted smoking with EC use. Methods: A questionnaire was prepared, translated into 10 different languages and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers. Results: In total, 19,414 participants were included in the analysis, with 88 of them (0.5%) reported not being smokers at the time of EC use initiation. Complete substitution of smoking was reported by 81.0% of participants (former smokers) while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. They were using ECs for a median of 10 months. They initiated EC use with a median of 18 mg/mL nicotine-concentration liquids; 21.5% used higher than 20 mg/mL. Only 3.5% of participants were using 0-nicotine liquids at the time of the survey. Former smokers were highly dependent (Fagerström Test for Cigarette Dependence = 7) and were heavier smokers (21 cigarettes per day when smoking) compared to current smokers. The most important reasons for initiating EC use for both subgroups was to reduce the harm associated with smoking and to reduce exposure of family members to second-hand smoking. Most considered ECs as less harmful than tobacco cigarettes, while 11.0% considered them absolutely harmless. Side effects were reported by more than half of the participants (59.8%), with the most common being sore/dry mouth and throat; side effects were mild and in most cases were subsequently resolved (partially or completely). Participants experienced significant benefits in physical status and improvements in pre-existing disease conditions (including respiratory disease such as asthma and chronic obstructive lung disease). Being former smoker was independently associated with positive effects in health and improvements in disease conditions. Conclusions: The results of this worldwide survey of dedicated users indicate that ECs are mostly used to avoid the harm associated with smoking. They can be effective even in highly-dependent smokers and are used as long-term substitutes for smoking. High levels of nicotine are used at initiation; subsequently, users try to reduce nicotine consumption, with only a small minority using non-nicotine liquids. Side effects are minor and health benefits are substantial, especially for those who completely substitute smoking with EC use. Further population and interventional studies are warranted. Full article

The aim of this study is to evaluate the significance of grand multiparous (GM) status in the mortality from cancers of the digestive system among a cohort of GM women in Taiwan during the period 1978–2008. The study cohort consisted of 144,922 women with at least five children (GM women) in the Taiwan Birth Register between 1 January 1978 and 31 December 2003. Standardized mortality ratios (SMRs) for cancers of the digestive system including esophagus, stomach, colon, rectum, liver, and pancreas were calculated by dividing the numbers of observed cancer deaths to the expected numbers of deaths based on the rates of national female population. Among the 144,922 GM women, a total of 23, 220, 213, 92, 397, and 65 deaths were caused by cancers of the esophagus, stomach, colon, rectum, liver, and pancreas, respectively. The SMRs among GM women were 1.61 (95% confidence intervals (CI): 0.95–2.27) for esophageal cancer, 1.15 (95% CI: 1.00–1.31) for stomach cancer, 1.07 (95% CI: 0.93–1.22) for colon cancer, 0.94 (95% CI: 0.75–1.14) for rectal cancer, 1.18 (95% CI: 1.06–1.30) for liver cancer, and 0.79 (95% CI: 0.60–0.98) for pancreatic cancer. This study provides evidence that grand multiparity may confer a protective effect on the risk of death from pancreatic cancer. However, the results suggest that GM women may increase the risk of death from cancers of the liver and stomach. Full article

Lead (Pb) and methyl mercury (MeHg) are well established neurodevelopmental toxicants (NDTs), but joint exposure to chemical and nonchemical (e.g., maternal stress) stressors has rarely been considered. We characterized exposure to Pb, MeHg and a measure of physiological dysregulation associated with chronic stress and examined race/ethnicity as a predictor of joint NDT exposure. Using data from the 2003−2004 NHANES, potential chronic stress exposure was estimated using allostatic load (AL), a quantitative measure of physiological dysregulation. A Hazard Index was calculated for joint exposure to Pb and MeHg (HI_NDT). Logistic regression was used to assess the relationship between an indicator of elevated joint NDT exposures (HI_NDT > 1) and race/ethnicity. The multivariate model was stratified by AL groups to examine effect measure modification. African American (adjusted odds ratio [OR] [95% confidence interval] = 2.2 [1.4, 3.3]) and Mexican American (1.4 [0.7, 2.6]) women were more likely to have an HI_NDT > 1 compared to Caucasian women. Chronic stress was identified as an effect measure modifier with the largest ORs among women with high AL scores (African Americans = 4.3 [2.0, 9.5]; Mexican Americans = 4.2 [1.3, 14.1]). Chronic stress was found to modify the association between elevated joint NDT exposure and race/ethnicity, highlighting the importance of evaluating chemical and nonchemical stressor exposures leading to a common endpoint. Full article

