Journal of Environmental and Public Health The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Successful Strategies to Engage Research Partners for Translating Evidence into Action in Community Health: A Critical Review Sun, 01 Mar 2015 12:33:33 +0000 Objectives. To undertake a critical review describing key strategies supporting development of participatory research (PR) teams to engage partners for creation and translation of action-oriented knowledge. Methods. Sources are four leading PR practitioners identified via bibliometric analysis. Authors’ publications were identified in January 1995–October 2009 in PubMed, Embase, ISI Web of Science and CAB databases, and books. Works were limited to those with a process description describing a research project and practitioners were first, second, third, or last author. Results. Adapting and applying the “Reliability Tested Guidelines for Assessing Participatory Research Projects” to retained records identified five key strategies: developing advisory committees of researchers and intended research users; developing research agreements; using formal and informal group facilitation techniques; hiring co-researchers/partners from community; and ensuring frequent communication. Other less frequently mentioned strategies were also identified. Conclusion. This review is the first time these guidelines were used to identify key strategies supporting PR projects. They proved effective at identifying and evaluating engagement strategies as reported by completed research projects. Adapting these guidelines identified gaps where the tool was unable to assess fundamental PR elements of power dynamics, equity of resources, and member turnover. Our resulting template serves as a new tool to measure partnerships. Jon Salsberg, David Parry, Pierre Pluye, Soultana Macridis, Carol P. Herbert, and Ann C. Macaulay Copyright © 2015 Jon Salsberg et al. All rights reserved. Comparative Assessment of Blood Lead Levels of Automobile Technicians in Organised and Roadside Garages in Lagos, Nigeria Tue, 10 Feb 2015 11:59:09 +0000 Occupational exposure to lead is common among automobile technicians and constitutes 0.9% of total global health burden with a majority of cases in developing countries. The aim of this study was to determine and compare the blood lead levels of automobile technicians in roadside and organised garages in Lagos State, Nigeria. This was a comparative cross-sectional study. Data were collected using interviewer-administered questionnaires. Physical examinations were conducted and blood was analysed for lead using atomic spectrophotometery. Statistical analyses were performed to compare the median blood lead levels of each group using the independent sample (Mann-Whitney U) test. Seventy-three (40.3%) of the organised compared to 59 (34.3%) of the roadside groups had high blood lead levels. The organised group had statistically significant higher median blood lead levels of, 66.0 µg/dL than the roadside 43.5 µg/dL (P < 0.05). There was also statistically significant association between high blood lead levels and abnormal discolouration of the mucosa of the mouth in the organised group. Automobile technicians in organised garages in Lagos have higher prevalence of elevated blood lead levels and higher median levels than the roadside group. Preventive strategies against lead exposures should be instituted by the employers and further actions should be taken to minimize exposures, improve work practices, implement engineering controls (e.g., proper ventilation), and ensure the use of personal protective equipment. Abdulsalam Saliu, Onajole Adebayo, Odeyemi Kofoworola, Ogunowo Babatunde, and Abdussalam Ismail Copyright © 2015 Abdulsalam Saliu et al. All rights reserved. Short-Term Relationship between Hip Fracture and Weather Conditions in Two Spanish Health Areas with Different Climates Tue, 10 Feb 2015 06:28:45 +0000 Objective. To evaluate differences in the short-term relationship between weather conditions and the incidence of hip fracture in people aged 65 and over among two regions of Spain. Methods. Hip fracture incidence was calculated for the years 2000–2008 for residents of Health Area 14 in Valencian Community (Mediterranean climate) and the “Mancha Centro” Health Area in Castilla-La Mancha (inland climate), Spain. The relationship between hip fracture incidence and weather was analyzed with a case-crossover design and explored in subgroups defined by sex, age, and fracture type. Results. In the inland area, a positive and significant tendency for hip fracture incidence was observed (annual increase: 1.5%) whereas in the Mediterranean area a seasonal increase of 9% was noted in autumn and winter with respect to spring. Weather conditions, especially wind, were significantly associated with hip fracture incidence: days with more frequent windy periods and/or a greater wind velocity were associated with an increase in hip fracture incidence of 51% in the Mediterranean area and 44% in the inland area. Conclusions. Hip fracture incidence exhibits seasonal changes that differ between the Mediterranean and inland areas. The short-term relationship with climate, although similar in both areas, may partly explain these seasonal changes. José María Tenías, Marisa Estarlich, Eusebio Crespo, Carmen Román-Ortiz, Angel Arias-Arias, and Ferran Ballester Copyright © 2015 José María Tenías et al. All rights reserved. Occupational Health Hazards among Healthcare Workers in Kampala, Uganda Sat, 31 Jan 2015 14:51:37 +0000 Objective. To assess the occupational health hazards faced by healthcare workers and the mitigation measures. Methods. We conducted a cross-sectional study utilizing quantitative data collection methods among 200 respondents who worked in 8 major health facilities in Kampala. Results. Overall, 50.0% of respondents reported experiencing an occupational health hazard. Among these, 39.5% experienced biological hazards while 31.5% experienced nonbiological hazards. Predictors for experiencing hazards included not wearing the necessary personal protective equipment (PPE), working overtime, job related pressures, and working in multiple