text: International Journal of Environmental Research and Public Health http://www.mdpi.com/journal/ijerph Latest open access articles published in Int. J. Environ. Res. Public Health at http://www.mdpi.com/journal/ijerph http://www.mdpi.com/1660-4601/13/7/670 Children's exposure assessment is a key input into epidemiology studies, risk assessment and source apportionment. The goals of this article are to describe a methodology for children's exposure assessment that can be used for these purposes and to apply the methodology to source apportionment for the case study chemical, diethylhexylphthalate (DEHP). A key feature is the comparison of total (aggregate) exposure calculated via a pathways approach to that derived from a biomonitoring approach. The 4-step methodology and its results for DEHP are: (1) Prioritization of life stages and exposure pathways, with pregnancy, breast-fed infants, and toddlers the focus of the case study and pathways selected that are relevant to these groups; (2) Estimation of pathway-specific exposures by life stage wherein diet was found to be the largest contributor for pregnant women, breast milk and mouthing behavior for the nursing infant and diet, house dust, and mouthing for toddlers; (3) Comparison of aggregate exposure by pathways vs biomonitoring-based approaches wherein good concordance was found for toddlers and pregnant women providing confidence in the exposure assessment; (4) Source apportionment in which DEHP presence in foods, children's products, consumer products and the built environment are discussed with respect to early life mouthing, house dust and dietary exposure. A potential fifth step of the method involves the calculation of exposure doses for risk assessment which is described but outside the scope for the current case study. In summary, the methodology has been used to synthesize the available information to identify key sources of early life exposure to DEHP. International Journal of Environmental Research and Public Health 2016-07-01 13 7 Review 10.3390/ijerph13070670 670 1660-4601 2016-07-01 doi: 10.3390/ijerph13070670 Gary Ginsberg Justine Ginsberg Brenda Foos http://www.mdpi.com/1660-4601/13/7/672 We thank the comments of Fernández-Niño [1] addressing our article [2] "Increase in Suicide Rates by Hanging in the Population of Tabasco, Mexico between 2003 and 2012", which pointed out that the use of the epidemiological concept "prevalence" is not correctly applied in the present manuscript. International Journal of Environmental Research and Public Health 2016-07-01 13 7 Reply 10.3390/ijerph13070672 672 1660-4601 2016-07-01 doi: 10.3390/ijerph13070672 Mervyn Hernández-Alvarado Thelma González-Castro Carlos Tovilla-Zárate Ana Fresán Isela Juárez-Rojop María López-Narváez Mario Villar-Soto Alma Genis-Mendoza http://www.mdpi.com/1660-4601/13/7/671 I recently reviewed the paper published in this journal by Hernández-Alvarado et al., titled "Increase in Suicide Rates by Hanging in the Population of Tabasco, Mexico between 2003 and 2012" [1], and I noticed that the epidemiological concept "prevalence" is not correctly used.[...] International Journal of Environmental Research and Public Health 2016-07-01 13 7 Comment 10.3390/ijerph13070671 671 1660-4601 2016-07-01 doi: 10.3390/ijerph13070671 Julián Fernández-Niño http://www.mdpi.com/1660-4601/13/7/666 (1) Background: Supplementary feeding programs (SFPs) are effective in the community-based treatment of moderate acute malnutrition (MAM) and prevention of severe acute malnutrition (SAM); (2) Methods: A retrospective study was conducted on a sample of 1266 Zambian malnourished children assisted from 2012 to 2014 in the Rainbow Project SFPs. Nutritional status was evaluated according to WHO/Unicef methodology. We performed univariate and multivariate Cox proportional risk regression to identify the main predictors of mortality. In addition, a time-to event analysis was performed to identify predictors of failure and time to cure events; (3) Results: The analysis included 858 malnourished children (19 months ± 9.4; 49.9% males). Program outcomes met international standards with a better performance for MAM compared to SAM. Cox regression identified SAM (3.8; 2.1–6.8), HIV infection (3.1; 1.7–5.5), and WAZ <−3 (3.1; 1.6–5.7) as predictors of death. Time to event showed 80% of children recovered by SAM/MAM at 24 weeks. (4) Conclusions: Preventing deterioration of malnutrition, coupled to early detection of HIV/AIDS with adequate antiretroviral treatment, and extending the duration of feeding supplementation, could be crucial elements for ensuring full recovery and improve child survival in malnourished Zambian children. International Journal of Environmental Research and Public Health 2016-07-01 13 7 Article 10.3390/ijerph13070666 666 1660-4601 2016-07-01 doi: 10.3390/ijerph13070666 Stefania Moramarco Giulia Amerio Clarice Ciarlantini Jean Chipoma Matilda Simpungwe Karin Nielsen-Saines Leonardo Palombi Ersilia Buonomo http://www.mdpi.com/1660-4601/13/7/663 The study evaluates the health risk caused by heavy metals to the inhabitants of a gold mining area. In this study, 56 soil samples from five mine tailings and 17 from two mine villages were collected and analyzed for Asernic (As), Lead (Pb), Mercury (Hg), Cadmium (Cd), Chromium (Cr), Cobalt (Co), Nickel (Ni), Copper (Cu) and Zinc (Zn) using ICP-MS. Measured concentrations of these heavy metals were then used to calculate the health risk for adults and children. Their concentrations were such that Cr > Ni > As > Zn > Cu > Co > Pb > Hg > Cd, with As, Cr and Ni higher than permissible levels. For the adult population, the Hazard Index value for all pathways was found to be 2.13, making non-carcinogenic effects significant to the adult population. For children, the Hazard Index value was 43.80, a value >>1, which poses serious non-carcinogenic effect to children living in the gold mining area. The carcinogenic risk was found to be 1.7 × 10−4 implying that 1 person in every 5882 adults may be affected. In addition, for children, in every 2725 individuals, 1 child may be affected (3.67 × 10−4). These carcinogenic risk values were both higher than acceptable values. International Journal of Environmental Research and Public Health 2016-06-30 13 7 Article 10.3390/ijerph13070663 663 1660-4601 2016-06-30 doi: 10.3390/ijerph13070663 Caspah Kamunda Manny Mathuthu Morgan Madhuku http://www.mdpi.com/1660-4601/13/7/664 Only 9% of Canadian children meet the National Guidelines of 60 min of daily moderate-to-vigorous intensity physical activity. The aim of this review is to assess the mid- and long-term effectiveness of physical activity interventions and their impact on cardiovascular risk factors in children. We assessed the success of interventions within three different categories: those using a behavioural and social approach, an informational approach or an environmental approach. The average number of children included in these studies was 860 (range of 30–5106); the age range was from 2 to 18 years; and the mean intervention duration was 1607 min (range of 12–8160 min). The length of follow-up post-intervention averaged 13 months (ranging from 0.25 to 96 months). A positive impact on physical activity was found in 74% and on any measured outcomes in 90% of the studies reviewed. However, the benefits of physical activity interventions decreased with longer follow-up. Regardless of the approaches, physical activity interventions improved cardiovascular risk factors. However, the challenge of any program is to maintain beneficial effects once the intervention is completed. These findings will inform the development of future intervention programs in order to optimize sustained cardiovascular benefits. International Journal of Environmental Research and Public Health 2016-06-30 13 7 Review 10.3390/ijerph13070664 664 1660-4601 2016-06-30 doi: 10.3390/ijerph13070664 Sally Nguyen Anna-Luisa Häcker Melanie Henderson Tracie Barnett Marie-Eve Mathieu Linda Pagani Jean-Luc Bigras http://www.mdpi.com/1660-4601/13/7/665 There is growing scientific and public recognition that human actions, directly and indirectly, have profoundly changed the Earth system, in a still accelerating process, increasingly called the "Anthropocene". Planetary transformation, including of the atmosphere, climate, ecosystems and biodiversity, has enormous implications for human health, many of which are deeply disturbing, especially in low-income settings. A few health consequences of the Anthropocene have been partially recognized, including within environmental epidemiology, but their long-term consequences remain poorly understood and greatly under-rated. For example Syria could be a "sentinel" population, giving a glimpse to a much wider dystopian future. Health-Earth is a research network, co-founded in 2014, which seeks, with other groups, to catalyse a powerful curative response by the wider health community. This paper builds on a symposium presented by Health-Earth members at the 2015 conference of the International Society for Environmental Epidemiology. It reviews and synthesizes parts of the large literature relevant to the interaction between the changing Earth system and human health. It concludes that this topic should be prominent within future environmental epidemiology and public health. Created by our species, these challenges may be soluble, but solutions require far more understanding and resources than are currently being made available. International Journal of Environmental Research and Public Health 2016-06-30 13 7 Article 10.3390/ijerph13070665 665 1660-4601 2016-06-30 doi: 10.3390/ijerph13070665 Colin Butler http://www.mdpi.com/1660-4601/13/7/660 Coronary artery disease (CAD) is a disease which has become a leading cause of death worldwide. The polymorphisms in Interleukin-17 (IL-17A), including rs2275913, rs3819024, rs3819025, rs3748067, rs8193037, rs4711998, and rs8193036, have been found to be probably associated with the risk of CAD. However, the results were inconsistent and inconclusive. The present study performed a meta-analysis to get a more precise and comprehensive estimation of the association between the IL-17A polymorphisms and CAD risk. The Pubmed, Embase, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, and Chinese Biomedical Literature Databases were searched for related studies. A total of six studies, including 3542 cases and 3212 controls, were identified for the meta-analysis. The main findings of the present meta-analysis show that the TT genotype of IL-17A rs3748067 is associated with a significant lower risk of CAD in the homozygous model odds ratio (OR) (OR = 0.37) in Asians. No significant association was found for rs2275913, rs3819024, rs3819025, rs8193037, rs4711998, and rs8193036 with CAD susceptibility in the overall analysis. However, subgroup analysis indicated a significant decreased risk of CAD for the GG genotype and G allele of rs2275913 in a small sample size group, and a higher risk of CAD for the GG genotype and G allele of rs8193037 in a heterozygous model (OR = 1.56), dominant model (OR = 1.54), and allelic model (OR = 1.47) in Asians. In conclusion, the current meta-analysis suggests a significant relationship between rs3748067, rs8193037, and CAD in Asians, while for rs2275913, rs3819024, rs3819025, rs4711998, rs8193036, no such relations were found. Thus, IL-17A rs3748067 and rs8193037 might be recommended as a predictor for susceptibility of CAD for Asians. However, the results of this meta-analysis are hypothesis-generating results which should be interpreted with caution because of the heterogeneity and publication bias among study designs. International Journal of Environmental Research and Public Health 2016-06-30 13 7 Article 10.3390/ijerph13070660 660 1660-4601 2016-06-30 doi: 10.3390/ijerph13070660 Mei-Hua Bao Huai-Qing Luo Ju Xiang Liang Tang Li-Ping Dong Guang-Yi Li Jie Zeng Jian-Ming Li http://www.mdpi.com/1660-4601/13/7/661 The aims of the study were to (1) describe how and why smokers start to vape and what products they use; (2) relate findings to the COM-B theory of behaviour change (three conditions are necessary for behaviour change (B): capability (C), opportunity (O), and motivation (M)); and (3) to consider implications for e-cigarette policy research. Semi-structured interviews (n = 30) were conducted in London, UK, with smokers or ex-smokers who were currently using or had used e-cigarettes. E-cigarette initiation (behaviour) was facilitated by: capability (physical capability to use an e-cigarette and psychological capability to understand that using e-cigarettes was less harmful than smoking); opportunity (physical opportunity to access e-cigarettes in shops, at a lower cost than cigarettes, and to vape in "smoke-free" environments, as well as social opportunity to vape with friends and family); and motivation (automatic motivation including curiosity, and reflective motivation, including self-conscious decision-making processes related to perceived health benefits). The application of the COM-B model identified multiple factors that may lead to e-cigarette initiation, including those that could be influenced by policy, such as price relative to cigarettes and use in smoke-free environments. The effects of these policies on initiation should be further investigated along with the possible moderating/mediating effects of social support. International Journal of Environmental Research and Public Health 2016-06-30 13 7 Article 10.3390/ijerph13070661 661 1660-4601 2016-06-30 doi: 10.3390/ijerph13070661 Elle Wadsworth Joanne Neale Ann McNeill Sara Hitchman http://www.mdpi.com/1660-4601/13/7/662 Animal manure is commonly used as fertilizer for agricultural crops worldwide, even though it is believed to contribute to the spread of antibiotic resistance from animal intestines to the soil environment. However, it is unclear whether and how there is any impact of manure fertilization on populations and community structure of antibiotic-resistant endophytic bacteria (AREB) in plant tissues. To investigate the effect of manure and organic fertilizer on endophytic bacterial communities, pot experiments were performed with pakchoi grown with the following treatments: (1) non-treated; (2) chicken manure-treated and (3) organic fertilizer-treated. Manure or organic fertilizer significantly increased the abundances of total cultivable endophytic bacteria (TCEB) and AREB in pakchoi, and the effect of chicken manure was greater than that of organic fertilizer. Further, 16S rDNA sequencing and the phylogenetic analysis indicated that chicken manure or organic fertilizer application increased the populations of multiple antibiotic-resistant bacteria (MARB) in soil and multiple antibiotic-resistant endophytic bacteria (MAREB) in pakchoi. The identical multiple antibiotic-resistant bacterial populations detected in chicken manure, manure- or organic fertilizer-amended soil and the vegetable endophytic system were Brevundimonas diminuta, Brachybacterium sp. and Bordetella sp., suggesting that MARB from manure could enter and colonize the vegetable tissues through manure fertilization. The fact that some human pathogens with multiple antibiotic resistance were detected in harvested vegetables after growing in manure-amended soil demonstrated a potential threat to human health. International Journal of Environmental Research and Public Health 2016-06-30 13 7 Article 10.3390/ijerph13070662 662 1660-4601 2016-06-30 doi: 10.3390/ijerph13070662 Qingxiang Yang Hao Zhang Yuhui Guo Tiantian Tian http://www.mdpi.com/1660-4601/13/7/655 Cigarette warning labels are important sources of risk information, but warning research for other tobacco products is limited. This study aimed to gauge perceptions about warnings that may be used for e-cigarettes. We conducted six small focus groups in late 2014/early 2015 with adult current e-cigarette users and cigarette-only smokers. Participants rated and discussed their perceptions of six e-cigarette warning statements, and warnings in two existing Vuse and MarkTen e-cigarette ads. Participants were open to e-cigarette warnings and provided the strongest reactions to statements warning that e-liquid/e-vapor or e-cigarettes can be poisonous, contain toxins, or are "not a safe alternative to smoking". However, many also noted that these statements were exaggerated, potentially misleading, and could scare smokers away from reducing their harm by switching to e-cigarettes. Opinions on the Food and Drug Administration's proposed nicotine addiction warning and warnings that e-cigarettes had not been approved for smoking cessation or had unknown health effects were mixed. Participants perceived MarkTen's advertisement warning to be stronger and more noticeable than Vuse's. Care should be taken in developing e-cigarette warnings given their relative recentness and potential for harm reduction compared to other tobacco products. Additional research, including with varied audiences, would be instructive. International Journal of Environmental Research and Public Health 2016-06-30 13 7 Article 10.3390/ijerph13070655 655 1660-4601 2016-06-30 doi: 10.3390/ijerph13070655 Olivia Wackowski David Hammond Richard O'Connor Andrew Strasser Cristine Delnevo http://www.mdpi.com/1660-4601/13/7/650 The number of asylum seekers arriving in Germany has increased rapidly since 2014 and cases of vaccine-preventable diseases at reception centres were reported. Asylum seekers 12 years and older arriving in Lower Saxony were serologically