Disasters serve as shocks and precipitate unanticipated disturbances to the health care system. Public health surveillance is generally focused on monitoring latent health and environmental exposure effects, rather than health system performance in response to these local shocks. The following intervention study sought to determine the long-term effects of the 2005 chlorine spill in Graniteville, South Carolina on primary care access for vulnerable populations. We used an interrupted time-series approach to model monthly visits for Ambulatory Care Sensitive Conditions, an indicator of unmet primary care need, to quantify the impact of the disaster on unmet primary care need in Medicaid beneficiaries. The results showed Medicaid beneficiaries in the directly impacted service area experienced improved access to primary care in the 24 months post-disaster. We provide evidence that a health system serving the medically underserved can prove resilient and display improved adaptive capacity under adverse circumstances (i.e., technological disasters) to ensure access to primary care for vulnerable sub-groups. The results suggests a new application for ambulatory care sensitive conditions as a population-based metric to advance anecdotal evidence of secondary surge and evaluate pre- and post-health system surge capacity following a disaster. Full article

Epidemiologic evidence provides some support for a causal association between maternal secondhand smoke (SHS) exposure during pregnancy and reduction in infant birth weight. The purpose of this cross-sectional study is to examine the magnitude of this association in China, where both prevalence and dose of SHS exposure are thought to be higher than in U.S. populations. Women who gave birth in Beijing and Changchun September 2000–November 2001 were interviewed to quantify self-reported prenatal SHS exposure. Their medical records were reviewed for data on pregnancy complications and birth outcomes. Non-smoking women who delivered term babies (≥37 weeks gestation) were included in the study (N = 2,770). Nearly a quarter of the women (24%) reported daily SHS exposure, 47% reported no prenatal exposure, and 75% denied any SHS exposure from the husband smoking at home. Overall, no deficit in mean birth weight was observed with exposure from all sources of SHS combined (+11 grams, 95% CI: +2, +21). Infants had higher mean birth weights among the exposed than the unexposed for all measures of SHS exposure. Future studies on SHS exposure and infant birth weight in China should emphasize more objective measures of exposure to quantify and account for any exposure misclassification. Full article

Objective: To estimate the prevalence and social, psychological and environmental-structural determinants of tobacco experimentation among adolescents in Shanghai, China. Methods: We conducted a cross-sectional study based on a two-stage cluster sample design by using the Chinese version of the Global Youth Tobacco Survey (GYTS) to investigate smoking behavior among 19,117 students from 41 junior and senior high schools in Shanghai, China. The association between potential factors and tobacco experimentation were assessed using complex samples procedure logistic regression. Results: Of the 19,117 respondents, 10.5% (15.3% boys and 6.2% girls) reported the tobacco experimentation. The main social, psychological, and environmental-structural factors associated with tobacco experimentation were having close friends who smoke (AOR = 8.21; 95% CI: 6.49–10.39); one or both parents smoking (AOR 1.57; CI: 1.39–1.77); a poor school tobacco control environment (AOR 1.53; CI: 1.37–1.83); a high acceptance level of tobacco use (AOR 1.44; CI: 1.28–1.82); and a high level of media tobacco exposure (AOR 1.23; CI: 1.10–1.37). Peer smoking might contribute to smoking experimentation among girls (AOR 8.93; CI: 5.84–13.66) more so than among boys (AOR 7.79; CI: 5.97–9.94) and media tobacco exposure had no association with tobacco experimentation among female students. Conclusions: Social, psychological, and environmental factors are closely associated with tobacco experimentation among adolescents. Prevention programs aimed at reducing teen tobacco experimentation should be conducted at home and school with support by parents, peers and teachers. Our findings should prove useful for future development of intervention strategies among adolescents in Shanghai, China. Full article