health facilities. Control measures to mitigate hazards were availing separate areas and containers to store medical waste and provision of safety tools and equipment. Conclusion. Healthcare workers in this setting experience several hazards in their workplaces. Associated factors include not wearing all necessary protective equipment, working overtime, experiencing work related pressures, and working in multiple facilities. Interventions should be instituted to mitigate the hazards. Specifically PPE supply gaps, job related pressures, and complacence in adhering to mitigation measures should be addressed. Rawlance Ndejjo, Geofrey Musinguzi, Xiaozhong Yu, Esther Buregyeya, David Musoke, Jia-Sheng Wang, Abdullah Ali Halage, Christopher Whalen, William Bazeyo, Phillip Williams, and John Ssempebwa Copyright © 2015 Rawlance Ndejjo et al. All rights reserved. Patterns of Exposure to Multiple Metals and Associations with Neurodevelopment of Preschool Children from Montevideo, Uruguay Wed, 28 Jan 2015 07:51:50 +0000 While it is known that toxic metals contribute individually to child cognitive and behavioral deficits, we still know little about the effects of exposure to multiple metals, particularly when exposures are low. We studied the association between children’s blood lead and hair arsenic, cadmium, and manganese and their performance on the Bayley Scales of Infant Development III. Ninety-two preschool children (age 13–42 months) from Montevideo, Uruguay, provided a hair sample and 78 had a blood lead level (BLL) measurement. Using latent class analysis (LCA), we identified four groups of exposure based on metal concentrations: (1) low metals, (2) low-to-moderate metals, (3) high lead and cadmium, and (4) high metals. Using the four-group exposure variable as the main predictor, and fitting raw scores on the cognitive, receptive vocabulary, and expressive vocabulary scales as dependent variables, both complete-case and multiple imputation (MI) analyses were conducted. We found no association between multiple-metal exposures and neurodevelopment in covariate-adjusted models. This study demonstrates the use of LCA together with MI to determine patterns of exposure to multiple toxic metals and relate these to child neurodevelopment. However, because the overall study population was small, other studies with larger sample sizes are needed to investigate these associations. Katarzyna Kordas, Graciela Ardoino, Donna L. Coffman, Elena I. Queirolo, Daniela Ciccariello, Nelly Mañay, and Adrienne S. Ettinger Copyright © 2015 Katarzyna Kordas et al. All rights reserved. Comparison of Selected Metals Content in Cambodian Striped Snakehead Fish (Channa striata) Using Solar Drying System and Open Sun Drying Thu, 22 Jan 2015 13:48:08 +0000 The content of 12 elements in Cambodian dried striped snakehead fish was determined using inductively coupled plasma mass spectrometry. The present study compares the level of the trace toxic metals and nutritional trace elements in the fish processed using solar drying system (SDS) and open sun drying (OSD). The skin of SDS fish has lower level of As, Pb, and Cd compared to the OSD sample. As such, the flesh of the fish accumulated higher amount of toxic metals during OSD compared to SDS. However, arsenic was detected in both samples within the safe limit. The nutritional elements (Fe, Mn, Mg, Se, Mo, Cu, Ni, and Cr) were higher in the skin sample SDS fish compared to OSD fish. These beneficial metals were not accumulated in the flesh sample SDS fish demonstrating lower level compared to drying under conventional system. The reddish coloration of the SDS fish was due to the presence of high Cu content in both the skin and flesh samples which possibly account for no mold formation 5 days after packaging. As conclusion, drying of Cambodian C. striata using solar-assisted system has proven higher content of the nutritious elements compared to using the conventional system despite only slight difference in the toxic metals level between the two systems. Dayang Fredalina Basri, Nur Faizah Abu Bakar, Ahmad Fudholi, Mohd Hafidz Ruslan, and Im Saroeun Copyright © 2015 Dayang Fredalina Basri et al. All rights reserved. Outdoor Air Pollution and Cardiovascular Diseases in Lebanon: A Case-Control Study Tue, 13 Jan 2015 14:24:02 +0000 Outdoor air pollution is increasingly considered as a serious threat for cardiovascular diseases (CVD). The aim of this study is to investigate the association between outdoor pollutants and cardiovascular diseases among adults in Lebanon and to examine the possible moderator effect of cigarette smoking status on this association. A multicenter case-control study was conducted between October 2011 and October 2012. Cases were hospitalized patients diagnosed with CVD by a cardiologist while the control group subjects were free of any cardiac diseases. Information on sociodemographic characteristics, tobacco consumption, self-rated global health, pollution exposure, and other risk factors was collected using a questionnaire. The results of the logistic regression revealed that living near busy highway (OR 5.04, 95% CI (4.44–12.85), ) and close to local diesel generator (OR 4.76, 95% CI (2.07–10.91), ) was significantly associated with CVD. The association between the CVD and exposure to outside pollutants differed by cigarette smoking status. A clear difference was noted between nonsmokers and current smokers OR 4.6, 95% CI (1.10–19.25) and OR 10.11, 95% CI (7.33–20.23), respectively. Forthcoming studies are needed to clarify the potential link between outdoor air pollution and cardiovascular diseases in Lebanon. Public health interventions must be implemented to reduce air pollution and to improve air quality. Zeina Nasser, Pascale Salameh, Habib Dakik, Elias Elias, Linda Abou Abbas, and Alain Levêque Copyright © 2015 Zeina Nasser et al. All rights reserved. Residential Exposure to Urban Traffic Is Associated with Increased Carotid Intima-Media Thickness in Children Thu, 08 Jan 2015 12:00:15 +0000 Chronic exposure to urban traffic pollution is documented to promote atherosclerosis in adults but little is known about its potential effects in children. Our