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1.  Integrated Health Risk Assessment of Heavy Metals in Suxian County, South China 
The purpose of this study was to assess soil heavy metal contamination and the potential risk for local residents in Suxian county of Hunan Province, southern China. Soil, rice and vegetable samples from the areas near the mining industrial districts were sampled and analyzed. The results indicate that the anthropogenic mining activities have caused local agricultural soil contamination with As, Pb, Cu and Cd in the ranges of 8.47–341.33 mg/kg, 19.91–837.52 mg/kg, 8.41–148.73 mg/kg and 0.35–6.47 mg/kg, respectively. GIS-based mapping shows that soil heavy metal concentrations abruptly diminish with increasing distance from the polluting source. The concentrations of As, Pb, Cu and Cd found in rice were in the ranges of 0.02–1.48 mg/kg, 0.66–5.78 mg/kg, 0.09–6.75 mg/kg, and up to 1.39 mg/kg, respectively. Most of these concentrations exceed their maximum permissible levels for contaminants in foods in China. Heavy metals accumulate to significantly different levels between leafy vegetables and non-leafy vegetables. Food consumption and soil ingestion exposure are the two routes that contribute to the average daily intake dose of heavy metals for local adults. Moreover, the total hazard indices of As, Pb and Cd are greater than or close to the safety threshold of 1. Long-term As, Pb and Cd exposure through the regular consumption of the soil, rice and vegetables in the investigated area poses potential health problems to residents in the vicinity of the mining industry.
doi:10.3390/ijerph120707100
PMCID: PMC4515644  PMID: 26114243
mining activities; heavy metals; soil and crop contamination; risk assessment; spatial distribution
2.  Quantification of Protozoa and Viruses from Small Water Volumes 
Large sample volumes are traditionally required for the analysis of waterborne pathogens. The need for large volumes greatly limits the number of samples that can be processed. The goals of this study were to compare extraction and detection procedures for quantifying protozoan parasites and viruses from small volumes of marine water. The intent was to evaluate a logistically simpler method of sample collection and processing that would facilitate direct pathogen measures as part of routine monitoring programs. Samples were collected simultaneously using a bilayer device with protozoa capture by size (top filter) and viruses capture by charge (bottom filter). Protozoan detection technologies utilized for recovery of Cryptosporidium spp. and Giardia spp. were qPCR and the more traditional immunomagnetic separation—IFA-microscopy, while virus (poliovirus) detection was based upon qPCR versus plaque assay. Filters were eluted using reagents consistent with the downstream detection technologies. Results showed higher mean recoveries using traditional detection methods over qPCR for Cryptosporidium (91% vs. 45%) and poliovirus (67% vs. 55%) whereas for Giardia the qPCR-based methods were characterized by higher mean recoveries (41% vs. 28%). Overall mean recoveries are considered high for all detection technologies. Results suggest that simultaneous filtration may be suitable for isolating different classes of pathogens from small marine water volumes. More research is needed to evaluate the suitability of this method for detecting pathogens at low ambient concentration levels.
doi:10.3390/ijerph120707118
PMCID: PMC4515645  PMID: 26114244
Cryptosporidium; Giardia; enterovirus; quantitative PCR; water quality
3.  The Role of Sister Cities’ Staff Exchanges in Developing “Learning Cities”: Exploring Necessary and Sufficient Conditions in Social Capital Development Utilizing Proportional Odds Modeling 
In the last half century former international adversaries have become cooperators through networking and knowledge sharing for decision making aimed at improving quality of life and sustainability; nowhere has this been more striking then at the urban level where such activity is seen as a key component in building “learning cities” through the development of social capital. Although mega-cities have been leaders in such efforts, mid-sized cities with lesser resource endowments have striven to follow by focusing on more frugal sister city type exchanges. The underlying thesis of our research is that great value can be derived from city-to-city exchanges through social capital development. However, such a study must differentiate between necessary and sufficient conditions. Past studies assumed necessary conditions were met and immediately jumped to demonstrating the existence of structural relationships by measuring networking while further assuming that the existence of such demonstrated a parallel development of cognitive social capital. Our research addresses this lacuna by stepping back and critically examining these assumptions. To accomplish this goal we use a Proportional Odds Modeling with a Cumulative Logit Link approach to demonstrate the existence of a common latent structure, hence asserting that necessary conditions are met.