A coupling kinetics model is developed to simulate the release and transport of landfill leachate pollutants in a deformable municipal solid waste landfill by taking into account of landfill settlement, seepage of leachate water, hydrolyse of insoluble and degradable organic pollutants in solid phase, biodegradation of soluble and degradable organic pollutants in solid phase and aqueous one, growth of aerobic and anaerobic microorganism, and consumption of dissolved oxygen. The release and transport of organic pollutants and microorganisms in landfills in the process of landfill settlement was simulated by considering no hydraulic effect. Simulation results demonstrated that the interaction between landfill settlement and the release, transport and biodegradation of landfill leachate pollutants was significant. Porosity and saturated hydraulic conductivity were not constants because of the landfill settlement, which affected the release, transport and biodegradation of landfill leachate pollutants, and furthermore acted on the landfill settlement. The simulation results accorded with the practical situation, which preliminarily verified the reliability of the mathematical model and the numerical program in this paper. Full article

There is little information about health professionals’ behavior regarding oral health care during pregnancy. We evaluated attitudes of obstetricians/gynecologists, nurses, and dentists working at a public community service towards pregnant women’s oral health. Health professionals responded to a self-applied questionnaire. Cluster analysis identified two clusters of respondents; Chi-square, Student’s t test, and logistic regression were used to compare the two clusters in terms of the independent variables. Respondents were categorized into cluster 1 ‘less favorable’ (n = 159) and cluster 2 ‘more favorable’ (n = 124) attitudes. Professionals that had attended a residency or specialization program (OR = 2.08, 95% CI = 1.15–3.77, p = 0.016) and worked exclusively at the public service (OR = 2.15, 95% CI = 1.10–4.20, p = 0.025) presented more favorable attitudes. Obstetricians/gynecologists (OR = 0.22, 95% CI = 0.09–0.54, p = 0.001) and nurses (OR = 0.50, 95% CI = 0.29–0.86, p = 0.013) showed less favorable attitudes than dentists. Health care providers’ attitudes regarding pregnant women’s oral health were related to their occupation, qualification, and dedication to the public service. Full article

Aim: This study examined the influence of the social context in which people live on self-ratings of their oral health. Method: This study involved a representative sample of 2,907 South African adults (≥16 years) who participated in the 2007 South African Social Attitude Survey (SASAS). We used the 2005 General Household Survey (n = 107,987 persons from 28,129 households) to obtain living environment characteristics of SASAS participants, including sources of water and energy, and household cell-phone ownership (a proxy measure for the social network available to them). Information obtained from SASAS included socio-demographic data, respondents’ level of trust in people, oral health behaviors and self-rated oral health. Results: Of the respondents, 76.3% self-rated their oral health as good. Social context influenced women’s self-rated oral health differently from that of men. Good self-rated oral health was significantly higher among non-smokers, employed respondents and women living in areas with higher household cell-phone ownership. Furthermore, trust and higher social position were associated with good self-rated oral health among men and women respectively. Overall, 55.1% and 18.3% of the variance in self-rated oral health were explained by factors operating at the individual and community levels respectively. Conclusion: The findings highlight the potential role of social capital in improving the population’s oral health. Full article

The Hartbeespoort (HBP) Dam is a reservoir used for agricultural, domestic supply of raw potable water and recreational activities in South Africa’s North-West Province. Eutrophication and cyanobacterial blooms have long been a cause of water-quality problems in this reservoir. The most prevalent bloom-forming species is Microcystis aeruginosa, often producing the toxin microcystin, a hepatotoxin which can negatively impact aquatic animal and human health, and poses a problem for potable water supply. Algal samples were collected monthly from four pre-determined sites in the dam during the summer months (December 2010–March 2011). Intracellular microcystins (MCs) were extracted using SPE C₁₈ cartridges, followed by separation, identification and quantification using LC-ESI-MS techniques. Quantitative variation studies of MCs were conducted with respect to MC congener isolated, sampling site and month. Three main MC congeners (MC-RR, -LR and-YR) were isolated, identified and quantified. In addition, three minor MCs (MC-WR, MC-(H₄)YR and (D-Asp³, Dha⁷)MC-RR were also identified, but were not quantified. The MC dominance followed the order MC-RR>MC-LR>MC-YR across all sites and time. The maximum and minimum concentrations were 268 µg/g and 0.14 µg/g DW for MC-RR and MC-YR, respectively, of the total MCs quantified from this study. One-way ANOVA showed that there were no significant differences between average MC concentrations recorded across months (P = 0.62), there was, however, a marginally-significant difference in concentrations among MC congeners (P = 0.06). ANCOVA revealed a highly significant interaction between sites and MC congeners on MC concentration (P < 0.001). Full article