screened for antibodies against measles, rubella and varicella between November 2014 and October 2015. We calculated the seroprevalence from the screening data by disease, country of origin and age group and compared them to literature-based herd immunity thresholds in order to identify immunisation gaps. In total, 23,647 specimens were included in our study. Although the vast majority of asylum seekers tested positive for antibodies against measles, rubella and varicella, the seroprevalences were not sufficient to ensure herd immunity. The seroprevalences varied substantially between countries of origin and increased with age. Immunisation of asylum seekers against measles, rubella and varicella is needed and the detailed information on seroprevalences among subgroups of asylum seekers can be used for targeted immunisations at reception centres. International Journal of Environmental Research and Public Health 2016-06-30 13 7 Article 10.3390/ijerph13070650 650 1660-4601 2016-06-30 doi: 10.3390/ijerph13070650 Salla Toikkanen Armin Baillot Johannes Dreesman Elke Mertens http://www.mdpi.com/1660-4601/13/7/645 The management and treatment of adult asthma has been associated with utilization of health services. Objectives: First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents. Data Source: Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678). Study Design: Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable. Findings: Those with asthma are found more likely (OR 1.50, 95% CI 1.05–2.15) to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56–11.69) to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32–2.65) and hospitalization (OR 2.21, 95% CI 1.39–3.50), associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays. Conclusion: Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma patients are increasingly more likely to be characterized as frequent utilizers of both primary and emergency department care as the threshold for what constitutes frequent utilization increases. Investments in prevention and better management of the chronic condition may result in less demand for acute care services, especially among high frequency utilizers. International Journal of Environmental Research and Public Health 2016-06-30 13 7 Article 10.3390/ijerph13070645 645 1660-4601 2016-06-30 doi: 10.3390/ijerph13070645 Joshua Behr Rafael Diaz Muge Akpinar-Elci http://www.mdpi.com/1660-4601/13/7/648 Knowledge, attitude, and practice (KAP) are three key components for reducing the adverse health impacts of heat waves. However, research in eastern China regarding this is scarce. The present study aimed to evaluate the heat wave-related KAP of a population in Licheng in northeast China. This cross-sectional study included 2241 participants. Data regarding demographic characteristics, KAP, and heat illnesses were collected using a structured questionnaire. Univariate analysis and unconditional logistic regression models were used to analyze the data. Most residents had high KAP scores, with a mean score of 12.23 (standard deviation = 2.23) on a 17-point scale. Urban women and participants aged 35–44 years had relatively high total scores, and those with high education levels had the highest total score. There was an increased risk of heat-related illness among those with knowledge scores of 3–5 on an 8-point scale with mean score of 5.40 (standard deviation = 1.45). Having a positive attitude toward sunstroke prevention and engaging in more preventive practices to avoid heat exposure had a protective interaction effect on reducing the prevalence of heat-related illnesses. Although the KAP scores were relatively high, knowledge and practice were lacking to some extent. Therefore, governments should further develop risk-awareness strategies that increase awareness and knowledge regarding the adverse health impact of heat and help in planning response strategies to improve the ability of individuals to cope with heat waves. International Journal of Environmental Research and Public Health 2016-06-29 13 7 Article 10.3390/ijerph13070648 648 1660-4601 2016-06-29 doi: 10.3390/ijerph13070648 Jing Li Xin Xu Guoyong Ding Yun Zhao Ruixia Zhao Fuzhong Xue Jing Li Jinghong Gao Jun Yang Baofa Jiang Qiyong Liu http://www.mdpi.com/1660-4601/13/7/647 The meaning and influence of light to biomolecular interactions, and consequently to health, has been analyzed using the Resonant Recognition Model (RRM). The RRM proposes that biological processes/interactions are based on electromagnetic resonances between interacting biomolecules at specific electromagnetic frequencies within the infra-red, visible and ultra-violet frequency ranges, where each interaction can be identified by the certain frequency critical for resonant activation of specific biological activities of proteins and DNA. We found that: (1) the various biological interactions could be grouped according to their resonant frequency into super families of these functions, enabling simpler analyses of these interactions and consequently analyses of influence of electromagnetic frequencies to health; (2) the RRM spectrum of all analyzed biological functions/interactions is the same as the spectrum of the sun light on the Earth, which is in accordance with fact that life is sustained by the sun light; (3) the water is transparent to RRM frequencies, enabling proteins and DNA to interact without loss of energy; (4) the spectrum of some artificial sources of light, as opposed to the sun light, do not cover the whole RRM spectrum, causing concerns for disturbance to some biological functions and consequently we speculate that it can influence health. International Journal of Environmental Research and Public Health 2016-06-29 13 7 Article 10.3390/ijerph13070647 647 1660-4601 2016-06-29 doi: 10.3390/ijerph13070647 Irena Cosic Drasko Cosic Katarina Lazar http://www.mdpi.com/1660-4601/13/7/644 A well-designed open space that encourages outdoor activity and social communication is a community asset that could potentially contribute to the health of local residents and social harmony of the community. Numerous factors may influence the use of each single space and may result in a variety of visitors. Compared with previous studies that focused on accessibility, this study highlights the relationship between the utilization and characteristics of community open spaces in China. The Overseas Chinese Town community in Shenzhen is regarded as an example. The association between the number of visitors and space characteristics is examined with multivariate regression models. Results show that large areas with accessible lawns, well-maintained footpaths, seats, commercial facilities, and water landscapes are important characteristics that could increase the use of community open spaces. However, adding green vegetation, sculptures, and landscape accessories in open spaces has limited effects on increasing the outdoor activities of residents. Thus, to increase the use of community open spaces, landscape designers should focus more on creating user-oriented spaces with facilities that encourage active use than on improving ornamental vegetation and accessories. International Journal of Environmental Research and Public Health 2016-06-28 13 7 Article 10.3390/ijerph13070644 644 1660-4601 2016-06-28 doi: 10.3390/ijerph13070644 Yiyong Chen Tao Liu Xiaohuan Xie Barbara Marušić http://www.mdpi.com/1660-4601/13/7/643 Household air pollution (HAP) contributes to the global burden of disease. Our primary purpose was to determine whether HAP exposure was associated with reduced lung function and respiratory and non-respiratory symptoms in Belizean adults and children. Our secondary purpose was to investigate whether lifestyle (physical activity (PA) and fruit and vegetable consumption (FV)) is associated with reported symptoms. Belizean adults (n = 67, 19 Male) and children (n = 23, 6 Male) from San Ignacio Belize and surrounding areas participated in this cross-sectional study. Data collection took place at free walk-in clinics. Investigators performed initial screenings and administered questionnaires on (1) sources of HAP exposure; (2) reported respiratory and non-respiratory symptoms and (3) validated lifestyle questionnaires. Participants then performed pulmonary function tests (PFTs) and exhaled breath carbon monoxide (CO). There were no significant associations between HAP exposure and pulmonary function in adults. Increased exhaled CO was associated with a significantly lower forced expiratory volume in 1-s divided by forced vital capacity (FEV1/FVC) in children. Exposed adults experienced headaches, burning eyes, wheezing and phlegm production more frequently than unexposed adults. Adults who met PA guidelines were less likely to experience tightness and pressure in the chest compared to those not meeting guidelines. In conclusion, adults exposed to HAP experienced greater respiratory and non-respiratory symptoms, which may be attenuated by lifestyle modifications. International Journal of Environmental Research and Public Health 2016-06-28 13 7 Article 10.3390/ijerph13070643 643 1660-4601 2016-06-28 doi: 10.3390/ijerph13070643 Stephanie Kurti Allison Kurti Sam Emerson Richard Rosenkranz Joshua Smith Craig Harms Sara Rosenkranz http://www.mdpi.com/1660-4601/13/7/646 The title article [1] is a duplicate publication of [2].[...] International Journal of Environmental Research and Public Health 2016-06-28 13 7 Retraction 10.3390/ijerph13070646 646 1660-4601 2016-06-28 doi: 10.3390/ijerph13070646 International Journal of Environmental Research and Public Health Editorial Office http://www.mdpi.com/1660-4601/13/7/635 The relationship among the lysyl oxidase (LOX) G473A single nucleotide polymorphism (SNP), cigarette smoking and lung, colorectal, colon and rectum cancer susceptibility was studied in 200 cases of lung cancer, 335 cases of colorectal cancer including 130 cases of colon cancer and 205 cases of rectum cancer, and 335 healthy people in Tangshan, China. Peripheral blood DNA samples were collected, DNA sequencing and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) performed, followed by multivariate logistic regression analysis. In comparison to LOX473GG genotype carriers, individuals with LOX473AA exhibited a higher susceptibility to lung, colon-rectum, colon, and rectum cancers with OR values amounting to 3.84-, 2.74-, 2.75-, and 2.74-fold of the control, respectively. In the LOX 473AA-positive population, females were more susceptible than males to carcinogenesis with OR values (female vs. male): 5.25 vs. 3.23, 2.29 vs. 1.51, 2.27 vs. 1.45, and 2.25 vs. 1.53, respectively, for lung, colon-rectum combined, colon, and rectum cancers. LOX G473A polymorphism apparently elevated human sensitivity to cigarette smoking carcinogens for eliciting cancers in the lung and colon only. Thus, LOX G473A polymorphism positively correlates with carcinogenesis and it may be used as an ideal intrinsic biomarker for prediction or diagnosis of carcinogenesis in humans. International Journal of Environmental Research and Public Health 2016-06-28 13 7 Article 10.3390/ijerph13070635 635 1660-4601 2016-06-28 doi: 10.3390/ijerph13070635 Guoli Wang Yanqing Shen Guang Cheng Haimei Bo Jia Lin Maogen Zheng Jianmin Li Yinzhi Zhao Wande Li http://www.mdpi.com/1660-4601/13/7/641 The occurrence of waterborne parasites coupled with water parameters at various processing sites of two drinking water treatment plants (A and B) and seven distribution system (DS) sites in Sarawak, Malaysia were studied. Ten liters of water underwent immunomagnetic separation (IMS) technique to detect the presence of Giardia and Cryptosporidium (oo)cysts. The remaining supernatant was used to detect other parasites whilst 50 mL of water sample was each used in the detection of free-living amoebae and fecal coliforms. Sampled water was positive for Giardia (32.9%; 28/85), Cryptosporidium (18.8%; 16/85) followed by Spirometra ova-like (25.9%; 22/85), Blastocystis-like (25.9%; 22/85), nematode larvae-like (8.2%; 7/85) and Taenia ova-like (1.2%; 1/85). Meanwhile, 90.2% (55/61) samples were positive for Acanthamoeba and Naegleria via cultivation and of these, 11 isolates were confirmed as Acanthamoeba genotype T3 (5/7) and T4 (2/7) followed by Naegleria sp. (4/11), Naegleria italica (2/11), Naegleria australiensis (1/11), Naegleria angularis (1/11) and Vahlkampfia sp. (3/11). Cryptosporidium, Acanthamoeba and Naegleria were also detected in one of the seven tested DS sites. Only Giardia and Cryptosporidium showed significant correlations with fluoride and fecal coliforms. These results describe the occurrence of waterborne parasites that will assist key stakeholders in mitigating contamination at the specific sites. International Journal of Environmental Research and Public Health 2016-06-28 13 7 Article 10.3390/ijerph13070641 641 1660-4601 2016-06-28 doi: 10.3390/ijerph13070641 Reena Richard Init Ithoi Mohamad Abd Majid Wan Wan Sulaiman Tian Tan Veeranoot Nissapatorn Yvonne Lim http://www.mdpi.com/1660-4601/13/7/639 Public parks, salient locations for engaging populations in health promoting physical activity, are especially important in high-density cities. We used the System for Observing Physical Activity in Communities (SOPARC) to conduct the first-ever surveillance study of nine public parks in Hong Kong (288 observation sessions during 36 weekdays and 36 weekend days) and observed 28,585 visitors in 262 diverse areas/facilities. Parks were widely used throughout the day on weekdays and weekend days and across summer and autumn; visitor rates were among the highest seen in 24 SOPARC studies. In contrast to other studies where teens and children dominated park use, most visitors (71%) were adults and seniors. More males (61%) than females used the parks, and they dominated areas designed for sports. Over 60% of visitors were observed engaging in moderate-to-vigorous physical activity, a rate higher than other SOPARC studies. Facilities with user fees were less accessible than non-fee areas, but they provided relatively more supervised and organized activities. Assessing parks by age, gender, and physical activity can provide useful information relative to population health. This study not only provides information useful to local administrators for planning and programming park facilities relative to physical activity, but it also provides a baseline for comparison by other high-density cities. International Journal of Environmental Research and Public Health 2016-06-28 13 7 Article 10.3390/ijerph13070639 639 1660-4601 2016-06-28 doi: 10.3390/ijerph13070639 Bik Chow Thomas McKenzie Cindy Sit http://www.mdpi.com/1660-4601/13/7/640 The study reported here examined, as the research subject, surface soils in the Liuxin mining area of Xuzhou, and explored the heavy metal content and spectral data by establishing quantitative models with Multivariable Linear Regression (MLR), Generalized Regression Neural Network (GRNN) and Sequential Minimal Optimization for Support Vector Machine (SMO-SVM) methods. The study results are as follows: (1) the estimations of the spectral inversion models established based on MLR, GRNN and SMO-SVM are satisfactory, and the MLR model provides the worst estimation, with R2 of more than 0.46. This result suggests that the stress sensitive bands of heavy metal pollution contain enough effective spectral information; (2) the GRNN model can simulate the data from small samples more effectively than the MLR model, and the R2 between the contents of the five heavy metals estimated by the GRNN model and the measured values are approximately 0.7; (3) the stability and accuracy of the spectral estimation using the SMO-SVM model are obviously better than that of the GRNN and MLR models. Among all five types of heavy metals, the estimation for cadmium (Cd) is the best when using the SMO-SVM model, and its R2 value reaches 0.8628; (4) using the optimal model to invert the Cd content in wheat that are planted on mine reclamation soil, the R2 and RMSE between the measured and the estimated values are 0.6683 and 0.0489, respectively. This result suggests that the method using the SMO-SVM model to estimate the contents of heavy metals in wheat samples is feasible. International Journal of Environmental Research and Public Health 2016-06-28 13 7 Article 10.3390/ijerph13070640 640 1660-4601 2016-06-28 doi: 10.3390/ijerph13070640 Jihong Dong Wenting Dai Jiren Xu Songnian Li http://www.mdpi.com/1660-4601/13/7/642 The objective was to assess the transient association between air pollution and cardiac arrhythmia. Five databases were searched for studies investigating the association between daily increases in air pollutants (PM2.5, PM10, carbon monoxide, nitrogen dioxide, sulfur dioxide and ozone) and arrhythmia hospitalization or arrhythmia mortality. Two reviewers independently selected studies, extracted data, and assessed risk of bias. Outcomes were analyzed via a random-effects model and reported as relative risk and 95% confidence interval. 