Int. J. Environ. Res. Public Health, Volume 15, Issue 3 (March 2018) – 168 articles

Driven by fast-growing economies worldwide, the number of international construction projects is booming, and employing expatriates has inevitably become a strategy used by construction firms. However, stress arising from expatriate assignments can lead to early return, assignment failure, and staff turnover, causing in significant losses to an organisation. Extensive research has focused on the effectiveness of coping behaviours in relation to stress. However, studies investigating the antecedents of coping are rare. The limited studies to date tend to focus on content-based motivations (identifying what), instead of on how coping behaviours can be motivated in the stress management process (identifying how). Focus on expatriate construction professionals (ECPs) is further limited. Hence, this study aims to investigate from a process theory perspective the role of motivation in the stress management process. Using a qualitative interview study approach, involving 22 in-depth interviews, this study first identifies the content of motivation, coping behaviours, performance, and stress in the context of Hong Kong ECPs working on cross-cultural projects in China; it then unveils and explains the associations between the identified variables. Based on the results, stakeholders are recommended to review pre-departure training, so as to ensure that key elements such as personal awareness of stress (cognitive, affective, and physical), expectancies of coping strategies on stress (adaptive or maladaptive), and expectancies of the influence of stress on performance are covered. Full article

Monitoring the creative content within food marketing to children is strongly advocated by public health authorities, but few studies address the prevalence of health-related messaging in television adverts. Food and beverage adverts (n = 18,888 in 2008, n = 6664 in 2010) from UK television channels popular with children were coded and analyzed. Physical-activity depiction displayed an 18.8 percentage point increase from 2008 (4.4%) to 2010 (23.2%). Of the food adverts containing physical-activity depiction in 2010, 81.1% were for non-core foods. The appearance of health claims in food adverts in 2010 increased 4.1 percentage points from 2008 levels (20.7% to 24.8%) where the majority of food adverts featuring health and nutrition claims were for non-core foods (58.3%). Health-related (e.g., health/nutrition, weight loss/diet) appeals were used in 17.1% of food adverts during peak child-viewing times, rising to 33.0% of adverts shown on dedicated children’s channels in 2010. Implicit (physical activity) and explicit (health claims) health messages are increasingly prevalent in UK television food advertising viewed by children, and are frequently used to promote unhealthy foods. Policy makers in the UK should consider amendments to the existing statutory approach in order to address this issue. Full article

Objectives: This study analyses the perceived relevance of stress-dimensions in work-settings from the differential views of Human Resource Managers (HRM), Occupational Physicians (OP), Primary Care Physicians (PCP) and Psychotherapists (PT) in Germany. Methods: Cross-sectional study design, using a self-report questionnaire. Descriptive measures and explorative bivariate methods were applied for group-comparisons. Results are presented as rankings of perceived importance and as polarity profiles of contrasting views. Results: N = 627 participants completed the questionnaires (HRM: n = 172; OP: n = 133; PCP: n = 136; PT: n = 186). The stress dimensions with the highest mean ratings across all four professions were: ‘social relationships in the work place’ (M = 3.55, SD = 0.62) and ‘superiors´ leadership style’ (M = 3.54, SD = 0.64). Mean ratings of perceived relevance of stress dimensions differed most between HRM and the three medical professions. Conclusions: The perceived importance of work-related stress-dimensions seems to be higher in the medical disciplines (OP, PCP, PT) than in the group from the management sector (HRM). However, no fundamental disagreement on the role of work-related stress-dimensions seems to hinder e.g., intensified efforts of cooperation across sectors in tackling the “stress-pandemic” and improving the (mental) health of employees. Full article