study examined the association of long-term exposure to traffic with carotid intima-media thickness (cIMT) in 287 healthy children. Residential proximity and distance-weighted traffic density (DWTD) were used as proximity markers for traffic-related air pollution exposure. The multivariable analyses revealed that children residing <100 meters from the nearest heavily trafficked road had cIMT mean and maximum measurements that were increased by 15% and 11% compared to those living ≥ 200 meters away (). Similar increases in cIMT were identified for children in the highest versus lowest DWTD tertile. Children who resided 100–199 meters from traffic or in the middle DWTD tertile also exhibited increased cIMT but these differences were not statistically significant. No statistically significant differences were identified between residential distance to traffic or DWTD and systemic inflammation indicators (CRP, IL-6). The study results suggest that exposure to urban traffic promotes arterial remodeling in children. This finding is important since even small increases in cIMT over time can potentially lead to earlier progression to atherosclerosis. It is also important because traffic-related pollution is potentially modifiable. Rodrigo X. Armijos, M. Margaret Weigel, Orrin B. Myers, Wen-Whai Li, Marcia Racines, and Marianne Berwick Copyright © 2015 Rodrigo X. Armijos et al. All rights reserved. The StrongWomen Change Clubs: Engaging Residents to Catalyze Positive Change in Food and Physical Activity Environments Sun, 30 Nov 2014 00:10:13 +0000 Introduction. The epidemic of obesity is a multifaceted public health issue. Positive policy and environmental changes are needed to support healthier eating and increased physical activity. Methods. StrongWomen Change Clubs (SWCCs) were developed through an academic-community research partnership between researchers at Cornell University and Tufts University and community partners (cooperative extension educators) in rural towns in seven U.S. states. Extension educators served as the local leader and each recruited 10–15 residents to undertake a project to improve some aspect of the nutrition or physical activity environment. Most residents had limited (or no) experience in civic engagement. At 6 and 12 months after implementation, the research team conducted key informant interviews with SWCC leaders to capture their perceptions of program process, benchmark achievement, and self-efficacy. Results. At 12 months, each SWCC had accomplished one benchmark; the majority had completed three or more benchmarks. They described common processes for achieving benchmarks such as building relationships and leveraging stakeholder partnerships. Barriers to benchmark achievement included busy schedules and resistance to and slow pace of change. Conclusion. Findings suggest that community change initiatives that involve stakeholders, build upon existing activities and organizational resources, and establish feasible timelines and goals can successfully catalyze environmental change. Rebecca A. Seguin, Sara C. Folta, Mackenzie Sehlke, Miriam E. Nelson, Eleanor Heidkamp-Young, Mark Fenton, and Bridgid Junot Copyright © 2014 Rebecca A. Seguin et al. All rights reserved. The Shared Pathoetiological Effects of Particulate Air Pollution and the Social Environment on Fetal-Placental Development Wed, 26 Nov 2014 00:10:06 +0000 Exposure to particulate air pollution and socioeconomic risk factors are shown to be independently associated with adverse pregnancy outcomes; however, their confounding relationship is an epidemiological challenge that requires understanding of their shared etiologic pathways affecting fetal-placental development. The purpose of this paper is to explore the etiological mechanisms associated with exposure to particulate air pollution in contributing to adverse pregnancy outcomes and how these mechanisms intersect with those related to socioeconomic status. Here we review the role of oxidative stress, inflammation and endocrine modification in the pathoetiology of deficient deep placentation and detail how the physical and social environments can act alone and collectively to mediate the established pathology linked to a spectrum of adverse pregnancy outcomes. We review the experimental and epidemiological literature showing that diet/nutrition, smoking, and psychosocial stress share similar pathways with that of particulate air pollution exposure to potentially exasperate the negative effects of either insult alone. Therefore, socially patterned risk factors often treated as nuisance parameters should be explored as potential effect modifiers that may operate at multiple levels of social geography. The degree to which deleterious exposures can be ameliorated or exacerbated via community-level social and environmental characteristics needs further exploration. Anders C. Erickson and Laura Arbour Copyright © 2014 Anders C. Erickson and Laura Arbour. All rights reserved. Problem-Solving and Mental Health Outcomes of Women and Children in the Wake of Intimate Partner Violence Tue, 11 Nov 2014 11:41:58 +0000 The environmental stress of intimate partner violence is common and often results in mental health problems of depression, anxiety, and PTSD for women and behavioral dysfunctions for their children. Problem-solving skills can serve to mitigate or accentuate the environmental stress of violence and associated impact on mental health. To better understand the relationship between problem-solving skills and mental health of abused women with children, a cross-sectional predictive analysis of 285 abused women who used justice or shelter services was completed. The women were asked about social problem-solving, and mental health symptoms of depression, anxiety, and PTSD as well as behavioral functioning of their children. Higher negative problem-solving scores were associated with significantly greater odds of having clinically significant levels of PTSD, anxiety, depression, and somatization for the woman and significantly greater odds of her child having borderline or clinically significant levels of both internalizing and externalizing behaviors. A