Int. J. Environ. Res. Public Health, Volume 15, Issue 7 (July 2018) – 266 articles

This study aimed to examine gender differences in the association between serum uric acid (SUA) and the risk of prediabetes in a longitudinal cohort. A total of 8237 participants in the Beijing Health Management Cohort study were recruited and surveyed during 2008–2009, and followed up in 2011–2012 and 2014–2015 surveys. Generalized estimating equation (GEE) models were used to evaluate the association between SUA and prediabetes. Furthermore, subgroup analyses assessed the primary outcome according to status of abdominal obesity, age and status of hypertension. During six years of follow-up, we identified 1083 prediabetes events. The GEE analyses confirmed and clarified the association between SUA and prediabetes (RR = 1.362; 95% CI = 1.095–1.696; p = 0.006) after adjusting for other potential confounders, especially in females (RR = 2.109; 95% CI = 1.329–3.347; p = 0.002). In addition, this association was stronger in the subgroup of females aged ≥48 years old (RR = 2.384; 95% CI = 1.417–4.010; p = 0.001). The risk for prediabetes increased significantly with increasing SUA for females in the Chinese population. This association was strongly confirmed in older females aged ≥48 years old rather than in younger females, which may provide clues for pathogenic mechanisms of gender differences in the association between SUA and prediabetes. Full article

Listeria innocua retains many conserved homologous domains with Listeria monocytogenes, which is a food-borne and water-borne diarrhea-causing bacterium. Studies of antimicrobial resistance in L. innocua showed that this microbe is more prone to acquire resistance than other bacteria in the genus Listeria. However, little is known about the seasonal population distribution and antimicrobial resistance patterns of L. innocua in natural water environments. The aims of the study were: (1) to investigate the occurrence of L. innocua isolates in a subtropical watershed and reconstruct the population structure and (2) to analyze the antibacterial resistance patterns of the identified L. innocua isolates according to ERIC type. A total of 288 water samples was collected from the Puzi River basin (23°28’ N, 120°13’ E) between March 2014 and March 2015, and 36 L. innocua isolates were recovered from 15 positive water samples. With regard to seasonal variation, L. innocua was only detected in the spring and summer. Eighteen enterobacterial repetitive intergenic consensus (ERIC)-PCR types were identified, and two genogroups with four subgroups were reconstructed in a minimum spanning tree. Isolates from different sampling areas that were located near each other were genetically different. All L. innocua isolates (including 41.7% of the multidrug-resistant (MDR) isolates) were resistant to oxacillin and showed high minimum inhibitory concentrations of tetracycline. These findings demonstrate the seasonal variations and differing geographical distributions of L. innocua in this subtropical water environment, as well as the existence of strong population structures and MDR and antimicrobial resistance patterns. Phylogenetic analysis based on ERIC-type showed that the Cluster A isolates were resistant to more antibiotics, and two types, ERIC8 and ERIC15 were multidrug resistant. The more commonly detected types, such as ERIC1 and ERIC12, were also more likely to be resistant to two or more antibiotics. Close monitoring of drug resistance in environmental L. innocua is warranted due to its potential for transferring antimicrobial resistance determinants to pathogenic Listeria. Full article

Smoking is a well-known behavior that has an important negative impact on human health, and is considered to be a significant factor related to the development and progression of head and neck squamous cell carcinomas (HNSCCs). Use of high-dimensional datasets to discern novel HNSCC driver genes related to smoking represents an important challenge. The Cancer Genome Atlas (TCGA) analysis was performed in three co-existing groups of HNSCC in order to assess whether gene expression landscape is affected by tobacco smoking, having quit, or non-smoking status. We identified a set of differentially expressed genes that discriminate between smokers and non-smokers or based on human papilloma virus (HPV)16 status, or the co-occurrence of these two exposome components in HNSCC. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways classification shows that most of the genes are specific to cellular metabolism, emphasizing metabolic detoxification pathways, metabolism of chemical carcinogenesis, or drug metabolism. In the case of HPV16-positive patients it has been demonstrated that the altered genes are related to cellular adhesion and inflammation. The correlation between smoking and the survival rate was not statistically significant. This emphasizes the importance of the complex environmental exposure and genetic factors in order to establish prevention assays and personalized care system for HNSCC, with the potential for being extended to other cancer types. Full article