Analyzing individual exposure in urban areas offers several challenges where both the individual’s activities and air pollution levels demonstrate a large degree of spatial and temporal dynamics. This review article discusses the concepts, key elements, current developments in assessing personal exposure to urban air pollution (seventy-two studies reviewed) and respective advantages and disadvantages. A new conceptual structure to organize personal exposure assessment methods is proposed according to two classification criteria: (i) spatial-temporal variations of individuals’ activities (point-fixed or trajectory based) and (ii) characterization of air quality (variable or uniform). This review suggests that the spatial and temporal variability of urban air pollution levels in combination with indoor exposures and individual’s time-activity patterns are key elements of personal exposure assessment. In the literature review, the majority of revised studies (44 studies) indicate that the trajectory based with variable air quality approach provides a promising framework for tackling the important question of inter- and intra-variability of individual exposure. However, future quantitative comparison between the different approaches should be performed, and the selection of the most appropriate approach for exposure quantification should take into account the purpose of the health study. This review provides a structured basis for the intercomparing of different methodologies and to make their advantages and limitations more transparent in addressing specific research objectives. Full article

In the United States, racial minorities generally experience poorer cardiovascular health compared to whites, and differences in alcohol consumption and sleep could contribute to these disparities. With a nationally representative sample of 187,950 adults in the National Health Interview Survey from 2004 to 2015, we examined the relationship between alcohol-drinking patterns and sleep duration/quality by race and sex. Using Poisson regression models with robust variance, we estimated sex-specific prevalence ratios for each sleep duration/quality category among blacks compared to whites within categories of alcohol-drinking pattern, adjusting for socioeconomic status and other potential confounders. Across alcohol drinking patterns, blacks were less likely than whites to report recommended sleep of 7–<9 h/day. Short (PR = 1.30 [95% CI: 1.22–1.39]) and long (PR = 1.30 [95% CI: 1.07–1.58]) sleep were 30% more prevalent among black-male infrequent heavy drinkers compared to white-male infrequent heavy drinkers. Short (PR = 1.27 [95% CI: 1.21–1.34]) sleep was more prevalent among black-female infrequent heavy drinkers compared to white-female infrequent heavy drinkers, but there was no difference for long sleep (PR = 1.09 [95% CI: 0.97–1.23]). Black female infrequent moderate drinkers, however, had a 16% higher (PR = 1.16 [95% CI: 1.01–1.33]) prevalence of long sleep compared to their white counterparts. Environmental, social, and biological factors contributing to these findings, along with their impact on disparate health outcomes, should be studied in greater detail. Full article

Cadmium and its compounds are human carcinogens with severe organ toxicity, and their contamination of agricultural soil in China has been frequently reported; however, the dietary exposure to cadmium in residents and the relevant health risk have seldom been reported. In this study, the concentration of cadmium in various types of food collected from 2013 to 2015 were analyzed using graphite furnace atomic absorption spectrometry, and the dietary exposure to cadmium assessed based on a dietary survey in 2976 Guangzhou residents. In total, 3074 out of 4039 food samples had cadmium levels above the limit of detection. The mean ± standard deviation (50th, 95th percentile) cadmium content in all samples was 159.0 ± 112.7 (8.6, 392.4) μg/kg, with levels ranging from 1.0 to 7830 μg/kg. Using the mean cadmium concentrations, the average monthly dietary exposure of Guangzhou residents to cadmium was 14.4 (μg/kg body weight (BW), accounting for 57.6% of the provisional tolerable monthly intake (PTMI). Rice, laver, vegetables, and live aquatic products were the main sources of cadmium intake, on average accounting for 89% of the total value. The dietary cadmium exposure in high consumers (95th percentile food consumption) was 41.0 μg/kg·BW/month, accounting for 163% of the PTMI. Additionally, dietary cadmium exposure at mean consumption but high cadmium food concentration (95th percentile) was 32.3 μg/kg·BW/month, corresponding to 129% of the PTMI. The level of dietary exposure to cadmium in most Guangzhou residents was within the safety limit, thus increased health risk from dietary cadmium exposure is low at present. However, continued efforts by local governments to monitor the levels of cadmium in the four main food categories contributing to exposure are necessary. Full article

