International Journal of Environmental Research and Public Health

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• IJERPH, Vol. 13, Pages 578: A Preliminary Assessment of the Role of Ambient Nitric Oxide Exposure in Hospitalization with Respiratory Syncytial Virus Bronchiolitis

  Posted:2016-06-09

  Some in vitro studies have indicated a possible link between respiratory syncytial virus (RSV) infection and exposure to Nitric Oxide (NO). However, these studies used much higher NO concentrations than normally found in the ambient environment. This preliminary study explored whether an association was present with short-term exposure to NO in the environment. RSV-related admission data between November 2011 and February 2012 were obtained from Sheffield Children’s Hospital. The dates of admission were linked to contemporaneous ambient NO derived from sentinel air monitors. The case-crossover design was used to study the relationship between daily RSV admissions and NO, controlling for temperature and relative humidity. We found little evidence of association between daily RSV admission rates and exposure to ambient NO at different lags or average exposure across several lags. The findings should, however, be viewed with caution due to the low number of events observed during the time frame. It is possible that the apparent lack of association may be accounted for by the timing of the seasonal RSV epidemic in relation to peaks in NO concentrations. A larger study incorporating a wider range of RSV and NO peaks would determine whether said peaks enhanced the number of RSV hospitalizations in children.

• IJERPH, Vol. 13, Pages 580: Survival and Risk Comparison of Campylobacter jejuni on Various Processed Meat Products

  Posted:2016-06-09

  The objective of this study was to investigate survival kinetics of Campylobacter jejuni on various processed meat products (dry-cured ham, round ham with/without sodium nitrite, garlic seasoned ham with/without sodium nitrite, and sausage without sodium nitrite). Additionally, a semi-quantitative risk assessment of C. jejuni on various processed meat products was conducted using FDA-iRISK 1.0. Inoculated processed meat products with 6.0 ± 0.5 log CFU/g of C. jejuni were vacuum packed and stored at 4, 10, 17, 24, 30, and 36 °C. Survival curves were fitted to the Weibull model to obtain the delta values of C. jejuni on various processed meat products. The most rapid death of C. jejuni was observed on dry-cured ham, followed by sausage without sodium nitrite. The results of semi-quantitative risk assessment indicate that dry-cured ham represented the lowest risk among all samples. C. jejuni on processed meats presented a greater risk at 4 °C than at 10 °C. The risk of ham was greater than the risk of sausage, regardless of type. Among all samples, the highest risk of C. jejuni was observed in round ham without sodium nitrite. Overall, our data indicates that risk of processed meat products due to C. jejuni is relatively low.

• IJERPH, Vol. 13, Pages 579: The Effect of Seasonal Variations in Airborne Particulate Matter on Asthma-Related Airway Inflammation in Mice

  Posted:2016-06-09

  This study aimed to investigate the effects of winter and spring particulate matter (PM) on airway inflammation and allergies in a mouse asthma model. PM was collected during 7–28 February 2013 (winter) and during 7–28 April 2013 (spring) in Yonago, Japan. NC/Nga mice were co-sensitized using intranasal instillation of the PMs and Dermatophagoides farinae (Df) for 5 consecutive days, and were subsequently challenged using intranasal Df at 7 days after the last sensitization. At 24 h after the challenge, serum immunoglobulin levels, differential leukocyte counts, and inflammatory cytokines levels were measured in the mice’s bronchoalveolar lavage fluid (BALF). Compared to co-sensitization using spring PM and Df, winter PM and Df induced greater increases in the BALF neutrophil and eosinophil counts and total serum IgE and IgG2a levels. Furthermore, winter PM-sensitized mice exhibited higher BALF levels of interleukin-5, interleukin-13, interleukin-6, and keratinocyte-derived chemokine. Therefore, we observed seasonal variations in the effects of PM on asthma-related airway inflammation. These findings suggest that the compositions of PM vary according to season, and that it is important to evaluate PM compositions in order to understand the associations between asthma and PM.

• IJERPH, Vol. 13, Pages 577: Effects of Cerium and Titanium Oxide Nanoparticles in Soil on the Nutrient Composition of Barley (Hordeum vulgare L.) Kernels

  Posted:2016-06-09

  The implications of metal nanoparticles (MeNPs) are still unknown for many food crops. The purpose of this study was to evaluate the effects of cerium oxide (nCeO2) and titanium oxide (nTiO2) nanoparticles in soil at 0, 500 and 1000 mg·kg−1 on the nutritional parameters of barley (Hordeum vulgare L.) kernels. Mineral nutrients, amylose, β-glucans, amino acid and crude protein (CP) concentrations were measured in kernels. Whole flour samples were analyzed by ICP-AES/MS, HPLC and Elemental CHNS Analyzer. Results showed that Ce and Ti accumulation under MeNPs treatments did not differ from the control treatment. However, nCeO2 and nTiO2 had an impact on composition and nutritional quality of barley kernels in contrasting ways. Both MeNPs left β-glucans unaffected but reduced amylose content by approximately 21%. Most amino acids and CP increased. Among amino acids, lysine followed by proline saw the largest increase (51% and 37%, respectively). Potassium and S were both negatively impacted by MeNPs, while B was only affected by 500 mg nCeO2·kg−1. On the contrary Zn and Mn concentrations were improved by 500 mg nTiO2·kg−1, and Ca by both nTiO2 treatments. Generally, our findings demonstrated that kernels are negatively affected by nCeO2 while nTiO2 can potentially have beneficial effects. However, both MeNPs have the potential to negatively impact malt and feed production.

• IJERPH, Vol. 13, Pages 576: Use of a Sampling Area-Adjusted Adenosine Triphosphate Bioluminescence Assay Based on Digital Image Quantification to Assess the Cleanliness of Hospital Surfaces

  Posted:2016-06-09

  Contaminated surfaces play an important role in the transmission of pathogens. We sought to establish a criterion that could indicate “cleanliness” using a sampling area–adjusted adenosine triphosphate (ATP) assay. In the first phase of the study, target surfaces were selected for swab sampling before and after daily cleaning; then, an aerobic colony count (ACC) plate assay of bacteria and antibiotic-resistant bacteria was conducted. ATP swabs were also tested, and the ATP readings were reported as relative light units (RLUs). The results of the ACC and ATP assays were adjusted according to the sampling area. During the second phase of the study, a new cleaning process employing sodium dichloroisocyanurate (NaDCC) was implemented for comparison. Using the criterion of 2.5 colony-forming units (CFU)/cm2, 45% of the sampled sites were successfully cleaned during phase one of the study. During phase two, the pass rates of the surface samples (64%) were significantly improved, except under stringent (5 RLU/cm2) and lax (500 RLU) ATP criteria. Using receiver-operating characteristic curve analysis, the best cut-off point for an area-adjusted ATP level was 7.34 RLU/cm2, which corresponded to culture-assay levels of <2.5 CFU/cm2. An area adjustment of the ATP assay improved the degree of correlation with the ACC-assay results from weak to moderate.

• IJERPH, Vol. 13, Pages 574: Association between IGF2BP2 Polymorphisms and Type 2 Diabetes Mellitus: A Case–Control Study and Meta-Analysis

  Posted:2016-06-09

  Background: Genome-wide association studies (GWAS) found that IGF2BP2 rs4402960 and rs1470579 polymorphisms were associated with type 2 diabetes mellitus (T2DM) risk. Many studies have replicated this association, but yielded inconsistent results. Materials and Methods: A case-control study consisting of 461 T2DM patients and 434 health controls was conducted to detect the genetic susceptibility of IGF2BP2 in a northern Han Chinese population. A meta-analysis was to evaluate the association more precisely in Asians. Results: In the case-control study, the carriers of TT genotype at rs4402960 had a higher T2DM risk than the G carriers (TG + GG) (adjusted odd ratio (AOR) = 1.962, 95% confidence interval (95% CI) = 1.065–3.612, p = 0.031]; CC carriers at rs1470579 were more susceptible to T2DM than A carriers (CA + AA) (AOR = 2.014, 95% CI = 1.114–3.642, p = 0.021). The meta-analysis containing 36 studies demonstrated that the two polymorphisms were associated with T2DM under the allele comparison, genetic models of dominant and recessive in Asians (p < 0.05). The rs4402960 polymorphisms were significantly associated with the T2DM risk after stratification by diagnostic criterion, size of sample and average age and BMI of cases, while there’re no consistent results for rs1470579. Conclusions: Our data suggests that IGF2BP2 polymorphisms are associated with T2DM in Asian populations.

• IJERPH, Vol. 13, Pages 575: Effect of Nano-Al2O3 on the Toxicity and Oxidative Stress of Copper towards Scenedesmus obliquus

  Posted:2016-06-09

  Nano-Al2O3 has been widely used in various industries; unfortunately, it can be released into the aquatic environment. Although nano-Al2O3 is believed to be of low toxicity, it can interact with other pollutants in water, such as heavy metals. However, the interactions between nano-Al2O3 and heavy metals as well as the effect of nano-Al2O3 on the toxicity of the metals have been rarely investigated. The current study investigated copper toxicity in the presence of nano-Al2O3 towards Scenedesmus obliquus. Superoxide dismutase activity and concentration of glutathione and malondialdehyde in cells were determined in order to quantify oxidative stress in this study. Results showed that the presence of nano-Al2O3 reduced the toxicity of Cu towards S. obliquus. The existence of nano-Al2O3 decreased the growth inhibition of S. obliquus. The accumulation of copper and the level of oxidative stress in algae were reduced in the presence of nano-Al2O3. Furthermore, lower copper accumulation was the main factor that mitigated copper toxicity with the addition of nano-Al2O3. The decreased copper uptake could be attributed to the adsorption of copper onto nanoparticles and the subsequent decrease of available copper in water.

• IJERPH, Vol. 13, Pages 573: Addressing Emerging Risks: Scientific and Regulatory Challenges Associated with Environmentally Persistent Free Radicals

  Posted:2016-06-08

  Airborne fine and ultrafine particulate matter (PM) are often generated through widely-used thermal processes such as the combustion of fuels or the thermal decomposition of waste. Residents near Superfund sites are exposed to PM through the inhalation of windblown dust, ingestion of soil and sediments, and inhalation of emissions from the on-site thermal treatment of contaminated soils. Epidemiological evidence supports a link between exposure to airborne PM and an increased risk of cardiovascular and pulmonary diseases. It is well-known that during combustion processes, incomplete combustion can lead to the production of organic pollutants that can adsorb to the surface of PM. Recent studies have demonstrated that their interaction with metal centers can lead to the generation of a surface stabilized metal-radical complex capable of redox cycling to produce ROS. Moreover, these free radicals can persist in the environment, hence their designation as Environmentally Persistent Free Radicals (EPFR). EPFR has been demonstrated in both ambient air PM2.5 (diameter < 2.5 µm) and in PM from a variety of combustion sources. Thus, low-temperature, thermal treatment of soils can potentially increase the concentration of EPFR in areas in and around Superfund sites. In this review, we will outline the evidence to date supporting EPFR formation and its environmental significance. Furthermore, we will address the lack of methodologies for specifically addressing its risk assessment and challenges associated with regulating this new, emerging contaminant.

• IJERPH, Vol. 13, Pages 571: Assessing Community Readiness to Reduce Childhood Diarrheal Disease and Improve Food Security in Dioro, Mali

  Posted:2016-06-08

  Diarrhea and malnutrition represent leading causes of death for children in Mali. Understanding a community’s needs and ideas are critical to ensure the success of prevention and treatment interventions for diarrheal disease, as well as to improve food security to help reduce malnutrition. The objective of this study was to incorporate the Community Readiness Model (CRM) for the issues of childhood diarrheal disease and food security in Mali to measure baseline community readiness prior to any program implementation. Thirteen key respondents residing in Dioro, Mali were selected based on varied social roles and demographics and completed two questionnaires on these public health issues. The overall readiness score to reduce childhood diarrheal disease was 5.75 ± 1.0 standard deviation (preparation stage). The overall readiness score to improve food security was 5.5 ± 0.5 standard deviation (preparation stage). The preparation stage indicates that at least some of the community have basic knowledge regarding these issues, and want to act locally to reduce childhood diarrhea and improve food security and nutrition. Proposed activities to increase community readiness on these issues are provided and are broad enough to allow opportunities to implement community- and culturally-specific activities by the Dioro community.

• IJERPH, Vol. 13, Pages 572: The Diet of Preschool Children in the Mediterranean Countries of the European Union: A Systematic Review

  Posted:2016-06-08

  This systematic review discusses data on the dietary intake of preschool children living in the Mediterranean countries of the European Union, including the comparison with a Mediterranean-like diet and the association with nutritional status. Specifically, data from the multinational European Identification and Prevention on Dietary and life style induced health effects in children and infants (IDEFICS) study and national studies, such as the Estudo do Padrão Alimentar e de Crescimento Infantil (EPACI) study and Geração XXI cohort in Portugal, ALimentando la SAlud del MAñana (ALSALMA) study in Spain, Étude des Déterminants pré-et postnatals précoces du développement et de la santé de l’ENfant (EDEN) cohort in France, Nutrintake 636 study in Italy, and Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) cohort in Greece, were analyzed. In the majority of countries, young children consumed fruit and vegetables quite frequently, but also consumed sugared beverages and snacks. High energy and high protein intakes mainly from dairy products were found in the majority of countries. The majority of children also consumed excessive sodium intake. Early high prevalence of overweight and obesity was found, and both early consumption of energy-dense foods and overweight seemed to track across toddler and preschool ages. Most children living in the analyzed countries showed low adherence to a Mediterranean-like diet, which in turn was associated with being overweight/obese. Unhealthier diets were associated with lower maternal educational level and parental unemployment. Programs promoting adherence of young children to the traditional Mediterranean diet should be part of a multi-intervention strategy for the prevention and treatment of pediatric overweight and obesity.

• IJERPH, Vol. 13, Pages 569: Interactions between Neighborhood Social Environment and Walkability to Explain Belgian Older Adults’ Physical Activity and Sedentary Time

  Posted:2016-06-07

  This study examined associations between neighborhood social factors and physical activity (PA) and sedentary behavior (SB) in older adults. Furthermore, possible moderating effects of neighborhood walkability were explored. Data from 431 community-dwelling Belgian older adults (≥65 years) were analyzed. Neighborhood social factors included measures of neighboring, social trust and cohesion and social diversity. Neighborhood walkability was measured objectively. Outcome measures were self-reported weekly minutes of domain-specific walking and TV viewing, and accelerometer-assessed weekly minutes of moderate-to-vigorous physical activity (MVPA) and overall SB. A higher frequency of talking to neighbors was associated with higher levels of self-reported walking for transport and for recreation. Moderation analyses showed that only in highly-walkable neighborhoods, higher social diversity of the neighborhood environment was associated with more transport walking; and talking to neighbors and social interactions among neighbors were negatively associated with overall SB and television viewing, respectively. Findings suggest that a combination of a favorable neighborhood social and physical environment are important to promote older adults’ PA and limit SB.

• IJERPH, Vol. 13, Pages 568: Viral Suppression and Resistance in a Cohort of Perinatally-HIV Infected (PHIV+) Pregnant Women

  Posted:2016-06-07

  Our objective was to describe viral suppression and antiretroviral (ARV) resistance mutations in an ongoing cohort of perinatally-infected HIV+ (PHIV+) pregnant women. Descriptive analysis was performed using SPSS 18.0. From 2011 to 2014, we followed 22 PHIV+ pregnant women. Median age at prenatal entry was 19 years (Interquartile range (IQR) 17.6–21.0); 86% had an AIDS diagnosis; 81% had disclosed their HIV status to partner 11. The median age at HIV diagnosis was 8.3 y (IQR 4.0–13.6), the median age at sexual debut was 16 years (IQR 14–18). At the time of prenatal care initiation, four (18%) were on their first antiretroviral treatment (ART), eight (36%) in their second regimen and nine (41%) in their third regimen or beyond, and one had no data. Seventeen of 22 (77%) had HIV-viral load (VL) > 50 copies/mL at prenatal care entry, 16 had a genotyping exam performed. Seventeen of 22 PHIV+ had VL results near delivery: 7/17 (41%) had VL < 50 copies/mL. Among those who had genotyping at prenatal entry, 11/16 (69%) had mutations associated with ARV resistance. The most frequent major mutations were K103N, M184V, T215, M41L, D67N at reverse transcriptase gene and M46, I54V and V82A at protease gene. No vertical transmissions occurred. Management of pregnancy among PHIV+ is challenging. Individualized ART are needed to achieve viral suppression in a highly ART-exposed subpopulation.