predominately negative problem-solving approach was strongly associated with poorer outcomes for both mothers and children in the aftermath of the environmental stress of abuse. Interventions addressing problem-solving ability may be beneficial in increasing abused women’s abilities to navigate the daily stressors of life following abuse. John Maddoux, Lene Symes, Judith McFarlane, Anne Koci, Heidi Gilroy, and Nina Fredland Copyright © 2014 John Maddoux et al. All rights reserved. Applicability of the Environmental Relative Moldiness Index for Quantification of Residential Mold Contamination in an Air Pollution Health Effects Study Sun, 09 Nov 2014 00:00:00 +0000 The Near-Road Exposures and Effects of Urban Air Pollutants Study (NEXUS) investigated the impact of exposure to traffic-related air pollution on the respiratory health of asthmatic children in Detroit, Michigan. Since indoor mold exposure may also contribute to asthma, floor dust samples were collected in participants homes () to assess mold contamination using the Environmental Relative Moldiness Index (ERMI). The repeatability of the ERMI over time, as well as ERMI differences between rooms and dust collection methods, was evaluated for insights into the application of the ERMI metric. ERMI values for the standard settled floor dust samples had a mean standard deviation of , indicating high levels of mold contamination. ERMI values for samples collected from the same home 1 to 7 months apart () were consistent and without systematic bias. ERMI values for separate bedroom and living room samples were highly correlated (, ). Vacuum bag dust ERMI values were lower than for floor dust but correlated (, ). These results support the use of the ERMI to evaluate residential mold exposure as a confounder in air pollution health effects studies. Ali Kamal, Janet Burke, Stephen Vesper, Stuart Batterman, Alan Vette, Christopher Godwin, Marina Chavez-Camarena, and Gary Norris Copyright © 2014 Ali Kamal et al. All rights reserved. Lifestyle Behaviors and Self-Rated Health: The Living for Health Program Tue, 28 Oct 2014 08:06:02 +0000 Background. Lack of adherence to dietary and physical activity guidelines has been linked to an increase in chronic diseases in the United States (US). The aim of this study was to assess the association of lifestyle behaviors with self-rated health (SRH). Methods. This cross-sectional study used self-reported data from Living for Health Program ( 1,701) which was conducted from 2008 to 2012 in 190 health fair events in South Florida, US. Results. Significantly higher percent of females as compared to males were classified as obese (35.4% versus 27.0%), reported poor/fair SRH (23.4% versus 15.0%), and were less physically active (33.9% versus 25.4%). Adjusted logistic regression models indicated that both females and males were more likely to report poor/fair SRH if they consumed 2 servings of fruits and vegetables per day (, 95% CI 1.30–3.54; , 95% CI 1.12–7.35, resp.) and consumed mostly high fat foods (, 95% CI 1.03–2.43; , 95% CI 1.67–2.43, resp.). The association of SRH with less physical activity was only significant in females (, 95% CI 1.17–2.35). Conclusion. Gender differences in health behaviors should be considered in designing and monitoring lifestyle interventions to prevent cardiovascular diseases. Gustavo G. Zarini, Joan A. Vaccaro, Maria A. Canossa Terris, Joel C. Exebio, Laura Tokayer, Janet Antwi, Sahar Ajabshir, Amanpreet Cheema, and Fatma G. Huffman Copyright © 2014 Gustavo G. Zarini et al. All rights reserved. An Approach to Developing Local Climate Change Environmental Public Health Indicators, Vulnerability Assessments, and Projections of Future Impacts Tue, 30 Sep 2014 07:52:12 +0000 Environmental public health indicators (EPHIs) are used by local, state, and federal health agencies to track the status of environmental hazards; exposure to those hazards; health effects of exposure; and public health interventions designed to reduce or prevent the hazard, exposure, or resulting health effect. Climate and health EPHIs have been developed at the state, federal, and international levels. However, they are also needed at the local level to track variations in community vulnerability and to evaluate the effectiveness of interventions designed to enhance community resilience. This review draws on a guidance document developed by the U.S. Council of State and Territorial Epidemiologists’ State Environmental Health Indicators Collaborative climate change working group to present a three-tiered approach to develop local climate change EPHIs. Local climate change EPHIs can assist local health departments (LHDs) in implementing key steps of the 10 essential public health services and the U.S. Centers for Disease Control and Prevention’s Building Resilience Against Climate Effects framework. They also allow LHDs to incorporate climate-related trends into the larger health department planning process and can be used to perform vulnerability assessments which can be leveraged to ensure that interventions designed to address climate change do not exacerbate existing health disparities. Adele Houghton and Paul English Copyright © 2014 Adele Houghton and Paul English. All rights reserved. Estimating the Effectiveness of Health-Risk Communications with Propensity-Score Matching: Application to Arsenic Groundwater Contamination in Four US Locations Tue, 30 Sep 2014 00:00:00 +0000 This paper provides a demonstration of propensity-score matching estimation methods to evaluate the effectiveness of health-risk communication efforts. This study develops a two-stage regression model to investigate household and respondent characteristics as they contribute to aversion behavior to reduce exposure to arsenic-contaminated groundwater. The aversion activity under study is a household-level point-of-use filtration device. Since the acquisition of arsenic contamination information and the engagement in an aversion activity may be codetermined, a two-stage propensity-score model is developed. In the first stage, the propensity for households to acquire arsenic contamination information is estimated. Then, the propensity