25 studies satisfied our inclusion criteria and 23 contributed to the meta-analysis. Arrhythmia hospitalization or mortality were associated with increases in PM2.5 (RR = 1.015 per 10 μg/m3, 95% CI: 1.006–1.024), PM10 (RR = 1.009 per 10 μg/m3, 95% CI: 1.004–1.014), carbon monoxide (RR = 1.041 per 1 ppm, 95% CI: 1.017–1.065), nitrogen dioxide (RR = 1.036 per 10 ppb, 95% CI: 1.020–1.053), and sulfur dioxide (RR = 1.021 per 10 ppb, 95% CI: 1.003–1.039), but not ozone (RR = 1.012 per 10 ppb, 95% CI: 0.997–1.027). Both particulate and gaseous components, with the exception of ozone, have a temporal association with arrhythmia hospitalization or mortality. Compared with Europe and North America, a stronger association was noted in Asia. International Journal of Environmental Research and Public Health 2016-06-28 13 7 Article 10.3390/ijerph13070642 642 1660-4601 2016-06-28 doi: 10.3390/ijerph13070642 Xuping Song Yu Liu Yuling Hu Xiaoyan Zhao Jinhui Tian Guowu Ding Shigong Wang http://www.mdpi.com/1660-4601/13/7/638 Globally, falls from height (FFH) are a substantial public health jeopardy and are among the important leading causes of serious and fatal injuries for construction workers. A comprehensive understanding of the causal factors in FFH incidents is urgently required; however, the literature appears to lack a scientific review of FFH. In this study, 297 articles that contribute to the topic of fall incidents were reviewed. Seventy-five (75) articles met the criteria for relevance and were aggregated in a database to support a critical review. A synthesis of macro-variables approach was adopted rather than a structured meta-analysis. Such a method of analysis provides the flexibility to combine previous studies' findings. The most common factors associated with FFH are risky activities, individual characteristics, site conditions, organizational characteristics, agents (scaffolds/ladders) and weather conditions. The outcomes contributed to identifying the most significant research area for safety enhancement by improving engineering facilities, behaviour investigations and FFH prevention methods. International Journal of Environmental Research and Public Health 2016-06-28 13 7 Review 10.3390/ijerph13070638 638 1660-4601 2016-06-28 doi: 10.3390/ijerph13070638 Evan Nadhim Carol Hon Bo Xia Ian Stewart Dongping Fang http://www.mdpi.com/1660-4601/13/7/637 Water, Sanitation and Hygiene (WASH) programs in schools can increase the health, dignity and comfort of students and teachers. Understanding the costs of WASH facilities and services in schools is one essential piece for policy makers to utilize when budgeting for schools and helping to make WASH programs more sustainable. In this study we collected data from NGO and government offices, local hardware shops and 89 rural primary schools across three Kenyan counties. Current expenditures on WASH, from school and external (NGO, government, parent) sources, averaged 1.83 USD per student per year. After reviewing current expenditures, estimated costs of operations and maintenance for bringing schools up to basic WASH standards, were calculated to be 3.03 USD per student per year. This includes recurrent costs, but not the cost of installing or setting up WASH infrastructure, which was 18,916 USD per school, for a school of 400 students (4.92 USD per student, per year). These findings demonstrate the need for increases in allocations to schools in Kenya, and stricter guidance on how money should be spent on WASH inputs to enable all schools to provide basic WASH for all students. International Journal of Environmental Research and Public Health 2016-06-27 13 7 Article 10.3390/ijerph13070637 637 1660-4601 2016-06-27 doi: 10.3390/ijerph13070637 Kelly Alexander Alex Mwaki Dorothy Adhiambo Malaika Cheney-Coker Richard Muga Matthew Freeman http://www.mdpi.com/1660-4601/13/7/636 Previous studies showed that C-reactive protein (CRP), an inflammatory marker, was associated with stroke severity and long-term outcome. However, the relationship between the acute-phase CRP level and discharge outcome has received little attention. We prospectively studied 301 patients with acute ischemic stroke (over a period of two weeks) from two hospital stroke wards and one rehabilitation department in Henan, China. Patients' demographic and clinical data were collected and evaluated at admission. Poor discharge outcome was assessed in patients at discharge using the Modified Rankin Scale (MRS > 2). Multivariate logistic regression analysis was performed to determine the risk factors of poor discharge outcome after adjusting for potential confounders. Poor discharge outcome was observed in 78 patients (25.9%). Univariate analyses showed that factors significantly influencing poor discharge outcome were age, residence, recurrent acute ischemic stroke, coronary heart disease, the National Institutes of Health Stroke Scale (NIHSS) score at admission, non-lacunar stroke, time from onset of stroke to admission, CRP, TBIL (total bilirubin), direct bilirubin (DBIL), ALB (albumin), FIB (fibrinogen) and D-dimer (p < 0.05). After adjusting for age, residence, recurrent ischemic stroke, coronary heart disease, NIHSS score at admission, lacunar stroke, time from onset of stroke to admission, CRP, TBIL, DBIL, ALB, FIB and D-dimer, multivariate logistic regression analyses revealed that poor outcome at discharge was associated with recurrent acute ischemic stroke (OR, 2.115; 95% CI, 1.094–4.087), non-lacunar stroke (OR, 2.943; 95% CI, 1.436–6.032), DBIL (OR, 1.795; 95% CI, 1.311–2.458), and CRP (OR, 4.890; 95% CI, 3.063–7.808). In conclusion, the CRP level measured at admission was found to be an independent predictor of poor outcome at discharge. Recurrent acute ischemic stroke, non-lacunar stroke and DBIL were also significantly associated with discharge outcome in acute ischemic stroke. International Journal of Environmental Research and Public Health 2016-06-27 13 7 Article 10.3390/ijerph13070636 636 1660-4601 2016-06-27 doi: 10.3390/ijerph13070636 He-Hong Geng Xin-Wang Wang Rong-Li Fu Meng-Juan Jing Ling-Ling Huang Qing Zhang Xiao-Xiao Wang Pei-Xi Wang http://www.mdpi.com/1660-4601/13/7/634 Speeding is a major contributing factor to traffic crashes and frequently happens in areas where there is a mutation in speed limits, such as the transition zones that connect urban areas from rural areas. The purpose of this study is to investigate the effects of an in-vehicle audio warning system and lit speed limit sign on preventing drivers' speeding behavior in transition zones. A high-fidelity driving simulator was used to establish a roadway network with the transition zone. A total of 41 participants were recruited for this experiment, and the driving speed performance data were collected from the simulator. The experimental results display that the implementation of the audio warning system could significantly reduce drivers' operating speed before they entered the urban area, while the lit speed limit sign had a minimal effect on improving the drivers' speed control performance. Without consideration of different types of speed limit signs, it is found that male drivers generally had a higher operating speed both upstream and in the transition zones and have a larger maximum deceleration for speed reduction than female drivers. Moreover, the drivers who had medium-level driving experience had the higher operating speed and were more likely to have speeding behaviors in the transition zones than those who had low-level and high-level driving experience in the transition zones. International Journal of Environmental Research and Public Health 2016-06-25 13 7 Article 10.3390/ijerph13070634 634 1660-4601 2016-06-25 doi: 10.3390/ijerph13070634 Xuedong Yan Jiali Wang Jiawei Wu http://www.mdpi.com/1660-4601/13/7/631 Waste management, namely, collection, transport, sorting and processing, and disposal, is an issue of social concern owing to its environmental impact and effects on public health. In fact, waste management activities are carried out according to procedures that can have various negative effects on the environment and, potentially, on human health. The aim of our study was to assess the potential effects on respiratory health of this exposure in workers in the waste management and disposal field, as compared with a group of workers with no occupational exposure to outdoor pollutants. The sample consisted of a total of 124 subjects, 63 waste collectors, and 61 office clerks. Informed consent was obtained from all subjects before inclusion in the study. The entire study population underwent pulmonary function assessments with spirometry and completed two validated questionnaires for the diagnosis of rhinitis and chronic bronchitis. Statistical analyses were performed using STATA 13. Spirometry showed a statistically significant reduction in the mean Tiffenau Index values in the exposed workers, as compared with the controls, after adjusting for the confounding factors of age, BMI, and smoking habit. Similarly, the mean FEV1 values were lower in the exposed workers than in the controls, this difference being again statistically significant. The FVC differences measured in the two groups were not found to be statistically significant. We ran a cross-sectional study to investigate the respiratory health of a group of workers in the solid waste collection and disposal field as compared with a group of office workers. In agreement with most of the data in the literature, our findings support the existence of a prevalence of respiratory deficits in waste disposal workers. Our data suggest the importance of adopting preventive measures, such as wearing specific individual protection devices, to protect this particular category of workers from adverse effects on respiratory health. International Journal of Environmental Research and Public Health 2016-06-24 13 7 Article 10.3390/ijerph13070631 631 1660-4601 2016-06-24 doi: 10.3390/ijerph13070631 Luigi Vimercati Antonio Baldassarre Maria Gatti Luigi De Maria Antonio Caputi Angelica Dirodi Francesco Cuccaro Raffaello Bellino http://www.mdpi.com/1660-4601/13/7/633 Endophytes are ubiquitous in plants, and they may have a natural capacity to biodegrade polycyclic aromatic hydrocarbons (PAHs). In our study, a phenanthrene-degrading endophytic Paenibacillus sp. PHE-3 was isolated from P. asiatica L. grown in a PAH-contaminated site. The effects of environmental variables on phenanthrene biodegradation by strain PHE-3 were studied, and the ability of strain PHE-3 to use high molecular weight PAH (HMW-PAH) as a sole carbon source was also evaluated. Our results indicated that pH value of 4.0–8.0, temperature of 30 °C–42 °C, initial phenanthrene concentration less than 100 mg·L−1, and some additional nutrients are favorable for the biodegradation of phenanthrene by strain PHE-3. The maximum biodegradation efficiency of phenanthrene was achieved at 99.9% after 84 h cultivation with additional glutamate. Moreover, the phenanthrene biodegradation by strain PHE-3 was positively correlated with the catechol 2,3-dioxygenase activity (ρ = 0.981, p < 0.05), suggesting that strain PHE-3 had the capability of degrading HMW-PAHs. In the presence of other 2-, 3-ringed PAHs, strain PHE-3 effectively degraded HMW-PAHs through co-metabolism. The results of this study are beneficial in that the re-colonization potential and PAH degradation performance of endophytic Paenibacillus sp. PHE-3 may be applied towards reducing PAH contamination in plants. International Journal of Environmental Research and Public Health 2016-06-24 13 7 Article 10.3390/ijerph13070633 633 1660-4601 2016-06-24 doi: 10.3390/ijerph13070633 Xuezhu Zhu Li Jin Kai Sun Shuang Li Wanting Ling Xuelin Li http://www.mdpi.com/1660-4601/13/7/632 This study proposes an inventory analysis method to evaluate the greenhouse gas (GHG) emissions from Portland cement concrete pavement construction, based on a case project in the west of China. The concrete pavement construction process was divided into three phases, namely raw material production, concrete manufacture and pavement onsite construction. The GHG emissions of the three phases are analyzed by a life cycle inventory method. The CO2e is used to indicate the GHG emissions. The results show that for 1 km Portland cement concrete pavement construction, the total CO2e is 8215.31 tons. Based on the evaluation results, the CO2e of the raw material production phase is 7617.27 tons, accounting for 92.7% of the total GHG emissions; the CO2e of the concrete manufacture phase is 598,033.10 kg, accounting for 7.2% of the total GHG emissions. Lastly, the CO2e of the pavement onsite construction phase is 8396.59 kg, accounting for only 0.1% of the total GHG emissions. The main greenhouse gas is CO2 in each phase, which accounts for more than 98% of total emissions. N2O and CH4 emissions are relatively insignificant. International Journal of Environmental Research and Public Health 2016-06-24 13 7 Article 10.3390/ijerph13070632 632 1660-4601 2016-06-24 doi: 10.3390/ijerph13070632 Feng Ma Aimin Sha Panpan Yang Yue Huang http://www.mdpi.com/1660-4601/13/7/630 Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient. International Journal of Environmental Research and Public Health 2016-06-24 13 7 Article 10.3390/ijerph13070630 630 1660-4601 2016-06-24 doi: 10.3390/ijerph13070630 Yi-Kai Juan Yu-Ching Cheng Yeng-Horng Perng Daniel Castro-Lacouture http://www.mdpi.com/1660-4601/13/7/628 Background: Undergoing a routine medical examination may be associated with the prevalence rate of chronic diseases from a population-based household interview survey. However, this important issue has not been examined so far. Methods: Data came from the first health service household interview of Hunan province, China, in 2013. A Rao–Scott chi-square test was performed to examine the difference in prevalence rates between subgroups. Adjusted odds ratio (OR) was calculated using the PROC SURVEYLOGISTIC procedure of SAS9.1 statistical software. Results: In total, 24,282 residents of 8400 households were surveyed. A higher proportion of elderly adults had undergone a medical examination within the prior 12 months compared with young adults (≥65 years, 60%; 45–64 years, 46%; 18–44 years, 37%). After controlling for location, sex, and household income per capita, undergoing a medical examination was significantly associated with high prevalence rates of hypertension (adjusted OR: 2.0, 95% CI: 1.1–3.5) and of diabetes mellitus (adjusted OR: 3.3, 95% CI: 1.7–6.5) for young adults aged 18–44 years. The associations were not statistically significant for age groups 45–64 years and 65 years or older. Conclusion: The prevalence rates of hypertension and diabetes mellitus may be seriously underestimated for young adults not undergoing a routine medical examination in a health household interview survey. International Journal of Environmental Research and Public Health 2016-06-23 13 7 Article 10.3390/ijerph13070628 628 1660-4601 2016-06-23 doi: 10.3390/ijerph13070628 Lin Zhang Wei Zhang Lingling Zhang Danping Tian Li Li Xin Deng Jing Deng Peishan Ning Guoqing Hu http://www.mdpi.com/1660-4601/13/7/629 Although there have been numerous studies examining the toxicity and carcinogenicity of nickel compounds in humans and animals, its molecular mechanisms of action are not fully elucidated. In our research, NIH/3T3 cells were exposed to nickel-refining fumes at the concentrations of 0, 6.25, 12.50, 25, 50 and 100 μg/mL for 24 h. Cell viability, cell apoptosis, reactive oxygen species (ROS) level, lactate dehydrogenase (LDH) assay, the level of glutathione (GSH), activities of superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA) level were detected. The exposure of NIH/3T3 cells to nickel-refining fumes significantly reduced cell viability and induced cell apoptotic death in a dose-dependent manner. Nickel-refining fumes significantly increased ROS levels and induced DNA damage. Nickel-refining fumes may induce the changes in the state of ROS, which may eventually initiate oxidative stress, DNA damage and apoptosis of NIH/3T3 cells. International Journal of Environmental Research and Public Health 2016-06-23 13 7 Article 10.3390/ijerph13070629 629 1660-4601 2016-06-23 doi: 10.3390/ijerph13070629 Yue Wang Sheng-Yuan Wang Li Jia Lin Zhang Jing-Chong Ba Dan Han Cui-Ping Yu Yong-Hui Wu http://www.mdpi.com/1660-4601/13/7/627 There have been relatively few opportunities to examine the cardiovascular effects of an extreme air pollution event in China. We aimed to examine the impact of the 2013 Eastern China Smog occurring from 2 to 9 December 2013, on outpatient visits for coronary heart diseases (CHD) in a typical hospital in Shanghai, China. We used the over-dispersed, generalized additive model to estimate the relative risk (RR) of the 2013 Eastern China Smog on the outpatient visits by comparing the smog period (2–9 December 2013; 8 days) to the non-smog period (1 November–1 December 2013, and 10 December–28 February 2014; 112 days). This model also controlled for time trends, days of the week, holidays, and meteorological factors. A stratification analysis was performed to estimate sex- and age-specific RRs. The daily average PM2.5 (fine particulate matter with an aerodynamic diameter less than 2.5 μm) concentrations during the smog period were 212 μg/m3, which were three times higher than during the non-smog period (76 μg/m3). The smog in Eastern China in 2013 was significantly associated with an increased risk of outpatient visits for CHD. For example, the RR was 1.18 (95% CI: 1.04, 1.32) on lag 0 day. There were similar effects on males and females. Our analyses provided preliminary evidence that smog constituted a significant risk factor of CHD in China. International Journal of Environmental Research and Public Health 2016-06-23 13 7 Article 10.3390/ijerph13070627 627 1660-4601 2016-06-23 doi: 10.3390/ijerph13070627 Fang Huang Renjie Chen Yuetian Shen Haidong Kan Xingya Kuang http://www.mdpi.com/1660-4601/13/7/625 The purpose of this