• IJERPH, Vol. 13, Pages 570: Modelling of Radiological Health Risks from Gold Mine Tailings in Wonderfonteinspruit Catchment Area, South Africa

  Posted:2016-06-07

  Mining is one of the major causes of elevation of naturally-occurring radionuclide material (NORM) concentrations on the Earth’s surface. The aim of this study was to evaluate the human risk associated with exposure to NORMs in soils from mine tailings around a gold mine. A broad-energy germanium detector was used to measure activity concentrations of these NORMs in 66 soil samples (56 from five mine tailings and 10 from the control area). The RESidual RADioactivity (RESRAD) OFFSITE modeling program (version 3.1) was then used to estimate the radiation doses and the cancer morbidity risk of uranium-238 (238U), thorium-232 (232Th), and potassium-40 (40K) for a hypothetical resident scenario. According to RESRAD prediction, the maximum total effective dose equivalent (TEDE) during 100 years was found to be 0.0315 mSv/year at year 30, while the maximum total excess cancer morbidity risk for all the pathways was 3.04 × 10−5 at year 15. The US Environmental Protection Agency considers acceptable for regulatory purposes a cancer risk in the range of 10−6 to 10−4. Therefore, results obtained from RESRAD OFFSITE code has shown that the health risk from gold mine tailings is within acceptable levels according to international standards.

• IJERPH, Vol. 13, Pages 566: Students’ Perceived Heat-Health Symptoms Increased with Warmer Classroom Temperatures

  Posted:2016-06-07

  Temperatures in Africa are expected to increase by the end of the century. Heat-related health impacts and perceived health symptoms are potentially a problem, especially in public schools with limited resources. Students (n = 252) aged ~14–18 years from eight high schools completed an hourly heat-health symptom log over 5 days. Data loggers measured indoor classroom temperatures. A high proportion of students felt tired (97.2%), had low concentration (96.8%) and felt sleepy (94.1%) during at least one hour on any day. There were statistically significant correlations, when controlling for school cluster effect and time of day, between indoor temperatures ≥32 °C and students who felt tired and found it hard to breathe. Consistently higher indoor classroom temperatures were observed in classrooms constructed of prefabricated asbestos sheeting with corrugated iron roof and converted shipping container compared to brick classrooms. Longitudinal studies in multiple seasons and different classroom building types are needed.

• IJERPH, Vol. 13, Pages 565: Childhood Health Status and Adulthood Cardiovascular Disease Morbidity in Rural China: Are They Related?

  Posted:2016-06-06

  Cardiovascular diseases (CVDs) are among the top health problems of the Chinese population. Although mounting evidence suggests that early childhood health status has an enduring effect on late life chronic morbidity, no study so far has analyzed the issue in China. Using nationally representative data from the 2013 China Health and Retirement Longitudinal Study (CHARLS), a Probit model and Two-Stage Residual Inclusion estimation estimator were applied to analyze the relationship between childhood health status and adulthood cardiovascular disease in rural China. Good childhood health was associated with reduced risk of adult CVDs. Given the long-term effects of childhood health on adulthood health later on, health policy and programs to improve the health status and well-being of Chinese populations over the entire life cycle, especially in persons’ early life, are expected to be effective and successful.

• IJERPH, Vol. 13, Pages 567: Individual Characteristics Influencing Physicians’ Perceptions of Job Demands and Control: The Role of Affectivity, Work Engagement and Workaholism

  Posted:2016-06-06

  The first purpose of the present study was to investigate the role of individual characteristics, i.e., positive and negative affectivity, in explaining the different perception of job control and job demands in a particularly demanding environment such as the healthcare setting. In addition, we aimed to explore the mediational role of work engagement and workaholism using the Job Demands-Resources Model as a theoretical framework. Data were collected using a sample of 269 Italian head physicians working in nine general hospitals. To test our hypotheses, the collected data were analyzed with structural equation modeling. Moreover, Sobel Test and bootstrapping were employed to assess the mediating hypotheses. Our results indicated that positive affectivity is related to work engagement, which, in its turn, showed a positive association with job control. In addition, workaholism mediated the relationship between negative affectivity and job demands. All in all, this study represents a first attempt to explore the role of trait affectivity as a dispositional characteristic able to foster the level of work engagement and workaholism exhibited by employees and, in turn, to increase the perceived levels of job control and job demands.

• IJERPH, Vol. 13, Pages 564: Nutrient Intakes in Early Life and Risk of Obesity

  Posted:2016-06-06

  There is increasing evidence that environmental factors in early life predict later health. The early adiposity rebound recorded in most obese subjects suggests that factors promoting body fat development have operated in the first years of life. Birth weight, growth velocity and body mass index (BMI) trajectories seem to be highly sensitive to the environmental conditions present during pregnancy and in early life (“The first 1000 days”). Particularly, nutritional exposure can have a long-term effect on health in adulthood. The high protein-low fat diet often recorded in young children may have contributed to the rapid rise of childhood obesity prevalence during the last decades. Metabolic programming by early nutrition could explain the development of later obesity and adult diseases.

• IJERPH, Vol. 13, Pages 562: Health-Care Waste Treatment Technology Selection Using the Interval 2-Tuple Induced TOPSIS Method

  Posted:2016-06-04

  Health-care waste (HCW) management is a major challenge for municipalities, particularly in the cities of developing nations. Selecting the best treatment technology for HCW can be regarded as a complex multi-criteria decision making (MCDM) issue involving a number of alternatives and multiple evaluation criteria. In addition, decision makers tend to express their personal assessments via multi-granularity linguistic term sets because of different backgrounds and knowledge, some of which may be imprecise, uncertain and incomplete. Therefore, the main objective of this study is to propose a new hybrid decision making approach combining interval 2-tuple induced distance operators with the technique for order preference by similarity to an ideal solution (TOPSIS) for tackling HCW treatment technology selection problems with linguistic information. The proposed interval 2-tuple induced TOPSIS (ITI-TOPSIS) can not only model the uncertainty and diversity of the assessment information given by decision makers, but also reflect the complex attitudinal characters of decision makers and provide much more complete information for the selection of the optimum disposal alternative. Finally, an empirical example in Shanghai, China is provided to illustrate the proposed decision making method, and results show that the ITI-TOPSIS proposed in this paper can solve the problem of HCW treatment technology selection effectively.

• IJERPH, Vol. 13, Pages 563: Hand- and Object-Mouthing of Rural Bangladeshi Children 3–18 Months Old

  Posted:2016-06-04

  Children are exposed to environmental contaminants by placing contaminated hands or objects in their mouths. We quantified hand- and object-mouthing frequencies of Bangladeshi children and determined if they differ from those of U.S. children to evaluate the appropriateness of applying U.S. exposure models in other socio-cultural contexts. We conducted a five-hour structured observation of the mouthing behaviors of 148 rural Bangladeshi children aged 3–18 months. We modeled mouthing frequencies using 2-parameter Weibull distributions to compare the modeled medians with those of U.S. children. In Bangladesh the median frequency of hand-mouthing was 37.3 contacts/h for children 3–6 months old, 34.4 contacts/h for children 6–12 months old, and 29.7 contacts/h for children 12–18 months old. The median frequency of object-mouthing was 23.1 contacts/h for children 3–6 months old, 29.6 contacts/h for children 6–12 months old, and 15.2 contacts/h for children 12–18 months old. At all ages both hand- and object-mouthing frequencies were higher than those of U.S. children. Mouthing frequencies were not associated with child location (indoor/outdoor). Using hand- and object-mouthing exposure models from U.S. and other high-income countries might not accurately estimate children’s exposure to environmental contaminants via mouthing in low- and middle-income countries.

• IJERPH, Vol. 13, Pages 561: Genetic Variation in POU4F3 and GRHL2 Associated with Noise-Induced Hearing Loss in Chinese Population: A Case-Control Study

  Posted:2016-06-03

  Noise-induced hearing loss (NIHL) is an important occupational disease worldwide resulting from interactions between genetic and environmental factors. The purpose of this study was to examine whether genetic variations in POU4F3 and GRHL2 may influence susceptibility to NIHL in the Chinese population. A matched case-control study was carried out among 293 hearing loss individuals and 293 normal hearing workers drawn from a population of 3790 noise-exposed workers. Ten single-nucleotide polymorphisms (SNPs) in POU4F3 and GRHL2 were selected and genotyped. Logistic regression was performed to analyze the main effects of SNPs and the interactions between noise exposure and SNPs. Moreover, the interactions between predictor haplotypes and noise exposure were also analyzed. Analysis revealed that the CC genotype of rs1981361 in the GRHL2 gene was associated with a higher risk of NIHL (adjusted OR = 1.59; 95% CI: 1.08–2.32, p = 0.018). Additionally, the GG genotype of rs3735715 in the GRHL2 gene was also a risk genotype (adjusted OR = 1.48; 95% CI: 1.01–2.19, p = 0.046). Significant interactions were found between rs3735715, rs1981361 (GRHL2), rs1368402 as well as rs891969 (POU4F3) and noise exposure in the high-level exposure groups. Furthermore, the protective haplotype CA in the POU4F3 gene and the risk haplotype GCCG in the GRHL2 gene were identified combined with noise exposure. These results indicated that GRHL2 might be an NIHL susceptibility gene, but the effect of POU4F3 on NIHL could only be detected when taking noise exposure into account, and their effects were enhanced by higher levels of noise exposure. However, the differences were not significant after the Bonferroni correction was applied. These results should be seen as suggestive.

• IJERPH, Vol. 13, Pages 560: An Evaluation of Voluntary Varicella Vaccination Coverage in Zhejiang Province, East China

  Posted:2016-06-03

  Background: In 2014 a 2-doses varicella vaccine (VarV) schedule was recommended by the Zhejiang Provincial Center for Disease Control and Prevention. We aimed to assess the coverage of the 1st dose of VarV (VarV1) and the 2nd dose of VarV (VarV2) among children aged 2–6 years through the Zhejiang Provincial Immunization Information System (ZJIIS) and to explore the determinants associated with the VarV coverage. Methods: Children aged 2–6 years (born from 1 January 2009 to 31 December 2013) registered in ZJIIS were enrolled. Anonymized individual records of target children were extracted from the ZJIIS database on 1 January 2016, including their VarV and (measles-containing vaccine) MCV vaccination information. The VarV1 and VarV2 coverage rates were evaluated for each birth cohorts. The coverage of VarV also was estimated among strata defined by cities, gender and immigration status. We also evaluated the difference in coverage between VarV and MCV. Results: A total of 3,028,222 children aged 2–6 years were enrolled. The coverage of VarV1 ranged from 84.8% to 87.9% in the 2009–2013 birth cohorts, while the coverage of VarV2 increased from 31.8% for the 2009 birth cohort to 48.7% for the 2011 birth cohort. Higher coverage rates for both VarV1 and VarV2 were observed among resident children in relevant birth cohorts. The coverage rates of VarV1 and VarV2 were lower than those for the 1st and 2nd dose of MCV, which were above 95%. The proportion of children who were vaccinated with VarV1 at the recommended age increased from 34.6% for the 2009 birth cohort to 75.2% for the 2013 birth cohort, while the proportion of children who were vaccinated with VarV2 at the recommended age increased from 19.7% for the 2009 birth cohort to 48.7% for the 2011 birth cohort. Conclusions: Our study showed a rapid increasing VarV2 coverage of children, indicating a growing acceptance of the 2-doses VarV schedule among children’s caregivers and physicians after the new recommendation released. We highlighted the necessity for a 2-doses VarV vaccination school-entry requirement to achieve the high coverage of >90% and to eliminate disparities in coverage among sub-populations. We also recommended continuous monitoring of the VarV coverage via ZJIIS over time.

• IJERPH, Vol. 13, Pages 559: Incidence and Mortality Risks of Cancer in Patients with Type 2 Diabetes: A Retrospective Study in Shanghai, China

  Posted:2016-06-03

  Background: Evidence from epidemiologic investigation indicates that people with type 2 diabetes (T2DM) are at a significantly higher risk of many types of cancer and mortality. The aim of this study was to investigate the incidence and mortality risks of cancer in patients with T2DM compared with the general population in Shanghai, China. Methods: Based on the Shanghai Diabetes Registry (SDR) database linking to the Shanghai Cancer Registry and Surveillance System (SCRSS), a total of 12,276 T2DM patients without cancer were defined and followed up from 1 December 2001 to 31 July 2011. Standardized incidence ratio (SIR) and standardized mortality ratio (SMR) with 95% confidence interval (CI) were calculated using the whole gender and age-matched general population of Shanghai as a reference during the same period. Results: The overall cancer risk was found higher in both males and females T2DM patients, with the SIR of 3.14 (95% CI 2.73–3.56) and 4.29 (95% CI 3.64–4.94), respectively. The overall mortality risk of cancer also significantly increased with the SMR of 2.27 (95% CI 1.86–2.68) and 1.86 (95% CI 1.46–2.26), respectively. Pancreatic cancer was with the highest SIR and SMR in both genders. Conclusions: Compared with the general population, patients with T2DM were associated with higher incidence and mortality risks of cancer, especially pancreatic cancer.

• IJERPH, Vol. 13, Pages 557: Increased Risk of Respiratory Mortality Associated with the High-Tech Manufacturing Industry: A 26-Year Study

  Posted:2016-06-03

  Global high-tech manufacturers are mainly located in newly industrialized countries, raising concerns about adverse health consequences from industrial pollution for people living nearby. We investigated the ecological association between respiratory mortality and the development of Taiwan’s high-tech manufacturing, taking into account industrialization and socioeconomic development, for 19 cities and counties—6 in the science park group and 13 in the control group—from 1982 to 2007. We applied a linear mixed-effects model to analyze how science park development over time is associated with age-adjusted and sex-specific mortality rates for asthma and chronic obstructive pulmonary disease (COPD). Asthma and female COPD mortality rates decreased in both groups, but they decreased 9%–16% slower in the science park group. Male COPD mortality rates increased in both groups, but the rate increased 10% faster in the science park group. Science park development over time was a significant predictor of death from asthma (p ≤ 0.0001) and COPD (p = 0.0212). The long-term development of clustered high-tech manufacturing may negatively affect nearby populations, constraining health advantages that were anticipated, given overall progress in living standards, knowledge, and health services. National governments should incorporate the long-term health effects on local populations into environmental impact assessments.

• IJERPH, Vol. 13, Pages 558: Individual Monitoring and Occupational Dose Record Management in China: History, Current Status and Perspectives

  Posted:2016-06-03

  This review paper presents an overview of individual monitoring, as well as the national dose register and dose record management of radiation workers in China. Progress has recently been made on the individual monitoring of radiation workers. A critical analysis of current status and problems in individual monitoring is also presented and necessary future research on individual monitoring, such as the monitoring technology in the form of the ring dosimeters and eye lens dosimeters, is suggested.

• IJERPH, Vol. 13, Pages 555: Identifying Hot-Spots of Metal Contamination in Campus Dust of Xi’an, China

  Posted:2016-06-03

  The concentrations of heavy metals (As, Ba, Co, Cr, Cu, Mn, Ni, Pb, V, and Zn) in campus dust from kindergartens, elementary schools, middle schools, and universities in the city of Xi’an, China, were determined by X-ray fluorescence spectrometry. The pollution levels and hotspots of metals were analyzed using a geoaccumulation index and Local Moran’s I, an indicator of spatial association, respectively. The dust samples from the campuses had metal concentrations higher than background levels, especially for Pb, Zn, Co, Cu, Cr, and Ba. The pollution assessment indicated that the campus dusts were not contaminated with As, Mn, Ni, or V, were moderately or not contaminated with Ba and Cr and were moderately to strongly contaminated with Co, Cu, Pb, and Zn. Local Moran’s I analysis detected the locations of spatial clusters and outliers and indicated that the pollution with these 10 metals occurred in significant high-high spatial clusters, low-high, or even high-low spatial outliers. As, Cu, Mn, Ni, Pb, V, and Zn had important high-high patterns in the center of Xi’an. The western and southwestern regions of the study area, i.e., areas of old and high-tech industries, have strongly contributed to the Co content in the campus dust.

