Proportion of mesothelioma attributable to living in industrially contaminated areas in Italy

Objectives The aim of this study was to estimate the attributable proportion (AP) of mesothelioma resulting from living in or close to major Italian industrially contaminated areas. Methods For populations living close to 39 sites of "national priority for remediation", incident mesothelioma cases were extracted from the Italian National Mesothelioma Registry (ReNaM) in the period 2000‒2011. Each site was classified in one of seven asbestos risk groups (RG) on the basis of the type of industrial plants. RG were ranked by the a priori evidence on asbestos risk. The AP for each RG was calculated as the meta-analytic estimate of AP of sites of the same group by gender and age class (0–64, 65–74, ≥75 years). The sex ratio (men/women) was computed for each RG. Results Among men, the AP by age class had the same gradient in each RG, with the highest values in the age class 0–64 years and the lowest in the ≥75 class; in the age class 0–64 years, the AP was positive in each RG, >90% in the presence of asbestos cement factories and harbors with shipyards. Among women, the overall AP decreased by RG, with negative values in the last two ranked RG; the AP by age class was variable without a definite gradient. The sex ratio was close to one only in the RG "only asbestos-cement factories"; the highest value (9.6) was observed in the age class 0–64 years in the RG "harbors with shipyard". Conclusions The integration of a geographic- and case-based approach provides valuable insights into occupational and environmental determinants of mesothelioma risk in industrially contaminated sites. by Pasetto R, Zona A, Fazzo L, Binazzi A, Bruno C, Pirastu R, Comba P, Marinaccio A. doi:10.5271/sjweh.3806

https://ift.tt/2GRpnSm

IJERPH, Vol. 16, Pages 735: Using Three Cross-Sectional Surveys to Compare Workplace Psychosocial Stressors and Associated Mental Health Status in Six Migrant Groups Working in Australia Compared with Australian-Born Workers

IJERPH, Vol. 16, Pages 735: Using Three Cross-Sectional Surveys to Compare Workplace Psychosocial Stressors and Associated Mental Health Status in Six Migrant Groups Working in Australia Compared with Australian-Born Workers

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050735

Authors: Daly Carey Darcey Chih LaMontagne Milner Reid

Migrant workers may be more likely to be exposed to workplace psychosocial stressors (WPS) which have an affect on physical and mental health. Given the relative lack of research on this topic, the study objectives were to estimate and compare the prevalence of WPS in migrant and Australian workers and investigate associated mental health problems. Three cross-sectional surveys, two with migrant workers and one with Australian workers, were pooled to provide estimates of prevalence. Regressions were conducted to investigate associations between workers and WPS. All WPS, except unfair pay, were associated with higher probability of mental health problems. The association between WPS and mental health did differ between some migrant groups. Compared with Australian-born workers, all other migrant groups tended to have a lower risk of mental health outcomes. Interactions between WPS and migrants showed variable levels in the risk of having a mental health problem, some attenuated and some increased. The study showed that country of birth does play a part in how treatment in the workplace is perceived and responded to. Any interventions to improve workplace conditions for migrant workers need to be aware of the different experiences related to migrant ethnicity.

https://ift.tt/2TkQX0f

IJERPH, Vol. 16, Pages 733: Combined Assessment of Preschool Childrens’ Exposure to Substances in Household Products

IJERPH, Vol. 16, Pages 733: Combined Assessment of Preschool Childrens’ Exposure to Substances in Household Products

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050733

Authors: Kim Seok

Understanding how indoor-air contaminants affect human health is of critical importance in our developed society. We assessed the combined exposure by inhalation of preschool children and children to household products. A total of 1175 families with 72 infants, 158 toddlers, 230 children, and 239 youths were surveyed to determine the combined respiratory exposure concentrations and amounts associated with 21 substances in eight household product groups. We determined the mean concentrations of these substances in each product, and derived reference toxicity values based on the information gathered in order to identify respiratory health risks. On average, cleaners were used at a rate of 1.0 × 103 g/month, while coating agents and other substances were used at 43 g/month. The combined inhalation exposure concentrations of methanol to infants and toddlers were 5.1 and 4.2 mg/m3 per month, respectively, with values of 2.1 and 1.7 mg/m3 for isopropanol, respectively. Risks to preschool children and children should be assessed on the basis of the toxicity values of combined exposed hazardous substances, as well as their combined concentrations and amounts. This exposure assessment approach can be used to establish improved guidelines for products that may pose inhalation hazards to preschool children and children.