The current study investigated the prevalence and risk factors for poor nutritional status among children less than 36 months of age in the Kilimanjaro region of Tanzania. Using a cross sectional study design, children and their caregivers were recruited into the study. Anthropometric measures were taken based on established protocol while a standard questionnaire was utilized to collect socio-demographic data. A finger-prick blood sample was collected from all the children and haemoglobin (Hb) concentration analyzed using a HemoCue photometer (HemoCue AB, Angelholm, Sweden). Four hundred and twenty three (423) children (214 females) took part in this study. Participating children were aged between 1–35 months (mean = 13.04, SD = 7.70). We observed high rates of stunting (44.2%) and underweight (19.1%). Nearly 70% (n = 295) of the sample was anaemic (Hb < 11 g/dL). In a multivariate logistic regression model concerns on child growth, maternal education, and child’s age were found to independently predict stunting; whereas concerns over child’s growth and development, and distance to water source were found to uniquely predict being underweight. Maternal education was the only factor related to the child’s anaemia. The current study further emphasizes the need to implement context relevant interventions to combat malnutrition in this region of Tanzania and other similar settings. Full article

The study was carried out to estimate the prevalence of self-medication with antibiotics among tertiary level students in Accra (Ghana) and evaluate factors associated with the practice. This was a descriptive cross-sectional study and involved face-to-face interviews of 600 respondents selected by convenient sampling. Prevalence of self medication was 70% (95% CI: 66.3–73.7), and the practice was significantly lower among medically inclined students (OR: 0.2, 95% CI: 0.1–0.4, p < 0.001). Among the respondents who practiced self medication, the most common frequency of antibiotic usage was at intervals of one month (30%, 95% CI: 25.6–34.4%), and the most common antibiotic used was amoxacillin (23.9%, 95% CI: 21.0–26.8%). Treatment failure were reported by 35% (95% CI: 30.5–39.6%) of the respondents, and the main reasons cited for self medication were that, it was less expensive compared to medical care in the hospital and secondly, medical care in hospitals were associated with long delays. Forty nine percent (95% CI: 44.2–53.8%) of the respondents had poor knowledge about the health implications of irrational use of antibiotics, and 46% (95% CI: 41.2–50.8%) did not comply with the completion of the full course of antibiotics. Self medication among tertiary students in Accra is an important public health problem and this may reflect the situation among tertiary students in the whole of Ghana. Full article

The quality of the consumed drinking water may affect oral health. For example, the presence of iron in drinking water can cause aesthetic problems related to changes in dental enamel color. This study assessed the prevalence of extrinsic enamel color changes and their relationship with the quality of the water in the town of Caapiranga/AM-Brazil. Three hundred and forty six residents of the urban area were examined, and they also answered a questionnaire on eating habits and self-perceived oral health. As the initial results indicated an insufficient number of observations for the application of variance analysis (one-way ANOVA), the Student t test was chosen to compare levels of iron content in the water coming from two sources. The change in tooth color had a prevalence of 5.78% (20 people). The majority of the population (n = 261, 75.43%) consumed well water. Those who presented extrinsic stains were uncomfortable with the appearance of their teeth (15.09%). We conclude that while there is excess of iron in the water in this region of Brazil, no association between extrinsic stains on the enamel and the level of iron in the water was found. There was a low prevalence of extrinsic stains in Caaparinga, being found only in children and adolescents. In the present study, an association between the presence of stains and the consumption of açai was determined, and those who presented them felt uncomfortable about their aesthetics. Full article