scores are used to weight observations in a probit regression on the decision to avert the arsenic-related health risk. Of four potential sources of information, utility, media, friend, or others, information received from a friend appears to be the source of information most associated with aversion behavior. Other statistically significant covariates in the household’s decision to avert contamination include reported household income, the presence of children in household, and region-level indicator variables. These findings are primarily illustrative and demonstrate the usefulness of propensity-score methods to estimate health-risk communication effectiveness. They may also be suggestive of areas for future research. Andrew J. Leidner Copyright © 2014 Andrew J. Leidner. All rights reserved. Levels of Heavy Metals in Adolescents Living in the Industrialised Area of Milazzo-Valle del Mela (Northern Sicily) Tue, 23 Sep 2014 04:56:12 +0000 In the Milazzo-Valle del Mela area, the presence of industrial plants and the oil refinery make local residents concerned for their health. For this reason, we evaluated the levels of heavy metals in 226 children aged 12–14 years, living in the 7 municipalities of the area. A control age-matched population living 45 km far from the industrial site was also enrolled. Arsenic, cadmium, chromium, mercury, nickel, and vanadium were analysed in 24 h urine samples, while lead concentration was evaluated in blood samples. A questionnaire regarding life style and risk perception was also administered. Adolescents from Milazzo-Valle del Mela had cadmium levels significantly higher compared to either controls   or the reference values of the European Germany Environmental Survey (GerES-IV) and the American National Health and Nutrition Examination Survey (NHANES). Furthermore, children had higher perception of living in a high-risk environment. The present data, for the first time, clearly indicate that adolescents living in Milazzo-Valle del Mela have increased body concentration of cadmium, which may be harmful to human health. These results deserve particular attention by the local and regional government to initiate prevention programmes in this susceptible population. Monica Interdonato, Alessandra Bitto, Gabriele Pizzino, Natasha Irrera, Giovanni Pallio, Anna Mecchio, Antonino Cuspilici, Letteria Minutoli, Domenica Altavilla, and Francesco Squadrito Copyright © 2014 Monica Interdonato et al. All rights reserved. Factors Associated with Larval Control Practices in a Dengue Outbreak Prone Area Wed, 17 Sep 2014 08:27:23 +0000 In order to reduce the risk of dengue outbreak recurrence in a dengue outbreak prone area, the members of the community need to sustain certain behavior to prevent mosquito from breeding. Our study aims to identify the factors associated with larval control practices in this particular community. A cross-sectional study involves 322 respondents living in a dengue outbreak prone area who were interviewed using a pretested questionnaire. The level of knowledge about Aedes mosquitoes, dengue transmission, its symptoms, and personal preventive measures ranges from fair to good. The level of attitude towards preventive measures was high. However, reported level of personal larval control practices was low (33.2%). Our multiple logistic regression analysis showed that only those with a good level of attitude towards personal preventive measure and frequent attendance to health campaigns were significantly associated with the good larval control practices. We conclude that, in a dengue outbreak prone area, having a good attitude towards preventive measures and frequent participation in health campaigns are important factors to sustain practices on larval control. Mariam Mohamad, Mohamad Ikhsan Selamat, and Zaliha Ismail Copyright © 2014 Mariam Mohamad et al. All rights reserved. Environmental and Organizational Factors Associated with Elbow/Forearm and Hand/Wrist Disorder among Sewing Machine Operators of Garment Industry in Ethiopia Mon, 15 Sep 2014 00:00:00 +0000 Occupational health problems related to upper limp musculoskeletal disorders were the major issue among sewing machine operators of garment industries in Ethiopia. The aim of this study was to assess the prevalence and associated risk factors of work related elbow and wrist musculoskeletal disorders among sewing machine operators of garment industries in Galan City, Oromia Regional State. A cross-sectional study was conducted from April 1 to 30, 2012. A total of 422 study subjects were included in this study. Standard Nordic Musculoskeletal Questionnaire was used to collect detailed information on musculoskeletal symptom, sociodemographic data, and factors associated with the problems through face to face interview. From a total of 422 sewing machine operators included in the study 370 (87.7%) were females and 306 (72.5%) were in the age group of <30 years. The prevalence of self-reported work related elbow and wrist musculoskeletal disorders was 40% and 37.7%, respectively. In multivariate analysis, those who had >16 years of service were about five times more likely to develop elbow and wrist musculoskeletal disorders than those who had short (1–5 years) year of services [AOR = 4.7, 95% CI: 1.55–13.02], physical activities [AOR = 5.02, 95% CI: 1.57–16.00], and methods of payment [AOR = 2.01, 95% CI: 1.23–3.28], factors significantly associated with this disorders. Work related elbow and wrist musculoskeletal disorders were high among sewing machine operators in selected garment industries. Moreover, personal and environmental factors were identified as the potential risk factors related to elbow and wrist musculoskeletal disorders among the study group. Therefore, government and the owner of the garment industries should give special attention to prevent and control the problems through proper occupational health and safety policy implementation in the country. Wakjira Kebede Deyyas and Ararso Tafese Copyright © 2014 Wakjira Kebede Deyyas and Ararso Tafese. All rights reserved. Sanitary Conditions of Food Vending Sites and Food Handling Practices of Street Food Vendors in Benin City, Nigeria: Implication for Food Hygiene and Safety Wed, 03 Sep 2014 00:00:00 +0000 Objective. To determine the sanitary conditions of vending sites as well as food handling practices of street food vendors in Benin City, Nigeria. Methodology. A descriptive cross-sectional study was done using an observational checklist and researcher-administered questionnaire. 