A sharp drop in physical activity and skyrocketing obesity rate has accompanied rapid urbanization in China. The urban planning concept of transit-oriented development (TOD) has been widely advocated in China to promote physical activity, especially walking. Indeed, many design features thought to promote walking—e.g., mixed land use, densification, and well-connected street network—often characterize both TODs and established urban neighborhoods. Thus, it is often assumed that TODs have similar physical activity benefits as established urban neighborhoods. To verify this assumption, this study compared walking behaviors in established urban neighborhoods and transit-oriented new towns in Hong Kong. To address the limitation of self-selection bias, we conducted a study using Hong Kong citywide public housing scheme, which assigns residents to different housing estates by flat availability and family size rather than personal preference. The results show new town residents walked less for transportation purpose than urban residents. New town residents far from the transit station (800–1200 m) walked less for recreational purpose than TOD residents close to a rail transit station (<400 m) or urban residents. The observed disparity in walking behaviors challenges the common assumption that TOD and established urban neighborhoods have similar impact on walking behavior. The results suggest the necessity for more nuanced planning strategies, taking local-level factors into account to promote walking of TOD residents who live far from transit stations. Full article

The Shared Socioeconomic Pathways (SSPs) are the new set of alternative futures of societal development that inform global and regional climate change research. They have the potential to foster the integration of socioeconomic scenarios within assessments of future climate-related health impacts. To date, such assessments have primarily superimposed climate scenarios on current socioeconomic conditions only. Until now, the few assessments of future health risks that employed the SSPs have focused on future human exposure—i.e., mainly future population patterns—, neglecting future human vulnerability. This paper first explores the research gaps—mainly linked to the paucity of available projections—that explain such a lack of consideration of human vulnerability under the SSPs. It then highlights the need for projections of socioeconomic variables covering the wide range of determinants of human vulnerability, available at relevant spatial and temporal scales, and accounting for local specificities through sectoral and regional extended versions of the global SSPs. Finally, this paper presents two innovative methods of obtaining and computing such socioeconomic projections under the SSPs—namely the scenario matching approach and an approach based on experts’ elicitation and correlation analyses—and applies them to the case of Europe. They offer a variety of possibilities for practical application, producing projections at sub-national level of various drivers of human vulnerability such as demographic and social characteristics, urbanization, state of the environment, infrastructure, health status, and living arrangements. Both the innovative approaches presented in this paper and existing methods—such as the spatial disaggregation of existing projections and the use of sectoral models—show great potential to enhance the availability of relevant projections of determinants of human vulnerability. Assessments of future climate-related health impacts should thus rely on these methods to account for future human vulnerability—under varying levels of socioeconomic development—and to explore its influence on future health risks under different degrees of climate change. Full article

The object of this exploratory study is to identify the positive, neutral and negative environment factors that affect users who visit Spanish hotels in order to help the hotel managers decide how to improve the quality of the services provided. To carry out the research a Sentiment Analysis was initially performed, grouping the sample of tweets (n = 14459) according to the feelings shown and then a textual analysis was used to identify the key environment factors in these feelings using the qualitative analysis software Nvivo (QSR International, Melbourne, Australia). The results of the exploratory study present the key environment factors that affect the users experience when visiting hotels in Spain, such as actions that support local traditions and products, the maintenance of rural areas respecting the local environment and nature, or respecting air quality in the areas where hotels have facilities and offer services. The conclusions of the research can help hotels improve their services and the impact on the environment, as well as improving the visitors experience based on the positive, neutral and negative environment factors which the visitors themselves identified. Full article

Due to low employment rates associated to chronic conditions in Europe, it is essential to foster effective integration and re-integration into work strategies. The objective of this systematic review is to summarize the evidence on the effectiveness of strategies for integration and re-integration to work for persons with chronic diseases or with musculoskeletal disorders, implemented in Europe in the past five years. A systematic search was conducted in MedLine, PsycINFO, CDR-HTA, CDR-DARE and Cochrane Systematic Reviews. Overall, 32 relevant publications were identified. Of these, 21 were considered eligible after a methodological assessment and included. Positive changes in employment status, return to work and sick leave outcomes were achieved with graded sickness-absence certificates, part-time sick leave, early ergonomic interventions for back pain, disability evaluation followed by information and advice, and with multidisciplinary, coordinated and tailored return to work interventions. Additionally, a positive association between the co-existence of active labour market policies to promote employment and passive support measures (e.g., pensions or benefits) and the probability of finding a job was observed. Research on the evaluation of the effectiveness of strategies targeting integration and re-integration into work for persons with chronic health conditions needs, however, to be improved and strengthened. Full article