doi:10.3390/ijerph120707133
PMCID: PMC4515646  PMID: 26114245
sister cities; learning cities; social capital; proportional odds modeling; quality of life; sustainability; Japan
4.  Αlpha 2a-Adrenoceptor Gene Expression and Early Life Stress-Mediated Propensity to Alcohol Drinking in Outbred Rats  
Stressful events early in life, later high alcohol consumption and vulnerability to alcohol use disorder (AUD) are tightly linked. Norepinephrine is highly involved in the stress response and the α2A-adrenoceptor, which is an important regulator of norepinephrine signalling, is a putative target in pharmacotherapy of AUD. The aim of the present study was to investigate the effects of early-life stress and adult voluntary alcohol drinking on the α2A-adrenoceptor. The relative expression and promoter DNA methylation of the Adra2a gene were measured in the hypothalamus, a key brain region in stress regulation. A well-characterized animal model of early-life stress was used in combination with an episodic voluntary drinking in adulthood. Alcohol drinking rats with a history of early-life stress had lower Adra2a expression than drinking rats not exposed to stress. Alcohol intake and Adra2a gene expression were negatively correlated in high-drinking animals, which were predominantly rats subjected to early-life stress. The results provide support for a link between early-life stress, susceptibility for high alcohol consumption, and low Adra2a expression in the hypothalamus. These findings can increase our understanding of the neurobiological basis for vulnerability to initiate risk alcohol consumption and individual differences in the response to α2A-adrenoceptor agonists.
doi:10.3390/ijerph120707154
PMCID: PMC4515647  PMID: 26121187
α2A-adrenoceptor; alcohol; brain; gene expression; rat; maternal separation; stress
5.  Forecasting and Analyzing the Disease Burden of Aged Population in China, Based on the 2010 Global Burden of Disease Study  
Background: Forecasting the disease burden of the elderly will contribute to make a comprehensive assessment about physical and mental status of the elderly in China and provide a basis for reducing the negative consequences of aging society to a minimum. Methods: This study collected data from a public database online provided by Global Burden of Disease Study 2010. Grey model GM (1, 1) was used to forecast all-cause and disease-specific rates of disability adjusted life years (DALYs) in 2015 and 2020. Results: After cross-sectional and longitudinal analysis, we found that non-communicable diseases (NCDs) were still the greatest threats in the elderly, followed by injuries. As for 136 predicted causes, more than half of NCDs increased obviously with age, less than a quarter of communicable, material, neonatal, and nutritional disorders or injuries had uptrend. Conclusions: The findings display the health condition of the Chinese elderly in the future, which will provide critical information for scientific and sociological researches on preventing and reducing the risks of aging society.
doi:10.3390/ijerph120707172
PMCID: PMC4515648  PMID: 26121188
disease burden; aged population; China; Grey model
6.  Physical Activity and Snus: Is There a Link? 
The study aimed at assessing the link between physical activity (PA), sports activity and snus use among young men in Switzerland. Data from the Cohort Study on Substance Use Risk Factors (C-SURF) were used to measure PA with the International Physical Activity Questionnaire and sports activity with a single item. Multivariate logistic regression analysis was conducted to measure the association between snus use, PA and sports activity. Similar models were run for smoking and snuff use. Snus use increased in a dose-response association with PA (high level: OR = 1.72; 95% CI 1.16–2.55) and with individuals exercising once a week or more often (OR = 1.65; 95% CI 1.26–2.16; p < 0.001) or almost every day (OR = 2.27; 95% CI 1.72–3.01; p < 0.001) in separate models. Entered simultaneously, only sports and exercise maintained a basically unchanged significant dose-response relationship, whereas PA became non-significant. A non-significant dose-response relation was found for cigarette smoking and snuff use, indicating that the association with sport is specific to snus and not to tobacco use in general or smokeless tobacco in particular. This study showed that the association between snus use and sports is not specific to Nordic countries.