• IJERPH, Vol. 13, Pages 556: A Diffusive Gradient-in-Thin-Film Technique for Evaluation of the Bioavailability of Cd in Soil Contaminated with Cd and Pb

  Posted:2016-06-02

  Management of heavy metal contamination requires accurate information about the distribution of bioavailable fractions, and about exchange between the solid and solution phases. In this study, we employed diffusive gradients in thin-films (DGT) and traditional chemical extraction methods (soil solution, HOAc, EDTA, CaCl2, and NaOAc) to determine the Cd bioavailability in Cd-contaminated soil with the addition of Pb. Two typical terrestrial species (wheat, Bainong AK58; maize, Zhengdan 958) were selected as the accumulation plants. The results showed that the added Pb may enhance the efficiency of Cd phytoextraction which is indicated by the increasing concentration of Cd accumulating in the plant tissues. The DGT-measured Cd concentrations and all the selected traditional extractants measured Cd concentrations all increased with increasing concentration of the addition Pb which were similar to the change trends of the accumulated Cd concentrations in plant tissues. Moreover, the Pearson regression coefficients between the different indicators obtained Cd concentrations and plants uptake Cd concentrations were further indicated significant correlations (p < 0.01). However, the values of Pearson regression coefficients showed the merits of DGT, CaCl2, and Csol over the other three methods. Consequently, the in situ measurement of DGT and the ex situ traditional methods could all reflect the inhibition effects between Cd and Pb. Due to the feature of dynamic measurements of DGT, it could be a robust tool to predict Cd bioavaiability in complex contaminated soil.

• IJERPH, Vol. 13, Pages 554: Development and Validation of an Instrument Measuring Theory-Based Determinants of Monitoring Obesogenic Behaviors of Pre-Schoolers among Hispanic Mothers

  Posted:2016-06-02

  Public health interventions are greatly needed for obesity prevention, and planning for such strategies should include community participation. The study’s purpose was to develop and validate a theory-based instrument with low-income, Hispanic mothers of preschoolers, to assess theory-based determinants of maternal monitoring of child’s consumption of fruits and vegetables and sugar-sweetened beverages (SSB). Nine focus groups with mothers were conducted to determine nutrition-related behaviors that mothers found as most obesogenic for their children. Next, behaviors were operationally defined and rated for importance and changeability. Two behaviors were selected for investigation (fruits and vegetable and SSB). Twenty semi-structured interviews with mothers were conducted next to develop culturally appropriate items for the instrument. Afterwards, face and content validity were established using a panel of six experts. Finally, the instrument was tested with a sample of 238 mothers. Psychometric properties evaluated included construct validity (using the maximum likelihood extraction method of factor analysis), and internal consistency reliability (Cronbach’s alpha). Results suggested that all scales on the instrument were valid and reliable, except for the autonomy scales. Researchers and community planners working with Hispanic families can use this instrument to measure theory-based determinants of parenting behaviors related to preschoolers’ consumption of fruits and vegetables, and SSB.

• IJERPH, Vol. 13, Pages 553: Empirical Model for Evaluating PM10 Concentration Caused by River Dust Episodes

  Posted:2016-06-02

  Around the estuary of the Zhuo-Shui River in Taiwan, the waters recede during the winter, causing an increase in bare land area and exposing a large amount of fine earth and sand particles that were deposited on the riverbed. Observations at the site revealed that when northeastern monsoons blow over bare land without vegetation or water cover, the fine particles are readily lifted by the wind, forming river dust, which greatly endangers the health of nearby residents. Therefore, determining which factors affect river dust and constructing a model to predict river dust concentration are extremely important in the research and development of a prototype warning system for areas at risk of river dust emissions. In this study, the region around the estuary of the Zhuo-Shui River (from the Zi-Qiang Bridge to the Xi-Bin Bridge) was selected as the research area. Data from a nearby air quality monitoring station were used to screen for days with river dust episodes. The relationships between PM10 concentration and meteorological factors or bare land area were analyzed at different temporal scales to explore the factors that affect river dust emissions. Study results showed that no single factor alone had adequate power to explain daily average or daily maximum PM10 concentration. Stepwise regression analysis of multiple factors showed that the model could not effectively predict daily average PM10 concentration, but daily maximum PM10 concentration could be predicted by a combination of wind velocity, temperature, and bare land area; the coefficient of determination for this model was 0.67. It was inferred that river dust episodes are caused by the combined effect of multiple factors. In addition, research data also showed a time lag effect between meteorological factors and hourly PM10 concentration. This characteristic was applied to the construction of a prediction model, and can be used in an early warning system for local residents.

• IJERPH, Vol. 13, Pages 552: Increase in Suicide Rates by Hanging in the Population of Tabasco, Mexico between 2003 and 2012

  Posted:2016-06-01

  Background: Worldwide, the suicide rate is decreasing. To examine changes in the rates of completed suicide in the Mexican population from 2003 to 2012, we analyzed these changes according to: (i) the method of suicide; (ii) age group and (iii) gender. Methods: The data analyzed were obtained from governmental organizations from the State of Tabasco, Mexico. The data provided 1836 cases of subjects born and residing in Tabasco, who completed suicide in this state. Results: Suicide by hanging was a common choice of suicide method for Mexicans. The rate of suicide by hanging increased from 5.80 to 6.49 per 100,000 persons between 2003 and 2012, a rate percentage increase of 11.89%. Conclusions: Hanging was found to be the most common choice of suicide in the Mexican population, probably because the materials required are easily available and the method does not require complicated techniques, especially in the 55–64 age group. Strategies for prevention and intervention should be developed for the Mexican population considering suicide rates by age group and gender.

• IJERPH, Vol. 13, Pages 547: LBMR: Load-Balanced Multipath Routing for Wireless Data-Intensive Transmission in Real-Time Medical Monitoring

  Posted:2016-05-31

  In wireless networks, low-power Zigbee is an excellent network solution for wireless medical monitoring systems. Medical monitoring generally involves transmission of a large amount of data and easily causes bottleneck problems. Although Zigbee’s AODV mesh routing provides extensible multi-hop data transmission to extend network coverage, it originally does not, and needs to support some form of load balancing mechanism to avoid bottlenecks. To guarantee a more reliable multi-hop data transmission for life-critical medical applications, we have developed a multipath solution, called Load-Balanced Multipath Routing (LBMR) to replace Zigbee’s routing mechanism. LBMR consists of three main parts: Layer Routing Construction (LRC), a Load Estimation Algorithm (LEA), and a Route Maintenance (RM) mechanism. LRC assigns nodes into different layers based on the node’s distance to the medical data gateway. Nodes can have multiple next-hops delivering medical data toward the gateway. All neighboring layer-nodes exchange flow information containing current load, which is the used by the LEA to estimate future load of next-hops to the gateway. With LBMR, nodes can choose the neighbors with the least load as the next-hops and thus can achieve load balancing and avoid bottlenecks. Furthermore, RM can detect route failures in real-time and perform route redirection to ensure routing robustness. Since LRC and LEA prevent bottlenecks while RM ensures routing fault tolerance, LBMR provides a highly reliable routing service for medical monitoring. To evaluate these accomplishments, we compare LBMR with Zigbee’s AODV and another multipath protocol, AOMDV. The simulation results demonstrate LBMR achieves better load balancing, less unreachable nodes, and better packet delivery ratio than either AODV or AOMDV.

• IJERPH, Vol. 13, Pages 551: A Comprehensive Evaluation of the Burden of Heat-Related Illness and Death within the Florida Population

  Posted:2016-05-31

  The failure of the human body to thermoregulate can lead to severe outcomes (e.g., death) and lasting physiological damage. However, heat-related illness (HRI) is highly preventable via individual- and community-level modification. A thorough understanding of the burden is necessary for effective intervention. This paper describes the burden of severe HRI morbidity and mortality among residents of a humid subtropical climate. Work-related and non-work-related HRI emergency department (ED) visits, hospitalizations, and deaths among Florida residents during May to October (2005–2012) were examined. Sub-groups susceptible to HRI were identified. The age-adjusted rates/100,000 person-years for non-work-related HRI were 33.1 ED visits, 5.9 hospitalizations, and 0.2 deaths, while for work-related HRI/100,000 worker-years there were 8.5 ED visits, 1.1 hospitalizations, and 0.1 deaths. The rates of HRI varied by county, data source, and work-related status, with the highest rates observed in the panhandle and south central Florida. The sub-groups with the highest relative rates regardless of data source or work-relatedness were males, minorities, and rural residents. Those aged 15–35 years had the highest ED visit rates, while for non-work-related hospitalizations and deaths the rates increased with age. The results of this study can be used for targeted interventions and evaluating changes in the HRI burden over time.

• IJERPH, Vol. 13, Pages 549: Children’s Personal Exposure Measurements to Extremely Low Frequency Magnetic Fields in Italy

  Posted:2016-05-31

  Extremely low frequency magnetic fields (ELF-MFs) exposure is still a topic of concern due to their possible impact on children’s health. Although epidemiological studies claimed an evidence of a possible association between ELF-MF above 0.4 μT and childhood leukemia, biological mechanisms able to support a causal relationship between ELF-MF and this disease were not found yet. To provide further knowledge about children’s ELF-MF exposure correlated to children’s daily activities, a measurement study was conducted in Milan (Italy). Eighty-six children were recruited, 52 of whom were specifically chosen with respect to the distance to power lines and built-in transformers to oversample potentially highly exposed children. Personal and bedroom measurements were performed for each child in two different seasons. The major outcomes of this study are: (1) median values over 24-h personal and bedroom measurements were <3 μT established by the Italian law as the quality target; (2) geometric mean values over 24-h bedroom measurements were mostly <0.4 μT; (3) seasonal variations did not significantly influence personal and bedroom measurements; (4) the highest average MF levels were mostly found at home during the day and outdoors; (5) no significant differences were found in the median and geometric mean values between personal and bedroom measurements, but were found in the arithmetic mean.

• IJERPH, Vol. 13, Pages 550: Tracking Restoration of Park and Urban Street Settings in Coronary Artery Disease Patients

  Posted:2016-05-31

  The physiological effects of natural and urban environments on the cardiovascular system of coronary artery disease (CAD) patients are not fully understood. This controlled field study examines the effects of restorative walking in a park vs. in an urban street environment on CAD patients’ stress parameters and cardiac function. Methods: Twenty stable CAD patients were randomly allocated to 7 days controlled walking in a city park or in an urban street environment group. The relationship between different environmental exposures and health effects was analyzed using Wilcoxon signed-rank test and exact Mann-Whitney U test. Results: The mean reduction in cortisol levels and negative effects after the walk on the first day was greater in the city park than in the urban street exposed group, while a reduction in negative effects in the urban group were greater after seven days. The reduction in diastolic blood pressure (DBP) in the park group was evident on the seventh day before the walk (−4 mm Hg, p = 0.031) and 60 min after the walk (−6.00 mm Hg, p = 0.002). The cortisol slope was negatively associated with the DBP changes (r = −0.514, p < 0.05). Conclusions: Physical activity in a green environment with noise and air pollution levels lower than in an urban environment has a greater positive effect on CAD patients’ stress level and hemodynamic parameters. Mitigating green environmental influences may allow urban residents to maintain health and reduce disability.

• IJERPH, Vol. 13, Pages 548: An Improved Multi-Objective Programming with Augmented ε-Constraint Method for Hazardous Waste Location-Routing Problems

  Posted:2016-05-31

  Hazardous waste location-routing problems are of importance due to the potential risk for nearby residents and the environment. In this paper, an improved mathematical formulation is developed based upon a multi-objective mixed integer programming approach. The model aims at assisting decision makers in selecting locations for different facilities including treatment plants, recycling plants and disposal sites, providing appropriate technologies for hazardous waste treatment, and routing transportation. In the model, two critical factors are taken into account: system operating costs and risk imposed on local residents, and a compensation factor is introduced to the risk objective function in order to account for the fact that the risk level imposed by one type of hazardous waste or treatment technology may significantly vary from that of other types. Besides, the policy instruments for promoting waste recycling are considered, and their influence on the costs and risk of hazardous waste management is also discussed. The model is coded and calculated in Lingo optimization solver, and the augmented ε-constraint method is employed to generate the Pareto optimal curve of the multi-objective optimization problem. The trade-off between different objectives is illustrated in the numerical experiment.

• IJERPH, Vol. 13, Pages 546: Review of the Literature on Determinants of Chemical Hazard Information Recall among Workers and Consumers

  Posted:2016-05-31

  In many low and middle income countries (LMIC), workers’ and consumers’ only access to risk and hazard information in relation to the chemicals they use or work with is on the chemical label and safety data sheet. Recall of chemical hazard information is vital in order for label warnings and precautionary information to promote effective safety behaviors. A literature review, therefore, was conducted on determinants of chemical hazard information recall among workers and consumers globally. Since comprehension and recall are closely linked, the determinants of both were reviewed. Literature was reviewed from both online and print peer reviewed journals for all study designs and countries. This review indicated that the level of education, previous training and the inclusion of pictograms on the hazard communication material are all factors that contribute to the recall of hazard information. The influence of gender and age on recall is incongruent and remains to be explored. More research is required on the demographic predictors of the recall of hazard information, the effect of design and non-design factors on recall, the effect of training on the recall among low literate populations and the examining of different regions or contexts.

• IJERPH, Vol. 13, Pages 545: Clinical Significance of Long Non-Coding RNA CASC8 rs10505477 Polymorphism in Lung Cancer Susceptibility, Platinum-Based Chemotherapy Response, and Toxicity

  Posted:2016-05-30

  Long non-coding RNA (lncRNA) CASC8 rs10505477 polymorphism has been identified to be related to risk of many kinds of cancers, such as colorectal cancer, gastric cancer, and invasive ovarian cancer, and it may be involved in the prognosis of gastric cancer patients who have received platinum-based chemotherapy after surgical treatment. So far, there is no study investigating the clinical significance of lncRNA CASC8 rs10505477 in lung cancer susceptibility and treatment. In this study, we genotyped 498 lung cancer patients and 213 healthy control subjects to explore the correlation between the rs10505477 polymorphism and lung cancer risk in a Chinese population. Among the 498 patients, 467 were selected for the chemotherapy response and toxicity study. We found that the single nucleotide polymorphisms (SNP) rs10505477 was greatly related to lung cancer risk in male and adenocarcinoma subgroups in recessive model (adjusted OR = 0.51, 95%CI = 0.29–0.90, p = 0.02; adjusted OR = 0.52, 95%CI = 0.30–0.89, p = 0.02, respectively). It was also closely correlated with platinum-based chemotherapy response in dominant model (adjusted OR = 1.58, 95%CI = 1.05–2.39, p = 0.03). Additionally, we observed that CASC8 rs10505477 polymorphism was significantly relevant to severe hematologic toxicity in non-small-cell lung cancer (NSCLC) subgroup in dominant model (adjusted OR = 0.59, 95%CI = 0.35–0.98, p = 0.04) and in additive model (adjusted OR = 0.62, 95%CI = 0.43–0.90, p = 0.01). Furthermore, it was found that rs10505477 polymorphism was greatly associated with gastrointestinal toxicity in SCLC and cisplatin subgroups in dominant model (adjusted OR = 7.82, 95%CI = 1.36–45.07, p = 0.02; adjusted OR = 1.94, 95%CI = 1.07–3.53, p = 0.03, respectively). Thus, lncRNA CASC8 rs10505477 could serve as a possible risk marker for diagnosing lung cancer, and could be used to forecast the response and toxicity of platinum-based treatment in lung cancer patients.

• IJERPH, Vol. 13, Pages 543: Analysis of the Relationship between Estradiol and Follicle-Stimulating Hormone Concentrations and Polymorphisms of Apolipoprotein E and LeptinGenes in Women Post-Menopause

  Posted:2016-05-28

  Background: Menopause is the permanent cessation of menstruation due to loss of ovarian follicular activity. A review of the available literature indicates that correlations between the changes that take place in a woman’s body after menopause and different genetic variants are still being sought. Methods: The study was conducted in 252 women who had completed physiological menopause. The women were divided into groups according to the time elapsed since menopause. The total concentrations of estradiol and follicle-stimulating hormone were determined by means of electrochemiluminescence. The apolipoprotein E (APOE) and lepitn (LEP) genotypes were determined by real-time PCR and polymerase chain reaction–restriction fragment length polymorphism, respectively. Results: We observed that people with the APOE3/E3 genotype entered menopause insignificantly later compared to other genotypes. Additionally, in the group of patients with the APOE3/E3 genotypes, differences in the E2 concentration were significantly related to the time since their last menstruation. There is no association found in the literature between these polymorphisms of the LEP gene and hormones. Conclusions: To date, attempts to formulate a model describing the association between E2 and FSH concentration with the polymorphisms of various genes of menopause in women have not been successful. This relationship is difficult to study because of the number of nongenetic factors. Environmental factors can explain variation in postmenopausal changes in hormone levels.