The aim of the study was to assess the prevalence of fruits and vegetable consumption and associated factors among Southeast Asian in-school adolescents. Data were collected by self-report questionnaire from nationally representative samples (total 16,084) of school children aged 13 to 15 years in five Southeast Asian countries. Overall, 76.3% of the 13 to 15 year-olds had inadequate fruits and vegetables consumptions (less than five servings per day); 28% reported consuming fruits less than once per day and 13.8% indicated consuming vegetables less than once per day. In multivariable analysis, lack of protective factors and being physically inactive were associated with inadequate fruits and vegetable consumption, and sedentary behaviour and being overweight was protective of inadequate fruits and vegetable consumption. The results stress the need for intervention programmes aimed at increased consumption of fruits and vegetables, targeting proximal factors such as the family environment and distal factors by aiming at integrating other risk factors such as physical activity into health promotion among adolescents. Full article

A principle strategic insight of the Final Report for WHO’s Commission on Social Determinants of Health (SDOH) is that the nurturant qualities of the environments where children grow up, live, and learn matter the most for their development. A key determinant of early childhood development is the establishment of a secure attachment between a caregiver and child. We report initial field-tests of the integration of caregiver-child attachment assessment by community health workers (CHWs) as a routine component of Primary Health Care (PHC), focusing on households with children under 5 years of age in three slum communities near Nairobi, Kenya. Of the 2,560 children assessed from July–December 2010, 2,391 (90.2%) were assessed as having a secure attachment with a parent or other caregiver, while 259 (9.8%) were assessed as being at risk for having an insecure attachment. Parent workshops were provided as a primary intervention, with re-enforcement of teachings by CHWs on subsequent home visits. Reassessment of attachment by CHWs showed positive changes. Assessment of caregiver-child attachment in the setting of routine home visits by CHWs in a community-based PHC context is feasible and may yield valuable insights into household-level risks, a critical step for understanding and addressing the SDOH. Full article

At a time when anthropogenic activities are increasingly disturbing the overall ecological integrity of freshwater ecosystems, monitoring of biological communities is central to assessing the health and function of streams. This study aimed to use a large nation-wide database to develop a multimetric index (the Korean Benthic macroinvertebrate Index of Biological Integrity—KB-IBI) applicable to the biological assessment of Korean streams. Reference and impaired conditions were determined based on watershed, chemical and physical criteria. Eight of an initial 34 candidate metrics were selected using a stepwise procedure that evaluated metric variability, redundancy, sensitivity and responsiveness to environmental gradients. The selected metrics were number of taxa, percent Ephemeroptera-Plecoptera-Trichoptera (EPT) individuals, percent of a dominant taxon, percent taxa abundance without Chironomidae, Shannon’s diversity index, percent gatherer individuals, ratio of filterers and scrapers, and the Korean saprobic index. Our multimetric index successfully distinguished reference from impaired conditions. A scoring system was established for each core metric using its quartile range and response to anthropogenic disturbances. The multimetric index was classified by aggregating the individual metric ..scores and the value range was quadrisected to provide a narrative criterion (Poor, Fair, Good and Excellent) to describe the biological integrity of the streams in the study. A validation procedure showed that the index is an effective method for evaluating stream conditions, and thus is appropriate for use in future studies measuring the long-term status of streams, and the effectiveness of restoration methods. Full article

A better understanding of the relative importance of different spatial scale determinants on fish communities will eventually increase the accuracy and precision of their bioassessments. Many studies have described the influence of environmental variables on fish communities on multiple spatial scales. However, there is very limited information available on this topic for the East Asian monsoon region, including Korea. In this study, we evaluated the relationship between fish communities and environmental variables at multiple spatial scales using self-organizing map (SOM), random forest, and theoretical path models. The SOM explored differences among fish communities, reflecting environmental gradients, such as a longitudinal gradient from upstream to downstream, and differences in land cover types and water quality. The random forest model for predicting fish community patterns that used all 14 environmental variables was more powerful than a model using any single variable or other combination of environmental variables, and the random forest model was effective at predicting the occurrence of species and evaluating the contribution of environmental variables to that prediction. The theoretical path model described the responses of different species to their environment at multiple spatial scales, showing the importance of altitude, forest, and water quality factors to fish assemblages. Full article