286 randomly selected vending units were surveyed, and their operators interviewed on their food handling practices. Results. A higher proportion, 259 (90.5%), of the observed vending sites appeared clean. The following sanitary facilities were observed in and around the respective food premises of the respondents: waste bin, 124 (43.4%), refuse dumpsite, 41 (14.3%), wash hand basin, 201 (71.2%), hand towel, 210 (73.4%), and soap, 220 (76.9%). There were also the presence of flies 118, (41.3%), and the presence of rats/cockroaches, 7 (2.4%). Respondents with tertiary education, 5 (38.5%), vended foods in environment with good hygiene status compared to those with secondary, 45 (31.7%), and primary education, 33 (27.3%). There was no statistically significant association between educational status and the hygiene status of food premise (). Conclusion. This study showed that street food vending sites in Benin City were sanitary and that food vendors had good food handling practices. P. W. Okojie and E. C. Isah Copyright © 2014 P. W. Okojie and E. C. Isah. All rights reserved. Antenatal Care Strengthening in Jimma, Ethiopia: A Mixed-Method Needs Assessment Sun, 31 Aug 2014 07:52:19 +0000 Objective. We assessed how health system priorities matched user expectations and what the needs for antenatal care (ANC) strengthening were for improved maternal health in Jimma, Ethiopia. Methods. A questionnaire survey among all recent mothers in the study area was conducted to study the content of ANC and to identify the predictors of low ANC satisfaction. Further, a qualitative approach was applied to understand perceptions, practices, and policies of ANC. Results. There were no national guidelines for ANC in Ethiopia. Within the health system, the teaching of health professional students was given high priority, and that contributed to a lack of continuity and privacy. To the women, poor user-provider interaction was a serious concern hindering the trust in the health care providers. Further, the care provision was compromised by the inadequate laboratory facilities, unstructured health education, and lack of training of health professionals. Conclusions. Health system trials are needed to study the feasibility of ANC strengthening in the study area. Nationally and internationally, the leadership needs to be strengthened with supportive supervision geared towards building trust and mutual respect to protect maternal and infant health. Sarah Fredsted Villadsen, Britt Pinkowski Tersbøl, Dereje Negussie, Abebe GebreMariam, Abebech Tilahun, Henrik Friis, and Vibeke Rasch Copyright © 2014 Sarah Fredsted Villadsen et al. All rights reserved. Religion, Acculturation, and Incarceration: Determinants of Substance Use among Hispanic Adults in the United States Mon, 25 Aug 2014 05:51:59 +0000 Objective. The influence of religion, acculturation, and incarceration on substance abuse has been studied, though predominantly among adolescents. Little research exists on how such factors influence substance use among Hispanic adults. The objective of this study was to assess key determinants of substance use among Hispanic adults. Methods. Public access 2012 National Survey on Drug Use and Health was utilized. Univariate and multivariable logistic regression analyses were conducted while accounting for complex survey design to obtain population-weighted estimates. Receiver operator curve analysis was used to evaluate the relative contribution of each variable. Results. Importance of religious influence in life and Spanish language interview were associated with lower odds of substance use, while history of incarceration increased the likelihood of substance use among Hispanic adults. Other factors associated with lower odds were increasing age, being female, and currently married. Other factors associated with increased odds were high school graduate and some college in addition to living above the 200% federal poverty level. Discussion. Results from this study add to the limited body of the literature on determinants of substance use among Hispanic adults. Health education measures should target acculturated Hispanic adults and those with incarceration history to reduce substance use. Benjamin J. Becerra, Monideepa B. Becerra, Miryam C. Gerdine, and Jim E. Banta Copyright © 2014 Benjamin J. Becerra et al. All rights reserved. Contaminated Turmeric Is a Potential Source of Lead Exposure for Children in Rural Bangladesh Sun, 24 Aug 2014 09:24:19 +0000 Background. During the conduct of a cohort study intended to study the associations between mixed metal exposures and child health outcomes, we found that 78% of 309 children aged 20–40 months evaluated in the Munshiganj District of Bangladesh had blood lead concentrations ≥5 µg/dL and 27% had concentrations ≥10 µg/dL. Hypothesis. Environmental sources such as spices (e.g., turmeric, which has already faced recalls in Bangladesh due to high lead levels) may be a potential route of lead exposure. Methods. We conducted visits to the homes of 28 children randomly selected from among high and low blood lead concentration groups. During the visits, we administered a structured questionnaire and obtained soil, dust, rice, and spice samples. We obtained water samples from community water sources, as well as environmental samples from neighborhood businesses. Results. Lead concentrations in many turmeric samples were elevated, with lead concentrations as high as 483 ppm. Analyses showed high bioaccessibility of lead. Conclusions. Contamination of turmeric powder is a potentially important source of lead exposure in this population. Kelsey Gleason, James P. Shine, Nadia Shobnam, Lisa B. Rokoff, Hafiza Sultana Suchanda, Md Omar Sharif Ibne Hasan, Golam Mostofa, Chitra Amarasiriwardena, Quazi Quamruzzaman, Mahmuder Rahman, Molly