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1.  A Systematic Review and Meta-Analysis of Dengue Risk with Temperature Change 
Dengue fever (DF) is the most serious mosquito-borne viral disease in the world and is significantly affected by temperature. Although associations between DF and temperatures have been reported repeatedly, conclusions have been inconsistent. Six databases were searched up to 23 March 2014, without language and geographical restrictions. The articles that studied the correlations between temperatures and dengue were selected, and a random-effects model was used to calculate the pooled odds ratio and 95% confidence intervals. Of 1589 identified articles, 137 were reviewed further, with 33 satisfying inclusion criteria. The closest associations were observed between mean temperature from the included studies (23.2–27.7 °C) and DF (OR 35.0% per 1 °C; 95% CI 18.3%–51.6%) positively. Additionally, minimum (18.1–24.2 °C) (29.5% per 1 °C; 20.9%–38.1%) and maximum temperature (28.0–34.5 °C) (28.9%; 10.3%–47.5%) were also associated with increased dengue transmission. The OR of DF incidence increased steeply from 22 °C to 29 °C, suggesting an inflexion of DF risk between these lower and upper limits of DF risk. This discovery is helpful for government decision-makers focused on preventing and controlling dengue in areas with temperatures within this range.
doi:10.3390/ijerph120100001
PMCID: PMC4306847  PMID: 25546270
dengue fever (DF); temperature; correlation; odds ratio (OR); systematic review; meta-analysis
2.  Applying an Ecohealth Perspective in a State of the Environment Report: Experiences of a Local Public Health Unit in Canada 
We applied an Ecohealth perspective into a State of the Environment report for Grey Bruce Health Unit and summarized environmental and health data relevant for public health practice. We aimed for comprehensiveness in our data compilation, including: standard media categories (e.g., air, water, land); and ecological indicators (e.g., vectors, forests, wetlands). Data sources included both primary (collected by an organization) and secondary (assembled by others). We organized indicators with the Driving forces-Pressure-State-Exposure-Effect-Action (DPSEEA) framework created by the World Health Organization. Indicators of air, water and land quality generally appeared to point towards a healthy state. Vector-borne diseases remained low. Forests and wetlands appeared to be in good condition, however more monitoring data was needed to determine trends in their ecological indicators. Data were not available on biodiversity and fish conditions. The results of our application of the DPSEEA framework suggest that routinely collected environmental and health data can be structured into the framework, though challenges arose due to gaps in data availability, particularly for social and gender analyses. Ecohealth approaches had legitimacy with broader healthy community partners but applying such approaches was a complex undertaking.
doi:10.3390/ijerph120100016
PMCID: PMC4306848  PMID: 25546271
Ecohealth; environmental indicators; public health; state of the environment
3.  Agricultural and Management Practices and Bacterial Contamination in Greenhouse versus Open Field Lettuce Production 
The aim of this study was to gain insight into potential differences in risk factors for microbial contamination in greenhouse versus open field lettuce production. Information was collected on sources, testing, and monitoring and if applicable, treatment of irrigation and harvest rinsing water. These data were combined with results of analysis on the levels of Escherichia coli as a fecal indicator organism and the presence of enteric bacterial pathogens on both lettuce crops and environmental samples. Enterohemorragic Escherichia coli (EHEC) PCR signals (vt1 or vt2 positive and eae positive), Campylobacter spp., and Salmonella spp. isolates were more often obtained from irrigation water sampled from open field farms (21/45, 46.7%) versus from greenhouse production (9/75, 12.0%). The open field production was shown to be more prone to fecal contamination as the number of lettuce samples and irrigation water with elevated E. coli was significantly higher. Farmers comply with generic guidelines on good agricultural practices available at the national level, but monitoring of microbial quality, and if applicable appropriateness of water treatment, or water used for irrigation or at harvest is restricted. These results indicate the need for further elaboration of specific guidelines and control measures for leafy greens with regard to microbial hazards.