Implementing a suite of best management practices (BMPs) can reduce non-point source (NPS) pollutants from various land use activities. Watershed models are generally used to evaluate the effectiveness of BMP performance in improving water quality as the basis for watershed management recommendations. This study evaluates 171 management practice combinations that incorporate nutrient management, vegetated filter strips (VFS) and grazing management for their performances in improving water quality in a pasture-dominated watershed with dynamic land use changes during 1992–2007 by using the Soil and Water Assessment Tool (SWAT). These selected BMPs were further examined with future climate conditions (2010–2069) downscaled from three general circulation models (GCMs) for understanding how climate change may impact BMP performance. Simulation results indicate that total nitrogen (TN) and total phosphorus (TP) losses increase with increasing litter application rates. Alum-treated litter applications resulted in greater TN losses, and fewer TP losses than the losses from untreated poultry litter applications. For the same litter application rates, sediment and TP losses are greater for summer applications than fall and spring applications, while TN losses are greater for fall applications. Overgrazing management resulted in the greatest sediment and phosphorus losses, and VFS is the most influential management practice in reducing pollutant losses. Simulations also indicate that climate change impacts TSS losses the most, resulting in a larger magnitude of TSS losses. However, the performance of selected BMPs in reducing TN and TP losses was more stable in future climate change conditions than in the BMP performance in the historical climate condition. We recommend that selection of BMPs to reduce TSS losses should be a priority concern when multiple uses of BMPs that benefit nutrient reductions are considered in a watershed. Therefore, the BMP combination of spring litter application, optimum grazing management and filter strip with a VFS ratio of 42 could be a promising alternative for use in mitigating future climate change. Full article

In the event of a large-scale chemical release in the UK decontamination of ambulant casualties would be undertaken by the Fire and Rescue Service (FRS). The aim of this study was to track the movement of volunteer casualties at two mass decontamination field exercises using passive Radio Frequency Identification tags and detection mats that were placed at pre-defined locations. The exercise data were then used to inform a computer model of the FRS component of the mass decontamination process. Having removed all clothing and having showered, the re-dressing (termed re-robing) of casualties was found to be a bottleneck in the mass decontamination process during both exercises. Computer simulations showed that increasing the capacity of each lane of the re-robe section to accommodate 10 rather than five casualties would be optimal in general, but that a capacity of 15 might be required to accommodate vulnerable individuals. If the duration of the shower was decreased from three minutes to one minute then a per lane re-robe capacity of 20 might be necessary to maximise the throughput of casualties. In conclusion, one practical enhancement to the FRS response may be to provide at least one additional re-robe section per mass decontamination unit. Full article

Arsenic (As) contamination in groundwater is a great environmental health concern and is often the result of contact between groundwater and arsenic-containing rocks or sediments and from variation of pH and redox potentials in the subsurface. In the past decade, magnetite nanoparticles (MNPs) have been shown to have high adsorption activity towards As. Alerted by the reported cytotoxicity of 5–12 nm MNP, we studied the adsorption behavior of 1.15 nm MNP and a MNP composite (MNPC), MNPs interlinked by silane coupling agents. With an initial concentration of As at 25 mg L⁻¹, MNPs exhibited high adsorption capacity for As(V) and As (III), 206.9 mg·g⁻¹ and 168.6 mg·g⁻¹ under anaerobic conditions, respectively, and 109.9 mg·g⁻¹ and 108.6 mg·g⁻¹ under aerobic conditions, respectively. Under aerobic conditions, MNPC achieved even higher adsorption capacity than MNP, 165.1 mg·g⁻¹ on As(V) and 157.9 mg·g⁻¹ on As(III). For As(V) at 50 mg L⁻¹, MNPC achieved an adsorption capacity as high as 341.8 mg·g⁻¹, the highest in the literature. A kinetic study indicated that this adsorption reaction can reach equilibrium within 15 min and the rate constant of As(V) is about 1.9 times higher than that of As(III). These results suggested that MNPC can serve as a highly effective adsorbent for fast removal of As. Full article