https://ift.tt/2GP1dIl

IJERPH, Vol. 16, Pages 734: Sanitation in Rural India: Exploring the Associations between Dwelling Space and Household Latrine Ownership

IJERPH, Vol. 16, Pages 734: Sanitation in Rural India: Exploring the Associations between Dwelling Space and Household Latrine Ownership

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050734

Authors: Anoop Jain Lia C.H. Fernald Kirk R. Smith S.V. Subramanian

In 2017, the Joint Monitoring Programme estimated that 520 million people in India were defecating in the open every day. This is despite efforts made by the government, Non-Governmental Organizations (NGOs), and multilaterals to improve latrine coverage throughout India. We hypothesize that this might be because current interventions focus mostly on individual-level determinants, such as attitudes and beliefs, instead of considering all possible social determinants of latrine ownership. Given this, we ask two questions: what is the association between the amount of dwelling space owned by households in rural India and their likelihood of toilet ownership and what proportion of the variation in household latrine ownership is attributable to villages and states? We used multilevel modeling and found significant associations between the amount of household dwelling space and the likelihood of latrine ownership. Furthermore, considerable variation in latrine ownership is attributable to villages and states, suggesting that additional research is required to elucidate the contextual effects of villages and states on household latrine ownership. Thus, sanitation interventions should consider household dwelling space and village and state context as important social determinants of latrine ownership in rural India. Doing so could bolster progress towards Sustainable Development Goal (SDG) 6.

https://ift.tt/2NxXWxy

IJERPH, Vol. 16, Pages 732: Parents’ Willingness and Perception of Children’s Autonomy as Predictors of Greater Independent Mobility to School

IJERPH, Vol. 16, Pages 732: Parents’ Willingness and Perception of Children’s Autonomy as Predictors of Greater Independent Mobility to School

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050732

Authors: Ester Ayllón Nieves Moyano Azucena Lozano María-Jesús Cava

The present study aimed to examine the factors associated with different forms of independent mobility (IM) to school (IM one way and IM both ways) according to their parents’ opinions. To do so, several variables were evaluated: how parents assess their children’s autonomy, the difficulty they perceive for IM to school, reasons for IM/no IM to school, parents’ willingness for IM to school, frequency of children’s IM for leisure activities, children having house keys and dangers perceived in the neighborhood. Family-related socio-demographic variables were also assessed: number of children, position occupied by them in the family, family composition, living with both parents or just one, and each parent’s nationality, level of education and job status. This study examined the data collected from 1450 parents (mothers and fathers) with children studying Primary Education years 4, 5 and 6 (M age = 10.53, SD = 0.90). The results showed that 42.3% of the schoolchildren did not practice IM to school, 18.1% practiced IM one way (they went to or from school alone), and 39.5% practiced IM both way (they went to/from school alone). These findings underline the importance of parents’ willingness for IM to school, and how the balance between how they perceive their children’s autonomy and difficulty for IM is relevant for greater IM to school.

https://ift.tt/2TpNwFu

IJERPH, Vol. 16, Pages 730: Is a One Health Approach Utilized for Q Fever Control? A Comprehensive Literature Review

IJERPH, Vol. 16, Pages 730: Is a One Health Approach Utilized for Q Fever Control? A Comprehensive Literature Review

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050730

Authors: Md Rezanur Rahaman Adriana Milazzo Helen Marshall Peng Bi

Q fever, a zoonotic disease transmitted from animals to humans, is a significant public health problem with a potential for outbreaks to occur. Q fever prevention strategies should incorporate human, animal, and environmental domains. A One Health approach, which engages cross-sectoral collaboration among multiple stakeholders, may be an appropriate framework and has the underlying principles to control Q fever holistically. To assess whether components of One Health for Q fever prevention and control have been applied, a comprehensive literature review was undertaken. We found 16 studies that had practiced or recommended a One Health approach. Seven emerging themes were identified: Human risk assessment, human and animal serology, integrated human–animal surveillance, vaccination for at-risk groups, environmental management, multi-sectoral collaboration, and education and training. Within the multi-sectoral theme, we identified five subthemes: Policy and practice guidelines, information sharing and intelligence exchange, risk communication, joint intervention, and evaluation. One Health practices varied between studies possibly due to differences in intercountry policy, practice, and feasibility. However, the key issue of the need for multi-sectoral collaboration was highlighted across most of the studies. Further research is warranted to explore the barriers and opportunities of adopting a One Health approach in Q fever prevention and control.