doi:10.3390/ijerph120100032
PMCID: PMC4306849  PMID: 25546272
lettuce; water quality; primary production; pathogens; good agricultural practice
4.  NNK, a Tobacco-Specific Carcinogen, Inhibits the Expression of Lysyl Oxidase, a Tumor Suppressor 
A tobacco-specific carcinogen, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), is believed to contribute to the cancer burden in cigarette smokers. To evaluate NNK effects on the expression of lysyl oxidase (LOX), a tumor suppressor, we examined this enzyme at various levels in NNK-treated rat fetal lung fibroblasts (RFL6). Exposure of cells to NNK reduced levels of steady-states LOX mRNA and new transcript synthesis. NNK inhibited all LOX protein species in a dose-dependent manner. Although 300 µM NNK markedly decreased the level in the 46 kDa preproenzyme, under same conditions, there was no detectable amounts of the 50 kDa proenzyme and the 32 kDa mature enzyme suggesting NNK perturbing the LOX protein processing to its mature form. Moreover, NNK also suppressed LOX activities in conditioned media of treated cells. At the promoter level, NNK enhanced methylation of CpG, but decreased acetylation of histone H3 at the core promoter region of the LOX gene. These results indicated that transcriptional and translational processes of LOX are major targets for NNK. Thus, inactivation of tumor suppressor gene LOX may play a critical role in NNK carcinogenesis.
doi:10.3390/ijerph120100064
PMCID: PMC4306850  PMID: 25546273
lysyl oxidase (LOX); 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK); CpG methylation; histone H3 acetylation
5.  Blood Lead Concentrations in Jamaican Children with and without Autism Spectrum Disorder 
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder manifesting by early childhood. Lead is a toxic metal shown to cause neurodevelopmental disorders in children. Several studies have investigated the possible association between exposure to lead and ASD, but their findings are conflicting. Using data from 100 ASD cases (2–8 years of age) and their age- and sex-matched typically developing controls, we investigated the association between blood lead concentrations (BLC) and ASD in Jamaican children. We administered a questionnaire to assess demographic and socioeconomic information as well as exposure to potential lead sources. We used General Linear Models (GLM) to assess the association of BLC with ASD status as well as with sources of exposure to lead. In univariable GLM, we found a significant difference between geometric mean blood lead concentrations of ASD cases and controls (2.25 μg/dL cases vs. 2.73 μg/dL controls, p < 0.05). However, after controlling for potential confounders, there were no significant differences between adjusted geometric mean blood lead concentrations of ASD cases and controls (2.55 μg/dL vs. 2.72 μg/dL, p = 0.64). Our results do not support an association between BLC and ASD in Jamaican children. We have identified significant confounders when assessing an association between ASD and BLC.
doi:10.3390/ijerph120100083
PMCID: PMC4306851  PMID: 25546274
autism spectrum disorder; blood lead concentrations; seafood; vegetables; fruits; Jamaica
6.  Moving beyond Green: Exploring the Relationship of Environment Type and Indicators of Perceived Environmental Quality on Emotional Well-Being following Group Walks 
Against the backdrop of increasing interest in the relationship between Nature and health, this study examined the effect of perceived environment type and indicators of perceived environmental quality on short-term emotional well-being following outdoor group walks. Participants (n = 127) of a national group walk program completed pre- and post-walk questionnaires for each walk attended (n = 1009) within a 13-week study period. Multilevel linear modelling was used to examine the main and moderation effects. To isolate the environmental from the physical activity elements, analyses controlled for walk duration and perceived intensity. Analyses revealed that perceived restorativeness and perceived walk intensity predicted greater positive affect and happiness following an outdoor group walk. Perceived restorativeness and perceived bird biodiversity predicted post-walk negative affect. Perceived restorativeness moderated the relationship between perceived naturalness and positive affect. Results suggest that restorative quality of an environment may be an important element for enhancing well-being, and that perceived restorativeness and naturalness of an environment may interact to amplify positive affect. These findings highlight the importance of further research on the contribution of environment type and quality on well-being, and the need to control for effects of physical activity in green exercise research.