doi:10.3390/ijerph120707185
PMCID: PMC4515649  PMID: 26121189
smokeless tobacco; youth tobacco use; education—youth prevention
7.  Accessible Transportation, Geographic Elevation, and Masticatory Ability Among Elderly Residents of a Rural Area 
Given that public transportation networks are often worse in rural areas than in urban areas, rural residents who do not drive can find it difficult to access health-promoting goods, services, and resources related to masticatory ability. Moreover, geographical location, assessed by elevation, could modify this association. The aim of this study was to test whether the association between access to transportation and masticatory ability varied by elevation. Data were collected from a cross-sectional study conducted in Mizuho and Iwami counties, Japan. Objective masticatory ability was evaluated using a test gummy jelly and elevation was estimated by the geographic information systems according to the participant’s address. After excluding subjects with missing data, 672 subjects (Mizuho = 401 and Iwami = 271) were analyzed. After adjustment for potential confounders, being a driver was not significantly associated with masticatory ability among elderly people living at low elevation (≤313 m) in Mizuho county. However, after the same adjustment, being a driver remained significantly associated with increased masticatory ability among elderly at high elevations. Similar findings were observed in Iwami county. Accessible transportation was significantly associated with increased mastication ability in elderly people living at high elevations, but not in those living at low elevations.
doi:10.3390/ijerph120707199
PMCID: PMC4515650  PMID: 26132474
masticatory ability; accessible transportation; elevation; mountainous area
8.  Accessibility of Catering Service Venues and Adolescent Drinking in Beijing, China 
This study assessed the association between accessibility of catering service venues and adolescents’ alcohol use over the previous 30 days. The data were collected from cross-sectional surveys conducted in 2014, 2223 students at 27 high schools in Chaoyang and Xicheng districts, Beijing using self-administered questionnaires to collect the adolescents information on socio-demographic characteristics and recent alcohol experiences. The accessibility of, and proximity to, catering service venues were summarized by weights, which were calculated by multiplication of the type-weight and the distance-weight. All sampled schools were categorized into three subgroups (low, middle, and high geographic density) based on the tertile of nearby catering service venues, and a multi-level logistic regression analysis was performed to explore variance between the school levels. Considering the setting characteristics, the catering service venues weighted value was found to account for 8.6% of the school level variance of adolescent alcohol use. The odds ratios (OR) and 95% confidence intervals (CI) of drinking over the past 30-days among adolescents with medium and high accessibility of catering service venues were 1.17 (0.86, 1.57) and 1.47 (1.06, 2.02), respectively (p < 0.001 for trend test). This study addressed a gap in the adolescent drinking influence by the catering service venues around schools in China. Results suggest that the greater accessibility of catering service venues around schools is associated with a growing risk of recent drinking.
doi:10.3390/ijerph120707208
PMCID: PMC4515651  PMID: 26132475
adolescent drinking; catering service venues; alcoholic beverage; accessibility; school environment
9.  The Construction and Validation of the Heat Vulnerability Index, a Review 
The occurrence of extreme heat and its adverse effects will be exacerbated with the trend of global warming. An increasing number of researchers have been working on aggregating multiple heat-related indicators to create composite indices for heat vulnerability assessments and have visualized the vulnerability through geographic information systems to provide references for reducing the adverse effects of extreme heat more effectively. This review includes 15 studies concerning heat vulnerability assessment. We have studied the indicators utilized and the methods adopted in these studies for the construction of the heat vulnerability index (HVI) and then further reviewed some of the studies that validated the HVI. We concluded that the HVI is useful for targeting the intervention of heat risk, and that heat-related health outcomes could be used to validate and optimize the HVI. In the future, more studies should be conducted to provide references for the selection of heat-related indicators and the determination of weight values of these indicators in the development of the HVI. Studies concerning the application of the HVI are also needed.
doi:10.3390/ijerph120707220
PMCID: PMC4515652  PMID: 26132476
extreme heat; heat vulnerability index; vulnerability map; validation of HVI
10.  The Prefrontal Cortex Activity and Psychological Effects of Viewing Forest Landscapes in Autumn Season 
Recently reported research indicate that forest environments have physiological and psychological relaxing effects compared to urban environments. However, some researchers claim that the stress of the subjects from being watched by others during measurements can affect the measurement result in urban experiments conducted in the center of a street. The present study was conducted to determine whether forest environments have physiological and psychological relaxing effects, using comparison of viewing a forest area with viewing an urban area from the roof of an urban building without being watched by others. Near-infrared spectroscopy (NIRS) measurement was performed on subjects while they viewed scenery for 15 min at each experimental site (urban and forest areas). Subjective assessments were performed after the NIRS measurement was complete. Total hemoglobin and oxyhemoglobin concentrations were significantly lower in the forest area than in the urban area. For semantic differential in subjective assessments, feelings of “comfortable”, “natural”, and “soothed” were significantly higher in the forest area than in the urban area, and for profile of mood states, negative emotions were significantly lower in the forest area than in the urban area. The results of physiological and psychological measurements show that viewing the forest enabled effective relaxation.