Nitrate levels in our water resources have increased in many areas of the world largely due to applications of inorganic fertilizer and animal manure in agricultural areas. The regulatory limit for nitrate in public drinking water supplies was set to protect against infant methemoglobinemia, but other health effects were not considered. Risk of specific cancers and birth defects may be increased when nitrate is ingested under conditions that increase formation of N-nitroso compounds. We previously reviewed epidemiologic studies before 2005 of nitrate intake from drinking water and cancer, adverse reproductive outcomes and other health effects. Since that review, more than 30 epidemiologic studies have evaluated drinking water nitrate and these outcomes. The most common endpoints studied were colorectal cancer, bladder, and breast cancer (three studies each), and thyroid disease (four studies). Considering all studies, the strongest evidence for a relationship between drinking water nitrate ingestion and adverse health outcomes (besides methemoglobinemia) is for colorectal cancer, thyroid disease, and neural tube defects. Many studies observed increased risk with ingestion of water nitrate levels that were below regulatory limits. Future studies of these and other health outcomes should include improved exposure assessment and accurate characterization of individual factors that affect endogenous nitrosation. Full article

Coal and coal seam gas mining have impacts on the water and sediment quality in the proximity of the mining areas, increasing the concentrations of heavy metals downstream of the mine discharge points. The objective of this study was to assess the impact of coal mining on the environment in the Sydney region, by investigating macroinvertebrates and chlorophyll as indicators of industrial pollution and environmental impairment. The study revealed changes in abundance, taxonomic richness, and pollution sensitive macroinvertebrate groups. A statistical evaluation of the aquatic life was performed and a correlation of the contaminants with the presence of a community in the ecosystem were studied. The environmental sustainability of the investigated rivers and streams with water chemistry affecting the biological system was assessed. A non-uniformity in the changes were observed, indicating a difference in the tolerance level of different invertebrates. Full article

Background: Variations in the foot structure related with the high or low arch are identified common lower limb conditions, and it is supposed to be the effect on the quality of life (QoL) associated to foot health in adults. Here we aimed to determine the relationships between relatively high and low feet arches and QoL. Methods: A cross-sectional study was carried out. Among 138 adults enrolled in the study, 66 had a high arch, 21 had a low arch, and 51 were within the normal range. Changes related to the foot structure were analyzed using Area Calc version 2.6 software, and data obtained using the Foot-Health-Status-Questionnaire (FHSQ), whose domains were compared between foot arch groups by means of the one-way analysis of variance (ANOVA). Results: The results of the FHSQ comparison between the three groups within the sample population did not show any statistically significant difference (p > 0.05) for any domains of specific foot (pain, function, general health and footwear) and general (general health, physical activity, social function and vigor) health-related QoL. Conclusions: Specific foot and general health-related QoL did not seem to be influenced by the foot arch height between high, normal and low feet arches heights. Nevertheless, further studies with higher sample sizes and matched-paired groups should be carried out. Full article

Health literacy has been a prominent issue on the agenda of the World Health Organization (WHO) for almost two decades. WHO recently established a strong global mandate for public policy action on health literacy by positioning it as one of three key pillars for achieving sustainable development and health equity in the Shanghai Declaration on Health Promotion. Several countries have national health literacy policies, with many others expected to develop them in the immediate future. It is, therefore, timely to examine current policy approaches to health literacy. The purpose of this study was to analyze a selection of existing policy documents for their strengths, limitations and themes, and offer observations about their potential to improve health literacy and health outcomes. In doing so our intention is to offer lessons and advice from early adopters that will have usefulness for future policy development and implementation. We selected six policies for review; Australia, Austria, China, New Zealand, Scotland, and the United States. We used a set of criteria to guide a systematic analysis of policy documents for their context, intended target audiences, objectives, proposed actions and interventions, evidence of financial investment and intentions to monitor outcomes. We observed a number of common features that provide helpful signposting for future policy development in other countries. All represent a response to perceived deficiencies in the quality of patient communication and patient engagement. Most present health literacy as a universal challenge, with some also identifying groups who are of higher priority. They all recognize the importance of professional education in improving the quality of communication, and most recognize that the health literacy responsiveness of the health system needs to be improved. However, there was significant variability in linking resources to specific strategies and actions, as well as in the systems for monitoring progress and accountability for progress. This variability reflects important contextual differences between countries and health systems. However, this lack of specificity will likely have an impact on the priority given to improving health literacy and on the long-term sustainability of defined actions to improve health literacy in populations. Full article