study was to investigate the effect of two-hour exposure to a forest environment on cytokine, anti-oxidant and stress levels among university students and to compare the results to those measured in urban environments. Forty-one subjects were recruited. For our crossover design, subjects were divided into two groups based on similar demographic characteristics. Group A remained in the urban environment and was asked to perform regular breathing for 2 h. Blood samples were collected and the serum levels of cytokines including interleukin-6 (IL-6), IL-8, tumor necrosis factor-α (TNF-α), and glutathione peroxidase (GPx) were examined. Subjects were moved to a small town in a rural area for an equal amount of time to exclude carryover effects, and then remained for another 2 h in a forest environment. The second set of blood samples was collected to assess the effect of exposure to the forest environment. Using the same method, Group B was first exposed to the forest environment, followed by exposure to the urban environment. Blood samples collected after the subjects were exposed to the forest environment showed significantly lower levels of IL-8 and TNF-α compared to those in samples collected after urban environment exposure (10.76 vs. 9.21, t = 4.559, p < 0.001, and 0.97 vs. 0.87, t = 4.130, p < 0.001). The GPx concentration increased significantly after exposure to the forest environment (LnGPx = 5.09 vs. LnGPx = 5.21, t = −2.039, p < 0.05). International Journal of Environmental Research and Public Health 2016-06-23 13 7 Article 10.3390/ijerph13070625 625 1660-4601 2016-06-23 doi: 10.3390/ijerph13070625 Su Im Han Choi Yo-Han Jeon Min-Kyu Song Won Kim Jong-Min Woo http://www.mdpi.com/1660-4601/13/7/626 Malaria and iron-deficient anemia during pregnancy pose considerable risks for the mother and newborn. Intermittent Preventive Treatment during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) and iron supplement to prevent anemia to all pregnant women receiving antenatal care (ANC) services is highly recommended. However, their compliance remains low. This study aimed at identifying factors influencing non-compliance of medications among pregnant women. A descriptive cross-sectional study was conducted in Simiyu region in northwest Tanzania using a structured questionnaire to collect data from 430 women who were pregnant or gave birth 12 months prior to data collection. Data were analyzed using non-parametric statistical analysis with STATA 10. Overall, 284 (66%) and 195 (45%) of interviewed women received IPTp-SP and iron supplementation during their ANC visits, respectively. The majority (85%) of women whom received medications were aware if they had received IPTp-SP or iron supplementation. Of those received IPTp-SP, only 11% took all the three doses, while the remaining 89% took only two doses or one dose. For women who received iron supplementation, 29% reported that they did not take any dose at all. Reasons given for not complying with regiments included not liking the medications and disapproval from male partners. Our findings suggest that IPTp-SP and iron supplement compliance among pregnant women in Simiyu region is low. Intensification of community education, further qualitative research and administration of medication through directly-observed therapy (DOT) are recommended to address the problem. International Journal of Environmental Research and Public Health 2016-06-23 13 7 Article 10.3390/ijerph13070626 626 1660-4601 2016-06-23 doi: 10.3390/ijerph13070626 Benatus Sambili Ronald Kimambo Yun Peng Elison Ishunga Edna Matasha Godfrey Matumu Rita Noronha David Ngilangwa http://www.mdpi.com/1660-4601/13/6/623 Certain attitudes toward suicide may be a risk factor for suicide among the bereaved. To explore this possibility, we examined the relationship between attitudes toward suicide and family history of suicide. We focused on two specific attitudes indicating resignation in a survey: #1 "When a person chooses to die by suicide, the suicide is inevitable" (i.e., inevitability belief); and #2 "A suicide cannot be stopped by any person, because suicide is unpreventable" (i.e., unpreventable belief). The data of 5117 fully completed questionnaires were analyzed. Logistic regression analysis revealed that the two attitudes of resignation were significantly associated with a family history of suicide. The adjusted odds ratio for #1 was 1.39 (95% CI, 1.07–1.79) for individuals having experienced suicide by a family member or relative, while that for #2 was 1.57 (95% CI, 1.27–1.95) for experiencing a suicide by a family member or relative and 1.25 (95% CI, 1.05–1.49) for experiencing a suicide by a friend, business associate, partner or other. These two attitudes of resignation toward suicide were significantly associated with a family history of suicide. These attitudes might increase suicide risk among the bereaved. International Journal of Environmental Research and Public Health 2016-06-22 13 6 Article 10.3390/ijerph13060623 623 1660-4601 2016-06-22 doi: 10.3390/ijerph13060623 Teruomi Tsukahara Hiroaki Arai Tomoko Kamijo Yoshikiyo Kobayashi Shinsuke Washizuka Heihachiro Arito Tetsuo Nomiyama http://www.mdpi.com/1660-4601/13/6/622 In this paper, we assume that a professional pollutant treatment enterprise treats all of the pollutants emitted by multiple small and medium-sized enterprises (SMEs). In order to determine the treatment price, SMEs can bargain with the pollutant treatment enterprise individually, or through forming alliances. We propose a bargaining game model of centralized pollutant treatment to study how the pollutant treatment price is determined through negotiation. Then, we consider that there is a moral hazard from SMEs in centralized pollutant treatment; in other words, they may break their agreement concerning their quantities of production and pollutant emissions with the pollutant treatment enterprise. We study how the pollutant treatment enterprise can prevent this by pricing mechanism design. It is found that the pollutant treatment enterprise can prevent SMEs' moral hazard through tiered pricing. If the marginal treatment cost of the pollutant treatment enterprise is a constant, SMEs could bargain with the pollutant treatment enterprise individually, otherwise, they should form a grand alliance to bargain with it as a whole. International Journal of Environmental Research and Public Health 2016-06-22 13 6 Article 10.3390/ijerph13060622 622 1660-4601 2016-06-22 doi: 10.3390/ijerph13060622 Yuyu Li Bo Huang Fengming Tao http://www.mdpi.com/1660-4601/13/6/624 Infant and neonatal mortality indicators are known to vary geographically, possibly as a result of socioeconomic and environmental inequalities. To better understand how these factors contribute to spatial and temporal patterns, we conducted a French ecological study comparing two time periods between 2002 and 2009 for three (purposefully distinct) Metropolitan Areas (MAs) and the city of Paris, using the French census block of parental residence as the geographic unit of analysis. We identified areas of excess risk and assessed the role of neighborhood deprivation and average nitrogen dioxide concentrations using generalized additive models to generate maps smoothed on longitude and latitude. Comparison of the two time periods indicated that statistically significant areas of elevated infant and neonatal mortality shifted northwards for the city of Paris, are present only in the earlier time period for Lille MA, only in the later time period for Lyon MA, and decrease over time for Marseille MA. These city-specific geographic patterns in neonatal and infant mortality are largely explained by socioeconomic and environmental inequalities. Spatial analysis can be a useful tool for understanding how risk factors contribute to disparities in health outcomes ranging from infant mortality to infectious disease—a leading cause of infant mortality. International Journal of Environmental Research and Public Health 2016-06-22 13 6 Article 10.3390/ijerph13060624 624 1660-4601 2016-06-22 doi: 10.3390/ijerph13060624 Cindy Padilla Wahida Kihal-Talantikit Verónica Vieira Séverine Deguen http://www.mdpi.com/1660-4601/13/6/619 Background: Humans and animals are continuously exposed to a number of environmental substances that act as endocrine disruptors (EDs). While a growing body of evidence is available to prove their adverse health effects, very little is known about the consequences of simultaneous exposure to a combination of such chemicals; Methods: Here, we used an in vitro model to demonstrate how exposure to bisphenol A, zearalenone, arsenic, and 4-methylbenzylidene camphor, alone or in combination, affect estrogen receptor β (ERβ) mRNA expression in primary cerebellar cell cultures. Additionally, we also show the modulatory role of intrinsic biological factors, such as estradiol (E2), triiodo-thyronine (T3), and glial cells, as potential effect modulators; Results: Results show a wide diversity in ED effects on ERβ mRNA expression, and that the magnitude of these ED effects highly depends on the presence or absence of E2, T3, and glial cells; Conclusion: The observed potency of the EDs to influence ERβ mRNA expression, and the modulatory role of E2, T3, and the glia suggests that environmental ED effects may be masked as long as the hormonal milieu is physiological, but may tend to turn additive or superadditive in case of hormone deficiency. International Journal of Environmental Research and Public Health 2016-06-22 13 6 Article 10.3390/ijerph13060619 619 1660-4601 2016-06-22 doi: 10.3390/ijerph13060619 Gergely Jocsak David Kiss Istvan Toth Greta Goszleth Tibor Bartha Laszlo Frenyo Tamas Horvath Attila Zsarnovszky http://www.mdpi.com/1660-4601/13/6/621 Coarse particle matter, PMcoarse, is associated with increased respiratory morbidity and mortality. The aim of this study was to investigate the association between short-term changes in PMcoarse and sub-clininal airway inflammation in children. Healthy children aged 11 years from two northern Swedish elementary schools underwent fraction of exhaled nitrogen oxide (FENO) measurements to determine levels of airway inflammation twice weekly during the study period from 11 April–6 June 2011. Daily exposure to PMcoarse, PM2.5, NO2, NOx, NO and O3 and birch pollen was estimated. Multiple linear regression was used. Personal covariates were included as fixed effects and subjects were included as a random effect. In total, 95 children participated in the study, and in all 493 FENO measurements were made. The mean level of PMcoarse was 16.1 μg/m3 (range 4.1–42.3), and that of O3 was 75.0 μg/m3 (range: 51.3–106.3). That of NO2 was 17.0 μg/m3 (range: 4.7–31.3), NOx was 82.1 μg/m3 (range: 13.3–165.3), and NO was 65 μg/m3 (range: 8.7–138.4) during the study period. In multi-pollutant models an interquartile range increase in 24 h PMcoarse was associated with increases in FENO by between 6.9 ppb (95% confidence interval 0.0–14) and 7.3 ppb (95% confidence interval 0.4–14.9). PMcoarse was associated with an increase in FENO, indicating sub-clinical airway inflammation in healthy children. International Journal of Environmental Research and Public Health 2016-06-22 13 6 Article 10.3390/ijerph13060621 621 1660-4601 2016-06-22 doi: 10.3390/ijerph13060621 Hanne Carlsen Peter Boman Bodil Björ Anna-Carin Olin Bertil Forsberg http://www.mdpi.com/1660-4601/13/6/618 Compassion fatigue (CF) is stress resulting from exposure to a traumatized individual. CF has been described as the convergence of secondary traumatic stress (STS) and cumulative burnout (BO), a state of physical and mental exhaustion caused by a depleted ability to cope with one's everyday environment. Professionals regularly exposed to the traumatic experiences of the people they service, such as healthcare, emergency and community service workers, are particularly susceptible to developing CF. This can impact standards of patient care, relationships with colleagues, or lead to more serious mental health conditions such as posttraumatic stress disorder (PTSD), anxiety or depression. A systematic review of the effectiveness of interventions to reduce CF in healthcare, emergency and community service workers was conducted. Thirteen relevant studies were identified, the majority of which were conducted on nurses (n = 10). Three included studies focused on community service workers (social workers, disability sector workers), while no studies targeting emergency service workers were identified. Seven studies reported a significant difference post-intervention in BO (n = 4) or STS (n = 3). This review revealed that evidence of the effectiveness of CF interventions in at-risk health and social care professions is relatively recent. Therefore, we recommend more research to determine how best to protect vulnerable workers at work to prevent not only CF, but also the health and economic consequences related to the ensuing, and more disabling, physical and mental health outcomes. International Journal of Environmental Research and Public Health 2016-06-22 13 6 Review 10.3390/ijerph13060618 618 1660-4601 2016-06-22 doi: 10.3390/ijerph13060618 Fiona Cocker Nerida Joss http://www.mdpi.com/1660-4601/13/6/620 It is not clear whether between-country health inequity in Sub-Saharan Africa has been reduced over time due to economic development and increased foreign investments. We used the World Health Organization's data about 46 nations in Sub-Saharan Africa to test if under-5 mortality rate (U5MR) and life expectancy (LE) converged or diverged from 1990 to 2011. We explored whether the standard deviation of selected health indicators decreased over time (i.e., sigma convergence), and whether the less developed countries moved toward the average level in the group (i.e., beta convergence). The variation of U5MR between countries became smaller from 1990 to 2001. Yet this sigma convergence trend did not continue after 2002. Life expectancy in Africa from 1990–2011 demonstrated a consistent convergence trend, even after controlling for initial differences of country-level factors. The lack of consistent convergence in U5MR partially resulted from the fact that countries with higher U5MR in 1990 eventually performed better than those countries with lower U5MRs in 1990, constituting a reversal in between-country health inequity. Thus, international aid agencies might consider to reassess the funding priority about which countries to invest in, especially in the field of early childhood health. International Journal of Environmental Research and Public Health 2016-06-22 13 6 Article 10.3390/ijerph13060620 620 1660-4601 2016-06-22 doi: 10.3390/ijerph13060620 Jiajie Jin Di Liang Lu Shi Jiayan Huang http://www.mdpi.com/1660-4601/13/6/617 The sediment microbial community in downstream-linked lakes can be affected by the operation of large-scale water conservancy projects. The present study determined Illumina reads (16S rRNA gene amplicons) to analyze and compare the bacterial communities from sediments in Dongting Lake (China) before and after impoundment of the Three Gorges Dam (TGD), the largest hydroelectric project in the world. Bacterial communities in sediment samples in Dongting Lake before impoundment of the TGD (the high water period) had a higher diversity than after impoundment of the TGD (the low water period). The most abundant phylum in the sediment samples was Proteobacteria (36.4%–51.5%), and this result was due to the significant abundance of Betaproteobacteria and Deltaproteobacteria in the sediment samples before impoundment of the TGD and the abundance of Gammaproteobacteria in the sediment samples after impoundment of the TGD. In addition, bacterial sequences of the sediment samples are also affiliated with Acidobacteria (11.0% on average), Chloroflexi (10.9% on average), Bacteroidetes (6.7% on average), and Nitrospirae (5.1% on average). Variations in the composition of the bacterial community within some sediment samples from the river estuary into Dongting Lake were related to the pH values. The bacterial community in the samples from the three lake districts of Dongting Lake before and after impoundment of the TGD was linked to the nutrient concentration. International Journal of Environmental Research and Public Health 2016-06-21 13 6 Article 10.3390/ijerph13060617 617 1660-4601 2016-06-21 doi: 10.3390/ijerph13060617 Wei Huang Xia Jiang http://www.mdpi.com/1660-4601/13/6/616 Perceptions of intergroup threat have been related to both experiences of physiological stress responses and derogation of the outgroup. In this study, a neuroscience perspective was used to investigate the relationship between stress and opportunity to derogate the outgroup, in a threatening intergroup context. Research from a social identity perspective suggests that engaging in outgroup derogation alleviates stress when perceiving an intergroup threat. However, in line with the model of intergroup anxiety, opportunity to derogate could exacerbate the negative connotations of a threatening situation, resulting in more stress. Canadian participants (N = 110) were exposed to text describing either discriminatory or favorable comments expressed by Chinese individuals towards Canadians. Half of the participants were given the opportunity to derogate via a bias task. Salivary cortisol was used as a measure of stress and was collected at baseline, post-threat, and post-derogation. As expected, threatening identity led to more stress as evidenced by increased cortisol