• IJERPH, Vol. 13, Pages 544: BMI and BMD: The Potential Interplay between Obesity and Bone Fragility

  Posted:2016-05-28

  Recent evidence demonstrating an increased fracture risk among obese individuals suggests that adipose tissue may negatively impact bone health, challenging the traditional paradigm of fat mass playing a protective role towards bone health. White adipose tissue, far from being a mere energy depot, is a dynamic tissue actively implicated in metabolic reactions, and in fact secretes several hormones called adipokines and inflammatory factors that may in turn promote bone resorption. More specifically, Visceral Adipose Tissue (VAT) may potentially prove detrimental. It is widely acknowledged that obesity is positively associated to many chronic disorders such as metabolic syndrome, dyslipidemia and type 2 diabetes, conditions that could themselves affect bone health. Although aging is largely known to decrease bone strength, little is yet known on the mechanisms via which obesity and its comorbidities may contribute to such damage. Given the exponentially growing obesity rate in recent years and the increased life expectancy of western countries it appears of utmost importance to timely focus on this topic.

• IJERPH, Vol. 13, Pages 542: Prevalence of Depression among Rural Residents with Diabetes Mellitus: A Cross-Sectional Study from Northeast China

  Posted:2016-05-28

  Recent economic development in China has resulted in large increases in psychogenic and metabolic diseases. However, few studies have focused on the mental status of rural residents with diabetes. We aimed to investigate the prevalence of depressive symptoms among patients with diabetes to establish the association between depressive symptoms and socio-demographic and clinical factors. We conducted a cross-sectional analysis of 1187 patients with diabetes aged ≥35 years from rural Northeast China. Metabolic and anthropometric indicators were measured according to standard methods. Depressive symptoms were defined using the Patient Health Questionnaire-9 (PHQ-9). Five hundred and twenty-six residents (44.3%) of the total sample were male and 931 (78.4%) were <65 years old. One hundred and eight residents (8.76%) score ≥10 on the PHQ-9 scale. A statistically significant relationship was found between depressive symptoms and female gender, older age (≥65 years), high school or above education level, moderate physical activity, high family income, multiple additional illnesses, current alcohol consumption, and 7–8 h/d sleep duration. Multivariate analysis showed that female gender [odds ratio (OR) = 1.984, p = 0.028], high family income (OR = 0.483 for 5000–20,000 CNY/year, p = 0.011; OR = 0.356 for >2000 CNY/year, p = 0.003), 7–8 h/d sleep duration (OR = 0.453, p = 0.020), and having multiple additional illness (OR = 3.080, p < 0.001) were significantly associated with depressive symptoms. Prevalence of depressive symptoms in our study was high. Female gender and multiple illnesses were risk factors for depression, while long sleep duration and high family income seem to protect against depression among rural residents with diabetes in China.

• IJERPH, Vol. 13, Pages 541: Investigation and Evaluation of Children’s Blood Lead Levels around a Lead Battery Factory and Influencing Factors

  Posted:2016-05-28

  Lead pollution incidents have occurred frequently in mainland China, which has caused many lead poisoning incidents. This paper took a battery recycling factory as the subject, and focused on measuring the blood lead levels of environmental samples and all the children living around the factory, and analyzed the relationship between them. We collected blood samples from the surrounding residential area, as well as soil, water, vegetables. The atomic absorption method was applied to measure the lead content in these samples. The basic information of the generation procedure, operation type, habit and personal protect equipment was collected by an occupational hygiene investigation. Blood lead levels in 43.12% of the subjects exceeded 100 μg/L. The 50th and the 95th percentiles were 89 μg/L and 232 μg/L for blood lead levels in children, respectively, and the geometric mean was 94 μg/L. Children were stratified into groups by age, gender, parents’ occupation, distance and direction from the recycling plant. The difference of blood lead levels between groups was significant (p < 0.05). Four risk factors for elevated blood lead levels were found by logistic regression analysis, including younger age, male, shorter distance from the recycling plant, and parents with at least one working in the recycling plant. The rate of excess lead concentration in water was 6.25%, 6.06% in soil and 44.44% in leaf vegetables, which were all higher than the Chinese environment standards. The shorter the distance to the factory, the higher the value of BLL and lead levels in vegetable and environment samples. The lead level in the environmental samples was higher downwind of the recycling plant.

• IJERPH, Vol. 13, Pages 539: A Case of Acute Osteomyelitis: An Update on Diagnosis and Treatment

  Posted:2016-05-27

  Osteomyelitis in children is a serious disease in children requiring early diagnosis and treatment to minimize the risk of sequelae. Therefore, it is of primary importance to recognize the signs and symptoms at the onset and to properly use the available diagnostic tools. It is important to maintain a high index of suspicion and be aware of the evolving epidemiology and of the emergence of antibiotic resistant and aggressive strains requiring careful monitoring and targeted therapy. Hereby we present an instructive case and review the literature data on diagnosis and treatment.

• IJERPH, Vol. 13, Pages 538: Situation of Diabetes and Related Disease Surveillance in Rural Areas of Jilin Province, Northeast China

  Posted:2016-05-27

  Background: Several studies have investigated the prevalence and awareness of diabetes mellitus (DM) in China, but little is known about the situation of DM in the northeastern rural areas. Our present study investigated the prevalence, awareness and associated characteristics of DM in rural areas of Jilin Province, aiming to suggest more efforts for the prevention and control of DM. Methods: A multistage stratified random cluster sampling design was used in this cross-sectional study which took place in 2012. Data were collected by face-to-face interviews and physical examinations. Rao-Scott Chi-square test, t test and multivariate logistic regression analysis were used. Results: The estimated prevalence of DM in rural areas of Jilin province was 7.2%. DM was positively associated with age, Body mass index (BMI), hypotension, dyslipidemia and was high in participants with a family history of diabetes and those who exercise frequently, but low for high education level and married participants. 69.0% participants with DM were aware of their diabetes status, 88.2% of whom received treatment and 34.4% of whom had received treatment controlled their DM status. Conclusions: We observed a high prevalence and low awareness status of DM among the rural residents in Jilin Province, but the rate of effective control in those who have received treatment was considerable. The low rate of disease surveillance should draw health authority’s attention.

• IJERPH, Vol. 13, Pages 540: Association between Obese Phenotype and Mildly Reduced eGFR among the General Population from Rural Northeast China

  Posted:2016-05-27

  Obesity contributes to reduced kidney function; however, whether this is due to obesity itself or the metabolic abnormalities that accompany it is unclear. Besides, most previous studies enrolled participants with moderate or severe stage of chronic kidney disease. In the present study, we aim to investigate the possible relationship between obesity, metabolic abnormalities and mildly reduced estimated glomerular filtration rate (eGFR). A total of 11,127 Chinese participants (age ≥ 35 years) were enrolled in a survey conducted from January 2012 to August 2013. eGFR 60–90 mL/min/1.73 m2 was defined as mildly reduced eGFR. Obese phenotype was divided into four types: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically abnormal non-obese (MANO) and metabolically abnormal obese (MAO). Among all participants, 1941 (17.4%) of them had mildly reduced eGFR (16.7% for men and 18.1% for women, p = 0.025). The prevalence of obese phenotype was 22.5% for MHNO, 9.1% for MHO, 32.1% for MANO and 36.4% for MAO. The prevalence of mildly reduced eGFR was 9.0% among MHNO, 7.0% among MHO, 22.6% among MANO and 20.7% among MAO (p < 0.001). Multivariate logistic regression analysis revealed that obese phenotype did not statically contributed to mildly reduced eGFR (MHO: OR = 1.107, p = 0.662; MANO: OR = 0.800, p = 0.127; MAO: OR = 1.119, p = 0.525). However, gender (OR = 1.475, p < 0.001), aging (OR = 1.283, p < 0.001), dyslipidemia (OR = 1.544, 95%CI: 1.315, 1.814, p < 0.001) and hyperglycemia (OR = 1.247, 95%CI: 1.068, 1.455, p = 0.005) was associated with increased risk of mild reduced eGFR. Among the general population from rural Northeast China, mildly reduced eGFR was associated with metabolic disorders like dyslipidemia and hyperglycemia, but not obesity.

• IJERPH, Vol. 13, Pages 536: The Knowledge Base for Achieving the Sustainable Development Goal Targets on Water Supply, Sanitation and Hygiene

  Posted:2016-05-27

  Safe drinking water, sanitation, and hygiene (WASH) are fundamental to an improved standard of living. Globally, 91% of households used improved drinking water sources in 2015, while for improved sanitation it is 68%. Wealth disparities are stark, with rural populations, slum dwellers and marginalized groups lagging significantly behind. Service coverage is significantly lower when considering the new water and sanitation targets under the sustainable development goals (SDGs) which aspire to a higher standard of ‘safely managed’ water and sanitation. Lack of access to WASH can have an economic impact as much as 7% of Gross Domestic Product, not including the social and environmental consequences. Research points to significant health and socio-economic consequences of poor nutritional status, child growth and school performance caused by inadequate WASH. Groundwater over-extraction and pollution of surface water bodies have serious impacts on water resource availability and biodiversity, while climate change exacerbates the health risks of water insecurity. A significant literature documents the beneficial impacts of WASH interventions, and a growing number of impact evaluation studies assess how interventions are optimally financed, implemented and sustained. Many innovations in behavior change and service delivery offer potential for scaling up services to meet the SDGs.

• IJERPH, Vol. 13, Pages 537: Residential Risk Factors for Atopic Dermatitis in 3- to 6-Year Old Children: A Cross-Sectional Study in Shanghai, China

  Posted:2016-05-27

  Background: Atopic dermatitis (AD) is common among pre-school children in Shanghai. This study aimed to identify the risk factors for childhood AD from the perspectives of home environment, demographics and parents-grandparents’ atopic disease. Methods: A cross-sectional study was conducted in Shanghai in April–June, 2010. Preschool children’s parents or guardians were invited to participate a questionnaire survey in six districts (two urban and four suburban/rural) and 6624 children were finally recruited (51.3% boys). AD diagnosis was based on the U.K. Working Party’s (UKWP) criteria. Adjusted odds ratios (AOR) with 95% confidence intervals (95% CI) were calculated by multiple logistic regression. Results: A total of 8.5% of children ever had AD. Around 10.2% of the mothers had lived in newly renovated/decorated homes (NRDH) during the prenatal period (one year before or during pregnancy) and 9.5% got new home furniture (NHF) during the same period. AD was more common in children when mothers had lived in NRDH homes during the prenatal period (AOR = 1.41; 95% CI 1.03–1.93), the current home had indoor mold (2.00, 1.48–2.70), parents-grandparents’ had atopic diseases (3.85, 3.05–4.87), the children had food allergy (3.40, 2.63–4.40) or children lived in urban area (1.52, 1.18–1.96). Associations between AD and NRDH, NHF and indoor molds were only significant in children without parents-grandparents’ atopic diseases. There was an interaction effect between parents-grandparents’ atopic diseases and NRDH (p < 0.05). Conclusions: Home renovation/ redecoration, new furniture and indoor mold, urban residency, heredity disposition and food allergy can be risk factors for childhood AD in Shanghai.

• IJERPH, Vol. 13, Pages 527: Literature Review of Associations among Attributes of Reported Drinking Water Disease Outbreaks

  Posted:2016-05-27

  Waterborne disease outbreaks attributed to various pathogens and drinking water system characteristics have adversely affected public health worldwide throughout recorded history. Data from drinking water disease outbreak (DWDO) reports of widely varying breadth and depth were synthesized to investigate associations between outbreak attributes and human health impacts. Among 1519 outbreaks described in 475 sources identified during review of the primarily peer-reviewed, English language literature, most occurred in the U.S., the U.K. and Canada (in descending order). The outbreaks are most frequently associated with pathogens of unknown etiology, groundwater and untreated systems, and catchment realm-associated deficiencies (i.e., contamination events). Relative frequencies of outbreaks by various attributes are comparable with those within other DWDO reviews, with water system size and treatment type likely driving most of the (often statistically-significant at p < 0.05) differences in outbreak frequency, case count and attack rate. Temporal analysis suggests that while implementation of surface (drinking) water management policies is associated with decreased disease burden, further strengthening of related policies is needed to address the remaining burden attributed to catchment and distribution realm-associated deficiencies and to groundwater viral and disinfection-only system outbreaks.

• IJERPH, Vol. 13, Pages 535: Change in Environmental Benefits of Urban Land Use and Its Drivers in Chinese Cities, 2000–2010

  Posted:2016-05-26

  Driven by rising income and urban population growth, China has experienced rapid urban expansion since the 1980s. Urbanization can have positive effects on the urban environment; however, improvement of urban environment quality, especially its divergence between relatively developed and undeveloped cities in China, is currently a rather rudimentary and subjective issue. This study analyzed urban environmental benefits among China’s prefectural cities based on their structure of urban land use in 2000 and 2010. First, we divided 347 prefectural cities into two groups, 81 coastal and capital cities in the relatively developed group (RD) and 266 other prefectural cities in the undeveloped group (RP). Then, we defined three areas of urban environmental benefits, including green infrastructure, industrial upgrade, and environmental management, and developed an assessment index system. Results showed that all prefectural cities saw improvement in urban environmental quality in 2000–2010. Although the RD cities had higher income and more population growth, they had less improvement than the RP cities during the same period. We also found that demographic and urban land agglomeration among RD cities restrained green infrastructure expansion, making green infrastructure unsuitable as a permanent solution to environmental improvement. It is therefore urgent for China to promote balanced improvement among the three areas of urban environmental benefits and between the RD and RP cities through regional differentiation policies.

• IJERPH, Vol. 13, Pages 534: Dissipation and Residues of Dichlorprop-P and Bentazone in Wheat-Field Ecosystem

  Posted:2016-05-26

  Dichlorprop-P and bentazone have been widely used in the prevention and control of weeds in wheat field ecosystems. There is a concern that pesticide residues and metabolites remain on or in the wheat. Thus, the study of the determination and monitoring of their residues in wheat has important significance. A rapid, simple and reliable QuEChERS (Quick, Easy, Cheap, Effective, Rugged and Safe) method was modified, developed and validated for the determination of dichlorprop-P, bentazone and its metabolites (6-hydroxy-bentazone and 8-hydroxy-bentazone) in wheat (wheat plants, wheat straw and grains of wheat) using high-performance liquid chromatography coupled with tandem mass spectrometry (HPLC-MS/MS). The average recoveries of this method ranged from 72.9% to 108.7%, and the limits of quantification (LOQs) were 2.5–12 μg/kg. The dissipation and final residue of four compounds in three provinces (Shandong, Jiangsu and Heilongjiang) in China were studied. The trial results showed that the half-lives of dichlorprop-P and bentazone were 1.9–2.5 days and 0.5–2.4 days in wheat plants, respectively. The terminal residues in grains of wheat and wheat straw at harvest were all much below the maximum residue limit (MRL) of 0.2 mg/kg for dichlorprop-P and 0.1 mg/kg for bentazone established by the European Union (EU, Regulation No. 396/2005).

• IJERPH, Vol. 13, Pages 531: Lessons from the Bone Chapter of the Malaysian Aging Men Study

  Posted:2016-05-25

  Male osteoporosis in Malaysia is a largely neglected problem. Therefore, a bone health study in men using quantitative ultrasonometry was launched as part of the Malaysian Aging Men Study in 2009–2012. This review aimed to summarize the findings of the aforementioned bone health study. The study examined the bone health of Chinese and Malaysian men aged 20 years and above living in Kuala Lumpur using a quantitative ultrasound device. Participants answered a questionnaire on their demographic details and physical activity status. Body anthropometry of the participants was measured and their blood collected for biochemical analysis. Results showed that a significant proportion of the Malaysian Chinese and Malay men had suboptimal bone health indicated by calcaneal speed of sound and vitamin D status. Age-related decline of the calcaneal speed of sound in these men was gradual and biphasic without ethnic difference. Body anthropometry such as height, weight, body mass index, and body fat percentage contributed to the variation of the calcaneal speed of sound in Malaysian men. Age-related changes in testosterone, insulin-like growth factor 1, and thyroid stimulating hormone also influenced the calcaneal speed of sound in these men. This study serves as a reminder that male osteoporosis in Malaysia should be an issue of concern. It is also a basis for a more comprehensive study on bone health in men in the future.

• IJERPH, Vol. 13, Pages 533: Response to the Svingen Comments on Li et al. Effects of in Utero Exposure to Dicyclohexyl Phthalate on Rat Fetal Leydig Cells. Int. J. Environ. Res. Public Health, 2016, 13, 246

  Posted:2016-05-25

  Referring to the comments of Svingen [1] on our latest publication about Effects of in utero Exposure to Dicyclohexyl Phthalate on Rat Fetal Leydig Cells [2], we would like to give some comments.[...]