The rapid rise of Internet-based technologies to disseminate health information and services has been shown to enhance online health information acquisition. A Chinese version of the electronic health literacy scale (C-eHEALS) was developed to measure patients’ combined knowledge and perceived skills at finding and applying electronic health information to health problems. A valid sample of 352 interviewees responded to the online questionnaire, and their responses were analyzed. The C-eHEALS, by showing high internal consistency and predictive validity, is an effective screening tool for detecting levels of health literacy in clinical settings. Individuals’ sociodemographic status, perceived health status, and level of health literacy were identified for describing technology users’ characteristics. A strong association between eHealth literacy level, media information use, and computer literacy was found. The emphasis of face-to-face inquiry for obtaining health information was important in the low eHealth literacy group while Internet-based technologies crucially affected decision-making skills in the high eHealth literacy group. This information is timely because it implies that health care providers can use the C-eHEALS to screen eHealth literacy skills and empower patients with chronic diseases with online resources. Full article

Prochloraz is a fungicide that is widely used on vegetables to maintain freshness during storage. To ensure that prochloraz is used in a safe way that reduces the levels of residue on the product, we evaluated two treatment methods (soaking and spraying) that are commonly used for garlic sprouts. An ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method was developed and validated for prochloraz residue on garlic sprouts. The linear range of the method was 5–500 μg/kg and the correlation coefficient was 0.9983. The average recovery range was 88–94%, and the relative standard deviation range was 2.6–9.7%. Garlic sprout samples that had been soaked in or sprayed with prochloraz were collected from cold storage facilities in Laixi and Pingdu, China. For the soaked samples, the ranges for the levels of prochloraz residue on the whole garlic sprouts and stems (edible portion) were 15.76–25.14 mg/kg and 0.58–1.62 mg/kg, respectively. For the sprayed samples, the ranges for the levels of prochloraz residue on the whole garlic sprouts and stems were 1.85–7.89 mg/kg and 0.01–1.29 mg/kg, respectively. The results of this study provide a scientific basis for rationalizing the use of prochloraz and improving the safety of edible garlic sprouts. Full article

Rainwater is consumed for drinking water in many parts of Australia, either preferentially over municipal water or in regional or remote areas, because rainwater is the primary source of water. Previous rainwater studies in other areas in Australia have shown the levels of some metals to be above the Australian Drinking Water Guidelines (ADWG). This study assessed the level of metals in rainwater harvested in the Adelaide region. Water samples were collected from 53 tanks from three different sampling corridors. A total of 365 water samples were analysed for lead, zinc, copper, and cadmium using atomic absorption spectrophotometry. In 47 out of the 53 tanks, lead was above the ADWG of 0.01 ppm in at least one sample (with 180/365 samples above 0.01 ppm). Zinc was above the ADWG (3.0 ppm) in 53/365 samples, copper was above the ADWG (2.0 ppm) in eight samples out of 365 samples, and cadmium was above the ADWG (0.002 ppm) in 19 samples out of 365 samples. These data are consistent with other studies of rainwater quality in Australia. Comparisons of levels of metals and volume of rainfall in the sampling and preceding month, roof material, and tank material, the presence of a first-flush device, sampling corridor, and sample pH showed that the roof material was related to higher levels of metals. There was a significant relationship between sampling corridors and the levels of lead and zinc. Nine of the tanks surveyed had filters installed. There was a small, but statistically significant, decrease in the levels of metals that passed through a filter prior to collection but, in those samples, filters did not remove metals to below guideline concentrations. An estimate of exposure, and a brief discussion of health risks as a result of exposure to metals, is presented. Full article