https://ift.tt/2XvNACT

IJERPH, Vol. 16, Pages 729: Frailty Level Monitoring and Analysis after a Pilot Six-Week Randomized Controlled Clinical Trial Using the FRED Exergame Including Biofeedback Supervision in an Elderly Day Care Centre

IJERPH, Vol. 16, Pages 729: Frailty Level Monitoring and Analysis after a Pilot Six-Week Randomized Controlled Clinical Trial Using the FRED Exergame Including Biofeedback Supervision in an Elderly Day Care Centre

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050729

Authors: Iranzu Mugueta-Aguinaga Begonya Garcia-Zapirain

Background: Frailty is a status of extreme vulnerability to endogenous and exogenous stressors exposing the individual to a higher risk of negative health-related outcomes. Exercise using interactive videos, known as exergames, is being increasingly used to increase physical activity by improving health and the physical function in elderly adults. The purpose of this study is to ascertain the reduction in the degree of frailty, the degree of independence in activities of daily living, the perception of one’s state of health, safety and cardiac healthiness by the exercise done using FRED over a 6-week period in elderly day care centre. Material and Methods: Frail volunteers >65 years of age, with a score of <10 points (SPPB), took part in the study. A study group and a control group of 20 participants respectively were obtained. Following randomisation, the study group (20) took part in 18 sessions in total over 6 months, and biofeedback was recorded in each session. Results: After 6 weeks, 100% of patients from the control group continued evidencing frailty risk, whereas only 5% of patients from the study group did so, with p < 0.001 statistical significance. In the case of the EQ-VAS, the control group worsened (−12.63 points) whereas the study group improved (12.05 points). The Barthel Index showed an improvement in the study group after 6 weeks, with statistically significant evidence and a value of p < 0.003906. Safety compliance with the physical activity exceeded 87% and even improved as the days went by. Discussion: Our results stand out from those obtained by other authors in that FRED is an ad hoc-designed exergame, significantly reduced the presence and severity of frailty in a sample of sedentary elders, thus potentially modifying their risk profile. It in turn improves the degree of independence in activities of daily living and the perception of one’s state of health, proving to be a safe and cardiac healthy exercise. Conclusions: The study undertaken confirms the fact that the FRED game proves to be a valid technological solution for reducing frailty risk. Based on the study conducted, the exergame may be considered an effective, safe and entertaining alternative.

https://ift.tt/2ECnBlY

IJERPH, Vol. 16, Pages 728: Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework

IJERPH, Vol. 16, Pages 728: Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050728

Authors: Saria Hassan Alexis Cooke Haneefa Saleem Dorothy Mushi Jessie Mbwambo Barrot H. Lambdin

There are an estimated 50,000 people who inject drugs in Tanzania, with an HIV prevalence in this population of 42%. The Integrated Methadone and Anti-Retroviral Therapy (IMAT) strategy was developed to integrate HIV services into an opioid treatment program (OTP) in sub-Saharan Africa and increase anti-retroviral therapy (ART) initiation rates. In this paper, we evaluate the IMAT strategy using an implementation science framework to inform future care integration efforts in the region. IMAT centralized HIV services into an OTP clinic in Dar Es Salaam, Tanzania: HIV diagnosis, ART initiation, monitoring and follow up. A mixed-methods, concurrent design, was used for evaluation: quantitative programmatic data and semi-structured interviews with providers and clients addressed 4 out of 5 components of the RE-AIM framework: reach, effectiveness, adoption, implementation. Results showed high reach: 98% of HIV-positive clients received HIV services; effectiveness: 90-day ART initiation rate doubled, from 41% pre-IMAT to 87% post-IMAT (p < 0.001); proportion of HIV-positive eligible clients on ART increased from 71% pre-IMAT to 98% post-IMAT (p < 0.001). There was high adoption and implementation protocol fidelity. Qualitative results informed barriers and facilitators of RE-AIM components. In conclusion, we successfully integrated HIV care into an OTP clinic in sub-Saharan Africa with increased rates of ART initiation. The IMAT strategy represents an effective care integration model to improve HIV care delivery for OTP clients.

https://ift.tt/2VkAsyK

IJERPH, Vol. 16, Pages 731: Geospatial Distributions of Groundwater Quality in Gedaref State Using Geographic Information System (GIS) and Drinking Water Quality Index (DWQI)