Home injuries are an important public health issue in both developed and developing countries. This study focused on the Italian epidemiological framework between 1999 and 2006, using a nation-representative sample provided by the National Institute of Statistics. Every year, about 3,000,000 Italian residents reported at least one home injury, with an overall annual rate of 5.2/100 (95% CI 5.1–5.4); 3.2/100 (3.0–3.4) for males and 7.2/100 (6.9–7.4) for females. Poisson regression models were used for different age-specific populations (children, young/adults and older people), to evaluate the effects of socio-demographic, health/income satisfaction and housing variables. For children, non-applicable variables (including smoking and health satisfaction) were taken as those of the head of family, while housework time was taken the family mean time. Evidence of decreasing time trend in risk of home injury was found only among young/adults (p < 0.01). The following were risk factors: female gender (adjusted relative risk—RR 2.0 for older people and RR 1.9 for young/adults, p < 0.01); one additional hour of work at home (RR 1.009, p < 0.01 for young/adults and RR 1.016, p = 0.01 for children); smoking (RR 1.3, p < 0.01 for young/adults and p = 0.02 for children); health dissatisfaction (RR 1.3, p = 0.05 for children, RR 1.6 for young/adults and RR 1.7 for older people, p < 0.01); income dissatisfaction (RR 1.2, p < 0.01 for young/adults ); living alone (RR 1.5, p < 0.01 for young/adults and RR 1.2, p < 0.02 for the older people); having a garden (RR 1.1, p < 0.01 for young/adults ). Awareness of the need for safety at home could be boosted by information campaigns on the risk, and its social cost could be reduced by specific prevention schemes. Developing tools for assessing the risk at home and for removing the main hazards would be useful for both informative and prevention interventions. Full article

It is known that overweight is associated with chronic knee pain (CKP) and chronic low back pain (CLBP). Several risk factors for these conditions have been postulated, including age, sex, overweight, occupation, and socioeconomic factors. In addition, physical environment has been studied as a potential risk factor in recent years. However, the associations of overweight and physical environment with CKP and CLBP remains unclear. The aim of this study conducted in a rural mountainous region was to examine whether overweight individuals living at higher elevations have an increased probability of experiencing CKP and CLBP. In 2009, we conducted a mail survey with a random sample aged between 40 to 79 years. Questionnaires were sent to 6,000 individuals and a total of 4,559 individuals responded to this survey. After excluding the respondents with missing data, we conducted a logistic regression analysis of the data for 3,109 individuals. There was statistically significantly higher adjusted odds ratio (aOR) of CKP for those who were overweight living at low elevation (aOR = 1.90, 95% CI = 1.21–2.98), moderate elevation (aOR = 1.73, 95% CI = 1.05–2.87), and high elevation (aOR = 2.13, 95% CI = 1.31–3.46) than those who were not overweight living at low elevation. However, similar patterns were not observed for CLBP. Our results show that specific overweight–elevation associations were observed for CKP in a rural mountainous region. Full article

Nitrogen is an essential element for plant growth and development; however, due to environmental pollution, high nitrate concentrations accumulate in the edible parts of these leafy vegetables, particularly if excessive nitrogen fertilizer has been applied. Consuming these crops can harm human health; thus, developing a suitable strategy for the agricultural application of nitrogen fertilizer is important. Organic, inorganic, and liquid fertilizers were utilized in this study to investigate their effect on nitrate concentrations and lettuce growth. The results of this pot experiment show that the total nitrogen concentration in soil and the nitrate concentration in lettuce increased as the amount of nitrogen fertilizer increased. If the recommended amount of inorganic fertilizer (200 kg·N·ha⁻¹) is used as a standard of comparison, lettuce augmented with organic fertilizers (200 kg·N·ha⁻¹) have significantly longer and wider leaves, higher shoot, and lower concentrations of nitrate. Full article