New emerging issues appears regarding the possible aerosolization of micro-organisms from biofilters to the ambient air. Traditional bioaerosol sampling and cultural methods used in literature offer relative efficiencies. In this study, a new method revolving around a particle counter capable of detecting total and viable particles in real time was used. This counter (BioTrak 9510-BD) uses laser-induced fluorescence (LIF) technology to determine the biological nature of the particle. The concentration of viable particles was measured on two semi-industrial pilot scale biofilters in order to estimate the Removal Efficiency in viable particles (RE_vp) in stable conditions and to examine the influence of pollutant feeding and relative humidification of the gaseous effluent on the RE_vp. The RE_vp of biofilters reached near 80% and highlighted both the stability of that removal and the statistical equivalence between two identical biofilters. Pollutant deprivation periods of 12 h, 48 h and 30 days were shown to have no influence on the biofilters’ removal capacity, demonstrating the robustness and adaptation capacities of the flora. In contrast, a 90-day famine period turned the biofilters into emitters of viable particles. Finally, the humidification of the effluent was shown to negatively influence the removal capacity for viable particles, as drying off the air was shown to increase the RE_vp from 60 to 85%. Full article

Inner Mongolia, an autonomous region of the People’s Republic of China, has experienced severe soil erosion following a period of rapid economic development and urbanization. To investigate how urbanization has influenced the extent of soil erosion in Inner Mongolia, we used urbanization and soil erosion data from 2000 through 2010 to determine the relationship between urbanization and soil erosion patterns. Two empirical equations—the Revised Universal Soil Loss Equation (RUSLE) and the Revised Wind Erosion Equation (RWEQ)—were used to estimate the intensity of soil erosion, and we performed backward linear regression to model how it changed with greater urbanization. There was an apparent increase in the rate of urbanization and a decrease in the area affected by soil erosion in 2010 compared to the corresponding values for 2000. The urban population stood at 11.32 million in 2010, which represented a 16.47% increase over that in 2000. The area affected by soil erosion in 2000 totaled 704,817 km², yet it had decreased to 674,135 km² by 2010. However, a path of modest urban development (rural–urban mitigation) and reasonable industrial structuring (the development of GDP-2) may partially reduce urbanization’s ecological pressure and thus indirectly reduce the threat of soil erosion to human security. Therefore, to better control soil erosion in Inner Mongolia during the process of urbanization, the current model of economic development should be modified to improve the eco-efficiency of urbanization, while also promoting new modes of urbanization that are environmentally sustainable, cost-effective, and conserve limited resources. Full article

The Institute of Medicine has recommended that improvements are needed in patient-centered care. This study examined hematological cancer patients’ perceptions of which aspects of cancer care were being delivered well and areas that required improvement, and whether patient characteristics, or the treatment center they attended, were associated with quality of patient-centered care. Participants were recruited via three Australian hematological cancer treatment centers and completed a paper-and-pen survey assessing sociodemographic, disease, and psychological and treatment characteristics at recruitment. A second survey that contained the Quality of Patient-Centered Cancer Care measure was completed one month after recruitment (n = 215). The most frequently delivered feature of patient-centered cancer care was hospital staff showing respect for patients (91.0%). The area of care reported most commonly as not being delivered was hospital staff helping the patient find other cancer patients to talk to (29.8%). Patients without depression reported higher perceived quality of treatment decision-making, co-ordinated and integrated care, emotional support, follow-up care, respectful communication, and cancer information than patients with depression. The treatment center that was attended was associated only with the quality of cancer information patients received. Privacy issues may hinder staff connecting patients directly but this could be overcome via referrals to cancer organizations that offer peer support services. Full article