IJERPH, Vol. 16, Pages 731: Geospatial Distributions of Groundwater Quality in Gedaref State Using Geographic Information System (GIS) and Drinking Water Quality Index (DWQI)

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050731

Authors: Basheer A. Elubid Tao Huag Ekhlas H. Ahmed Jianfei Zhao Khalid. M. Elhag Waleed Abbass Mohammed M. Babiker

The observation of groundwater quality elements is essential for understanding the classification and distribution of drinking water. Geographic Information System (GIS) and remote sensing (RS), are intensive tools for the performance and analysis of spatial datum associated with groundwater sources control. In this study, groundwater quality parameters were observed in three different aquifers including: sandstone, alluvium and basalt. These aquifers are the primary source of national drinking water and partly for agricultural activity in El Faw, El Raha (Fw-Rh), El Qalabat and El Quresha (Qa-Qu) localities in the southern part of Gedaref State in eastern Sudan. The aquifers have been overworked intensively as the main source of indigenous water supply in the study area. The interpolation methods were used to demonstrate the facies pattern and Drinking Water Quality Index (DWQI) of the groundwater in the research area. The GIS interpolation tool was used to obtain the spatial distribution of groundwater quality parameters and DWQI in the area. Forty samples were assembled and investigated for the analysis of major cations and anions. The groundwater in this research is controlled by sodium and bicarbonate ions that defined the composition of the water type to be Na HCO3. However, from the plots of piper diagram; the samples result revealed (40%) Na-Mg-HCO3 and (35%) Na-HCO3 water types. The outcome of the analysis reveals that several groundwater samples have been found to be suitable for drinking purposes in Fa-Rh and Qa-Qu areas.

https://ift.tt/2EEaVv2

IJERPH, Vol. 16, Pages 722: Frequency and Predictors of Alcohol-Related Outcomes Following Alcohol Residential Rehabilitation Programs: A 12-Month Follow-Up Study

IJERPH, Vol. 16, Pages 722: Frequency and Predictors of Alcohol-Related Outcomes Following Alcohol Residential Rehabilitation Programs: A 12-Month Follow-Up Study

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050722

Authors: Elena Fiabane Lorenza Scotti Antonella Zambon Giovanni Vittadini Ines Giorgi

Excessive use of alcohol has been identified as a major risk factor for diseases, injury conditions and increased mortality. The aims of this study were to estimate the frequency of success (abstinence and no alcohol related hospitalization) at 6- and 12-month follow-up after hospital discharge, and to identify the predictors of success. In 2009, a total of 1040 patients at their first admission in one of the 12 Residential Alcohol Abuse Rehabilitation Units (RAARUs) participating in the CORRAL (COordinamento of Residenzialità Riabilitative ALcologiche) project were included in the study. Several socio-demographic and clinical variables, and the number of treatments’ strategies during the rehabilitation were collected. Information on alcohol abstinence and no alcohol related hospitalization was assessed through a phone interview using a health worker-administered structured questionnaire at six and 12 months after discharge. An inverse probability weighted, repeated measures Poisson regression model with robust variance was applied to estimate the association between patients’ characteristics and the study’s outcomes, accounting for non-responders status. The frequencies of abstinence and non-alcohol related hospitalization were 68.38% and 90.73% at six months, respectively, and 68.65% and 87.6% at 12 months, respectively. Patients that were already abstainers in the month before RAARUs’ admission have an increased probability of being abstainers after discharge (relative risk: RR 1.20, 95% confidence interval: 95%CI 1.08–1.33) and of having an alcohol related hospitalization at 12 months. Subjects undergoing more than four treatment strategies (RR 1.19; 95% CI 1.01–1.40) had a higher abstinence probability and lower probability of no alcohol related hospitalizations after 12 months. Finally, patients with dual diagnosis (co-occurrence of alcohol abuse/dependence and psychiatric disorders) have a decreased probability of not being hospitalized for alcohol-related problems (RR 0.95; 95% CI 0.91–0.99). The results of this study suggest that specific attention should be paid to the intensity of treatment, with particular regard to a multidisciplinary rehabilitation in order to respond to the complexity of alcohol dependent patients.

https://ift.tt/2EC6L6F

IJERPH, Vol. 16, Pages 726: Caring for Workers’ Health: Do German Employers Follow a Comprehensive Approach Similar to the Total Worker Health Concept? Results of a Survey in an Economically Powerful Region in Germany