doi:10.3390/ijerph120100106
PMCID: PMC4306852  PMID: 25546275
emotional well-being; perceived restorativeness; biodiversity; attention restoration theory; environmental quality indicators; green exercise; group walks
7.  Suicide Risks among Adolescents and Young Adults in Rural China 
Background: In China, suicide is one of the major causes of death among adolescents and young adults aged 15 to 34 years. Aim: The current study examines how risk factors vary by age groups in rural China, referring to those aged 15 to 24 years and those aged 25 to 34 years. Method: A case-control psychological autopsy (PA) study is conducted in sixteen counties from three Chinese provinces, including 392 suicide cases and 416 community living controls in the sample. Results: In China, young adults aged 25 to 34 years have a higher risk for suicide than adolescents aged 15 to 24 years, and it holds true even controlling for relevant social factors. In addition, age-related factors such as education, marital status, whether having children, status in the family, physical health, and personal income all have varying degrees of impact on suicide risks for rural youth. Conclusions: This study shows that there are some age-related risk factors for suicide at certain life stages and emphasizes that young adults in rural China aged 25 to 34 years have an increased risk of suicide as a result of experiencing more psychological strains with age.
doi:10.3390/ijerph120100131
PMCID: PMC4306853  PMID: 25546276
suicide; risk factors; adolescent; young adult
8.  Daily Physical Activity and Screen Time, but Not Other Sedentary Activities, Are Associated with Measures of Obesity during Childhood 
Childhood obesity is related to low physical activity level and a sedentary lifestyle. The aim of this study was to assess the physical activity level and sedentary behaviour of Malaysian children aged 7 to 12 years and to examine their association with body mass index (BMI), BMI-for-age Z-score (BAZ), body fatness (%BF) and waist circumference (WC). A total of 1736 children, representing all ethnic groups were recruited from six regions of Malaysia. Anthropometric measurements included body weight, height and waist circumference. Body fat percentage (%BF) was assessed using bioelectrical impedance. Physical activity was assessed by a physical activity questionnaire (PAQ) in all children and by pedometers in a subsample (n = 514). PAQ score and pedometer step counts were negatively associated with BMI, BAZ, %BF and WC after adjusting for covariates. Screen time was positively associated with BAZ and WC. However, other sedentary activities were not significantly related with any anthropometric indicators. Strategies to promote active living among children in Malaysia should focus not only on increasing physical activity but also emphasise reduction in sedentary behaviours.
doi:10.3390/ijerph120100146
PMCID: PMC4306854  PMID: 25546277
anthropometric indicators; body fat; body mass index; physical activity; screen time; sedentary behaviour; waist circumference
9.  Childhood Obesity: A Role for Gut Microbiota? 
Obesity is a serious public health issue affecting both children and adults. Prevention and management of obesity is proposed to begin in childhood when environmental factors exert a long-term effect on the risk for obesity in adulthood. Thus, identifying modifiable factors may help to reduce this risk. Recent evidence suggests that gut microbiota is involved in the control of body weight, energy homeostasis and inflammation and thus, plays a role in the pathophysiology of obesity. Prebiotics and probiotics are of interest because they have been shown to alter the composition of gut microbiota and to affect food intake and appetite, body weight and composition and metabolic functions through gastrointestinal pathways and modulation of the gut bacterial community. As shown in this review, prebiotics and probiotics have physiologic functions that contribute to changes in the composition of gut microbiota, maintenance of a healthy body weight and control of factors associated with childhood obesity through their effects on mechanisms controlling food intake, fat storage and alterations in gut microbiota.
doi:10.3390/ijerph120100162
PMCID: PMC4306855  PMID: 25546278
childhood obesity; gut microbiota; prebiotics; probiotics; body weight; composition
10.  Residents’ Preferences for Household Kitchen Waste Source Separation Services in Beijing: A Choice Experiment Approach 
A source separation program for household kitchen waste has been in place in Beijing since 2010. However, the participation rate of residents is far from satisfactory. This study was carried out to identify residents’ preferences based on an improved management strategy for household kitchen waste source separation. We determine the preferences of residents in an ad hoc sample, according to their age level, for source separation services and their marginal willingness to accept compensation for the service attributes. We used a multinomial logit model to analyze the data, collected from 394 residents in Haidian and Dongcheng districts of Beijing City through a choice experiment. The results show there are differences of preferences on the services attributes between young, middle, and old age residents. Low compensation is not a major factor to promote young and middle age residents accept the proposed separation services. However, on average, most of them prefer services with frequent, evening, plastic bag attributes and without instructor. This study indicates that there is a potential for local government to improve the current separation services accordingly.