Antibiotics are widely used in aquaculture, however, this often results in undesirable ecological effects. To evaluate the occurrence, temporal variations, and ecological risk of antibiotics in five crab ponds of Lake Guchenghu Basin, China, 44 antibiotics from nine classes were analyzed by rapid resolution liquid chromatography-tandem mass spectrometry (RRLC-MS/MS). Twelve antibiotics belonging to six classes were detected in the aqueous phase of five crab ponds, among which sulfonamides and macrolides were the predominant classes, and six compounds (sulfamonomethoxine, sulfadiazine, trimethoprim, erythromycin-H₂O, monensin, and florfenicol) were frequently detected at high concentrations. In general, the antibiotic levels varied between different crab ponds, with the average concentrations ranging from 122 to 1440 ng/L. The antibiotic concentrations in crab ponds exhibited obvious seasonal variations, with the highest concentration and detection frequency detected in summer. Multivariate analysis showed that antibiotic concentrations were significantly correlated with environmental variables, such as total organic carbon, phosphate, ammonia nitrogen, and pH. Sulfadiazine, clarithromycin, erythromycin-H₂O, and ciprofloxacin posed a high risk to algae, while the mixture of antibiotics could pose a high risk to aquatic organisms in the crab ponds. Overall, the usage of antibiotics in farming ponds should be comprehensively investigated and controlled to preserve a healthy aquaculture ecosystem. Full article

During the last decades, Mediterranean freshwater ecosystems, especially lakes, have been under severe pressure due to increasing eutrophication and water quality deterioration. In this article, we compared the effectiveness of different data analysis methods by assessing the contribution of environmental parameters to eutrophication processes. For this purpose, principal components analysis (PCA), cluster analysis, and a self-organizing map (SOM) were applied, using water quality data from two transboundary lakes of North Greece. SOM is considered as an advanced and powerful data analysis tool because of its ability to represent complex and nonlinear relationships among multivariate data sets. The results of PCA and cluster analysis agreed with the SOM results, although the latter provided more information because of the visualization abilities regarding the parameters’ relationships. Besides nutrients that were found to be a key factor for controlling chlorophyll-a (Chl-a), water temperature was related positively with algal production, while the Secchi disk depth parameter was found to be highly important and negatively related toeutrophic conditions. In general, the SOM results were more specific and allowed direct associations between the water quality variables. Our work showed that SOMs can be used effectively in limnological studies to produce robust and interpretable results, aiding scientists and managers to cope with environmental problems such as eutrophication. Full article

Long-lasting insecticidal nets (LLINs) have been widely used as an effective alternative to conventional insecticide-treated nets (ITNs) for over a decade. Due to the growing number of field trials and interventions reporting the effectiveness of LLINs in controlling malaria, there is a need to systematically review the literature on LLINs and ITNs to examine the relative effectiveness and characteristics of both insecticide nettings. A systematic review of over 2000 scholarly articles published since the year 2000 was conducted. The odds ratios (ORs) of insecticidal net effectiveness in reducing malaria were recorded. The final dataset included 26 articles for meta-regression analysis, with a sample size of 154 subgroup observations. While there is substantial heterogeneity in study characteristics and effect size, we found that the overall OR for reducing malaria by LLIN use was 0.44 (95% CI = 0.41–0.48, p < 0.01) indicating a risk reduction of 56%, while ITNs were slightly less effective with an OR of 0.59 (95% CI = 0.57–0.61, p <0.01). A meta-regression model confirms that LLINs are significantly more effective than ITNs in the prevention of malaria, when controlling for other covariates. For both types of nets, protective efficacy was greater in high transmission areas when nets were used for an extended period. However, cross-sectional studies may overestimate the effect of the nets. The results surprisingly suggest that nets are less effective in protecting children under the age of five, which may be due to differences in child behavior or inadequate coverage. Compared to a previous meta-analysis, insecticide-treated nets appear to have improved their efficacy despite the risks of insecticide resistance. These findings have practical implications for policymakers seeking effective malaria control strategies. Full article