IJERPH, Vol. 16, Pages 726: Caring for Workers’ Health: Do German Employers Follow a Comprehensive Approach Similar to the Total Worker Health Concept? Results of a Survey in an Economically Powerful Region in Germany

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050726

Authors: Aileen Hoge Anna T. Ehmann Monika A. Rieger Achim Siegel

Similar to ‘Total Worker Health’ in the United States (USA), ‘Workplace Health Management’ in Germany is a holistic strategy to protect, promote, and manage employees’ health at the workplace. It consists of four subcategories. While the subcategories ‘occupational health and safety’ and ‘reintegration management’ contain measures prescribed by law, ‘workplace health promotion’ and ‘personnel development’ can be designed more individually by the companies. The present study focused on the current implementation of voluntary and legally required measures of the four subcategories, as well as companies’ satisfaction with the implementation. A total of N = 222/906 companies (small, medium, and big enterprises of one German county) answered a standardized questionnaire addressing the implementation of health-related measures, satisfaction with the implementation, and several company characteristics. In the subcategory ‘occupational health and safety’, 23.9% of the companies fulfilled all of the legally required measures, whereas in the category ‘reintegration management’, that rate amounted to 50.9%. There was a positive correlation between company size and the implementation grade, and as well between company size and the fulfilling of measures required by law. Companies tended to be more satisfied with higher implementation grades. Nevertheless, a surprisingly high proportion of the companies with poor implementation indicated satisfaction with the measures’ implementation.

https://ift.tt/2VjXWEa

IJERPH, Vol. 16, Pages 727: Are Small Cities More Environmentally Friendly? An Empirical Study from China

IJERPH, Vol. 16, Pages 727: Are Small Cities More Environmentally Friendly? An Empirical Study from China

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050727

Authors: Shuai Liu Fei Fan Jianqing Zhang

City sizes are rapidly expanding, and urban air pollution is a serious challenge in China. PM2.5 (fine particulate matter) is the primary pollutant of urban pollution. This study aimed to examine the correlations between PM2.5 and city size. In this paper, using the panel data of 278 cities in China from 2007 to 2016, we constructed a static and dynamic panel model based on the STIRPAT (Stochastic Impacts by Regression on Population, Affluence and Technology) analytical framework. We found that there was a significantly inverted N-shaped correlation between PM2.5 and city size. Two inflection points were found at 949,200 and 3,736,100. We found no evidence to support the EKC (Environmental Kuznets Curve) hypothesis, while the “Pollution Haven Hypothesis” gained support. The contradiction between PM2.5 and city size will exist for the long term. Policy recommendations were proposed based on our findings. Controlling the city size does not seem to be necessary for very large cities as they have passed the second inflection point. Cities with a growing population are under great pressure to prevent PM2.5 pollution and need to implement greater measures to reduce pollution.

https://ift.tt/2ECHGbW

IJERPH, Vol. 16, Pages 725: Post-Traumatic Stress Disorder (PTSD) Symptoms in Secondary Stalked Children of Danish Stalking Survivors—A Pilot Study

IJERPH, Vol. 16, Pages 725: Post-Traumatic Stress Disorder (PTSD) Symptoms in Secondary Stalked Children of Danish Stalking Survivors—A Pilot Study

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050725

Authors: Ask Elklit Lene Annie Gregers Vangsgaard Anne Sophie Witt Olsen Sara Al Ali

There is a lack of research examining secondary stalking and its effect on children who, in many cases, can be direct targets, or secondary survivors, of the stalking of their parent. The present study examines trauma reactions in children of stalking survivors in a Danish sample. It investigates the differences and similarities of such reactions across three age groups. Fifty-seven children were divided into groups depending on their age. The symptoms of the youngest group, 0–6-year-olds, were investigated by way of a maternal diagnostic interview. The two older groups, 7–11- and 12–19-year-olds completed the age-appropriate questionnaires, “Darryl” and “HTQ”, respectively, online. Twenty-two percent of the youngest group met the criteria for Post-Traumatic Stress Disorder (PTSD). Eighty-five percent of the middle age group and 58% of the older age group met PTSD diagnostic criteria. The findings illustrate that reactions to secondary stalking were predominantly within the arousal cluster of PTSD symptomology, with sleep disturbances and irritability commonly reported. The overall prevalence of children meeting PTSD diagnostic criteria in the sample was 56%. Future studies will benefit from larger samples and from knowledge of any pre-existing relationship between parent and stalker.