doi:10.3390/ijerph120100176
PMCID: PMC4306856  PMID: 25546279
waste recycling; waste separation; household waste; multinomial logit model; China
11.  Water-Borne Diseases and Extreme Weather Events in Cambodia: Review of Impacts and Implications of Climate Change 
Cambodia is prone to extreme weather events, especially floods, droughts and typhoons. Climate change is predicted to increase the frequency and intensity of such events. The Cambodian population is highly vulnerable to the impacts of these events due to poverty; malnutrition; agricultural dependence; settlements in flood-prone areas, and public health, governance and technological limitations. Yet little is known about the health impacts of extreme weather events in Cambodia. Given the extremely low adaptive capacity of the population, this is a crucial knowledge gap. A literature review of the health impacts of floods, droughts and typhoons in Cambodia was conducted, with regional and global information reviewed where Cambodia-specific literature was lacking. Water-borne diseases are of particular concern in Cambodia, in the face of extreme weather events and climate change, due to, inter alia, a high pre-existing burden of diseases such as diarrhoeal illness and a lack of improved sanitation infrastructure in rural areas. A time-series analysis under quasi-Poisson distribution was used to evaluate the association between floods and diarrhoeal disease incidence in Cambodian children between 2001 and 2012 in 16 Cambodian provinces. Floods were significantly associated with increased diarrhoeal disease in two provinces, while the analysis conducted suggested a possible protective effect from toilets and piped water. Addressing the specific, local pre-existing vulnerabilities is vital to promoting population health resilience and strengthening adaptive capacity to extreme weather events and climate change in Cambodia.
doi:10.3390/ijerph120100191
PMCID: PMC4306857  PMID: 25546280
flood; drought; extreme weather event; climate change; Cambodia; health; water-borne disease; diarrhoea
12.  Association between Changing Mortality of Digestive Tract Cancers and Water Pollution: A Case Study in the Huai River Basin, China 
The relationship between the ever-increasing cancer mortality and water pollution is an important public concern in China. This study aimed to explore the association between serious water pollution and increasing digestive cancer mortality in the Huai River Basin (HRB) in China. A series of frequency of serious pollution (FSP) indices including water quality grade (FSPWQG), biochemical oxygen demand (FSPBOD), chemical oxygen demand (FSPCOD), and ammonia nitrogen (FSPAN) were used to characterize the surface water quality between 1997 and 2006. Data on the county-level changing mortality (CM) due to digestive tract cancers between 1975 and 2006 were collected for 14 counties in the study area. Most of investigated counties (eight) with high FSPWQG (>50%) distributed in the northern region of the HRB and had larger CMs of digestive tract cancers. In addition to their similar spatial distribution, significant correlations between FSP indices and CMs were observed by controlling for drinking water safety (DWS), gross domestic product (GDP), and population (POP). Furthermore, the above-mentioned partial correlations were clearly increased when only controlling for GDP and POP. Our study indicated that county-level variations of digestive cancer mortality are remarkably associated with water pollution, and suggested that continuous measures for improving surface water quality and DWS and hygienic interventions should be effectively implemented by local governments.
doi:10.3390/ijerph120100214
PMCID: PMC4306858  PMID: 25546281
increasing mortality; digestive tract cancers; water pollution; drinking water safety; Huai River Basin
13.  The Excess Heat Factor: A Metric for Heatwave Intensity and Its Use in Classifying Heatwave Severity 
Heatwaves represent a significant natural hazard in Australia, arguably more hazardous to human life than bushfires, tropical cyclones and floods. In the 2008/2009 summer, for example, many more lives were lost to heatwaves than to that summer’s bushfires which were among the worst in the history of the Australian nation. For many years, these other forms of natural disaster have received much greater public attention than heatwaves, although there are some signs of change. We propose a new index, called the excess heat factor (EHF) for use in Australian heatwave monitoring and forecasting. The index is based on a three-day-averaged daily mean temperature (DMT), and is intended to capture heatwave intensity as it applies to human health outcomes, although its usefulness is likely to be much broader and with potential for international applicability. The index is described and placed in a climatological context in order to derive heatwave severity. Heatwave severity, as characterised by the climatological distribution of heatwave intensity, has been used to normalise the climatological variation in heatwave intensity range across Australia. This methodology was used to introduce a pilot national heatwave forecasting service for Australia during the 2013/2014 summer. Some results on the performance of the service are presented.