Migration is an important driver of population dynamics in Europe. Although migrants are generally healthy, subgroups of migrants are at increased risk of a range of infectious diseases. Early identification of infections is important as it prevents morbidity and mortality. However, identifying infections needs to be supported by appropriate systems to link individuals to specialist care where they can receive further diagnostic tests and clinical management. In this commentary we will discuss the importance of linkage to care and how to minimise attrition in clinical pathways. Full article

Adequate infection control plays a key role in preventing healthcare-associated infections (HAIs). This study aimed to explore staff perceptions of hospital infection control in a rural and an urban hospital in Vietnam. Individual interviews were conducted with hospital managers, and focus group discussions were conducted with doctors, nurses and cleaning workers separately. Content analysis was applied. An interview guide including discussion points on HAIs, hand hygiene and healthcare waste management was used. Generally, the staff were knowledgeable of hospital infection control, but they were not aware of the situation in their own hospital, and infection control practices in the hospitals remained poor. Reported difficulties in infection control included lack of resources, poor awareness and patient overload. A main theme emerged: ‘Making data on HAIs available for health workers can improve their awareness and motivate them to put their existing knowledge into practice, thus decreasing the know-do gap in infection control’. This could be a feasible intervention to improve infection control practice in the hospitals with limited resources, high workload and patient overload. Full article

Workplace bullying entails negative consequences on workers’ life. Yet, there is lack of research on workplace bullying in an Asian context. Moreover, less is known about the potential mechanisms linking workplace bullying and employee well-being. This study examined the associations between workplace bullying and Korean employees’ well-being (quality of life, occupational health) and whether the associations were mediated by work-to-family conflict. Cross-sectional data came from 307 workers in South Korea who were employed in healthcare, education, and banking industries. Analyses adjusted for industry, age, gender, education, marital status, and work hours. Employees who had more exposure to workplace bullying reported lower levels of quality of life and occupational health. These associations were mediated by work-to-family conflict, such that more exposure to workplace bullying was associated with greater work-to-family conflict, which, in turn, was associated with lower levels of quality of life and occupational health. These mediating pathways were consistent across the three industries. Korean employees who experience more workplace bullying may bring unfinished work stress to the home (thus greater work-to-family conflict), which impairs their well-being. Future research may need to consider the role of work-to-family conflict when targeting to reduce the negative consequences of workplace bullying. Full article

A move towards more compact and climate-resilient cities is being encouraged around the world. As part of these plans, there is a need to manage the potential conflict between increasing urban densities and the extent of tree canopy in cities. Reductions in tree canopy are a major contributor to the urban heat island (UHI) effect, which will act to reduce rather than increase climate resilience in many cities. A systems thinking approach called Collaborative Conceptual Modelling was used to study the interaction between urban infill, tree canopy, and human health in Perth, Australia. The results indicated that under current planning policies and development practices, the behaviour of the system is dominated by the drive towards higher housing densities. While this may result in the attainment of urban infill targets, it is likely to lead to a reduction in tree canopy, higher temperatures, and a decrease in a range of other benefits provided by trees. Recommended actions to overcome this behaviour were determined by the identification of leverage points in the system. These included a shift to a sustainable development paradigm that places greater value on the environmental and social benefits provided by trees and a greater emphasis on a climate-resilient future. Market and legislative mechanisms should be integrated into the city’s greening strategy and development plans to ensure the protection of existing trees and the inclusion of new trees on public and private land. Full article

With the economic restructuring during the 1980s and 1990s in Hong Kong, most manufacturing plants were relocated to China and many industrial buildings were left neglected or vacant. At the same time, owing to limited land supply, a shortage of affordable housing has been a problem in Hong Kong for many years. Adaptive reuse of industrial buildings may be a way of solving this problem. However, adaptive reuse is not an easy decision because there are many factors affecting adaptive reuse. Therefore, this paper examines the current situation of adaptive reuse of industrial buildings in Hong Kong and identifies a list of factors affecting the adaptive reuse of industrial buildings. Six factors are considered Critical Success Factors (CSFs). Based on a Principal Component Analysis, 33 factors are grouped into eight principal components, namely, sustainability, economics and finance, the market, changeability, location and neighborhood, culture and public interests, legal and regulatory matters, and the physical condition of the building. The identified CSFs and principal factors provide a useful reference for various stakeholders to have a clear understanding of the adaptive reuse of industrial buildings in Hong Kong, especially for the government to review current policies of adaptive reuse. Full article