https://ift.tt/2H5XOnS

IJERPH, Vol. 16, Pages 724: A Comparison of E-Cigarette Use Patterns and Smoking Cessation Behavior among Vapers by Primary Place of Purchase

IJERPH, Vol. 16, Pages 724: A Comparison of E-Cigarette Use Patterns and Smoking Cessation Behavior among Vapers by Primary Place of Purchase

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050724

Authors: Greta Hsu Anthony C. Gamst Yue-Lin Zhuang Tanya Wolfson Shu-Hong Zhu

Background: E-cigarettes are purchased through multiple channels, including general retail, online, and specialty smoke and vape shops. We examine how e-cigarette users’ primary purchase place relates to e-cigarette use and smoking cessation behaviors. Methods: Probability-based samples of the U.S. population who were current e-cigarette users were surveyed in 2014 (N = 879) and 2016 (N = 743), with responses combined for most analyses. E-cigarette use and smoking cessation behaviors were compared across users’ primary purchase place. Results: Higher percentages of vape shop (59.1%) and internet (42.9%) customers were current daily users of e-cigarettes compared to retail (19.7%) and smoke shop (23.2%) customers (p-values < 0.001). Higher percentages of vape shop (40.2%) and internet (35.1%) customers were also former smokers, compared to 17.7% of retail and 19.3% of smoke shop customers (p’s < 0.001). Among those smoking 12 months prior to survey, smoking cessation rates were higher for vape shop (22.2%) and internet customers (22.5%) than for retail customers (10.7%, p = 0.010 and p = 0.022, respectively), even though retail customers were more likely to use FDA-approved smoking cessation aids. The percentage of customers purchasing from vape shops increased from 20.4% in 2014 to 37.6% in 2016, surpassing general retail (27.7%) as the most likely channel in 2016. Conclusions: E-cigarette customers differed in significant ways by channels of purchase, most notably in their smoking cessation behaviors. Previous population studies have relied mostly on retail channel data, which accounted for less than 30% of all products sold by 2016. Future studies of e-cigarette use should consider a broader set of channels.

https://ift.tt/2tK1Km8

IJERPH, Vol. 16, Pages 721: A Community-Based Intervention for Improving Medication Adherence for Elderly Patients with Hypertension in Korea

IJERPH, Vol. 16, Pages 721: A Community-Based Intervention for Improving Medication Adherence for Elderly Patients with Hypertension in Korea

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050721

Authors: Kang-Ju Son Hyo-Rim Son Bohyeun Park Hee-Ja Kim Chun-Bae Kim

The chronic disease management program, a community-based intervention including patient education, recall and remind service, and reduction of out-of-pocket payment, was implemented in 2005 in Korea to improve patients’ adherence for antihypertensive medications. This study aimed to assess the effect of a community-based hypertension intervention intended to enhance patient adherence to prescribed medications. This study applied a non-equivalent control group design using the Korean National Health Insurance Big Data. Hongcheon County has been continuously implementing the intervention program since 2012. This study involved a cohort of patients with hypertension aged >65 and <85 years, among residents who lived in the study area for five years (between 2010 and 2014). The final number of subjects was 2685 in both the intervention and control region. The indirect indicators were analyzed as patients’ adherence and level of continuous treatment using the difference-in-difference regression. The proportion of hypertensive patients who continuously received insurance benefits for >240 days in 2014 was 81.0% in the intervention region and 79.7% in the control region. The number of dispensations per prescription and the dispensation days per hypertensive patient in the intervention region increased by approximately 10.88% and 2.2 days on average by month, respectively, compared to those in the control region. The intervention program encouraged elderly patients with hypertension to receive continuous care. Another research is needed to determine whether further improvement in the continuity of comprehensive care will prevent the progression of cardiovascular diseases.

https://ift.tt/2EBWuHI

IJERPH, Vol. 16, Pages 720: Health Benefits from Upgrading Public Buses for Cleaner Air: A Case Study of Clark County, Nevada and the United States

IJERPH, Vol. 16, Pages 720: Health Benefits from Upgrading Public Buses for Cleaner Air: A Case Study of Clark County, Nevada and the United States