doi:10.3390/ijerph120100227
PMCID: PMC4306859  PMID: 25546282
heatwave; heatwave intensity; heatwave severity; excess heat factor; heatwave monitoring; heatwave forecasting; heat acclimatisation; heatwave adaptation
14.  Developing a Heatwave Early Warning System for Sweden: Evaluating Sensitivity of Different Epidemiological Modelling Approaches to Forecast Temperatures 
Over the last two decades a number of heatwaves have brought the need for heatwave early warning systems (HEWS) to the attention of many European governments. The HEWS in Europe are operating under the assumption that there is a high correlation between observed and forecasted temperatures. We investigated the sensitivity of different temperature mortality relationships when using forecast temperatures. We modelled mortality in Stockholm using observed temperatures and made predictions using forecast temperatures from the European Centre for Medium-range Weather Forecasts to assess the sensitivity. We found that the forecast will alter the expected future risk differently for different temperature mortality relationships. The more complex models seemed more sensitive to inaccurate forecasts. Despite the difference between models, there was a high agreement between models when identifying risk-days. We find that considerations of the accuracy in temperature forecasts should be part of the design of a HEWS. Currently operating HEWS do evaluate their predictive performance; this information should also be part of the evaluation of the epidemiological models that are the foundation in the HEWS. The most accurate description of the relationship between high temperature and mortality might not be the most suitable or practical when incorporated into a HEWS.
doi:10.3390/ijerph120100254
PMCID: PMC4306860  PMID: 25546283
heatwave; early warning; forecast
15.  Evaluation of the Relationship between 5-HTT and MAO Gene Polymorphisms, Mood and Level of Anxiety among Postmenopausal Women 
Objective: The aim of this study was to analyze how mood and anxiety level are related to the functional genetic polymorphism in the promoter region of SLC6A4 (5-HTTLPR) and the 30-bp VNTR polymorphism in the MAO A promoter region. Methods: The study involved 272 postmenopausal women from Poland. The authors employed the State-Trait Anxiety Inventory for measuring levels of anxiety, the Mood Adjective Check List for measuring mood, and genetic tests. Results: Analysis did not show any statistically significant differences in the mean levels of anxiety, and mood disorders in women in relation to genotypes of the 5-HTTLPR (SLC6A4) polymorphism and the 30-bp VNTR polymorphism in the MAO A promoter region. However, these problems were more severe among women with s/s genotype. In the case of MAO A gene polymorphism, the level of anxiety was higher in women with a 4/4 genotype. Conclusions: The study did not prove the possibility of the identification of homogeneous groups of women with an elevated risk of developing anxiety and mood disorders during the post-menopausal period. Nevertheless, it showed that respondents with s/s genotype of the 44-bp polymorphism in the 5-HTT (SLC6A4) promoter region had the highest average anxiety levels both as a state and as a trait. Furthermore, the analysis of the 30-bp VNTR polymorphism in the MAO A promoter region demonstrated slight differences in anxiety levels between the women, indicating that those with a 4/4 genotype had higher severity of anxiety symptoms.
doi:10.3390/ijerph120100268
PMCID: PMC4306861  PMID: 25547397
mood disorders; postmenopause; 5HTTLPR; MAO A; anxiety
16.  Electronic Cigarettes and Indoor Air Quality: A Simple Approach to Modeling Potential Bystander Exposures to Nicotine 
There has been rapid growth in the use of electronic cigarettes (“vaping”) in Europe, North America and elsewhere. With such increased prevalence, there is currently a debate on whether the aerosol exhaled following the use of e-cigarettes has implications for the quality of air breathed by bystanders. Conducting chemical analysis of the indoor environment can be costly and resource intensive, limiting the number of studies which can be conducted. However, this can be modelled reasonably accurately based on empirical emissions data and using some basic assumptions. Here, we present a simplified model, based on physical principles, which considers aerosol propagation, dilution and extraction to determine the potential contribution of a single puff from an e-cigarette to indoor air. From this, it was then possible to simulate the cumulative effect of vaping over time. The model was applied to a virtual, but plausible, scenario considering an e-cigarette user and a non-user working in the same office space. The model was also used to reproduce published experimental studies and showed good agreement with the published values of indoor air nicotine concentration. With some additional refinements, such an approach may be a cost-effective and rapid way of assessing the potential exposure of bystanders to exhaled e-cigarette aerosol constituents.