concentrations. Furthermore, threatened participants who had an opportunity to derogate showed greater cortisol concentrations than those who did not. These results demonstrate a link between stress and the opportunity to derogate, and highlights the value of using biological markers within the intergroup context. Rewrite abstract to remove all the references (they are meaningless because the abstracting services will use the abstract as is but will not provide the references so their presence is useless. International Journal of Environmental Research and Public Health 2016-06-21 13 6 Article 10.3390/ijerph13060616 616 1660-4601 2016-06-21 doi: 10.3390/ijerph13060616 Sinthujaa Sampasivam Katherine Collins Catherine Bielajew Richard Clément http://www.mdpi.com/1660-4601/13/6/614 Childhood obesity is complex and requires a 'systems approach' that collectively engages across multiple community settings. Sustainable Childhood Obesity Prevention through Community Engagement (SCOPE) has implemented Live 5-2-1-0—a multi-sector, multi-component childhood obesity prevention initiative informed by systems thinking and participatory research via an innovative knowledge translation (KT) model (RE-FRAME). This paper describes the protocol for implementing and evaluating RE-FRAME in two 'existing' (>2 years of implementation) and two 'new' Live 5-2-1-0 communities to understand how to facilitate and sustain systems/community-level change. In this mixed-methods study, RE-FRAME was implemented via online resources, webinars, a backbone organization (SCOPE) coordinating the initiative, and a linking system supporting KT. Qualitative and quantitative data were collected using surveys and stakeholder interviews, analyzed using thematic analysis and descriptive statistics, respectively. Existing communities described the consistency of Live 5-2-1-0 and extensive local partnerships/champions as catalysts for synergistic community-wide action; new communities felt that the simplicity of the message combined with the transfer of experiential learning would inform their own strategies and policies/programs to broadly disseminate Live 5-2-1-0. RE-FRAME effectively guided the refinement of the initiative and provided a framework upon which evaluation results described how to implement a community-based systems approach to childhood obesity prevention. International Journal of Environmental Research and Public Health 2016-06-21 13 6 Article 10.3390/ijerph13060614 614 1660-4601 2016-06-21 doi: 10.3390/ijerph13060614 Shazhan Amed Stephanie Shea Susan Pinkney Joan Wharf Higgins Patti-Jean Naylor http://www.mdpi.com/1660-4601/13/6/615 Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers' role in the treatment adherence of children and adolescents living with HIV (CALHIV). Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors. International Journal of Environmental Research and Public Health 2016-06-21 13 6 Article 10.3390/ijerph13060615 615 1660-4601 2016-06-21 doi: 10.3390/ijerph13060615 Maria Cruz Claudete Cardoso Mariana Darmont Paulo Dickstein Francisco Bastos Edvaldo Souza Solange Andrade Marcia Fabbro Rosana Fonseca Simone Monteiro http://www.mdpi.com/1660-4601/13/6/613 Background: Air pollution has become a major global public health problem. A number of studies have confirmed the association between air pollutants and emergency room (ER) visits for respiratory diseases in developed countries and some Asian countries, but little evidence has been seen in Western China. This study aims to concentrate on this region. Methods: A time-series analysis was used to examine the specific effects of major air pollutants (PM10, SO2 and NO2) on ER visits for respiratory diseases from 2007 to 2011 in the severely polluted city of Lanzhou. We examined the effects of air pollutants for stratified groups by age and gender, accounting for the modifying effect of dust storms in spring to test the possible interaction. Results: Significant associations were found between outdoor air pollution concentrations and respiratory diseases, as expressed by daily ER visits in Lanzhou in the spring dust season. The association between air pollution and ER visits appeared to be more evident on dust days than non-dust days. Relative risks (RRs) and 95% CIs per 10 µg/m3 increase in 3-day PM10 (L3), 5-day SO2 (L5), and the average of current and previous 2-day NO2 (L01) were 1.140 (1.071–1.214), 1.080 (0.967–1.205), and 1.298 (1.158–1.454), respectively, on dust days. More significant associations between PM10, SO2 and NO2 and ER visits were found on dust days for elderly females, elderly males and adult males, respectively. Conclusions: This study strengthens the evidence of dust-exacerbated ER visits for respiratory diseases in Lanzhou. International Journal of Environmental Research and Public Health 2016-06-21 13 6 Article 10.3390/ijerph13060613 613 1660-4601 2016-06-21 doi: 10.3390/ijerph13060613 Yuxia Ma Bingshuang Xiao Chang Liu Yuxin Zhao Xiaodong Zheng http://www.mdpi.com/1660-4601/13/6/611 Background: Few studies have used GPS data to analyze the relationship between Walk Score, transportation choice and walking. Additionally, the influence of Walk Score is understudied using trips rather than individuals as statistical units. The purpose of this study is to examine associations at the trip level between Walk Score, transportation mode choice, and walking among Paris adults who were tracked with GPS receivers and accelerometers in the RECORD GPS Study. Methods: In the RECORD GPS Study, 227 participants were tracked during seven days with GPS receivers and accelerometers. Participants were also surveyed with a GPS-based web mapping application on their activities and transportation modes for all trips (6969 trips). Walk Score, which calculates neighborhood walkability, was assessed for each origin and destination of every trip. Multilevel logistic and linear regression analyses were conducted to estimate associations between Walk Score and walking in the trip or accelerometry-assessed number of steps for each trip, after adjustment for individual/neighborhood characteristics. Results: The mean overall Walk Scores for trip origins were 87.1 (SD = 14.4) and for trip destinations 87.1 (SD = 14.5). In adjusted trip-level associations between Walk Score and walking only in the trip, we found that a walkable neighborhood in the trip origin and trip destination was associated with increased odds of walking in the trip assessed in the survey. The odds of only walking in the trip were 3.48 (95% CI: 2.73 to 4.44) times higher when the Walk Score for the trip origin was "Walker's Paradise" compared to less walkable neighborhoods (Very/Car-Dependent or Somewhat Walkable), with an identical independent effect of trip destination Walk Score on walking. The number of steps per 10 min (as assessed with accelerometry) was cumulatively higher for trips both originating and ending in walkable neighborhoods (i.e., "Very Walkable"). Conclusions: Walkable neighborhoods were associated with increases in walking among adults in Paris, as documented at the trip level. Creating walkable neighborhoods (through neighborhood design increased commercial activity) may increase walking trips and, therefore, could be a relevant health promotion strategy to increase physical activity. International Journal of Environmental Research and Public Health 2016-06-20 13 6 Article 10.3390/ijerph13060611 611 1660-4601 2016-06-20 doi: 10.3390/ijerph13060611 Dustin Duncan Julie Méline Yan Kestens Kristen Day Brian Elbel Leonardo Trasande Basile Chaix http://www.mdpi.com/1660-4601/13/6/612 Indoor air quality (IAQ) control of hospitals plays a critical role in protecting both hospital staffs and patients, particularly those who are highly susceptible to the adverse effects of indoor noxious hazards. However, moxibustion in outpatient departments (OPDs) of traditional Chinese medicine (TCM) may be a source of indoor air pollution in hospitals. Some studies have investigated indoor air pollution during moxibustion in Chinese medicine clinics (CMCs) and moxibustion rooms, demonstrating elevated air pollutants that pose a threat to the health of medical staff and patients. Our study investigated the indoor air pollutants of indoor carbon dioxide (CO2), carbon monoxide (CO), formaldehyde (HCHO), total volatile organic compounds (TVOCs), airborne particulate matter with a diameter of ≤10 µm (PM10) and ≤2.5 µm (PM2.5) during moxibustion in an acupuncture and moxibustion room of the OPD in a hospital in Taipei. To evaluate the different control strategies for indoor air pollution from moxibution, a comparison of air pollutants during moxibution among the methods of using alternative old moxa wools, local exhaust ventilation and an air cleaner was conducted. In this study, burning alternative old moxa wools for moxibustion obviously reduced all gaseous pollutants except for aerosols comparing burning fresh moxa wools. Using local exhaust ventilation reduced most of the aerosols after burning moxa. We also found that using an air cleaner was inefficient for controlling indoor air pollutants, particularly gaseous pollutants. Therefore, combining replacing alternative old moxa wools and local exhaust ventilation could be a suitable design for controlling indoor air pollution during moxibustion therapy. International Journal of Environmental Research and Public Health 2016-06-20 13 6 Article 10.3390/ijerph13060612 612 1660-4601 2016-06-20 doi: 10.3390/ijerph13060612 Chung-Yen Lu Sy-Yuan Kang Shu-Hui Liu Cheng-Wei Mai Chao-Heng Tseng http://www.mdpi.com/1660-4601/13/6/610 Epidemics of hand, foot and mouth disease (HFMD) among children have caused concern in China since 2007. We have conducted a retrospective study to investigate risk factors associated with HFMD. In this non-matching case-control study, 99 HFMD patients and 126 control from Guangdong Province were enlisted as participants. Data comprising demographic, socio-economic, clinical and behavior factors were collected from children's parents through face-to-face interviews by trained interviewers using a standardized questionnaire. Results of the primary logistic regression analyses revealed that age, history of cold food consumption, hand-washing routines, and airing out bedding were significantly associated with HFMD cases. Results of further multivariate analysis indicated that older age (OR = 0.44, 95% CI: 0.34–0.56) and hand-washing before meals (OR = 0.3, 95% CI: 0.13–0.70) are protective factors, whereas airing out bedding more than thrice a month (OR = 4.55, 95% CI: 1.19–17.37) was associated with increased risk for HFMD. Therefore, hand-washing should be recommended to prevent HFMD, and the potential threat of airing out bedding should be carefully considered. However, further studies are needed to examine other possible risk factors. International Journal of Environmental Research and Public Health 2016-06-18 13 6 Article 10.3390/ijerph13060610 610 1660-4601 2016-06-18 doi: 10.3390/ijerph13060610 Dingmei Zhang Zhiyuan Li Wangjian Zhang Pi Guo Zhanzhong Ma Qian Chen Shaokun Du Jing Peng Yu Deng Yuantao Hao http://www.mdpi.com/1660-4601/13/6/609 Traffic and environmental conditions (e.g., weather conditions), which frequently change with time, have a significant impact on crash occurrence. Traditional crash frequency models with large temporal scales and aggregated variables are not sufficient to capture the time-varying nature of driving environmental factors, causing significant loss of critical information on crash frequency modeling. This paper aims at developing crash frequency models with refined temporal scales for complex driving environments, with such an effort providing more detailed and accurate crash risk information which can allow for more effective and proactive traffic management and law enforcement intervention. Zero-inflated, negative binomial (ZINB) models with site-specific random effects are developed with unbalanced panel data to analyze hourly crash frequency on highway segments. The real-time driving environment information, including traffic, weather and road surface condition data, sourced primarily from the Road Weather Information System, is incorporated into the models along with site-specific road characteristics. The estimation results of unbalanced panel data ZINB models suggest there are a number of factors influencing crash frequency, including time-varying factors (e.g., visibility and hourly traffic volume) and site-varying factors (e.g., speed limit). The study confirms the unique significance of the real-time weather, road surface condition and traffic data to crash frequency modeling. International Journal of Environmental Research and Public Health 2016-06-18 13 6 Article 10.3390/ijerph13060609 609 1660-4601 2016-06-18 doi: 10.3390/ijerph13060609 Feng Chen Suren Chen Xiaoxiang Ma http://www.mdpi.com/1660-4601/13/6/605 For binary outcome data from epidemiological studies, this article investigates the interval estimation of several measures of interest in the absence or presence of categorical covariates. When covariates are present, the logistic regression model as well as the log-binomial model are investigated. The measures considered include the common odds ratio (OR) from several studies, the number needed to treat (NNT), and the prevalence ratio. For each parameter, confidence intervals are constructed using the concepts of generalized pivotal quantities and fiducial quantities. Numerical results show that the confidence intervals so obtained exhibit satisfactory performance in terms of maintaining the coverage probabilities even when the sample sizes are not large. An appealing feature of the proposed solutions is that they are not based on maximization of the likelihood, and hence are free from convergence issues associated with the numerical calculation of the maximum likelihood estimators, especially in the context of the log-binomial model. The results are illustrated with a number of examples. The overall conclusion is that the proposed methodologies based on generalized pivotal quantities and fiducial quantities provide an accurate and unified approach for the interval estimation of the various epidemiological measures in the context of binary outcome data with or without covariates. International Journal of Environmental Research and Public Health 2016-06-18 13 6 Article 10.3390/ijerph13060605 605 1660-4601 2016-06-18 doi: 10.3390/ijerph13060605 Ionut Bebu George Luta Thomas Mathew Brian Agan http://www.mdpi.com/1660-4601/13/6/606 Arsenic contamination is a serious problem in rice cultivated soils of many developing countries. Hence, it is critical to monitor and control arsenic uptake in rice plants to avoid adverse effects on human health. This study evaluated the feasibility of using reflectance spectroscopy to monitor arsenic in rice plants. Four arsenic levels were induced in hydroponically grown rice plants with application of 0, 5, 10 and 20 µmol·L−1 sodium arsenate. Reflectance spectra of upper fully expanded leaves were acquired over visible and infrared (NIR) wavelengths. Additionally, canopy reflectance for the four arsenic levels was simulated using SAIL (Scattering by Arbitrarily Inclined Leaves) model for various soil moisture conditions and leaf area indices (LAI). Further, sensitivity of various vegetative indices (VIs) to arsenic levels was assessed. Results suggest that plants accumulate high arsenic amounts causing plant stress and changes in reflectance characteristics. All leaf spectra based VIs related strongly with arsenic with coefficient of determination (r2) greater than 0.6 while at canopy scale, background reflectance and LAI confounded with spectral signals of arsenic affecting the VIs' performance. Among studied VIs, combined index, transformed chlorophyll absorption reflectance index (TCARI)/optimized soil adjusted vegetation index (OSAVI) exhibited higher sensitivity to arsenic levels and better resistance to soil backgrounds and LAI followed by red edge based VIs (modified chlorophyll absorption reflectance index (MCARI) and TCARI) suggesting that these VIs could prove to be valuable aids for monitoring arsenic in rice fields. International Journal of Environmental Research and Public Health 2016-06-18 13 6 Article 10.3390/ijerph13060606 606 1660-4601 2016-06-18 doi: 10.3390/ijerph13060606 Varaprasad Bandaru Craig Daughtry Eton Codling David Hansen Susan White-Hansen Carrie Green http://www.mdpi.com/1660-4601/13/6/607 Substance use disorders are widely recognized as one of the most pressing global public health problems, and recent research indicates that environmental factors, including access and exposure to substances of abuse, neighborhood disadvantage and disorder, and environmental barriers to treatment, influence substance use behaviors. Racial and socioeconomic inequities in the factors that create risky substance use environments may engender disparities in rates of substance use disorders and treatment outcomes. Environmental justice researchers, with substantial experience in addressing racial and ethnic inequities in environmental risk from technological and other hazards, should consider similar inequities in risky substance use environments as an environmental justice issue. Research should aim at illustrating where, why, and how such inequities in risky substance use environments occur, the implications of such inequities for disparities in substance use disorders and treatment outcomes, and the implications for tobacco, alcohol, and drug policies and prevention and