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050720

Authors: John O. Olawepo L.-W. Antony Chen

Public transit buses, which move more than 5 billion passengers annually in the United States (U.S.), can contribute substantially to the environmental health burden through emitted air pollutants. As a leader in transforming to cleaner bus fleets, the Regional Transport Commission of Southern Nevada (RTC) has been transitioning from diesel to compressed natural gas (CNG) transit buses since 1999. By 2017, ~75% of RTC’s buses operating in Clark County, Nevada were CNG-powered. This study assesses the health benefits of the venture using the US Environmental Protection Agency’s (EPA) Co-Benefits Risk Assessment (COBRA) model, considering the emission and exposure changes from the 2017 baseline for two hypothetical scenarios: (1) no transition (CC_D) and (2) complete transition (CC_N). The CC_D scenario shows realized health benefits, mostly due to avoided mortality, of $0.79–8.21 million per year for 2017 alone, while CC_N suggests an additional $0.88–2.24 million annually that could be achieved by completing the transition. The wide range of estimates partly reflects uncertainties in determining diesel bus emissions under business-as-usual. These health benefits were not limited locally, with ~70% going to other counties. Two national-scale scenarios, US_D and US_N, were also constructed to explore the health impact of transitioning from diesel to CNG buses across the U.S. As of 2017, with CNG powering only ~20% of transit bus mileages nationwide, there could be massive unrealized health benefits of $0.98–2.48 billion per year including 114–258 avoided premature deaths and >5000 avoided respiratory and cardiovascular illnesses. Taking into account the health benefits, economic costs, and the inter-state nature of air pollution, expanding federal assistances to accelerate a nationwide transition to cleaner bus fleets is highly recommended.

https://ift.tt/2VpEPIY

IJERPH, Vol. 16, Pages 719: The Effect of Special Medical Examination for Night Shift Workers and Follow-Up Management Against Hypertension

IJERPH, Vol. 16, Pages 719: The Effect of Special Medical Examination for Night Shift Workers and Follow-Up Management Against Hypertension

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050719

Authors: Won Seon Choi Ji-Won Lee Jae Yong Lee Kyeong Yeon Kim Jun-Pyo Myong Won-Chul Lee

Background: Special health examination is a screening program introduced in 1973 in Korea to examine health problems of workers who are regularly exposed to 177 hazardous substances and physical environments specified by the Occupational Safety and Health Act. Shiftwork was added as a risk factor in 2013. The purpose of this study was to analyze changes of hypertension status after a special medical examination and subsequent follow-up management. Methods: We used the data based on the special medical examination outcomes for night shift workers, performed at seven different health examination centers under the Korea Medical Institute (KMI) between 2014 and 2016. Workers who received special medical examinations for two consecutive years (2014–2015 and 2015–2016) were selected. A final study population of 2070 was evaluated. Results: Compared with the first-year examination, 1503 subjects (72.6%) received hypertension medication or showed improvement in blood pressure in their second-year examination. Older age (≥40s), women, larger workplaces (≥300 full-time workers), long-term workers (≥12 years), improvement in smoking habits, improvements for diabetes or dyslipidemia, normal or reduced BMI, and normal waist circumference were associated with proper management of hypertension. Conclusions: An appropriate follow-up management program should be developed to provide health management for night shift workers that need to focus on the factors identified in this study.

https://ift.tt/2ECmF11

IJERPH, Vol. 16, Pages 723: When Less is More: Vaping Low-Nicotine vs. High-Nicotine E-Liquid is Compensated by Increased Wattage and Higher Liquid Consumption

IJERPH, Vol. 16, Pages 723: When Less is More: Vaping Low-Nicotine vs. High-Nicotine E-Liquid is Compensated by Increased Wattage and Higher Liquid Consumption

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050723

Authors: Jorien Smets Frank Baeyens Martin Chaumont Karolien Adriaens Dinska Van Gucht