doi:10.3390/ijerph120707235
PMCID: PMC4515653  PMID: 26132477
forest therapy; near-infrared spectroscopy; prefrontal cortex activity; hemoglobin concentration; semantic differential method; profile of mood states
11.  Arsenic Accumulation and Translocation in Mangrove (Aegiceras corniculatum L.) Grown in Arsenic Contaminated Soils 
Mangrove wetlands serve as both a sink and source for arsenic (As), as mangrove plants are able to uptake and accumulate As. The present study used pot experiments to evaluate As accumulation and translocation in mangrove (Aegiceras corniculatum L.) seedlings grown in As contaminated soils. Results indicated that A. corniculatum seedlings grew normally under As stress with minute growth inhibition and biomass reduction at different As treatment concentrations in a range of 0–150 mg·kg−1. As concentrations in roots, stems and leaves were increased with increasing As treatment concentrations, but As accumulated mainly in roots, with accumulation rates of 74.54%–89.26% of the total As accumulation. In particular, relatively high bioconcentration factor (BCF) in root (2.12–1.79), low BCF in stem (0.44–0.14) and leaf (0.06–0.01), and thereby a low translocation factor (TF) in stem/root (0.21–0.08) and leaf/root (0.02–0.008) were observed. These results demonstrated that A. corniculatum is an As excluder with the innate capacity to tolerate As stress and root tissues may be employed as a bio-indicator of As in polluted sediments. Additionally, A. corniculatum is a potential candidate mangrove species for As phytostabilization in tropical and subtropical estuarine wetlands.
doi:10.3390/ijerph120707244
PMCID: PMC4515654  PMID: 26132478
arsenic; Aegiceras corniculatum L.; accumulation; translocation; phytostabilization
12.  Scrub Typhus Incidence Modeling with Meteorological Factors in South Korea 
Since its recurrence in 1986, scrub typhus has been occurring annually and it is considered as one of the most prevalent diseases in Korea. Scrub typhus is a 3rd grade nationally notifiable disease that has greatly increased in Korea since 2000. The objective of this study is to construct a disease incidence model for prediction and quantification of the incidences of scrub typhus. Using data from 2001 to 2010, the incidence Artificial Neural Network (ANN) model, which considers the time-lag between scrub typhus and minimum temperature, precipitation and average wind speed based on the Granger causality and spectral analysis, is constructed and tested for 2011 to 2012. Results show reliable simulation of scrub typhus incidences with selected predictors, and indicate that the seasonality in meteorological data should be considered.
doi:10.3390/ijerph120707254
PMCID: PMC4515655  PMID: 26132479
scrub typhus; ANN; meteorological variables
13.  The Significance of Experiences of Nature for People with Parkinson’s Disease, with Special Focus on Freezing of Gait—The Necessity for a Biophilic Environment. A Multi-Method Single Subject Study 
Freezing of Gait (FOG) is a common condition in people with Parkinson’s disease (PD). FOG entails suddenly experiencing difficulties moving or feeling that one’s feet are as glued to the ground. It is triggered, e.g., when passing through doorways. Earlier studies suggest that being in natural environments affects FOG in a positive way. Five subjects were recruited to serve as five single subject cases. We used interviews, observations, questionnaires and collected gait pattern data with aid of an accelerometer. A special designed outdoor setting was used, where we investigated whether passing through hedge openings with or without built elements triggered FOG. We found that no one experienced a FOG reaction when they passed through hedge openings without built elements. However, FOG was triggered when a doorframe was inserted into a hedge opening, and/or when peripheral vision was blocked. We interpret the results such that the doorframe triggered a phobic reflex, causing a freezing reaction. Passing through hedge openings does not trigger FOG, which we interpret as a biophilic reaction. Our results, if repeated in future studies, may have significance to everyday lives of PD patients, who could get a simpler life by consciously prioritizing stays in natural surroundings.