The association of metabolic syndrome (MetS) components with elevated serum alanine aminotransferase (ALT) levels, a marker of hepatic injury, may differ between men and women. However, the sex-specific association in a military young population which has a low prevalence of MetS was unclear. We conducted a cross-sectional examination in 6738 men and 766 women, aged 18–50 years, from the cardiorespiratory fitness study in armed forces (CHIEF) in eastern Taiwan. The components of MetS were defined according to the updated International Diabetes Federation (IDF) ethnic criteria for Asians. Elevated ALT levels were defined as ≥40 U/L for both sexes and ≥30 U/L for women alternatively. Multivariate logistic regression analysis was performed to determine the sex-specific association between MetS components and elevated ALT. The prevalence of MetS and elevated ALT in men were 11.9% and 12.7% respectively, and in women were 3.5%, and 3.8% respectively. In men, high-density lipoprotein < 40 mg/dL, blood pressures ≥ 130/85 mmHg, serum triglycerides ≥ 150 mg/dL, and waist size ≥ 90 cm were associated with elevated ALT (odds ratios (OR) and 95% confidence intervals: 1.59 (1.34–1.90), 1.40 (1.19–1.65), 2.00 (1.68–2.39), and 1.68 (1.38–2.04); all p < 0.001); whereas in women, only fasting plasma glucose ≥ 100 mg/dL was associated with elevated ALT ≥ 40 U/L (OR: 7.59 (2.35–24.51), p = 0.001) and ALT ≥ 30 U/L (2.67 (0.89–7.95), p = 0.08). Our findings suggest that the relationship between metabolic abnormalities and elevated ALT may differ by sex, possibly due to the MetS more prevalent in young adult men than in women. Full article

Background: Energy drinks (EDs) are very popular among young people, who consume them for various reasons. A standard ED typically contains 80 mg of caffeine, as well as glucose, taurine, vitamins and other ingredients. Excessive consumption of EDs and accumulation of the above ingredients, as well as their mutual interactions, can be hazardous to the health of young adults. The purpose of this study was to assess the effect of acute consumption of energy drinks on blood pressure, heart rate and blood glucose. Methods: The study involved 68 volunteers, healthy young adults (mean age 25 years), who were divided into two groups: the first consumed three EDs at one-hour intervals, and the second drank the same amount of water. All participants had their blood pressure (BP)—systolic and diastolic (SBP and DBP)—as well as heart rate (HR) and blood glucose (BG) measured. In addition, participants could report any health problems before and after consuming each portion of ED. Results: In the above experiment, having consumed three portions of ED (240 mg of caffeine), the participants presented a significant increase in DBP (p = 0.003), by over 8%, which coincided with a lack of any significant impact on SBP (p = 0.809). No significant changes were noted in HR (p = 0.750). Consumption of EDs caused a significant increase (p < 0.001) in BG, by ca. 21%, on average. Some participants reported various discomforts, which escalated after 2 and 3 EDs. Conclusions: Acute consumption of EDs contributed to increased diastolic blood pressure, blood glucose and level of discomfort in healthy young people. Our results reinforce the need for further studies on a larger population to provide sufficient evidence. Full article

This paper presents the results of an experimental study aimed at investigating the effect of operative parameters on the efficiency of a soil flushing process, conducted on real contaminated soil containing high amounts of Cu and Zn. Soil flushing tests were carried out with Ethylenediamine-N,N′-disuccinic acid (EDDS) as a flushing agent due to its high biodegradability and environmentally friendly characteristics. Process parameters such as Empty-Bed Contact Time (EBCT) and EDDS solution molarity were varied from 21–33 h and from 0.36–3.6 mM, respectively. Effects on the mobility of cations such as Fe and Mn were also investigated. Results showed that very high performances can be obtained at [EDDS] = 3.6 mM and EBCT = 33 h. In these conditions, in fact, the amount of removed Cu was 53%, and the amount of removed Zn was 46%. Metal distribution at different depths from the top surface revealed that Cu has higher mobility than Zn. The process results were strongly dependent on the exchange of metals due to the different stability constants of the EDDS complexes. Finally, results from a comparative study showed that soil washing treatment reached the same removal efficiency of the flushing process in a shorter time but required a larger amount of the EDDS solution. Full article