treatment programs. International Journal of Environmental Research and Public Health 2016-06-18 13 6 Review 10.3390/ijerph13060607 607 1660-4601 2016-06-18 doi: 10.3390/ijerph13060607 Jeremy Mennis Gerald Stahler Michael Mason http://www.mdpi.com/1660-4601/13/6/603 Body weight is regulated by energy intake which occurs several times a day in humans. In this meta-analysis, we evaluated whether eating frequency (EF) is associated with obesity risk and energy intake in adults without any dietary restriction. Experimental and observational studies published before July 2015 were selected through English-language literature searches in several databases. These studies reported the association between EF and obesity risk (odd ratios, ORs) in adults who were not in dietary restriction. R software was used to perform statistical analyses. Ten cross-sectional studies, consisting of 65,742 participants, were included in this analysis. ORs were considered as effect size for the analysis about the effect of EF on obesity risk. Results showed that the increase of EF was associated with 0.83 time lower odds of obesity (i.e., OR = 0.83, 95% confidence intervals (CI) 0.70–0.99, p = 0.040). Analysis about the effect of EF on differences in participants' energy intake revealed that increased EF was associated with higher energy intake (β = 125.36, 95% CI 21.76–228.97, p = 0.017). We conclude that increased EF may lead to lower obesity risk but higher energy intake. Clinical trials are warranted to confirm these results and to assess the clinical practice applicability. International Journal of Environmental Research and Public Health 2016-06-17 13 6 Article 10.3390/ijerph13060603 603 1660-4601 2016-06-17 doi: 10.3390/ijerph13060603 Yue-Qiao Wang Yun-Quan Zhang Fei Zhang Yi-Wen Zhang Rui Li Guo-Xun Chen http://www.mdpi.com/1660-4601/13/6/608 Cigarette tax increases result in a reduced demand for cigarettes and increased efforts by smokers to reduce their cost of smoking. Less is known about how smokers think about their expenditures for cigarettes and the possible mechanisms that underlie price-minimizing behaviors. In-depth longitudinal interviews were conducted with Minnesota smokers to explore the factors that influence smokers' decisions one month prior to a $1.75 cigarette tax increase and again one and three months after the increase. A total of 42 were sampled with 35 completed interviews at all three time points, resulting in 106 interviews across all participants at all time points. A qualitative descriptive approach examined smoking and buying habits, as well as reasons behind these decisions. A hierarchy of ways to save money on cigarettes included saving the most money by changing to roll your own pipe tobacco, changing to a cheaper brand, cutting down or quitting, changing to cigarillos, and buying online. Using coupons, shopping around, buying by the carton, changing the style of cigarette, and stocking up prior to the tax increase were described as less effective. Five factors emerged as impacting smokers' efforts to save money on cigarettes after the tax: brand loyalty, frugality, addiction, stress, and acclimation. International Journal of Environmental Research and Public Health 2016-06-17 13 6 Article 10.3390/ijerph13060608 608 1660-4601 2016-06-17 doi: 10.3390/ijerph13060608 Anne Betzner Raymond Boyle Ann St. Claire http://www.mdpi.com/1660-4601/13/6/604 Hepatitis B virus (HBV) infection is a major risk factor for the development of hepatocellular carcinoma (HCC) in China. At present, there still are 9.3 million chronic HBV-infected Chinese. Numerous studies have explored the association between possible factors and hepatocellular carcinoma risk, however, the results remains inconsistent. Therefore, we did this pooled analysis so as to get a precise result. Here, we took the chronic HBV-infected Chinese as the object. We systematically searched for studies evaluating whether the proposed factors changed HCC risk in PubMed, Chinese National Knowledge Infrastructure, VIP database and Wanfang data. Odds ratios (OR) with 95% confidence intervals (CI) were calculated by Review Manager 5.0 and publication bias was determined by Begg's test and Egger's test. In total, 3165 cases and 10,896 controls from 27 studies were included in this meta-analysis. Our results showed that pooled OR with 95% CI for each of the factors investigated were: non-antiviral treatment 2.70 (2.01, 3.62), high HBV DNA levels 2.61 (1.73, 3.94), alcohol consumption 2.19 (1.53, 3.13), a family history of HCC 3.58 (2.53, 5.06) and male gender 2.14 (1.68, 2.73), respectively. Our meta-analysis supports that high HBV DNA levels, non-antiviral treatment, alcohol consumption, a family history of HCC and male gender contributed to the risk of hepatocellular carcinoma in chronic HBV-infected Chinese from currently available evidence. Given the high prevalence of the non-antiviral treatment and alcohol drinking, behavior interventions for the two factors should be tackled first. International Journal of Environmental Research and Public Health 2016-06-17 13 6 Review 10.3390/ijerph13060604 604 1660-4601 2016-06-17 doi: 10.3390/ijerph13060604 Xiang Lyu Kui Liu Yongdi Chen Zhifang Wang Jun Yao Gaofeng Cai Zhenggang Jiang Zhengting Wang Jianmin Jiang Hua Gu http://www.mdpi.com/1660-4601/13/6/601 Hypertension is considered to be the result of genes, environment, and their interactions. Among them age, sex, tobacco use, alcohol consumption, and being overweight/obesity are well documented environmental determinants, and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism is nominated as a potential genetic candidate. However, the synergistic effect of the MTHFR C677T polymorphism with these environmental factors on the risk of hypertension has received little attention. The aim of this study was to explore the associations of the MTHFR C677T polymorphism, environmental factors, and their interactions with hypertension predisposition in a Northern Chinese Han population. A total of 708 participants were enrolled in the study. The genotypes of the MTHFR C677T were determined by a TaqMan assay. We found that participants of an older age, being overweight/obesity, with a smoking habit, drinking habit, or carrying the 677T allele were at an increased risk of hypertension. Additionally, there existed marginally significant interactions of the polymorphism with age and overweight/obesity. However, future large, well-designed studies in Chinese and other populations, as well as mechanistic studies, are still needed to validate our findings, especially considering that the interactions observed in our study were only marginally significant. International Journal of Environmental Research and Public Health 2016-06-17 13 6 Article 10.3390/ijerph13060601 601 1660-4601 2016-06-17 doi: 10.3390/ijerph13060601 Shujun Fan Boyi Yang Xueyuan Zhi Yanxun Wang Jian Wei Quanmei Zheng Guifan Sun http://www.mdpi.com/1660-4601/13/6/602 Perfluorooctanoic acid (PFOA) is an emerging contaminant of concern due to its toxicity for human health and ecosystems. However, successful degradation of PFOA in aqueous solutions with a cost-effective method remains a challenge, especially for groundwater. In this study, the degradation of PFOA using activated persulfate under mild conditions was investigated. The impact of different factors on persulfate activity, including pH, temperature (25 °C–50 °C), persulfate dosage and reaction time, was evaluated under different experimental conditions. Contrary to the traditional alkaline-activated persulfate oxidation, it was found that PFOA can be effectively degraded using activated persulfate under acidic conditions, with the degradation kinetics following the pseudo-first-order decay model. Higher temperature, higher persulfate dosage and increased reaction time generally result in higher PFOA degradation efficiency. Experimental results show that a PFOA degradation efficiency of 89.9% can be achieved by activated persulfate at pH of 2.0, with the reaction temperature of 50 °C, molar ratio of PFOA to persulfate as 1:100, and a reaction time of 100 h. The corresponding defluorination ratio under these conditions was 23.9%, indicating that not all PFOA decomposed via fluorine removal. The electron paramagnetic resonance spectrometer analysis results indicate that both SO4−• and •OH contribute to the decomposition of PFOA. It is proposed that PFOA degradation occurs via a decarboxylation reaction triggered by SO4−•, followed by a HF elimination process aided by •OH, which produces one-CF2-unit-shortened perfluoroalkyl carboxylic acids (PFCAs, Cn−1F2n−1COOH). The decarboxylation and HF elimination processes would repeat and eventually lead to the complete mineralization all PFCAs. International Journal of Environmental Research and Public Health 2016-06-17 13 6 Article 10.3390/ijerph13060602 602 1660-4601 2016-06-17 doi: 10.3390/ijerph13060602 Penghua Yin Zhihao Hu Xin Song Jianguo Liu Na Lin http://www.mdpi.com/1660-4601/13/6/597 Bacterial pathogens are a leading cause of waterborne disease, and may result in gastrointestinal outbreaks worldwide. Inhabitants of the Bassaseachic Falls National Park in Chihuahua, Mexico show seasonal gastroenteritis problems. This aim of this study was to detect enteropathogenic microorganisms responsible for diarrheal outbreaks in this area. In 2013, 49 surface water samples from 13 selected sampling sites along the Basaseachi waterfall and its main rivers, were collected during the spring, summer, autumn, and winter seasons. Fecal and total coliform counts were determined using standard methods; the AutoScan-4 system was used for identification of isolates and the antibiotic resistance profile by challenging each organism using 21 antibiotics. Significant differences among seasons were detected, where autumn samples resulted in the highest total (p < 0.05) and fecal (p < 0.001) coliform counts, whereas the lowest total coliform counts were recorded in spring. Significant differences between sampling sites were observed, where samples from sites 6, 8, and 11 had the highest total coliform counts (p < 0.009), whereas samples from site 9 exhibited the lowest one. From the microbiological analysis, 33 bacterial isolates from 13 different sites and four sampling seasons were selected; 53% of isolates were resistant to at least one antibiotic, and 15% exhibited a multidrug resistance (MDB) phenotype. MDB were identified as Klebsiella oxytoca (two out of four identified isolates), Escherichia coli (2/7), and Enterobacter cloacae (1/3). In addition, some water-borne microorganisms exhibited resistance to cefazoline, cefuroxime, ampicillin, and ampicillin-sulbactam. The presence of these microorganisms near rural settlements suggests that wastewater is the contamination source, providing one possible transmission mechanism for diarrheal outbreaks. International Journal of Environmental Research and Public Health 2016-06-16 13 6 Article 10.3390/ijerph13060597 597 1660-4601 2016-06-16 doi: 10.3390/ijerph13060597 Ma. Delgado-Gardea Patricia Tamez-Guerra Ricardo Gomez-Flores Francisco Zavala-Díaz de la Serna Gilberto Eroza-de la Vega Guadalupe Nevárez-Moorillón María Pérez-Recoder Blanca Sánchez-Ramírez María González-Horta Rocío Infante-Ramírez http://www.mdpi.com/1660-4601/13/6/600 China was attacked by a serious influenza A (H7N9) virus in 2013. The first human infection case was confirmed in Shanghai City and soon spread across most of eastern China. Using the methods of Geographic Information Systems (GIS) and ecological niche modeling (ENM), this research quantitatively analyzed the relationships between the H7N9 occurrence and the main environmental factors, including meteorological variables, human population density, bird migratory routes, wetland distribution, and live poultry farms, markets, and processing factories. Based on these relationships the probability of the presence of H7N9 was predicted. Results indicated that the distribution of live poultry processing factories, farms, and human population density were the top three most important determinants of the H7N9 human infection. The relative contributions to the model of live poultry processing factories, farms and human population density were 39.9%, 17.7% and 17.7%, respectively, while the maximum temperature of the warmest month and mean relative humidity had nearly no contribution to the model. The paper has developed an ecological niche model (ENM) that predicts the spatial distribution of H7N9 cases in China using environmental variables. The area under the curve (AUC) values of the model were greater than 0.9 (0.992 for the training samples and 0.961 for the test data). The findings indicated that most of the high risk areas were distributed in the Yangtze River Delta. These findings have important significance for the Chinese government to enhance the environmental surveillance at multiple human poultry interfaces in the high risk area. International Journal of Environmental Research and Public Health 2016-06-16 13 6 Article 10.3390/ijerph13060600 600 1660-4601 2016-06-16 doi: 10.3390/ijerph13060600 Min Xu Chunxiang Cao Qun Li Peng Jia Jian Zhao http://www.mdpi.com/1660-4601/13/6/599 The bacterioplankton community composition's (BCC) spatial and temporal variation patterns in three reservoirs (Shiyan, Xikeng, and LuoTian Reservoir) of similar trophic status in Bao'an District, Shenzhen (China), were investigated using PCR amplification of the 16S rDNA gene and the denaturing gradient gel electrophoresis (DGGE) techniques. Water samples were collected monthly in each reservoir during 12 consecutive months. Distinct differences were detected in band number, pattern, and density of DGGE at different sampling sites and time points. Analysis of the DGGE fingerprints showed that changes in the bacterial community structure mainly varied with seasons, and the patterns of change indicated that seasonal forces might have a more significant impact on the BCC than eutrophic status in the reservoirs, despite the similar Shannon-Weiner index among the three reservoirs. The sequences obtained from excised bands were affiliated with Cyanobacteria, Firmicutes, Bacteriodetes, Acidobacteria, Actinobacteria, Planctomycetes, and Proteobacteria. International Journal of Environmental Research and Public Health 2016-06-16 13 6 Article 10.3390/ijerph13060599 599 1660-4601 2016-06-16 doi: 10.3390/ijerph13060599 Jiancheng Li Cheng Chen Jun Lu Anping Lei Zhangli Hu http://www.mdpi.com/1660-4601/13/6/598 Background: Due to moisture and the anatomical complexity of the oral mucosa, it is difficult to measure the extent of gingival melanosis in an optical manner. Therefore, we developed a new quantitative method using clinical oral photographs and compared the extent of gingival melanosis before and after smoking cessation. Methods: A new analysis method, which we named the gingival melanosis record (GMR), is a quantitative analysis method using clinical oral photographs. We obtained 659 clinical photographs from 263 patients from 16 general dental offices in Japan. Standardized measuring sites were automatically spotted on the screen, and the presence of gingival melanosis was determined at the measuring sites. We assessed the validity of the GMR with the previously reported Hedin's classification using Spearman's rank correlation and intraclass correlation coefficients. Results: The GMR showed a significant association with Hedin's classification (p < 0.01, correlation coefficient = 0.94). The GMR also showed excellent reproducibility of the substantial repeated agreement intraclass correlation coefficients (ICC) (1,1) and ICC (2,1), p > 0.61). The longitudinal loss of gingival melanosis was confirmed by a change in the GMR among patients who successfully achieved smoking cessation for a mean of 4.5 years. Conclusion: The GMR is an effective method to assess gingival melanosis. The loss of gingival melanosis after smoking cessation can be objectively confirmed with the use of the GMR. International Journal of Environmental Research and Public Health 2016-06-16 13 6 Article 10.3390/ijerph13060598 598 1660-4601 2016-06-16 doi: 10.3390/ijerph13060598 Tomotaka Kato Hiroya Takiuchi Seiichi Sugiyama Michiko Makino Satoshi Noguchi Tomoko Katayama-Ono Takashi Hanioka Toru Naito http://www.mdpi.com/1660-4601/13/6/595 Organic amendments have been proposed as a means of remediation for Cd-contaminated soils. However, understanding the inhibitory effects of organic materials on metal immobilization requires further research. In this study colza cake, a typical organic amendment material, was investigated in order to elucidate the ability of this material to reduce toxicity of Cd-contaminated soil. Available concentrations of Cd in soils were measured using an in situ diffusive gradients in thin films (DGT) technique in combination with traditional chemical methods, such as HOAc (aqua regia), EDTA (ethylene diamine tetraacetic acid), NaOAc (sodium acetate), CaCl2, and labile Cd in pore water. These results were applied to predict the Cd bioavailability after the addition of colza cake to Cd-contaminated soil. Two commonly grown cash crops, wheat and maize, were selected for Cd accumulation studies, and were found to be sensitive to Cd bioavailability. Results showed that the addition of colza cake may inhibit the growth of wheat and maize. Furthermore, the addition of increasing colza cake doses led to decreasing shoot and root biomass accumulation. However, increasing colza cake doses did lead to the reduction