Background: With the influx of rural migrants into urban areas, the spread of HIV has increased significantly in Shaanxi Province (China). Migrant workers are at high risk of HIV infection due to social conditions and hardships (isolation, separation, marginalization, barriers to services, etc.). Objective: We explored the efficacy of a HIV/AIDS prevention and control program for rural migrants in Shaanxi Province, administered at both rural and urban sites. Methods: Guidance concerning HIV/AIDS prevention was given to the experimental group (266 migrants) for 1 year by the center of disease control, community health agencies and family planning department. The intervention was conducted according to the HIV/AIDS Prevention Management Manual for Rural Migrants. A control group of migrants only received general population intervention. The impact of the intervention was evaluated by administering HIV/AIDS knowledge, attitudes and sexual behavior (KAB) questionnaires after 6 and 12 months. Results: In the experimental group; 6 months of intervention achieved improvements in HIV/AIDS related knowledge. After 12 months; HIV/AIDS-related knowledge reached near maximal scores. Attitude and most behaviors scores were significantly improved. Moreover; the experimental group showed significant differences in HIV-AIDS knowledge; attitude and most behavior compared with the control group. Conclusions: The systematic long-term cross-site HIV/AIDS prevention in both rural and urban areas is a highly effective method to improve HIV/AIDS KAB among rural migrants. Full article

To investigate the effects of a high-carbohydrate and low-fat (HC/LF) diet on plasma lipids and apolipoproteins (Apos) of healthy Chinese Han youth with different genotypes of lipoprotein lipase gene (LPL) rs326, 56 subjects were given a washout diet of 30.1% fat and 54.1% carbohydrate for seven days, followed by the HC/LF diet of 13.8% fat and 70.1% carbohydrate for six days, with no total energy restriction. Plasma glucose, triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), Apo B-100 and Apo A-I were analyzed at baseline and before and after the HC/LF diet. The results show that, when compared with before the HC/LF diet, only the male G carriers experienced increased HDL-C (p = 0.008) and Apo A-I (p = 0.005) after the HC/LF diet. Decreased TC in both males and females and increased TG in females were found regardless of the genotype after the HC/LF diet. LDL-C decreased in all the subjects although the decrease was not significant in the female G carriers. These results demonstrate that the G allele of LPL rs326 associates with the elevated levels of HDL-C and Apo A-I after the HC/LF diet in males of the healthy Chinese Han Youth. Full article

An increasing interest in organic agriculture for food production is seen throughout the world and one key reason for this interest is the assumption that organic food consumption is beneficial to public health. The present paper focuses on the background of organic agriculture, important public health related compounds from crop food and variations in the amount of health related compounds in crops. In addition, influence of organic farming on health related compounds, on pesticide residues and heavy metals in crops, and relations between organic food and health biomarkers as well as in vitro studies are also the focus of the present paper. Nutritionally beneficial compounds of highest relevance for public health were micronutrients, especially Fe and Zn, and bioactive compounds such as carotenoids (including pro-vitamin A compounds), tocopherols (including vitamin E) and phenolic compounds. Extremely large variations in the contents of these compounds were seen, depending on genotype, climate, environment, farming conditions, harvest time, and part of the crop. Highest amounts seen were related to the choice of genotype and were also increased by genetic modification of the crop. Organic cultivation did not influence the content of most of the nutritional beneficial compounds, except the phenolic compounds that were increased with the amounts of pathogens. However, higher amounts of pesticide residues and in many cases also of heavy metals were seen in the conventionally produced crops compared to the organic ones. Animal studies as well as in vitro studies showed a clear indication of a beneficial effect of organic food/extracts as compared to conventional ones. Thus, consumption of organic food seems to be positive from a public health point of view, although the reasons are unclear, and synergistic effects between various constituents within the food are likely. Full article