doi:10.3390/ijerph120707274
PMCID: PMC4515656  PMID: 26132480
natural environments; biophilia; perception; instincts; supporting environments; phobic reactions; attention
14.  Removal Efficiency of Faecal Indicator Organisms, Nutrients and Heavy Metals from a Peri-Urban Wastewater Treatment Plant in Thohoyandou, Limpopo Province, South Africa 
Wastewater treatment facilities are known sources of fresh water pollution. This study was carried out from January to June 2014 to assess the reduction efficiency of some selected contaminants in the Thohoyandou wastewater treatment plant (WWTP). The pH and electrical conductivity of the effluent fell within the South African wastewater discharge guidelines. The WWTP showed the chemical oxygen demand reduction efficiency required by the Department of Water Affairs (DWA) guidelines of 75 mg/L for the months of April and June, although it was below this standard in March and May. Free chlorine concentration varied between 0.26–0.96 mg/L and exceeded the DWA guideline value of 0.25 mg/L. The concentration of nitrate-nitrogen (NO3− N) in the influent and effluent varied between 0.499–2.31 mg/L and 7.545–19.413 mg/L, respectively. The concentration of NO3− N in the effluent complied with DWA effluent discharge standard of 15 mg/L, except in April and May. Phosphate concentrations in the influent and effluent were in the ranges of 0.552–42.646 mg/L and 1.572–32.554 mg/L, respectively. The WWTP showed reduction efficiencies of E. coli and Enterococci during some sampling periods but the level found in the effluent exceeded the recommended guideline value of 1000 cfu/100 mL for faecal indicator organisms in wastewater effluents. Consistent removal efficiencies were observed for Al (32–74%), Fe (7–32%) and Zn (24–94%) in most of the sampling months. In conclusion, the Thohoyandou WWTP is inefficient in treating wastewater to the acceptable quality before discharge.
doi:10.3390/ijerph120707300
PMCID: PMC4515657  PMID: 26132481
E. coli; effluents; health; influent; impacts; treatment; wastewater
15.  Effects of the Visual Exercise Environments on Cognitive Directed Attention, Energy Expenditure and Perceived Exertion 
Green exercise research often reports psychological health outcomes without rigorously controlling exercise. This study examines effects of visual exercise environments on directed attention, perceived exertion and time to exhaustion, whilst measuring and controlling the exercise component. Participants completed three experimental conditions in a randomized counterbalanced order. Conditions varied by video content viewed (nature; built; control) during two consistently-ordered exercise bouts (Exercise 1: 60% VO2peakInt for 15-mins; Exercise 2: 85% VO2peakInt to voluntary exhaustion). In each condition, participants completed modified Backwards Digit Span tests (a measure of directed attention) pre- and post-Exercise 1. Energy expenditure, respiratory exchange ratio and perceived exertion were measured during both exercise bouts. Time to exhaustion in Exercise 2 was also recorded. There was a significant time by condition interaction for Backwards Digit Span scores (F2,22 = 6.267, p = 0.007). Scores significantly improved in the nature condition (p < 0.001) but did not in the built or control conditions. There were no significant differences between conditions for either perceived exertion or physiological measures during either Exercise 1 or Exercise 2, or for time to exhaustion in Exercise 2. This was the first study to demonstrate effects of controlled exercise conducted in different visual environments on post-exercise directed attention. Via psychological mechanisms alone, visual nature facilitates attention restoration during moderate-intensity exercise.
doi:10.3390/ijerph120707321
PMCID: PMC4515658  PMID: 26133125
green exercise; cognitive functioning; wellbeing; directed attention; exercise environments; perceived exertion
16.  Breastfeeding Rates and Growth Charts—the Zhejiang Infant Feeding Trial 
A randomised control trial was undertaken in Hangzhou, China, to study the influence of the growth chart used on breastfeeding rates. Mothers with infants who were being fully breastfed at 6 weeks after birth (n = 1602) were invited to participate in the trial; 1415 agreed to participate and 1295 completed the study. Two growth charts were used, one that was heavier for the first six months of life (Chart A, n = 686) and a lighter growth chart (Chart B, n = 609). Mothers were interviewed and infants measured at 6 weeks and 3, 4, 5 and 6 months after delivery. At 6 months the full breastfeeding rates were 18.1% in the group using the heavier growth chart compared to 22.8% in the lighter growth chart group. After adjusting for potential confounders this difference remained significant (aOR 1.41, 95% confidence intervals 1.02, 1.93). These results suggest that breastfeeding rates may be influenced by the type of growth chart used. Mothers who perceive that their infants are not growing adequately (i.e., using the heavier charts) may introduce other foods to their infants earlier than mothers using the lighter chart. While a larger trial is required to confirm the results, in the interim it is suggested that if heavier growth charts are used, a lower percentile line could be used to assess adequacy of growth.