of Cd accumulation in plant tissues, as indicated by the decreasing Cd concentrations in shoots and roots. The labile concentration of Cd obtained by DGT measurements and the traditional chemical extraction methods, showed the clear decrease of Cd with the addition of increasing colza cake doses. All indicators showed significant positive correlations (p < 0.01) with the accumulation of Cd in plant tissues, however, all of the methods could not reflect plant growth status. Additionally, the capability of Cd to change from solid phase to become available in a soil solution decreased with increasing colza cake doses. This was reflected by the decreases in the ratio (R) value of CDGT to Csol. Our study suggests that the sharp decrease in R values could not only reflect the extremely low capability of labile Cd to be released from its solid phase, but may also be applied to evaluate the abnormal growth of the plants. International Journal of Environmental Research and Public Health 2016-06-15 13 6 Article 10.3390/ijerph13060595 595 1660-4601 2016-06-15 doi: 10.3390/ijerph13060595 Yu Yao Qin Sun Chao Wang Pei-Fang Wang Ling-Zhan Miao Shi-Ming Ding http://www.mdpi.com/1660-4601/13/6/596 An air-conditioned coach is an important form of transportation in modern motorized society; as a result, there is an increasing concern of in-vehicle air pollution. In this study, we aimed to identify and quantify the levels of volatile organic compounds (VOCs) and carbonyl compounds (CCs) in air samples collected from the cabins of newly produced, medium- and large-size coaches. Among the identified VOCs and CCs, toluene, ethylbenzene, xylene, formaldehyde, acetaldehyde, acrolein/acetone, and isovaleraldehyde were relatively abundant in the cabins. Time was found to affect the emissions of the contaminants in the coaches. Except for benzaldehyde, valeraldehyde and benzene, the highest in-vehicle concentrations of VOCs and CCs were observed on the 15th day after coming off the assembly line, and the concentrations exhibited an approximately inverted U-shaped pattern as a function of time. Interestingly, this study also showed that the interior temperature of the coaches significantly affected the VOCs emissions from the interior materials, whereas the levels of CCs were mainly influenced by the relative humidity within the coaches. In China, guidelines and regulations for the in-vehicle air quality assessment of the coaches have not yet been issued. The results of this study provide further understanding of the in-vehicle air quality of air-conditioned coaches and can be used in the development of both specific and general rules regarding medium- and large-size coaches. International Journal of Environmental Research and Public Health 2016-06-15 13 6 Article 10.3390/ijerph13060596 596 1660-4601 2016-06-15 doi: 10.3390/ijerph13060596 Yan-Yang Lu Yi Lin Han Zhang Dongxiao Ding Xia Sun Qiansheng Huang Lifeng Lin Ya-Jie Chen Yu-Lang Chi Sijun Dong http://www.mdpi.com/1660-4601/13/6/594 As flood water is discharged from a high dam, low frequency (i.e., lower than 10 Hz) noise (LFN) associated with air pulsation is generated and propagated in the surrounding areas, causing environmental problems such as vibrations of windows and doors and discomfort of residents and construction workers. To study the generation mechanisms and key influencing factors of LFN induced by energy dissipation through submerged jets at a high dam, detailed prototype observations and analyses of LFN are conducted. The discharge flow field is simulated using a gas-liquid turbulent flow model, and the vorticity fluctuation characteristics are then analyzed. The mathematical model for the LFN intensity is developed based on vortex sound theory and a turbulent flow model, verified by prototype observations. The model results reveal that the vorticity fluctuation in strong shear layers around the high-velocity submerged jets is highly correlated with the on-site LFN, and the strong shear layers are the main regions of acoustic source for the LFN. In addition, the predicted and observed magnitudes of LFN intensity agree quite well. This is the first time that the LFN intensity has been shown to be able to be predicted quantitatively. International Journal of Environmental Research and Public Health 2016-06-15 13 6 Article 10.3390/ijerph13060594 594 1660-4601 2016-06-15 doi: 10.3390/ijerph13060594 Jijian Lian Wenjiao Zhang Qizhong Guo Fang Liu http://www.mdpi.com/1660-4601/13/6/593 Despite the implementation of smoke-free policies by local authorities and a statutory requirement to promote the health and well-being of looked-after children and young people in England, rates of tobacco use by this population are substantially higher than in the general youth population. A mixed-methods study, comprising a survey of residential care officers in 15 local authority-operated residential units and semi-structured, face-to-face interviews with residential carers in three local authority-operated residential units, was conducted in the East Midlands. Survey data were descriptively analysed; and interview data were transcribed and analysed using thematic framework analysis. Forty-two care officers (18% response rate) completed the survey, and 14 participated in the interviews. Despite reporting substantial awareness of smoke-free policies, a lack of adherence and enforcement became apparent, and levels of reported training in relation to smoking and smoking cessation were low (21%). Potential problems relating to wider tobacco-related harms, such as exploitative relationships; a reliance on tacit knowledge; and pessimistic attitudes towards LAC quitting smoking, were indicated. The findings highlight the need for the development of comprehensive strategies to promote adherence to and enforcement of local smoke-free policy within residential units for looked-after children and young people, and to ensure appropriate support pathways are in place for this population. International Journal of Environmental Research and Public Health 2016-06-15 13 6 Article 10.3390/ijerph13060593 593 1660-4601 2016-06-15 doi: 10.3390/ijerph13060593 Lisa Huddlestone Catherine Pritchard Elena Ratschen http://www.mdpi.com/1660-4601/13/6/590 The objective of this study was to evaluate the effectiveness of simultaneous training for children with autism spectrum disorder (ASD) and their parents, with a focus on social skills enhancement (STSSE) by evaluating behavioral changes in children with ASD and changes in family functioning. STSSE was conducted on 17 children of elementary school age with ASD and their parents. Changes in scores on the social skills scale for education (SS-scale), the child behavior checklist, the Feetham Family Functioning Survey (FFFS), and the confidence degree questionnaire for families (CDQ) were used to assess the effectiveness of STSSE. Improvements were seen for "Communication Skills" on the children's SS-scale (p = 0.029). Significant improvements were seen in the mothers' FFFS scores for "The 4th factor: illness and worries" (p = 0.016) and in the median CDQ scores for one of 18 items after STSSE (p = 0.01). Although additional studies with larger sample sizes will be necessary before these findings are generalizable, the positive changes seen in both parents and children as a result of STSSE are promising. International Journal of Environmental Research and Public Health 2016-06-14 13 6 Article 10.3390/ijerph13060590 590 1660-4601 2016-06-14 doi: 10.3390/ijerph13060590 Hiroko Okuno Tomoka Yamamoto Aika Tatsumi Ikuko Mohri Masako Taniike http://www.mdpi.com/1660-4601/13/6/591 The paper discusses the necessity to bring environmental equity within the Pata Rât Roma community in Northwest Romania, relying on the answers to three questions: "Does environmental equity exist in Pata Rât?", "How can it be attained?", and "To what extent can it be brought to the targeted people?" It was shown how a trio of factors tailors the destiny of Roma inhabitants: being a minority, their ethnicity, and the fact they are living on and off what society rejects and dumps—a landfill. The framing of the environmental equity concerns within a vision considering negotiation as the most adequate means to attain it is a novel approach. Further on, the results of the study can fuel win-win solutions in environmental equity. The information abstracted from a set of indicators, assessed through an evaluation matrix, represents a beneficial platform for future bottom-up decisions concerning landfill residents. Three action options were analyzed: on-site living opportunities—that resulted to be preferred, off-site living opportunities, and "Do nothing". The analysis provides qualitative evidence that the evaluation of environmental equity is largely subjective, because of its complexity and specificity related to geographical, historical, cultural characteristics, and political interests. International Journal of Environmental Research and Public Health 2016-06-14 13 6 Article 10.3390/ijerph13060591 591 1660-4601 2016-06-14 doi: 10.3390/ijerph13060591 Ruxandra Petrescu-Mag Dacinia Petrescu Ioan Oroian Ovidiu Safirescu Nicoleta Bican-Brișan http://www.mdpi.com/1660-4601/13/6/592 Particulate matter (PM) is a key indicator of air pollution and a significant risk factor for adverse health outcomes in humans. PM is not a self-contained pollutant but a mixture of different compounds including chemical and biological fractions. While several reviews have focused on the chemical components of PM and associated health effects, there is a dearth of review studies that holistically examine the role of biological and chemical components of inhalable and respirable PM in disease causation. A literature search using various search engines and (or) keywords was done. Articles selected for review were chosen following predefined criteria, to extract and analyze data. The results show that the biological and chemical components of inhalable and respirable PM play a significant role in the burden of health effects attributed to PM. These health outcomes include low birth weight, emergency room visit, hospital admission, respiratory and pulmonary diseases, cardiovascular disease, cancer, non-communicable diseases, and premature death, among others. This review justifies the importance of each or synergistic effects of the biological and chemical constituents of PM on health. It also provides information that informs policy on the establishment of exposure limits for PM composition metrics rather than the existing exposure limits of the total mass of PM. This will allow for more effective management strategies for improving outdoor air quality. International Journal of Environmental Research and Public Health 2016-06-14 13 6 Review 10.3390/ijerph13060592 592 1660-4601 2016-06-14 doi: 10.3390/ijerph13060592 Oyewale Morakinyo Matlou Mokgobu Murembiwa Mukhola Raymond Hunter http://www.mdpi.com/1660-4601/13/6/584 Malaria is a serious public health threat in Sub-Saharan Africa (SSA), and its transmission risk varies geographically. Modelling its geographic characteristics is essential for identifying the spatial and temporal risk of malaria transmission. Remote sensing (RS) has been serving as an important tool in providing and assessing a variety of potential climatic/environmental malaria transmission variables in diverse areas. This review focuses on the utilization of RS-driven climatic/environmental variables in determining malaria transmission in SSA. A systematic search on Google Scholar and the Institute for Scientific Information (ISI) Web of KnowledgeSM databases (PubMed, Web of Science and ScienceDirect) was carried out. We identified thirty-five peer-reviewed articles that studied the relationship between remotely-sensed climatic variable(s) and malaria epidemiological data in the SSA sub-regions. The relationship between malaria disease and different climatic/environmental proxies was examined using different statistical methods. Across the SSA sub-region, the normalized difference vegetation index (NDVI) derived from either the National Oceanic and Atmospheric Administration (NOAA) Advanced Very High Resolution Radiometer (AVHRR) or Moderate-resolution Imaging Spectrometer (MODIS) satellite sensors was most frequently returned as a statistically-significant variable to model both spatial and temporal malaria transmission. Furthermore, generalized linear models (linear regression, logistic regression and Poisson regression) were the most frequently-employed methods of statistical analysis in determining malaria transmission predictors in East, Southern and West Africa. By contrast, multivariate analysis was used in Central Africa. We stress that the utilization of RS in determining reliable malaria transmission predictors and climatic/environmental monitoring variables would require a tailored approach that will have cognizance of the geographical/climatic setting, the stage of malaria elimination continuum, the characteristics of the RS variables and the analytical approach, which in turn, would support the channeling of intervention resources sustainably. International Journal of Environmental Research and Public Health 2016-06-14 13 6 Review 10.3390/ijerph13060584 584 1660-4601 2016-06-14 doi: 10.3390/ijerph13060584 Osadolor Ebhuoma Michael Gebreslasie http://www.mdpi.com/1660-4601/13/6/589 Background: Childhood obesity has become one of the most serious public health challenges in the 21st century in most developing countries. The percentile curve tool is useful for monitoring and screening obesity at population level, however, in China, no official recommendations on childhood body mass index (BMI) and waist circumference (WC) reference percentiles have been made in practice. Aims: to construct the percentile reference values for BMI and WC, and then to calculate the prevalence of overall and abdominal obesity for Chinese children and adolescents. Methods: A total of 5062 anthropometric records for children and adolescents aged from 7 to 18 years (2679 boys and 2383 girls) were included for analysis. The participants were recruited as part of the national representative "China Health and Nutrition Survey" (CHNS). Age, gender, weight, height, and WC were assessed. Smoothed BMI and WC percentile curves and values for the 3rd, 5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, 95th and 97th percentiles were constructed by using the Lambda-Mu-Sigma (LMS) method. The prevalence estimates of the overall and abdominal obesity were calculated by using the cut-offs from our CHNS study and the previous "Chinese National Survey on Students' Constitution and Health" (CNSSCH) study, respectively. The difference between prevalence estimates was tested by a McNemar test, and the agreement between these prevalence estimates was calculated by using the Cohen's kappa coefficient. Results: The prevalence values of overall obesity based on the cut-offs from CHNS and CNSSCH studies were at an almost perfect agreement level in boys (κ = 0.93). However, among girls, the overall obesity prevalence differed between the studies (p < 0.001) and the agreement was weaker (κ = 0.76). The abdominal obesity prevalence estimates were significant different according to the two systems both in boys and girls, although the agreement reached to 0.88, which represented an almost perfect agreement level. Conclusions: This study provided new BMI and WC percentile curves and reference values for Chinese children and adolescents aged 7–18 years, which can be adopted in future researches. Large longitudinal study is still needed to reveal the childhood growth pattern and validate the inconsistence between different percentile studies. International Journal of Environmental Research and Public Health 2016-06-14 13 6 Article 10.3390/ijerph13060589 589 1660-4601 2016-06-14 doi: 10.3390/ijerph13060589 Peige Song Xue Li Danijela Gasevic Ana Flores Zengli Yu http://www.mdpi.com/1660-4601/13/6/586 This review article outlines epidemiologic studies that support the hypothesis that maternal environment (including early nutrition) plays a seminal role in determining the offspring's long-term health and metabolism, known as the concept of Developmental Origins of Health and Diseases (DOHaD). In this context, current concerns are particularly focused on the increased incidence of obesity and diabetes, particularly in youth and women of child-bearing age. We summarize key similarities, differences and limitations of various animal models used to study fetal programming, with a particular focus on placentation, which is critical for translating animal findings to humans. This review will assist researchers and their scientific audience in recognizing the pros and cons of various rodent and non-rodent animal models used to understand mechanisms involved in fetal programming. Knowledge gained will lead to improved translation of proposed interventional therapies before they can be implemented in humans. Although rodents are essential for fundamental exploration of biological processes, other species such as rabbits and other domestic animals offer more tissue-specific physiological (rabbit placenta) or physical (ovine maternal and lamb birth weight) resemblances to humans. We highlight the important maternal, placental, and fetal/neonatal characteristics that contribute to developmentally programmed diseases, specifically in offspring that were affected in utero by undernutrition, overnutrition or maternal diabetes. Selected interventions aimed at prevention are summarized