• IJERPH, Vol. 13, Pages 532: Comments on Li et al. Effects of in Utero Exposure to Dicyclohexyl Phthalate on Rat Fetal Leydig Cells. Int. J. Environ. Res. Public Health 2016, 13, 246

  Posted:2016-05-25

  Profiling the expression levels of genes or proteins in tissues comprising two or more cell types is commonplace in biological sciences. Such analyses present particular challenges, however, for example a potential shift in cellular composition, or ‘cellularity’, between specimens. That is, does an observed change in expression level represent what occurs within individual cells, or does it represent a shift in the ratio of different cell types within the tissue? This commentary attempts to highlight the importance of considering cellularity when interpreting quantitative expression data, using the mammalian testis and a recent study on the effects of phthalate exposure on testis function as an example.

• IJERPH, Vol. 13, Pages 530: Weight Gain Prevention among Midlife Women: A Randomized Controlled Trial to Address Needs Related to the Physical and Social Environment

  Posted:2016-05-25

  Women tend to gain weight at midlife (40–60 years) increasing risk of obesity-related chronic diseases. Within specific eating occasions, needs related to the physical and social environment may result in less healthy eating behavior, which can lead to weight gain over time. The purpose of this study was to determine if a dietitian-delivered nutrition counseling intervention tailored to eating occasion needs could improve diet and prevent weight gain among midlife women over two years. A randomized controlled trial was conducted with healthy midlife women (n = 354) in one U.S. metropolitan area. The intervention group (n = 185) received ten hours of individual nutrition counseling from dietitians over six months, while women in a control group (n = 169) received no counseling. Measured height, weight and waist circumference, and dietary intakes were collected at baseline and every six months over two years. Mixed linear models were used to test for intervention effect on change in outcome variables over time. Dietary intakes of fruit, reduced/low-fat dairy foods and refined grains were significantly improved over time in the intervention compared to control group. However, the intervention had no effect on weight over time (p = 0.48). Nutrition counseling tailored to address eating occasion needs improved self-reported diet but did not significantly affect weight change.

• IJERPH, Vol. 13, Pages 528: Systolic Blood Pressure Lower than Heart Rate upon Arrival at and Departure from the Emergency Department Indicates a Poor Outcome for Adult Trauma Patients

  Posted:2016-05-25

  Background: Hemorrhage is a leading cause of preventable trauma death. In this study, we used the reverse shock index (RSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), to evaluate the hemodynamic stability of trauma patients. As an SBP lower than the HR (RSI < 1) may indicate hemodynamic instability, the objective of this study was to assess the associated complications in trauma patients with an RSI < 1 upon arrival at the emergency department (ED) (indicated as (A)RSI) and at the time of departure from the ED (indicated as (L)RSI) to the operative room or for admission. Methods: Data obtained from all 16,548 hospitalized patients recorded in the trauma registry system at a Level I trauma center between January 2009 and December 2013 were retrospectively reviewed. A total of 10,234 adult trauma patients aged ≥20 were enrolled and subsequently divided into four groups: Group I, (A)RSI ≥ 1 and (L)RSI ≥ 1 (n = 9827); Group II, (A)RSI ≥ 1 and (L)RSI < 1 (n = 76); Group III, (A)RSI < 1 and (L)RSI ≥ 1 (n = 251); and Group IV, (A)RSI < 1 and (L)RSI < 1 (n = 80). Pearson’s χ2 test, Fisher’s exact test, or independent Student’s t-test was conducted to compare trauma patients in Groups II, III, and IV with those in Group I. Results: Patients in Groups II, III, and IV had a higher injury severity score and underwent a higher number of procedures, including intubation, chest tube insertion, and blood transfusion, than Group I patients. Additionally, patients of these groups had increased hospital length of stay (16.3 days, 14.9 days, and 22.0 days, respectively), proportion of patients admitted to the intensive care unit (ICU) (48.7%, 43.0%, and 62.5%, respectively), and in-hospital mortality (19.7%, 7.6%, and 27.5%, respectively). Although the trauma patients who had a SBP < 90 mmHg either upon arrival at or departure from the ED also present a more severe injury and poor outcome, those patients who had a SBP ≥ 90 mmHg but an RSI < 1 had a more severe injury and poor outcome than those patients who had a SBP ≥ 90 mmHg and an RSI ≥ 1. Conclusions: SBP lower than heart rate (RSI < 1) either upon arrival at or departure from the ED may indicate a detrimental sign of poor outcome in adult trauma patients even in the absence of noted hypotension.

• IJERPH, Vol. 13, Pages 529: Both Direct and Vicarious Experiences of Nature Affect Children’s Willingness to Conserve Biodiversity

  Posted:2016-05-25

  Children are becoming less likely to have direct contact with nature. This ongoing loss of human interactions with nature, the extinction of experience, is viewed as one of the most fundamental obstacles to addressing global environmental challenges. However, the consequences for biodiversity conservation have been examined very little. Here, we conducted a questionnaire survey of elementary schoolchildren and investigated effects of the frequency of direct (participating in nature-based activities) and vicarious experiences of nature (reading books or watching TV programs about nature and talking about nature with parents or friends) on their affective attitudes (individuals’ emotional feelings) toward and willingness to conserve biodiversity. A total of 397 children participated in the surveys in Tokyo. Children’s affective attitudes and willingness to conserve biodiversity were positively associated with the frequency of both direct and vicarious experiences of nature. Path analysis showed that effects of direct and vicarious experiences on children’s willingness to conserve biodiversity were mediated by their affective attitudes. This study demonstrates that children who frequently experience nature are likely to develop greater emotional affinity to and support for protecting biodiversity. We suggest that children should be encouraged to experience nature and be provided with various types of these experiences.

• IJERPH, Vol. 13, Pages 524: Prevalence of Hypertension among Adults in Remote Rural Areas of Xinjiang, China

  Posted:2016-05-24

  Objective: The present study aimed to estimate prevalence of hypertension among adults in rural remote areas of Xinjiang, China and evaluate the associated factors of hypertension. Methods: The survey was based on questionnaire interviews and clinical measurements of 11,340 individuals (≥18 years old), and was conducted during 2009–2010 via a stratified cluster random sampling method in the remote rural areas of Xinjiang, about 4407 km away from the capital Beijing. Hypertension was defined according to WHO/ISH criteria. Results: Systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the population were (126.3 ± 21.4) and (80.9 ± 13.4) mmHg. Compared with Han nationality subjects, SBP and DBP of Kazakh nationality subjects were significantly high (p < 0.05), while the SBP and DBP of Uyghur subjects were significantly low (Kazakh: (128.7 ± 23.9) and (83.0 ± 14.6) mmHg, Uyghur: (123.6 ± 19.3) and (77.4 ± 12.7) mmHg, Han: (126.5 ± 20.5) and (82.6 ± 11.9) mmHg, p < 0.05). Prevalence of hypertension of the population was 32.1%, and was greater among Kazakhs and lower among Uyghur than Han (Kazakh: 36.9%, Uyghur: 26.1%, Han: 33.7%, p < 0.05). The age-standardized prevalence of hypertension was 30.2%, and was greater among Kazakhs while lower among Uyghurs than Han subjects (Kazakh: 37.0%, Uyghur: 26.0%, Han: 33.8%, p < 0.05, p < 0.05). Multivariate logistic regression analyses showed Gender (OR = 1.324), age (OR = 2.098, 3.681, 6.794, 9.473, 14.646), nationality (OR = 1.541), occupation (OR = 1.659, 1.576), education (OR = 1.260), BMI (OR = 1.842), WC (OR = 1.585), WHR (OR = 1.188), WHR (OR = 1.188), diabetes (OR = 1.879), hypertriglyceridemia (OR = 1.361), hypercholesterolemia (OR = 1.131) and high blood low density lipoprotein cholesterol (LDL-C) (OR = 1.956) were all positively correlated with hypertension, while low blood high density lipoprotein cholesterol (HDL-C) (OR = 0.765) was negatively correlated with hypertension. Conclusions: Prevalence of hypertension among adults in remote rural areas of Xinjiang was higher than the national average. Prevalence of hypertension was greater among Kazakhs and lower among Uyghurs than Han nationals, thus indicating significant differences between regions and nationalities. Gender, age, nation, occupation, education, overweight or obesity, abdominal obesity, diabetes, hyperlipidemia, hypercholesterolemia, high LDL-C were positively correlated with hypertension, low HDL-C was negatively correlated with hypertension.

• IJERPH, Vol. 13, Pages 526: Dutch Primary Schoolchildren’s Perspectives of Activity-Friendly School Playgrounds: A Participatory Study

  Posted:2016-05-24

  School playgrounds are important physical activity (PA) environments for children, yet only a small number of children reaches the target of 40% of moderate-to-vigorous PA time during recess. The aim of this study was to explore children’s perspectives (i.e., child-identified determinants) of activity-friendly school playgrounds. We conducted participatory research with children as co-researchers, framed as a project to give children the opportunity to discuss their views and ideas about their school playgrounds. At three schools, six children (9–12 years old) met over five to seven group meetings. Data analysis included children’s conclusions obtained during the project and the researcher’s analysis of written reports of all meetings. Children indicated a strong desire for fun and active play, with physical playground characteristics and safety, rules and supervision, peer-interactions, and variation in equipment/games as important determinants. Our results indicate that improving activity-friendliness of playgrounds requires an integrated and multi-faceted approach. It also indicates that children, as primary users, are able to identify barriers for active play that are easily overlooked, unknown or differently perceived by adults. Hence, we believe that structural involvement of children in designing, developing and improving playgrounds may increase children’s’ active play and consequently PA levels during recess.

• IJERPH, Vol. 13, Pages 523: Urolithiasis, Urinary Cancer, and Home Drinking Water Source in the United States Territory of Guam, 2006–2010

  Posted:2016-05-24

  We reviewed patient records with a first-listed diagnosis of urolithiasis—also known as urinary tract or kidney stone disease, nephrolithiasis—upon discharge from Guam’s sole civilian hospital during 2006 to 2010 and urinary cancer mortality records from the Guam Cancer Registry for 1970 to 2009 to determine the source of municipal water supplied to the patients’ residence. The objective was to investigate a possible relationship between the sources of municipal water supplied to Guam villages and the incidence of urolithiasis and urinary cancer. We analyzed hospital discharge diagnoses of urolithiasis or renal calculi by calculating the incidence of first-mentioned discharge for urolithiasis or renal calculi and comparing rates across demographic or geographic categories while adjusting by age, sex, and ethnicity/race. We reviewed cancer registry records of urinary cancer deaths by patient residence. The annual incidence of hospitalization for urolithiasis was 5.22 per 10,000. Rates adjusted for sex or age exhibited almost no change. The rate of 9.83 per 10,000 among Chamorros was significantly higher (p < 0.05) than the rates among any other ethnic group or race. When villages were grouped by water source, rates of patients discharged with a first-listed diagnosis of urolithiasis, adjusted for ethnicity/race, were similar for villages using either well water (5.44 per 10,000) or mixed source water (5.39 per 10,000), and significantly greater than the rate for villages using exclusively reservoir water (1.35 per 10,000). No statistically significant differences were found between the water source or village of residence and urinary cancer mortality. Some Guam residents living in villages served completely or partly by deep well water high in calcium carbonate may be at increased risk for urolithiasis compared with residents living in villages served by surface waters. Although the risk appears to be highest in villagers of Chamorro ethnicity, residents should be aware of other contributing risk factors and steps to take to avoid developing this health problem.

• IJERPH, Vol. 13, Pages 525: Preconceptional Iron Intake and Gestational Diabetes Mellitus

  Posted:2016-05-24

  Our objective was to assess the impact of preconceptional heme and non-heme iron on gestational diabetes mellitius (GDM) in the Boston University Slone Epidemiology Birth Defects Study (BDS). This retrospective cohort analysis included 7229 participants enrolled in the BDS between 1998 and 2008 who gave birth to non-malformed infants and were free of pre-existing diabetes. All data were collected through structured interviews conducted within 6 months of delivery. Calorie-adjusted and multivariable odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression models. Preconceptional dietary heme iron was modestly associated with an elevated risk of GDM among those (multivariable OR comparing the fifth quintile to the first: 1.55; 95% CI 0.98, 2.46). Conversely, preconceptional dietary non-heme iron was associated with a decreased risk of GDM among those in the fifth quintile of intake compared to the first (multivariable OR: 0.48; 95% CI 0.28, 0.81). Women who consumed supplemental iron during preconception also had a decreased risk of GDM (multivariable OR: 0.78; 95% CI 0.60, 1.02). In conclusion, our data support a positive association between preconceptional heme iron intake and GDM and an inverse association between preconceptional non-heme iron intake from foods and preconceptional intake from supplements.

• IJERPH, Vol. 13, Pages 522: Alcoholic Beverage Consumption and Chronic Diseases

  Posted:2016-05-24

  Epidemiological and experimental studies have consistently linked alcoholic beverage consumption with the development of several chronic disorders, such as cancer, cardiovascular diseases, diabetes mellitus and obesity. The impact of drinking is usually dose-dependent, and light to moderate drinking tends to lower risks of certain diseases, while heavy drinking tends to increase the risks. Besides, other factors such as drinking frequency, genetic susceptibility, smoking, diet, and hormone status can modify the association. The amount of ethanol in alcoholic beverages is the determining factor in most cases, and beverage types could also make an influence. This review summarizes recent studies on alcoholic beverage consumption and several chronic diseases, trying to assess the effects of different drinking patterns, beverage types, interaction with other risk factors, and provide mechanistic explanations.

• IJERPH, Vol. 13, Pages 521: Association of Children’s Urinary CC16 Levels with Arsenic Concentrations in Multiple Environmental Media

  Posted:2016-05-23

  Arsenic exposure has been associated with decreased club cell secretory protein (CC16) levels in adults. Further, both arsenic exposure and decreased levels of CC16 in childhood have been associated with decreased adult lung function. Our objective was to determine if urinary CC16 levels in children are associated with arsenic concentrations in environmental media collected from their homes. Yard soil, house dust, and tap water were taken from 34 homes. Urine and toenail samples were collected from 68 children. All concentrations were natural log-transformed prior to data analysis. There were associations between urinary CC16 and arsenic concentration in soil (b = −0.43, p = 0.001, R2 = 0.08), water (b = −0.22, p = 0.07, R2 = 0.03), house dust (b = −0.37, p = 0.07, R2 = 0.04), and dust loading (b = −0.21, p = 0.04, R2 = 0.04). In multiple analyses, only the concentration of arsenic in soil was associated with urinary CC16 levels (b = −0.42, p = 0.02, R2 = 0.14 (full model)) after accounting for other factors. The association between urinary CC16 and soil arsenic may suggest that localized arsenic exposure in the lungs could damage the airway epithelium and predispose children for diminished lung function. Future work to assess this possible mechanism should examine potential associations between airborne arsenic exposures, CC16 levels, lung function, and other possible confounders in children in arsenic-impacted communities.

• IJERPH, Vol. 13, Pages 520: Antifungal Effect of Henna against Candida albicans Adhered to Acrylic Resin as a Possible Method for Prevention of Denture Stomatitis

  Posted:2016-05-23

  Denture stomatitis is a very common disease affecting the oral mucosa of denture wearers. The aim of this study was to measure the antifungal effect of henna against Candida albicans adhered to acrylic resin as a possible method for prevention of denture stomatitis. One-hundred-eighty acrylic plates were prepared of heat-cured acrylic denture resin. The specimens were divided into six groups of 30 samples each. The first group was only polymer and monomer following the conventional manufacturer instruction for processing complete dentures. The other five groups were processed by adding different concentration of Yamani henna powder (Harazi) to the polymer in a concentration of henna: polymer 1%, 2.5%, 5%, 7.5% and 10%, respectively. Samples were incubated in artificial saliva rich with Candida albicans at 37 °C, and the effect of henna on Candida albicans was evaluated in two different methods: semi-quantitative slide count and a culture-based quantitative assay (quantitative). Variation in the number of live Candida was observed with the increase in the concentration of Yamani henna powder. It was observed that the variation in live Candida, between control group and group B (concentration of Yamani henna powder was 1%), was statistically significant with a p-value of 0.0001. Similarly, variations in live Candida were significant, when the concentration of powder was 7.5% or 10% in contrast with control group and p-values were 0.0001 and 0.001 respectively. Adding henna to acrylic resin denture could be effective in controlling Candida albicans proliferation on the denture surface; however, its effects on the physical properties of acrylic resin denture need further studies.