doi:10.3390/ijerph120100282
PMCID: PMC4306862  PMID: 25547398
air quality modelling; indoor air pollution; e-cigarette; bystander exposure; nicotine
17.  Health Impact Assessment of Urban Waterway Decisions 
Health impact assessments (HIA) promote the consideration of health in a wide range of public decisions. Although each HIA is different, common pathways, evidence bases, and strategies for community engagement tend to emerge in certain sectors, such as urban redevelopment, natural resource extraction, or transportation planning. To date, a limited number of HIAs have been conducted on decisions affecting water resources and waterfronts. This review presents four recent HIAs of water-related decisions in the United States and Puerto Rico. Although the four cases are topically and geographically diverse, several common themes emerged from the consideration of health in water-related decisions. Water resource decisions are characterized by multiple competing uses, inter-institutional and inter-jurisdictional complexity, scientific uncertainty, long time scales for environmental change, diverse cultural and historical human values, and tradeoffs between private use and public access. These four case studies reveal challenges and opportunities of examining waterfront decisions through a “health lens”. This review analyzes these cases, common themes, and lessons learned for the future practice of HIA in the waterfront zone and beyond.
doi:10.3390/ijerph120100300
PMCID: PMC4306863  PMID: 25547399
health impact assessment; urban development; urban health; environment and public health; water quality; recreation; rivers
18.  Polycyclic Aromatic Hydrocarbon Residues in Serum Samples of Autopsied Individuals from Tennessee 
This study reports the concentrations of Polycyclic Aromatic Hydrocarbons (PAHs) in human blood sera samples (n = 650) obtained at autopsy from individuals who died of drug abuse, alcohol toxicity, homicide, suicide and other unknown causes. The analyzed samples from decedents revealed the presence of PAHs of which B(a)P was the most predominant one, followed by benzo(b)fluoranthene and benzo(k)fluoranthene. The other PAHs detected sporadically and measured were benzo(g,h,i)perylene, acenaphthene, anthracene, phenanthrene, and fluoranthene The mean concentrations of PAHs were greater in the twenties to fifties age groups compared to others. The PAH residue levels detected were high in African Americans compared to Caucasians, Asians, and Hispanics. It appears that environmental exposure, dietary intake and in some cases occupational exposure may have contributed to the PAH body burden. While the PAH residue concentrations measured fall within the range of those reported for healthy adults elsewhere, in isolated cases, the concentrations detected were high, calling the need for a reduction in PAH emissions and human biomonitoring studies for purposes of risk assessment.
doi:10.3390/ijerph120100322
PMCID: PMC4306864  PMID: 25547400
polycyclic aromatic hydrocarbons; benzo(a)pyrene; body burden; autopsy; serum; postmortem
19.  Dental Caries and Periodontal Disease in Brazilian Children and Adolescents with Cerebral Palsy 
The aim of the present study was determine the prevalence and factors associated with dental caries and periodontal disease in Brazilian children and adolescents with cerebral palsy (CP). This is a cross-sectional study conducted with 80 patients ranging in age from 2 to 18 years old. Oral exams were conducted by an examiner with records of DMFT, dmft, Gingival Bleeding Index (GBI) and Community Periodontal Index (CPI). The statistical analysis used Poisson Regression with robust variance estimation (α = 0.05). The prevalence of dental caries was 59.3%, with DMFT and mean dmft of 1.71 ± 2.42 and 2.22 ± 3.23, respectively. The mean GBI was 22.44%, and in the CPI, the prevalence of gingival bleeding, calculus, shallow and deep pockets were 94.73%, 79.62%, 12.90% and 3.22%, respectively. The caregiver’s educational level of less than eight years were associated with the dental caries experience (PR = 1.439; 95%CI = 1.09–1.89). The periodontal alterations were associated with female sex (PR = 0.82; 95%CI = 0.69–0.97), caregiver’s educational level of less than eight years (PR = 1.15; 95%CI = 1.03–1.29), poor oral perception (PR = 0.89; 95%CI = 0.80–0.98), serious communication problem (PR = 0.87; 95%CI = 0.76–0.99) and athetoid type of CP (PR = 0.85; 95%CI = 0.75–0.97). The patients with CP presented high dental caries experience and periodontal alterations, which were associated with their demographic, socioeconomic, oral health perception and systemic information.