doi:10.3390/ijerph120707337
PMCID: PMC4515659  PMID: 26133126
growth chart; mother’s perceptions; percentiles; breastfeeding rates; China
17.  Extremely Low Frequency Magnetic Field Exposure and Parkinson’s Disease—A Systematic Review and Meta-Analysis of the Data 
Objective: To examine the association between occupational exposure to extremely-low-frequency magnetic fields (ELF-MF) and Parkinson’s disease. Methods: We systematically searched publications reporting risk estimates of Parkinson’s disease in workers exposed to ELF-MF. Summary relative risks were obtained with random effects meta-analysis. Results: We included 11 studies. To assign exposure, four studies evaluated occupational records, four used census, interview or questionnaire information and three used death certificates. Risk of Parkinson’s disease was not elevated in workers exposed to ELF-MF with a summary relative risk of 1.05, 95% CI 0.98–1.13. Conclusions: Overall, there was no evidence that the exposure to ELF-MF increases the risk of Parkinson’s disease.
doi:10.3390/ijerph120707348
PMCID: PMC4515660  PMID: 26133127
meta-analysis; Parkinson’s disease; magnetic field; human
18.  Cross-Sectional Study of Hepatitis A Virus Infection in the Pantanal Population before Vaccine Implementation in Brazil: Usage of Non-Invasive Specimen Collection 
Population-based prevalence studies are essential tools for screening of hepatitis A and provide important data on susceptible groups. However, surveillance in isolated communities is difficult because of the limited access to these areas and the need for blood sample collection. This study aimed to determine the anti-HAV prevalence using oral fluid samples to provide an alternative tool for epidemiological studies that might be useful for vaccination-related decisions. The study population was composed of 224 volunteers from South Pantanal, aged 3 to 86 years old. This study was performed using oral fluids, previously standardized for anti-HAV antibody detection, which were collected using a ChemBio device. Eluates were tested using modified commercial EIA to detect anti-HAV antibodies. The overall prevalence was 79.1%, corresponding to 178 reactive EIA tests out of 224 samples. The age stratified data revealed a prevalence of 47.8% between 0–10 years, 84% in 11–20 years and 91.9% in subjects older than 21 years. Results indicate that hepatitis A prevalence was higher in adolescents and adults, corroborating the literature reports. Thus, oral fluid samples could replace serum in HAV epidemiological studies in isolated communities as they are efficient at detecting anti-HAV antibodies.
doi:10.3390/ijerph120707357
PMCID: PMC4515661  PMID: 26133128
hepatitis A; epidemiology; oral fluid; vaccine
19.  Cost-Effectiveness of a New Nordic Diet as a Strategy for Health Promotion 
Inappropriate diets constitute an important health risk and an increasing environmental burden. Healthy regional diets may contribute to meeting this dual challenge. A palatable, healthy and sustainable New Nordic diet (NND) based on organic products from the Nordic region has been developed. This study assesses whether a large-scale introduction of NND is a cost-effective health promotion strategy by combining an economic model for estimating the utility-maximizing composition of NND, a life cycle assessment model to assess environmental effects of the dietary change, and a health impact model to assess impacts on the disease burden. Consumer expenditure for food and beverages in the NND is about 16% higher than currently, with the largest relative difference in low-income households. Environmental loads from food consumption are 15%–25% lower, and more than 18,000 disability-adjusted life years (DALY) will be saved per year in Denmark. NND exhibits a cost-effectiveness ratio of about €73,000–94,000 per DALY saved. This cost-effectiveness improves considerably, if the NND’s emphasis on organic and Nordic-origin products is relaxed.