with a specific focus on the 1000 days initiative in humans, and maternal exercise or modification of the n-3/n-6 polyunsaturated fatty acid (PUFA) balance in the diet, which are currently being successfully tested in animal models to correct or reduce adverse prenatal programming. Animal models are essential to understand mechanisms involved in fetal programming and in order to propose interventional therapies before they can be implemented in humans. Non-rodent animals are particularly important and should not be neglected, as they are often more physiologically-appropriate models to mimic the human situation. International Journal of Environmental Research and Public Health 2016-06-14 13 6 Article 10.3390/ijerph13060586 586 1660-4601 2016-06-14 doi: 10.3390/ijerph13060586 Pascale Chavatte-Palmer Anne Tarrade Delphine Rousseau-Ralliard http://www.mdpi.com/1660-4601/13/6/588 Hospital effluents represent an important source for the release of antibiotics and antibiotic resistant bacteria into the environment. This study aims to determine concentrations of various antibiotics in wastewater before and after wastewater treatment in a rural hospital (60 km from the center of Hanoi) and in an urban hospital (in the center of Hanoi) in Vietnam, and it aims to explore the relationship between antibiotic concentrations in wastewater before wastewater treatment and quantities of antibiotics used in the rural hospital, over a period of one year in 2013. Water samples were collected using continuous sampling for 24 h in the last week of every month. The data on quantities of antibiotics delivered to all inpatient wards were collected from the Pharmacy department in the rural hospital. Solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry were used for chemical analysis. Significant concentrations of antibiotics were present in the wastewater both before and after wastewater treatment of both the rural and the urban hospital. Ciprofloxacin was detected at the highest concentrations in the rural hospital's wastewater (before treatment: mean = 42.8 µg/L; after treatment: mean = 21.5 µg/L). Metronidazole was detected at the highest concentrations in the urban hospital's wastewater (before treatment: mean = 36.5 µg/L; after treatment: mean = 14.8 µg/L). A significant correlation between antibiotic concentrations in wastewater before treatment and quantities of antibiotics used in the rural hospital was found for ciprofloxacin (r = 0.78; p = 0.01) and metronidazole (r = 0.99; p < 0.001). International Journal of Environmental Research and Public Health 2016-06-14 13 6 Article 10.3390/ijerph13060588 588 1660-4601 2016-06-14 doi: 10.3390/ijerph13060588 La Lien Nguyen Hoa Nguyen Chuc Nguyen Thoa Ho Phuc Vishal Diwan Nguyen Dat Ashok Tamhankar Cecilia Lundborg http://www.mdpi.com/1660-4601/13/6/585 Background: The incidence of people with dementia is expected to increase significantly in the coming years, but it seems that there is a relationship between an active lifestyle and cognitive decline. The present study aimed to compare the characteristics and engagement in the physical activity (PA) of three groups of Italian elderly with different cognitive statuses at baseline phase. Methods: Data were examined using the results from the "My Mind Project" on 305 community-dwelling Italians. The sample was comprised of 93 subjects with Alzheimer's disease (AD), 109 with mild cognitive impairment (MCI) and 103 healthy elderly (HE). Results: Classification of subjects on the basis of Physical Activity Scale for the Elderly (PASE) score showed that 47% of HE performed the highest level of physical activity while 40% of AD performed the lowest level. MCI subjects were distributed quite homogeneously across the levels (p < 0.001). Physical activity such as walking and light sports was carried out mainly and more frequently by HE as compared to the others (p < 0.05). As regards functional status, AD presented worse conditions in basic and instrumental activities of daily living than the other groups (p < 0.001). Conclusions: Our results evidenced that subjects with cognitive decline had the tendency to engage in PA less than HE. In particular, age and education negatively affected engagement in PA. International Journal of Environmental Research and Public Health 2016-06-14 13 6 Brief Report 10.3390/ijerph13060585 585 1660-4601 2016-06-14 doi: 10.3390/ijerph13060585 Cristina Gagliardi Roberta Papa Demetrio Postacchini Cinzia Giuli http://www.mdpi.com/1660-4601/13/6/587 In 1980, Clair C. Patterson stated: "Sometime in the near future it probably will be shown that the older urban areas of the United States have been rendered more or less uninhabitable by the millions of tons of poisonous industrial lead residues that have accumulated in cities during the past century". We live in the near future about which this quote expressed concern. This special volume of 19 papers explores the status of scientific evidence regarding Dr. Patterson's statement on the habitability of the environments of communities. Authors from 10 countries describe a variety of lead issues in the context of large and small communities, smelter sites, lead industries, lead-based painted houses, and vehicle fuel treated with lead additives dispersed by traffic. These articles represent the microcosm of the larger health issues associated with lead. The challenges of lead risk require a concerted global action for primary prevention. International Journal of Environmental Research and Public Health 2016-06-14 13 6 Editorial 10.3390/ijerph13060587 587 1660-4601 2016-06-14 doi: 10.3390/ijerph13060587 Howard Mielke http://www.mdpi.com/1660-4601/13/6/583 Middle East Respiratory Syndrome (MERS), a pandemic threat to human beings, has aroused huge concern worldwide, but no bibliometric studies have been conducted on MERS research. The aim of this study was to map research productivity on the disease based on the articles indexed in PubMed. The articles related to MERS dated from 2012 to 2015 were retrieved from PubMed. The articles were classified into three categories according to their focus. Publication outputs were assessed and frequently used terms were mapped using the VOS viewer software. A total of 443 articles were included for analysis. They were published in 162 journals, with Journal of Virology being the most productive (44 articles; 9.9%) and by six types of organizations, with universities being the most productive (276 articles; 62.4%).The largest proportion of the articles focused on basic medical sciences and clinical studies (47.2%) and those on prevention and control ranked third (26.2%), with those on other focuses coming in between (26.6%). The articles on prevention and control had the highest mean rank for impact factor (IF) (226.34), followed by those on basic medical sciences and clinical studies (180.23) and those on other focuses (168.03). The mean rank differences were statistically significant (p = 0.000). Besides, "conronavirus", "case", "transmission" and "detection" were found to be the most frequently used terms. The findings of this first bibliometric study on MERS suggest that the prevention and control of the disease has become a big concern and related research should be strengthened. International Journal of Environmental Research and Public Health 2016-06-13 13 6 Article 10.3390/ijerph13060583 583 1660-4601 2016-06-13 doi: 10.3390/ijerph13060583 Zhengting Wang Yongdi Chen Gaofeng Cai Zhenggang Jiang Kui Liu Bin Chen Jianmin Jiang Hua Gu http://www.mdpi.com/1660-4601/13/6/581 Cardiovascular disease (CVD), including heart failure, is a major cause of morbidity and mortality, particularly among African Americans. Exposure to ambient air pollution, such as that produced by vehicular traffic, is believed to be associated with heart failure, possibly by impairing cardiac function. We evaluated the cross-sectional association between residential proximity to major roads, a marker of long-term exposure to traffic-related pollution, and echocardiographic indicators of left and pulmonary vascular function in African Americans enrolled in the Jackson Heart Study (JHS): left ventricular ejection fraction, E-wave velocity, isovolumic relaxation time, left atrial diameter index, and pulmonary artery systolic pressure. We examined these associations using multivariable linear or logistic regression, adjusting for potential confounders. Of 4866 participants at study enrollment, 106 lived <150 m, 159 lived 150–299 m, 1161 lived 300–999 m, and 3440 lived ≥1000 m from a major roadway. We did not observe any associations between residential distance to major roads and these markers of cardiac function. Results were similar with additional adjustment for diabetes and hypertension, when considering varying definitions of major roadways, or when limiting analyses to those free from cardiovascular disease at baseline. Overall, we observed little evidence that residential proximity to major roads was associated with cardiac function among African Americans. International Journal of Environmental Research and Public Health 2016-06-13 13 6 Article 10.3390/ijerph13060581 581 1660-4601 2016-06-13 doi: 10.3390/ijerph13060581 Anne Weaver Gregory Wellenius Wen-Chih Wu DeMarc Hickson Masoor Kamalesh Yi Wang http://www.mdpi.com/1660-4601/13/6/582 According to the WHO report, alcohol is the third most significant health risk factor for the global population. There are contrary reports about heavy metals concentrations in patients with alcoholic liver cirrhosis. The aim of this study was to investigate serum concentrations of selected heavy metals in patients with alcoholic liver cirrhosis living in the eastern part of Poland according to cirrhosis stage. The participants came from various hospitals of the Lublin region were enrolled. The study group included 46 male and 16 female patients. The control group consisted of 18 healthy individuals without liver disease. High Performance Ion Chromatography was used to determine the concentrations of metal ions (Cd, Zn, Cu, Ni, Co, Mn, and Pb) in serum samples. The concentrations of copper, zinc, nickel, and cobalt were found to be significantly lower in patients with alcoholic liver cirrhosis compared to the control group. The serum concentration of cadmium was significantly higher in patients with advanced alcoholic liver cirrhosis compared to the control group. We hypothesize that disorders of metabolism of heavy metals seem to be the outcome of impaired digestion and absorption, which are common in cirrhosis, improper diet, environmental and occupational exposure. International Journal of Environmental Research and Public Health 2016-06-13 13 6 Article 10.3390/ijerph13060582 582 1660-4601 2016-06-13 doi: 10.3390/ijerph13060582 Andrzej Prystupa Anna Błażewicz Paweł Kiciński Jarosław Sak Jarosław Niedziałek Wojciech Załuska http://www.mdpi.com/1660-4601/13/6/578 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. International Journal of Environmental Research and Public Health 2016-06-09 13 6 Communication 10.3390/ijerph13060578 578 1660-4601 2016-06-09 doi: 10.3390/ijerph13060578 Nuredin Mohammed Mark Everard Jon Ayres Nicola Barker Ian Litchfield http://www.mdpi.com/1660-4601/13/6/580 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. International Journal of Environmental Research and Public Health 2016-06-09 13 6 Article 10.3390/ijerph13060580 580 1660-4601 2016-06-09 doi: 10.3390/ijerph13060580 Soo Hong Han Kim Ki Yoon http://www.mdpi.com/1660-4601/13/6/579 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. International Journal of Environmental Research and Public Health 2016-06-09 13 6 Article 10.3390/ijerph13060579 579 1660-4601 2016-06-09 doi: 10.3390/ijerph13060579 Jun Kurai Masanari Watanabe Hiroyuki Sano Degejirihu Hantan Eiji Shimizu http://www.mdpi.com/1660-4601/13/6/577 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. International Journal of Environmental Research and Public Health 2016-06-09 13 6 Article 10.3390/ijerph13060577 577 1660-4601 2016-06-09 doi: 10.3390/ijerph13060577 Filip Pošćić Alessandro Mattiello Guido Fellet Fabiano Miceli Luca Marchiol http://www.mdpi.com/1660-4601/13/6/576 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. International Journal of Environmental Research and Public Health 2016-06-09 13 6 Article 10.3390/ijerph13060576 576 1660-4601 2016-06-09 doi: 10.3390/ijerph13060576 Yu-Huai Ho Lih-Shinn Wang Hui-Li Jiang Chih-Hui Chang Chia-Jung Hsieh Dan-Chi Chang Hsin-Yu Tu Tan-Yun Chiu Huei-Jen Chao Chun-Chieh Tseng http://www.mdpi.com/1660-4601/13/6/574 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. International Journal of Environmental Research and Public Health 2016-06-09 13 6 Article 10.3390/ijerph13060574 574 1660-4601 2016-06-09 doi: 10.3390/ijerph13060574 Ping Rao Hao Wang Honghong Fang Qing Gao Jie Zhang Manshu Song Yong Zhou Youxin Wang Wei Wang http://www.mdpi.com/1660-4601/13/6/575 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. International Journal of Environmental Research and Public Health 2016-06-09 13 6 Article 10.3390/ijerph13060575 575 1660-4601 2016-06-09 doi: 10.3390/ijerph13060575 Xiaomin Li Suyang Zhou Wenhong Fan http://www.mdpi.com/1660-4601/13/6/573 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. International Journal of Environmental Research and Public Health 2016-06-08 13 6 Review 10.3390/ijerph13060573 573 1660-4601 2016-06-08 doi: 10.3390/ijerph13060573 Tammy Dugas Slawomir Lomnicki Stephania Cormier Barry Dellinger Margaret Reams http://www.mdpi.com/1660-4601/13/6/571 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. International Journal of Environmental Research and Public Health 2016-06-08 13 6 Article 10.3390/ijerph13060571 571 1660-4601 2016-06-08 doi: 10.3390/ijerph13060571 Erica Borresen Cordelia Stone Abdoulaye Boré Alima Cissoko Ababacar Maiga Ousmane Koita Elizabeth Ryan http://www.mdpi.com/1660-4601/13/6/572 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. International Journal of Environmental Research and Public Health 2016-06-08 13 6 Article 10.3390/ijerph13060572 572 1660-4601 2016-06-08 doi: 10.3390/ijerph13060572 Luís Pereira-da-Silva Carla Rêgo Angelo Pietrobelli http://www.mdpi.com/1660-4601/13/6/569 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. International Journal of Environmental Research and Public Health 2016-06-07 13 6 Article 10.3390/ijerph13060569 569 1660-4601 2016-06-07 doi: 10.3390/ijerph13060569 Veerle Van Holle Jelle Van Cauwenberg Ilse De Bourdeaudhuij Benedicte Deforche Nico Van de Weghe Delfien Van Dyck http://www.mdpi.com/1660-4601/13/6/568 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. International Journal of Environmental Research and Public Health 2016-06-07 13 6 Article 10.3390/ijerph13060568 568 1660-4601 2016-06-07 doi: 10.3390/ijerph13060568 Maria Cruz Edwiges Santos Maria Benamor Teixeira Monica Poletti Carolina Sousa Maria Gouvea Karin Nielsen-Saines Esaú João http://www.mdpi.com/1660-4601/13/6/570 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. International Journal of Environmental Research and Public Health 2016-06-07 13 6 Article 10.3390/ijerph13060570 570 1660-4601 2016-06-07 doi: 10.3390/ijerph13060570 Manny Mathuthu Caspah Kamunda Morgan Madhuku http://www.mdpi.com/1660-4601/13/6/566 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. International Journal of Environmental Research and Public Health 2016-06-07 13 6 Article 10.3390/ijerph13060566 566 1660-4601 2016-06-07 doi: 10.3390/ijerph13060566 Shalin Bidassey-Manilal Caradee Wright Jacobus Engelbrecht Patricia Albers Rebecca Garland Mamopeli Matooane http://www.mdpi.com/1660-4601/13/6/565 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. International Journal of Environmental Research and Public Health 2016-06-06 13 6 Article 10.3390/ijerph13060565 565 1660-4601 2016-06-06 doi: 10.3390/ijerph13060565 Qing Wang Jay Shen http://www.mdpi.com/1660-4601/13/6/567 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. International Journal of Environmental Research and Public Health 2016-06-06 13 6 Article 10.3390/ijerph13060567 567 1660-4601 2016-06-06 doi: 10.3390/ijerph13060567 Greta Mazzetti Roberta Biolcati Dina Guglielmi Caryn Vallesi Wilmar Schaufeli http://www.mdpi.com/1660-4601/13/6/564 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. International Journal of Environmental Research and Public Health 2016-06-06 13 6 Article 10.3390/ijerph13060564 564 1660-4601 2016-06-06 doi: 10.3390/ijerph13060564 Marie Rolland-Cachera Mouna Akrout Sandrine Péneau http://www.mdpi.com/1660-4601/13/6/562 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. International Journal of Environmental Research and Public Health 2016-06-04 13 6 Article 10.3390/ijerph13060562 562 1660-4601 2016-06-04 doi: 10.3390/ijerph13060562 Chao Lu Jian-Xin You Hu-Chen Liu Ping Li http://www.mdpi.com/1660-4601/13/6/563 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. International Journal of Environmental Research and Public Health 2016-06-04 13 6 Article 10.3390/ijerph13060563 563 1660-4601 2016-06-04 doi: 10.3390/ijerph13060563 Laura Kwong Ayse Ercumen Amy Pickering Leanne Unicomb Jennifer Davis Stephen Luby http://www.mdpi.com/1660-4601/13/6/561 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. International Journal of Environmental Research and Public Health 2016-06-03 13 6 Article 10.3390/ijerph13060561 561 1660-4601 2016-06-03 doi: 10.3390/ijerph13060561 Xiangrong Xu Qiuyue Yang Jie Jiao Lihua He Shanfa Yu Jingjing Wang Guizhen Gu Guoshun Chen Wenhui Zhou Hui Wu Yanhong Li Huanling Zhang