L. Kile, David C. Bellinger, David C. Christiani, Robert O. Wright, and Maitreyi Mazumdar Copyright © 2014 Kelsey Gleason et al. All rights reserved. Determination of Lead, Cations, and Anions Concentration in Indoor and Outdoor Air at the Primary Schools in Kuala Lumpur Tue, 22 Jul 2014 10:22:34 +0000 This study was carried out to determine the concentration of lead (Pb), anions, and cations at six primary schools located around Kuala Lumpur. Low volume sampler (MiniVol ) was used to collect the suspended particulates in indoor and outdoor air. Results showed that the concentration of Pb in indoor air was in the range of 5.18 ± 1.08 μg/g–7.01 ± 0.08 μg/g. All the concentrations of Pb in indoor air were higher than in outdoor air at all sampling stations. The concentrations of cations and anions were higher in outdoor air than in indoor air. The concentration of (39.51 ± 5.01 mg/g–65.13 ± 9.42 mg/g) was the highest because the cation existed naturally in soil dusts, while the concentrations of and were higher in outdoor air because there were more sources of exposure for anions in outdoor air, such as highly congested traffic and motor vehicles emissions. In comparison, the concentration of (29.72 ± 0.31 μg/g–32.00 ± 0.75 μg/g) was slightly higher than . The concentrations of most of the parameters in this study, such as , , , , and , were higher in outdoor air than in indoor air at all sampling stations. Normah Awang and Farhana Jamaluddin Copyright © 2014 Normah Awang and Farhana Jamaluddin. All rights reserved. An Overview of Thunderstorm-Associated Asthma Outbreak in Southwest of Iran Sun, 29 Jun 2014 09:00:31 +0000 The aim of this study was to report the characteristics and treatment strategies of all patients with acute bronchospasm who were presented to the emergency departments of Ahvaz, Iran, following the occurrence of a thunderstorm on November 2, 2013. A total of 2000 patients presenting with asthma attacks triggered by thunderstorm were interviewed and an initial questionnaire was completed for each individual. After twenty days, patients were asked to complete a supplementary questionnaire, but only 800 of them accepted to do so. The majority of subjects was aged 20–40 years (60.5%) and had no history of asthma in most cases (60.0%). The symptoms had started outdoors for 60.0% of the participants. In most patients, the onset of the condition was on November 2. Short-acting β2-agonist (salbutamol) and aminophylline were the most commonly prescribed medications in the emergency department. Upon the second interview, 85.3% of the patients were still symptomatic. Overall, 63.6% did not have a follow-up visit after hospital discharge, although all of them were referred to the specialist. The findings of the present study suggest that thunderstorm-associated asthma could affect young adults with no gender priority, with or without asthma history, which put a strain on emergency medical services. Arash Forouzan, Kambiz Masoumi, Maryam Haddadzadeh Shoushtari, Esmaeil Idani, Fatemeh Tirandaz, Maryam Feli, Mohammad Ali Assarehzadegan, and Ali Asgari Darian Copyright © 2014 Arash Forouzan et al. All rights reserved. How Adolescent Subjective Health and Satisfaction with Weight and Body Shape Are Related to Participation in Sports Thu, 12 Jun 2014 00:00:00 +0000 Background. Physical exercise has positive effects on health. However, its associations with self-rated health and body image, which are important predictors for adolescents’ wellbeing and later morbidity, are complex. Methods. Cross-sectional survey among 2527 Norwegian adolescents. We examined the relations between self-reported gender, body size, amount and type of exercise and measures of self-rated health, drive for thinness, and desire to change body, with binary logistic regression analyses. Results. Girls and overweight students reported to a greater extent than their peers impaired self-rated health, weight concerns, and desire to change their body. Increasing amount of time spent on sports was related to improved self-rated health in a dose-response manner. Both girls and boys who engaged in individual sports with an advantage of leanness, but only girls engaged in team sports, reported an increased desire to change the body. However, weight concern was not related to amount or type of sports. Conclusions. Physical exercise is positively related to self-reported health but has negative associations with body image for many adolescents. Health promotion efforts should consider this paradox and stimulate physical activity and sports along with body acceptance. Åse Eriksen Dyremyhr, Esperanza Diaz, and Eivind Meland Copyright © 2014 Åse Eriksen Dyremyhr et al. All rights reserved. The Impact of “Unseasonably” Warm Spring Temperatures on Acute Myocardial Infarction Hospital Admissions in Melbourne, Australia: A City with a Temperate Climate Wed, 04 Jun 2014 11:23:55 +0000 The effects of extreme temperatures on human health have been well described. However, the adverse health effects of warm weather that occurs outside the summer period have had little attention. We used daily anomalous AMI morbidity and daily anomalous temperature to determine the impact of “unseasonable” temperature on human health. The “unseasonably” warm weather was attributed to a slow moving high pressure system to the east of Melbourne. No morbidity displacement was noted during either of these periods suggesting that morbidity due to “unseasonable” temperatures is avoidable. An increase in warmer weather during the cooler months of spring may result in increased morbidity, and an alert system based on summer thresholds may not be appropriate for early season heat health warnings. A straightforward alert system based on calculating anomalous temperature from daily weather forecasts may reduce the public health impact of “unseasonably” warm weather. Margaret Loughnan, Nigel Tapper, and Terence Loughnan Copyright © 2014 Margaret Loughnan et al. All rights reserved. Factors Affecting Parent-Adolescent Discussion on Reproductive Health Issues in Harar, Eastern Ethiopia: A Cross-Sectional Study Thu, 29 May 2014 09:17:00 +0000 Background. Open family