• IJERPH, Vol. 13, Pages 519: Geographic Clustering of Cardiometabolic Risk Factors in Metropolitan Centres in France and Australia

  Posted:2016-05-21

  Understanding how health outcomes are spatially distributed represents a first step in investigating the scale and nature of environmental influences on health and has important implications for statistical power and analytic efficiency. Using Australian and French cohort data, this study aimed to describe and compare the extent of geographic variation, and the implications for analytic efficiency, across geographic units, countries and a range of cardiometabolic parameters (Body Mass Index (BMI) waist circumference, blood pressure, resting heart rate, triglycerides, cholesterol, glucose, HbA1c). Geographic clustering was assessed using Intra-Class Correlation (ICC) coefficients in biomedical cohorts from Adelaide (Australia, n = 3893) and Paris (France, n = 6430) for eight geographic administrative units. The median ICC was 0.01 suggesting 1% of risk factor variance attributable to variation between geographic units. Clustering differed by cardiometabolic parameters, administrative units and countries and was greatest for BMI and resting heart rate in the French sample, HbA1c in the Australian sample, and for smaller geographic units. Analytic inefficiency due to clustering was greatest for geographic units in which participants were nested in fewer, larger geographic units. Differences observed in geographic clustering across risk factors have implications for choice of geographic unit in sampling and analysis, and highlight potential cross-country differences in the distribution, or role, of environmental features related to cardiometabolic health.

• IJERPH, Vol. 13, Pages 518: Analysis of Heat Stress and the Indoor Climate Control Requirements for Movable Refuge Chambers

  Posted:2016-05-20

  Movable refuge chambers are a new kind of rescue device for underground mining, which is believed to have a potential positive impact on reducing the rate of fatalities. It is likely to be hot and humid inside a movable refuge chamber due to the metabolism of trapped miners, heat generated by equipment and heat transferred from outside. To investigate the heat stress experienced by miners trapped in a movable refuge chamber, the predicted heat strain (PHS) model was used to simulate the heat transfer process between the person and the thermal environment. The variations of heat stress with the temperature and humidity inside the refuge chamber were analyzed. The effects of air temperature outside the refuge chamber and the overall heat transfer coefficient of the refuge chamber shell on the heat stress inside the refuge chamber was also investigated. The relationship between the limit of exposure duration and the air temperature and humidity was numerically analyzed to determine the upper limits of temperature and humidity inside a refuge chamber. Air temperature of 32 °C and relative humidity of 70% are recommended as the design standard for internal thermal environment control of movable refuge chambers.

• IJERPH, Vol. 13, Pages 514: Knowledge and Perceptions about Nicotine, Nicotine Replacement Therapies and Electronic Cigarettes among Healthcare Professionals in Greece

  Posted:2016-05-20

  Introduction. The purpose of this study was to evaluate the knowledge and perceptions of Greek healthcare professionals about nicotine, nicotine replacement therapies and electronic cigarettes. Methods. An online survey was performed, in which physicians and nurses working in private and public healthcare sectors in Athens-Greece were asked to participate through email invitations. A knowledge score was calculated by scoring the correct answers to specific questions with 1 point. Results. A total of 262 healthcare professionals were included to the analysis. Most had daily contact with smokers in their working environment. About half of them considered that nicotine has an extremely or very important contribution to smoking-related disease. More than 30% considered nicotine replacement therapies equally or more addictive than smoking, 76.7% overestimated their smoking cessation efficacy and only 21.0% would recommend them as long-term smoking substitutes. For electronic cigarettes, 45.0% considered them equally or more addictive than smoking and 24.4% equally or more harmful than tobacco cigarettes. Additionally, 35.5% thought they involve combustion while the majority responded that nicotine in electronic cigarettes is synthetically produced. Only 14.5% knew about the pending European regulation, but 33.2% have recommended them to smokers in the past. Still, more than 40% would not recommend electronic cigarettes to smokers unwilling or unable to quit smoking with currently approved medications. Cardiologists and respiratory physicians, who are responsible for smoking cessation therapy in Greece, were even more reluctant to recommend electronic cigarettes to this subpopulation of smokers compared to all other participants. The knowledge score of the whole study sample was 7.7 (SD: 2.4) out of a maximum score of 16. Higher score was associated with specific physician specialties. Conclusions. Greek healthcare professionals appear to overestimate the adverse effects of nicotine, and many would not recommend any nicotine-containing product as a long-term smoking substitute. Additionally, they have poor knowledge about the function and characteristics of electronic cigarettes.

• IJERPH, Vol. 13, Pages 517: Strongyloidiasis: A Disease of Socioeconomic Disadvantage

  Posted:2016-05-20

  Strongyloidiasis is a disease caused by soil transmitted helminths of the Strongyloides genus. Currently, it is predominately described as a neglected tropical disease. However, this description is misleading as it focuses on the geographical location of the disease and not the primary consideration, which is the socioeconomic conditions and poor infrastructure found within endemic regions. This classification may result in misdiagnosis and mistreatment by physicians, but more importantly, it influences how the disease is fundamentally viewed. Strongyloidiasis must be first and foremost considered as a disease of disadvantage, to ensure the correct strategies and control measures are used to prevent infection. Changing how strongyloidiasis is perceived from a geographic and clinical issue to an environmental health issue represents the first step in identifying appropriate long term control measures. This includes emphasis on environmental health controls, such as better infrastructure, sanitation and living conditions. This review explores the global prevalence of strongyloidiasis in relation to its presence in subtropical, tropical and temperate climate zones with mild and cold winters, but also explores the corresponding socioeconomic conditions of these regions. The evidence shows that strongyloidiasis is primarily determined by the socioeconomic status of the communities rather than geographic or climatic conditions. It demonstrates that strongyloidiasis should no longer be referred to as a “tropical” disease but rather a disease of disadvantage. This philosophical shift will promote the development of correct control strategies for preventing this disease of disadvantage.

• IJERPH, Vol. 13, Pages 516: Cross-Sectional Associations between Body Mass Index and Hyperlipidemia among Adults in Northeastern China

  Posted:2016-05-20

  Background: There is evidence that body mass index (BMI) is closely related to hyperlipidemia. This study aimed to estimate the cross-sectional relationship between Body Mass Index (BMI) and hyperlipidemia. Methods: We recruited 21,435 subjects (aged 18–79 years and residing in Jilin province, China) using the multistage stratified cluster random sampling method. Subjects were interviewed with a standardized questionnaire and physically examined. We analyzed the cross-sectional relationship between BMI and hyperlipidemia. Results: The prevalence of hyperlipidemia was 51.09% (52.04% in male and 50.21% in female). The prevalence of overweight and obesity was 31.89% and 6.23%, respectively. Our study showed that underweight (OR = 0.499, 95% CI: 0.426–0.585), overweight (OR = 2.587, 95% CI: 2.428–2.756), and obesity (OR = 3.614, 95% CI: 3.183–4.104) were significantly associated with hyperlipidemia (p < 0.001) in the age- and sex-adjusted logistic regression. After further adjusting for age, gender, region, district, ethnicity, education, marital status, main occupation, monthly family income per capita, smoking, drinking, exercise, central obesity, waist and hip, underweight (OR = 0.729, 95% CI: 0.616–0.864), overweight (OR = 1.651, 95% CI: 1.520–1.793), and obesity (OR = 1.714, 95% CI: 1.457–2.017) were independently associated with hyperlipidemia (p < 0.001). The restricted cubic spline model illustrated a nonlinear dose-response relationship between levels of BMI and the prevalence of hyperlipidemia (Pnonlinearity < 0.001). Conclusion: Our study demonstrated that the continuous variance of BMI was significantly associated with the prevalence of hyperlipidemia.

• IJERPH, Vol. 13, Pages 515: A Case Study of Community Involvement Influence on Policy Decisions: Victories of a Community-Based Participatory Research Partnership

  Posted:2016-05-20

  The Buffalo Lupus Project was a community-university partnership that investigated associations between exposure to a local waste site and high rates of lupus and other autoimmune diseases. The partnership’s major accomplishment was successful advocacy for containment and clean-up of the site. As a result of community education, the remediation plan suggested by the community was adopted. Additionally, when a local childhood lead poisoning testing program was canceled, community members signed a letter to legislators urging them to replace the funding, which was restored within one week. This demonstrated how coordinated community-based capacity-building efforts can influence health policy.

• IJERPH, Vol. 13, Pages 513: Health-Related Behaviors in Swimming Pool Users: Influence of Knowledge of Regulations and Awareness of Health Risks

  Posted:2016-05-19

  Background: Swimming pool attendance exposes users to infection and chemical risks that could be largely reduced with the adoption of healthy behaviors. This study aims to investigate if the knowledge of swimming pool regulations and awareness of health risks can be associated with users’ health-related behaviors. Methods: A cross-sectional study was conducted using self-administered questionnaires to collect data from two different target groups of swimming users: 184 adults and 184 children/adolescents. The association between specific variables and patterns of behaviors and knowledge was assessed through multivariate logistic regression models. Results: Although more than 80% of both groups declared they knew the regulations, compliance with healthy behaviors was often unsatisfactory, especially in adolescents and youth. In the children/adolescents group, healthy behaviors significantly increased with the frequency of attendance per week. In both groups, compliance increased with educational level (of parents for children/adolescents), while no positive association was observed between viewing the regulations and adopting appropriate behaviors. In the adult group, a higher knowledge/awareness of health risks was related to decreased odds of at least one unhealthy behavior. Conclusions: Guaranteeing the public display of regulations in swimming facilities is not sufficient to promote and change health-related behaviors. Much more attention should be given to educational interventions aimed to increase knowledge of health risks and the awareness that bathers are directly responsible for their own well-being.

• IJERPH, Vol. 13, Pages 511: Prenatal Exposure to Perfluoroalkyl Substances and Behavioral Development in Children

  Posted:2016-05-19

  Background: In recent years, prevalence rates of behavioral disorders in children have increased. One factor possibly implied in the etiology of behavioral disorders is exposure to perfluoroalkyl substances (PFASs). The use of PFASs is highly integrated into everyday life, and exposure is ubiquitous. Exposure to PFASs during early life may be particularly harmful, as it represents a critical time window for brain development. However, research in the area is limited, especially among preschool children. The objective of the current study was to explore the relationship between prenatal exposure to several PFASs and behavioral development at the age of 18 months. Methods: Data from the Dutch cohort LINC (Linking Maternal Nutrition to Child Health) were used. Perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) were measured in cord plasma. The total exposure of PFASs was also calculated (ΣPFASs). Behavioral development was assessed with the Child Behavior Checklist 1.5–5 (CBCL 1.5–5). The CBCL scales “Attention Deficit Hyperactivity Disorder” (ADHD) and “Externalizing problems” were used for further analysis. Separate regression models were composed for each combination, in which exposure levels were classified in tertiles. Both whole population and sex-stratified analyses were performed. A family history of ADHD, the educational level, smoking or using alcohol or illicit drugs during pregnancy were considered as confounders. In total, data from 76 mother-child pairs was included. Results: No significant associations were found between prenatal PFAS exposure and ADHD scores in the whole population and in the sex-stratified analyses. With regard to externalizing behavior, a significant negative association was found between the highest levels of ΣPFAS exposure and externalizing problem behavior in the whole population, but only in the crude model. After stratifying for sex, boys in the second and third tertile of exposure to PFOA presented significantly lower scores on the Externalizing Problem Scale than boys with the lowest exposure levels in the adjusted model. Girls exposed to higher levels of ΣPFAS exposure (T2) showed significantly lower scores on the Externalizing Problem Scale, in both crude and adjusted models. No significant associations with PFOS were found. Conclusions: Results from the current study show that prenatal exposure to PFOA was negatively related to externalizing behavior in boys. Results were different for boys and girls, emphasizing that mechanisms at work might be sex-dependent. However, results should be interpreted with caution as the sample size was small.

• IJERPH, Vol. 13, Pages 512: Prevalence, Awareness, Treatment and Control of Diabetes Mellitus—A Population Based Study in Shanghai, China

  Posted:2016-05-19

  In this study, we aimed to investigate the prevalence, awareness, treatment, and control of diabetes in Shanghai, China. A sample of 3600 residents aged from 18 to 80 years selected by a randomized stratified multiple-stage sampling method in Shanghai was investigated, with blood samples collected. Diabetes was defined as fasting plasma glucose (FPG) ≥ 7.0 mmol/L, or glycated haemoglobin (HbA1c) ≥ 6.5% (48 mmol/mol), or previous diagnosis by a physician. Adequate control of diabetes was taken as a level of HbA1c < 7.0% (53 mmol/mol) among people with treated diabetes. Multivariable regression analysis was used to explore associated factors for diabetes and prediabetes. In the 3136 participants suitable for analysis, the prevalences of diabetes, prediabetes, and previously diagnosed diabetes were 15.91%, 37.37%, and 4.46%, respectively. Among those with diabetes, only 28.06% were aware of their condition, 25.85% were currently undergoing medication treatment, and 12.42% achieved glycaemic control. Logistic regression showed that old age, preobesity, obesity, elevated triglyceride (TG), elevated C-reactive protein (CRP), and lower education level were associated with an increased risk of diabetes; old age, obesity, elevated TG, and elevated low-density lipoprotein (LDL) were associated with an increased risk of prediabetes, while male sex and rural residence were associated with a decreased risk of prediabetes. In summary, the state of diabetes in China is alarming; the rates of awareness, treatment, and control were relatively low. More efforts should be made to promote the prevention and control of diabetes in china.

• IJERPH, Vol. 13, Pages 508: Measurement and Study of Lidar Ratio by Using a Raman Lidar in Central China

  Posted:2016-05-18

  We comprehensively evaluated particle lidar ratios (i.e., particle extinction to backscatter ratio) at 532 nm over Wuhan in Central China by using a Raman lidar from July 2013 to May 2015. We utilized the Raman lidar data to obtain homogeneous aerosol lidar ratios near the surface through the Raman method during no-rain nights. The lidar ratios were approximately 57 ± 7 sr, 50 ± 5 sr, and 22 ± 4 sr under the three cases with obviously different pollution levels. The haze layer below 1.8 km has a large particle extinction coefficient (from 5.4e-4 m−1 to 1.6e-4 m−1) and particle backscatter coefficient (between 1.1e-05 m−1sr−1 and 1.7e-06 m−1sr−1) in the heavily polluted case. Furthermore, the particle lidar ratios varied according to season, especially between winter (57 ± 13 sr) and summer (33 ± 10 sr). The seasonal variation in lidar ratios at Wuhan suggests that the East Asian monsoon significantly affects the primary aerosol types and aerosol optical properties in this region. The relationships between particle lidar ratios and wind indicate that large lidar ratio values correspond well with weak winds and strong northerly winds, whereas significantly low lidar ratio values are associated with prevailing southwesterly and southerly wind.

• IJERPH, Vol. 13, Pages 509: Applications of a Novel Clustering Approach Using Non-Negative Matrix Factorization to Environmental Research in Public Health

  Posted:2016-05-18

  Often data can be represented as a matrix, e.g., observations as rows and variables as columns, or as a doubly classified contingency table. Researchers may be interested in clustering the observations, the variables, or both. If the data is non-negative, then Non-negative Matrix Factorization (NMF) can be used to perform the clustering. By its nature, NMF-based clustering is focused on the large values. If the data is normalized by subtracting the row/column means, it becomes of mixed signs and the original NMF cannot be used. Our idea is to split and then concatenate the positive and negative parts of the matrix, after taking the absolute value of the negative elements. NMF applied to the concatenated data, which we call PosNegNMF, offers the advantages of the original NMF approach, while giving equal weight to large and small values. We use two public health datasets to illustrate the new method and compare it with alternative clustering methods, such as K-means and clustering methods based on the Singular Value Decomposition (SVD) or Principal Component Analysis (PCA). With the exception of situations where a reasonably accurate factorization can be achieved using the first SVD component, we recommend that the epidemiologists and environmental scientists use the new method to obtain clusters with improved quality and interpretability.

• IJERPH, Vol. 13, Pages 510: Which Factors Determine Metal Accumulation in Agricultural Soils in the Severely Human-Coupled Ecosystem?

  Posted:2016-05-17

  Agricultural soil is typically an important component of urban ecosystems, contributing directly or indirectly to the general quality of human life. To understand which factors influence metal accumulation in agricultural soils in urban ecosystems is becoming increasingly important. Land use, soil type and urbanization indicators all account for considerable differences in metal accumulation in agricultural soils, and the interactions between these factors on metal concentrations were also examined. Results showed that Zn, Cu, and Cd concentrations varied significantly among different land use types. Concentrations of all metals, except for Cd, were higher in calcareous cinnamon soil than in fluvo-aquic soil. Expansion distance and road density were adopted as urbanization indicators, and distance from the urban center was significantly negatively correlated with concentrations of Hg, and negatively correlated with concentrations of Zn, and road density was positively correlated with Cd concentrations. Multivariate analysis of variance indicated that Hg concentration was significantly influenced by the four-way interaction among all factors. The results in this study provide basic data to support the management of agricultural soils and to help policy makers to plan ahead in Beijing.