doi:10.3390/ijerph120707370
PMCID: PMC4515662  PMID: 26133129
New Nordic Diet; environmental impact; public health; cost-effectiveness
20.  Association Between Geographic Elevation, Bone Status, and Exercise Habits: The Shimane CoHRE Study 
In recent years, there has been growing interest in the association between the residential environment and health. The association between residential environment (i.e., geographic elevation) and bone status is unknown. Furthermore, these associations could differ by exercise habits due to the chronically greater daily activity caused by steep slopes in mountainous areas. The aim of this study was to test whether the association between bone status of elderly people measured using quantitative ultrasound (QUS) and elevation varied according to the exercise habits in a mountainous area population. Data were collected from a cross-sectional study conducted during 2012–2013. QUS value was expressed as a proportion of the young adult mean (%YAM), with higher scores donating better bone status. After excluding subjects with missing data, we analyzed the data for 321 men and 500 women. Our results indicate that %YAM was not associated with elevation among men, or among women with exercise habits. However, elevation was associated with %YAM among women without exercise habits. Our results highlight the importance of considering residential environment and exercise habits when establishing promotion strategies to maintain bone status of the elderly people who live in rural mountainous areas.
doi:10.3390/ijerph120707392
PMCID: PMC4515663  PMID: 26133130
bone status; quantitative ultrasound; geographic elevation; aging population
21.  Toxicity and Bioaccumulation of Heavy Metals in Spinach (Spinacia oleracea) Grown in a Controlled Environment 
The impact of heavy metal toxicity on the shoot and root lengths, total protein, fiber characteristics, moisture content and nutrient composition of spinach (Spinacia oleracea) was evaluated. Plants were grown in pots containing soil and treated with different concentrations (mg/kg) of lead (Pb; 300, 400 and 500), cadmium (Cd; 0.5, 1 and 1.5) and zinc (Zn; 250, 500, and 700) as well as mixtures of Cd and Pb (0.5/300, 1/400, 1.5/500), Cd and Zn (0.5/250, 1/500, 1.5/700), and Pb and Zn (300/250, 400/500, 500/700). Soil contaminated by long-term irrigation with wastewater containing heavy metals was simulated. An increase in concentrations of heavy metals both individually and as mixtures significantly (p < 0.05) reduced the growth parameters and nutrient contents of S. oleracea. The uptake patterns of heavy metals in mixtures showed antagonistic impacts on each other. The toxicities of the mixtures Cd and Pb, Cd and Zn as well as Pb and Zn were higher than those observed in separate heavy metal applications but less than their additive sums. The toxicity caused by individual heavy metals was the highest for Cd followed by Pb and Zn. The highest toxicity was observed in plants grown in soil contaminated by Cd and Pb.
doi:10.3390/ijerph120707400
PMCID: PMC4515664  PMID: 26133131
bioaccumulation; cadmium; contamination; irrigation; lead; nutrient; spinach; toxicity; water resources management; zinc
22.  Sexual Health of Polish Athletes with Disabilities 
The purpose of this study was to determine sexual functioning of Polish athletes with disabilities (including paralympians). The study encompassed 218 people with physical disabilities, aged between 18 and 45 (149 men and 69 women). The entire research population was divided into three groups: Polish paralympians (n = 45), athletes with disabilities (n = 126) and non-athletes with disabilities (n = 47). The quality of sexual life of Polish paralympians was measured by using the Polish version of Female Sexual Function Index and International Index of Erectile Function. Clinically significant erectile dysfunctions were most often diagnosed in non-athletes (83.33%) with 50% result of severe erectile dysfunctions, followed by athletes and paralympians with comparable results of 56.98% and 54.17% respectively (p = 0.00388). Statistically significant clinical sexual dysfunctions concerned lubrication, orgasm as well as pain domains, and prevailed among female non-athletes (68.42%, 68.42% and 57.89%). Practising sports at the highest level has a favourable effect on the sexuality of men and women with physical disabilities. Men with physical disabilities manifest more sexual disorders than women, an aspect which should be considered by health-care professionals working with people with disabilities.
doi:10.3390/ijerph120707417
PMCID: PMC4515665  PMID: 26133132
Paralympic Games; paralympians; physical activity; sexual functioning
23.  Two-Year Monitoring of Water Samples from Dam of Iskar and the Black Sea, Bulgaria, by Molecular Analysis: Focus on Mycobacterium spp. 