Watersheds are recognized as the most effective management unit for the protection of water resources. For surface water supplies that use water from upstream watersheds, evaluating threats to water quality and implementing a watershed management plan are crucial for the maintenance of drinking water safe for humans. The aim of this article is to establish a risk assessment model that provides basic information for identifying critical pollutants and areas at high risk for degraded water quality. In this study, a quantitative risk model that uses hazard quotients for each water quality parameter was combined with a qualitative risk model that uses the relative risk level of potential pollution events in order to characterize the current condition and potential risk of watersheds providing drinking water. In a case study of Taipei Source Water Area in northern Taiwan, total coliforms and total phosphorus were the top two pollutants of concern. Intensive tea-growing and recreational activities around the riparian zone may contribute the greatest pollution to the watershed. Our risk assessment tool may be enhanced by developing, recording, and updating information on pollution sources in the water supply watersheds. Moreover, management authorities could use the resultant information to create watershed risk management plans. Full article

Little is known about the health-related quality of life (HRQoL) and work-related stress and its risk factors among white-collar businessmen and management workers that migrate to high-income developing countries. A structural questionnaire survey was administered to 156 white-collar Taiwanese management personnel of representative companies of their industries in Taiwan, who were assigned long-term job positions in China. Questionnaire content included demographics and medical history, self-reported physical and mental conditions, personal lifestyle and behavior, Beck Depression Inventory, and information on HRQoL. White-collar migrant workers reported a high prevalence of alcohol consumption (72.4%) and perceived work-related stress (62.2%), and a lower prevalence of regular exercise (12.2%). Workers with higher levels of perceived work-related stress reported more alcohol consumption, a history of hyperlipidemia, and a higher prevalence of self-reported neck pain, poor sleep, and mild/moderate/severe depression. In our primary multivariate risk model to determine lifestyle and work-related stress variables and HRQoL, perceived work-related stress and a feeling of depression negatively impacted both the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the SF-36 health survey. Hyperlipidemia and self-reported neck pain were associated with significantly lower PCS scores, whereas cardiovascular disease, gastric ulcer, and poor sleep were associated with statistically lower MCS scores. White-collar migrant workers are generally younger with high socioeconomic status. Perceived work-related stress and a feeling of depression indirectly affect HRQoL. Hyperlipidemia, self-reported neck pain, cardiovascular disease, gastric ulcer, and poor sleep also had a significant negative impact on HRQoL. Full article

French speakers residing in predominantly English-speaking communities have been linked to difficulties accessing health care. This study examined health care access experiences of immigrants and non-immigrants who self-identify as Francophone or French speakers in a mainly English speaking province of Canada. We used semi-structured interviews to gather opinions of recent users of physician and hospital services (N = 26). Language barriers and difficulties finding family doctors were experienced by both French speaking immigrants and non-immigrants alike. This was exacerbated by a general preference for health services in French and less interest in using language interpreters during a medical consultation. Some participants experienced emotional distress, were discontent with care received, often delayed seeking care due to language barriers. Recent immigrants identified lack of insurance coverage for drugs, transportation difficulties and limited knowledge of the healthcare system as major detractors to achieving health. This study provided the groundwork for future research on health issues of official language minorities in Canada. Full article

Increasing evidence suggests that socioeconomic factors may be associated with an increased risk of dental caries. To provide better evidence of the association between dental caries in adults and socioeconomic indicators, we evaluated the relation between these two conditions in a thorough review of the literature. Seven databases were systematically searched: Pubmed, Cochrane, Web of Science, Bireme, Controlled Trials, Clinical Trials and the National Institute for Health and Clinical Excellence. No restrictions were placed on the language or year of publication. The search yielded 41 studies for systematic review. Two independent reviewers screened the studies for inclusion, extracted data and evaluated quality using the Newcastle-Ottawa scale. The following socioeconomic indicators were found: educational level, income, occupation, socio-economic status and the community index. These indicators were significantly associated with a greater occurrence of dental caries: the subject’s education, subject’s income, subject’s occupation and the Gini coefficient. A high degree of heterogeneity was found among the methods. Quality varied across studies. The criteria employed for socioeconomic indicators and dental caries should be standardized in future studies. The scientific evidence reveals that educational level, income, occupation and the Gini coefficient are associated with dental caries. Full article