This research relates Burnout Syndrome (BS) with the Body Mass Index (BMI) among middle and senior managers of the Mexican manufacturing industry. Even though BS incidence is high in the Mexican industrial population, few systematic studies have explored BS and its relationship with other health problems, such as obesity. The goal of this research is to determine the relationship between BS and the BMI in employees with normal weight, overweight, and obesity. We present three structural equation models to relate BS and the BMI. The BMI ranges were determined according to the parameters (normal weight, overweight, and obesity) proposed by the World Health Organization (WHO). The sample includes 361 employees that voluntarily answered a 31-item questionnaire. We measure the levels of BS using the Maslach Burnout Inventory–General Survey (MBI-GS) and analyze anthropometric and sociodemographic data from the participants. Then, we determine the relationships between the variables through structural equation models and estimate the direct, indirect, and total effects in the three models, which show acceptable reliability. As main findings, the normal weight model has a larger explanatory power than the overweight and obesity models. The same research hypotheses were tested and the effects of BS on the BMI differ across the three models. Such results are presented by taking into account that obesity and overweight require additional factors, such as genetic factors and personal eating habits, to be better explained. Full article

This paper addresses the public health issue of toy product recalls in the United States, an under-addressed topic in scholarly literature, yet highly relevant to the prevention of pediatric injuries. Toy-related injuries led to 274,000 emergency room visits and seven fatalities in 2016 in the United States, and toy-related injury rates have remained stable over the last five years despite declining incidences of recalls. While dangerous toys not being recalled and the misuse of “safe” products are possible contributing factors, consumer non-response to recall notices also contributes to unintentional child injury from dangerous toys. We discuss the process of recalling toys, and the role of the U.S. Consumer Product Safety Commission in that process. We also review potential factors behind significant consumer non-response to recall notifications, citing economic and psychological theories as explanations for the actions of multiple stakeholders in the recall process. We close by proposing reforms at the regulatory, consumer, and retailer levels that might boost compliance with recall notifications and ultimately reduce injury morbidity and mortality. Full article

We previously studied the association between fish consumption and prevalence of type 2 diabetes (T2D) in Manitoba and Ontario First Nations (FNs), Canada and found different results. In this study, we used a difference in difference model to analyze the data. Dietary and health data from the First Nations Food Nutrition and Environment Study, a cross-sectional study of 706 Manitoba and 1429 Ontario FNs were analyzed. The consumption of fish was estimated using a food frequency questionnaire. Fish samples were analyzed for dichloro diphenyldichloro ethylene (DDE) and polychlorinated biphenyls (PCBs) content. Difference in difference model results showed that persistent organic pollutant (POP) exposure was positively associated with T2D in a dose-response manner. Stronger positive associations were found among females (OR = 14.96 (3.72–60.11)) than in males (OR = 2.85 (1.14–8.04)). The breakpoints for DDE and PCB intake were 2.11 ng/kg/day and 1.47 ng/kg/day, respectively. Each further 1 ng/kg/day increase in DDE and PCB intake increased the risk of T2D with ORs 2.29 (1.26–4.17) and 1.44 (1.09–1.89), respectively. Our findings suggest that the balance of risk and benefits associated with fish consumption is highly dependent on the regional POP concentrations in fish. Full article

Disasters and climate change have significant implications for human health worldwide. Both climate change and the climate-sensitive hazards that result in disasters, are discussed in terms of direct and indirect impacts on health. A growing body of literature has argued for the need to link disaster risk reduction and climate change adaptation. However, there is limited articulation of the commonalities between these health impacts. Understanding the shared risk pathways is an important starting point for developing joint strategies for adapting to, and reducing, health risks. Therefore, this article discusses the common aspects of direct and indirect health risks of climate change and climate-sensitive disasters. Based on this discussion a theoretical framework is presented for understanding these commonalities. As such, this article hopes to extend the current health impact frameworks and provide a platform for further research exploring opportunities for linked adaptation and risk reduction strategies. Full article