Individual Placement and Support (IPS) is an internationally accepted and effective form of supported employment for people with severe mental health conditions. Despite its strong evidence base, the implementation of IPS has been slow and inconsistent. In England, a demonstration project, Making IPS Work, was developed to offer support for the implementation of IPS in six local sites National Health Service Mental Health trusts. The project aimed to: Establish Individual Placement and Support services within clinical teams; develop high fidelity practice and leave a sustainable IPS service beyond the project. The number of people gaining open employment in each site was monitored. Fidelity checks were carried out at three sites by independent assessors. Stakeholders were interviewed over the 18-month lifetime of the implementation period to examine the experience of developing the services in the six sites. A total of 421 jobs were found for people with mental health conditions over 18 months with a large variation between the highest and lowest performing sites. The sites assessed for fidelity all attained the threshold for a ‘Good Fidelity’ service. The new services were readily accepted by mental health service users, clinical staff and managers across the trust sites. Maintaining the funding for the Individual Placement and Support services beyond the project period proved to be problematic for many sites. Placing the services within a broader strategy of improving psychosocial services and bringing together decision making at the corporate, commissioning and clinical management level were helpful in achieving success. The growth and maintenance of these services is difficult to achieve whilst the current cost pressures on the NHS continue. Full article

The accurate monitoring and measurement of emission reductions is a critical step in Reducing Emissions from Deforestation and Degradation (REDD+). However, the existence of uncertainty in emission reduction estimates affects the performance of REDD+ projects. We assert that incentive could be a valuable policy tool for reducing monitoring errors and transaction costs. Using Stackelberg models and simulation research, this paper examines the effects of uncertainty and incentive on performance and stakeholder benefits of REDD+ projects. Finally, the uncertainties in REDD+ projects are further discussed, and equilibrium errors, emission reductions, and stakeholder benefits in different scenarios are compared. The results show that errors do affect the measured value of carbon emissions and compensation payments. However, incentive for investors can reduce monitoring errors and improve the performance of REDD+ projects. Therefore, in the future, incentive should be provided to investors rather than landholders. Full article

Violence victimization can adversely affect adolescents’ long-term health. Existing research has mainly focused on the link between victimization and substance use; however, the evidence obtained to date has been inconsistent. This study, using a Korean national representative sample, examined the association between violence victimization and substance-use patterns (including tobacco, alcohol, and drug use) in terms of sex and number of violence victimization experiences. We analyzed secondary data from the 2017 Korean Youth Risk Behavior Web-based Survey. Chi-squared test analyses and logistic regression analysis were used to examine substance use in terms of violence victimization; additionally, p-values for trends were calculated to reveal the dose-response relationship per number of violence victimization experiences. We consequently found that participants’ rates of tobacco, alcohol, and drug use were higher among those who experienced violence victimization than among those who did not. For each substance-use-related variable, the greater the violence victimization experience, the higher the odds of substance use (p for trend < 0.001). Early intervention may help prevent the development of substance use, especially among adolescents who have experienced violence victimization. Prevention efforts regarding substance abuse and violence prevention should be included in school curricula to effectively prevent adverse health consequences among adolescents. Full article

The proliferation of vector-borne diseases are predicted to increase in a changing climate and Leishmaniases, as a vector-borne diseases, are re-emerging diseases in several regions of the world. In Morocco, during the last decade, a sharp increase in cutaneous leishmaniases cases has been reported. Nevertheless, in Morocco, leishmaniases are a major public health problem, and little interest was given to climate change impacts on the distribution and spread of these diseases. As insect-borne diseases, the incidence and distribution of leishmaniases are influenced by environmental changes, but also by several socio-economic and cultural factors. From a biological point of view, environmental variables have effects on the survival of insect vectors and mammalian reservoirs, which, in turn, affects transmission. Here, we highlight the effects of climate change in Morocco and discuss its consequences on the epidemiology of leishmaniases to identify challenges and define targeted recommendations to fight this disease. Full article