• IJERPH, Vol. 13, Pages 507: Unequal Recovery? Federal Resource Distribution after a Midwest Flood Disaster

  Posted:2016-05-17

  Following severe flooding in 2008, three Iowa communities acquired over 1000 damaged properties to support disaster recovery and mitigation. This research applies a distributive justice framework to analyze the distribution of disaster recovery funds for property acquisition. Two research questions drive the analysis: (1) how does recovery vary by acquisition funding source; and (2) what is the relationship between recovery and vulnerable populations? Through spatial econometric modeling, relative recovery is compared between two federal programs that funded the acquisitions, and across socially vulnerable populations. The results indicate both distributive and temporal inequalities in the allocation of federal recovery funds. In particular, Latino and elderly populations were associated with lower recovery rates. Recommendations for future research in flood recovery and acquisitions are provided.

• IJERPH, Vol. 13, Pages 506: Contributing Factors to Colorectal Cancer Screening among Chinese People: A Review of Quantitative Studies

  Posted:2016-05-17

  Colorectal cancer (CRC) is a major health problem in Asia. It has been reported that the Chinese are more susceptible to CRC than many other ethnic groups. Screening for CRC is a cost-effective prevention and control strategy; however, the screening rates among the Chinese are sub-optimal. We conducted a review to identify the factors associated with CRC screening participation among Chinese people. Twenty-two studies that examined the factors related to CRC screening behaviors among the Chinese were identified through five databases. Seven factors were consistently reported to influence CRC screening behaviors in at least one of the studies: socio-demographic characteristics (educational level, health insurance, and knowledge about CRC and its screening); psychological factors (perceived severity of CRC, susceptibility of having CRC, and barriers to screening); and contact with medical provider (physician recommendation). The evidence base for many of these relationships is quite limited. Furthermore, the associations of many factors, including age, gender, income, cancer worry/fear, and self-efficacy with CRC screening behaviors, were mixed or inconsistent across these studies, thereby indicating that more studies are needed in this area.

• IJERPH, Vol. 13, Pages 505: Boiling over: A Descriptive Analysis of Drinking Water Advisories in First Nations Communities in Ontario, Canada

  Posted:2016-05-17

  Access to safe and reliable drinking water is commonplace for most Canadians. However, the right to safe and reliable drinking water is denied to many First Nations peoples across the country, highlighting a priority public health and environmental justice issue in Canada. This paper describes trends and characteristics of drinking water advisories, used as a proxy for reliable access to safe drinking water, among First Nations communities in the province of Ontario. Visual and statistical tools were used to summarize the advisory data in general, temporal trends, and characteristics of the drinking water systems in which advisories were issued. Overall, 402 advisories were issued during the study period. The number of advisories increased from 25 in 2004 to 75 in 2013. The average advisory duration was 294 days. Most advisories were reported in summer months and equipment malfunction was the most commonly reported reason for issuing an advisory. Nearly half of all advisories occurred in drinking water systems where additional operator training was needed. These findings underscore that the prevalence of drinking water advisories in First Nations communities is a problem that must be addressed. Concerted and multi-faceted efforts are called for to improve the provision of safe and reliable drinking water First Nations communities.

• IJERPH, Vol. 13, Pages 497: Orange Is the New Green: Exploring the Restorative Capacity of Seasonal Foliage in Schoolyard Trees

  Posted:2016-05-17

  Urban schoolyard environments are increasingly characterized by a proliferation of hard surfaces with little if any greenery. Schoolyard “greening” initiatives are becoming increasingly popular; however, schoolyard designs often fail to realize their restorative potential. In this quasi-experimental study, a proposed schoolyard greening project was used to visualize alternative planting designs and seasonal tree foliage; these design alternatives were subsequently used as visual stimuli in a survey administered to children who will use the schoolyard to assess the perceived restorative capacity of different design features. The findings indicate that seasonal changes in tree foliage enhance the perceived restorative quality of schoolyard environments. Specifically, fall foliage colour, when compared to green foliage, is rated as being perceived to be equally restorative for children. Additionally, seasonal planting, including evergreen conifers, may enhance the restorative quality of the schoolyard especially when deciduous trees are leafless. Landscape design professionals, community-based organizations, and other decision-makers in schoolyard greening efforts should strategically consider their tree choices to maximize year-round support for healthy attention functioning in children through restoration.

• IJERPH, Vol. 13, Pages 502: Prevalence and Factors Associated with Substance Use and Misuse among Kosovar Adolescents; Cross Sectional Study of Scholastic, Familial-, and Sports-Related Factors of Influence

  Posted:2016-05-16

  Adolescence is considered to be the most important period for the prevention of substance use and misuse (SUM). The aim of this study was to investigate the problem of SUM and to establish potentially important factors associated with SUM in Kosovar adolescents. Multi-stage simple random sampling was used to select participants. At the end of their high school education, 980 adolescents (623 females) ages 17 to 19 years old were enrolled in the study. The prevalence of smoking, alcohol consumption (measured by Alcohol Use Disorder Identification Test–AUDIT), and illegal drug use (dependent variables), as well as socio-demographic, scholastic, familial, and sports-related factors (independent variables), were assessed. Boys smoke cigarettes more often than girls with daily-smoking prevalence of 16% among boys and 9% among girls (OR = 1.85, 95% = CI 1.25–2.75). The prevalence of harmful drinking (i.e., AUDIT scores of >10) is found to be alarming (41% and 37% for boys and girls, respectively; OR = 1.13, 95% CI = 0.87–1.48), while 17% of boys and 9% of girls used illegal drugs (OR = 2.01, 95% CI = 1.35–2.95). The behavioral grade (observed as: excellent–average-poor) is the factor that was most significantly correlated with SUM both in boys and girls, with lower behavioral grades among those adolescents who consume substances. In girls, lower maternal education levels were associated with a decreased likelihood of SUM, whereas sports achievement was negatively associated with risky drinking. In boys, sports achievement decreased the likelihood of daily smoking. Information on the factors associated with SUM should be disseminated among sports and school authorities.

• IJERPH, Vol. 13, Pages 504: Epigenetic Effect of Environmental Factors on Autism Spectrum Disorders

  Posted:2016-05-14

  Both environmental factors and genetic factors are involved in the pathogenesis of autism spectrum disorders (ASDs). Epigenetics, an essential mechanism for gene regulation based on chemical modifications of DNA and histone proteins, is also involved in congenital ASDs. It was recently demonstrated that environmental factors, such as endocrine disrupting chemicals and mental stress in early life, can change epigenetic status and gene expression, and can cause ASDs. Moreover, environmentally induced epigenetic changes are not erased during gametogenesis and are transmitted to subsequent generations, leading to changes in behavior phenotypes. However, epigenetics has a reversible nature since it is based on the addition or removal of chemical residues, and thus the original epigenetic status may be restored. Indeed, several antidepressants and anticonvulsants used for mental disorders including ASDs restore the epigenetic state and gene expression. Therefore, further epigenetic understanding of ASDs is important for the development of new drugs that take advantages of epigenetic reversibility.

• IJERPH, Vol. 13, Pages 503: Physiological and Molecular Response of Prorocentrum minimum to Tannic Acid: An Experimental Study to Evaluate the Feasibility of Using Tannic Acid in Controling the Red Tide in a Eutrophic Coastal Water

  Posted:2016-05-14

  Bioassay and gene expression experiments were conducted in order to evaluate the growth and physiology of Prorocentrum minimum isolated from a eutrophic coastal water in response to tannic acid. In the bioassay experiments, variations in abundance, chlorophyll (chl) a concentration, maximum fluorescence (in vivo Fm), and photosynthetic efficiency (Fv/Fm) were measured over the course of a seven-day incubation. Moreover, stress-related gene expression in both the control and an experimental (2.5 ppm TA treatment) group was observed for 24 h and 48 h. The molecular markers used in this study were the heat shock proteins (Hsp70 and Hsp90) and cyclophilin (CYP). The findings show that P. minimum can thrive and grow at low concentrations (<2.5 ppm) of tannic acid, and, above this concentration, cells begin to slow down development. In addition, TA concentration of 10 ppm halted photosynthetic activity. At the molecular level, treatment with tannic acid increased the expression of Hsp70, Hsp90, and CYP, and heat shock proteins are more upregulated than the cyclophilin gene. Exposure to tannic acid increased the expression of stress factors over time (48 h) by 10- to 27-fold the expression level of the control group. These results suggest that tannic acid can be used to control harmful algal blooms such as those containing P. minimum in eutrophic coastal waters.

• IJERPH, Vol. 13, Pages 501: Nonylphenol Toxicity Evaluation and Discovery of Biomarkers in Rat Urine by a Metabolomics Strategy through HPLC-QTOF-MS

  Posted:2016-05-14

  Nonylphenol (NP) was quantified using liquid chromatography tandem mass spectrometry (LC-MS/MS) in the urine and plasma of rats treated with 0, 50, and 250 mg/kg/day of NP for four consecutive days. A urinary metabolomic strategy was originally implemented by high performance liquid chromatography time of flight mass spectrometry (HPLC-QTOF-MS) to explore the toxicological effects of NP and determine the overall alterations in the metabolite profiles so as to find potential biomarkers. It is essential to point out that from the observation, the metabolic data were clearly clustered and separated for the three groups. To further identify differentiated metabolites, multivariate analysis, including principal component analysis (PCA), orthogonal partial least-squares discriminant analysis (OPLS-DA), high-resolution MS/MS analysis, as well as searches of Metlin and Massbank databases, were conducted on a series of metabolites between the control and dose groups. Finally, five metabolites, including glycine, glycerophosphocholine, 5-hydroxytryptamine, malonaldehyde (showing an upward trend), and tryptophan (showing a downward trend), were identified as the potential urinary biomarkers of NP-induced toxicity. In order to validate the reliability of these potential biomarkers, an independent validation was performed by using the multiple reaction monitoring (MRM)-based targeted approach. The oxidative stress reflected by urinary 8-oxo-deoxyguanosine (8-oxodG) levels was elevated in individuals highly exposed to NP, supporting the hypothesis that mitochondrial dysfunction was a result of xenoestrogen accumulation. This study reveals a promising approach to find biomarkers to assist researchers in monitoring NP.

• IJERPH, Vol. 13, Pages 496: Opportunities for Environmental Noise Mapping in Saudi Arabia: A Case of Traffic Noise Annoyance in an Urban Area in Jeddah City

  Posted:2016-05-13

  As the traffic and other environmental noise generating activities are growing in The Kingdom of Saudi Arabia (KSA), adverse health and other impacts are expected to develop. The management of such problem involves many actions, of which noise mapping has been proven to be a helpful approach. The objective of the current study was to test the adequacy of the available data in KSA municipalities for generating urban noise maps and to verify the applicability of available environmental noise mapping and noise annoyance models for KSA. Therefore, noise maps were produced for Al-Fayha District in Jeddah City, KSA using commercially available noise mapping software and applying the French national computation method “NMPB” for traffic noise. Most of the data required for traffic noise prediction and annoyance analysis were available, either in the Municipality GIS department or in other governmental authorities. The predicted noise levels during the three time periods, i.e., daytime, evening, and nighttime, were found higher than the maximum recommended levels established in KSA environmental noise standards. Annoyance analysis revealed that high percentages of the District inhabitants were highly annoyed, depending on the type of planning zone and period of interest. These results reflect the urgent need to consider environmental noise reduction in KSA national plans. The accuracy of the predicted noise levels and the availability of most of the necessary data should encourage further studies on the use of noise mapping as part of noise reduction plans.

• IJERPH, Vol. 13, Pages 500: Expelling Stress for Primary School Teachers: Self-Affirmation Increases Positive Emotions in Teaching and Emotion Reappraisal

  Posted:2016-05-13

  The aim of the present pilot study was to assess the effect of a brief work-related self-affirming implementation intention (WS-AII) on the well-being of primary school teachers. Participants were randomly allocated to one of two conditions: one in which they were asked to create a WS-AII or one in which they were asked to create a control implementation intention (C-II). State anxiety was measured pre- and post-manipulation, self-efficacy at post-manipulation only, and emotions in teaching and emotion regulation at baseline and at a two-week follow-up. There were statistically significant differences between the WS-AII condition and the control. Teachers who created work-related self-affirming implementation intentions reported an immediate reduction in state anxiety. Positive effects extended over the two-week period, with teachers in the WS-AII condition also reporting more positive emotions in teaching and the use of reappraisal emotion regulation strategies rather than emotion suppression. Results suggest that the integration of the WS-AII into existing organisational practice may be of benefit to the well-being of teachers and other highly stressed workers.

• IJERPH, Vol. 13, Pages 499: Fever and Pain Management in Childhood: Healthcare Providers’ and Parents’ Adherence to Current Recommendations

  Posted:2016-05-13

  In order to evaluate the adherence of healthcare providers and parents to the current recommendations concerning fever and pain management, randomized samples of 500 healthcare providers caring for children and 500 families were asked to complete an anonymous questionnaire. The 378 health care providers (HCPs) responding to the survey (75.6%) included 144 primary care pediatricians (38.1%), 98 hospital pediatricians (25.9%), 62 pediatric residents (16.4%), and 71 pediatric nurses (19.6%); the 464 responding parents (92.8%) included 175 whose youngest (or only) child was ≤5 years old (37.7%), 175 whose youngest (or only) child was aged 6–10 years (37.7%), and 114 whose youngest (or only) child was aged 11–14 years (24.6%). There were gaps in the knowledge of both healthcare providers and parents. Global adherence to the guidelines was lower among the pediatric nurses than the other healthcare providers (odds ratio 0.875; 95% confidence interval 0.795–0.964). Among the parents, those of children aged 6–10 and 11–14 years old, those who were older, and those without a degree answered the questions correctly significantly less frequently than the others. These findings suggest that there is an urgent need to improve the dissemination of the current recommendations concerning fever and pain management among healthcare providers and parents in order to avoid mistaken and sometimes risky attitudes, common therapeutic errors, and the unnecessary overloading of emergency department resources. Pediatric nurses and parents with older children, those who are older, and those with a lower educational level should be the priority targets of educational programmes.

• IJERPH, Vol. 13, Pages 498: Brazilian Green Propolis Improves Antioxidant Function in Patients with Type 2 Diabetes Mellitus

  Posted:2016-05-13

  Propolis contains a variety of bioactive components and possesses many biological properties. This study was designed to evaluate potential effects of Brazilian green propolis on glucose metabolism and antioxidant function in patients with type 2 diabetes mellitus (T2DM). In the 18-week randomized controlled study, enrolled patients with T2DM were randomly assigned to Brazilian green propolis group (900 mg/day) (n = 32) and control group (n = 33). At the end of the study, no significant difference was found in serum glucose, glycosylated hemoglobin, insulin, aldose reductase or adiponectin between the two groups. However, serum GSH and total polyphenols were significantly increased, and serum carbonyls and lactate dehydrogenase activity were significantly reduced in the Brazilian green propolis group. Serum TNF-α was significantly decreased, whereas serum IL-1β and IL-6 were significantly increased in the Brazilian green propolis group. It is concluded that Brazilian green propolis is effective in improving antioxidant function in T2DM patients.

• IJERPH, Vol. 13, Pages 495: Combined Effects of Prenatal Exposures to Environmental Chemicals on Birth Weight

  Posted:2016-05-12

  Prenatal chemical exposure has been frequently associated with reduced fetal growth by single pollutant regression models although inconsistent results have been obtained. Our study estimated the effects of exposure to single pollutants and mixtures on birth weight in 248 mother-child pairs. Arsenic, copper, lead, manganese and thallium were measured in cord blood, cadmium in maternal blood, methylmercury in maternal hair, and five organochlorines, two perfluorinated compounds and diethylhexyl phthalate metabolites in cord plasma. Daily exposure to particulate matter was modeled and averaged over the duration of gestation. In single pollutant models, arsenic was significantly associated with reduced birth weight. The effect estimate increased when including cadmium, and mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP) co-exposure. Combining exposures by principal component analysis generated an exposure factor loaded by cadmium and arsenic that was associated with reduced birth weight. MECPP induced gender specific effects. In girls, the effect estimate was doubled with co-exposure of thallium, PFOS, lead, cadmium, manganese, and mercury, while in boys, the mixture of MECPP with cadmium showed the strongest association with birth weight. In conclusion, birth weight was consistently inversely associated with exposure to pollutant mixtures. Chemicals not showing significant associations at single pollutant level contributed to stronger effects when analyzed as mixtures.