The coast of the Bulgarian Black Sea is a popular summer holiday destination. The Dam of Iskar is the largest artificial dam in Bulgaria, with a capacity of 675 million m3. It is the main source of tap water for the capital Sofia and for irrigating the surrounding valley. There is a close relationship between the quality of aquatic ecosystems and human health as many infections are waterborne. Rapid molecular methods for the analysis of highly pathogenic bacteria have been developed for monitoring quality. Mycobacterial species can be isolated from waste, surface, recreational, ground and tap waters and human pathogenicity of nontuberculose mycobacteria (NTM) is well recognized. The objective of our study was to perform molecular analysis for key-pathogens, with a focus on mycobacteria, in water samples collected from the Black Sea and the Dam of Iskar. In a two year period, 38 water samples were collected—24 from the Dam of Iskar and 14 from the Black Sea coastal zone. Fifty liter water samples were concentrated by ultrafiltration. Molecular analysis for 15 pathogens, including all species of genus Mycobacterium was performed. Our results showed presence of Vibrio spp. in the Black Sea. Rotavirus A was also identified in four samples from the Dam of Iskar. Toxigenic Escherichia coli was present in both locations, based on markers for stx1 and stx2 genes. No detectable amounts of Cryptosporidium were detected in either location using immunomagnetic separation and fluorescence microscopy. Furthermore, mass spectrometry analyses did not detect key cyanobacterial toxins. On the basis of the results obtained we can conclude that for the period 2012–2014 no Mycobacterium species were present in the water samples. During the study period no cases of waterborne infections were reported.
doi:10.3390/ijerph120707430
PMCID: PMC4515666  PMID: 26133133
molecular detection; PCR; monitoring pathogens; Bulgaria
24.  Comparison of the Cumulative Incidence Rates of Coal Workers’ Pneumoconiosis between 1970 and 2013 among Four State-Owned Colliery Groups in China 
The purpose of this study was to identify differences in the incidence characteristics of coal workers’ pneumoconiosis (CWP) based on data from four large state-owned colliery groups of China, by comparing the cumulative incidence rates of CWP. We investigated 87,904 coal workers from the Datong, Kailuan, Fuxin, and Tiefa Colliery Groups, who were exposed to dust for at least 1 year. The cumulative incidence rate of CWP was calculated with the life-table method and stratified analysis among coal workers with different occupational categories during different years of first dust exposure. Our results showed the cumulative incidence rate of Datong was higher than that of any other colliery group among workers with different occupational categories during different years of first dust exposure. For Datong workers who started their dust exposure in the 1970s, the cumulative incidence rates of CWP among tunneling, mining, combining, and helping workers were 34.77%, 10.20%, 34.59%, and 4.91% during the observed time of 34 years, respectively. For those in the 1980s, the cumulative incidence rates were 32.29%, 13.51%, 2.98%, and 0.47%, respectively. The cumulative incidence rates of Fuxin and Tiefa were the lowest. In conclusion, the Datong colliery has the highest cumulative incidence rate of CWP among the four studied collieries, followed by Kailuan. The cumulative incidence rates of Fuxin and Tiefa were the lowest. Additional dust-proofing measures for decreasing dust concentrations are still necessary.
doi:10.3390/ijerph120707444
PMCID: PMC4515667  PMID: 26133134
coal workers’ pneumoconiosis; cumulative incidence rate; life-table method
25.  Irrigation Water Quality for Leafy Crops: A Perspective of Risks and Potential Solutions 
There is increasing evidence of the contribution of irrigation water in the contamination of produce leading to subsequent outbreaks of foodborne illness. This is a particular risk in the production of leafy vegetables that will be eaten raw without cooking. Retailers selling leafy vegetables are increasingly targeting zero-risk production systems and the associated requirements for irrigation water quality have become more stringent in regulations and quality assurance schemes (QAS) followed by growers. Growers can identify water sources that are contaminated with potential pathogens through a monitoring regime and only use water free of pathogens, but the low prevalence of pathogens makes the use of faecal indicators, particularly E. coli, a more practical approach. Where growers have to utilise water sources of moderate quality, they can reduce the risk of contamination of the edible portion of the crop (i.e., the leaves) by treating irrigation water before use through physical or chemical disinfection systems, or avoid contact between the leaves and irrigation water through the use of drip or furrow irrigation, or the use of hydroponic growing systems. This study gives an overview of the main problems in the production of leafy vegetables associated with irrigation water, including microbial risk and difficulties in water monitoring, compliance with evolving regulations and quality standards, and summarises the current alternatives available for growers to reduce microbial risks.
doi:10.3390/ijerph120707457
PMCID: PMC4515668  PMID: 26151764
leafy vegetables; irrigation water; food safety; QAS; GAP; water disinfection treatment; hydroponics

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