This field study elaborates the role of grass swale in the management of stormwater in an urban parking lot. Grass swale was constructed by using different vegetations and local soil media in the parking lot of Mapu-gu Seoul, Korea. In this study, rainfall runoff was first retained in soil and the vegetation layers of the grass swale, and then infiltrated rainwater was collected with the help of underground perforated pipe, and passed to an underground storage trench. In this way, grass swale detained a large amount of rainwater for a longer period of time and delayed peak discharge. In this field study, various real storm events were monitored and the research results were analyzed to evaluate the performance of grass swale for managing rainfall runoff in an urban area. From the analysis of field experiments, grass swale showed the significant rainfall runoff retention in different rain events. Grass swale markedly reduced total rainfall runoff volume and peak flow during the small storm events of intensity about 30 mm/h. From the analysis, on average rainfall runoff retention from the grass swale was found around 40 to 75% during the various small rain events. From the results, we can say that grass swale is a stormwater mitigation practice which can help avoid flash flooding problems in urban areas. Full article

This study aimed to assess the prevalence and correlates of condom use at last sexual intercourse among people aged 15–49 years in Nepal. Secondary data analysis was performed using the Nepal Demographic and Health Survey 2011. The study was restricted to the respondents who reported ever having had sexual intercourse; 9843 females and 3017 males were included. Condom use was assessed by asking if respondents used condoms in their most recent sexual intercourse. Chi-square test and multivariate logistic regression analysis were performed using Complex Sample Analysis Procedure to adjust for sample weight and multistage sampling design. Overall, 7.6% of total, and 16.3% of males and 6.2% of females reported using condoms in their last sexual intercourse. Living in Far-Western region, age and wealth quintile were positively associated with condom use in both males and females. Being unmarried was the most important predictor of condom use among males. Higher education was associated with increased likelihood of condom use in females. However, mobility, having multiple sexual partners, and HIV knowledge were not significant correlates of condom use in both sexes. A big difference was observed in the variance accounted for males and females; indicating use of condoms is poorly predicted by the variables included in the study among females. Condom use was more associated with sociodemographic factors than with sexual behavior and HIV knowledge. Full article

2017 was a record year for disasters and disaster response in the U.S. Redefining and differentiating key response roles like “immediate responders” and “first responders” is critical. Traditional first responders are not and cannot remain the only cadre of expected lifesavers following a mass casualty event. The authors argue that the U.S. needs to expand its understanding of response roles to include that of the immediate responders, or those individuals who find themselves at the incident scene and are able to assist others. Through universal training and education of the citizenry, the U.S. has the opportunity increase overall disaster resiliency and community outcomes following large-scale disasters. Such education could easily be incorporated into high school curriculums or other required educational experiences in order to provide all persons with the knowledge, skills, and basic abilities needed to save lives immediately following a disaster. Full article

Descriptions of time use patterns in people with chronic obstructive pulmonary disease (COPD) are scarce and the relationship between use-of-time and COPD severity remains unclear. This study aimed to describe a typical day for people with COPD and to explore the differences in time-use patterns across the Body Mass-Index, Airflow Obstruction, Dyspnoea and Exercise Capacity (BODE) index using compositional analyses. Using a cross-sectional design, 141 adults with clinically stable COPD had their demographics, objective measures of function (pulmonary, exercise capacity and physical activity), and self-reported COPD-related impairment recorded. Daily time-use compositions were derived from 24-h accelerometry and 24-h use-of-time recall interviews. Compositional multiple linear regression models were used to explore the relationship between the BODE index and 24-h time-use compositions. These models were used to predict daily time (min/d) that is spent in time-use components across the BODE index. The BODE index score was clearly associated with 24-h accelerometry (p < 0.0001) and 24-h use-of-time recall (p < 0.0001) compositions. Relative to the remaining time-use components, higher BODE index scores were associated with greater sedentary behaviour (p < 0.0001), Quiet time (p < 0.0001), Screen time (p = 0.001) and Self-care (p = 0.022), and less daily Chores (p < 0.0001) and Household administration (p = 0.015) time. As the BODE index scores increased, time-use predictions were strongly associated with decreases in Chores (up to 206 min/d), and increases in Screen (up to 156 min/d) and Quiet time (up to 131 min/d). Time–use patterns may provide a basis for planning interventions relative to the severity of COPD. Full article