discussion on reproductive health (RH) issues often leads to increased awareness on RH matters and reduces risky behaviors among adolescents. This study was conducted to assess factors affecting parent-adolescent discussion on RH issues in Harar, Ethiopia. Methods. A cross-sectional survey using face to face interview supplemented with focus group discussion (FGD) was conducted on 751 randomly selected parents of 10–19-year-old adolescents. Data was analyzed using SPSS version 15. Results. More than one-fourth (28.76%) of parents reported discussing RH issues with their adolescents during the last six months. In the logistic regression, parents who have demonstrated good RH knowledge and positive attitude towards RH were almost six times and seventy percent (AOR 5.69, 95% CI: 3.67–8.82; AOR 1.70, 95% CI: 1.08–2.68) higher in discussing RH with their adolescents than their counterparts, respectively. Conclusion. Parent-adolescent discussion about RH issues rarely occurs and is bounded by lack of knowledge, sociocultural norms, and parental concern that discussion would encourage premarital sex. Reproductive health programs should target on improving awareness of parents and addressing sociocultural norms surrounding reproductive health issues. Tesfaye Assebe Yadeta, Haji Kedir Bedane, and Abera Kenay Tura Copyright © 2014 Tesfaye Assebe Yadeta et al. All rights reserved. Early Childhood Nutritional Status in CARICOM Countries: An Overview with respect to Five Nutrition Related Millennium Development Goals Thu, 08 May 2014 13:10:54 +0000 Previous reviews of nutritional status in children under 5 years describe the Caribbean grouped with Latin America. This paper focuses specifically on the Caribbean and the goals and targets of the Millennium Declaration that have bearing on childhood development. The results indicate that CARICOM countries have made progress in terms of child health as assessed by gross health indicators. Yet, the millennium generation experiences coexistence of undernutrition and overweight in early childhood. The associations of GNI with markers such as poverty indices are somewhat inconsistent with traditional findings and highlight a need to reassess the causes of infant mortality and low birth weight. However, a lack of systematic local data has hampered progress on an individual country basis. Interventions that deal more pointedly with country specific needs are required including those targeting obesity if the MDGs are to be attained by all member states. Pamela S. Gaskin, Anders L. Nielsen, Douladel Willie, and Tara C. Durant Copyright © 2014 Pamela S. Gaskin et al. All rights reserved. Relationship between Objectively Measured Walkability and Exercise Walking among Adults with Diabetes Wed, 26 Mar 2014 09:53:23 +0000 Little is known about the relationship between objectively measured walkability and walking for exercise among adults with diabetes. Information regarding walking behavior of adults with diabetes residing in 3 Upstate New York counties was collected through an interview survey. Walkability measures were collected through an environmental audit of a sample of street segments. Overall walkability and 4 subgroup measures of walkability were aggregated at the ZIP level. Multivariate logistic regression was used for analysis. Study participants were 61.0% female, 56.7% non-Hispanic White, and 35.1% African-American, with a mean age of 62.0 years. 108 participants (51.9%) walked for exercise on community streets, and 62 (29.8%) met the expert-recommended level of walking for ≥150 minutes/week. After adjustment for age, gender, race/ethnicity, education, BMI, physical impairment, and social support for exercise, walking any minutes/week was associated with traffic safety (OR 1.34, 95% CI 1.15–1.65). Walking ≥150 minutes/week was associated with overall walkability of the community (2.65, 1.22, and 5.74), as well as sidewalks (1.73, 1.12–2.67), street amenity (2.04, 1.12–3.71), and traffic safety (1.92, 1.02–3.72). This study suggests that walkability of the community should be an integral part of the socioecologic approach to increase physical activity among adults with diabetes. Akiko S. Hosler, Mary P. Gallant, Mary Riley-Jacome, and Deepa T. Rajulu Copyright © 2014 Akiko S. Hosler et al. All rights reserved. Risk Factors of Domestic Violence in Iran Tue, 25 Mar 2014 13:36:52 +0000 Objectives. In this study, we have evaluated the lifetime and past-year prevalence of exposure to physical violence among married women in the city of Tehran and urban and rural areas of Hashtgerd. Methods. The target population were noninstitutionalized female citizens, aged 15 years or older, who have at least one history of marriage and who resided in the capital city of Tehran or Hashtgerd County from the summer of 2008 to fall of 2010. We used a multistage sampling method. Tehran’s District Six, a central district in Tehran, was selected as a representative cluster of all municipal districts in Tehran. A total of fifty blocks were randomly selected from this district, from which 1,000 married women aged 15 years or older were interviewed using a cross-sectional design. Data was gathered face-to-face using a structured questionnaire. The lifetime prevalence, past-year prevalence, and related factors of domestic violence were measured. SPSS version 11.5 was used for the analyses. Results. Figures for lifetime prevalence and past-year prevalence were measured to be 38.7% and 6.6%, respectively. The independent effects of marital status and location and type of residency for women, along with education and smoking habits of their spouses, were statistically significant in multivariate logistic regression analysis. Conclusion. Domestic violence is a public health concern in Iran. Based on our findings, we propose that empowering women through education, and improving their ability to find employment and income, along with increasing public awareness of human rights issues through education could lower the prevalence of domestic violence. M. Rasoulian, S. Habib, J. Bolhari, M. Hakim Shooshtari, M. Nojomi, and Sh. Abedi Copyright © 2014 M. Rasoulian et al. All rights reserved.