• IJERPH, Vol. 13, Pages 494: Prevention of Asbestos-Related Disease in Countries Currently Using Asbestos

  Posted:2016-05-12

  More than 40 years of evaluation have consistently confirmed the carcinogenicity of asbestos in all of its forms. This notwithstanding, according to recent figures, the annual world production of asbestos is approximatively 2,000,000 tons. Currently, about 90% of world asbestos comes from four countries: Russia, China, Brazil and Kazakhstan; and the wide use of asbestos worldwide represents a global threat. The purpose of this paper is to present a review of the asbestos health impact and to discuss the role of epidemiological investigations in countries where asbestos is still used. In these contexts, new, “local” studies can stimulate awareness of the size of the problem by public opinion and other stakeholders and provide important information on the circumstances of exposure, as well as local asbestos-related health impacts. This paper suggests an agenda for an international cooperation framework dedicated to foster a public health response to asbestos, including: new epidemiological studies for assessing the health impact of asbestos in specific contexts; socio-cultural and economic analyses for contributing to identifying stakeholders and to address both the local and global implications of asbestos diffusion; public awareness on the health and socio-economic impact of asbestos use and banning.

• IJERPH, Vol. 13, Pages 493: Factors Affecting Parent’s Perception on Air Quality—From the Individual to the Community Level

  Posted:2016-05-12

  The perception of air quality significantly affects the acceptance of the public of the government’s environmental policies. The aim of this research is to explore the relationship between the perception of the air quality of parents and scientific monitoring data and to analyze the factors that affect parents’ perceptions. Scientific data of air quality were obtained from Wuhan’s environmental condition reports. One thousand parents were investigated for their knowledge and perception of air quality. Scientific data show that the air quality of Wuhan follows an improving trend in general, while most participants believed that the air quality of Wuhan has deteriorated, which indicates a significant difference between public perception and reality. On the individual level, respondents with an age of 40 or above (40 or above: OR = 3.252; 95% CI: 1.170–9.040), a higher educational level (college and above: OR = 7.598; 95% CI: 2.244–25.732) or children with poor healthy conditions (poor: OR = 6.864; 95% CI: 2.212–21.302) have much more negative perception of air quality. On the community level, industrial facilities, vehicles and city construction have major effects on parents’ perception of air quality. Our investigation provides baseline information for environmental policy researchers and makers regarding the public’s perception and expectation of air quality and the benefits to the environmental policy completing and enforcing.

• IJERPH, Vol. 13, Pages 484: Effects of Fine Particulate Matter (PM2.5) on Systemic Oxidative Stress and Cardiac Function in ApoE−/− Mice

  Posted:2016-05-12

  Aim: In this study, we aimed to explore the toxic mechanisms of cardiovascular injuries induced by ambient fine particulate matter (PM2.5) in atherosclerotic-susceptible ApoE−/− mice. An acute toxicological animal experiment was designed with PM2.5 exposure once a day, every other day, for three days. Methods: ApoE−/− and C57BL/6 mice were randomly categorized into four groups, respectively (n = 6): one control group, three groups exposed to PM2.5 alone at low-, mid-, and high-dose (3, 10, or 30 mg/kg b.w.). Heart rate (HR) and electrocardiogram (ECG) were monitored before instillation of PM2.5 and 24 h after the last instillation, respectively. Cardiac function was monitored by echocardiography (Echo) after the last instillation. Biomarkers of systemic oxidative injuries (MDA, SOD), heart oxidative stress (MDA, SOD), and NAD(P)H oxidase subunits (p22phox, p47phox) mRNA and protein expression were analyzed in mice. The results showed that PM2.5 exposure could trigger the significant increase of MDA, and induce the decrease of heart rate variability (HRV), a marker of cardiac autonomic nervous system (ANS) function with a dose–response manner. Meanwhile, abnormal ECG types were monitored in mice after exposure to PM2.5. The expression of cytokines related with oxidative injuries, and mRNA and protein expression of NADPH, increased significantly in ApoE−/− mice in the high-dose group when compared with the dose-matched C57BL6 mice, but no significant difference was observed at Echo. In conclusion, PM2.5 exposure could cause oxidative and ANS injuries, and ApoE−/− mice displayed more severe oxidative effects induced by PM2.5.

• IJERPH, Vol. 13, Pages 487: A Combination of Geographically Weighted Regression, Particle Swarm Optimization and Support Vector Machine for Landslide Susceptibility Mapping: A Case Study at Wanzhou in the Three Gorges Area, China

  Posted:2016-05-11

  In this study, a novel coupling model for landslide susceptibility mapping is presented. In practice, environmental factors may have different impacts at a local scale in study areas. To provide better predictions, a geographically weighted regression (GWR) technique is firstly used in our method to segment study areas into a series of prediction regions with appropriate sizes. Meanwhile, a support vector machine (SVM) classifier is exploited in each prediction region for landslide susceptibility mapping. To further improve the prediction performance, the particle swarm optimization (PSO) algorithm is used in the prediction regions to obtain optimal parameters for the SVM classifier. To evaluate the prediction performance of our model, several SVM-based prediction models are utilized for comparison on a study area of the Wanzhou district in the Three Gorges Reservoir. Experimental results, based on three objective quantitative measures and visual qualitative evaluation, indicate that our model can achieve better prediction accuracies and is more effective for landslide susceptibility mapping. For instance, our model can achieve an overall prediction accuracy of 91.10%, which is 7.8%–19.1% higher than the traditional SVM-based models. In addition, the obtained landslide susceptibility map by our model can demonstrate an intensive correlation between the classified very high-susceptibility zone and the previously investigated landslides.

• IJERPH, Vol. 13, Pages 490: Analysis of Sampling Methodologies for Noise Pollution Assessment and the Impact on the Population

  Posted:2016-05-11

  Today, noise pollution is an increasing environmental stressor. Noise maps are recognised as the main tool for assessing and managing environmental noise, but their accuracy largely depends on the sampling method used. The sampling methods most commonly used by different researchers (grid, legislative road types and categorisation methods) were analysed and compared using the city of Talca (Chile) as a test case. The results show that the stratification of sound values in road categories has a significantly lower prediction error and a higher capacity for discrimination and prediction than in the legislative road types used by the Ministry of Transport and Telecommunications in Chile. Also, the use of one or another method implies significant differences in the assessment of population exposure to noise pollution. Thus, the selection of a suitable method for performing noise maps through measurements is essential to achieve an accurate assessment of the impact of noise pollution on the population.

• IJERPH, Vol. 13, Pages 492: A Primrose Path? Moderating Effects of Age and Gender in the Association between Green Space and Mental Health

  Posted:2016-05-11

  This paper explored whether the association between green space and mental health is moderated by age and gender. Questionnaires on psychopathology and quality of life were filled out by 4924 individuals from the general Dutch population and regressed on greenness levels. Green space was associated with better mental health, but only in specific age and gender groups, and only in a 3 km, not a 1 km buffer. The moderating effects of age and gender may be explained by whether or not people have the opportunity to make use of their green living environment.

• IJERPH, Vol. 13, Pages 491: Preliminary Assessment of Health Risks of Potentially Toxic Elements in Settled Dust over Beijing Urban Area

  Posted:2016-05-11

  To examine levels, health risks, sources, and spatial distributions of potentially toxic elements in settled dust over Beijing urban area, 62 samples were collected mostly from residential building outdoor surfaces, and their <63 μm fractions were measured for 12 potentially toxic elements. The results show that V, Cr, Mn, Co, Ni, and Ba in dust are from predominantly natural sources, whereas Cu, Zn, As, Cd, Sb, and Pb mostly originate from anthropogenic sources. Exposure to these elements in dust has significant non-cancer risks to children but insignificant to adults. Cancer risks of Cr, Co, Ni, As, and Cd via inhalation and dermal contact are below the threshold of 10−6–10−4 but As via dust ingestion shows a tolerable risk. The non-cancer risks to children are contributed mainly (75%) by As, Pb, and Sb, and dominantly (92%) via dust ingestion, with relatively higher risks mainly occurring in the eastern and northeastern Beijing urban areas. Although Cd, Zn, and Cu in dust are heavily affected by anthropogenic sources, their health risks are insignificant. Source appointments suggest that coal burning emissions, the dominant source of As, are likely the largest contributors to the health risk, and traffic-related and industrial emissions are also important because they contribute most of the Pb and Sb in dust.

• IJERPH, Vol. 13, Pages 482: The Risk of Breast Cancer in Women Using Menopausal Hormone Replacement Therapy in Taiwan

  Posted:2016-05-11

  Menopausal hormone replacement therapy (HRT) increases the risk of breast cancer in Western countries; however, there are fewer reports from the Asian population, which has a lower incidence of breast cancer. A population-based retrospective cohort study was conducted by analyzing longitudinal National Health Insurance claim data of a 200,000-person national representative cohort. A total of 22,929 women aged ≥45 years in 1997 without previous diagnosis of breast cancer were enrolled and stratified into two birth cohorts born before or after 1933. HRT prescriptions were traced in outpatient data files and incident breast cancer cases were identified from 1997 to 2004. The Cox proportional hazards model was used to analyze breast cancer hazard ratio (HR). HRT users were censored after they discontinued HRT. The results showed that women born during 1933–1952 had a twofold increased risk of breast cancer (HR = 2.10, 95% CI = 1.47–3.00) compared with women born before 1933, when adjusted for HRT use. When adjusted for the birth-cohort difference, HRT users had significantly increased breast cancer HR versus non-users after four years of use (adjusted HR = 1.48, 95% CI = 1.03–2.13); the HR further increased to 1.95 (95% CI = 1.34–2.84) after eight years of use. In conclusion, a longer duration of current HRT use was associated with a higher risk of breast cancer independent of the birth-cohort difference.

• IJERPH, Vol. 13, Pages 489: Identifying Ethical Issues in Mental Health Research with Minors Adolescents: Results of a Delphi Study

  Posted:2016-05-11

  Research with minors, especially for preventive purposes, e.g., suicide prevention, investigating risk or self-destructive behaviors such as deviance, drug abuse, or suicidal behavior, is ethically sensitive. We present a Delphi study exploring the ethical implications of the needs formulated by researchers in an international pre-conference who would benefit from ethics support and guidance in conducting Mental Health Research with minors. The resulting List of Ethical Issues (LEI) was submitted to a 2-rounds Delphi process via the Internet, including 34 multidisciplinary experts. In the first round, the experts reviewed the LEI and completed a questionnaire. Results from this round were analyzed and grouped in nine categories comprising 40 items. In the second round, the experts had to agree/disagree with the needs expressed in the LEI leading to a final list of 25 ethical issues considered relevant for Mental Health Research with minors such as: confidentiality of the sensitive data, competence for consenting alone and risk of harm and stigma related to the methodology used in research. It was shown that studies like SEYLE (Saving and Empowering Young Lives in Europe) trigger among researchers wishes to obtain specific recommendations helping to comply with standards for good practice in conducting research with minors.

• IJERPH, Vol. 13, Pages 486: Attitude, Acceptability and Knowledge of HPV Vaccination among Local University Students in Hong Kong

  Posted:2016-05-11

  The Human Papillomavirus (HPV) vaccine has the great potential to prevent HPV-related infections for millions of women and men worldwide. However, the success of the vaccine is highly dependent on the vaccination rate. Factors influencing the attitudes of undergraduate students towards HPV vaccination should be studied. This is a cross-sectional survey that was conducted to estimate the HPV vaccination rate among undergraduate students in Hong Kong, and to identify the predictors of their attitude towards HPV vaccination. The results showed that the HPV vaccination rate was 13.3%. Factors related to knowledge of vaccination were the main predictors of the students’ attitude towards vaccination (there were seven predictors, with B = 1.36 to 2.30; p < 0.05), followed by gender (B = −1.40; p < 0.05), acceptable maximum price (B = 0.35; p < 0.05), and willingness to receive the HPV vaccine if it can protect against cervical/anal cancer and genital warts (B = −1.90; p < 0.001). The regression model that was developed based on the predictors had a moderate effect size (adj-R2 = 0.33). To conclude, the HPV vaccination rate among undergraduate students in Hong Kong was low. They should be provided with more active education and activities to promote HPV vaccination to improve their knowledge on the subject.

• IJERPH, Vol. 13, Pages 485: Migrant Sexual Health Help-Seeking and Experiences of Stigmatization and Discrimination in Perth, Western Australia: Exploring Barriers and Enablers

  Posted:2016-05-11

  Increasing HIV notifications amongst migrant and mobile populations to Australia is a significant public health issue. Generalizations about migrant health needs and delayed or deterred help-seeking behaviors can result from disregarding the variation between and within cultures including factors, such as drivers for migration and country of birth. This study explored barriers and enablers to accessing sexual health services, including experiences of stigma and discrimination, within a purposive sample of sub-Saharan African, Southeast Asian, and East Asian migrants. A qualitative design was employed using key informant interviews and focus group discussions. A total of 45 people with ages ranging from 18 to 50 years, participated in focus group discussions. Common barriers and enablers to help seeking behaviors were sociocultural and religious influence, financial constraints, and knowledge dissemination to reduce stigma. Additionally, common experiences of stigma and discrimination were related to employment and the social and self-isolation of people living with HIV. Overcoming barriers to accessing sexual health services, imparting sexual health knowledge, recognizing variations within cultures, and a reduction in stigma and discrimination will simultaneously accelerate help-seeking and result in better sexual health outcomes in migrant populations.

• IJERPH, Vol. 13, Pages 488: A Mouse Model for Studying Nutritional Programming: Effects of Early Life Exposure to Soy Isoflavones on Bone and Reproductive Health

  Posted:2016-05-11

  Over the past decade, our research group has characterized and used a mouse model to demonstrate that “nutritional programming” of bone development occurs when mice receive soy isoflavones (ISO) during the first days of life. Nutritional programming of bone development can be defined as the ability for diet during early life to set a trajectory for better or compromised bone health at adulthood. We have shown that CD-1 mice exposed to soy ISO during early neonatal life have higher bone mineral density (BMD) and greater trabecular inter-connectivity in long bones and lumbar spine at young adulthood. These skeletal sites also withstand greater forces before fracture. Because the chemical structure of ISO resembles that of 17-β-estradiol and can bind to estrogen receptors in reproductive tissues, it was prudent to expand analyses to include measures of reproductive health. This review highlights aspects of our studies in CD-1 mice to understand the early life programming effects of soy ISO on bone and reproductive health. Preclinical mouse models can provide useful data to help develop and guide the design of studies in human cohorts, which may, depending on findings and considerations of safety, lead to dietary interventions that optimize bone health.

• IJERPH, Vol. 13, Pages 483: Effects of Size-Fractionated Particulate Matter on Cellular Oxidant Radical Generation in Human Bronchial Epithelial BEAS-2B Cells

  Posted:2016-05-10

  The aim of the present study was to investigate the effects of size-fractionated (i.e., <1; 1–2.5, and 2.5–10 µm in an aerodynamic diameter) ambient particulate matter (PM) on reactive oxygen species (ROS) activity and cell viability in human bronchial epithelial cells (BEAS-2B). The PM samples were collected from an urban site (uPM) in Beijing and a steel factory site (sPM) in Anshan, China, from March 2013 to December 2014. Metal elements, organic and elemental carbon, and water-soluble inorganic ions in the uPM and sPM were analyzed. The cell viability and ROS generation in PM-exposed BEAS-2B cells were measured by MTS and DCFH-DA. The results showed that both uPM and sPM caused a decrease in the cell viability and an increase in ROS generation. The level of ROS measured in sPM1.0 was approximately triple that in uPM1.0. The results of correlation analysis showed that the ROS activity and cytotoxicity were related to different PM composition. Moreover, deferoxamine (DFO) significantly prevented the increase of ROS generation and the decrease of cell viability. Taken together, our results suggest that the metals absorbed on PM induced oxidant radical generation in BEAS-2B cells that could lead to impairment of pulmonary function.

• IJERPH, Vol. 13, Pages 481: Effects of Meteorological Parameters and PM10 on the Incidence of Hand, Foot, and Mouth Disease in Children in China

  Posted:2016-05-10

  Hand, foot, and mouth disease (HFMD) is a globally-prevalent infectious disease. However, few data are available on prevention measures for HFMD. The purpose of this investigation was to evaluate the impacts of temperature, humidity, and air pollution, particularly levels of particulate matter with an aerodynamic diameter 10 micrometers (PM10), on the incidence of HFMD in a city in Eastern China. Daily morbidity, meteorological, and air pollution data for Ningbo City were collected for the period from January 2012 to December 2014. A total of 86,695 HFMD cases were enrolled in this study. We used a distributed lag nonlinear model (DLNM) with Poisson distribution to analyze the nonlinear lag effects of daily mean temperature, daily humidity, and found significant relationships with the incidence of HFMD; in contrast, PM10 level showed no relationship to the incidence of HFMD. Our findings will facilitate the development of effective preventive measures and early forecasting of HFMD outbreaks.