doi:10.3390/ijerph120100335
PMCID: PMC4306865  PMID: 25551517
dental caries; periodontal index; cerebral palsy; epidemiology
20.  Identifying Environmental Risk Factors of Cholera in a Coastal Area with Geospatial Technologies 
Satellites contribute significantly to environmental quality and public health. Environmental factors are important indicators for the prediction of disease outbreaks. This study reveals the environmental factors associated with cholera in Zhejiang, a coastal province of China, using both Remote Sensing (RS) and Geographic information System (GIS). The analysis validated the correlation between the indirect satellite measurements of sea surface temperature (SST), sea surface height (SSH) and ocean chlorophyll concentration (OCC) and the local cholera magnitude based on a ten-year monthly data from the year 1999 to 2008. Cholera magnitude has been strongly affected by the concurrent variables of SST and SSH, while OCC has a one-month time lag effect. A cholera prediction model has been established based on the sea environmental factors. The results of hot spot analysis showed the local cholera magnitude in counties significantly associated with the estuaries and rivers.
doi:10.3390/ijerph120100354
PMCID: PMC4306866  PMID: 25551518
cholera; environmental factors; remote sensing; geographic information system (GIS); spatial analysis
21.  Biodegradation Kinetics of Tetrahydrofuran, Benzene, Toluene, and Ethylbenzene as Multi-substrate by Pseudomonas oleovorans DT4 
The biodegradation kinetics of tetrahydrofuran, benzene (B), toluene (T), and ethylbenzene (E) were systematically investigated individually and as mixtures by a series of aerobic batch degradation experiments initiated by Pseudomonas oleovorans DT4. The Andrews model parameters, e.g., maximum specific growth rates (μmax), half saturation, and substrate inhibition constant, were obtained from single-substrate experiments. The interaction parameters in the sum kinetics model (SKIP) were obtained from the dual substrates. The μmax value of 1.01 for tetrahydrofuran indicated that cell growth using tetrahydrofuran as carbon source was faster than the growth on B (μmax, B = 0.39) or T (μmax, T = 0.39). The interactions in the dual-substrate experiments, including genhancement, inhibition, and co-metabolism, in the mixtures of tetrahydrofuran with B or T or E were identified. The degradation of the four compounds existing simultaneously could be predicted by the combination of SKIP and co-metabolism models. This study is the first to quantify the interactions between tetrahydrofuran and BTE.
doi:10.3390/ijerph120100371
PMCID: PMC4306867  PMID: 25561017
biodegradation; tetrahydrofuran; benzene; toluene; ethylbenzene; kinetics model
22.  The Role of Adolescent Nutrition and Physical Activity in the Prediction of Verbal Intelligence during Early Adulthood: A Genetically Informed Analysis of Twin Pairs 
A large body of research has revealed that nutrition and physical activity influence brain functioning at various stages of the life course. Nevertheless, very few studies have explored whether diet and exercise influence verbal intelligence as youth transition from adolescence into young adulthood. Even fewer studies have explored the link between these health behaviors and verbal intelligence while accounting for genetic and environmental factors that are shared between siblings. Employing data from the National Longitudinal Study of Adolescent Health, the current study uses a sample of same-sex twin pairs to test whether youth who engage in poorer fitness and nutritional practices are significantly more likely to exhibit reduced verbal intelligence during young adulthood. The results suggests that, independent of the effects of genetic and shared environmental factors, a number of nutritional and exercise factors during adolescence influence verbal intelligence during adulthood. Limitations are noted and suggestions for future research are outlined.