Examination of the greenspace—human health relationship operates in at least four dimensions: what is considered greenspace? which moderators and mediators are included? what outcomes are measured? and which units of analysis (e.g., individuals, cities) are studied? We examined three of these four dimensions in a cross-sectional study of 496 of the 500 most populated US cities (total population size = 97,574,613, average population per city = 197,920). Spatial average models tested the effect of two greenspace measures (Normalized Difference Vegetation Index greenness and tree cover) on two outcomes (obesity and mental health), while adjusting for income, race and ethnicity, sprawl, age, sex, physical inactivity, median age of housing, and total population. We conducted analyses at the city scale, which is an understudied unit of analysis, and compared findings to individual- and neighborhood-level studies. In two of four models, greenspace was associated with better health. We found race and ethnicity moderated this relationship with varying results. In full sample analyses, cities with greater percentages of non-Hispanic Whites showed links between higher tree cover and lower obesity but marginal relationships between higher greenness and lower obesity. In subsample analyses with majority-non-Hispanic Black cities, higher tree cover was associated with lower obesity and better mental health. These findings advance previous research by showing that race and ethnicity moderate the greenspace—health link at the city level. Full article

Analysis of sediment grain sizes and heavy metal correlations in the western part of Lake Taihu shows that the grain size of the sediment is stable as a whole. With increasing depth, the grain size tends to decrease. Heavy metals such as Cr, Cd, Pd and Sr are strongly correlated and influence each other. Based on the positive matrix factorization (PMF) model, this study classified the origin of heavy metals in the sediments of western Lake Taihu into three major categories: Agricultural, industrial and geogenic. The contributions of the three heavy metal sources in each sample were analyzed and calculated. Overall, prior to the Chinese economic reform, the study area mainly practiced agriculture. The sources of heavy metals in the sediments were mostly of agricultural and geogenic origin, and remained relatively stable with contribution rates of 44.07 ± 11.84% (n = 30) and 35.67 ± 11.70% (n = 30), respectively. After the reform and opening up of China, as the economy experienced rapid development, industry and agriculture became the main sources of heavy metals in sediments, accounting for 56.99 ± 15.73% (n = 15) and 31.22 ± 14.31% (n = 15), respectively. The PMF model is convenient and efficient, and a good method to determine the origin of heavy metals in sediments. Full article

Escherichia coli is an important commensal of our gut, however, many pathogenic strains exist, causing various severe infections in the gut or beyond. Due to several antibiotic resistance patterns of E. coli, research of alternative treatments or adjuvant therapy is important. One of these is the use of probiotics as antagonistic agents against E. coli. Most published studies investigate only one strain of E. coli and single-strain probiotics. The objectives of this study were to evaluate the antagonistic activity of selected single-strain and multi-strain probiotic supplements against selected clinical E. coli pathotypes using the in vitro agar spot test and the co-culturing method. Molecular methods were used to determine the presence of the genus lactobacilli and bifidobacteria as well as certain selected strains in the probiotic supplements. The agar-spot test showed that the multi-strain probiotics were more effective than the single-strain probiotics. On the other hand, the co-culturing method showed the opposite result, indicating that results are importantly influenced by the chosen method. The most effective single-strain probiotics against E. coli strains were Bifidobacterium animalis subsp. lactis BB-12 and Lactobacillus reuteri DSM 17938. The most effective multi-strain probiotics contained lactobacilli, bifidobacteria and enterococci strains, thus proving that most effective probiotics against E. coli strains are the lactic acid bacteria and bifidobacteria. The overall results from both in vitro tests reveal that all selected probiotics exhibited an antagonistic activity against all E. coli strains. From a public health perspective probiotics have thus proved to be successful in inhibiting the growth of E. coli and could therefore be used as adjuvant therapy or alternative therapy in E. coli infections. Full article