Chernobyl demonstrated that iodine-131 (¹³¹I) released in a nuclear accident can cause malignant thyroid nodules to develop in children within a 300 mile radius of the incident. Timely potassium iodide (KI) administration can prevent the development of thyroid cancer and the American Thyroid Association (ATA) and a number of United States governmental agencies recommend KI prophylaxis. Current pre-distribution of KI by the United States government and other governments with nuclear reactors is probably ineffective. Thus we undertook a thorough scientific review, regarding emergency response to ¹³¹I exposures. We propose: (1) pre-distribution of KI to at risk populations; (2) prompt administration, within 2 hours of the incident; (3) utilization of a lowest effective KI dose; (4) distribution extension to at least 300 miles from the epicenter of a potential nuclear incident; (5) education of the public about dietary iodide sources; (6) continued post-hoc analysis of the long-term impact of nuclear accidents; and (7) support for global iodine sufficiency programs. Approximately two billion people are at risk for iodine deficiency disorder (IDD), the world’s leading cause of preventable brain damage. Iodide deficient individuals are at greater risk of developing thyroid cancer after ¹³¹I exposure. There are virtually no studies of KI prophylaxis in infants, children and adolescents, our target population. Because of their sensitivity to these side effects, we have suggested that we should extrapolate from the lowest effective adult dose, 15–30 mg or 1–2 mg per 10 pounds for children. We encourage global health agencies (private and governmental) to consider these critical recommendations. Full article

Microbial pollution in aquatic environments is one of the crucial issues with regard to the sanitary state of water bodies used for drinking water supply, recreational activities and harvesting seafood due to a potential contamination by pathogenic bacteria, protozoa or viruses. To address this risk, microbial contamination monitoring is usually assessed by turbidity measurements performed at drinking water plants. Some recent studies have shown significant correlations of microbial contamination with the risk of endemic gastroenteresis. However the relevance of turbidimetry may be limited since the presence of colloids in water creates interferences with the nephelometric response. Thus there is a need for a more relevant, simple and fast indicator for microbial contamination detection in water, especially in the perspective of climate change with the increase of heavy rainfall events. This review focuses on the one hand on sources, fate and behavior of microorganisms in water and factors influencing pathogens’ presence, transportation and mobilization, and on the second hand, on the existing optical methods used for monitoring microbiological risks. Finally, this paper proposes new ways of research. Full article

During the last few years, our research group has been investigating the phenomenon of adaptive response in animals exposed to non-ionizing radiofrequency fields. The results from several separate studies indicated a significant increase in survival, decreases in genetic damage as well as oxidative damage and, alterations in several cellular processes in mice pre-exposed to radiofrequency fields and subsequently subjected to sub-lethal or lethal doses of γ-radiation or injected with bleomycin, a radiomimetic chemical mutagen. These observations indicated the induction of adaptive response providing the animals the ability to resist subsequent damage. Similar studies conducted by independent researchers in mice and rats have supported our observation on increased survival. In this paper, we have presented a brief review of all of our own and other independent investigations on radiofrequency fields-induced adaptive response and some underlying mechanisms discussed. Full article

This paper describes results from a systematic review and a series of meta-analyses of nearly three decades worth of epidemiologic research on the relationship between non-Hodgkin lymphoma (NHL) and occupational exposure to agricultural pesticide active ingredients and chemical groups. Estimates of associations of NHL with 21 pesticide chemical groups and 80 active ingredients were extracted from 44 papers, all of which reported results from analyses of studies conducted in high-income countries. Random effects meta-analyses showed that phenoxy herbicides, carbamate insecticides, organophosphorus insecticides and the active ingredient lindane, an organochlorine insecticide, were positively associated with NHL. In a handful of papers, associations between pesticides and NHL subtypes were reported; B cell lymphoma was positively associated with phenoxy herbicides and the organophosphorus herbicide glyphosate. Diffuse large B-cell lymphoma was positively associated with phenoxy herbicide exposure. Despite compelling evidence that NHL is associated with certain chemicals, this review indicates the need for investigations of a larger variety of pesticides in more geographic areas, especially in low- and middle-income countries, which, despite producing a large portion of the world’s agriculture, were missing in the literature that were reviewed. Full article