(1) Background: Previous research (Van Gucht, Adriaens, and Baeyens, 2017) showed that almost all (99%) of the 203 surveyed customers of a Dutch online vape shop had a history of smoking before they had started using an e-cigarette. Almost all were daily vapers who used on average 20 mL e-liquid per week, with an average nicotine concentration of 10 mg/mL. In the current study, we wanted to investigate certain evolutions with regard to technical aspects of vaping behaviour, such as wattage, the volume of e-liquid used and nicotine concentration. In recent years, much more powerful devices have become widely available, e-liquids with very low nicotine concentrations have become the rule rather than the exception in the market supply, and the legislation has been adjusted, including a restriction on maximum nicotine concentrations to 20 mg/mL. (2) Methods: Customers (n = 150) from the same Dutch online vape shop were contacted (to allow a historical comparison), as well as 274 visitors from the Facebook group “Belgian Vape Bond” to compare between groups from two different geographies and/or vaping cultures. (3) Results: Most results were in line with earlier findings: Almost all surveyed vapers were (ex-)smokers, had started (80%) vaping to quit smoking and reported similar positive effects of having switched from smoking to vaping (e.g., improved health). A striking observation, however, was that whereas customers of the Dutch online vape shop used e-liquids with a similar nicotine concentration as that observed previously, the Belgian vapers used e-liquids with a significantly lower nicotine concentration but consumed much more of it. The resulting intake of the total quantity of nicotine did not differ between groups. (4) Conclusions: Among vapers, different vaping typologies may exist, depending on subcultural and/or geographic parameters. As a consequence of choosing low nicotine concentrations and consuming more e-liquid, the Belgian vapers may have a greater potential to expose themselves to larger quantities of harmful or potentially harmful constituents (HPHCs) released during vaping.

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IJERPH, Vol. 16, Pages 717: Stomach Cancer and Exposure to Talc Powder without Asbestos via Chinese Herbal Medicine: A Population-Based Cohort Study

IJERPH, Vol. 16, Pages 717: Stomach Cancer and Exposure to Talc Powder without Asbestos via Chinese Herbal Medicine: A Population-Based Cohort Study

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050717

Authors: Che-Jui Chang Yao-Hsu Yang Pau-Chung Chen Hsin-Yi Peng Yi-Chia Lu Sheng-Rong Song Hsiao-Yu Yang

The present investigation was designed to explore the risk of stomach cancer by oral intake of talc powder without asbestos. We conducted a population-based cohort study on a randomly sampled cohort from Taiwan’s health insurance database, with population of 1,000,000. The study participants were followed up through 2013. The outcome event of interest was the diagnosis of stomach cancer. The exposure of interest was the prescription of talc powder. Cox regression analyses were performed respectively. There were 584,077 persons without talc exposure and 21,575 talc users, 1849 diagnosed with stomach cancer. Persons with exposure of talc had a higher hazard ratio of stomach cancer (adjusted hazard ratio, 2.13; 95% confidence interval (CI), 1.54–2.94; p < 0.001). Classification by cumulative exposure of talc yielded adjusted hazard ratios of stomach cancer of 1.58 (95% CI, 0.79–3.17; p = 0.19) and 2.30 (95% CI, 1.48–3.57; p < 0.001) among persons with high (>21 g) and medium (6–21 g) exposure of talc, as compared to the low-exposure counterparts. Our data demonstrated positive association between increased risk of stomach cancer and oral intake of talc without asbestos. Despite the absence of dose-response effect, there might be a link between stomach cancer and talc.

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IJERPH, Vol. 16, Pages 716: Heat Acclimation Does Not Protect Trained Males from Hyperthermia-Induced Impairments in Complex Task Performance

IJERPH, Vol. 16, Pages 716: Heat Acclimation Does Not Protect Trained Males from Hyperthermia-Induced Impairments in Complex Task Performance

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16050716

Authors: Jacob F. Piil Chris J. Mikkelsen Nicklas Junge Nathan B. Morris Lars Nybo

This study evaluated if adaptation to environmental heat stress can counteract the negative effects of hyperthermia on complex motor performance. Thirteen healthy, trained males completed 28 days of heat acclimation with 1 h daily exercise exposure to environmental heat (39.4 ± 0.3 °C and 27.0 ± 1.0% relative humidity). Following comprehensive familiarization, the participants completed motor-cognitive testing before acclimation, as well as after 14 and 28 days of training in the heat. On all three occasions, the participants were tested, at baseline (after ~15 min passive heat exposure) and following exercise-induced hyperthermia which provoked an increase in core temperature of 2.8 ± 0.1 °C (similar across days). Both cognitively dominated test scores and motor performance were maintained during passive heat exposure (no reduction or difference between day 0, 14, and 28 compared to cool conditions). In contrast, complex motor task performance was significantly reduced in hyperthermic conditions by 9.4 ± 3.4% at day 0; 15.1 ± 5.0% at day 14, and 13.0 ± 4.8% at day 28 (all p < 0.05 compared to baseline but not different across days). These results let us conclude that heat acclimation cannot protect trained males from being negatively affected by hyperthermia when they perform complex tasks relying on a combination of cognitive performance and motor function.

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