Pediatricians are trained to provide non-surgical medical care to children. Improvements in medical treatments and surgical techniques have extended the survival of children with congenital diseases and chronic illnesses. Consequently, pediatricians may provide continuous medical service to their patients into adulthood. Meanwhile, as Taiwan’s birth rate has fallen to one of the lowest in the world, pediatricians are encountering growing competition. As a source of continued revenue, pediatricians could also provide medical care to adults with common diseases and patients with adult-onset chronic diseases. The aim of this study was to investigate the pattern of adult ambulatory visits to pediatric clinics recorded by Taiwan’s National Health Insurance (NHI) system during 2000 to 2011. From 1/500 sampling datasets, we found that adult ambulatory visits to pediatric clinics rose steadily and statistically significantly from 16% of total visits to pediatric clinics in 2000 to 32% in 2011. Analysis of the diagnoses associated with adult ambulatory visits to pediatric clinics indicated that the most common diagnoses for such patients at academic medical centers were chronic illnesses, including epilepsy, cardiac and circulatory congenital anomalies, and diabetes. Meanwhile, at physician clinics, airway infections/diseases and gastroenteritis were the most common diagnoses. In an era of low birth rates, our findings contribute to an evidence-based discussion and provide new information that may assist in healthcare policymaking. Full article

Flushing tap water is promoted as a low cost approach to reducing water lead exposures. This study evaluated lead reduction when prevailing flush guidelines (30 s–2 min) are implemented in a city compliant with lead-associated water regulations (New Orleans, LA, USA). Water samples (n = 1497) collected from a convenience sample of 376 residential sites (2015–2017) were analyzed for lead. Samples were collected at (1) first draw (n = 375) and after incremental flushes of (2) 30–45 s (n = 375); (3) 2.5–3 min (n = 373), and (4) 5.5–6 min (n = 218). There was a small but significant increase in water lead after the 30 s flush (vs. first draw lead). There was no significant lead reduction until the 6 min flush (p < 0.05); but of these samples, 52% still had detectable lead (≥1 ppb). Older homes (pre-1950) and low occupancy sites had significantly higher water lead (p < 0.05). Each sample type had health-based standard exceedances in over 50% of sites sampled (max: 58 ppb). While flushing may be an effective short-term approach to remediate high lead, prevailing flush recommendations are an inconsistently effective exposure prevention measure that may inadvertently increase exposures. Public health messages should be modified to ensure appropriate application of flushing, while acknowledging its short-comings and practical limitations. Full article

Lambda-cyhalothrin (λ-cyhalothrin) is the most commonly used pyrethroid insecticide for vegetable farming in Benin. This insecticide is misused and overused by farmers, and hence may pose health hazards to consumers. We monitored λ-cyhalothrin residues in lettuce and cabbage from farms at the market gates in Cotonou and Parakou using high performance liquid chromatography (HPLC) analysis techniques. These residues were also monitored on samples directly from farms (on-farm sampling) for 14 days post-treatment. Potential factors such as photolysis and hydrolysis involved in λ-cyhalothrin degradation were also screened. Results revealed that the level of λ-cyhalothrin residue concentrations in lettuce from Houeyiho decreased from 4.2 mg/kg on Day 1 to about 0.2 mg/kg on Day 7. On Day 9, analyzed lettuces were all λ-cyhalothrin free. In contrast, even 14 days after treatment of cabbage from Bawera (Parakou), we still recorded the presence of λ-cyhalothrin residues in analyzed samples. For samples from market gates, λ-cyhalothrin residues were found in lettuce from two markets out of the nine surveyed in Cotonou. Interestingly, none of these contaminated samples had residues above the maximum residue limit for lettuce (MRL = 0.5 mg/kg). Similarly, in Parakou, samples from all five surveyed vegetable markets were contaminated with λ-cyhalothrin residues at concentrations below the MRL for cabbage (MRL = 0.2 mg/kg). We conclude that λ-cyhalothrin residues in lettuce and cabbage from farms and markets in Parakou and Cotonou are within the MRL, and hence are relatively safe for consumption. Full article

This paper tests the hypothesis of whether being bullied in an environment where bullying is infrequent decreases adolescents’ life satisfaction. Analyses were based on the international standard questionnaire from the 2005/2006 Health Behaviour in School-aged Children study (HBSC). The sample included answers from 183,736 children in 35 Western, industrialized countries. Our results show that the negative effects of being bullied on the life satisfaction of individuals are stronger in schools and countries where bullying is less frequent. We therefore conclude that the prevalence of bullying in the students’ surroundings may act as a mediating variable explaining the relationship between bullying and life satisfaction. Full article