doi:10.3390/ijerph120100385
PMCID: PMC4306868  PMID: 25568969
nutrition; diet; physical activity; exercise; verbal intelligence; heritability; twins; DF (Defries-Fulker) analysis
23.  Hyperlipidemia and Statins Affect Neurological Outcome in Lumbar Spine Injury 
The disabling pathophysiologic effects of lipid and neuroprotective effects of statins have recently been demonstrated for acute spinal cord injuries in animal models. This large scale population-based study aimed to investigate the effect hyperlipidemia and the use of statins in patients with lumbar spine injury. The National Health Insurance Research Database of Taiwan was used to identify patients with lumbar spine injury. A total of 2844 patients were grouped into three: no hyperlipidemia, hyperlipidemia using low-dose of statins (≤90 of the defined daily dosage (DDD)), and severe hyperlipidemia using high-dose of statins (>90 DDD). A Cox multiple regression model was used to compare the incidence rates of disability among the three groups. The results showed that patients with hyperlipidemia appeared a higher risk of permanent disability (adjusted HR = 1.38, p = 0.28). In subgroup analysis, patients with severe hyperlipidemia had a higher risk of disability (adjusted HR = 3.1, p < 0.004), whereas hyperlipidemia using low-dose statins had a similar risk of permanently disability (adjusted HR = 0.83, p = 0.661). Hyperlipidemia adversely affected the neurological outcomes of lumbar spinal injury. Statins may have the potential to reverse this higher risk of disability. However, this beneficiary effect of statins only existed in patients using a lower dose (≤90 DDD).
doi:10.3390/ijerph120100402
PMCID: PMC4306869  PMID: 25568970
statins; hyperlipidemia; lumbar spine injury; national health insurance
24.  Empowering Sedentary Adults to Reduce Sedentary Behavior and Increase Physical Activity Levels and Energy Expenditure: A Pilot Study 
Objective: The purpose of this study was to assess the effectiveness of a 4-week intervention in which an online personal activity monitor (Gruve-Technologies™) was used to reduce sedentary behavior among sedentary adults. Method: Eighteen, sedentary adult volunteers (12 men, six women, mean age 29 ± 4.0 years) were recruited to participate in the study. Time spent in sedentary activities and light-, moderate-, and vigorous-intensity physical activity and energy expenditure were assessed during waking hours using the monitor and the 7-day SLIPA Log at both baseline and post-intervention. Results: A significant decrease of 33% (3.1 h/day; p < 0.001) was found between the time spent in sedentary activities measured at baseline (9.4 ± 1.1 h/day) and at the end of the 4-week intervention (6.3 ± 0.8 h/day). Consequent to the changes in sedentary time, significant increases were found in the amount of time spent in light- (45% (2.6 h/day), p < 0.001), moderate- (33% (1 h/day) p < 0.001), vigorous-intensity physical activity (39% (0.16 h/day), p < 0.001), and energy expenditure (47% (216.7 kcal/day), p < 0.001). Conclusion: This monitor contributes to a meaningful reduction in time spent in sedentary activities and has a large effect on energy expenditure and physical activity patterns.
doi:10.3390/ijerph120100414
PMCID: PMC4306870  PMID: 25568971
objective measurement of sedentary behavior; accelerometer; 7-day SLIPA log; self-report physical activity
25.  Brand Cigarillos — A Cheap and Less Harmful Alternative to Cigarettes? Particulate Matter Emissions Suggest Otherwise 
Background: Environmental tobacco smoke (ETS)-associated particulate matter (PM) constitutes a considerable health risk for passive smokers. It ought to be assessed separately from the other known toxic compounds of tobacco smoke. Brand-specific differences between cigarettes and particularly between cigarettes and favorably taxed cigarillos, are of public interest and therefore worth being investigated. Methods: An automatic environmental tobacco smoke emitter (AETSE) was developed to generate cigarette and cigarillo smoke in a reliable and reproducible way. John Player Special (JPS) Red cigarettes, JPS filter cigarillos and 3R4F standard research cigarettes were smoked automatically in a 2.88 m3 glass chamber according to a standardized protocol until 5 cm from the top were burned down. Results: Mean concentrations (Cmean) and area of the curve (AUC) of PM2.5 were measured and compared. Cmean PM2.5 were found to be 804 µg/m3 for 3R4F reference cigarettes, 1633 µg/m3 for JPS cigarettes, and 1059 µg/m3 for JPS filter cigarillos. AUC PM2.5-values are 433,873 µg/m3×s for 3R4F reference cigarettes, 534,267 µg/m3×s for JPS Red cigarettes and 782,850 µg/m3×s for JPS filter cigarillos. Conclusion: Potential brand-specific differences of ETS-associated PM emissions among brands of cigarettes, and between cigarettes and cigarillos of the same brand and size should be investigated and published. Information about relative PM-emissions should be printed on the package.
doi:10.3390/ijerph120100428
PMCID: PMC4306871  PMID: 25568972
particulate matter; tobacco; smoke; cigarette; cigarillo

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