Type 2 Diabetes Mellitus (T2DM) is a chronic disease that has risen in prominence in recent years and can cause serious complications. Several studies show that the level of adherence to different types of treatment has a direct correlation with the positive evolution of chronic diseases. While such studies relate to patient adherence to medication, those that concern adherence to medical appointments do not distinguish between the different disciplines that attend to or refer patients. This study analyses the relationship between adherence to referrals made by three distinct disciplines (doctors, nurses, and nutritionists) and the results of HbA1c tests from a sample of 2290 patients with T2DM. The aim is to determine whether a relationship exists between patient improvement and the frequency with which they attend scheduled appointments in a timely manner, having been previously referred from or to a particular discipline. Results showed that patients tended to be more adherent when their next appointment is with a doctor, and less adherent when it is with a nurse or nutritionist. Furthermore, patients that remained stable had higher rates of adherence, whereas those with lower adherence tended to be more decompensated. The results can enable healthcare professionals to monitor patients and place particular emphasis on those who do not attend their scheduled appointments in a timely manner. Full article

Growing amounts of evidence support an association between self-reported greenspace near the home and lower noise annoyance; however, objectively defined greenspace has rarely been considered. In the present study, we tested the association between objective measures of greenspace and noise annoyance, with a focus on underpinning pathways through noise level and perceived greenspace. We sampled 720 students aged 18 to 35 years from the city of Plovdiv, Bulgaria. Objective greenspace was defined by several Geographic Information System (GIS)-derived metrics: Normalized Difference Vegetation Index (NDVI), tree cover density, percentage of green space in circular buffers of 100, 300 and 500 m, and the Euclidean distance to the nearest structured green space. Perceived greenspace was defined by the mean of responses to five items asking about its quantity, accessibility, visibility, usage, and quality. We assessed noise annoyance due to transportation and other neighborhood noise sources and daytime noise level (L_day) at the residence. Tests of the parallel mediation models showed that higher NDVI and percentage of green space in all buffers were associated with lower noise annoyance, whereas for higher tree cover this association was observed only in the 100 m buffer zone. In addition, the effects of NDVI and percentage of green space were mediated by higher perceived greenspace and lower L_day. In the case of tree cover, only perceived greenspace was a mediator. Our findings suggest that the potential for greenspace to reduce noise annoyance extends beyond noise abatement. Applying a combination of GIS-derived and perceptual measures should enable researchers to better tap individuals’ experience of residential greenspace and noise. Full article

School food environments and policies can play a pivotal role in inculcating healthy food habits among young people. This cross-sectional survey explored teachers’ and parents’ views of the role of school food environments and policies in promoting healthy food consumption among Indian adolescents. Thirty-two teachers and 280 parents from five private, English-speaking, secondary schools in Kolkata, India took part in a short questionnaire survey which included closed and open answer questions. Descriptive and chi-square analyses were performed to compare the responses of parents and teachers. Thematic data analysis underpinned by Template Analysis Technique was employed to examine the qualitative responses. The easy availability and accessibility of energy-dense, nutrient-poor foods, the limited availability of nutritious foods, the absence of written food policies, and inflated prices of nutritious foods were reported as problems in the Indian school food environment. However, the respondents also noted that schools restricted the sale of sugar-sweetened beverages and adopted hygienic food practices. Novel ideas for creating healthy school food environments and effective school canteen policies were also captured during the survey. These findings point to the need to create effective school food policies in Indian secondary schools to help adolescents eat healthily at school. Future research is required to test the feasibility of the implementation of school food policies. Full article

An ambitious citizen science effort in the city of Indianapolis (IN, USA) led to the collection and analysis of a large number of samples at the property scale, facilitating the analysis of differences in soil metal concentrations as a function of property location (i.e., dripline, yard, and street) and location within the city. This effort indicated that dripline soils had substantially higher values of lead and zinc than other soil locations on a given property, and this pattern was heightened in properties nearer the urban core. Soil lead values typically exceeded the levels deemed safe for children’s play areas in the United States (<400 ppm), and almost always exceeded safe gardening guidelines (<200 ppm). As a whole, this study identified locations within properties and cities that exhibited the highest exposure risk to children, and also exhibited the power of citizen science to produce data at a spatial scale (i.e., within a property boundary), which is usually impossible to feasibly collect in a typical research study. Full article